[21] CHAPTER IX LESSON 3 Flashcards
In medicine, venipuncture or venepuncture is the process of obtaining intravenous access for the purpose of venous blood sampling (also called phlebotomy) or[?].
intravenous therapy
The process for collecting blood from donors is similar to that used for [?]; however, a few additional measures are required for collection of donated blood.
blood sampling
These measures are primarily to ensure patient safety, but also to minimize [?] of a donated blood unit or its derived components, particularly contamination from the skin flora of the donor’s arm.
exogenous contamination
Because of the volume or blood collected and the [?], pathogens can multiply during storage.
length of storage
ensures that the blood products are safe for therapeutic use throughout their shelf life.
Safe collection
Step1. Identify donor and label blood collection bag and test tubes
Disinfect the skin
Step 2.
Select the vein
Step 3.
Disinfect the skin
Step 4.
Perform the venipuncture
Step 5.
Monitor the donor and the donated unit
Step 6.
Remove the needle and collect samples
Ask the donor to state their full name.
Step1
the blood collection bag is of the correct type
Step1
the labels on the blood collection bag and all its satellite bags, sample tubes and donor records have the correct patient name and number
Step1
the information on the labels matches with the donor’s information
Step1
Select a large, firm vein, preferably in the antecubital fossa, from an area free from skin lesions or scars.
Step 2
Apply a tourniquet or blood pressure cuff inflated to 40-60 mm Hg, to make the vein more prominent
Step 2
Ask the donor to open and close the hand a few times
Step 2
Once the vein is selected, release the pressure device or tourniquet before the skin site is prepared.
Step 2
If the site selected for venipuncture is visibly dirty, wash the area with soap and water, and then wipe it dry with single-use towels.
Step 3
(recommended – takes about one minute)
One-step procedure
use a product combining 2% chlorhexidine gluconate in 70% isopropyl alcohol
One-step procedure
cover the whole area and ensure that the skin area is in contact with the disinfectant for at least 30 seconds
One-step procedure
allow the area to dry completely, or for a minimum of 30 seconds by the clock.
One-step procedure
(if chlorhexidine gluconate in 70% isopropyl alcohol is not available, use the following procedure – takes about two minutes)
Two-step procedure
– use 70% isopropyl alcohol
Two-step procedure step 1
cover the whole area and ensure that the skin area is in contact with the disinfectant for at least 30 seconds
Two-step procedure step 1
allow the area to dry completely (about 30 seconds)
Two-step procedure step 1
– use tincture of iodine (more effective than povidone iodine) or chlorhexidine (2%)
Two-step procedure step 2
cover the whole area and ensure that the skin area is in contact with the disinfectant for at least 30 seconds
Two-step procedure Step 2
allow the area to dry completely (about 30 seconds)
Two-step procedure 2
Whichever procedure is used, DO NOT touch the venipuncture site once the skin has been disinfected.
Step 3
Perform venipuncture using a smooth, clean entry with the needle.
Step 4
In general, use a 16-gauge needle, which is usually attached to the blood collection bag.
Step 4
Use of a retractable needle or safety needle with a needle cover is preferred if available, but all should be cut off at the end of the procedure rather than recapped.
Step 4
Ask the donor to open and close the first slowly every 10–12 seconds during collection.
Step 4
Remove the tourniquet when the blood flow is established or after 2 minutes, whichever comes first.
Step 4
Closely monitor the donor and the injection site throughout the donation process
Step 5
sweating, pallor or complaints of feeling faint that may precede fainting
Step 5
development of a hematoma at the injection site
Step 5
changes in blood flow that may indicate the needle has moved in the vein, and needs to be repositioned
Step 5
About every 30 seconds during the donation, mix the collected blood gently with the anticoagulant, either manually or by continuous mechanical mixing.
Step 5
Cut off the needle using a sterile pair of scissors
Step 6
Collect blood samples for laboratory testing.
Step 6
ask the donor to remain in the chair and relax for a few minutes
After a blood donation: Donor care
inspect the venipuncture site; if it is not bleeding, apply a bandage to the site; if it is bleeding, apply further pressure
After a blood donation: Donor care
ask the donor to sit up slowly and ask how the person is feeling
After a blood donation: Donor care
before the donor leaves the donation room, ensure that the person can stand up without dizziness and without a drop in blood pressure
After a blood donation: Donor care
offer the donor some refreshments.
After a blood donation: Donor care
Blood collected in an anticoagulant can be stored and transfused to a patient in an unmodified state. This is known as [?].
‘whole blood’ transfusion
However, blood can be used more effectively if it is processed into components, such as red cell [?]. In this way, it can meet the needs of more than one patient
concentrates, platelet concentrates, plasma and cryoprecipitate
Most whole blood donations are spun in centrifuges to separate it into transfusable components:
red cells, platelets, and plasma.
Plasma may be processed into components such as[?], which helps control the risk of bleeding by helping blood to clot.
cryoprecipitate
Red cells and platelets are [?], which means your white cells are removed in order to reduce the possibility of the recipient having a reaction to the transfusion.
leuko-reduced
Each component is packaged as a “[?],” a standardized amount that doctors will use when transfusing a patient.
unit
When test results are received, units suitable for transfusion are [?].
labeled and stored
Red cells are stored in refrigerators at [?] depending on the anticoagulant used.
6ºC for up to 42 days
Platelets are stored at room temperature in agitators for up to [?].
five days
Plasma and cryoprecipitate are frozen and stored in freezers for up to [?].
one year
Advantages of Component Therapy
1. the recipient can be treated with only those blood components that are lacking, reducing the occurrence of [?];
2. [?] can be treated with blood components derived from one donation;
3. therapeutic support for patients with special transfusion requirements can be provided, for example, plasma that often is not directly needed for transfusion can be used manufacturing of [?] for Hemophilia A patients;
4. [?] of each component when varied storage conditions and shelf lives were applied.
adverse transfusion reactions
more than one patient
Factor VIII concentrate
improved quality and functional capacity
Once dispensed, any [?] shall be immediately transported directly to the RN or LIP requesting the component for transfusion.
PRBCs
PRBCs are stored in a Blood Bank refrigerator at a temp of [?] until issue.
1-6ºC
The shelf life is [?] from the date of collection
42 days
The expiration date is located on the
unit(s).
If the transfusion cannot be initiated within a time frame that would allow for completion within [?] of time issued, return the component to the Blood Bank.
4 hours
Blood can be stored in a Blood Bank validated cooler for up to [?].
6 hours
The cooler must be returned to the Blood Bank prior to the [?] cooler expiration time.
6-hour
The cooler will then be [?] if the blood products are still needed.
repacked and reissued
The cooler expiration time is noted on the [?] of the cooler.
outside
[?] must be thawed prior to issue. This process takes approximately [?].
Frozen Plasma
45 minutes
Once dispensed, any plasma shall be immediately transported directly to the [?] requesting the component for transfusion.
RN or LIP
Frozen Plasma is maintained in the Blood Bank freezer at a temp [?] until it is thawed.
≤-18ºC
Once thawed, it is stored in a Blood Bank refrigerator at a temp of [?] until issue.
1-6ºC
Frozen Plasma - The shelf life is [?] from the date of collection.
1 year
Thawed Plasma - The shelf life of thawed plasma is either [?], depending on the plasma product.
The expiration date is located on the unit(s). Returns- Same as pRBCs.
24 hours or 5 days
- Therapeutic dose collected from 1 via an automated apheresis procedure
Apheresis Platelets or Single Donor Platelets
is equivalent to 6 whole blood derived
Apheresis Platelets or Single Donor Platelets
- Therapeutic dose from up to 6 whole blood donors pooled together
Pooled Platelets
is equivalent a single apheresis platelet unit.
Pooled Platelets
Once dispensed, platelets shall be immediately transported directly to the [?] requesting the component for transfusion.
RN or LIP
Platelets must remain at
room temperature.
Platelets are never place inside a [?] for any reason.
Blood Bank blood cooler
All platelets are stored at [?] with gentle agitation until issue. o
room temperature (20-24ºC)
The shelf life of plt is [?] from the date of collection.
5 days
Pooled Platelets expire [?] from the time of preparation (pooling if required) pooling.
4 hours
The expiration date of plt is located on the [?].
unit(s)
Return plt as soon as possible if the component is not able to be [?].
transfused
A therapeutic dose of cryoprecipitate is generally a pool of 5 units
Cryoprecipitate
this is typically issued as a single bag containing all of the individual units pooled together
Cryoprecipitate
The pool size and the number of units required for a therapeutic dose are determined by the blood supplier and available inventory may vary.
Cryoprecipitate
Cryoprecipitate will need to be thawed prior to issue. This process takes approximately [?].
45 minutes
Pooling of individual units, if required, may take additional time.
Cryoprecipitate
Once dispensed, [?] shall be immediately transported directly to the one requesting the component for transfusion.
Cryoprecipitate
Must remain at room temperature.
Never place inside a Blood Bank blood cooler for any reason.
Cryoprecipitate
Cryoprecipitate is stored in the Blood Bank freezer at a temp of [?] until thawing.
≤18°C
After thawing, Cryoprecipitate should be maintained at room temperature [?].
(20 - 24°C)
It should never be refrigerated or placed in a blood cooler.
Cryoprecipitate
Frozen Cryoprecipitate - The shelf life is [?] from the date of collection. Single units expire [?] from time of thawing.
1 year
6 hours
The expiration date is located on the unit(s).
Return as soon as possible if the component is not able to be transfused.
Cryoprecipitate
The recommended transport conditions must be maintained when blood is moved from one location to another, including:
o from a [?] to the laboratory
o from the blood bank to a [?] (to a hospital or clinic or another blood bank)
o from the blood bank to [?] (WHO, 2005)
mobile or satellite collection site
different facility
hospital wards or operating rooms
Thus, each blood transport box must have [?] as coolants in order to ensure an acceptable cold life. (WHO, 2002).
frozen ice packs
The transport method in the policy must specify transport conditions for the different [?] as recommended below: (WHO, 2005)
individual blood products
-Ice should not be allowed to come into direct contact with the blood as the red cells nearest to the ice may freeze and hemolyze.
- Red cell components
Appropriate materials and packing arrangements are therefore necessary.
- Red cell components
Transport temperature range: 2-10 degrees Celsius
- Red cell components
-There should be at least as much wet ice in the cold box as there is plasma.
- Plasma
If possible, they should have been placed in cardboard boxes before freezing to protect the bags from developing small cracks.
- Plasma
Transport temperature range: At or below –25 degrees Celsius
- Plasma
