Clin Skills 2 Blood Flashcards
Blood is made up of two parts:
Fluid (plasma or serum)
Cell (RBC,WBC, platelets)
__ contains various substances including glucose, electrolytes, proteins, and water.
Plasma
__ is the fluid part that remains after the blood is allowed to clot in a test tube. It is the fluid part of blood after a substance called fibrinogen has been removed by clotting.
Serum
3 best sites for venipuncture
- Median cubital vein
- Cephalic vein
- Basilic vein.
7 inappropriate sites for venipuncture
Arm on same side of mastectomy Edematous/infectious areas Hematomas Arm in which blood is being transfused Scarred areas Arms with fistulas or vascular grafts Sites above an IV cannula
go in with the bevel which direction?
bevel up
What gauge needle is used for venipuncture?
16 gauge
What gauge needle is -Used with evacuated tube systems?
21 gauge
What gauge needle is Used w/ butterfly system, or syringes 0-5 mL capacity?
23 gauge
very small needles (>25 gauge can cause:)
often causes hemolysis of blood.
Blood collection tubes must be drawn in a specific order to avoid
cross-contamination of additives between tubes
The recommended order of draw for tubes is: (4)
- Blood culture bottle
- Coagulation tube (light blue top).
- Non-additive tube (red top)
- Additive tubes - Contains a gel separator and clot activator.
6 additive tubes (in order of blood draw)
- SST (serum separating tube) (red-gray or gold top)
- Sodium heparin (dark green top)
- PST (plasma separator) (light green top)
- EDTA (lavender top)
- ACDA or ACDB (pale yellow top). Contains acid citrate dextrose.
- Oxalate/fluoride (light gray top)
Which tubes must be thoroughly mixed?
Tubes with additives
Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive.
6 steps to PREPARE to perform venipuncture
- Identify patient. Name and date of birth. Confirm information matches requisition.
- Reassure patient.
- Assemble necessary equipment
- Wash hands. Apply gloves.
- Position patient - arm extended.
- Select appropriate vein
Do not attempt a venipuncture more than __.
twice
4 steps of performing the venipuncture (after you’ve prepared)
Apply tourniquet 3-4 inches above site.
Clean puncture site - smooth circular motion with 70% alcohol pad. Allow skin to dry.
* Do not touch the puncture site after cleaning.
Perform venipuncture
After blood flows, release tourniquet.
What type of injection: ( PPD) skin testing
Intradermal
What type of injection: vaccines, insulin, heparin injections
Subcutaneous
What type of injection: vaccines, pain meds, antibiotics
Intramuscular
Angles you approach with intradermal, SQ, IM
ID: 5-10º
SQ: 45º
IM: 90º
Contraindicationsfor Injections:(3)
Allery to any components of the injectate
Active infection or dermatitis at the injection site
Coagulopathy (IM injections)
what gauge needle for PPD?
small: 25, 26, or 27 gauge
How to perform Intradermal Injection:
Prep skin with alcohol pad. ( flexor surface of forearm- about 4in above elbow crease)
Introduce needle at 5-10 degree angle into upper layer of skin and inject antigen
If done properly a discrete white bleb or wheal will appear (10mm in diameter)
Bleb disappears soon (couple minutes)
