Module 5/6 Flashcards
How do you collect blood from a sleeping patient?
You don’t.
Gently wake them by touching the bed.
When should you interrupt the patient when they’re with their doctor or clergy?
If the sample required is STAT.
What is the most important step of sample collection?
Patient identification
How are patients identified?
Ask them to state their name.
Check their wrist band.
Cross check info with the req.
Check healthcare card or ask friend/relative/caretaker.
Can you identify a patient from an ID band not attached to them?
No
Goes for newborns too
What pre-phlebotomy criteria may have to be verified prior to collection?
Fasting
Times collections
Time of last/next medication
If not met the specimen shouldn’t be collected
What is implied consent?
The patient extending their arm.
What is informed consent?
Documents are signed either by the patient or a relative.
What can you do if a patient refuses to give a sample?
Tell them the doctor ordered the test.
Inform the supervisor and nursing staff/physicians office.
What can be done for nervous/apprehensive patients?
Distract them by speaking normally.
Use a topical anesthetic (EMLA cream, 30min prior).
How can patients be reassured?
Convert the volume to oz.
Equate one donor unit to 50 tubes.
Equate the total blood volume to 500 tubes.
Where do babies/children get their blood drawn from?
Arm or back of the hand.
What is used to collect children’s blood?
23 gauge butterfly
> 4yo can use vacutainer
What special or adapted techniques may be necessary?
Different arm positions
Help making fist
Stabilization
Alternate sites
Assistance
What are the objectives of specimen collection?
Obtain consent
Collect the best quality specimen
Perform it so the next time the patient will be less apprehensive
What are some pain reducing strategies?
Explain the procedure
Select the medial vein
Use 22-23 gauge needle
Ensure the alcohol is dry
What has happened if the patient experiences a shooting/electric like pain?
A nerve has been provoked.
What must you do it the patient insists you remove the needle?
You must stop the venipuncture.
What is hematoma?
The accumulation of blood under skin when blood escapes the vessels.
Causes pressure on surrounding tissues and nerves.
When may hematomas occur?
If the needle penetrates the vein completely.
If the bevel doesn’t enter the vein completely.
If the vein is too small for the gauge.
If the needle was removed before the tourniquet.
If insufficient direct pressure was applied afterwards.
If a tourniquet is applied above a recent venipuncture site.
What kinds of patients stop bleeding more slowly?
Those with coagulation deficiencies or on anticoagulants.
What’s the two point check?
Check for oozing
Check for mounding at the site
What is syncope?
Fainting- results from inadequate blood supply to the brain.
What do you do if a patient appears dizzy or goes unconscious?
Continually monitor
Stop venipuncture if they look dizzy, put their head between their legs.
Support an unconscious patient, call for help and lower them to the floor.
How should a patient who has previously fainted have their blood taken?
While lying down
What do you do if a patient is nauseous,
Instruct them to breathe slowly and deeply.
Discontinue if it worsens.
Give them something to throw up into.
What are signs of a seizure?
Loss of complexion colour
Eye rolling
Body arching/stiffening
What should you do if a patient starts having a seizure?
Stop venipuncture
Call for help
What is petechiae?
Small red spots that form after tourniquet application due to blood escaping the capillaries.
Why does petechiae occur?
Platelet or vascular defects.
What results from numerous venipunctures?
Build up of scar tissue.
Increases difficulty, interior diameter is narrowed.
How do you know the artery has been punctured?
The tube fills in spurts and the blood is bright red.
What do you do if the artery has been punctured?
Discontinue immediately
YOU apply direct pressure for 5 min
Report incident to supervisor
What are the side effects of puncturing an artery instead of a vein?
Increased risk of significant hematoma.
Arteries may spasm, affecting the area’s blood supply.
How do you enter a patient’s room if the door is closed?
Knock and or speak to them prior.
When is the syringe collection technique used?
If the pt. has fragile veins that collapse from using the evacuated system.
How can blood be transferred from the syringe to the evacuated tube?
Direct- push needle through stopper
Unstoppered- remove needle and lids, release blood into tube, used when RBCs are fragile
Transfer device
When are butterfly infusion sets used for collection?
Small veins, give a lot of control.
What angle are butterfly needles inserted at?
How is a butterfly needle seated?
The needle is threaded up the lumen of the vein to anchor the needle.
How can the blood in the tubing be drawn into the evacuated tube?
Reengaging it onto the holder needle.
What is blood culture collection used used for?
The detection of septicaemia.
Presence and extent of infection.
Identity of the microorganism.
Antibiotic the organism will be susceptible to.
When are blood culture specimens collected to increase the chance of isolation?
Just before or after a fever spike.
Before antibiotic therapy.
From more than one site.
Why must the optimum amount be collected in blood culture specimens and what is this amount?
10mL
So at least one bacterium will be caught
What is the BacT/ALERT system?
Blood is collected in vials of culture medium, incubated and observed for growth.
How is bacterial growth detected in blood culture specimens?
CO2 a production, colour sensor changes and is measured.
What are the effects of over/under filling blood culture specimens?
Over- false positive, WBCs also produce CO2
Under- false negative
What collection vials are there for blood cultures?
Aerobic- collected first
Anaerobic
Paediatric
What are ARDs?
Antimicrobial removal devices
Vials that contain resins and or charcoal to inactivate antibiotics.
When is anticoagulant SPS used?
In blood culture vials.
High concentrations may be toxic, max volumes are required.
How are blood cultures collected?
As sets- one aerobic and one anaerobic usually
Second site collection to increase chances of isolation
Consecutive collection- second set is collected immediately at a different site
Timed interval- second site is collected at a given time (20-30min later)
What must blood culture vials be checked for?
Cracks
Discolouration
Turbidity
Stopper bulging, depression or leakage (contamination)
What is the procedure for blood culture collection?
Inoculate at bedside
Sterile technique
Vials stored at room temp, incubated at 37°C
Can use syringe, butterfly or vacutainer needles
Do NOT overfill, vacuum draws more
What tubes can be used if blood culture vials aren’t available?
Yellow top SPS
What do you do if there’s an insufficient specimen?
Dependent on protocol
Split into two vials or only inoculate the aerobic vial.
When is venting required and how is it performed?
Releases gas prior to subculturing.
Performed in the BSC by inserting a sterile needle or venting device.
