PRE LAB EXPERIMENT 2 and 3 Flashcards
the drawing of blood- is an integral part of medical laboratory practice
PHLEBOTOMY
It is good to remember that no laboratory procedure will be any better than the quality of the specimen that is being tested.
PHLEBOTOMY
Each step in the process affects the quality of the specimen and is this important for preventing laboratory error and patient injury.
PHLEBOTOMY
For us medical technologist, this is the only time that we have
patient interaction.
PHLEBOTOMY
For us medical technologist, this is the only time that we have
patient interaction.
PHLEBOTOMY
affects the test result of the patient and the affects the quality of the specimen.
hemolysis
– get blood from veins, suitable for serology
• Venipuncture
– for micro sampling
• Capillary puncture
– it is not used in serology
• Arterial puncture
SOURCES BLOOD SPECIMEN
• Capillaries
• Arteries
• Veins
(55% of total volume)
• Plasma
o Fluid part
• Plasma
(45% of total volume)
• Formed elements
• Formed elements
o RBC
o WBC
o Platelets
• Test tube containing
whole blood
VENIPUNCTURE
• Open system
• Evacuated Tube system
• Winged Infusion set
• utilization of hypodermic syringe, most used syringe is 10ml.
OPEN SYSTEM
• Gauge used is
21-23; 25
o note: the (?) the gauge the (?) the bore each gauge has corresponding hub color
higher
smaller
• Length:
1 or 1.5 inches (1/2 to 1⁄4 in butterfly needle)
• also called CLOSED SYSTEM
EVACUATED TUBE SYSTEM
it is also used to collect multi samples or multi sampling
EVACUATED TUBE SYSTEM
• this type of sampling is only used if the vein is superficial
WINGED INFUSION SET
it is also known as BUTTERFLY SET
WINGED INFUSION SET
EQUIPMENTS
• Tourniquet
• Antiseptic solution
• Syringe and needle
• Evacuated tube set
• Butterfly infusion set
Antiseptic solution
o Isopropyl alcohol – iodine
o Chlorohexidine gluconate
o Benzalconium Cl / Zephiran
SITES OF COLLECTION
VEINS OF ANECUBITAL FOSSA ( 50-300 ANGLE)
VEINS OF ANECUBITAL FOSSA ( 50-300 ANGLE)
• Median cubital vein (1st choice)
• Cephalic vein (2nd)
• Basilic vein (3rd)
( 50-300 ANGLE)
VEINS OF ANECUBITAL FOSSA
(CAN BE LOWER THAN 50-300 ANGLE)
WRIST VEIN
Superficial vein of the dorsal hand
o cephalic vein, basilica vein, dorsal or metacarpal vein
WRIST VEINS
Superficial vein of the dorsal hand
VEINS ON DORSAL HAND
VEINS OF THE FOOT
Last resort for blood collection is from the (?) after the arm veins have been determine unsuitable.
VEINS OF THE FOOT
Always check with the hospital policy before this type of sampling is carried out.
VEINS OF THE FOOT
• Instituted by the Center of Disease Control in 1987
UNIVERSAL PRECAUTIONS 1987
all patients are considered to be possible carriers of blood-borne pathogens.
UNIVERSAL PRECAUTIONS 1987
wearing gloves when collecting or handling blood and body fluids contaminated with blood
UNIVERSAL PRECAUTIONS 1987
• The CDC excluded urine and body fluids that is not visibly contaminated by blood
UNIVERSAL PRECAUTIONS 1987
Although many specimens can contain a considerable amount of blood before it becomes visible.
UNIVERSAL PRECAUTIONS 1987
it only recommends wearing of gloves when there is a visual contamination of blood but if it is not visibly contaminated by blood, basically gloves are not recommended for use. This is one of the disadvantages
UNIVERSAL PRECAUTIONS 1987
• Guidelines are not limited to blood-borne pathogens
BODY SUBSTANCE ISOLATION
they consider all body fluids and moist body substances to be potentially infectious.
BODY SUBSTANCE ISOLATION
• (Unlike UP na kinoconsider lang as infectious ang body fluids that is contaminated by blood, BSI considers ALL body fluids).
BODY SUBSTANCE ISOLATION
• Personnel should wear gloves at all times when encountering
moist body substances.
BODY SUBSTANCE ISOLATION
• Major disadvantage: They do not recommend hand washing
following removal of gloves unless visual contamination is present.
BODY SUBSTANCE ISOLATION
• The CDC combined the major features of UP and BSI guidelines.
STANDARD PRECAUTIONS (1996)
• It is more complete and specific
STANDARD PRECAUTIONS (1996)
• We are now utilizing this one.
STANDARD PRECAUTIONS (1996)
• Addition of the following guidelines:
1. Hand washing
2. Gloves
3. Mask, eye protection and face shield
4. Gown
5. Patient care equipment
6. Environmental control
7. Linen
8. Occupational Health and Blood borne Pathogens
9. Patient placement
STANDARD PRECAUTIONS (1996)
WHAT TYPES OF EVACUATED TUBES ARE USED FOR
SEROLOGIC TESTING?
No additive (Red Top) and Serum Separator Tube are used for serologic testing
• This tube has no anticoagulant and it is used for blood clotting and the serum is separated by centrifugation.
NO ADDITIVE (RED TOP)
Wait for 30 minutes in order for the blood to clot and after that prepare the tube for serum.
NO ADDITIVE (RED TOP)
• These tubes contain clot activator and serum gel separator.
SERUM SEPARATOR TUBE (GOLD TOP) AND RED/GRAY MOTTLED TOP (TIGER TOP)
They contain serum gel at the bottom to separate the blood from serum upon centrifugation and used to form clot quickly and separate serum with gel at the bottom of the tube.
SERUM SEPARATOR TUBE (GOLD TOP) AND RED/GRAY MOTTLED TOP (TIGER TOP)
we don’t need to wait for 30 minutes. Direct to centrifugation.
SERUM SEPARATOR TUBE (GOLD TOP) AND RED/GRAY MOTTLED TOP (TIGER TOP)
NOTE:
A. No additive (red top)
B. Gold Top (SST)- We can see serum, gel, red cell (bottom of
the pic)
C. Tiger top (SST)
BLOOD SPILLS CAN ACCIDENTALLY HAPPEN IN THE LABORATORY. WHAT SHOULD BE DONE IN CASES OF SPILLAGE?
• Wipe immediately the blood spill.
The most commonly used disinfectant is a (?) prepared weekly and stored in a (?), not a glass, bottle.
1:10 dilution of sodium hypochlorite (household bleach)
plastic
The bleach should be allowed to air-dry on the (?) prior to removal.
a. Ibababad natin yung blood spill with the disinfectant, after na nag dry, iwipe natin siya ng cloth.
contaminated area
The National Committee for Clinical Laboratory Standards (NCCLS)states that a (?) can be used for routine cleaning
1:100 dilution
• If the patient is unconscious – take a look at the wristband, to confirm their identity
IN PATIENT
• Ask the watcher if the patient is unconscious
IN PATIENT
• If the patient is conscious, let them state their own name
IN PATIENT
• If the patient is a mute and has no wrist band, confirm it to the nurse station. Most of the time the beds have labels.
IN PATIENT
• Much easier, since they are conscious and ambulatory/mobile.
OUT PATIENT
• Always ask the patient to state his/her full name
OUT PATIENT
HOW IS PATIENT CARE SHOWN DURING PHLEBOTOMY?
• Not only done at the end of procedure but also when the patients (?) the phlebotomy area.
enters
• Introducing yourself to the patient
WELCOMING THE PATIENT
• Letting the patient know you’re happy to see them
WELCOMING THE PATIENT
• Making the patient feel important
WELCOMING THE PATIENT
• You can also mention the test that will be performed
WELCOMING THE PATIENT
• Assessing the patient’s comfort level quickly
PROVIDING PATIENT COMFORT
• Alleviating patient anxiety
PROVIDING PATIENT COMFORT
• Letting the patient know you care about their well being
PROVIDING PATIENT COMFORT
• Reassuring the patient they’re in good hands
PROVIDING PATIENT COMFORT
LETTING THE PATIENT KNOW IT WAS A PLEASURE TO SEE THEM
• Talking with the patient about the procedure so they’re kept informed and know what to expect
EFFECTIVE PATIENT COMMUNICATION
• Asking the patient if they’ve ever fainted during a blood draw
EFFECTIVE PATIENT COMMUNICATION
Asking for patient feedback during the procedure
EFFECTIVE PATIENT COMMUNICATION
• Thanking the patient for visiting the medical facility
AFTER PATIENT CARE
• After applying gauze, apply pressure
AFTER PATIENT CARE
• Puncture only the uppermost wall of the vein
HEMATOMA
• Remove the tourniquet before removing the needle
HEMATOMA
• Use the major superficial veins (preferred: median cubital
vein)
HEMATOMA
• Make sure the needle fully penetrates the upper most wall of
the vein. (Partial penetration may allow blood to leak into the
soft tissue surrounding the vein by way of the needle bevel)
HEMATOMA
• apply pressure to the venipuncture site
HEMATOMA
(WHICH CAN INTERFERE WITH MANY TESTS)
HEMOLYSIS
• Mix tubes with anticoagulant additives gently 5-10 times (inversions depend on the anticoagulant used. EDTA: 8 times ; Sodium citrate: 3-5 times)
HEMOLYSIS
• Avoid drawing blood from a hematoma
HEMOLYSIS
• Avoid drawing the plunger back too forcefully, if using a
needle and syringe, or too small a needle, and avoid frothing
of the sample.
HEMOLYSIS
• Make sure the venipuncture site is dry
HEMOLYSIS
• Avoid a probing, traumatic venipuncture
HEMOLYSIS
• Avoid prolonged tourniquet application (max of 2 minutes) or
fist clenching
HEMOLYSIS
o Fist clenching is not advised in terms of
venipuncture
o Fist clenching is advisable during
blood donation
• an increased concentration of larger molecules and formed elements in the blood
HEMOCONCENTRATION
• Prolonged tourniquest application (no more than 1 minute)
HEMOCONCENTRATION
• Massaging, squeezing, or probing a site
HEMOCONCENTRATION
• Long- term IV theraphy
HEMOCONCENTRATION
• Primary effect is hemoconcentration of non-filterable elements (i.e.proteins).
PROLONGED TOURNIQUET APPLICATION
The hydrostatic pressure causes some water ad filterable elements to leave the extracellular space.
PROLONGED TOURNIQUET APPLICATION
• Significant increases can be found in total protein, aspartate aminotransferase (AST), total lipids, cholesterol, iron
PROLONGED TOURNIQUET APPLICATION
• Affects packed cell volume and other cellular elements
PROLONGED TOURNIQUET APPLICATION
• Hemolysis may occur, with pseudohyperkalemia
PROLONGED TOURNIQUET APPLICATION
- false increase of potassium
Pseudohyperkalemia
• Preferred site:
antecubital fossa (median cubital vein)
• Median cubital vein (unavailable):
cephalic vein
• Least preferred area in the antecubital fossa:
basilic vein
• Antecubital fossa (unavailable): proceed to
superficial
veins of the dorsal hand
• Wrist vein (unavailable):
superficial veins of the foot
The last resort for blood collection is
• Superficial Veins of the foot
Always check with t5he hospital policy before this type of sampling is carried out
• Superficial Veins of the foot
place in an anticoagulated tube – after mixing it will be the
WHOLE BLOOD
anticoagulated – centrifuge – separate the supernatant and red cell
PLASMA
plain tube/red top with clot activator/ or with gel separator – centrifuge – separate supernatant and pack red cell
SERUM
• heat the serum at 56 degrees Celsius for 30 minutes
SERUM INACTIVATION
RED CELL SUSPENSION
• collect the pack red cell - washed with saline or the NSS
3x
concentration of red cell suspension
• 2-5%
• Desired red cell suspension (RCS) =
Washed packed red blood cell (WPRCB) volume x 100/Total volume (TV) of the RCS preparation
Total volume of RCS =
WPRBC + volume of diluent NSS added to prepare desired %RCS
• Liquid portion of unclotted blood
PLASMA
• Contains the fibrinogen group of coagulation factors
PLASMA
• Lighter yellow and little turbid
PLASMA
• Chemically does not contain much platelet derivatives
PLASMA
• Liquid portion of the clotted blood
SERUM
• Does not contain the fibrinogen group of coagulation factors
SERUM
• Darker yellow and clearer
SERUM
• Contains higher levels of platelet derivatives
SERUM
• Is a common reagent used for many serologic procedures
RED CELL SUSPENSION
• Provide the appropriate serum to allow for grading and
interpretation of test results
RED CELL SUSPENSION
• The concentration of RCS is 2-5%
RED CELL SUSPENSION
Since the antibodies are found in (?), it is the preferred sample to use in serologic testing.
serum
(?), also don’t have fibrinogen or other anticoagulant factors that may alter the results of the tests, while (?) that contains anticoagulant, is subject to affect the 50% of the total of the total laboratory turnaround.
Serum
plasma
is done to allow separation of the cells and clotting factors and to avoid the formation of fibrin clots while still maintaining proteins and other molecules that represent the whole-body system when centrifuged.
Complete clotting
After collection of the whole blood, it should be allowed to clot by living it undisturbed at room temperature. This is usually taking
15-30 minutes.
Remove the clot by centrifuging at (?) in a refrigerated centrifuge.
1,000-2,000 x g for 10 minutes
To prevent the formation of fibrin clots, since fibrin
clots may also cause a false positive reaction specially in terms of hemagglutination procedures
Complete clotting
DESCRIBE AND DISCUSS WHY THE FOLLOWING SAMPLES ARE NOT USED IN SEROLOGIC TESTING
HEMOLYZED SAMPLE
LIPEMIC SAMPLE
ICTERIC SAMPLE
once the red cells will lyze the hemoglobin will go out of the cell and because od that It cause non specific binding)
HEMOLYZED SAMPLE
• Serum samples containing more than (?) of hemoglobin can cause non-specific binding in serologic testing is not recommended for a serum sample containing more than this amount of hemoglobin.
100mg/dl
can interfere with measured analytes and chemical interactions.
LIPEMIC SAMPLE
This is especially important in electrophoretic methods.
LIPEMIC SAMPLE
can also non-specifically interfere in various immunoassays.
LIPEMIC SAMPLE
can interfere with antigen- antibody reaction by blocking binding sites on antibodies.
LIPEMIC SAMPLE
This can happen even when antibodies are bound to a solid surface.
LIPEMIC SAMPLE
Depending on the nature of the reaction, the interference can cause both, falsely elevated of falsely decreased result.
LIPEMIC SAMPLE
in serologic tests, some procedures require the use of
inactivated serum
Since Inactivation is the process that destroys complement activity, complement is known to interfere with the reactions certain syphilis tests and complement components.
inactivated serum
It can agglutinate latex particles and cause a false positive reaction in latex passive agglutination assays.
inactivated serum
Complement may also cause lysis of the indicator cells in hemagglutination assays
inactivated serum
wearing face shields when there is danger of blood splashing on mucous membranes and when disposing of all needles and sharp objects in puncture-resistant containers.
UNIVERSAL PRECAUTIONS 1987
