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CLINICAL CHEMISTRY > specimen collection ( capillary) > Flashcards

specimen collection ( capillary) Flashcards

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1
Q

“Proper patient identification is the first step in sample collection.”

A

SPECIMEN COLLECTION

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2
Q
  • Prime factor in order to attain accurate results in the clinical laboratory is
A

patient identification

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3
Q
  1. Conscious Inpatients/Hospitalized patients
  2. Sleeping patients
  3. Unconscious
  4. Infants and Children and Mentally Incompetent
  5. Outpatient/Ambulatory patients
A

PATIENT IDENTIFICATION PROCEDURES

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4
Q
  • Ask full name (verbally), confirm using ID
    bracelets
  • All of your question should not be answerable
    by yes or no.
  • Every patient admitted in the hospital has an ID
    bracelet
A

Conscious Inpatients/Hospitalized patients

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5
Q
  • Same as conscious, awakened before
    collection
  • Awaken the patient. Ask their full name verbally
    then confirm using ID bracelets.
A

Sleeping patients

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6
Q
  • Ask relative or nurse or physician and
    record name of person, ID bracelets
  • For coma and ICU patients, confirm details to their relative (first asked), nurse, or physician. Confirm ID Bracelet
A

Unconscious

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7
Q

Ask relative or nurse and record name of
person, ID bracelets

A

Infants and Children and Mentally Incompetent

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8
Q
  • Receptionist verifies the ID of the patient
    o The receptionist in the laboratory is the
    first to interact with the patient.
  • Patient may show ID with picture
  • Clinic issued ID card
  • In case there is no verification from the
    receptionist and no ID, make the patient state
    full name, date of birth and spell the last
    name
    o Usually, 2 or 3 items for verification is
    needed.
    ▪ Name, Date of Birth, Age, Address
  • Items for verification depends on the SOP of
    the hospital
A

Outpatient/Ambulatory patients

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9
Q

Method for blood collection, for adult males:

A

5-6L of whole blood

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10
Q

Method for blood collection, For adult females

A

4-5L of whole blood

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11
Q

cells composed of 40-45%

A

(1.89L)

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12
Q

Plasma composed of 55-60%

A

(2.84L)

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13
Q

_____ only a fraction of the whole blood that is circulating in our body.

A

plasma and cellular components

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14
Q

made up of water, proteins, nutrients, hormones, and electrolytes

A

PLASMA

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15
Q

BUFFY COAT ( wbc and platelets )
PACKED RBC

A

CELLULAR COMPONENTS

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16
Q

TYPES OF BLOOD SPECIMENS

A
  • serum
  • plasma
  • whole blood
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17
Q

_____ most common and the best specimen, but in case you want to decrease the turn-around-time and at
the same time for routine chem sometimes plasma is an
option

A

serum

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18
Q

used in clinical chemistry depending on the anticoagulant used

A

Plasma

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19
Q
  • clear
  • pale yellow in color
  • plain tube
  • clotted blood
  • without fibrinogen
A

serum

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20
Q
  • clear to slightly hazy
  • pale yellow in color
  • anticoagulated tube
  • unclotted blood
  • with fibrinogen
A

plasma

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21
Q

TYPES OF BIOLOGICAL SPECIMENS

A
  1. Saliva
  2. Urine
  3. Feces
  4. Synovial, Spinal, Amniotic, Pleural, Pericardial, Ascitic Fluid
  5. Various type of solid tissues
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22
Q

Blood Collection
o 3 methods

A
  1. Arterial Puncture (artery)
  2. Skin puncture (capillaries)
  3. Venipuncture (veins)
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23
Q

collect blood from the artery

A
  • arterial puncture
24
Q

collect blood from the capillaries

A

skin puncture

25
Q

defined as the process of collecting blood, comes from the Greek word “phleb” means veins and “tomy” meaning
slice or cut.

A

Phlebotomy

26
Q
  • Not all artery in the body can
    be used as a site for arterial
    puncture
  • The usual artery that is used
    for arterial puncture is the
    brachial artery, radial artery
    (preferred and common) and
    femoral artery.
  • The angle for the collection is
    45 or 90 degrees.
  • For infant or newborn, Scalp
    and Umbilical artery
A

ARTERIAL PUNCTURE

27
Q
  • Blood is obtained/withdrawn from a patient’s artery
  • Blood sample is collected without torniquet
A

ARTERIAL PUNCTURE

28
Q

▪ pH measurement
▪ 𝑃𝐶𝑂2 level
▪ 𝑃𝑂2 level
▪ Bicarbonate level

A

Blood Gas Analysis

29
Q

oxygenated blood with a bright red
color

A

Arterial blood

30
Q

o test for collateral circulation
o important procedure performed before arterial puncture to know if there are other arteries to supply blood on that part of the body.
o Commonly used anticoagulant in arterial puncture is Heparin because it is the additive or anticoagulant that is best to use in collecting blood to be used for Blood Gas Analysis.

A

Allen’s test

31
Q

to know the pH level, 𝑃𝑂2 level, and if the oxygenation of the patient is okay
o Uses either a glass syringe or plastic syringe

A

Arterial Blood Gas Analysis (ABGA)

32
Q
  • Produces good result
  • Advantage is it is
    reusable
A

Glass syringe

33
Q
  • Contamination is less
    because it is a one-time
    use
  • Allows more leakage
    when collecting blood
A

Plastic Syringe

34
Q
  • Bright red color
  • Obtained from artery
  • Oxygenated
A

Arterial Blood

35
Q
  • Dark red color
  • Obtained from vein
  • unoxygenated
A

Venous Blood

36
Q

5 SITES FOR ARTERIAL PUNCTURE

A
  • radial artery
  • brachial artery
  • femoral artery
  • scalp artery
  • umbilical artery
37
Q

Commonly used in newborn patients

A

Scalp Artery

38
Q

Ideal site for arterial puncture in newborn
patients

A

Umbilical Artery

39
Q
  • Length of lancet:1.75 mm
  • Depth of incision (depends on the patient)
    o Infants and children: <2.0 mm
    o Adults: <2.5 mm
  • Distance from skin surface to bone or cartilage: 1.5-2.4
    mm
    o Prevent contact with bones to avoid infection
A

Capillary Puncture or microsampling

40
Q

When to use skin puncture, aka Capillary Puncture or microsampling

A

o Small amount of sample needed
o Repeated venipuncture resulting to severe vein damage
o Burn patient with bandage

41
Q
  • No accessible veins
  • Fragile veins
  • Thrombotic veins/ those with clot-forming tendencies
  • POCT (point of care testing) samples
    o Random Blood Sugar using glucometer
  • Newborns and infants
A

Indications for skin puncture

42
Q
  • Lateral plant heel surface
    (newborn and infants <1)
  • Palmar surfaces of fingers
    (3rd and 4th)
  • Plantar surface of the big toe
  • Earlobes – least site
A

Preferred sites for skin puncture

43
Q
  • Central arch area of an infant’s heel
  • Fingers of newborn or infant, 1 y.o.
  • Thumb, index and 5th fingers
    o Thumb has pulse
    o Pinky finger has insufficient depth
  • Fingers on the side of mastectomy
  • With scarred areas
    o Bruises, edematous, cyanotic, calloused,
    infected, recently punctured
A

Sites not recommended or should be avoided

44
Q

collects blood from the capillary, the blood that is collected is a mixture of arterial and venous blood along with
interstitial and intracellular fluid.

Between the arterial and venous, it is more of the arterial blood. Mixture of oxygenated and
deoxygenated blood.

A

Skin puncture

45
Q

Patient tends to develop iatrogenic anemia, also known as hospital induced anemia. Anemia acquired due to repeated blood collection

A

Disadvantage of performing skin puncture

46
Q

person who can benefit with skin puncture

A
  • Pediatric children
  • Obese patients
  • Chemotherapeutic patients
  • burn patients
  • adult patients
47
Q
  • EDTA > Other additive tubes > Serum tubes
    o Example: purple, green, red
A

Order of filling microsampling

48
Q
  1. Hold finger between your index finger and thumb
  2. Puncture the finger using a quick, smooth motion
  3. Wipe away the first drop of blood (contains alcohol and interstitial fluid)
  4. Collect sample
A

Skin puncture procedure:

49
Q
  • BGA of newborn and infants, measuring pH and 𝑝𝐶𝑂2 but not 𝑝𝑂2
  • Preferred site: Earlobe
  • Commonly used site: Lateral plantar heel surface
  • Massage or apply warm compress on the site of puncture to enhance blood circulation.
    o Heel warmer or warm towels
A

Arterialized Capillary Blood

50
Q

a parameter of BGA that determines how
much oxygen is present or the partial pressure of the oxygen present.

▪ Cannot accurately measure this as
there is deoxygenated blood in the
sample

A

𝑝𝑂2

51
Q
  1. Warm the earlobe or heel surface with paper towel
    saturated with warm water (39-45⁰C).
  2. Flick the earlobe with the index finger.
  3. Cleans the area with 70% alcohol.
  4. 2 Heparinized tubes are placed in the center of next drop
    of blood and filled capacity without air bubbles.
  5. Both ends are sealed in clay after the insertion of flea.
    o flea- small metal bar used to stir blood inside
  6. Blood is stirred using a magnet.
A

Arterialized Capillary Blood Procedure

52
Q

o Arterial blood pressure is <95mmHg
(hypotensive)
o Area has poor blood supply
o Patient has decreased cardiac output
o Patient with vasoconstriction

A

Capillary arterialization should not be done

53
Q

minute metal filling that help mix the specimen while the blood is entering the tube
- moves the blood for a homogenous mixture

A

Flea

53
Q

best site for BGA for new
born

A

Indwelling umbilical artery

54
Q
  1. Choose puncture site.
  2. Cleanse the area with 70% alcohol.
  3. Puncture across the finger line and wipe the first drop of blood that could contain interstitial fluid that could affect the
    result.
  4. Collect blood using the capillary tube through capillary action. Prevent performing milking of the site
A

SKIN PUNCTURE PROCEDURE

55
Q
A

CLINICAL CHEMISTRY (7 decks)

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