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VENIPUNCTURE Pre collection: smoking, physical activity

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VENIPUNCTURE Pre collection: smoking, physical activity, stress During collection: -different time of day -posture: lying/standing/sitting ... – PowerPoint PPT presentation

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Title: VENIPUNCTURE Pre collection: smoking, physical activity


1
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2
Procedures for collection of Diagnostic Blood
specimens
3
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4
VENIPUNCTURE
  • ?Pre collection smoking, physical activity,
    stress
  • ?During collection
  • -different time of day
  • -posture lying/standing/sitting
  • -haemoconcentraction
    tourniquet
  • ?Handling of specimen
  • - Insufficient or excess anticoa.
  • -Inadequate mixing of blood with anticoa.
  • -pat./or specimen identification error
  • -delay to transit to Lab.

5
Room Facilities
  • Venipunture chair Bed
  • Blood collecting Trays
  • Gloves
  • NeedlesHolders
  • Sterile Syrings
  • Venous Blood collection Tubes
  • Tourniquets
  • Antiseptices
  • Guase Pads?55cm,7.57.5cm

6
  • Punture Resistance Disposal Container
  • Ice or refrigerator
  • Adhesive Bandages
  • Warming Devices
  • Test Reference Manual

7
Venipuncture Procedure
  • 1- Identify the patient
  • 2-Assess the patient physical disposition (diet,
    exercise ,stress,basal state)
  • 3-Equipment? necessary suppliesTubes
  • 4-Position the patient
  • 5-put on gloves
  • 6-Apply Tourniquent ?7.5-10cm above ven. Site ,
    Not too tightly No more than 1 min.
  • Patient should make a fist without pumping
    the hand
  • 7-Select the vein site Median cubital
    CephalicVein
  • Extencive scaring from burns surgery
  • Mastectomy Hematoma IV therapy ?below IV site
  • Cannula,Fistula Edematous

8
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9
  • 8- Clean the site ?Isopropyl or Ethyl Alcohol
    70
  • ?guaze pad ? 55-77cm
  • ? Circular motion from center to the periphery
  • 9-Insert needle 30degree
  • 10- Drawing the spec. open the hand
  • 11-Release Tour niquet
  • 12- Place gauze pad over the vein
  • 13- Re move the Needle
  • 14- Applying pressure to the site, making sure
    bleeding has stopped
  • 15- Collect the sample in the appropriate tubes
  • (Blood C ulture - non additive Tube, coagulation
    Tube, Heparin - EDTA Tubes)

10
  • 15- Disposing needles
  • 16-Lable the tubes and rec ord the time of
    collection
  • name ,age,ID no.,Dr. name,other Inf.(Iv site
    )
  • ? All Tubes must Labeled Immediately after blood
    specimen has been drawn.
  • 17-Chill the specimen (if required)
  • 18-Send to Labs.
  • ?Children? syringe gauge 20-23, winged blood
    collection set

11
Safety Infection Control
  • Wear gloves lab coats when handling bloob/body
    fluids
  • Change gloves after each pat.or if contaminated
  • Wash hands frequently
  • Dispose of needles immediately Do not bend,
    recap,break,resheath needles
  • Clean up any blood spills with a disinfectant as
    freshly made 10bleach

12
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  • Prolonged Tourniquet
  • Hb, HCT, RBC ? 2-3
  • Prior rest
  • - Hb, HCT, RBC ? 5-8 (1.5
    hr bed rest)
  • - Lymphocytes ?
  • Position of Arm
  • H b, H C T, R B C ? 2-3 in
    hanging down arm
  • Diurnal Variation
  • Hb, HCT higher in the morning than
    evening
  • WBC Neutrophil counts higher in the
    afternoon
  • Lymphocyte lowest in the morning and
    highest in the evening .
  • PLT is higher in the afternoon and
    evening
  • Cortisol, Fe
  • Excersise
  • - WBC, RBC, Hb, HCT rise
  • - intensive tranning ?
    lymphocyte count
  • -? CK, AST, LD,
    Fibrinolysis,Activate coag.
  • - physical training
    ?sexial hormons

14
Skin Puncture
  • 1- Equipment
  • 2- Choose the puncture site
  • distal digit of third or fourth finger
  • lateral or medial planter surface of
    heel(pre warming 420 3-5 min
  • planter surface of big toe
  • 3- Puncture with sterile Lancet (No deeper than
    2mm)
  • 4- Wipe the first drop
  • 5- Collecting the specimen

15
  • Blood must not be obtain from the
  • -Ear lobe
  • -Central area of an infant heel
  • -Swollen or previously punctured site

16
Punture must be on palmar surface of distal
phalanx across the fingerprints,of the
middleRing finger.
17
Difference between capillary and Venous Blood
  • - RBC, Hb, HCT capillary blood are slightly
    greater than venous leucocyte and PMN are
    higher 8 Monocyte 12
  • -PLT count higher in Venous blood 9
  • -Glucose is higher in capillary blood, K,
    Protein,Ca is lower
  • ? Smears prepared from capillary blood shows
    PLT aggregation

18
STORAGE
  • CBC?up to 4 h.(max. 6 h.) at room Tem.
  • Cell counts Indices are stable for 24 h. at 4c
  • Blood smear?1 h. at room Tem.
  • by 3 h. blood cell morphpology starts
  • - vacuolisation irregular lobulation of
    nucleos
  • -crenation sphering of RBC(after 6 hours)
  • Quantitative effect (gt4-6 h.at room tem)
  • -RBC swelling?MCV, ?HCT, ?ESR
  • - Leucocytes plt?gradually fall (count with 2
    h.)
  • - Hb remains un changes for days

19
The End
20
  • EDTA Chelate Ca
  • -Na2 EDTA powder sol. 100gr/l
  • -K2 EDTA powder sol.1650gr/l
  • 1.5 0.25 mg/ml
  • -K3 EDTA Liquid
  • Shrinkage RBC ?2-3 ?Hct
  • ?Not used for Coag. Tests except for Plt.
  • Ratio of 1.5mg/ml blood is considered optimal
  • Excess of EDTA gt2mg/ml
  • - ?Hct
  • -Plt swelling, disintegrate ? ?Plt

21
  • Sodium citrate chelate or band Ca
  • 3.2 (102-109mmol/l) Na3 C6H5O7 2H2O
  • Coag. Tests 1/9
  • ESR 1/4
  • Heparin Antithrombine
  • 10-20iu/ml , 0.2ml Sat/ml
  • O.F test
  • Coated cappillary collection tube

22
  • -Swelling RBC(K2EDTA)??MCV
  • -marked degree of crenation with few hours
  • Blood film
  • -fall to demonstrate bas. Stippling in lead
    poisioning
  • - minimum of plt agg.
  • - Cause leuco. Agglutination both Neu.Lym.
  • - In some normal individual induce plt.
    clumping ?pseudothrombocytopenia, plt adherance
    to Neu.
  • 1.5mg/ml 3mg/2ml
  • EDTA 6 6000mg 100ml
  • 3
    x0.05

23
Rejection of Samples
  • Hemolysis - this is usually caused by a
    procedural error such as using too small of a
    needle, or pulling back to hard on the plunger of
    a syringe used for collecting the sample. The
    red cells rupture resulting in hemoglobin being
    released into the serum/plasma, making the sample
    unsuitable for many laboratory tests. The
    serum/plasma will appear red instead of straw
    colored.
  • Clotted - failure to mix or inadequate mixing of
    samples collected into an additive tube. The red
    cells clump together making the sample unsuitable
    for testing.
  • Insufficient sample (QNS) - certain additive
    tubes must be filled completely. Incorrect blood
    to additive ratio will adversely affect the
    laboratory test results. When many tests are
    ordered on the same tube be sure to know the
    amount of sample needed for each test.
  • Wrong tube collected for test ordered. Always
    refer to procedure manual when uncertain.
  • Improper storage - certain tests must be
    collected and placed in ice, protected from
    light, or be kept warm after collection.
  • Improperly labeled
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