03 INTRO to Phleb

• UNCLOTTED BLOOD

  (Top to Bottom)

  1. Plasma
  2. WBC
  3. Platelets
  4. RBCs
• Serum

  • Liquid portion of clotted blood

  • W/o anticoagulant

  • Contains Albumin and Globulin
• Plasma

  • Liquid portion of unclotted blood

  • With anticoagulant

  • Contains albumin, globulin and fibrinogen
• Phlebotomy

  • Is the process of collecting blood through the vein by using incision or puncture methods to draw blood for analysis or as part of therapeutic or diagnostic measures under the physician’s request.
• PHLEBOTOMIST

  – people who are trained to draw blood from a person or animal for tests, transfusions, donation or research
• MAIN GOALS OF PHLEBOTOMY:

  • For diagnosis and treatment using blood samples

  • For transfusion, to remove blood from the donor

  • For removal of blood for polycythemia or therapeutic purposes
• ROLE OF PHLEBOTOMISTS:

  • To collect blood samples for laboratory testing or for transfusion.

  • Properly label collected blood samples with the necessary data to identify the patient.

  • Responsible in delivering or transporting collected samples within appropriate prescribed time limits.
• METHODS OF BLOOD COLLECTION:

  • Venipuncture (Main Method)

  • Capillary puncture (Main Method)

  • Arterial puncture
• PRE-EXAMINATION VARIABLES:

  • diet
  • posture
  • exercise
  • stress
  • smoking
  • altitude
  • age and gender
  • pregnancy
  • alcohol ingestion
• DIET

  The tests most affected are glucose and triglycerides.
• Serum or plasma collected from patients shortly after a meal may appear cloudy or turbid (lipemic) due to the presence of fatty compounds such as meat, cheese, butter, and cream.
• Alcohol consumption -> transient elevation in glucose

  chronic consumption -> liver function tests and triglycerides
• Caffeine -> hormone levels
• • Posture

  -Can cause variations in some blood constituents, such as cellular elements, plasma proteins, compounds bound to plasma proteins, and high molecular weight substances.
• Exercise

  • Increased activity of muscle enzymes
  • Elevated concentration of sex hormones
  • Elevated concentration of steroids
• • Stress -nervous patient before sample collection may increase levels of adrenal hormones, increase WBC counts, decrease serum iron, and markedly affect arterial blood gas (ABG) results
• Smoking

  • Acute effects : increase in glucose, BUN, cholesterol and triglycerides
  • Chronic effects: Increase in blood hemoglobin values (carboxyhemoglobin) Decrease in IgG, IgA, and IgM -> weak immune system
• Altitude

  • RBC counts and hemoglobin (Hgb) and hematocrit (Hct) levels are increased in high-altitude areas such as the mountains where there are reduced oxygen levels.
• Age and Gender

  • Laboratory results vary between infancy, childhood, adulthood, and the elderly -> gradual change in the composition of body fluids.
  • Hormone levels vary with age and gender
  • RBC, Hgb, and Hct values -> higher in male patients
• Pregnancy

  • caused by the physiological changes in the body including increases in plasma volume
• Antecubital fossa

  • The preferred site for venipuncture and is located anterior and below the bend of the elbow.
• Three Major Veins:

  • Median cubital vein
  • Cephalic vein
  • Basilic vein
• Median Cubital Vein

  • vein of choice because it is large and does not tend to move when the needle is inserted. It is the easiest to access and least painful for the patient
• Cephalic Vein

  • is the second choice for venipuncture. It is harder to palpate but is usually better when drawing blood from an obese patient.
• Basilic Vein

  • last vein of choice for venipuncture as it is not well anchored
  • punctures on this vein are more painful.
  • It has a tendency to “roll” and hematoma formation is more likely to occur.
• • Quite often the veins cannot be seen but usually felt by touching or palpating with the index finger of the non dominant hand
  • They will reveal themselves as elastic tubes beneath the surface of the skin.
• Arrangement of veins in the antecubital fossa:

  H-shaped pattern

  • includes the cephalic, median cubital, and basilic veins in a pattern that looks like a slanted H.
• Arrangement of veins in the antecubital fossa:

  M-shaped pattern

  • Includes the cephalic, median cephalic, median basilic, and basilic veins.
• Other preferred sites for venipuncture:

  • Dorsal hand veins are also acceptable for venipuncture.
  • Foot veins are a last resort because of the higher probability ofcomplications.
• Areas to Be Avoided for blood extraction:

  • Damaged Vein
  • Hematoma
  • Edema
  • Burns, Scars and Tattoos
  • Mastectomy
  • IV Line
  • Heparin and Saline Locks
  • Cannulas and Fistulas
• Patient Complications: [Immediate Local Complications]

  • Localized hemoconcentration or Venous stasis

  Remedy: 1 min application of tourniquet
• Patient Complications: [Immediate Local Complications]

  • Syncope or Fainting
  • -Remedy: Let the patient lie down
• Patient Complications: [Immediate Local Complications]

  Failure to obtain blood

  1. Needle Beside the Vein
  2. Collapsed Vein
  3. Needle Too Deep/ Too Shallow
  4. Bevel Against the Wall of the Vein
  5. Needle Position
  6. Faulty Evacuated Tube
• Delayed Local Complications:

  -Thrombosis of veins- Formation of blood clots inside the lumen of the vein due to trauma
• Delayed Local Complications:

  -Thrombophlebitis- Inflammation of the vein due to thrombus as manifested by an inflammatory reaction on the outer skin surface
• Delayed Local Complications:

  • Hematomas- Blue or black skin discoloration commonly due to repeated trauma or puncture of the veins
• General Delayed Complications- Serum Hepatitis, AIDS

  Prevention:

  • Use of disposable syringe or vacutainer set

  • Follow the procedures from the Universal Precautions in handling infectious specimens
• • Collection Attempts

  -When blood is not obtained from the initial venipuncture, the phlebotomist should select another site. Repeat the procedure using a new needle
• Nerve Injury

  • Temporary or permanent nerve damage can be caused by incorrect vein selection or improper venipuncture technique and may result in loss of movement to the arm or hand and the possibility of a lawsuit.
• Iatrogenic Anemia

  • pertains to a condition of blood loss caused by treatment. An anemia can occur when large amounts of blood are removed for testing at one time or over a period of time.