intro to phlebotomy

• 1. glucose

  • Blood, plasma, serum, cerebrospinal fluid, pleural fluid, and urine
• Plasma and serum

  • Standard sample for glucose analysis
  • Derived from a phlebotomy
• Whole blood

  • Capillary blood for most point of care 
  • 10-15% lower glucose readings than plasma
• Things that might contribute to inaccurate reading

  • Insufficient volume of blood
  • Outdated test strips
  • Alternative sites
  • Environmental factors
  • Malfunction Actioning meter
  • dirty meter
  • Hypertriglyceridemia, hypotension
• random blood sugar - for insulin shock and hyperglycemic
• Fasting blood sugar (FBS)

  • Measure overall glucose homeostasis
  • Requires NPO (nothing per orem) for at least 8 hrs
• 2 hour postprandial blood sugar (PPS)

  • Measures how well body metabolizes glucose
• Glucose tolerance test (GTT)

  • Multiple blood sugar test
  • How well body metabolizes glucose over required period of time
• glucose tolerance test should not be performed to diagnose gestational diabetes
• Glycosylated hemoglobin (HbAlc)

  • Aka glycated hemoglobin
  • Every 3-6 months
  • To monitor long-term glucose control
• Fructosamine

  • Aka glycosylated glycated albumin or plasma protein ketoamine
  • For short term glucose control (3-6 weeks)
• Electrolytes

  • Ions capable of carrying an electrical charge
  •  fluid contains equal number of cations and anions
• Lipids

  • Referred to as fats
  • Primary sources of fuel to provide stability to cell membrane and allow for membrane transport
  • Insoluble in blood and water but soluble in organic solvents
• serum additive preference - serum separating tubes
• preferred anticoagulant for plasma - ethyldiaminetetraacetic acid
• Tests: (fasting 10-12 hrs)

  1. Cholesterol
  2. Triglyceride
  3. High density lipoprotein (HDL)
  4. Low density lipoprotein  (LDL)
• Liver enzymes

  • Used to quantitate the severity of hepatic dysfunction
  • Serum or plasma
• tests for liver enzymes:

  • Total protein
  • Albumin
  • Bilirubin
• Enzymes: ALP, AST, ALT, GGT, LD
• Blood urea nitrogen (BUN)

  • Major end of product of protein and amino acid catabolism
  • Synthesized in the liver from carbon dioxide and ammonia
  • Test for renal blood flow
• Uric acid

  • Major product of purine catabolism
  • Final breakdown of nucleic acid catabolism
  • Serum or plasma
  • Fasting not required
  • High in newborns
• potassium oxalate: not recommended to be used in uric acid test
• 1. ammonia

  • Test for liver’s detoxification function
  • arterial blood is preferred
  • Heparinized or EDTA plasma
  • Not hemolyzed
• Cortisol

  • Hormone
  • Stimulates gluconeogenesis in the liver resulting in hyperglycemia (anti-insulin effect)
  • Antiinflamatorry and immunosuppressive
• cortisol levels:

  • Highest level: 8:00-10:00 am
  • Lowest level: 10:00-12:00mm
• Adrenocorticotropic hormone

  • Produced in response to low serum cortisol
• adrenocorticotropic hormone levels:

  • Highest levels: 6:00-8:00 am
  • Lowest levels: 6:00-11:00 pm
• adrenocorticotropic hormone:

  Plasma

  • Prechilled polystyrene (plastic) EDTA tube
• 1. pain

  • Put patients at ease before blood collection
• 1.  probing

  • Excessive, deep, blind, lateral redirection of the needle
• 1. fainting

  • Loss of consciousness and postural tone resulting from insufficient blood flow to the brain
• factors of fainting:

  • Anemia
  • Dehydration
  • Emotional problems
  • Fatigue
  • Hypoglycemia
  • Hyperventilation
  • Medication
  • Nausea
  • Needle phobia
• sings of fainting:

  • Paleness (pallor)
  • Perspiration
  • Hyperventilation
  • Vertigo
  • Dizziness
  • Lightheadedness
  • nausea
• 1. Excessive bleeding

  • Some patients, particularly those on aspirin or anticoagulant therapy may take longer to stop bleeding. 
• 1. fainting

  • Medical term: syncope
  • Described as loss of consciousness and postural tone (ability to maintain an upright posture) resulting from insufficient blood flow to the brain.
• 1. Nausea and vomiting

  • Unusual for a patient to experience nausea before, during, or after a blood draw
  • Shows signs that are similar to fainting
  • Signs: paleness or having beads of sweat appear at the forehead.
  • What to do: apply a cold, damp washcloth or other cold compress to the patient’s forehead
• 1. Petechiae

  • Less than 3mm in diameter
• bruise that is 5mm in diameter = ecchymoses
• • thrombocytopenia : low platelet count
• 1. seizures/convulsion

  • Rare
  • Discontinue the draw immediately if seizure happens
  • Hold pressure over the site without restricting the patient’s movement