PMLS 2 LAB EXAM 1 2ND SEM PPT

• Venipuncture Equipment

  Equipment used for drawing blood from a vein
• Vein-locating devices

  • Shine high-intensity LED or infrared red light through the patient's subcutaneous tissue to highlight veins
  • The hemoglobin in the blood within the veins absorbs the light, causing the veins to stand out as dark lines
• Vein-locating devices

  • Venoscope II
  • Neonatal Transilluminator
• Tourniquet

  A device that is applied or tied around a patient's arm prior to venipuncture to restrict blood flow
• Tourniquet

  • Tight enough to restrict venous flow out of the area but not so tight as to restrict arterial flow into the area
• Tourniquet

  • Stretchable strap tourniquets (latex, nitrile, vinyl)
• Reusable tourniquets have the potential to transmit bacteria, including methicillin-resistant Staphylococcus aureus (MRSA)
• Blood pressure cuff

  Can be used in place of a tourniquet
• Needles

  Sterile, disposable, and designed for a single use only
• Types of needles

  • Multisample needles (Evacuated Tube System)
  • Hypodermic needles (Syringe System)
  • Winged infusion needles (butterfly)

  
• Needle parts

  • Bevel (end that pierces the vein)
  • Shaft (long cylindrical portion)
  • Hub (end that attaches to the blood collection device)
  • Lumen (internal space of the needle)
• It is important to examine the packaging or seal of a needle before use. If the packaging is open or the seal is broken, the needle is no longer sterile and should not be used.
• Needle gauge

  A number related to the diameter of the lumen
• Common venipuncture needle gauges

  • 15-17 (special needle attached to collection bag)
  • 18 (hypodermic, used primarily as a transfer needle)
  • 20 (multisample, hypodermic)
  • 21 (multisample, hypodermic, standard for routine venipuncture)
  • 22 (multisample, hypodermic, for small veins)
  • 23 (butterfly, for infants, children, and difficult adult veins)
• Multisample needles

  • Traditional style: yellow 20 gauge, green 21 gauge, black 22 gauge
  • BD Eclipse safety needles: black 22 gauge, green 21 gauge
• Needle length

  1 or 1.5 inch, depending on user preference and vein depth
• Safety features on needles

  • Provide immediate permanent containment and be activated using one hand, which must stay behind the needle at all times
  • Examples: resheathing devices, blunting devices, retractable needles
• Desirable characteristics of safety features

  • Provide a barrier between the hands and the needle after use
  • An integral part of the device, not an accessory
  • In effect before disassembly and remains in effect after disposal
  • As simple as possible, requiring little or no training
• Evacuated Tube System (ETS)

  • A closed system where the patient's blood flows through a needle into collection tubes without being exposed to air or contaminants
  • Allows multiple tubes to be collected with a single venipuncture
• Multisample needles

  ETS needles that allow multiple tubes to be collected during a single venipuncture
• Tube holders

  Traditional and safety types, with needles attached
• Tube holders

  • Traditional tube holder with safety needle
  • Venipuncture Needle-Pro safety tube holder with needle resheathing device
• Needle and holder units

  Available as a single permanently attached unit or as both devices preassembled
• Needle and holder units

  • BD Vacutainer® Passive Shielding Blood Collection Needle
• Evacuated tubes

  • Used with both the ETS and syringe methods to collect blood specimens
  • Fill automatically due to the vacuum (negative pressure) inside
• Premature loss of vacuum can occur from improper storage, opening the tube, dropping the tube, advancing the tube too far onto the needle before venipuncture, or if the needle bevel becomes partially out of the skin during venipuncture
• Premature loss of vacuum, removing the tube before the vacuum is exhausted, or stoppage of blood flow during the draw can result in an underfilled tube called a partial draw or "short draw"
• Tube stoppers

  Typically made of rubber, some have a rubber stopper covered by a plastic shield
• Common stopper colors, additives, and departments

  • Light blue (sodium citrate, coagulation)
  • Red (none, chemistry/blood bank/serology)
  • Red (clot activator, chemistry)
  • Red/light gray (none, discard tube only)
  • Clear red/gold (clot activator and gel separator, chemistry)
  • Green/gray, light green (lithium heparin and gel separator, chemistry)
  • Green (lithium heparin, sodium heparin, ammonium heparin, chemistry)
  • Lavender (EDTA, hematology)
  • Pink (EDTA, blood bank)
  • Gray (sodium fluoride and potassium oxalate, sodium fluoride and EDTA, sodium fluoride, chemistry)
  • Orange gray/yellow (thrombin, chemistry)
  • Royal blue (none EDTA, sodium heparin, chemistry)
  • Tan (EDTA)
  • Yellow (sodium polyanethol sulfonate, microbiology)
  • Yellow (acid citrate dextrose, blood bank/immunohematology)
• Expiration dates

  Manufacturers guarantee reliability of additives and tube vacuum until an expiration date printed on the label
• Tube Colours

  • Light blue
  • Red
  • Red/light gray
  • Clear Red/black(tiger) Gold
  • Red/gold
  • Green/gray
  • Green
  • Lavender (purple)
  • Pink
  • Gray
  • Orange Gray/yellow
  • Royal blue
  • Tan
  • Yellow
• Tube Additives

  • Sodium citrate
  • Clot activator
  • Clot activatorand gel separator
  • Lithium heparin and gel separator
  • Lithium heparin Sodium heparin Ammoniumheparin
  • EDTA
  • Sodium fluoride and potassium oxalate Sodium fluoride and EDTA
  • Thrombin
  • Sodium polyanethol sulfonate (SPS)
  • Acid citrate dextrose(ACD)
• Tube Departments

  • Coagulation
  • Chemistry
  • NA (discard tube only)
  • Chemistry, Blood Bank, Serology/Immunology
  • Hematology
  • Blood Bank
  • Chemistry
  • Microbiology
  • Blood Bank/Immunohematology
• Manufacturers guarantee reliability of additives and tube vacuum until an expiration date printed on the label, provided the tubes are handled properly and stored between 4 and 25°C
• Evacuated tube system

  • Improvement over the syringe method
  • Vacuum already in the tube
  • Multiple blood samples can be collected without changing needles
• Evacuated tube system

  Preferred over the syringe method because it is direct, efficient, relatively safe for the patient and the phlebotomist, and allows multiple tubes to be easily collected
• Phlebotomy equipment

  • Evacuated tube holder
  • Disposable needle for evacuated system, 20, 21, or 22 gauge
  • Evacuated tube(s)
  • Tourniquet
  • Alcohol swabs
  • Gauze or cotton balls
  • Sharps container
  • Disposable gloves
  • Biohazard bag
  • Safety glasses and mask if potential for splatter
• All phlebotomy equipment should be new and sterile. Evacuated tube(s) should not be expired
• Procedure for proper venipuncture

  1. Wash hands and put on gloves

  2. Assemble equipment and materials

  3. Place venipuncture equipment and clean gauze within easy reach

  4. Identify patient

  5. Explain venipuncture procedure to patient and position patient

  6. Break the needle seal

  7. Thread the appropriate needle into the tube holder using the needle sheath as a wrench

  8. Place the tourniquet around the patient's arm above the elbow

  9. Instruct the patient to open and close the fist a few times

  10. Inspect the bend of the elbow to locate a suitable vein

  11. Palpate the vein with the fingertip(s) to determine the direction, size and depth

  12. Release the tourniquet

  13. Cleanse the skin of the puncture site using alcohol soaked gauze

  14. Allow the alcohol to dry

  15. Retie the tourniquet, being careful not to touch the sterile puncture site

  16. Instruct the patient to straighten the arm and make a fist

  17. Inspect the needle to see that the point is smooth and sharp

  18. With the bevel up, align the needle with the vein

  19. Hold the needle at a 15 or 30° angle to the arm and insert the needle into the vein

  20. Grasp the flange of the evacuated tube holder, and push the tube forward until the butt end of the needle punctures the stopper

  21. Fill the blood collection tube(s)

  22. Remove the last tube to draw from the holder

  23. Instruct the patient to open fist as soon as the vein has been entered

  24. Release the tourniquet when the desired amount of blood is obtained

  25. Place a dry, sterile gauze over the puncture site and withdraw the needle from the vein (do not press down on the needle)

  26. Instruct the patient to press the sterile gauze over the wound for 3-5 minutes with the arm extended

  27. Activate the safety feature of the needle using one hand. Discard the needle into a puncture-proof sharps container

  28. Label the tube properly with Name of Patient, Date, Time collected and initials of Phlebotomist

  29. Attend and thank the patient

  30. Discard the used materials properly
• Winged Infusion Set

  • Allows more flexibility and precision than a multisample needle and syringe
  • Collect blood from small or difficult veins such as hand veins and veins of elderly and pediatric patients