M6

• Pre-analytical testing phase

  • includes procedures such as laboratory handling and identification
  • takes place prior to any laboratory testing.
  • where proper control measures are placed.
• Pre-analytical testing phase

  • aside from the ability to draw blood from the patient, the phlebotomist should also possess the skill of being able to identify factors that affect the process and address the same as needed.
•  The physicians compare the laboratory results   to a reference range or interval.
•  Range shows the high and low limits of result values as compared to healthy individuals.
• Basal state

  • ideal in establishing reference range since it represents the condition of the metabolism of the body early in the morning or after approximately 12 hours of fasting.
  • can be influenced by age, gender and conditions of the body.
• Burns, Scars, & Tattoos

  • not recommended because veins in the area may be difficult to examine.
  • Burns too painful to touch t
  • tattoos may be susceptible to infection due to the dyes used.
• Damaged Veins

  • problem is the possibility of getting inaccurate results.
  • Veins could be Sclerosed or hardened.
• Edema

  • the tissues become fragile, making the task of locating the veins harder. This
  • condition maybe due to reactions from medications, pregnancy,etc
• Hematoma

  • a solid swelling or mass of blood in the tissues which is caused by the leakage of blood from the vessels during venipuncture
• Mastectomy -

  • Blood drawing becomes a challenge since the lymph flow is obstructed
  • there maybe swelling and infection after the surgery. 
• Obesity

  • veins are deep and they are harder to locate
  • A solution is to use a longer tourniquet or try locating the cephalic or cubital vein.
• VASCULAR ACCESS SITES AND DEVICES  (VADs) for blood sampling, infusing medication, central venous pressure readings and blood transfusion. 
• The choice of vascular access sites is based on the needs of the patient, the purpose and length of time it needs to remain in the body. 
• • Arterial Line.   To obtain samples for arterial blood gas and laboratory studies, critically ill patients require arterial lines where a thin catheter is inserted into an artery.
• Arteriovenous Shunt or Fistulama passageway

  • created thru surgery which is usually in the arms with the intention of connecting the artery and a vein directly
  • created for hemodialysis treatment or pathological process.
• Blood Sampling Device is used to avoid the use of needle sticks, reduce infections, and reduce wastage from line draws. 
• Heparin or Saline Lock "hep-lock,"

  • intravenous (IV) catheter attached to a stopcock or cap with diaphragm.
  • basic function is to provide access for administering medicine or drawing blood from the patient. 
• Intravenous (IV) Sites

  • a thin plastic tube or catheter inserted into a vein in the forearm to inject a volume of fluids into the bloodstream. 
  • The phlebotomist should avoid collecting blood from the arm with IV because the blood collected could be contaminated with IV fluid. 
• Central Vascular Access Devices (CVADs)

  • also known as indwelling lines
  • a tubing inserted to the main vein or artery used for blood collection, monitoring the patient's pressures, and administering medications and fluids.
• hree (3) types of CVADs

  • Central Venous catheter lines
  • implanted port
  • peripherally inserted central catheter.
• Adhesive allergy - a gauze should be placed over the site and should be removed after fifteen minutes.
• Antiseptic allergy - simply use a different antiseptic.
• Latex allergy - use a non-latex alternative for gloves, tourniquet and bandages.
• Excessive Bleeding

  • pressure should be applied to the site until the bleeding stops.
  • The attention of the authorized personnel should be called when it continues after five minutes.
• Fainting

  • If the patient is prone to it during venipuncture, they are asked to lie down during the procedure.
• Nausea and Vomiting

  • Discontinue the procedure until the patient feels better
  • A basin or wastebasket & a cold damp washcloth should be applied to the forehead.
• Pain

  • If the patient complains of extreme pain or numbness, remove the needle and apply ice to the site because this could indicate nerve involvement.
  • The phlebotomist needs to document the incident if the condition persists.
• Petechiae.   

  • this condition involves the appearance of small red or purple spots that look like rashes, which appear on the arm when tourniquet is applied
• Seizures/Convulsion

  • The blood draw should be discontinued immediately.
  • Hold pressure over the site but make sure that movement is not restricted.
• Hematoma Formation. A cold compress or ice pack maybe offered to help address the swelling.
• Some of the factors that trigger Hematoma are:

  • Excessive or blind probing
  • Size of the vein - too small
  • The needle penetration - all through the vein
  • Needle is not completely inserted
  • Tourniquet is still on when the needle was removed
• Iatrogenic Anemia

  • collect only the required specimen volume because if 10% of the blood volume is removed at once from the body, the patients could face a threat.
• Inadvertent Arterial Puncture

  This happens when blood is filling up the tube rapidly and there is a rapid formation of hematoma on the site
• Infection can be avoided by making sure that tapes or bandages are not opened ahead of time, needles are not preloaded into the tube holders, etc,
• Nerve Injuries  happen when there is improper site selection, rapid needle insertion, excessive redirection of the needle and blind probing. 
• Reflux of Anticoagulant  may cause adverse reaction because of the presence of tube additives, make sure to keep the arm of the patient in a downward position and the tube just below the venipuncture site.
• Vein Damage. could be avoided by following the proper technique and avoiding blind probing.
• SPECIMEN QUALITY

  1.Hemoconcentration 

  2.Hemolysis,

  3. Partially filled Tubes, or short draw

  4.Specimen Contamination

  5.Wrong or Expired Collection Tube 
• ensure that the following does not happen:

  1. Needle not inserted far enough
  2. Bevel partially out of skin
  3. Bevel partially into vein
  4. Bevel partially through vein
  5. Bevel completely through vein
  6. Bevel against vein wall
  7. Needle beside vein
  8. Undetermined position
• Collapsed Vein. The collapsed veins happens when there is a strong pressure in the vacuum of the tube or plunger, the tourniquet is too close to the site or it is too tight, or when the tourniquet was removed during the draw.