basic procedures in healthcare 1 (sol / vca81) topics: 7a) sampling of biological material –...

Basic procedures in healthcare 1 (SOL / VCA81)

TOPICS:7a) Sampling of biological material – principles, safety and health protection during work 7b) Characteristics of blood sampling7c) Blood sampling - arterial7d) Blood sampling - venous7e) Blood sampling - capillary7f) Types of blood tests

7a) Sampling of biological material

terms

the general principles of proper sampling of biological material

principles of safety and health protection during work when sampling of biological material

characteristics of blood sampling

Terms:

biological material – material of biological origin, i. e. derived from a human organism,

body fluids (blood, cerebrospinal fluid, gastric and duodenal juice),

secretions (of the skin and mucosal bearings, vaginal mucosa, punctate),

excreta (urine, faeces, vomit, sputum, sweat),

organ tissues,

pathology form of tissue.


Sampling of biological material, its transportation and laboratory processing is essential for proper diagnosis determination, early initiation of therapy and control of the effectiveness of the treatment.

biological materialsampling of biological material


The general principles of proper sampling of biological material:

to sample the material according to lab requirements,

to sample it into the labelled containers) (name, personal identification number, department, date and time, or an examination on STATIM),

to give a dispatch/requisition to each sampling,

to follow the requirements for transportation, to ensure it against destruction,

to record examination results,

to follow the principles of safety and health protection during work.


The general principles of proper sampling of biological material:

biological material is ALWAYS considered as a potentially infectious,

proper hands disinfection – before and after the samplingin individual patients + before we start with sampling,

we ALWAYS use the gloves,

we use disinfection after we take the gloves off,

we wash and disinfect hands immediately after a contamination of biological material,


we use a mask, protective shield in necessary cases,

it is necessary to prevent contamination of the outsideof the sample container with biological material,

we care aboutthe noninfectiousnessof the environment(ventilation, disinfection,cleaning).


7b) Biological material sampling – characteristics of blood sampling

It is examined the WHOLE BLOOD or PLASMA or SERUM

plasma – necessary to add anticoagulant solution

serum – sampling of coagulate blood serum is aspirated

coagulated blood is used for laboratory analysis, blood coagulates after the sampling, blood clot is separated

from blood serum, blood serum has to be hardened quickly to avoid

haemolysis distortion quick transportationto the laboratory.

7b) Biological material sampling – characteristics of blood sampling

anticoagulated blood sample container containing an anticoagulant means

The most commonly used anti-coagulating agents:

Wintrobe method (on the walls of the tube as white crystalsof oxalate),

heparin,

sodium citrate

K2 EDTA (ethylenediamine, tetracel salt – a thin filmon the walls of the tube).

7c) Blood sampling - arterial

indication

suitable sites for sampling

sample container

persons competent to arterial blood sampling


Sampling of arterial blood is most often performed as disposable puncture or a puncture from a central arterial catheter.

Indication:

examination of arterial blood for acid-base balance (ABB),

burn injuries

polytrauma / multiple trauma.


Suitable sites for sampling:

arteria radialis,

arteria brachialis,

arteria femoralis,

arteria dorsalis pedis.

The best are the arteries on the nondominant upper limb.

After sampling, we cover a site with sterile swab, we plaster it and compress.


Sample containers:

special sampling arterial microset,

syringes and needles.

syringes for arterial blood sampling syringes with needles


Persons competent to arterial blood sampling:

ONLY a physician when a nurse assists,

nurse specializing in anaesthesia, resuscitation, intensive care (ARIC).


Videos with arterial blood sampling procedure:

https://www.youtube.com/watch?v=UEVVUpz30RQ

https://www.youtube.com/watch?v=71LlfdW548U

7d) Blood sampling – venous

suitable sites for sampling

open method for blood sampling

closed method for blood sampling

tools

sampling containers

sampling procedures

sampling principles

the most common mistakes when sampling


Suitable sites for sampling:

veins in the parietal and temporal areas (infants, toddlers),

veins in the instep and ankle (in children),

v. mediana,

v. basilica,

v. cephalica,

back of the hand,forearm.


Open method for blood sampling:

using a needle and syringe,

using a needle, the blood let drip directly into the tube,

patients with weak veins and children,

less safe in terms of handlingand contact of medicalstaff with biological material.

open method for sampling


Closed method for blood sampling:

it enables accurate sampling,

using sampling systems (Vacuette-Vacutainer, Sarsted),

possibility of contamination of medical staff by biological material is minimized.

TOOL:

CLOSED SYSTEM OPEN SYSTEM

- disposable gloves - disposable gloves

- disinfection (Septoderm) - disinfection (Septoderm)

- tourniquet - tourniquet

- special needle - needle

- adapter (cap) - syringe

- vacuum tubes - blood sampling tubes (e. g., vacuum)

- vomit bowl - vomit bowl

- cellulose wadding squares, swab - cellulose wadding squares, swab

- adhesive plaster - adhesive plaster



Esmarch tourniquet

tools for venous blood sampling

needle with a cap for closedvenous blood sampling


disposable non-sterile gloves

disinfection of the skin

cellulose wadding squares


Sampling containers:

color-coded,

prepared for given kind of sampling (including anticoagulant agent),

according to the chosen sampling system.


Sampling procedure - the initial phase common to both methods:

completing the request form,

label tubes with identification label,

tools preparation,

checking the identity of the patient (ask him / her + through the identification label),

familiarization the patient with the performance,

positioning of the patient, choice of the proper limb,

putting cellulose wadding squares under the limb,

assess the quality of the venous system on upper limb, possibly lower limb,


hygienic hand disinfection,

applying a tourniquet,

the selection of a suitable vein for venepuncture (sight, palpation),

disinfection of skin, dry disinfectant,

put on the non-sterile disposable gloves (we do not feel the vein again),

alerts the patient to injection.

We continue according to the method of sampling (closed, open).


A) Using closed sampling method:

put the adapter to a sterile needle,

perform venepuncture, firm gripping of the adapter,pushing the tube on adapter,

removing the tourniquet,

filling tubes in the pressure balance („to the mark“),

removing the tube from the adapter,

gentle flipping tubes for mixing blood with anti-coagulant agent,

covering the injection site and the needle with a swab, gentle pressure to the swab with slow removing of the needle fromthe vein – carefully to the patient´s injury, using adhesive plaster, eventually compression of injection site.


B) Using open sampling method:

deploy the appropriate needle to the syringe,

perform venepuncture,

removing the tourniquet, when the first blood is filled in the syringe,

blood sucking gently with pulling the syringe plunger,

covering the injection site and the needle with a swab, gentle pressure to the swab with slow removing of the needle from the vein – carefully to the patient´s injury, using adhesive plaster, eventually compression of injection site,

perforate the cap of the tube with the needle in case of applicationof blood into vacuum tube and the tube is automatically filled.

an application of blood with gentle pressure through the needle.


Sampling procedure - the final phase common to both methods:

check the patient for the whole time of the procedure,

safe disposal of these materials begins immediately afterthe sampling (container for sharps and biological material), tools cleaning,

record of the procedure into the patient´s documentation,

ensure correct and timely transportation of blood and requisition in the laboratory.


closed method for blood sampling


venous blood sampling procedure


Videos with venous blood sampling procedure:

https://www.youtube.com/watch?v=nxky8rsezlU

https://www.youtube.com/watch?v=1Wv82hQCjrE

https://www.youtube.com/watch?v=u8yh5qjA_Yo


Sampling principles:

sampling is performed most often in the morning on empty stomach,

blood is sampled into a pre-labelled clean and dry containers,

sampling container must be labelled with an identification label,

we write a requisition to each sampled material,

if the patient is taking medications that can affect the outcome / effect, we record it to the requisition,

we ensure timely transport to the laboratory.


The most common mistakes when sampling:

haemolysis of blood when:

needle contamination using of wet or contaminated blood sampling system rapid injection of blood from the syringe into a test tube

and its foaming rapid shaking of tube with blood dripping of blood from the skin surface storage of blood in the fridge without former hardening

of serum storing the sampled blood on the radiator or the sun contamination of glass (blood sampling system)


The most common mistakes when sampling:

too long contraction of the limb with the tourniquet,

late delivery to the laboratory,

tubes exchange,

contaminated sampling.

7e) Blood sampling – capillary

indication

tools

sampling containers

sampling procedure

sampling principles


Indication:

blood sampling at blood glucose, blood count, acid-base balance examination.

glucometer

procedure for measuring blood glucose using a meter


Tools:

disposable gloves,

disinfection (Septoderm),

swabs,

needle, lancet...

sample container,

adhesive plaster.

lancets for capillary sampling

lancetsglucometer


Sample container:

capillary,

tube (kep)

sampling strips (e. g. into the meter).

microtube


capillary tube holder and capillary test strips into the glucometer


Sampling procedure:

it is performed by inserting from the side of fingertip onthe hands of adult, into the earlobe in children and footersin infants,

disinfection of the selected sites,

puncture,

wipe the first drop,

sampling,

treatment of injection site.


Sampling principles:

good blood circulation finger (heating, gentle rubbing),

perform puncture FROM THE SIDE of the fingertip,

collect blood WITHOUT AIR BUBBLES into the capillaries,

let the blood drip free.


Videos with the procedure of capillary blood into a glass capillary:

https://www.youtube.com/watch?v=ibU5PYOF2qg

https://www.youtube.com/watch?v=Wg-U7GlSGAk

7f) Types of blood tests

biochemical examination

haematological tests

microbiological testing

serological tests


Biochemical tests:

detecting the presence of inorganic and organic compounds in serum,

mineralogram (iontogram) – basic, extended,

renal complex hepatic complex,

proteins, enzymes,

lipids, glucose,

tumour markers, cardiac markers,

hormones, blood gases.


Haematological tests:

used to detect the properties of blood,

blood group and Rh factor, Quick test, APTT (activated partial thromboplastin time), detect of bleeding, blood count (CBC), erythrocyte sedimentation rate (ESR), LE cells, sample to fibrinogen, D-dimers.


erythrocyte sedimentation


Microbiological tests: detection of disease pathogens (bacteriology, mycology,

virology),

blood samplingfor haemo cultivation(haemo culture).


Serological tests: determining the level of certain antibodies, which arise as

a response to the action of microbes,

BWR – Bordet-Wasserman reaction (dg. of syphilis), VR – Widal reaction (dg. of typhoid fever), PBR – Paul-Bunnel reaction (dg. of infectious mononucleosis), EBV – Epstein-Barr virus (dg. of infectious mononucleosis), CMV – cytomegalovirus infection, chlamydia, mycoplasmas, rheumatoid tests - ASLO, LFR, CRP, HbsAg, lyme, Anti HIV.

Revision

What does the term biological material mean?

Which places on the human body is best suited for capillary blood sampling?

List the tools necessary for the sampling of venous blood.

Describe what is the Esmarch tourniquet for.

List the types of blood tests (including physiological range).

What principles must be followedfor the sampling of biological material?

How will you react if you puncturepatient´s vein during venous blood sampling?

List the indications for arterial blood sampling.

What is the procedure for sampling of venous / capillary blood?*

Reference:

LF3 – CUNI. Studijní materiály – Odběry biologického materiálu. [online]. 2015 [cit. 2015-04-05]. Dostupné z: http://www2.lf3.cuni.cz/opencms/export/sites/www.lf3.cuni.cz/cs/pracoviste/osetrovatelstvi/vyuka/studijni-materialy/CNPAZO42/studijni-materialy/Odbxry_krve.pdf

MIKŠOVÁ, Zdeňka, Marie FROŇKOVÁ a Marie ZAJÍČKOVÁ. Kapitoly z ošetřovatelské péče 2. Aktualiz. a dopl. vyd. Praha: Grada, 2006, 171 s. ISBN 8024714434.

SZSCB. Šablony. Odběry krve – obecně. [online]. 2015 [cit. 2015-04-05]. Dostupné z: http://www.szscb.wz.cz/info/projekty/sablony/os4/vy_32_inovace_os4-sk-08.pdf

VELKÝ LÉKAŘSKÝ SLOVNÍK [online]. 2015 [cit. 2015-04-05]. Dostupné z: www.lekarske.slovniky.cz

PICTURES * (if not specified differently): pinterest.com, google.com + using keywords („question“)

basic procedures in healthcare 1 (sol / vca81) topics: 7a) sampling of biological material –...

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