Download - Blood Specimen Extraction
-
8/6/2019 Blood Specimen Extraction
1/33
DEMONSTRATION
OF BLOOD
SPECIMEN
EXTRACTION
-
8/6/2019 Blood Specimen Extraction
2/33
INTRODUCTION :
BLOOD SPECIMEN COLLECTION IS
PERFORMED ROUTINELY TO OBTAIN BLOOD
FOR LABORATORY TESTING.BLOOD CAN BEOBTAIN FROM VENOUS ACCESS DEVICES
AND SOMETIMES BY FINGERSTICK.BLOOD IS
MOST PREQUENTLY OBTAINED VIAPERIPHERAL VEIN
PUNCTURE.(VENIPUNCTURE)
-
8/6/2019 Blood Specimen Extraction
3/33
DEFINITION OF TERMS:
SPECIMEN COLLECTION
To obtain a sample of a substance ormaterial for examination or study like
a urine specimen, a tissue specimen
or stool specimen.
-
8/6/2019 Blood Specimen Extraction
4/33
DEFINITION OF TERMS:
Venipuncture
is the process of obtaining intravenous
access for the purpose ofintravenous therapyor obtaining a sample ofvenous blood. It is one
of the most routinely performed invasive
procedures and is carried out for two reasons,
to obtain blood for diagnostic purposes or to
monitor levels of blood components.
-
8/6/2019 Blood Specimen Extraction
5/33
DEFINITION OF TERMS:
Hemolysis
The destruction ofred blood cells which leads to
the release ofhemoglobin from within the red blood
cells into the blood plasma.
Hemoconcentration
An increase in the number of red blood cellsresulting from either a decrease in plasma volume or
increased production of erythrocytes.
-
8/6/2019 Blood Specimen Extraction
6/33
DEFINITION OF TERMS:
Phlebotomy
is the act of drawing or removing blood from
the circulatory system through a cut (incision)or puncture in order to obtain a sample for
analysis and diagnosis. Phlebotomy is also
done as part of the patient's treatment for
certain blood disorders.
-
8/6/2019 Blood Specimen Extraction
7/33
OBJECTIVES:
To ensure proper guidelines in collecting
blood specimens by choosing preferred
venous access sites and its factors.
To discuss proper labelling procedures and
completion of laboratory requisitions.
To identify proper technique in withdrawing
blood samples by maintaining standards ofnursing practice.
-
8/6/2019 Blood Specimen Extraction
8/33
SITES OF BLOOD COLLECTION:
ANTECUBITAL FOSSA ANATOMY
-
8/6/2019 Blood Specimen Extraction
9/33
-
8/6/2019 Blood Specimen Extraction
10/33
MATERIALS AND
EQUIPMENTS PROCEDURE TROLLEY OR TRAY
CLEAN TRAY CONTAINING:
TOURNIQUET
CLEAN GLOVES
SYRINGES OR VACUTAINERS
70%ALCOHOL OR ANTISEPTIC SOLUTION
21-25 GAUGE NEEDLE OR SCALP VEIN NEEDLE
BLOOD COLLECTION TUBES OR TUBES NEEDED FORTHE SPECIFIC INVESTIGATIONS.
-
8/6/2019 Blood Specimen Extraction
11/33
-
8/6/2019 Blood Specimen Extraction
12/33
TYPES OF BLOOD COLLECTION
TUBES
-
8/6/2019 Blood Specimen Extraction
13/33
BLUE TUBE
PT Tube: The blue 3.2%
sodium citrate tubes are
mainly used in the test of
coagulation mechanism, with
the advantages of high
accuracy in mixing rate of
blood and anticoagulant.
the amount of blood1.8ml
and 4ml
-
8/6/2019 Blood Specimen Extraction
14/33
RED TUBE/ PLAIN TUBE
Additive NONE
Tube Type Glass 13* 75
mm
Draw Amount 3-5 ml
Laboratory Use For serum
determination in chemistry,
serology and blood banktesting
-
8/6/2019 Blood Specimen Extraction
15/33
VIOLET TUBE/ EDTA TUBE
Use for hematology and
blood bank testing.
Additives: EDTA( Ethylene
Dromine Tetro Acetic Acid
Mode of Reaction: Forms
Calcium salt to remove
calcilom.
Requires Full Drawn: Invert
8 times to prevent clotting
platelet dumping.
-
8/6/2019 Blood Specimen Extraction
16/33
ESR TUBE
The black 3.8% sodium
citrate tubes are used for
the collection and
transport of venousblood for blood
sedimentations rate
testing.
the amount of blood
1.6ml and 2.4ml
-
8/6/2019 Blood Specimen Extraction
17/33
BLOOD CULTURE BOTTLES
Blood culture bottles - used to
collect blood from patients
suspected of having septicemia or
bacterecemia.
NOTE: Tubes with additives must
be thoroughly mixed. Clotting oremerse test result may be
obtained when the blood is not
thoroughly mixed with the
additive.
Amount of blood: 3ml each bottle
Additives: Broth mixture
Blood can be stored for 3days
Mode of Action: Preserves viabilityof microorganism
-
8/6/2019 Blood Specimen Extraction
18/33
POLICY :
1. Peripheral vein blood collection may be performed by aqualified, trained staff nurse, with a written order of a physician.
2. Any staff nurse certified in the procedure may perform acentral venous stick to obtain a blood specimen on a writtenorder of a physician.
3. Proper hand washing and gloving should be observe.
4. All phlebotomy attempt should be recorded. This record shallreflect type of phlebotomy modality, type of specimen drawn,time drawn and how patient tolerated the procedure.
-
8/6/2019 Blood Specimen Extraction
19/33
VERIFY ORDER FOR BLOOD
EXTRACTION.
IDENTIFY THE PATIENT BY
CALLINGHIS NAME ANDCHECKING HIS ID BAND.
EXPLAIN THE PROCEDURE TO THE
PATIENT OR TO THE PARENTS FOR
SMALL BABIES.
ARRANGE ALL MATERIALS
NEEDED.
BLOOD EXTRACTION MUST BE
ORDERED BY A PHYSICIAN PRIOR TO
IMPLEMENTATION OF THIS
PROCEDURE.
CONFIRMS CLIENT IDENTITY.
TO PROVIDE KNOWLEDGE AND HELPS
ALLEVIATE ANXIETY ABOUT THEPROCEDURE.
FOR ACCESSIBILITY OF MATERIALS
NEEDED.
PROCEDURE RATIONALE
-
8/6/2019 Blood Specimen Extraction
20/33
TO ELIMINATEMICROORGANISM.
TO PROVIDE COMFORT TOTHE PATIENT AND TO BEABLE TO ASSESS
PROPERLY FOR TH
E SITEOF EXTRACTION.
PROCEDURE RATIONALE
-
8/6/2019 Blood Specimen Extraction
21/33
INSTRUCT THE PATIENT TO MAKE AFIST WITHOUT PUMPING THE HAND
THEN SELECT THE VENEPUNCTURESITE.TIE TOURNIQUET AFTER VEINSELECTION 3-4 INCHES ABOVE.
CLEAN THE VENIPUNCTURE SITEWITH ALCOHOL SWAB.
Dont wipe off the antiseptic
solution with alcohol. Wipe in a circular motion,
spiraling outward from the site.
Grasp the patients arm firmlyusing your thumb to draw the skinand anchor the vein. The needleshould form a 15-30 degree
angle with the surface of the arm,gently insert the needle throughthe skin and into the lumen of thevein.
Pull the plunger of syringe gently
VEIN MUST BE VISIBLE OR PALPABLEBEFORE VENIPUNCTURE ISATTEMPTED.THE TOURNIQUET SHOULDNOT BE APPLIED TOO TIGHTLY SO ITDOES NOT INTERFERE WITH ARTERIALBLOOD FLOW.
TO REDUCE THE NUMBER OF SKINMIROORGANISMS AND MINIMIZE THERISK FOR INFECTION.
PROCEDURE RATIONALE
-
8/6/2019 Blood Specimen Extraction
22/33
RATIONALE
REMOVE THE TOURNIQUET AS SOON ASTHE BLOOD FLOWS ADEQUATELY.
AFTER SAMPLE HAS BEEN EXTRACTED,REMOVED THE NEEDLE FROM THE VEINGENTLY, THEN APPLY COTTON/GAUZE ANDGENTLE PRESSURE TO THE PUNCTUREDSITE UNTIL BLEEDING STOPS AND APPLY
ADHESIVE BANDAGE.
DISPOSE CONTAMINATED MATERIALS/SUPPLIES IN DESIGNATED CONTAINER.
THE SAMLPES ARE TRANSFERRED INPROPER LABORATORY RECEPTACLELABELED WITH PATIENTS NAME DATE,TIME THE BLOOD COLLECTEDDEPT./SECTION AND MEDICAL RECORDNUMBER BEING CAREFUL TO AVOIDFOAMING.
TO AVOID FORMATION OFHEMATOMA.
TO PREVENT CROSSCONTAMINATION.
PROCEDURE
-
8/6/2019 Blood Specimen Extraction
23/33
PROCEDURE
RATIONALE
REASSESS VENIPUNCTURE SITE FOROOZING, BLEEDING OR EVIDENCE OFHEMATOMA.
RECORD THE DATE AND TIME OFBLOOD SAMPLE COLLECTION, THE
NAME OF THE TEST, THE AMOUNT OFTHE BLOOD COLLECTED AND ANYADVERSE REACTION TO THEPROCEDURE. THE AMOUNT OFBLOOD WITHDRAWN MUST BERECORDED IN THE INTAKE ANDOUTPUT SHEET BEFORE THEPURPOSE OF MONITORING BLOOD
VOLUME DEPLETION.THE DOCTORMUST BE NOTIFIED FORCONSIDERATION OF BLOODREPLACEMENT.
The purpose of recordingin the intake and outputsheet is to monitor theblood volume depletion.
-
8/6/2019 Blood Specimen Extraction
24/33
PROCEDURE RATIONALE
ONCE COLLECTED, SENT
THE SAMPLE TO
LABORATORYACCOMPANIED BY
APPROPRIATE LABORATORY
REQUEST.
CLEAN AND ARRANGE THE
TROLLEY RETURN TO
PROPER PLACE.
To avoid hemolytic
reaction.
For the preparation forthe next extraction.
-
8/6/2019 Blood Specimen Extraction
25/33
COMPLICATIONS:
THOUGHVENIPUNCTURE IS ROUTINELY DONE AND
RELATIVELY SAFE,THERE ARE FEW COMPLICATION
THAT CAN OCCUR,INCLUDING HEMATOMA
FORMATION,HEMOLYSIS AND
HEMOCONCENTRATION.IN ADDITION,EXCESSIVE
BLEEDING CAN OCCUR AND MANY PATIENTS HAVE
BEEN KNOWN TO FAINT DURING THE PROCEDURE.
-
8/6/2019 Blood Specimen Extraction
26/33
ADDITIONAL CONSIDERATIONS
TO PREVENT HEMATOMA
PUNCTURE ONLY THE UPPERMOST WALL OF THE VEIN.
REMOVE THE TOURNIQUET BEFORE REMOVING THE NEEDLE.
USE THE MAJOR SUPERFICIAL VEINS.
MAKE SURE THE NEEDLE FULLY PENETRATES THE UPPERMOST WALL OF
THE VEIN. PARTIAL PENETRATION MAY ALLOW BLOOD TO LEAK INTO THE
SOFT TISSUE SURROUNDING THE VEIN.
APPLY PRESSURE TO THE VENIPUNCTURE SITE.
-
8/6/2019 Blood Specimen Extraction
27/33
TO PREVENT HEMOLYSIS
MIX TUBES WITH ANTICOAGULANT ADDITIVES GENTLY 5-50 SECONDS.
AVOID DRAWING BLOOD FROM A HEMATOMA.
AVOID DRAWING THE PLUNGER BACK TOO FORCEFULLY, IF USING A NEEDLE
AND A SYRINGE, TO AVOID FROTHING OF THE SAMPLE.
MAKE SURE THE VENIPUNCTURE SITE IS DRY.
AVOID A PROBBING, TRAUMATIC VENIPUNCTURE.
TO AVOID HEMOCONCENTRATION
PROLONGED TOURNIQUET APPLICATION, NO MORE THAN 2 MINUTES. THE
HYDROSTATIC PRESSURE CAUSES SOME WATER AND FILTERABLE
ELEMENTS TO LEAVE THE EXTRACELLULAR SPACE.
MASSAGING, SQUEEZING, OR PROBING SITE.
LONG TERM IV THERAPY
SCLEROSED OR OCCLUDED VEINS
-
8/6/2019 Blood Specimen Extraction
28/33
PRECAUTION:
ALTHOUGH OBTAINING BLOOD SPECIMEN IS A ROUTINE FUNCTION,IT IS
ONE OF THE RISK PROCEDURE NURSES PERFORM.TO INCREASE THE
SAFETY OF BLOOD COLLECTION THIS PRECAUTION SHOULD BE FOLLOWED:
DO NOT USE A NEEDLE WHEN WITHDRAWING BLOOD FROM A PERIPHERAL
INTRAVENOUS LINE OR FROM A CENTRAL VENOUS ACCESS DEVICE.USING A
NEEDLELESS SYSTEM ALLOWS THE BLOOD TO BE DRAWN DIRECTLY INTO
SPECIMEN CONTAINERS.
DO NOT USE AN EXPOSED NEEDLE TO INJECT BLOOD IN SPECIMEN CONTAINERS OR
VACUUM TUBES.
-
8/6/2019 Blood Specimen Extraction
29/33
TO PROTECT YOURSELF AND
PATIENT PRACTICE UNIVERSAL PRECAUTION
WEAR GLOVES, GOWN WHEN HANDLING BLOOD AND BODY
FLUIDS.
CHANGE GLOVES AFTER EACH PATIENT OR WHEN
CONTAMINATED.
WASHHANDS FREQUENTLY.
DISPOSE ITEMS IN APPROPRIATE CONTAINERS.
PLACE BLOOD COLLECTION EQUIPMENT AWAY FROM
PATIENTS ESPECIALLY TO CHILDREN AND PSYCHIATRIC
PATIENTS.
-
8/6/2019 Blood Specimen Extraction
30/33
NURSING IMPLICATIONS
THE NURSE SHOULD ASSESS THE PATIENT PRIOR TO OBTAINING BLOOD
SPECIMENS NOTING FACTORS THAT MAY AFFECT TEST RESULTS INCLUDINGMEDICATIONS, PREGNANCY, AGE, AND SEX.
MAKE SURE THAT THE PATIENT HAS FOLLOWED ANY SPECIAL
INSTRUCTIONS WHICH COULD INCLUDE FASTING FOR A NUMBER OF
HOURS OR TAKING A MEDICATION AT A CERTAIN TIME.
ALTHOUGHMOST BLOOD WORK DOES NOT REQUIRE ANY SPECIALCONSENT SOME TESTS, IF NEEDED OBTAIN CONSENT PRIOR TO
COLLECTING THE SPECIMEN.
THERE ARE FOUR PATIENT RIGHTS THE NURSE SHOULD CONSIDER WHEN
COLLECTING BLOOD SPECIMENS;
1. RIGHT PATIENT2. RIGHT METHOD
3. RIGHT TIME
4. RIGHT SPECIMEN
-
8/6/2019 Blood Specimen Extraction
31/33
NURSING IMPLICATIONS
AVOID DRAWING BLOOD FROM AN ARM AFFECTED BY A STROKE
OR NEUROLOGICAL INJURY THAT HAS RESULTED IN A LOSS OF
SENSATION.
AVOID AREAS WITH EXTENSIVE SCARRING.
ATTEMPT TO COLLECT THE BLOOD SPECIMEN FROM THE
OPPOSITE ARM IF PATIENT IS RECEIVING INTRAVENOUS FLUIDS. DO NOT USE A SITE THAT IS SWOLLEN, AFFECTED BY CERTAIN
SKIN CONDITIONS LIKE ECZEMA OR IS INFECTED.
USE THE RIGHT SPECIMEN TUBES.
TRY TO USE PEDIATRIC TUBES WH
EN PATIENTH
AS FRAGILEVEINS.
SEND THE SPECIMEN TO THE LABORATORY AS SOON AS
POSSIBLE.
-
8/6/2019 Blood Specimen Extraction
32/33
HEALTH EDUCATION:
Blood specimen collection is performed primarily by nurses.The physician orders the laboratory test. The nurse is
responsible for instructing the patient regarding the procedure
and assessing the patients response, in addition the nurse
should be knowledgeable about the implication of thelaboratory result may have on patient care.
1. The nurse should assess the patient, noting factors that
may affect test result, make sure the patient has followed any
special instruction, which could include fasting for a number of
hours or taking a medication for a certain time.
2. Patient should also be assessed for their knowledge level
regarding the test ordered, instruct patient as needed about
the test and the procedure itself.
3. Make sure the specimen collected in the specimen ordered.
-
8/6/2019 Blood Specimen Extraction
33/33
4. Always verify the patients identification before
drawing a blood specimen, the person drawing the
specimen should also label the container it is drawn
into.5. Always follow universal precautions when
performing a venipuncture, to help reduce the risk of
exposure of the health care professionals skin or
mucous membranes to infectious materials.Itincludes the use of protective barriers, such as
gloves, mask or gowns or eye shield if needed.