Med A 220 Ppt Doc

• 1. Med A 220 Phlebotomy
  Venipuncture
  

2. Phlebotomy
What does it mean?
Process of collecting blood
Dates back to ancient Egypt
Bloodletting-bad blood
Greek translation
Phlebos- vein
Tome incision
3. Why collect blood?
Diagnosis and treatment of disease
Therapeutic purposes
Blood donation
4. Phlebotomist
One who is trained in performing phlebotomy
5. Phlebotomists Role
Perform venipuncture accurately and efficiently
Reliable test results
Provide quality care
Patient safety and confidentiality
Phlebotomist safety (PPE)
6. Circulatory System
Knowledge of the anatomy and physiology important for safe venipuncture
Blood forms in the bone marrow
Blood transports oxygen and nutrients throughout the body and removes carbon dioxide
Capillaries connect arteries to veins
7. Circulatory System ContdArteries and Veins
Arteries
Carry oxygenated blood away from the heart
Pulse
Thick walls
No Valves
Veins
Carry deoxygenated blood to the heart
No pulse
Thin elastic walls
Valves
8. More Circulatory Facts
Our bodies contain approximately 6 liters of blood
45%formed elements (erythrocytes, leukocytes,and Thrombocytes)
55%liquid plasma (a fluid allowing blood cells, electrolytes, proteins etc to travel the body via blood vessels).
9. Important Terms
Fibrinogen substance in blood Converted by the blood clotting process to fibrin
Fibrin- sticky web like substance traps the formed elements-result is a blood clot
Serum- clear liquid portion of blood extracted from the blood clot used for many tests
10. Important Terms
Centrifuge- machine which spins blood separating the RBC from the serum
Anticoagulant-used to prevent blood from clotting. Found in certain blood tubes
Buffy coat-layer separating plasma from RB
11. Serum Blood Collection
Diagnostic tests are most commonly performed on Serum, plasma, and whole blood
Serum tests use a serum separator tube containing thixotropic gel
Invert tube after draw in order to activate clotting
Tube must be centrifuged after clot has formed
12. Plasma and Whole Blood
Plasma and whole blood
Tube must be invertedafter drawing to mix additives
Tube must be centrifuged
Certain Serum, Plasma, and Whole blood specimens will require special treatment and/or transport to laboratory.
13. Phlebotomy Sites
Order of Draw by sites
Arm-Antecubital Space includes
Median cubital
Cephalic
Basilic
Veins in hand
Veins in feet
14. Preferred Sites in the arm
15. Arteries of Arm
Note locations of arteries in the arm. You DO NOT want to draw from an artery
Brachial
Radial
Ulnar
How can you distinguish an artery from a vein?
16. Venipuncture Methods
There are three main methods of drawing blood
Syringe
Vacuum Tube
Butterfly
17. Evacuated Tube Method
This method includes:
Vacutainer tube
Adapter
Double-pointed Needle
Features of this method are:
Closed system - needle stick risk low
Vacuum draws blood inside the tube
Safety needles meet OSHA guidelines
18. Equipment/Supplies Needed
Physician order and Lab requisition form
Pen black ink
Appropriate PPE (gloves, gown, goggles)
Needle holder and Needle (varying sizes)
Tubes varying sizes and types used
19. More Equipment/Supplies
Tourniquet or blood pressure cuff
Alcohol or Betadine
Cotton balls or gauze-preferred
Bandages or tape
Note: always ask patient about allergies
20. A Specimen Collection Tray is a practical way to carry all necessary supplies
21. Order of draw
Why? Prevent carryover or contamination - Order may vary between laboratories.
Basic order:
Sterile- sterile specimens
Light blue-sodium citrate
Red or plain tubes no additives or gel
SST Serum separator tube (Red/Gray, Yellow)
Green heparin
Lavender-EDTA
Gray oxalate-fluoride
22. A phlebotomist needs these skills

• Social

23. Technical 24. AdministrativeButThe most important skill is:
25. Good Therapeutic Communication
People dont like to have their blood drawn
Use your therapeutic communication skills to:
Put your patient at ease show confidence
Assess their comfort level
Ask them about past experiences
26. Preparing the patient
Identify yourself and explain the procedure
Remember your bedside manner
Properly Identify your patient ask them to:
State their name
For non-English speaking photo ID
Note fasting or non-fasting
27. Preparing to draw
Complete lab requisition and prepare labels
Organize equipment and supplies
Have spare tubes available
28. Remember to
Wash your hands
29. Preparing contd
Do Not draw from a resistant patient
Do Not draw if you are not comfortable
Uncooperative children must receive special care and be restrained for safety
Note any allergies to latex, alcohol, or tape
30. The Draw
Position your patient for safety:
sit
lie down
(note past history of fainting or loss of consciousness)
Select the appropriate site and vein free of:
Scars
Hematomas
A Pulse
31. The Tourniquet
To prevent inaccurate blood test results-do not leave on longer than one minute
Tourniquet may be applied over clothing for patient comfort
Remove tourniquet when blood flow is achieved or prior to inserting last tube
Always remove tourniquet prior to removing needle.
32. Proper completion of draw
Remove tourniquet
Remove needle and apply safety device whileApplying pressure to site (patient can assist)
Bandage appropriately
Tend to the safety of your patient
Label specimen tubes in front of patient
33. Important Information
If you havent succeeded in getting blood after 2 tries ask someone else to try
If no blood appears after inserting needle-pull needle back or change position before withdrawing
Tubes must be filled to appropriate levels for accuratetest results
34. Factors Affecting Lab Results
Blood Alcohol-elevateresults
Diurnal rhythm-RX or daily activity level
Exercise-runners anemia, change results
Fasting-inaccurate results
Hemolysis-destroys RBCs
Heparin-incorrect use interferes with results
Stress-Increase in WBCs
Tourniquet on too long-dilution hemoconcentration
35. Challenging Patients
Pediatric
The child, parents or guardians
Approach-explain get down to their level
Resistant-restraints ?
Geriatric
Physical-skin, hearing or vision impaired
Effects of disease-stroke, arthritis, Parkinsons tremors,
Dementia-Alzheimer's
Safety issues-wheelchairs, balance
36. More Challenges
Dialysis or Cancer patients -fistulas and shunts
(AV-arteriovenous-permanent access for dialysis)
Long-Term Care patients, Home Care, or Hospice Patients
Traveling phlebotomists
37. Problem Sites
Burns, Scars, Tattoos
Damaged Veins (sclerosed-thrombosed)
Edema-swelling due to abnormal accumulation of fluid
Hematoma-swelling or mass of blood
Mastectomy-caution lymph node removal
Obesity
38. Complications or Conditions
Allergies-adhesive, antiseptic, latex
Excessive bleeding due to medications, hemophilia
Fainting
Nausea and vomiting
Pain while drawing-what is normal what is NOT-stopping the draw
Seizures/Convulsions-stop draw immediately-get help
39. Thanks to:
Clinical Medical Assisting: A professional, Field Smart Approach to the Workplace, Textbook and Workbook
Phlebotomy Essentials 4th Edition
Laurel Lunden, BS CMA (AAMA)January 2010