Chapter 9 and 10 Case Studies

What complications might Charles expect and how should he prepare for them?

Because the patient appears ill, she should be asked to lie down to prevent her from fainting during specimen collection. An emesis basin or wastebasket should be close at hand in case she vomits.

Why did blood spurt into the tube and then stop?

Blood most likely spurted into the tube because althoughSara thought the needle was in the vein, it may have been only partially in the vein, with a tiny portion of it sticking out of the skin. Therefore the tube quickly lost vacuum.

Casey forgot to put something important on the labels of the micro tubes. What was it and why is that a problem?

Casey forgot to write on the labels that the microtubes contain venous blood. That is a problem because without that information it will be assumed that the specimens were collected by capillary puncture.

How to Charles go about selecting the blood collection site?

Charles should check the antecubital area of the right arm first, paying particular attention to the area of the cephalic vein if the median cubital veins not palpable. If not suitable vein is found, he should check for a hand vein on the right arm, followed by veins on the right dorsal wrist and forearm. He should never consider using veins on the underside (ventral or palmar area) of the wrist or forearm.

What options does Charles have if he is unable to collect a proper venipuncture site?

If Charles is unable to find a proper venipuncture site, he should consider capillary puncture. Both the CBC and glucose specimens can be easily collected by capillary puncture. The site will have to be warmed to enhance blood flow because the patient may be dehydrated.

What factors may have contributed to the specimen collection difficulties?

Improper direction of puncture and the presence of alcohol residue may have contributed to the blood running down the finger instead of forming drops, making it hard to collect the specimen. The phlebotomist's inexperience with children may have contributed to the Child being uncooperative. In addition, if the phlebotomist had been more experienced with capillary puncture in children, he may have held the child's hand differently and prevented the child from pulling away.

What most likely caused the hemolysis?

It appears the the phlebotomist started to collect the specimen without wiping away the first drop of blood. Consequently the hemolysis may have been caused by the alcohol residue. Trying to collect the specimen as it ran down the finger may have resulted in scraping the blood from the skin, which can also cause hemolysis n the specimen.

What physiological variables may be associated with the collection of the specimen and how should they be dealt with?

Physiological variables associated with this collection site include the following: the patient is ill and may be dehydrated from vomiting, she is overweight, she has had a mastectomy on the left side, and she is normally a difficult draw. Charles will be limited to drawing from the right arm. He will most likely need to draw the specimen using a butterfly and and the smallest tubes available. He should check the cephalic vein if he does not find another suitable antecubital vein. He may have to draw from a vein in the right hand, and he may have to warm the site to enhance blood flow. Because it is a physician office laboratory, he should check with the patient's physician to see if it is advisable to offer the patient water, because she is probably dehydrated. Dehydration would make it even more difficult to find a vein.

What can Sarah do to correct the problem?

Sara must position the needle in the vein, making certain that no part of the needle is out of the skin; then she must replace the tube with a new one.

One of the specimens is compromise even if the problem addressed by the first question had not happened. It might be compromised in another way also. Which specimen is it and describe why it is compromise for certain, and the second way that it also might be compromised.

The CBC is compromised because the tube was not filled to the required level. Excess anticoagulant in an undefiled microtube can negatively affect test results. The delay in filling and mixing the EDTA tube could also lead to micro clots that would make the specimen unsuitable for testing.

What clues are there to determine what the problem is?

The hissing sound and the fact that the tube no longer filled with blood even after the needle was repositioned are clues that the tube has lost vacuum.

How might the circumstances of collection have contributed to the platelet clumping in the specimen?

The phlebotomist tried to collect the specimen as it was running down the finger. A scooping or scraping motion during collection may have activated the platelets and caused them to clump. In addition, because the child was uncooperative, the specimen was not collected and mixed quickly, which may also have contributed to platelet clumping.

What effect that his forgetfulnessHabit when the results of the electrolytes and because I reported? What is her reason for your answer?

The results could be interpreted incorrectly because the concentration of glucose and potassium are higher in capillary blood than venous blood.