Phlebotomy CH 11 Special Collection
Phlebotomy CH 11 Special Collection P. 259 Arterial Blood Gases: (ABG's)
BRACHIAL AND FEMORAL ARTERY PUNCTURE SITES: ~The brachial artery is an alternative site for blood collection for ABG collections analysis. The brachial artery is in the cubital fossa of the arm. ~Another Choice, the Femoral artery, is the largest artery used in ABG collections. It is located in the groin area of the leg lateral (towards the sides of the body) to the femur. MODIFIED ALLEN TEST: To use the radial artery for blood collection for ABG analysis the HC provider must first perform a MODIFIED ALLEN TEST . 1. The HCW compresses both arteries w/ the index and middle fingers and the patient is asked to tightly clench his or her fist. 2. the patient is then asked to open his or her hand, and the healthcare provider releases the pressure on the ulnar artery 3. the hand should fills with blood within 5 to 10 seconds..if so the Allen Test is positive. If color does not return to the hand after 5-10 seconds the Allen test is negative test indicates the inability of ulna artery to supply blood to the hand adequately and shows a lack of collateral circulation
Phlebotomy CH 11 Special Collection P. 259 Donor Room Collection P. 280
COLLECTION OF CONOR'S BLOOD: ~The HCW in a donor room must operate under the supervision of a qualified, licensed physician. ~A donor should never be left alone ~Sometimes a patient must have the intentional removal of blood for treatment of a disorder. (therapeutic phlebotomy). ~The blood obtained through therapeutic bleeding may be used for homologous transfusion if the unit is deemed to be suitable by the director.
Phlebotomy CH 11 Special Collection P. 259 Blood Cultures P. 264
GLUCOSE TOLERANCE TEST : GTT Patients who have symptoms suggesting problems in carbohydrate metabolism, such as Diabetes mellitus, the 2-hour oral glucose tolerance test (OGTT orGTT) can be an effective diagnostic tool. 1. eat normal, balanced meals for at lest 3 days 2. Fast for 8-12 hours before the beginning of the test 3. Drink Water 4. Do Not drink unsweetened teas, coffee, or any other beverage during fasting or during the procedure. 5. Do not smoke, chew tobacco, or chew gum (including sugarless gum) during the fasting time or during the procedure, note this on the requisition form, because chewing gum may interfere with the rest results. ~Take initial blood specimen during fasting ~Then patient drinks (glucose) Dextrose (liquid drink called Glucola) 30, 60 & 120 minutes.
Phlebotomy CH 11 Special Collection P. 259 Glucose Monitoring P. 272
ON-Site lab testing to be obtained in various types of lab tests. ~The demand for POINT-OF-CARE-TESTING IS increasing because rapid turnaround of lab test results in necessary for prompt medical decisions making. ~ The other terms used for these direct lab services include: 1. Decentralized lab testing 2. On-site Testing 3. Bedside testing 4. Near patient testing 5. Patient-focused testing
Phlebotomy CH 11 Special Collection P. 259 Blood Cultures P. 264
POSSIBLE INTERFERING FACTOR ~The HC worker must be prepared to handle a situation when the patient becomes ill form drinking the glucose. ~If vomits and gets sick within 20 minutes of procedure discontinue and probably reschedule ~If vomits and gets sick later in the test lie patient down and complete the testing.
Phlebotomy CH 11 Special Collection P. 259 Blood Cultures P. 259
POSSIBLE INTERFERING FACTORS 1. Always perform Blood Culture collections first because needle can become contaminated and cause false positive results. 2. Do not scrape needle across skin as needled enters the venipuncture site this can contaminate the needle. 3. The anaerobic blood culture bottle must be inoculated first in all procedure except the butterfly assembly method , because injection of air into the anaerobic bottle can cause the death of some anaerobic microorganisms and result in a false-negative culture. 4. Some culture bottles contain resin beads that neutralize antibiotics already in the patient's blood specimen. If these vials are not gently mixed to neutralize the antibiotics in the blood, the antibiotics can inhibit bacterial growth and cause a false-negative blood culture results. 5. If using a tube holder/needle assembly for evacuated tubes, there is a possibility that media from the culture bottle might flow backward into the vein (reflux action). Therefore, most manufacturers recommend that the media collection bottles not be filled directly from a tube holder/needle assembly. the blood should be collected through a butterfly attached to a tube holder or directly into a syringe.
Phlebotomy CH 11 Special Collection P. 259 Postprandial Glucose Test P. 272
POSTPRANDIAL GLUCOSE TEST: The 2 hour postprandial (after meal) glucose test can be used to screen patients for diabetes, (including gestational diabetes), because glucose levels in serum specimens collected 2 hours after a meal are rarely elevated in normal patients. ~In contrast diabetic patients usually have increased values 2 hours after a meal.
Phlebotomy CH 11 Special Collection P. 259 Glucose Monitoring P. 276....CONTINUED
QULITY CONTROL IN POINT-OF-CARE TESTING AND DISINFECTING POCT ANALYZERS ~As described earlier, glucose monitoring instruments and instruments that measure other analyses should be monitored daily w/Quality Control Material. ~These values must also be monitored whenever a battery is changed or the mere is cleaned.
Phlebotomy CH 11 Special Collection P. 259 Arterial Blood Gases: (ABG's) ....CONTINUED
RADIAL ARTERY PUNTURE SITE: ~When an ABG analysis is ordered, the experienced HCW should palpate the areas of the forearm where the artery is typically close to the surface. ~The radial artery, located on the thumb side of the wrist is the artery most used for blood collection for ABG analysis.
Phlebotomy CH 11 Special Collection P. 259 Hematocrit, Hemoglobin and other Hematology parameters P. 279
The HEMATOCRIT (Asses circulatory system; it describes the concentration of RBC's and therefore provides a indirect measure of the oxygen-carying capacity of the blood) represents the volume of circulating blood that is occupied by red blood cells RBS's & is expressed as a percentage. ~Determining the patients HEMOGLOBIN LEVEL (the molecules that carry oxygen and Carbon Dioxide in the RBS"s) is another test to aid in the diagnosis and evaluation of anemia and other blood abnormalities.
Phlebotomy CH 11 Special Collection P. 259 Blood Cultures P. 264
The health care provider must initial identification labels, indicate the time and date of collection on the labels, indicate site of collection (Right Arm, Left Arm) and attached a label to each vial or tube. Clinical Alert: ~For any of the blood collection procedures, the venipuncture site must not be re-palpated after the venipuncture site is prepared for blood collection. ~Relocating the vein by re-palpation after sterilization recontaminates the site. ~Make mental note of the vein's location in relation to skin features such as amole, crease, freckles, and so on. ~If you re-palpate, do not palpate at the actual venipuncture site.
Phlebotomy CH 11 Special Collection P. 259 Cannulas and Fistulas P. 280
~ A CANNULA is a tubular instrument that is used in patients w/ kidney disease to gain access to venous blood for dialysis or blood collection. ~SPECIALLY TRAINED PERSONNEL MAY only collect in this procedure. ~A FITULA is an artificial shunt in which the vein and artery have been fused through surgery. It is a permanent connection tube located in the arm of the patients under going kidney dialysis.
Phlebotomy CH 11 Special Collection P. 259 Blood Cultures P. 259 CONTINUED
~Do NOT use in-dewelling catheter collections for blood cultures because of high contamination results. ~Important differences in a blood culture procedure related to the following: 1. The HCW must explain the procedure in greater detail to the patient 2. The puncture site must be decontaminated so that it is sterile. 3. The type of collection tubes used must contain culture media that enable bacteria to grow under laboratory conditions. 4. The timing and number of blood cultures obtained must be clearly indicated, as well as, the location (Right or left arm) of the venipuncture.
Phlebotomy CH 11 Special Collection P. 259 Blood Cultures P. 259
~FEVERS OF UNKNOWN ORIGINS (FUO):Blood cultures are often collected from patients who have Fevers Of Unknown Origins (FUO) ~BACTEREMIA: Sometimes during the course of bacterial infection in one location of the body bacteremia (presence of bacteria in the blood) or ~SEPTICEMIA: (Presence of pathogens in the circulating blood stream, sometimes called blood poisoning) ~Septicemia is a major cause of death in the U.S. ~Blood cultures aid in identifying the specific bacrial organism causing the infection. ~Venipuncture is the method used for collecting blood specimens for blood cultures
Phlebotomy CH 11 Special Collection P. 259 Donor Room Collection P. 280
~Properly trained HCW providers may be employed in a regional blood center or a hospital blood donor center to screen and collect blood form donors. ~Only an experienced, properly trained HCW or technologist should be considered for this function, because a phical , emotional or traumatic experience may keep a donor from volunteering in the future. ~ need to be at least 110lbs or many banks will not accept individual ~Temp must not exceed 99.5F ~Lower Temps than normal are usually of no significance ~But repeat temp to verify the low temp ~ Pulse at least 50-100 beats per minute/Taken for at lest 15 sec. ~ Blood Pressure should not be more than 180/systolic & diastolic/100 or less ....should have them see their physician ~No skin lesions, piercings or tattoos for over 12 months. ~Good General appearance ~Hematocrit or Hemoglobin values: must be no less 38% for Hematocrit and 12.5 g/dL for hemoglobin...A finger stick is commonly used
Phlebotomy CH 11 Special Collection P. 259 Blood Coagulation Monitoring P. 276
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Phlebotomy CH 11 Special Collection P. 259 Urine Collections P. 288
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Phlebotomy CH 11 Special Collection P. 259 Arterial Blood Gases: (ABG's)
Arterial Blood Gases: (ABG's) provide useful information about the reparatory status and the acid-based balance of patients w/pulmonary (lung) disease or disorders.
