SESSION 3.pptx stunent management notice

medicine

1. Collection of Blood Samples Prepared by Madam Emmanuela

2. Learning Objectives By the end of this session, you are expected to be able to: Define phlebotomy Identify the upper limb sites for venipuncture Identify different instruments for common laboratory procedure’s blood collection Describe the procedure for collection of blood sample Describe proper disposal of sharps and other infectious materials after the procedure Explain the handling techniques of the specimen after collection

3. Definition of Terms Phlebotomy: Is the procedure of opening the blood vessel and drawing blood from it. It comes from two Greek words: Phlebo = veins tom y = cutting Blood is commonly collected from: The veins (venous samples ) Capillaries (capillary samples by a finger prick ) Arteries (arterial samples; not routinely done except for specialized investigations )

4. Figure 1: Superficial Veins of the Upper Limb 1. Median Cubital Vein: A superficial vein, most commonly used for venepuncture . It lies over the cubital fossa and serves as an anastomosis between the cephalic and basilic vein. 2. Cephalic Vein: Shown in both the forearm and arm, it can be followed where it empties into the axillary vein. 3. Basilic Vein: Seen in the forearm and arm, it dives to join the brachial. The best area for venepuncture is antecubital fossa area.

5. Preparations for Taking a Venous Blood Sample Health worker preparation It is important for the health worker to be adequately prepared before clients are called in the phlebotomy room. This includes the assembly of all equipment and supplies necessary for the procedure Educating the patient. It is important to put the patient at ease when drawing blood. The providers should: Explain that the supplies are sterile and have never been used on another person Describe the procedure and how much time is needed for the results to be available Assure them that the procedure is safe and results of the test are confidential

6. Different instruments for common laboratory procedure’s blood collection Specimen containers Specific container depends on which test will be done Correct specimen bottle can be identified by the colour of its top or the label they carry Vacutainer tubes identified by the label on it Tourniquet Needles and syringes Small bore needles

7. Cont……………………………….. Gloves Aprons or laboratory coats Alcohol swabs Cotton Gauze/Wool Hand towels (Preferably disposable) Waste disposal containers

8. Cont…………………………….. Sharps bin (For disposal of sharps) Infectious waste bin (For disposal of non sharp infectious materials) Non infectious bean (For disposal of non infectious materials Marker pen for marking or labeling of specimen and forms Disinfectant (e.g. Jik , Clorox) Antiseptic for hand washing Bandages or plasters

9. Collection of Blood Sample from Patients: Safety Precautions: Always follow standard safety precautions when drawing blood Consider every person (patient or staff) as potentially infectious and susceptible to infection Wash hands before and after taking a sample from each patient Put on new gloves before collecting blood If blood is spilled, mop and disinfect area immediately Keep work area organized, clean, and disinfected Discard all used items in appropriate containers

10. Figure 2: Procedure for Taking a Venous Blood Sample Organization of materials and supplies Labeling of tube

11. Cont……………………….. Instruct the patient to form fist Clean venepuncture site with alcohol using a circular motion (after palpating path of vein) and allow area to dry

12. Cont……………………………. Assemble needle and vacuum tube holder Insert collection tube into holder until tube reaches needle

13. Cont………………………….. Remove cap from needle Use your thumb to draw skin tight about 1- 2” Below venepuncture site

14. Cont…………………….. Push vacutainer tube completely onto needle. Blood should begin to flow into tube and release tourniquet Carefully remove needle and apply gauze to venepuncture site

15. Cont………………………………….. Apply mild pressure until bleeding has stopped

16. Proper Handling of Specimen: Specimens must be properly handled from point of collection to delivery in the laboratory Results of laboratory investigations are only as good as the sample received by the laboratory. Use appropriate collection containers for specific testing needs Store specimens upright, in racks at the appropriate temperature Note the time of taking the specimens to ensure processing in the correct timeframe

17. Transporting the Specimen: Check samples and forms before they leave the phlebotomy area Before the samples leave the clinic they should be checked for errors: Are sample tubes labelled correctly? Are the forms completed correctly? Is there a form for every sample? Is there a sample for every form? Does the information on the form match that of the corresponding sample ? This check is critical because once a sample leaves clinic it may be impossible to correct certain errors

18. Proper Disposal of Used Materials Proper waste disposal is important in order to prevent potential harm and transmission of diseases with a contaminated sharp object. It is important to always dispose sharps in a puncture-resistant container and other infectious materials in an appropriate container with a non-leaking plastic bag inside. Sharp and wet materials should be disposed separately

19. Figure 3: Waste Disposal

20. Key Points : Taking a blood sample from a patient is a procedure that requires the preparation of relevant materials and supplies before it can be performed. Explaining the procedure to the patient can put them at ease Always follow standard safety precautions when collecting blood Proper waste disposal is important to prevent the spread of infection to both the patient and healthcare worker and the community. Proper sample handling is essential for getting quality results

21. Evaluation What is phlebotomy ? What is the best area of the arm for collecting blood? What are the procedures involved in the collection of blood sample ? What are the types of waste disposal containers used during phlebotomy?

22. Reference Becker F.J & Silverton R.E (1985). Introduction to Medical Laboratory Technology. (6th ed.) London: Butterworth. Carter, J. & Iema , O. (1994).Practical Laboratory Manual for Health Centres In Eastern Africa. Nairobi, Kenya: AMREF. CDC (2009). DPDx , Laboratory Identification of Parasites of Public Health Concern. Atlanta, Georgia: Centers for Disease Control. Retrieved (date unknown) at: http://www.dpd.cdc.gov/dpdx/HTML/Image_Library.htm/ Cheesbrough M.C. (1987). Medical Laboratory Manual for Tropical Countries, Vol I. (2nd ed ). London: Butterworth, Heinemann Ltd. Cheesbrough M.C. (2000). District Laboratory Practice in Tropical Countries –Part 2. Tropical Health Technology. Cambridge, UK:Cambirige University Press. Cheesbrough , M.C. (1998). District Laboratory Practice in Tropical Countries – Part 1. Tropical Health Technology. Cambridge: Tropical Health Technology.

23. BLOOD SMEAR PREPARATION

24. DEFINITION Blood smears Are simple procedures to perform aiming at demonstrating and acquiring information on blood cells, qualitatively and quantitatively. Quantitative importance enables the numbering of blood cells while the qualitative function is to demonstrate and identify the cell morphologies, including types of leukocytes, erythrocytes, monocytes , and platelets. Blood smears have also been used in detecting hematological disorders i.e. by observing the morphologies and quantifying the cell numbers.

25. A well-prepared blood smear is important to produce good results on analysis after doing a Giemsa stain, in identifying blood cells or/and demonstrating the presence of parasites in a sample. Below, we discuss the procedures for preparing both thin and thick smear for  Giemsa staining  technique, Importance, and applications of blood smears, in detail. Blood smears are mostly done for Differential Leukocyte count (DLC) i.e it quantifies the white blood cells and specifies the morphologies of each leukocyte. Normally, peripheral blood is used to prepare smears and depending on the function of the smear, two types of smear can be prepared.

26. TYPES OF BLOOD SMEAR Thin blood smear –  for species identification, demonstration and differentiation of leukocytes. b. Thick blood smear –  for diagnosis of blood protozoan parasites (Malaria) and blood abnormalities e.g. anemia. NOTE : Dry smears are the best for staining, so ensure your smear is completely dry before applying a staining technique.

27. Figure no.1

28. Objectives To prepare a thin blood smear To prepare a thick blood smear Instruments Sterile syringe & needle EDTA vials 70% isopropyl alcohol An applicator stick Microscopic glass slides

29. Equipments Microscope Tourniquet Thick Blood Smear Preparation Specimen : Venous blood sample

30. Principle Thick blood smears require larger volumes of blood than the thin blood smears. this allows them to be used for the detection of blood parasites in the blood samples. A thick blood smear is made by spreading a large blood drop in a small area of about 1 cm which provides a better opportunity to detect various parasitic forms against a more transparent background.

31. Procedure Collect blood sample by venipuncture and put in a clean test tube Using a capillary tube collects blood from the tube and put two large drops at the center of a sterile microscopic slide. Holding the slide between your thumb and index finger, gently shake the slide to spread the blood about 10mm in diameter. Air-dry the smear for 20-30 minutes till its completely dry then apply the appropriate Romanowski stain.

32. Thin Blood Smear Preparation Specimen : Venous Blood sample Principle The Thin Blood smear is prepared by making a drop of well-mixed venous blood, 2mm in diameter at the center of a sterilized microscopic glass slide. Some borders are left around the smear for easy counting and differentiating of the cells. A second glass slide is used as a spreader, streaking the blood into a thin film across the glass slide. This preparation is allowed to dry and then fixed with an appropriate Romanowski stain, depending on your objective.

33. Procedure Using a sterile pricking needle, make a prick on the index finger apply some pressure on the finger and put two drops of blood at the edge, leaving a margin on a sterile Microscopic slide. Place the edge of the sterile microscopic slide over the drops of blood, at an angle of 30-45 , and make two streaks rapidly but smoothly forward from the blood sample and spread it. This will leave a thin film of blood resembling a tongue-shape. Allow the slide to air dry and stain with an appropriate staining technique.

34. Applications of blood smears For classification of blood disorders including types of anemia, bleeding disorders To characterize blood-related disorders such as leukemia's To detect immune-mediated inflammatory disorders and infections To detect protozoa parasites:  Plasmodium falciparum ,   Mycoplasma spp ( Mycoplasma haemofelis  and  Mycoplasms haemominutus  and Bacteria such as  Bartonella  spp.

35. Advantages It is a rapid simple technique which requires basic equipment It can be performed with very small volumes of blood. Disadvantages Use clean slides to avoid the formation of grease spots (holes in the smear). Rapid air drying of smear to preserve cell morphologies Regular use of the technique to produce useful blood smears

36. Best of luck