Specimen collection part 1
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70 slides
Jun 21, 2020
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About This Presentation
lecture in specimen collection, presented by Abdelwahnab Kh. Ibrahim.
Slide Content
Specimens collection (1)Specimens collection (1)
INTRODUCTION :INTRODUCTION :
The result of any laboratory
examination is only as good as the
sample received in the laboratory
The quality of the work a laboratory
produces is only as good as the
quality of the samples it uses for
testing. The laboratory should ensure
that the samples it receives meet all of
the requirements needed to produce
accurate test results.
The result of any laboratory
examination is only as good as the
sample received in the laboratory
The quality of the work a laboratory
produces is only as good as the
quality of the samples it uses for
testing. The laboratory should ensure
that the samples it receives meet all of
the requirements needed to produce
accurate test results.
The result of any laboratory
examination is only as good as the
sample received in the laboratory
The quality of the work a laboratory
produces is only as good as the
quality of the samples it uses for
testing. The laboratory should ensure
that the samples it receives meet all of
the requirements needed to produce
accurate test results.
The result of any laboratory
examination is only as good as the
sample received in the laboratory
The quality of the work a laboratory
produces is only as good as the
quality of the samples it uses for
testing. The laboratory should ensure
that the samples it receives meet all of
the requirements needed to produce
accurate test results.
Sample ManagementSample Management
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Sample Management cont,Sample Management cont,
Sample Collection
Sample Labeling and documentation
Sample Transport
Sample Referral
Sample Storage
Sample Disposal
Sample Collection
Sample Labeling and documentation
Sample Transport
Sample Referral
Sample Storage
Sample Disposal
Sample Collection
Sample Labeling and documentation
Sample Transport
Sample Referral
Sample Storage
Sample Disposal
Sample Collection
Sample Labeling and documentation
Sample Transport
Sample Referral
Sample Storage
Sample Disposal
Sample Management cont,Sample Management cont,
Sample collection and preservation will vary,
depending on the test and the type of sample
to be collected. The laboratory must carefully
define a sample collection process for all
tests it performs. The following should be
considered when preparing instructions:
Patient preparation—Some tests require
that the patient be fasting. There may also
be special timing issues for tests such as
blood glucose, drug levels, and hormone
tests.
Sample collection and preservation will vary,
depending on the test and the type of sample
to be collected. The laboratory must carefully
define a sample collection process for all
tests it performs. The following should be
considered when preparing instructions:
Patient preparation—Some tests require
that the patient be fasting. There may also
be special timing issues for tests such as
blood glucose, drug levels, and hormone
tests.
Sample collection and preservation will vary,
depending on the test and the type of sample
to be collected. The laboratory must carefully
define a sample collection process for all
tests it performs. The following should be
considered when preparing instructions:
Patient preparation—Some tests require
that the patient be fasting. There may also
be special timing issues for tests such as
blood glucose, drug levels, and hormone
tests.
Sample collection and preservation will vary,
depending on the test and the type of sample
to be collected. The laboratory must carefully
define a sample collection process for all
tests it performs. The following should be
considered when preparing instructions:
Patient preparation—Some tests require
that the patient be fasting. There may also
be special timing issues for tests such as
blood glucose, drug levels, and hormone
tests.
Sample Management cont,Sample Management cont,
Patient identification—The person
collecting the sample must accurately
identify the patient. This might be
done by questioning the patient, by
questioning an accompanying family
member, or by the use of an
identifying wrist band or other device.
Patient identification—The person
collecting the sample must accurately
identify the patient. This might be
done by questioning the patient, by
questioning an accompanying family
member, or by the use of an
identifying wrist band or other device.
Patient identification—The person
collecting the sample must accurately
identify the patient. This might be
done by questioning the patient, by
questioning an accompanying family
member, or by the use of an
identifying wrist band or other device.
Patient identification—The person
collecting the sample must accurately
identify the patient. This might be
done by questioning the patient, by
questioning an accompanying family
member, or by the use of an
identifying wrist band or other device.
Sample Management cont,Sample Management cont,
Type of sample required—Blood
tests might require serum, plasma, or
whole blood. Other tests might
require urine or saliva. Microbiology
testing deals with a variety of sample
types, so specific information as to
what is required for the test is needed.
Type of sample required—Blood
tests might require serum, plasma, or
whole blood. Other tests might
require urine or saliva. Microbiology
testing deals with a variety of sample
types, so specific information as to
what is required for the test is needed.
Type of sample required—Blood
tests might require serum, plasma, or
whole blood. Other tests might
require urine or saliva. Microbiology
testing deals with a variety of sample
types, so specific information as to
what is required for the test is needed.
Type of sample required—Blood
tests might require serum, plasma, or
whole blood. Other tests might
require urine or saliva. Microbiology
testing deals with a variety of sample
types, so specific information as to
what is required for the test is needed.
Sample Management cont,Sample Management cont,
Type of container—The container for
the sample is often very important, as it
will affect volume and any needed
additives such as anti-coagulants and
preservatives. If the container does not
control volume, for example as with
Vacutainer® tubes, this will need to be
clearly specified. Some microbiology
samples will require specific transport
media to preserve microorganisms.
Type of container—The container for
the sample is often very important, as it
will affect volume and any needed
additives such as anti-coagulants and
preservatives. If the container does not
control volume, for example as with
Vacutainer® tubes, this will need to be
clearly specified. Some microbiology
samples will require specific transport
media to preserve microorganisms.
Type of container—The container for
the sample is often very important, as it
will affect volume and any needed
additives such as anti-coagulants and
preservatives. If the container does not
control volume, for example as with
Vacutainer® tubes, this will need to be
clearly specified. Some microbiology
samples will require specific transport
media to preserve microorganisms.
Type of container—The container for
the sample is often very important, as it
will affect volume and any needed
additives such as anti-coagulants and
preservatives. If the container does not
control volume, for example as with
Vacutainer® tubes, this will need to be
clearly specified. Some microbiology
samples will require specific transport
media to preserve microorganisms.
Sample Management cont,Sample Management cont,
Sample labeling—All requirements for
labeling of the sample at the time of
collection will need to be explained in
detail in the instructions for collection.
Special handling—Some samples may
require special handling, such as
immediate refrigeration, protection from
light, or prompt delivery to the laboratory.
Any importantsafety precautions
should be explained.
Sample labeling—All requirements for
labeling of the sample at the time of
collection will need to be explained in
detail in the instructions for collection.
Special handling—Some samples may
require special handling, such as
immediate refrigeration, protection from
light, or prompt delivery to the laboratory.
Any importantsafety precautions
should be explained.
Sample labeling—All requirements for
labeling of the sample at the time of
collection will need to be explained in
detail in the instructions for collection.
Special handling—Some samples may
require special handling, such as
immediate refrigeration, protection from
light, or prompt delivery to the laboratory.
Any importantsafety precautions
should be explained.
Sample labeling—All requirements for
labeling of the sample at the time of
collection will need to be explained in
detail in the instructions for collection.
Special handling—Some samples may
require special handling, such as
immediate refrigeration, protection from
light, or prompt delivery to the laboratory.
Any importantsafety precautions
should be explained.
Sample management entails theSample management entails the
following:following:
•Information needed on requisitions or forms
•Handling urgent requests
•Collection, labeling, preservation and
transport
•Safety practices (leaking or broken
containers, contaminated forms, other
biohazards)
•Processing and tracking samples
•Storage, retention, and disposal.
•Information needed on requisitions or forms
•Handling urgent requests
•Collection, labeling, preservation and
transport
•Safety practices (leaking or broken
containers, contaminated forms, other
biohazards)
•Processing and tracking samples
•Storage, retention, and disposal.
following:following:
•Information needed on requisitions or forms
•Handling urgent requests
•Collection, labeling, preservation and
transport
•Safety practices (leaking or broken
containers, contaminated forms, other
biohazards)
•Processing and tracking samples
•Storage, retention, and disposal.
•Information needed on requisitions or forms
•Handling urgent requests
•Collection, labeling, preservation and
transport
•Safety practices (leaking or broken
containers, contaminated forms, other
biohazards)
•Processing and tracking samples
•Storage, retention, and disposal.
Collection RequirementsCollection Requirements
Patient preparation
Patient identification
Type of sample
required
Type of container
needed
Labeling
Special handling
Safety precautions
Patient preparation
Patient identification
Type of sample
required
Type of container
needed
Labeling
Special handling
Safety precautions
Patient preparation
Patient identification
Type of sample
required
Type of container
needed
Labeling
Special handling
Safety precautions
Patient preparation
Patient identification
Type of sample
required
Type of container
needed
Labeling
Special handling
Safety precautions
Each sample should be labeled with:
Patient’s name
Patient’s unique ID
number
Test ordered
Time and date of
collection
Collector’s initials
Each sample should be labeled with:
Patient’s name
Patient’s unique ID
number
Test ordered
Time and date of
collection
Collector’s initials
Use computer-generated bar codes when possible
Patient’s name
Patient’s unique ID
number
Test ordered
Time and date of
collection
Collector’s initials
Each sample should be labeled with:
Patient’s name
Patient’s unique ID
number
Test ordered
Time and date of
collection
Collector’s initials
Use computer-generated bar codes when possible
SAMPLES REJECTION CRITERIASAMPLES REJECTION CRITERIA
The laboratory should establish rejection
criteria and follow them closely. It is the
responsibility of the laboratory to enforce
its policies on sample rejection so that
patient care is not compromised.
Management should regularly review the
number of rejected samples and reasons
for rejections, conduct training on sample
collection, and revise written procedures
for sample management as needed.
The laboratory should establish rejection
criteria and follow them closely. It is the
responsibility of the laboratory to enforce
its policies on sample rejection so that
patient care is not compromised.
Management should regularly review the
number of rejected samples and reasons
for rejections, conduct training on sample
collection, and revise written procedures
for sample management as needed.
The laboratory should establish rejection
criteria and follow them closely. It is the
responsibility of the laboratory to enforce
its policies on sample rejection so that
patient care is not compromised.
Management should regularly review the
number of rejected samples and reasons
for rejections, conduct training on sample
collection, and revise written procedures
for sample management as needed.
The laboratory should establish rejection
criteria and follow them closely. It is the
responsibility of the laboratory to enforce
its policies on sample rejection so that
patient care is not compromised.
Management should regularly review the
number of rejected samples and reasons
for rejections, conduct training on sample
collection, and revise written procedures
for sample management as needed.
The following are examples ofThe following are examples of
samples that should be rejected:samples that should be rejected:
1.Unlabeled sample;
2.Broken or leaking tube/container;
3.Insufficient patient information;
4.Sample label and patient name on
the test request form do not match;
5.Haemolyzedsample (depending on
test requested);
1.Unlabeled sample;
2.Broken or leaking tube/container;
3.Insufficient patient information;
4.Sample label and patient name on
the test request form do not match;
5.Haemolyzedsample (depending on
test requested);
samples that should be rejected:samples that should be rejected:
1.Unlabeled sample;
2.Broken or leaking tube/container;
3.Insufficient patient information;
4.Sample label and patient name on
the test request form do not match;
5.Haemolyzedsample (depending on
test requested);
1.Unlabeled sample;
2.Broken or leaking tube/container;
3.Insufficient patient information;
4.Sample label and patient name on
the test request form do not match;
5.Haemolyzedsample (depending on
test requested);
The examples of samples thatThe examples of samples that
should be rejected cont,should be rejected cont,
6. Non-fasting samples, for tests that
require fasting;
7. Sample collected in wrong
tube/container; for example, using the
wrong preservative or non-sterile
container;
8. Inadequate volume for the quantity of
preservative;
9. Insufficient quantity for the test
requested;
10. Prolonged transport time, or other
poor handling during transport.
6. Non-fasting samples, for tests that
require fasting;
7. Sample collected in wrong
tube/container; for example, using the
wrong preservative or non-sterile
container;
8. Inadequate volume for the quantity of
preservative;
9. Insufficient quantity for the test
requested;
10. Prolonged transport time, or other
poor handling during transport.
should be rejected cont,should be rejected cont,
6. Non-fasting samples, for tests that
require fasting;
7. Sample collected in wrong
tube/container; for example, using the
wrong preservative or non-sterile
container;
8. Inadequate volume for the quantity of
preservative;
9. Insufficient quantity for the test
requested;
10. Prolonged transport time, or other
poor handling during transport.
6. Non-fasting samples, for tests that
require fasting;
7. Sample collected in wrong
tube/container; for example, using the
wrong preservative or non-sterile
container;
8. Inadequate volume for the quantity of
preservative;
9. Insufficient quantity for the test
requested;
10. Prolonged transport time, or other
poor handling during transport.
Outcomes of Improper CollectionOutcomes of Improper Collection
Delays in reporting test results
Unnecessary re-draws/re-tests
Decreased customer satisfaction
Increased costs
Incorrect diagnosis / treatment
Injury
Death
Delays in reporting test results
Unnecessary re-draws/re-tests
Decreased customer satisfaction
Increased costs
Incorrect diagnosis / treatment
Injury
Death
Delays in reporting test results
Unnecessary re-draws/re-tests
Decreased customer satisfaction
Increased costs
Incorrect diagnosis / treatment
Injury
Death
Delays in reporting test results
Unnecessary re-draws/re-tests
Decreased customer satisfaction
Increased costs
Incorrect diagnosis / treatment
Injury
Death
TYPES OF SPECIMENS :TYPES OF SPECIMENS :
Specimens consist
◦Blood
◦Urine
◦Stool
◦Sputum
◦Wound drainage
◦Others
Specimens consist
◦Blood
◦Urine
◦Stool
◦Sputum
◦Wound drainage
◦Others
Specimens consist
◦Blood
◦Urine
◦Stool
◦Sputum
◦Wound drainage
◦Others
Specimens consist
◦Blood
◦Urine
◦Stool
◦Sputum
◦Wound drainage
◦Others
BLOOD COLLECTIONBLOOD COLLECTION
Veins :Anticubitalvein, veins of arm,
dorsum of hands, longsaphenousvein,
femoral vein, umbilical and scalp vein.
Capillaries :Finger tips, lobule of ear, heel
and thumb.
Arteries :femoral artery .
Veins :Anticubitalvein, veins of arm,
dorsum of hands, longsaphenousvein,
femoral vein, umbilical and scalp vein.
Capillaries :Finger tips, lobule of ear, heel
and thumb.
Arteries :femoral artery .
Veins :Anticubitalvein, veins of arm,
dorsum of hands, longsaphenousvein,
femoral vein, umbilical and scalp vein.
Capillaries :Finger tips, lobule of ear, heel
and thumb.
Arteries :femoral artery .
Veins :Anticubitalvein, veins of arm,
dorsum of hands, longsaphenousvein,
femoral vein, umbilical and scalp vein.
Capillaries :Finger tips, lobule of ear, heel
and thumb.
Arteries :femoral artery .
dorsum of hands, longsaphenousvein,
femoral vein, umbilical and scalp vein.
Capillaries :Finger tips, lobule of ear, heel
and thumb.
Arteries :femoral artery .
Veins :Anticubitalvein, veins of arm,
dorsum of hands, longsaphenousvein,
femoral vein, umbilical and scalp vein.
Capillaries :Finger tips, lobule of ear, heel
and thumb.
Arteries :femoral artery .
Veins :Anticubitalvein, veins of arm,
dorsum of hands, longsaphenousvein,
femoral vein, umbilical and scalp vein.
Capillaries :Finger tips, lobule of ear, heel
and thumb.
Arteries :femoral artery .
Veins :Anticubitalvein, veins of arm,
dorsum of hands, longsaphenousvein,
femoral vein, umbilical and scalp vein.
Capillaries :Finger tips, lobule of ear, heel
and thumb.
Arteries :femoral artery .
BLOOD COLLECTION TOOLSBLOOD COLLECTION TOOLS
BLOOD COLLECTION TUBESBLOOD COLLECTION TUBES
11..EDTA (Ethylene DiamineEDTA (Ethylene Diamine
TetraTetra--Acetate) liquid:Acetate) liquid:
Types: Na and K2EDTA (1.5-0.25mg
/ml)
Functions by forming Ca salts to
remove Ca.
Uses: most hematology studies. such
as: CBC, PCR and HbA1c. requires
full draw-invert8times to prevent
clotting and platelet clumping
Types: Na and K2EDTA (1.5-0.25mg
/ml)
Functions by forming Ca salts to
remove Ca.
Uses: most hematology studies. such
as: CBC, PCR and HbA1c. requires
full draw-invert8times to prevent
clotting and platelet clumping
TetraTetra--Acetate) liquid:Acetate) liquid:
Types: Na and K2EDTA (1.5-0.25mg
/ml)
Functions by forming Ca salts to
remove Ca.
Uses: most hematology studies. such
as: CBC, PCR and HbA1c. requires
full draw-invert8times to prevent
clotting and platelet clumping
Types: Na and K2EDTA (1.5-0.25mg
/ml)
Functions by forming Ca salts to
remove Ca.
Uses: most hematology studies. such
as: CBC, PCR and HbA1c. requires
full draw-invert8times to prevent
clotting and platelet clumping
22. Light Blue :. Light Blue :
Sodium citrate (1:9ratio).
Anticoagulant:32g/l.
Action: Remove Calcium.
Uses: Coagulation studies and platelet
function.
Sodium citrate (1:9ratio).
Anticoagulant:32g/l.
Action: Remove Calcium.
Uses: Coagulation studies and platelet
function.
Sodium citrate (1:9ratio).
Anticoagulant:32g/l.
Action: Remove Calcium.
Uses: Coagulation studies and platelet
function.
Sodium citrate (1:9ratio).
Anticoagulant:32g/l.
Action: Remove Calcium.
Uses: Coagulation studies and platelet
function.
33. Dark GREEN :. Dark GREEN :
Sodium Heparin or Lithium Heparin
anticoagulant.
Action: inactivate thrombin and
thromboplastin.
Uses:
-For Lithium level use Na Heparin
anticoagulant
-&for Ammonia level use Na or Lithium
Heparin
Sodium Heparin or Lithium Heparin
anticoagulant.
Action: inactivate thrombin and
thromboplastin.
Uses:
-For Lithium level use Na Heparin
anticoagulant
-&for Ammonia level use Na or Lithium
Heparin
Sodium Heparin or Lithium Heparin
anticoagulant.
Action: inactivate thrombin and
thromboplastin.
Uses:
-For Lithium level use Na Heparin
anticoagulant
-&for Ammonia level use Na or Lithium
Heparin
Sodium Heparin or Lithium Heparin
anticoagulant.
Action: inactivate thrombin and
thromboplastin.
Uses:
-For Lithium level use Na Heparin
anticoagulant
-&for Ammonia level use Na or Lithium
Heparin
44..Red (Plain tube):Red (Plain tube):
No preservative/anticoagulant.
Uses: usually for blood bank tests, toxicology
and serology
No preservative/anticoagulant.
Uses: usually for blood bank tests, toxicology
and serology
55. SST/ Gold top tube:. SST/ Gold top tube:
SST (Serum Separator Tube)
No additives.
Clotting accelerator and separation gel.
Uses: Chemistry, Immunology, and
Serology.
SST (Serum Separator Tube)
No additives.
Clotting accelerator and separation gel.
Uses: Chemistry, Immunology, and
Serology.
SST (Serum Separator Tube)
No additives.
Clotting accelerator and separation gel.
Uses: Chemistry, Immunology, and
Serology.
SST (Serum Separator Tube)
No additives.
Clotting accelerator and separation gel.
Uses: Chemistry, Immunology, and
Serology.
66. PST /Light Green. PST /Light Green
Plasma Separating Tube with
Lithium Heparin
Uses:Chemestries
Plasma Separating Tube with
Lithium Heparin
Uses:Chemestries
77. BLACK TOP:. BLACK TOP:
Na citrate1:4.
Action: Remove calcium.
Uses: Westergren sedimentation rate
(ESR).Requires full draw .
Na citrate1:4.
Action: Remove calcium.
Uses: Westergren sedimentation rate
(ESR).Requires full draw .
Na citrate1:4.
Action: Remove calcium.
Uses: Westergren sedimentation rate
(ESR).Requires full draw .
Na citrate1:4.
Action: Remove calcium.
Uses: Westergren sedimentation rate
(ESR).Requires full draw .
88. Light grey top. Light grey top
ADDITIVE : Sodium fluoride and
potassium oxalate .
Action :Antiglycoticagent preserves
glucose up to5days
USES : Glucoses, requires full draw (may
causehemolysisif short draw)
ADDITIVE : Sodium fluoride and
potassium oxalate .
Action :Antiglycoticagent preserves
glucose up to5days
USES : Glucoses, requires full draw (may
causehemolysisif short draw)
ADDITIVE : Sodium fluoride and
potassium oxalate .
Action :Antiglycoticagent preserves
glucose up to5days
USES : Glucoses, requires full draw (may
causehemolysisif short draw)
ADDITIVE : Sodium fluoride and
potassium oxalate .
Action :Antiglycoticagent preserves
glucose up to5days
USES : Glucoses, requires full draw (may
causehemolysisif short draw)
99. ESR tube. ESR tube
Additive:3.8% sodium citrate
Additive:3.8% sodium citrate
For fasting BS-empty stomach with a
preferable fasting of8-10hours
For PPBS-a full meal or75gm of glucose
intake
For lipid profile-a fasting sample of not
less than12hours, no fatty foods in
previous meal
No alcohol before sample collection
For fasting BS-empty stomach with a
preferable fasting of8-10hours
For PPBS-a full meal or75gm of glucose
intake
For lipid profile-a fasting sample of not
less than12hours, no fatty foods in
previous meal
No alcohol before sample collection
For fasting BS-empty stomach with a
preferable fasting of8-10hours
For PPBS-a full meal or75gm of glucose
intake
For lipid profile-a fasting sample of not
less than12hours, no fatty foods in
previous meal
No alcohol before sample collection
For fasting BS-empty stomach with a
preferable fasting of8-10hours
For PPBS-a full meal or75gm of glucose
intake
For lipid profile-a fasting sample of not
less than12hours, no fatty foods in
previous meal
No alcohol before sample collection
preferable fasting of8-10hours
For PPBS-a full meal or75gm of glucose
intake
For lipid profile-a fasting sample of not
less than12hours, no fatty foods in
previous meal
No alcohol before sample collection
For fasting BS-empty stomach with a
preferable fasting of8-10hours
For PPBS-a full meal or75gm of glucose
intake
For lipid profile-a fasting sample of not
less than12hours, no fatty foods in
previous meal
No alcohol before sample collection
For fasting BS-empty stomach with a
preferable fasting of8-10hours
For PPBS-a full meal or75gm of glucose
intake
For lipid profile-a fasting sample of not
less than12hours, no fatty foods in
previous meal
No alcohol before sample collection
For fasting BS-empty stomach with a
preferable fasting of8-10hours
For PPBS-a full meal or75gm of glucose
intake
For lipid profile-a fasting sample of not
less than12hours, no fatty foods in
previous meal
No alcohol before sample collection
VENOUS BLOOD cont,VENOUS BLOOD cont,
Most commonly required ….WHY??
Because most majority of routine tests
are performed on venous blood.
Blood can be taken directly from the vein.
The best site for venous collection is the
deep veins of the ante-cubitalfossa.
Most commonly required ….WHY??
Because most majority of routine tests
are performed on venous blood.
Blood can be taken directly from the vein.
The best site for venous collection is the
deep veins of the ante-cubitalfossa.
Most commonly required ….WHY??
Because most majority of routine tests
are performed on venous blood.
Blood can be taken directly from the vein.
The best site for venous collection is the
deep veins of the ante-cubitalfossa.
Most commonly required ….WHY??
Because most majority of routine tests
are performed on venous blood.
Blood can be taken directly from the vein.
The best site for venous collection is the
deep veins of the ante-cubitalfossa.
11. Forearm vein. Forearm vein
If difficult to obtain from the anteIf difficult to obtain from the ante--cubitalcubitalfossafossa
we can draw blood from following various site:we can draw blood from following various site:
2. Dorsum of hand vein 3. Femoral vein
we can draw blood from following various site:we can draw blood from following various site:
2. Dorsum of hand vein 3. Femoral vein
If difficult to obtain from the anteIf difficult to obtain from the ante--cubitalcubitalfossafossa
we can draw blood from following various site:we can draw blood from following various site:
4. Jugular vein 5. Scalp vein
we can draw blood from following various site:we can draw blood from following various site:
4. Jugular vein 5. Scalp vein
Purpose :
Patient identification
Organization of equipment
Collection of appropriate specimens
Purpose :
Patient identification
Organization of equipment
Collection of appropriate specimens
Patient identification
Organization of equipment
Collection of appropriate specimens
Purpose :
Patient identification
Organization of equipment
Collection of appropriate specimens
Introduce yourself
Begin communication process
Look and listen
Explain purpose of visit
Informed consent
Patient has the right to refuse-Patient Bill of
Rights
Guilty of assault if patient has the perception that
blood collector is ignoring his or her refusal
Wake a sleeping patient
Greet unconscious patients
Introduce yourself
Begin communication process
Look and listen
Explain purpose of visit
Informed consent
Patient has the right to refuse-Patient Bill of
Rights
Guilty of assault if patient has the perception that
blood collector is ignoring his or her refusal
Wake a sleeping patient
Greet unconscious patients
Begin communication process
Look and listen
Explain purpose of visit
Informed consent
Patient has the right to refuse-Patient Bill of
Rights
Guilty of assault if patient has the perception that
blood collector is ignoring his or her refusal
Wake a sleeping patient
Greet unconscious patients
Introduce yourself
Begin communication process
Look and listen
Explain purpose of visit
Informed consent
Patient has the right to refuse-Patient Bill of
Rights
Guilty of assault if patient has the perception that
blood collector is ignoring his or her refusal
Wake a sleeping patient
Greet unconscious patients
THIS IS THE MOST IMPORTANT STEP !
Written protocol
Hospital inpatients
Outpatients
THIS IS THE MOST IMPORTANT STEP !
Written protocol
Hospital inpatients
Outpatients
Written protocol
Hospital inpatients
Outpatients
THIS IS THE MOST IMPORTANT STEP !
Written protocol
Hospital inpatients
Outpatients
PreanalyticalPreanalyticalvariablesvariables
: :Medication affecting lab testsMedication affecting lab tests
Patient position :Patient position :
Site is convenient and supported
Place pillow under arm
Place fist under elbow
Place arm at downward
angle to prevent reflux
Safety
Patient is sitting or lying down
Remove objects from patient’s mouth
Be alert for syncope
Site is convenient and supported
Place pillow under arm
Place fist under elbow
Place arm at downward
angle to prevent reflux
Safety
Patient is sitting or lying down
Remove objects from patient’s mouth
Be alert for syncope
Site is convenient and supported
Place pillow under arm
Place fist under elbow
Place arm at downward
angle to prevent reflux
Safety
Patient is sitting or lying down
Remove objects from patient’s mouth
Be alert for syncope
Site is convenient and supported
Place pillow under arm
Place fist under elbow
Place arm at downward
angle to prevent reflux
Safety
Patient is sitting or lying down
Remove objects from patient’s mouth
Be alert for syncope
SELECT EQUIPMENTS :SELECT EQUIPMENTS :
Place all supplies close to patient
Collection equipment
Antiseptic pads
Gauze
Bandage
Needle disposal system
Examination requisition
form
Number and type of tubes
Extra tubes in case of loss of vacuum
Place all supplies close to patient
Collection equipment
Antiseptic pads
Gauze
Bandage
Needle disposal system
Examination requisition
form
Number and type of tubes
Extra tubes in case of loss of vacuum
Place all supplies close to patient
Collection equipment
Antiseptic pads
Gauze
Bandage
Needle disposal system
Examination requisition
form
Number and type of tubes
Extra tubes in case of loss of vacuum
Place all supplies close to patient
Collection equipment
Antiseptic pads
Gauze
Bandage
Needle disposal system
Examination requisition
form
Number and type of tubes
Extra tubes in case of loss of vacuum
PHLEBOTOMY PROCEDUREPHLEBOTOMY PROCEDURE
Wash hands Apply gloves
Wash hands Apply gloves
Procedure :Procedure :
11. Appropriate syringe and/or needle should be selected.. Appropriate syringe and/or needle should be selected.
22. If multiple specimens are to be collected its better to. If multiple specimens are to be collected its better to
use butterfly needle.use butterfly needle.
11. Appropriate syringe and/or needle should be selected.. Appropriate syringe and/or needle should be selected.
22. If multiple specimens are to be collected its better to. If multiple specimens are to be collected its better to
use butterfly needle.use butterfly needle.
Procedure cont,Procedure cont,
Attach needle to holder Place tube into holder
Attach needle to holder Place tube into holder
33. Tourniquet should be applied on. Tourniquet should be applied on
the upper arm.the upper arm.
Locate tourniquet3
to4inches above
site
Avoid or cover arms
with skin conditions
Avoid arms on the
side of a mastectomy
Do not use a
tourniquet for lactate
test
Locate tourniquet3
to4inches above
site
Avoid or cover arms
with skin conditions
Avoid arms on the
side of a mastectomy
Do not use a
tourniquet for lactate
test
the upper arm.the upper arm.
Locate tourniquet3
to4inches above
site
Avoid or cover arms
with skin conditions
Avoid arms on the
side of a mastectomy
Do not use a
tourniquet for lactate
test
Locate tourniquet3
to4inches above
site
Avoid or cover arms
with skin conditions
Avoid arms on the
side of a mastectomy
Do not use a
tourniquet for lactate
test
Length Of Application :Length Of Application :
Maximum time is1minute
Apply for site selection
Release for2minutes
Reapply
Release when blood flows
Prolonged tourniquet application :
Causeshemoconcentration
Increase in the ratio of certainanalytesto
plasma
Biochemical changes take place in the
trapped blood
Maximum time is1minute
Apply for site selection
Release for2minutes
Reapply
Release when blood flows
Prolonged tourniquet application :
Causeshemoconcentration
Increase in the ratio of certainanalytesto
plasma
Biochemical changes take place in the
trapped blood
Maximum time is1minute
Apply for site selection
Release for2minutes
Reapply
Release when blood flows
Prolonged tourniquet application :
Causeshemoconcentration
Increase in the ratio of certainanalytesto
plasma
Biochemical changes take place in the
trapped blood
Maximum time is1minute
Apply for site selection
Release for2minutes
Reapply
Release when blood flows
Prolonged tourniquet application :
Causeshemoconcentration
Increase in the ratio of certainanalytesto
plasma
Biochemical changes take place in the
trapped blood
Too tightly applied tourniquet :Too tightly applied tourniquet :
Causes :
Uncomfortable for patient
Obstruct blood flow
No radial pulse
Appearance ofpetechiae
Causes :
Uncomfortable for patient
Obstruct blood flow
No radial pulse
Appearance ofpetechiae
Causes :
Uncomfortable for patient
Obstruct blood flow
No radial pulse
Appearance ofpetechiae
Causes :
Uncomfortable for patient
Obstruct blood flow
No radial pulse
Appearance ofpetechiae
Procedure cont,Procedure cont,
4. Sterilize puncture area with a
spirit/alcohol swab and allow it to dry.
5. Visualize and palpate the vein.
Feeling is more important than sight
Probe with index finger, thumb has a pulse
Push, don’t stroke
Determine: size, depth, direction
Remember: veins are spongy, tendons are
rigid, arteries have a pulse
4. Sterilize puncture area with a
spirit/alcohol swab and allow it to dry.
5. Visualize and palpate the vein.
Feeling is more important than sight
Probe with index finger, thumb has a pulse
Push, don’t stroke
Determine: size, depth, direction
Remember: veins are spongy, tendons are
rigid, arteries have a pulse
4. Sterilize puncture area with a
spirit/alcohol swab and allow it to dry.
5. Visualize and palpate the vein.
Feeling is more important than sight
Probe with index finger, thumb has a pulse
Push, don’t stroke
Determine: size, depth, direction
Remember: veins are spongy, tendons are
rigid, arteries have a pulse
4. Sterilize puncture area with a
spirit/alcohol swab and allow it to dry.
5. Visualize and palpate the vein.
Feeling is more important than sight
Probe with index finger, thumb has a pulse
Push, don’t stroke
Determine: size, depth, direction
Remember: veins are spongy, tendons are
rigid, arteries have a pulse
Having difficulty locating a vein ?Having difficulty locating a vein ?
Check both arms
Listen to patient’s suggestions of
previously successful areas
Enhancement of the vein :
Massage the arm upward from the wrist
Briefly hang the arm down
Apply heat
Transilluminatordevice
Check both arms
Listen to patient’s suggestions of
previously successful areas
Enhancement of the vein :
Massage the arm upward from the wrist
Briefly hang the arm down
Apply heat
Transilluminatordevice
Check both arms
Listen to patient’s suggestions of
previously successful areas
Enhancement of the vein :
Massage the arm upward from the wrist
Briefly hang the arm down
Apply heat
Transilluminatordevice
Check both arms
Listen to patient’s suggestions of
previously successful areas
Enhancement of the vein :
Massage the arm upward from the wrist
Briefly hang the arm down
Apply heat
Transilluminatordevice
6. Don’t enter the vein directly and vertically.
Why?
Because there is more chance of puncturing
the other side of the venous wall by this
way.
Insert the needle :
Bevel up
15-to-30degree angle
Resistance lessens when the needle enters
the vein
Procedure cont,Procedure cont,
6. Don’t enter the vein directly and vertically.
Why?
Because there is more chance of puncturing
the other side of the venous wall by this
way.
Insert the needle :
Bevel up
15-to-30degree angle
Resistance lessens when the needle enters
the vein
Why?
Because there is more chance of puncturing
the other side of the venous wall by this
way.
Insert the needle :
Bevel up
15-to-30degree angle
Resistance lessens when the needle enters
the vein
Procedure cont,Procedure cont,
6. Don’t enter the vein directly and vertically.
Why?
Because there is more chance of puncturing
the other side of the venous wall by this
way.
Insert the needle :
Bevel up
15-to-30degree angle
Resistance lessens when the needle enters
the vein
Procedure cont,Procedure cont,
Hold vein in place Insert needle
Hold vein in place Insert needle
VENIPUNCTUREVENIPUNCTURE
Procedure cont,Procedure cont,
7. Draw blood according to required tests.
8. Withdraw the needle. Loosen the
tourniquet.
9. Press down on the gauze, applying
adequate pressure.
10. Apply a piece of band ormedi-plast.
11. Dispose of contaminated material in
designated container.
12. Put blood into a suitable container.
7. Draw blood according to required tests.
8. Withdraw the needle. Loosen the
tourniquet.
9. Press down on the gauze, applying
adequate pressure.
10. Apply a piece of band ormedi-plast.
11. Dispose of contaminated material in
designated container.
12. Put blood into a suitable container.
7. Draw blood according to required tests.
8. Withdraw the needle. Loosen the
tourniquet.
9. Press down on the gauze, applying
adequate pressure.
10. Apply a piece of band ormedi-plast.
11. Dispose of contaminated material in
designated container.
12. Put blood into a suitable container.
7. Draw blood according to required tests.
8. Withdraw the needle. Loosen the
tourniquet.
9. Press down on the gauze, applying
adequate pressure.
10. Apply a piece of band ormedi-plast.
11. Dispose of contaminated material in
designated container.
12. Put blood into a suitable container.
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:
1. IF AN INCOMPLETE
COLLECTION OR NO BLOOD IS
OBTAINED:
Change the position of the needle. Move it
forward (it may not be in the lumen)
1. IF AN INCOMPLETE
COLLECTION OR NO BLOOD IS
OBTAINED:
Change the position of the needle. Move it
forward (it may not be in the lumen)
1. IF AN INCOMPLETE
COLLECTION OR NO BLOOD IS
OBTAINED:
Change the position of the needle. Move it
forward (it may not be in the lumen)
1. IF AN INCOMPLETE
COLLECTION OR NO BLOOD IS
OBTAINED:
Change the position of the needle. Move it
forward (it may not be in the lumen)
Or move it backward (it may have
penetrated too far).
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:
penetrated too far).
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:
Adjust the angle (the bevel may be against
the vein wall).
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:
the vein wall).
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:
Loosen the tourniquet.
Try another tube. There may be no
vacuum in the one being used.
Re-anchor the vein. Veins sometimes roll
away from the point of the needle and
puncture site.
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:
Loosen the tourniquet.
Try another tube. There may be no
vacuum in the one being used.
Re-anchor the vein. Veins sometimes roll
away from the point of the needle and
puncture site.
Try another tube. There may be no
vacuum in the one being used.
Re-anchor the vein. Veins sometimes roll
away from the point of the needle and
puncture site.
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:
Loosen the tourniquet.
Try another tube. There may be no
vacuum in the one being used.
Re-anchor the vein. Veins sometimes roll
away from the point of the needle and
puncture site.
2. IF BLOOD STOPS FLOWING INTO
THE TUBE:
The vein may have collapsed;resecurethe
tourniquet to increase venous filling. If this is
not successful, remove the needle, take care
of the puncture site, and redraw.
The needle may have pulled out of the vein
when switching tubes. Hold equipment firmly
and place fingers against patient's arm, using
the flange for leverage when withdrawing
and inserting tubes.
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:
2. IF BLOOD STOPS FLOWING INTO
THE TUBE:
The vein may have collapsed;resecurethe
tourniquet to increase venous filling. If this is
not successful, remove the needle, take care
of the puncture site, and redraw.
The needle may have pulled out of the vein
when switching tubes. Hold equipment firmly
and place fingers against patient's arm, using
the flange for leverage when withdrawing
and inserting tubes.
THE TUBE:
The vein may have collapsed;resecurethe
tourniquet to increase venous filling. If this is
not successful, remove the needle, take care
of the puncture site, and redraw.
The needle may have pulled out of the vein
when switching tubes. Hold equipment firmly
and place fingers against patient's arm, using
the flange for leverage when withdrawing
and inserting tubes.
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:
2. IF BLOOD STOPS FLOWING INTO
THE TUBE:
The vein may have collapsed;resecurethe
tourniquet to increase venous filling. If this is
not successful, remove the needle, take care
of the puncture site, and redraw.
The needle may have pulled out of the vein
when switching tubes. Hold equipment firmly
and place fingers against patient's arm, using
the flange for leverage when withdrawing
and inserting tubes.
3. PROBLEMS OTHER THAN AN
INCOMPLETE COLLECTION:
A hematoma forms under the skin
adjacent to the puncture site-release the
tourniquet immediately and withdraw the
needle. Apply firm pressure.
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:
3. PROBLEMS OTHER THAN AN
INCOMPLETE COLLECTION:
A hematoma forms under the skin
adjacent to the puncture site-release the
tourniquet immediately and withdraw the
needle. Apply firm pressure.
INCOMPLETE COLLECTION:
A hematoma forms under the skin
adjacent to the puncture site-release the
tourniquet immediately and withdraw the
needle. Apply firm pressure.
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:
3. PROBLEMS OTHER THAN AN
INCOMPLETE COLLECTION:
A hematoma forms under the skin
adjacent to the puncture site-release the
tourniquet immediately and withdraw the
needle. Apply firm pressure.
The blood is bright red (arterial) rather
than venous. Apply firm pressure for more
than5minutes.
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:
than venous. Apply firm pressure for more
than5minutes.
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:
To draw only a small amount of blood in a
microtubeor strip for blood sugar and
bleeding time tests.
For infants and young children.
To draw only a small amount of blood in a
microtubeor strip for blood sugar and
bleeding time tests.
For infants and young children.
microtubeor strip for blood sugar and
bleeding time tests.
For infants and young children.
To draw only a small amount of blood in a
microtubeor strip for blood sugar and
bleeding time tests.
For infants and young children.
Capillaries structure :Capillaries structure :
Blood can be obtained from:Blood can be obtained from:
Blood can be obtained from:Blood can be obtained from:
1. Heel pulp 2. Finger pulp
1. Heel pulp 2. Finger pulp
33. Ear lobule. Ear lobule
How to collect capillary blood?How to collect capillary blood?
Select the least used
finger.
Cleanse the site with
alcohol swab.
Puncture across the
grain of the skin, then
transfer blood to a
strip or small
container.
Select the least used
finger.
Cleanse the site with
alcohol swab.
Puncture across the
grain of the skin, then
transfer blood to a
strip or small
container.
Select the least used
finger.
Cleanse the site with
alcohol swab.
Puncture across the
grain of the skin, then
transfer blood to a
strip or small
container.
Select the least used
finger.
Cleanse the site with
alcohol swab.
Puncture across the
grain of the skin, then
transfer blood to a
strip or small
container.
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