هستي خالق نام هستي به خالق نام به

خداورديان كتايون خداورديان دكتر كتايون دكتر

سالمت مرجع سالمت آزمايشگاه مرجع آزمايشگاه

وريدي گيري نمونه وريدي دستورالعمل گيري نمونه دستورالعملومويرگيومويرگي

VENIPUNCTUREVENIPUNCTURE

Pre collection: smoking, physical activity, stressPre collection: smoking, physical activity, stressDuring collection: During collection: -different time of day-different time of day -posture: lying/standing/sitting-posture: lying/standing/sitting -haemoconcentraction: prolong tourniquet -haemoconcentraction: prolong tourniquet Handling of specimen :Handling of specimen : - Insufficient or excess anticoagulant- Insufficient or excess anticoagulant -Inadequate mixing of blood with anticoagulant-Inadequate mixing of blood with anticoagulant -pat./or specimen identification error-pat./or specimen identification error -delay to transit to Lab.-delay to transit to Lab.

Room FacilitiesRoom Facilities Venipunture chair& BedVenipunture chair& Bed Blood collecting TraysBlood collecting Trays GlovesGloves Needles&HoldersNeedles&Holders Sterile SyringsSterile Syrings Venous Blood collection TubesVenous Blood collection Tubes TourniquetsTourniquets AntisepticesAntiseptices Guase Pads→5*5cm,7.5*7.5cmGuase Pads→5*5cm,7.5*7.5cm

Punture –Resistance Disposal ContainerPunture –Resistance Disposal Container Ice or refrigeratorIce or refrigerator Adhesive BandagesAdhesive Bandages Warming DevicesWarming Devices Test Reference ManualTest Reference Manual

Venipuncture ProcedureVenipuncture Procedure1- Identify the patient1- Identify the patient2-Assess the patient physical disposition (diet, 2-Assess the patient physical disposition (diet,

exercise ,stress,basal state)exercise ,stress,basal state)3-Equipment→ necessary supplies&Tubes3-Equipment→ necessary supplies&Tubes4-Position the patient4-Position the patient5-put on gloves5-put on gloves6-Apply Tourniquent →7.5-10cm above ven. Site , Not 6-Apply Tourniquent →7.5-10cm above ven. Site , Not

too tightly No more than too tightly No more than 11 min. min. Patient should make a fist without pumping the handPatient should make a fist without pumping the hand7-Select the vein site Median cubital & Cephalic7-Select the vein site Median cubital & Cephalic VeinVein **Extencive scaring from burns & surgeryExtencive scaring from burns & surgeryMastectomy Mastectomy ** Hematoma Hematoma ** IV therapy →below IV site IV therapy →below IV site** Cannula,Fistula Cannula,Fistula ** Edematous Edematous

VENIPUNCTURE SITESVENIPUNCTURE SITES

8- Clean the site →Isopropyl or Ethyl Alcohol 70%8- Clean the site →Isopropyl or Ethyl Alcohol 70%

► ►guaze pad → 5*5-7*7cmguaze pad → 5*5-7*7cm

-Circular motion from center to the periphery-Circular motion from center to the periphery

** allow to air dryallow to air dry

9-Insert needle ≤ 30degree9-Insert needle ≤ 30degree

10- Drawing the spec. 10- Drawing the spec. * open the hand * open the hand

11- 11- Release Tour niquetRelease Tour niquet

12- 12- Place gauze pad over the veinPlace gauze pad over the vein

13- Re move the Needle13- Re move the Needle

14- Applying pressure to the site, making sure 14- Applying pressure to the site, making sure bleeding has stoppedbleeding has stopped

15- Collect the sample in the appropriate tubes15- Collect the sample in the appropriate tubes

(Blood culture - coagulation Tube- non additive (Blood culture - coagulation Tube- non additive Tube- Heparin - EDTA Tubes) Tube- Heparin - EDTA Tubes)

15- Disposing needles15- Disposing needles

16-Lable the tubes and record the time of 16-Lable the tubes and record the time of collection:collection:

name ,age,ID no.,Dr. name,other Inf.(Iv site …)name ,age,ID no.,Dr. name,other Inf.(Iv site …)

All Tubes must Labeled Immediately All Tubes must Labeled Immediately afterafter blood blood ٭٭ specimen has been drawn.specimen has been drawn.

17-Chill the specimen (if required)17-Chill the specimen (if required)

18-Send to Labs. 18-Send to Labs.

Children→ syringe gauge 20-23, winged blood Children→ syringe gauge 20-23, winged blood٭٭collection setcollection set

Safety& Infection ControlSafety& Infection Control Wear gloves &lab coats when handling Wear gloves &lab coats when handling

bloob/body fluidsbloob/body fluids Change gloves frequently or if contaminatedChange gloves frequently or if contaminated Wash hands frequentlyWash hands frequently Dispose of needles immediately Dispose of needles immediately Do not bend, Do not bend,

recap,break,resheath needles recap,break,resheath needles Clean up any blood spills with a disinfectant as Clean up any blood spills with a disinfectant as

freshly made 10%bleachfreshly made 10%bleach

# # Prolonged Tourniquet:Prolonged Tourniquet: Hb, HCT, RBC Hb, HCT, RBC ↑ 2-3%↑ 2-3%# Prior rest:# Prior rest: - Hb, HCT, RBC ↓ 5-8% (1.5 hr bed rest)- Hb, HCT, RBC ↓ 5-8% (1.5 hr bed rest) - Lymphocytes ↓- Lymphocytes ↓# Position of Arm : # Position of Arm : H b, H C T, R B C H b, H C T, R B C ↑ 2-3% in hanging down arm↑ 2-3% in hanging down arm# Diurnal Variation :# Diurnal Variation : Hb, HCT higher in the morning than eveningHb, HCT higher in the morning than evening WBC & Neutrophil counts higher in the afternoonWBC & Neutrophil counts higher in the afternoon Lymphocyte lowest in the morning and highest in the Lymphocyte lowest in the morning and highest in the

evening . evening . PLT is higher in the afternoon and evening PLT is higher in the afternoon and evening Cortisol, Fe Cortisol, Fe # Excersise :# Excersise : - WBC, RBC, Hb, HCT rise- WBC, RBC, Hb, HCT rise - intensive tranning ↓ lymphocyte count - intensive tranning ↓ lymphocyte count -↑ CK, AST, LD, Fibrinolysis,&Activate coag.-↑ CK, AST, LD, Fibrinolysis,&Activate coag. - physical training: ↑sexial hormons - physical training: ↑sexial hormons

Skin PunctureSkin Puncture1- Equipment1- Equipment2- Choose the puncture site2- Choose the puncture site ¤ distal digit of third or fourth finger¤ distal digit of third or fourth finger ¤ lateral or medial planter surface of ¤ lateral or medial planter surface of

heel(pre warming 42heel(pre warming 420 0 3-5 min)3-5 min)3- Puncture with sterile Lancet (No deeper 3- Puncture with sterile Lancet (No deeper

than 2mm)than 2mm)4- Wipe the first drop4- Wipe the first drop5- Collecting the specimen5- Collecting the specimen

Punture must be on palmar surface of distal Punture must be on palmar surface of distal phalanx across the fingerprints,of the phalanx across the fingerprints,of the

middle&Ring finger.middle&Ring finger.

Blood must not be obtain from the:Blood must not be obtain from the:

-Ear lobe-Ear lobe

-Central area of an infant heel -Central area of an infant heel

-Swollen or previously punctured site-Swollen or previously punctured site

Difference between capillary and Venous Difference between capillary and Venous BloodBlood

- RBC, Hb, HCT capillary blood are slightly greater - RBC, Hb, HCT capillary blood are slightly greater than venous – leucocyte and PMN are higher 8% than venous – leucocyte and PMN are higher 8% Monocyte 12%Monocyte 12%

-PLT count higher in Venous blood 9% -PLT count higher in Venous blood 9%

-Glucose is higher in capillary blood, K, -Glucose is higher in capillary blood, K, Protein,Ca is lowerProtein,Ca is lower

✽ ✽ Smears prepared from capillary blood shows Smears prepared from capillary blood shows PLT aggregationPLT aggregation

STORAGESTORAGE CBC→up to 4 h.(max. 6 h.) at room Tem.CBC→up to 4 h.(max. 6 h.) at room Tem. Cell counts & Indices are stable for 24 h. at 4cCell counts & Indices are stable for 24 h. at 4c Blood smear→1 h. at room Tem. Blood smear→1 h. at room Tem. by 3 h. blood cell morphpology starts:by 3 h. blood cell morphpology starts: - vacuolisation & irregular lobulation of nucleos- vacuolisation & irregular lobulation of nucleos -crenation &sphering of RBC(after 6 hours)-crenation &sphering of RBC(after 6 hours) Quantitative effect (>4-6 h.at room tem):Quantitative effect (>4-6 h.at room tem): -RBC swelling→MCV, ↑HCT, ↓ESR-RBC swelling→MCV, ↑HCT, ↓ESR - Leucocytes & plt→gradually fall (count with 2 h.)- Leucocytes & plt→gradually fall (count with 2 h.) - Hb remains un changes for days- Hb remains un changes for days ESR:up to 4 hours at room tem.ESR:up to 4 hours at room tem. up to 12 hours at 4 degreeup to 12 hours at 4 degree

Reticolocyte:EDTA sample up to 6 hour at Reticolocyte:EDTA sample up to 6 hour at room tem.room tem.

up to 24 hours at 4 degreeup to 24 hours at 4 degree Blood grouping sample:48 hour at room Blood grouping sample:48 hour at room

tem. tem.

up to 7 days at 4 degreeup to 7 days at 4 degree

Rejection of SamplesRejection of Samples1. Hemolysis - this is usually caused by a procedural error such as using too

small of a needle, or pulling back to hard on the plunger of a syringe used for collecting the sample. The red cells rupture resulting in hemoglobin being released into the serum/plasma, making the sample unsuitable for many laboratory tests. The serum/plasma will appear red instead of straw colored.

2. Clotted - failure to mix or inadequate mixing of samples collected into an additive tube. The red cells clump together making the sample unsuitable for testing.

3. Insufficient sample (QNS) - certain additive tubes must be filled completely. Incorrect blood to additive ratio will adversely affect the laboratory test results. When many tests are ordered on the same tube be sure to know the amount of sample needed for each test.

4. Wrong tube collected for test ordered. Always refer to procedure manual when uncertain.

5. Improper storage - certain tests must be collected and placed in ice, protected from light, or be kept warm after collection.

6. Improperly labeled

Thanks for your attention