Blood Specimen Extraction

8/6/2019 Blood Specimen Extraction

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DEMONSTRATION

OF BLOOD

SPECIMEN

EXTRACTION


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INTRODUCTION :

BLOOD SPECIMEN COLLECTION IS

PERFORMED ROUTINELY TO OBTAIN BLOOD

FOR LABORATORY TESTING.BLOOD CAN BEOBTAIN FROM VENOUS ACCESS DEVICES

AND SOMETIMES BY FINGERSTICK.BLOOD IS

MOST PREQUENTLY OBTAINED VIAPERIPHERAL VEIN

PUNCTURE.(VENIPUNCTURE)


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DEFINITION OF TERMS:

SPECIMEN COLLECTION

To obtain a sample of a substance ormaterial for examination or study like

a urine specimen, a tissue specimen

or stool specimen.


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Venipuncture

is the process of obtaining intravenous

access for the purpose ofintravenous therapyor obtaining a sample ofvenous blood. It is one

of the most routinely performed invasive

procedures and is carried out for two reasons,

to obtain blood for diagnostic purposes or to

monitor levels of blood components.


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Hemolysis

The destruction ofred blood cells which leads to

the release ofhemoglobin from within the red blood

cells into the blood plasma.

Hemoconcentration

An increase in the number of red blood cellsresulting from either a decrease in plasma volume or

increased production of erythrocytes.


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Phlebotomy

is the act of drawing or removing blood from

the circulatory system through a cut (incision)or puncture in order to obtain a sample for

analysis and diagnosis. Phlebotomy is also

done as part of the patient's treatment for

certain blood disorders.


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OBJECTIVES:

To ensure proper guidelines in collecting

blood specimens by choosing preferred

venous access sites and its factors.

To discuss proper labelling procedures and

completion of laboratory requisitions.

To identify proper technique in withdrawing

blood samples by maintaining standards ofnursing practice.


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SITES OF BLOOD COLLECTION:

ANTECUBITAL FOSSA ANATOMY


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MATERIALS AND

EQUIPMENTS PROCEDURE TROLLEY OR TRAY

CLEAN TRAY CONTAINING:

TOURNIQUET

CLEAN GLOVES

SYRINGES OR VACUTAINERS

70%ALCOHOL OR ANTISEPTIC SOLUTION

21-25 GAUGE NEEDLE OR SCALP VEIN NEEDLE

BLOOD COLLECTION TUBES OR TUBES NEEDED FORTHE SPECIFIC INVESTIGATIONS.


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TYPES OF BLOOD COLLECTION

TUBES


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BLUE TUBE

PT Tube: The blue 3.2%

sodium citrate tubes are

mainly used in the test of

coagulation mechanism, with

the advantages of high

accuracy in mixing rate of

blood and anticoagulant.

the amount of blood1.8ml

and 4ml


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RED TUBE/ PLAIN TUBE

Additive NONE

Tube Type Glass 13* 75

mm

Draw Amount 3-5 ml

Laboratory Use For serum

determination in chemistry,

serology and blood banktesting


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VIOLET TUBE/ EDTA TUBE

Use for hematology and

blood bank testing.

Additives: EDTA( Ethylene

Dromine Tetro Acetic Acid

Mode of Reaction: Forms

Calcium salt to remove

calcilom.

Requires Full Drawn: Invert

8 times to prevent clotting

platelet dumping.


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ESR TUBE

The black 3.8% sodium

citrate tubes are used for

the collection and

transport of venousblood for blood

sedimentations rate

testing.

the amount of blood

1.6ml and 2.4ml


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BLOOD CULTURE BOTTLES

Blood culture bottles - used to

collect blood from patients

suspected of having septicemia or

bacterecemia.

NOTE: Tubes with additives must

be thoroughly mixed. Clotting oremerse test result may be

obtained when the blood is not

thoroughly mixed with the

additive.

Amount of blood: 3ml each bottle

Additives: Broth mixture

Blood can be stored for 3days

Mode of Action: Preserves viabilityof microorganism


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POLICY :

1. Peripheral vein blood collection may be performed by aqualified, trained staff nurse, with a written order of a physician.

2. Any staff nurse certified in the procedure may perform acentral venous stick to obtain a blood specimen on a writtenorder of a physician.

3. Proper hand washing and gloving should be observe.

4. All phlebotomy attempt should be recorded. This record shallreflect type of phlebotomy modality, type of specimen drawn,time drawn and how patient tolerated the procedure.


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VERIFY ORDER FOR BLOOD

EXTRACTION.

IDENTIFY THE PATIENT BY

CALLINGHIS NAME ANDCHECKING HIS ID BAND.

EXPLAIN THE PROCEDURE TO THE

PATIENT OR TO THE PARENTS FOR

SMALL BABIES.

ARRANGE ALL MATERIALS

NEEDED.

BLOOD EXTRACTION MUST BE

ORDERED BY A PHYSICIAN PRIOR TO

IMPLEMENTATION OF THIS

PROCEDURE.

CONFIRMS CLIENT IDENTITY.

TO PROVIDE KNOWLEDGE AND HELPS

ALLEVIATE ANXIETY ABOUT THEPROCEDURE.

FOR ACCESSIBILITY OF MATERIALS

NEEDED.

PROCEDURE RATIONALE


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TO ELIMINATEMICROORGANISM.

TO PROVIDE COMFORT TOTHE PATIENT AND TO BEABLE TO ASSESS

PROPERLY FOR TH

E SITEOF EXTRACTION.

PROCEDURE RATIONALE


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INSTRUCT THE PATIENT TO MAKE AFIST WITHOUT PUMPING THE HAND

THEN SELECT THE VENEPUNCTURESITE.TIE TOURNIQUET AFTER VEINSELECTION 3-4 INCHES ABOVE.

CLEAN THE VENIPUNCTURE SITEWITH ALCOHOL SWAB.

Dont wipe off the antiseptic

solution with alcohol. Wipe in a circular motion,

spiraling outward from the site.

Grasp the patients arm firmlyusing your thumb to draw the skinand anchor the vein. The needleshould form a 15-30 degree

angle with the surface of the arm,gently insert the needle throughthe skin and into the lumen of thevein.

Pull the plunger of syringe gently

VEIN MUST BE VISIBLE OR PALPABLEBEFORE VENIPUNCTURE ISATTEMPTED.THE TOURNIQUET SHOULDNOT BE APPLIED TOO TIGHTLY SO ITDOES NOT INTERFERE WITH ARTERIALBLOOD FLOW.

TO REDUCE THE NUMBER OF SKINMIROORGANISMS AND MINIMIZE THERISK FOR INFECTION.

PROCEDURE RATIONALE


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RATIONALE

REMOVE THE TOURNIQUET AS SOON ASTHE BLOOD FLOWS ADEQUATELY.

AFTER SAMPLE HAS BEEN EXTRACTED,REMOVED THE NEEDLE FROM THE VEINGENTLY, THEN APPLY COTTON/GAUZE ANDGENTLE PRESSURE TO THE PUNCTUREDSITE UNTIL BLEEDING STOPS AND APPLY

ADHESIVE BANDAGE.

DISPOSE CONTAMINATED MATERIALS/SUPPLIES IN DESIGNATED CONTAINER.

THE SAMLPES ARE TRANSFERRED INPROPER LABORATORY RECEPTACLELABELED WITH PATIENTS NAME DATE,TIME THE BLOOD COLLECTEDDEPT./SECTION AND MEDICAL RECORDNUMBER BEING CAREFUL TO AVOIDFOAMING.

TO AVOID FORMATION OFHEMATOMA.

TO PREVENT CROSSCONTAMINATION.

PROCEDURE


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PROCEDURE

RATIONALE

REASSESS VENIPUNCTURE SITE FOROOZING, BLEEDING OR EVIDENCE OFHEMATOMA.

RECORD THE DATE AND TIME OFBLOOD SAMPLE COLLECTION, THE

NAME OF THE TEST, THE AMOUNT OFTHE BLOOD COLLECTED AND ANYADVERSE REACTION TO THEPROCEDURE. THE AMOUNT OFBLOOD WITHDRAWN MUST BERECORDED IN THE INTAKE ANDOUTPUT SHEET BEFORE THEPURPOSE OF MONITORING BLOOD

VOLUME DEPLETION.THE DOCTORMUST BE NOTIFIED FORCONSIDERATION OF BLOODREPLACEMENT.

The purpose of recordingin the intake and outputsheet is to monitor theblood volume depletion.


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PROCEDURE RATIONALE

ONCE COLLECTED, SENT

THE SAMPLE TO

LABORATORYACCOMPANIED BY

APPROPRIATE LABORATORY

REQUEST.

CLEAN AND ARRANGE THE

TROLLEY RETURN TO

PROPER PLACE.

To avoid hemolytic

reaction.

For the preparation forthe next extraction.


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COMPLICATIONS:

THOUGHVENIPUNCTURE IS ROUTINELY DONE AND

RELATIVELY SAFE,THERE ARE FEW COMPLICATION

THAT CAN OCCUR,INCLUDING HEMATOMA

FORMATION,HEMOLYSIS AND

HEMOCONCENTRATION.IN ADDITION,EXCESSIVE

BLEEDING CAN OCCUR AND MANY PATIENTS HAVE

BEEN KNOWN TO FAINT DURING THE PROCEDURE.


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ADDITIONAL CONSIDERATIONS

TO PREVENT HEMATOMA

PUNCTURE ONLY THE UPPERMOST WALL OF THE VEIN.

REMOVE THE TOURNIQUET BEFORE REMOVING THE NEEDLE.

USE THE MAJOR SUPERFICIAL VEINS.

MAKE SURE THE NEEDLE FULLY PENETRATES THE UPPERMOST WALL OF

THE VEIN. PARTIAL PENETRATION MAY ALLOW BLOOD TO LEAK INTO THE

SOFT TISSUE SURROUNDING THE VEIN.

APPLY PRESSURE TO THE VENIPUNCTURE SITE.


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TO PREVENT HEMOLYSIS

MIX TUBES WITH ANTICOAGULANT ADDITIVES GENTLY 5-50 SECONDS.

AVOID DRAWING BLOOD FROM A HEMATOMA.

AVOID DRAWING THE PLUNGER BACK TOO FORCEFULLY, IF USING A NEEDLE

AND A SYRINGE, TO AVOID FROTHING OF THE SAMPLE.

MAKE SURE THE VENIPUNCTURE SITE IS DRY.

AVOID A PROBBING, TRAUMATIC VENIPUNCTURE.

TO AVOID HEMOCONCENTRATION

PROLONGED TOURNIQUET APPLICATION, NO MORE THAN 2 MINUTES. THE

HYDROSTATIC PRESSURE CAUSES SOME WATER AND FILTERABLE

ELEMENTS TO LEAVE THE EXTRACELLULAR SPACE.

MASSAGING, SQUEEZING, OR PROBING SITE.

LONG TERM IV THERAPY

SCLEROSED OR OCCLUDED VEINS


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PRECAUTION:

ALTHOUGH OBTAINING BLOOD SPECIMEN IS A ROUTINE FUNCTION,IT IS

ONE OF THE RISK PROCEDURE NURSES PERFORM.TO INCREASE THE

SAFETY OF BLOOD COLLECTION THIS PRECAUTION SHOULD BE FOLLOWED:

DO NOT USE A NEEDLE WHEN WITHDRAWING BLOOD FROM A PERIPHERAL

INTRAVENOUS LINE OR FROM A CENTRAL VENOUS ACCESS DEVICE.USING A

NEEDLELESS SYSTEM ALLOWS THE BLOOD TO BE DRAWN DIRECTLY INTO

SPECIMEN CONTAINERS.

DO NOT USE AN EXPOSED NEEDLE TO INJECT BLOOD IN SPECIMEN CONTAINERS OR

VACUUM TUBES.


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TO PROTECT YOURSELF AND

PATIENT PRACTICE UNIVERSAL PRECAUTION

WEAR GLOVES, GOWN WHEN HANDLING BLOOD AND BODY

FLUIDS.

CHANGE GLOVES AFTER EACH PATIENT OR WHEN

CONTAMINATED.

WASHHANDS FREQUENTLY.

DISPOSE ITEMS IN APPROPRIATE CONTAINERS.

PLACE BLOOD COLLECTION EQUIPMENT AWAY FROM

PATIENTS ESPECIALLY TO CHILDREN AND PSYCHIATRIC

PATIENTS.


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NURSING IMPLICATIONS

THE NURSE SHOULD ASSESS THE PATIENT PRIOR TO OBTAINING BLOOD

SPECIMENS NOTING FACTORS THAT MAY AFFECT TEST RESULTS INCLUDINGMEDICATIONS, PREGNANCY, AGE, AND SEX.

MAKE SURE THAT THE PATIENT HAS FOLLOWED ANY SPECIAL

INSTRUCTIONS WHICH COULD INCLUDE FASTING FOR A NUMBER OF

HOURS OR TAKING A MEDICATION AT A CERTAIN TIME.

ALTHOUGHMOST BLOOD WORK DOES NOT REQUIRE ANY SPECIALCONSENT SOME TESTS, IF NEEDED OBTAIN CONSENT PRIOR TO

COLLECTING THE SPECIMEN.

THERE ARE FOUR PATIENT RIGHTS THE NURSE SHOULD CONSIDER WHEN

COLLECTING BLOOD SPECIMENS;

1. RIGHT PATIENT2. RIGHT METHOD

3. RIGHT TIME

4. RIGHT SPECIMEN


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NURSING IMPLICATIONS

AVOID DRAWING BLOOD FROM AN ARM AFFECTED BY A STROKE

OR NEUROLOGICAL INJURY THAT HAS RESULTED IN A LOSS OF

SENSATION.

AVOID AREAS WITH EXTENSIVE SCARRING.

ATTEMPT TO COLLECT THE BLOOD SPECIMEN FROM THE

OPPOSITE ARM IF PATIENT IS RECEIVING INTRAVENOUS FLUIDS. DO NOT USE A SITE THAT IS SWOLLEN, AFFECTED BY CERTAIN

SKIN CONDITIONS LIKE ECZEMA OR IS INFECTED.

USE THE RIGHT SPECIMEN TUBES.

TRY TO USE PEDIATRIC TUBES WH

EN PATIENTH

AS FRAGILEVEINS.

SEND THE SPECIMEN TO THE LABORATORY AS SOON AS

POSSIBLE.


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HEALTH EDUCATION:

Blood specimen collection is performed primarily by nurses.The physician orders the laboratory test. The nurse is

responsible for instructing the patient regarding the procedure

and assessing the patients response, in addition the nurse

should be knowledgeable about the implication of thelaboratory result may have on patient care.

1. The nurse should assess the patient, noting factors that

may affect test result, make sure the patient has followed any

special instruction, which could include fasting for a number of

hours or taking a medication for a certain time.

2. Patient should also be assessed for their knowledge level

regarding the test ordered, instruct patient as needed about

the test and the procedure itself.

3. Make sure the specimen collected in the specimen ordered.


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4. Always verify the patients identification before

drawing a blood specimen, the person drawing the

specimen should also label the container it is drawn

into.5. Always follow universal precautions when

performing a venipuncture, to help reduce the risk of

exposure of the health care professionals skin or

mucous membranes to infectious materials.Itincludes the use of protective barriers, such as

gloves, mask or gowns or eye shield if needed.

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Blood Specimen Extraction

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