VENIPUNCTURE Pre collection: smoking, physical activity

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Procedures for collection of Diagnostic Blood
specimens
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VENIPUNCTURE

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

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Room Facilities

• Venipunture chair Bed
• Blood collecting Trays
• Gloves
• NeedlesHolders
• Sterile Syrings
• Venous Blood collection Tubes
• Tourniquets
• Antiseptices
• Guase Pads?55cm,7.57.5cm

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• Punture Resistance Disposal Container
• Ice or refrigerator
• Adhesive Bandages
• Warming Devices
• Test Reference Manual

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Venipuncture Procedure

• 1- Identify the patient
• 2-Assess the patient physical disposition (diet,
  exercise ,stress,basal state)
• 3-Equipment? necessary suppliesTubes
• 4-Position the patient
• 5-put on gloves
• 6-Apply Tourniquent ?7.5-10cm above ven. Site ,
  Not too tightly No more than 1 min.
• Patient should make a fist without pumping
  the hand
• 7-Select the vein site Median cubital
  CephalicVein
• Extencive scaring from burns surgery
• Mastectomy Hematoma IV therapy ?below IV site
• Cannula,Fistula Edematous

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• 8- Clean the site ?Isopropyl or Ethyl Alcohol
  70
• ?guaze pad ? 55-77cm
• ? Circular motion from center to the periphery
• 9-Insert needle 30degree
• 10- Drawing the spec. open the hand
• 11-Release Tour niquet
• 12- Place gauze pad over the vein
• 13- Re move the Needle
• 14- Applying pressure to the site, making sure
  bleeding has stopped
• 15- Collect the sample in the appropriate tubes
• (Blood C ulture - non additive Tube, coagulation
  Tube, Heparin - EDTA Tubes)

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• 15- Disposing needles
• 16-Lable the tubes and rec ord the time of
  collection
• name ,age,ID no.,Dr. name,other Inf.(Iv site
  )
• ? All Tubes must Labeled Immediately after blood
  specimen has been drawn.
• 17-Chill the specimen (if required)
• 18-Send to Labs.
• ?Children? syringe gauge 20-23, winged blood
  collection set

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Safety Infection Control

• Wear gloves lab coats when handling bloob/body
  fluids
• Change gloves after each pat.or if contaminated
• Wash hands frequently
• Dispose of needles immediately Do not bend,
  recap,break,resheath needles
• Clean up any blood spills with a disinfectant as
  freshly made 10bleach

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• Prolonged Tourniquet
• Hb, HCT, RBC ? 2-3
• Prior rest
• - Hb, HCT, RBC ? 5-8 (1.5
  hr bed rest)
• - Lymphocytes ?
• Position of Arm
• H b, H C T, R B C ? 2-3 in
  hanging down arm
• Diurnal Variation
• Hb, HCT higher in the morning than
  evening
• WBC Neutrophil counts higher in the
  afternoon
• Lymphocyte lowest in the morning and
  highest in the evening .
• PLT is higher in the afternoon and
  evening
• Cortisol, Fe
• Excersise
• - WBC, RBC, Hb, HCT rise
• - intensive tranning ?
  lymphocyte count
• -? CK, AST, LD,
  Fibrinolysis,Activate coag.
• - physical training
  ?sexial hormons

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Skin Puncture

• 1- Equipment
• 2- Choose the puncture site
• distal digit of third or fourth finger
• lateral or medial planter surface of
  heel(pre warming 420 3-5 min
• planter surface of big toe
• 3- Puncture with sterile Lancet (No deeper than
  2mm)
• 4- Wipe the first drop
• 5- Collecting the specimen

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• Blood must not be obtain from the
• -Ear lobe
• -Central area of an infant heel
• -Swollen or previously punctured site

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Punture must be on palmar surface of distal
phalanx across the fingerprints,of the
middleRing finger.
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Difference between capillary and Venous Blood

• - RBC, Hb, HCT capillary blood are slightly
  greater than venous leucocyte and PMN are
  higher 8 Monocyte 12
• -PLT count higher in Venous blood 9
• -Glucose is higher in capillary blood, K,
  Protein,Ca is lower
• ? Smears prepared from capillary blood shows
  PLT aggregation

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STORAGE

• CBC?up to 4 h.(max. 6 h.) at room Tem.
• Cell counts Indices are stable for 24 h. at 4c
• Blood smear?1 h. at room Tem.
• by 3 h. blood cell morphpology starts
• - vacuolisation irregular lobulation of
  nucleos
• -crenation sphering of RBC(after 6 hours)
• Quantitative effect (gt4-6 h.at room tem)
• -RBC swelling?MCV, ?HCT, ?ESR
• - Leucocytes plt?gradually fall (count with 2
  h.)
• - Hb remains un changes for days

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The End
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• EDTA Chelate Ca
• -Na2 EDTA powder sol. 100gr/l
• -K2 EDTA powder sol.1650gr/l
• 1.5 0.25 mg/ml
• -K3 EDTA Liquid
• Shrinkage RBC ?2-3 ?Hct
• ?Not used for Coag. Tests except for Plt.
• Ratio of 1.5mg/ml blood is considered optimal
• Excess of EDTA gt2mg/ml
• - ?Hct
• -Plt swelling, disintegrate ? ?Plt

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• Sodium citrate chelate or band Ca
• 3.2 (102-109mmol/l) Na3 C6H5O7 2H2O
• Coag. Tests 1/9
• ESR 1/4
• Heparin Antithrombine
• 10-20iu/ml , 0.2ml Sat/ml
  
• O.F test
• Coated cappillary collection tube

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• -Swelling RBC(K2EDTA)??MCV
• -marked degree of crenation with few hours
• Blood film
• -fall to demonstrate bas. Stippling in lead
  poisioning
• - minimum of plt agg.
• - Cause leuco. Agglutination both Neu.Lym.
• - In some normal individual induce plt.
  clumping ?pseudothrombocytopenia, plt adherance
  to Neu.
• 1.5mg/ml 3mg/2ml
• EDTA 6 6000mg 100ml
• 3
  x0.05

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Rejection of Samples

• 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.
• 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.
• 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.
• Wrong tube collected for test ordered. Always
  refer to procedure manual when uncertain.
• Improper storage - certain tests must be
  collected and placed in ice, protected from
  light, or be kept warm after collection.
• Improperly labeled