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COLLECTION &
PRESERVATION OF
     BLOOD
 It is a blood collection used an all labs to find
  out why symptoms are appear in the
  patient…
 Phlebotomy(“to cut a vein” in Greek) is the
  process of making incision in a vein.
 A person who practices phlebotomy is termed
  as phlebotomist.
Blood  analysis is one of the most
 important diagnostic tools
 available to clinician within
 healthcare. Its data is relied upon
 in the clinical setting for
 interpretation of clinical signs and
 symptoms…
 Requires  social, clerical and technical skills
 Phlebotomy is a link between the patient
  and the laboratory
 Apart of the healthcare team
To  collect blood for accurate and
 reliable test results
Accurate identification and
 collection procedures are critical
Important procedure to assist in
 the diagnosis and monitoring of
 patients
SAMPLE COLLECTION
 PATIENT     PREPARATION PRIOR TO TEST

   ESR   :   FASTING

   Hb , TLC, DLC, PBF, RED CELL
    INDICES, RETICULOCYTE COUNT , PLATELET
    COUNT : NEED NOT FASTING



                                             6
                                                 6
Identify tests & Determine :
 proper volume to be collected
*NOTE :
    ◦ ”.5ml serum/plasma”
    ◦ = 1ml of whole or un-centrifuged blood)
 Determine proper procedure based upon
 age and size of patient
          Communicate with patient about previous
          blood collection experiences
 Collect proper patient identifiers, request
 and equipment.
Blood collection  and preservation
   OUTPATIENTS: Sitting in chair
   INPATIENTS: lying in bed or sitting in chair

•Position check
list:
–There is no danger of the
patient falling
–There is easy access to
the arms
–The patient is comfortable
–There is adequate space
to place supplies within
reach
SYRINGES
NEEDLES
VACUTAINERS
GLOVES
MASKS
Tourniquet
Blood collection  and preservation
   5% SAVLON SOLUTION
   TINCTURE IODINE
   70% ALCOHAL
Capillary blood collection

Venous blood collection
 IV lines
 Injuries
 Presence of edema
 Medication
 Patient alertness
 Patient emotional
  and mental status
Blood collection  and preservation
   Clean the selected pt. finger with spirit swab
   Pick up sterile blood lancet with your right
    hand.
   With your left hand, firmly grasp the pt.
    middle finger.
   make deep stab on the ball of the finger.
   Eliminate the first drop.
    after that collect blood for require tests…..
   Blood from capillary network can be used to perform
    test for which only few drops of blood is required.
   Capillary blood is not recommended for those tests
    which require large amount of blood.
   It is not used for platelet count.


Suitable for
 Hb , TLC, DLC, RBC count by microdilution method.

 For preparation of thin blood film to determine
  blood picture.
Blood is collected from the
veins of the patient. it is
require when the large amount
of blood is required
   Anticubital veins
   Radial vein
   Dorsal vein
Jugular vein   Femoral vein
Surface of the forearm, Wrist area above the thumb or index
finger, Back of the wrist, Knuckle of the thumb or index finger, Foot or
ankle, Infants: head veins
   Choose the veins that are large
    and accessible.
   Large veins that are not well
    anchored in tissue frequently
    roll, so if you choose one, be
    sure to secure it with the thumb
    of your non dominant hand
    when you penetrate it with the
    needle.
   Avoid bruised and scarred areas.
1.   Median cubital vein - first choice, well
     supported
2.   Cephalic vein - second choice
3.   Basilic vein - third choice, often the most
     prominent vein, but it tends to roll easily
     and makes venipuncture difficult
INAPPROPRIATE SITES

   ARM ON SIDE OF MASTECTOMY

   EDEMATOUS AREAS

   HAEMATOMAS

   SCARRED AREAS

   ARMS WITH CANULAS



   SITES BEYOND IV LINE OF ANY KIND

                                       24


                                            24
Blood collection  and preservation
   Apply approximately 3-5 inches above anticubital
    fossa. (Not more than 1 min)
   If the skin appears blanched above and below the
    tourniquet it is too tight.
   If your finger can be inserted between the
    tourniquet and the patient's skin it is too loose.
   After tourniquet application have patient clench fist.
   Feel for a vein that rebounds (bounces) when pushed or
    tapped on.
   PALPATE any potential vein to help determine size, direction
    and depth. A slight rotation of the arm may help to better
    expose a vein that may otherwise be hidden.
   Tricks to Help Distend Veins:
    ◦ Have the patient "pump" the hand 3 times.
      Don't overdue it because over-pumping can create
       hemoconcentration
    ◦ Warm the area with a hot pack or warm, moist cloth
      heated to approximately 42°C.
    ◦ If all else fails, consult another technician for their
      opinion and/or intervention.
   After selecting a vein, clean the puncture site with a cotton ball
    saturated with 70% isopropyl alcohol or prepackage alcohol swabs.
    Rub the alcohol swab in a circular motion moving outward from the
    site Use enough pressure to remove all perspiration and dirt from
    the puncture site.
   Discreetly look at the swab when finished, if it appears excessively
    dirty repeat the cleansing process with a fresh alcohol swab. After
    cleansing do not touch the site, if the vein must be repalpated the
    area must be cleansed again. Some experts allow cleansing of the
    index finger before repalpating but this technique is debatable.
   Clean the selected area with spirit swab.
   The patient arm is gripped tightly with the
    help of tourniquet.
   The vein is penetrated by positioning the
    needle at 20 to 30 degree angle.
   After blood has been drawn, the patient
    should release the fist & the tourniquet is
    also released.
   A cotton ball is held firmly over the
    venipuncture site as soon as the needle is
    removed.
   After removing the needle the collected blood
    is dispensed in the appropriate tubes.
   The blood in the anticoagulant tubes are
    mixed carefully.
   The tubes are covered with appropriate
    stoppers.
   the needle should be disposed by using
    needle destroyer.
   Disposed used cotton, syringes into a non-
    penetrable containers. (Blue basket)
   Maintain stability of Coagulation Factors
   Prevent clot formation in sample prior to
    testing
   Prevent Factor activation in tube - even if
    clot does not form
   Additives in tube must not interfere with
    individual Coagulation Factors
 19 - 21gauge to avoid hemolysis in
  adults and 21 - 23 for pediatric
  samples.
 Non-wettable, siliconized surface or
  plastic tubes so as not to activate
  factors
 Contains buffered Sodium Citrate
  which…Ratio 1:9
                   1part anticoagulant
                    9 part blood
Sample is mixed by inversion of tube 2
  to 3 times.
Blood collection  and preservation
 Consider   all patients as potentially infectious

 Wear coat or apron when there is a
 possibility of a splash
 Wear mask/eye protection when there is a
 possibility of a splash
 All sharps must be disposed into a puncture-
 proof biohazard container.
 Frequent hand washing is an important
 safety precaution
 Wash hands when changing gloves and
 between patients if gloves become soiled
 Gloves are required to be worn during the
 phlebotomy procedure
 Wear gloves when handling body fluids
BEVEL ON UPPER WALL OF VEIN DOES NOT ALLOW BLOOD TO FLOW
•SOLUTION
•PULL BACK SLIGHTLY THE NEEDLE.
•BE ALERT TO HEMATOMA




NEEDLE PARTIALLY INSERTED CAUSES BLOOD LEAKAGE INTO
TISSUE(HEMATOMA LIKE)
•SOLUTION
•RELEASE TORNIQUET AND REMOVE NEEDLE
•APPLY FIRM PRESSURE OVER SWOLLEN AREA (OR ELEVATE AFFECTED ARM).REASSURE PATIENT
 THAT BRUISE WILL ASSURE. REPEAT VENIPUNTURE AT A DIFFERENT SITE(OPPOSITE ARM OR
 DISTAL DISTAL TO ORIGINAL ARM)



NEEDLE INSERTED THROUGH BOTH VEIN WALLS
•SOLUTION
•RELEASE TORNIQUET AND REMOVE THE NEEDLE
•APPLY FIRM PRESSURE OVER SWOLLEN AREA(OR ELEVATE AFFECTED ARM).REASSURE PATIENT
 THAT THE BRUISE WILL RESOLVE. REPEAT VENIPUNCTURE AT A DIFFERENT SITE (OPPOSITE 38
 ARM OR DISTAL TO ORIGINAL SITE)
COLLAPSED VEIN.
REDUCED OR NIL BLOOD FLOW
•ALLOW VEIN TO RECOVER BY RELEASING TORNIQUET
•REAPPLY TORNIQUET


NEEDLE NOT COMPLETELY IN VEIN OR HAS
NOT REACHED THE VEIN
•ADVANCE THE NEEDLE FORWARD UNTIL YOU FEEL THE
 „GIVE‟ AS NEEDLE PENETRATES



CORRECT INSERTION OF NEEDLE
•BLOOD FLOWS FREELY INTO NEEDLE

                                                39
FAINTING                            HAEMATOMA
                                                When the needle has
           Patient become dizzy &               gone completely
           may faint during                     through the vein & not
           collection                           enough pressure is
                                                applied.


                                                The tourniquet &
           Should be aware of the               needle should be
           patient condition                    removed immediately
           throughout the                       and firm pressure is
           procedure                            applied to the area for
                                                atleast 5 min.
EXCESSIVE
PETECHIAE   Small red spots
                                      BLEEDING
            appearing on patient
            skin, indicating minute               Patient on
            amount of blood                       anticoagulant therapy
            escaping into the skin
            epithelium


            This defect is due to
            coagulation defect.                   Remember to apply
                                                  pressure to the
            Make sure bleeding has                venipuncture site until
            stopped before leaving                bleeding stops
            patient side
COLLAPSED
SEIZURES
                                    VEIN
           This is rarely occur               If the syringe
           during blood                       plunger is
           collection                         withdrawn quickly




           Immediately call
                                              Release tourniquet,
           for help from the
                                              remove syringe
           nursing station
Intravenous                             HEMO
  therapy                           CONCENTRATION
                                                    Increase conc. Of
              Veins are visible &
                                                    larger molecule or
              palpable but
                                                    elements in the
              partially occluded.
                                                    blood.



                                                    Prolong tourniquet
              Avoid arm with IV                     application.
              line                                  Exessive massaging
                                                    or squeezing a site.
PRESERVATION OF BLOOD
   For many purposes blood may be safely persevered
    at 4ºC in Refrigerator.



EDTA is best preservative for Hemogram.

Tri-sodium citrate best for coagulation
study.

   Before procedure, the blood should be first
    allowed to warm up to room
    temperature, then mixed, preferably by
    rotation, for atleast 2 min.
   RBCs starts to swell resulting in increase in PCV.
   The reticulocytes count decrease as early as 6
    hours
   Osmotic fragility increases.
   Prothrombin time slowly increases.
   ESR decreases.
   Reticulocytes decreases after 6 hrs.
   The red cells may leads to progressive crenation
    and sphering.
   The nucleated red cells disappear from the blood
    within 1-2 days
   It is best to count leucocytes and platelets within
    2 hours
    If any delay:
   Some but not all neutrophils are affected. The
    nuclear lobes may become seperated and the
    cytoplasmic margin may appear less well defined.
    small vacuoles appear in the cytoplasm
   Some of the lymphocytes undergo some changes.
    Few vacuoles may be seen in the cytoplasm & and
    the nucleus may undergo major budding so as to
    give rise to the nuclei with 2 or 3 lobes.
   Platelet count, TLC, RBCs count decreases.
Blood collection  and preservation

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Blood collection and preservation

  • 2.  It is a blood collection used an all labs to find out why symptoms are appear in the patient…  Phlebotomy(“to cut a vein” in Greek) is the process of making incision in a vein.  A person who practices phlebotomy is termed as phlebotomist.
  • 3. Blood analysis is one of the most important diagnostic tools available to clinician within healthcare. Its data is relied upon in the clinical setting for interpretation of clinical signs and symptoms…
  • 4.  Requires social, clerical and technical skills  Phlebotomy is a link between the patient and the laboratory  Apart of the healthcare team
  • 5. To collect blood for accurate and reliable test results Accurate identification and collection procedures are critical Important procedure to assist in the diagnosis and monitoring of patients
  • 6. SAMPLE COLLECTION  PATIENT PREPARATION PRIOR TO TEST  ESR : FASTING  Hb , TLC, DLC, PBF, RED CELL INDICES, RETICULOCYTE COUNT , PLATELET COUNT : NEED NOT FASTING 6 6
  • 7. Identify tests & Determine :  proper volume to be collected *NOTE : ◦ ”.5ml serum/plasma” ◦ = 1ml of whole or un-centrifuged blood) Determine proper procedure based upon age and size of patient Communicate with patient about previous blood collection experiences Collect proper patient identifiers, request and equipment.
  • 9. OUTPATIENTS: Sitting in chair  INPATIENTS: lying in bed or sitting in chair •Position check list: –There is no danger of the patient falling –There is easy access to the arms –The patient is comfortable –There is adequate space to place supplies within reach
  • 12. 5% SAVLON SOLUTION  TINCTURE IODINE  70% ALCOHAL
  • 14.  IV lines  Injuries  Presence of edema  Medication  Patient alertness  Patient emotional and mental status
  • 16. Clean the selected pt. finger with spirit swab  Pick up sterile blood lancet with your right hand.  With your left hand, firmly grasp the pt. middle finger.  make deep stab on the ball of the finger.  Eliminate the first drop.  after that collect blood for require tests…..
  • 17. Blood from capillary network can be used to perform test for which only few drops of blood is required.  Capillary blood is not recommended for those tests which require large amount of blood.  It is not used for platelet count. Suitable for  Hb , TLC, DLC, RBC count by microdilution method.  For preparation of thin blood film to determine blood picture.
  • 18. Blood is collected from the veins of the patient. it is require when the large amount of blood is required
  • 19. Anticubital veins  Radial vein  Dorsal vein
  • 20. Jugular vein Femoral vein
  • 21. Surface of the forearm, Wrist area above the thumb or index finger, Back of the wrist, Knuckle of the thumb or index finger, Foot or ankle, Infants: head veins
  • 22. Choose the veins that are large and accessible.  Large veins that are not well anchored in tissue frequently roll, so if you choose one, be sure to secure it with the thumb of your non dominant hand when you penetrate it with the needle.  Avoid bruised and scarred areas.
  • 23. 1. Median cubital vein - first choice, well supported 2. Cephalic vein - second choice 3. Basilic vein - third choice, often the most prominent vein, but it tends to roll easily and makes venipuncture difficult
  • 24. INAPPROPRIATE SITES  ARM ON SIDE OF MASTECTOMY  EDEMATOUS AREAS  HAEMATOMAS  SCARRED AREAS  ARMS WITH CANULAS  SITES BEYOND IV LINE OF ANY KIND 24 24
  • 26. Apply approximately 3-5 inches above anticubital fossa. (Not more than 1 min)  If the skin appears blanched above and below the tourniquet it is too tight.  If your finger can be inserted between the tourniquet and the patient's skin it is too loose.
  • 27. After tourniquet application have patient clench fist.  Feel for a vein that rebounds (bounces) when pushed or tapped on.  PALPATE any potential vein to help determine size, direction and depth. A slight rotation of the arm may help to better expose a vein that may otherwise be hidden.
  • 28. Tricks to Help Distend Veins: ◦ Have the patient "pump" the hand 3 times.  Don't overdue it because over-pumping can create hemoconcentration ◦ Warm the area with a hot pack or warm, moist cloth heated to approximately 42°C. ◦ If all else fails, consult another technician for their opinion and/or intervention.
  • 29. After selecting a vein, clean the puncture site with a cotton ball saturated with 70% isopropyl alcohol or prepackage alcohol swabs. Rub the alcohol swab in a circular motion moving outward from the site Use enough pressure to remove all perspiration and dirt from the puncture site.  Discreetly look at the swab when finished, if it appears excessively dirty repeat the cleansing process with a fresh alcohol swab. After cleansing do not touch the site, if the vein must be repalpated the area must be cleansed again. Some experts allow cleansing of the index finger before repalpating but this technique is debatable.
  • 30. Clean the selected area with spirit swab.  The patient arm is gripped tightly with the help of tourniquet.  The vein is penetrated by positioning the needle at 20 to 30 degree angle.
  • 31. After blood has been drawn, the patient should release the fist & the tourniquet is also released.  A cotton ball is held firmly over the venipuncture site as soon as the needle is removed.  After removing the needle the collected blood is dispensed in the appropriate tubes.
  • 32. The blood in the anticoagulant tubes are mixed carefully.  The tubes are covered with appropriate stoppers.  the needle should be disposed by using needle destroyer.  Disposed used cotton, syringes into a non- penetrable containers. (Blue basket)
  • 33. Maintain stability of Coagulation Factors  Prevent clot formation in sample prior to testing  Prevent Factor activation in tube - even if clot does not form  Additives in tube must not interfere with individual Coagulation Factors
  • 34.  19 - 21gauge to avoid hemolysis in adults and 21 - 23 for pediatric samples.  Non-wettable, siliconized surface or plastic tubes so as not to activate factors  Contains buffered Sodium Citrate which…Ratio 1:9 1part anticoagulant 9 part blood Sample is mixed by inversion of tube 2 to 3 times.
  • 36.  Consider all patients as potentially infectious  Wear coat or apron when there is a possibility of a splash  Wear mask/eye protection when there is a possibility of a splash  All sharps must be disposed into a puncture- proof biohazard container.
  • 37.  Frequent hand washing is an important safety precaution  Wash hands when changing gloves and between patients if gloves become soiled  Gloves are required to be worn during the phlebotomy procedure  Wear gloves when handling body fluids
  • 38. BEVEL ON UPPER WALL OF VEIN DOES NOT ALLOW BLOOD TO FLOW •SOLUTION •PULL BACK SLIGHTLY THE NEEDLE. •BE ALERT TO HEMATOMA NEEDLE PARTIALLY INSERTED CAUSES BLOOD LEAKAGE INTO TISSUE(HEMATOMA LIKE) •SOLUTION •RELEASE TORNIQUET AND REMOVE NEEDLE •APPLY FIRM PRESSURE OVER SWOLLEN AREA (OR ELEVATE AFFECTED ARM).REASSURE PATIENT THAT BRUISE WILL ASSURE. REPEAT VENIPUNTURE AT A DIFFERENT SITE(OPPOSITE ARM OR DISTAL DISTAL TO ORIGINAL ARM) NEEDLE INSERTED THROUGH BOTH VEIN WALLS •SOLUTION •RELEASE TORNIQUET AND REMOVE THE NEEDLE •APPLY FIRM PRESSURE OVER SWOLLEN AREA(OR ELEVATE AFFECTED ARM).REASSURE PATIENT THAT THE BRUISE WILL RESOLVE. REPEAT VENIPUNCTURE AT A DIFFERENT SITE (OPPOSITE 38 ARM OR DISTAL TO ORIGINAL SITE)
  • 39. COLLAPSED VEIN. REDUCED OR NIL BLOOD FLOW •ALLOW VEIN TO RECOVER BY RELEASING TORNIQUET •REAPPLY TORNIQUET NEEDLE NOT COMPLETELY IN VEIN OR HAS NOT REACHED THE VEIN •ADVANCE THE NEEDLE FORWARD UNTIL YOU FEEL THE „GIVE‟ AS NEEDLE PENETRATES CORRECT INSERTION OF NEEDLE •BLOOD FLOWS FREELY INTO NEEDLE 39
  • 40. FAINTING HAEMATOMA When the needle has Patient become dizzy & gone completely may faint during through the vein & not collection enough pressure is applied. The tourniquet & Should be aware of the needle should be patient condition removed immediately throughout the and firm pressure is procedure applied to the area for atleast 5 min.
  • 41. EXCESSIVE PETECHIAE Small red spots BLEEDING appearing on patient skin, indicating minute Patient on amount of blood anticoagulant therapy escaping into the skin epithelium This defect is due to coagulation defect. Remember to apply pressure to the Make sure bleeding has venipuncture site until stopped before leaving bleeding stops patient side
  • 42. COLLAPSED SEIZURES VEIN This is rarely occur If the syringe during blood plunger is collection withdrawn quickly Immediately call Release tourniquet, for help from the remove syringe nursing station
  • 43. Intravenous HEMO therapy CONCENTRATION Increase conc. Of Veins are visible & larger molecule or palpable but elements in the partially occluded. blood. Prolong tourniquet Avoid arm with IV application. line Exessive massaging or squeezing a site.
  • 45. For many purposes blood may be safely persevered at 4ºC in Refrigerator. EDTA is best preservative for Hemogram. Tri-sodium citrate best for coagulation study.  Before procedure, the blood should be first allowed to warm up to room temperature, then mixed, preferably by rotation, for atleast 2 min.
  • 46. RBCs starts to swell resulting in increase in PCV.  The reticulocytes count decrease as early as 6 hours  Osmotic fragility increases.  Prothrombin time slowly increases.  ESR decreases.  Reticulocytes decreases after 6 hrs.  The red cells may leads to progressive crenation and sphering.  The nucleated red cells disappear from the blood within 1-2 days
  • 47. It is best to count leucocytes and platelets within 2 hours If any delay:  Some but not all neutrophils are affected. The nuclear lobes may become seperated and the cytoplasmic margin may appear less well defined. small vacuoles appear in the cytoplasm  Some of the lymphocytes undergo some changes. Few vacuoles may be seen in the cytoplasm & and the nucleus may undergo major budding so as to give rise to the nuclei with 2 or 3 lobes.  Platelet count, TLC, RBCs count decreases.