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VENIPUNCTURE
- Deoxygenated blood; contains subs that come from
metabolic activities of diff organs.
- Blood chemistry & immunologic studies.
- More easily collected than arterial blood.
SITES OF VENIPUNCTURE:
ANTECUBITAL FOSSA VEINS median cubital vein (most
preferred because it is large, most stationary and closer
to the surface) located near the center of the antecubital.
MEDIAN CEPHALIC VEIN 2ND vein of choice, fairly well
anchored & often the only vein that can be felt by obese
patients.
MEDIAN BASILIC VEIN last vein of choice, not well
anchored and roll easily.
OTHER VEINS: LEG, ANKLE & FOOT VEINS needs
doctors permission.
OTHER VEINS: HAND & WRIST VEINS but not the
underside of the wrist.
METHODS OF VENIPUNCTURE:
a.SYRINGE METHOD (most conventional)
- Single sample needles specifically for syringes
- Barrel, plunger, needle, needle holder (5&10), hub,
bevel
b.
EVACUATED TUBE SYSTEM (ETS)
- Multiple-sample needles should be used if more than 1
tube of blood is to be collected during venipuncture
(prevent leakage during tube changes).
- Gel: barrier bet serum & cells
- Marked w/ expiration date (lost vacuum/ ineffective
additive)
- Correct blood-AC ratio
- Needle: 2 way longer for tube; other for vein
c. BUTTERFLY INFUSION SET
- Stainless steel beveled needle with attached plastic
wing to facilitate needle insertion.
- Plastic tubing connects needle to adaptor- screws into
a tube holder = modified evacuated system or a syringe
can be attached to collect blood.
- For pediatrics/ babies & geriatrics
*gauge: bigger number = smaller bore (21: ideal; 26: blood
donation)
VENIPUNCTURE PROCEDURE:
1. Review & assessing of the Test Request
Completeness of patients request & the necessary
preparation (name, test, condition, etc.)
2. Identifying & Positioning the patient
Observe professionalism in approaching the patient.
Position the patients arm in a way comfortable for
both patient & you.
The arm must be supported by a firm surface.
Ask the patient his arm preference.
3. Prepare equipment
Needle & evacuated tubes or syringe.
4. Applying tourniquet to select the vein
- Downward angle position of arm, using force of gravity
to visualize vein.
- Site must be free of skin abrasions, lesions & scar
tissues.
- Select the well anchored vein of the arm.
- Remove the tourniquet to prevent hemoconcentration.
- 3 mins application increases CHON, Fe, AST, Bb & total
lipids
- Repeated fist clinching increases K+ 1-2nm
5. Applying the antiseptic (wet then dry)
- Cleanse with 70% isopropyl alcohol in Circular motion
(inside to out).
- Air drying permits maximum antiseptic action, prevents
contamination, avoids stinging on needle entry and
prevents hemolysis.
6. Reapplying tourniquet
Tight enough to increase pressure not so tight to cut
circulation.
7. Inserting the needle
5. EDTA
Lavender Top
6. Glycolytic inhibitor (NaF)
Gray Top
*SPS Sodium Polyanethol Sulfonate
*Clot coagulation tests if without the need for
yellow top tube, use a plain/red top tube before the
blue top tube (1st drop is discarded because it can
speed up clotting)
*Gel VS Non-gel: serum or plasma separator tubes
maybe unacceptable for some analytes
(therapeutic drug)
ACTION
Chelates calcium
USE
Hematologic
assays, lead
assays, CEA
determination &
cell counts
RED
ADDITIVE
EDTA
Versene
(disodium
salt)
Sequestrene
(dipottasium
salt)
none
Allow blood to
clot
RED/ GRAY
OR RED
BLACK
None;
separator
material
ORANGE
thrombin
BLUE
Buffered
citrate
Allows blood to
clot; barrier
between cells &
serum
Accelerated
clot
Binds Ca
Most chemistry,
immunologic &
blood bank tests
Most chemistry
tests
BLACK
Buffered
sodium citrate
NaF/
K2C2O4
GRAY
Binds Ca
Inhibits
glycolytic
enzymes
Iodoacetate
enolase & acts
as AC
STAT serum
test
Coagulation
assays like PT &
APTT
Westergren ESR
Glucose
determination
YELLOW
GREEN
Citrate
dextrose
Heparin (Na+.
Li+ or NH4+)
Inhibits
glyceraldehyde
s 3-phosphate
dehydrogenase
Preserves RBC
Inhibits
thrombin BGA,
ammonia CO-Hb
Blood culture
Active &
methemoglobin
2.
3.
-
ARTERIAL PUNCTURE
- Oxygenated blood; uniform composition throughout body.
- Used to measure Oxygen tension , Carbon dioxide
tension & blood pH.
- BLOOD GAS ANALYSIS (BGA): critical to patients with
pulmonary problems, oxygen therapy, cardiovascular
problems & those undergoing major operations.
- Sites: RADIAL, BRACHIAL & FEMORAL ARTERIES
- Radial & brachial: preferred sites
- Newborns: umbilical artery catheter
- Brachial: 18-20 gauge, 45-60O
- Radial: 23-25 gauge, 90O
- Heparin is used as anticoagulant.
DISADVANTAGES OF VENIPUNCTURE:
Harm on infants, children & obese individuals.
Requires more time & skill on the part of the operator.
More complications may arise.
COMPLICATIONS IN VENIPUNCTURE:
1.
LOCAL IMMEDIATE COMPLICATIONS
- Hemoconcentration
- Failure of blood to enter syringe
- Circulatory failure
- Fainting or syncope
2.
LOCAL DELAYED COMPLICATIONS
- Hematoma
- Thrombosis of vein
- Thrombophlebitis
3.
GENERAL DELAYED COMPLICATIONS
- Serum hepatitis
- AIDS
- HIV
SST clot activator reduce clotting time
PST green/ gray
- Li Heparin w/ gel
- Electrolytes, routine chem. (invert 505x)
Trace element tube: heparin, EDTA or none
SPS: Soidum/ Polyanithol sulfonate (micro)
ACD acid citrate dextrose (HLA typing)
PARTS:
1. needles
- adults: 20, 21
SPECIMEN INTERFERENCE:
A. LYSIS OF CELLS (HEMOLYZED SERUM)
Leakage of intracellular substances
Lysis of RBC = lacking/ hemolysis (in vivo or in vitro)
In vitro hemolysis is due to (common):
1. Use of vacuum tubes
2. Vigorous mixing
3. Use of too narrow/ too wide needle bores
4. Effect of alcohol (have to air dry)
5. Centrifugation & separation steps
Hemolysis is visible only not until a 200mg/L of Hb level.
B. ICTERSIA (ICTERIC SERUM)
Intensely yellow serum sample due to elevated bilirubin
value.
Jaundice: Bilirubin is greater than 430uM (25mg/L).
Bilirubin interferes with test using dyes & turbidity test.
PROCEDURE:
1.
ID patient
2.
Reassure
3.
Assemble equipment
4.
Prepare finger
5.
Puncture finger
6.
Eliminate 1st drop
7.
Produce large rounded drop
8.
Withdraw/collect blood
9.
Stop bleeding
Acetone
Blood ammonia
Catecholamines
FFA
Angiotensin converting enzyme
Lactic acid
Pyruvate
Renin activity
THINGS TO REMEMBER:
All materials should be dry & sterile to avoid hemolysis.
Never puncture or draw blood from vein where IV
medication is running. (false low/decrease)
Site of puncture should be thoroughly clean to avoid
Thrombophlebitis.
Tourniquet should be tied not too tight it may constrict
the arteries and veins.
Remove needle from adaptor of syringe & allow blood to
flow gently down sides of tube.
Containers are to be stoperred & those anticaogulated
tubes are to be inverted several times (6-10).
Needles should be properly disposed into the sharp
container
Always wear your PPE.
Reusable syringes: rinsed w/ tap H2O.
Tourniquet must always be released before withdrawing
needle from vein.
SPECIMEN COLLECTION VARIABLES:
1. TOURNIQUET: >3 minutes increases total protein
(TP), Iron, AST, Bilirubin and total lipids.
2. IV SITE: above IV should be avoided, below IV turn
off 2-5 minutes & discard first 5 mL.
3. CLEANING AGENTS: Betadine (Povidone Iodine)
FALSE HIGH, Phosphorous, Uric acid & Potassium.
4. SOURCE OF SAMPLE: