Lab Procedures Chapter 47: Venipuncture and Blood Collection Chapter 48: Hematology Part 2 Professor Fowler

Functions of Blood Transportation Protection Carries oxygen and nutrients to body and removes waste products to liver, kidneys and skin for elimination Protection White blood cells work with immune system to fight pathogens Heart, arteries, veins and capillaries Heart pumps blood Arteries: blood away from the heart Thick walls that allow to withstand pressure sustained when heart is pumping Blood contains oxygen Veins: blood towards the heart Blood contains high carbon dioxide Capillaries: where arteries meet veins – smallest vessels Blood regulates body temperature Warm: dilate to release heat Cold: constrict to retain heat

Blood Specimen Collection Blood and body fluid collection strictly regulated by OSHA regulations and CDC standard precautions CLIA sets standards that all labs must adhere to Always follow guidelines established by these organizations

Venipuncture Sites Figure 47-4 Antecubital space (depression in front of elbow) is the most commonly used site Four large veins in antecubital with easy access making this site ideal Most common vein used is median cephalic vein

Venipuncture Methods Vacuum tube Syringe and needle Butterfly Most common method Use large vein as small veins can collapse Procedure 47-3 (mannequin arm and live – practical) Syringe and needle Uses smaller vein and needle to get less blood Procedure 47-2 on mannequin arm Butterfly Used for small veins using smaller needle, tubing and vacuum tube costly

Venipuncture Equipment Wear PPE(gloves and lab coat/gown) Should be assembled and expiration dates checked before attempting use Important to fill the tubes in the order of draw recommended by Clinical Laboratory Standards Institute (CLSI) in order to prevent contamination of the tubes with skin bacteria or additive from another blood tube Vacuum tubes come in 5mL, 7mL, 10mL and 15mL Invert the tube 6-8 times so the anticoagulant and blood have mixed properly – DO NOT SHAKE as this will hemolyze the blood

Order of Draw Order of Draw Figure 47-16 tube colors, additives, inversions, and lab uses Some labs may use additional tubes like pink, tan-black, and royal blue

Venipuncture Patient preparation Challenges (Chapter 47) Fasting (lipid, GTT, FBS) Anxious patients Children Challenges (Chapter 47) Hematoma Patient refusal Stress Failure to Obtain Blood Specimen Problems Blood Cultures

Venipuncture Unexpected events Complications Fainting – immediately withdraw needle, and request pt lower head and arms or lie down – ammonia is available to help revive pts – if does not respond, call another member Nauseous – pt breathe deeply through mouth and provide basin Excessive anger – remain calm and reassuring – if continues or is disruptive, stop procedure Uncontrollable bleeding – apply pressure and call for assistance Complications Small veins (warm compress applied) Rolling veins (place one finger below where needle to go) Incomplete draw/not enough blood (may request more experienced professional)

Capillary Puncture Capillary puncture (manual) – Procedure 47-1 (47-4 black WB) Puncture sites Adults: fingers and earlobes Infants: heels Equipment and supplies

Preparing Slides Preparing blood slides procedure 48-4 (47-8 black WB)