2. 1 PowerPoint ® to accompany Second Edition Ramutkowski  Booth  Pugh  Thompson  Whicker Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Medical Assisting Chapter 48

3. 2 Objectives 48-1Discuss the composition and function of blood. 48-2Describe the process for collecting a blood specimen. 48-3Explain the importance of confirming patients' identities and correctly identifying blood samples. 48-4Describe how to perform venipuncture and capillary puncture procedures. 48-5Identify the equipment and supplies required for blood drawing procedures. Collecting, Processing and Testing Blood Specimens

4. 3 48-6Discuss the correct procedures for disposing of waste generated during blood-drawing procedures. 48-7Discuss common fears and concerns of patients and how to ease these fears. 48-9Identify common blood tests and explain their purposes. 48-10Perform certain blood tests. Objectives (cont.) Collecting, Processing and Testing Blood Specimens

5. 4 Introduction You will be responsible for collecting blood specimens and doing some testing in the waived category. You will be introduced to venipuncture and capillary collection procedures. You will also learn techniques for dealing with difficult types of patients and how to efficiently and effectively obtain blood samples.

6. 5 Role of the Medical Assistant  Examination of blood can provide extensive information about a patient’s condition.  Basic understanding of the anatomy and physiology of the circulatory system will help you perform these tasks.

7. 6 Functions of Blood  Heart pumps 8 to 12 pints of blood through more than 70,000 miles of veins, arteries, and capillaries.  Hematology  Hematology – the study of blood  Hematologists  Hematologists – study its function and composition Blood has many functions, all of which are important to overall health of the body.

8. 7 Functions of Blood (cont.)  Blood does all the following:  Distributes oxygen, nutrients, and hormones to body cells  Eliminates waste products  Maintains acid-base balance  Regulates body temperature  Attacks infecting pathogens

9. 8 Composition of Blood  Plasma  Plasma – liquid in which other components are suspended  Red blood cells (erythrocytes)  Red blood cells (erythrocytes) – vital role in internal respiration  White blood cells (leukocytes)  White blood cells (leukocytes) – protect the body against infection  Platelets (thrombocytes)  Platelets (thrombocytes) – crucial to clot formation

10. 9 Apply Your Knowledge What are three functions of blood?

11. 10 Answer Apply Your Knowledge - Answer 1. Distributes oxygen, nutrients, and hormones to body cells 2. Eliminates waste products 3. Maintains acid-base balance 4. Regulates body temperature 5. Attacks infecting pathogens What are three functions of blood?

12. 11 Collecting Blood Specimens  Reading and interpreting the test order  Assembling the equipment and supplies  Preparing the patient  Greeting and identifying the patient  Confirming pretest preparations  Explaining the procedure and safety precautions  Establishing chain of custody  Handling exposure incident

13. 12 Identifying the Patient  Ask patient to state their full name.  Be sure you hear both the first and last names correctly.  Verify that the name the patient gives is the name on the order.  Some places, the phlebotomist may ask for social security, patient ID, or chart number to further identify the patient.

14. 13 Drawing Blood  Some states permit medical assistants to obtain blood samples.  Your office will clarify your duties  Venipuncture – puncture of a vein  Phlebotomy – puncturing a vein with a needle to collect blood into a needle or tube Common Sites for Venipuncture

15. 14 Venipuncture Equipment  Evacuation system (VACUTAINER)  Evacuation system (VACUTAINER) –special double-pointed needle, needle holder, and collection tubes  Needle and syringe system  Needle and syringe system – use a sterile needle and a syringe to draw blood specimen  Butterfly system  Butterfly system – winged infusion set and syringe  Collection tubes –  Collection tubes – must mix blood with appropriate sample containers

16. 15 VACUTAINER  The VACUTAINER system uses interchangeable collection tubes that allow you to draw several blood specimens from the same venipuncture site.

17. 16 Capillary Puncture  Superficial puncture of skin with sharp point to draw small amount of blood.  Collected in small, calibrated glass tubes, slides, or reagent strips.

18. 17 Patient Needs  Alleviate patients fears or concerns  Provide more information about:  Pain  Bruises or scars  Serious diagnosis  Contracting a disease from procedure

19. 18  Children:  Talk with patient or caregivers before working with child  Address them directly  Speak calmly in soothing voice  Explain the procedure briefly in terms they can understand  Keep child informed of status of procedure Special Considerations

20. 19 Special Considerations (cont.)  Elderly Patients:  Changes in skin conditions make elderly patients prone to bruising  Decreased circulation makes it difficult to collect enough blood  Speak in clear, low-pitched tone  Give the patient time to respond to questions

21. 20  Patients at risk of uncontrolled bleeding such as hemophilia or taking blood- thinning drugs  Be careful and alert  Hold cotton ball over the puncture site for at least 5 minutes  Notify physician if bleeding is uncontrollable Special Considerations (cont.)

22. 21 Special Considerations (cont.)  Difficult venipuncture:  Try a second time and then give the patient a rest  Fainting patient:  Position before venipuncture so no injury will occur

23. 22  Angry or violent patients:  Encourage patient to submit to test and then talk with doctor  Do not force the issue  Patient has the right to refuse Special Considerations (cont.)

24. 23 Apply Your Knowledge What is one precaution you can take when drawing blood from a patient who had hemophilia?

25. 24 Answer Apply Your Knowledge - Answer  Hold cotton ball over the puncture site for at least 5 minutes  Be careful and alert  Notify physician if bleeding is uncontrollable What is one precaution you can take when drawing blood from a patient who had hemophilia?

26. 25 Performing Common Blood Tests  Results can aid in the diagnosis of specific conditions, disease, and disorders  Chemicals in lab:  Anticoagulants  Serum separators  Stains

27. 26 Hazardous Waste  Hazardous waste products include:  Blood and blood products  Body fluids and tissue  Cultures  Vaccines  Sharps  Gloves  Specula  Inoculating loops  Paper product contaminated with body fluids

28. 27 Hematologic Tests  Performed on venous or capillary blood specimens  Blood counts  Red blood cells  White blood cells  Platelets  Hematocrit  Hemoglobin Centrifuged Capillary Sample

29. 28  Erythrocyte sedimentation rate (ESR)  Erythrocyte sedimentation rate (ESR) – measures rate at which red blood cells settle to the bottom of blood sample  Put freshly collected blood into calibrated tube and place in sedimentation rack  In one hour determine how far the red blood cells have fallen  Record in mm/hr Hematologic Tests (cont.)

30. 29 Chemistry Tests  Highly detailed tests are not performed in POL labs because of expensive, sophisticated equipment and techniques.  Some tests such as blood glucose monitoring are often performed by medical assistant.

31. 30 Serologic Tests  Detect presence of specific substances in blood samples.  Refer to the introduction of an antigen or antibody into the specimen and to detect specific reaction to the antigen or antibody.  Used to detect disease antibodies, drugs, hormones and vitamins.

32. 31 Immunoassays  Western blot  Western blot – used to confirm HIV  Radio- immunoassay (RIA)  Radio- immunoassay (RIA) – usually performed in reference labs  Enzyme-linked immunosorbent assay (ELISA) –  Enzyme-linked immunosorbent assay (ELISA) – used to diagnose HIV infections

33. 32 Apply Your Knowledge How is a serological test different from a chemistry test?

34. 33 Answer Apply Your Knowledge - Answer Serological tests use the introduction of an antigen or antibody into the specimen to detect specific reactions to the antigen or antibody. How is a serological test different from a chemistry test?

35. 34 Summary Medical Assistant Successful phlebotomy procedures require not only superior technical skills but also excellent interpersonal communication skills. You may be called on to complete certain testing procedures or to explain the purpose of tests to patients.

36. 35 End of Chapter