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3. Metric System Length Volume Weight Meter Centimeter Millimeter
Liter (L)
Deciliter
Milliliter (ml)
Cubic centimeter (cm3)
Kilogram
Gram (g)
Milligram (mg)
The United States the only country in the world that does Not use the metric system: all other countries have used metric for many years! Metric is used to describe the sizes of the tubes used for blood collection and other measures in the lab. So we will need to have some knowledge of the metric system.
A meter is a measure of length—it is a about 3” longer than our Yard. Liter is measure of volume. We are used to seeing this when we buy a 2 liter bottle of cola. Then the wt. is in kilograms. Drs use the metric system esp in pediatric practices to determine by weight the amount of medicine to give to small children and babies. All the prefixes before each of these words gives us whether it is more or less than than just the stated value. Centi meaning one-hundredth
In the lab you will hear most lab test requirements mentioned in terms of how many milliters is needed to perform the test. A ml and cubic centimeter are the same measure just stated in a different term.
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4. Metric System (cont.) Temperature Time Measured in degrees Celsius
98.6°Fahrenheit =
37° Celsius
Reported as a 24-hour clock.
6:00 p.m. = 1800
Do a drawing of the metric measure for temps compared to the temps in fahrenheit. (just draw a straight line with 212 at top ansd 100 celsius. Then add the temp for body temp at 98.6 and 37 celsius. Add room temp at 72 compared to 25 celsius…then freezing at 32 and 0 celsius. Celsius is also called centrigrade.
Military time used to set times in some instances = 1 am up to 1200 which is noon. Anytime after that, if you are not sure: take 1600 and subtract 1200 and you know it is 4pm etc
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5. Syringe oldest system in use reserved for “hard to stick” or “fragile veins”
Syringe with safety needle. Top: ready for use. Bottom: safety system engaged.
Will see a “flash” of blood in the needle hub when the needle enters the vein.
Syringes are used for difficult to draw patients with thin, fragile or “rolly” veins that tend to collapse. Used for the “little ole lady syndrome” . Years ago the syringes were glass and had to be washed and autoclaved to be used again. Today there are syringes that will draw only 3cc or any part less than that. When using a syringe you will have a “flash” of blood in the needle when you enter the vein. For this reason they are great because you know you are in the vein. They are better on fragile veins because the pull you exert on the vein can be controlled by you…with the vacutainer system…the pulled is controlled by the vaccum in the tube. On fragile or tiny veins too much vacuum can cause the vein to collapse on the top of the bevel of the needle and stop the blood flow. So this is an option you can use if needed. Always tho before using the syringe be sure that you pull the plunger back and push it all the way back down before staring the drawing process because sometimes the plunger is not easy to pull at 1st. Be sure it is all the way back down – you do not want to introduce any air into the vein with your draw.
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6. Syringe Use is Limited Difficult – to - draw patients
Fragile, thin, “rolling” veins
Pediatric or geriatric patients
Veins on back of hand
Syringe use is limited because they are more expensive to use. They are an option tho to always keep in mind. There are other options for drawing purposes mentioned in your text. Pictures are on page 130.
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7. Needle Use Gauge Needle Use 25 gauge 23 gauge 22 gauge 21 gauge
Intramuscular injection
Butterfly or syringe collection Syringe or evacuated system
Syringe or evacuated system
IVs or blood donation
Gauge is the measure of the size of the opening of the bevel of the needle. The size is in reverse to the # of the gauge. The larger the # the smaller the opening in the needle. Most often in blood draws you will use a 21 or 22 gauge.
The 18 and 16 gauge will leave a mark on your arm—they are used mostly at blood collection centers. I once had a co-worker who donated plts. They would draw out a unit of blood , centrifuge the unit and remove the buffy coat area with the plts and then give back her blood. She had a mark in her arm where this was done that was always there.
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8. Evacuated System Often called Vacutainer
System uses a double-pointed needle.
Example:
Engineering
Controls
System uses a double-pointed needle. One end of the needle enters the patient’s vein, the other punctures the rubber stopper of the vacuum tube. This system is a registered trademark of B-D(becton-dickinson company) because the labs needed ways to draw multiple samples.
A rubber sleeve covers the tube end of the needle to prevent leakage. This rubber sleeve slides up and allows you to draw as many tubes as required for your pt. It could be 2 or 10. This safety needle is a eng. Control. The needle guard is there also to help protect you from sticking yourself by allowing you to close the guard over the needle in as safe a manner as possible.
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9. Vacutainer Top: needle holder with safety device attached to holder
Bottom: needle holder with safety device on needle
Here are 2 different needle holders. Each healthcare facility will have their own kind of needle holder. So when you start working, you will be using what they use but it should be some type of eng. Control device. Most all these needle holder are meant to be disposed off after using only 1 time. Some facilities may have a type that is not disposable—they will instruct you about how they expect you to use all their equipment for veinipuncture. Either way the needle holders will have a guard..it could be attached to the needle or to the holder itself.
The recommended length of the needle is 1’”to 1 1/2’”. You will get used to choosing your needle by the color mostly—green or black.
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10. Vacutainer Collection Tubes
Tubes can contain gel to separate cells from the serum or plasma.
SST
Tops on right =
hemogard
Some tubes contain silica particles on the sides of the tubes to activate clot formation. This is true with the tiger topped and gold tubes. Some also contain the gel barriers as seen here. Once the specimen is centrifuged the gel will separate the clot from the serum—this is called SST and is medium in wt between the serum and cells so that in centrifugation the gel is pushed to the middle between blood and serum or plasma. This type of tube is good for stabilizing samples before they can be tested and for storage.
Hemogard tube is another example of an eng. Control.
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11. Vacutainer Collection Tubes
Tubes are different sizes and contain different types of anticoagulant.
Collection tubes contain a vacuum to pull the blood from the patient. The tubes have a preset amount of vacuum accord to the size of the tube. These tubes are most commonly referred to as vaccutainer tubes (a system of tubes made by Becton-Dickinson) but could be made by another company other than BD. The colored tops of these tubes are called Hemogard caps. There is a good picture of a cut away of a Hemogard tube on page 139 in text. They are to benefit the worker in the lab so when the top is popped off the tube no aerosols escape. All tubes have expiration dates and can be used thro the end of that month/year. Most of these tubes now are plastic rather than glass. Only recently could the plastic made hold the vacuum properly to fill correctly.
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12. Vacutainer Collection Tubes
Centrifugation of a separator gel tube causes the gel to form an interface between the cells and the serum or plasma.
Many of the instruments in the lab now test direct from the tube. So the SST tube is used frequently for this reason.(esp, in the chemistry dept). When samples are centrifuged the cellular components, serum or plasma and the gel are separated by weight. This tube can be place directly on whichever instrument to have the test requested performed since most lab instruments today are made to use the tube the blood was collected in.
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13. Anticoagulants
Anticoagulants are used to keep the blood from clotting so that whole blood or plasma can be used in testing.
A CBC is a test that requires a whole blood specimen and contains anticoagulant also. You should always mix this lavender topped tube gently after you collect it to ensure the anticoagulant is well mixed with the blood and there are not tiny clots in your specimen.
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14. Anticoagulants (cont.)
Anticoagulants stop the clotting process by:
1. removing the calcium or
2. stopping the prothrombin to thrombin reaction.
Heparin works in the #2 step…all the other anticoagulants bind the calcium in the cells.
The green top heparin tube is the only tube that acts by stopping the prothrombin to thrombin reactionl.
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15. Anticoagulants (cont.) p. 145
Basic anticoagulant tubes
Gray top: potassium oxalate/sodium fluoride
Light blue top: sodium citrate
Lavender top: EDTA
Green top: lithium of sodium heparin
Royal blue top: EDTA, sodium heparin, or no additive
** Know which tube for which common tests!
Gray: word to remember is the oxalate…most commonly referred to by that word. Used to draw glucoses to help the glucose to remain stable for a longer period of time. Chem
LT, Blue: Citrated tube used for coagulation tests like the PT, PTT, fibrinogen --coag dept Must always be filled properly or will be refused because results will be inaccurate…these tubes fill to provide required 1:9 anticoagulant to blood ratio.
Lavender: EDTA --has a long name but just remember EDTA -- used for the CBC and goes to Hematology
Green: lithium or sodium heparin. Only tube that prevents clotting by stopping conversion of prothrombin to thrombin. Usu. Used most often in chemistry for Ammonia levels—now more for stats as well. Can be light or dark green with or without gel, but all contain heparin.
Royal blue: these tube are chemically cleaned inside so that they do not add to the element being tested for when the blood is drawn. Most people being tested for these would have a very low level normally. They are used for trace elements like, lead, arsenic and mercury. People working in some hazordous industries are most likely the ones to have these tests drawn. With or without additive..just remember chemically clean
Most hospitals are using computers now so all the labels that will be printed out for you will have the pt information along with the test name and the type and size of specimen you would need. Like jane doe, hosp #, and she needs a PT, to be drawn in a blue top tube.
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16. Butterfly Collection System
Butterfly collection system is for small, difficult veins.
These butterfly collection systems are great for pediatrics. The needle size is the same as the regular 1” needle they are just shorter in length. The line tho allows movement that is pretty common when drawing children. Plus it has the added benefit( like a syringe) that when you are in the vein you immediately have blood return in the lower portion of the line or top portion of the needle so that you know you are in the vein. They are commonly used more now than when they 1st came to the labs. Then they were quite expensive—now not as bad. They are good to use in hand veins, esp on the little ladies or men who have tiny rolly fragile veins. The older we are the more fragile are veins become and sometimes they just cannot take a vaccutainer tube. Even the butterfly may cause the vein to “blow” as we say and cause a large bruise.
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17. Microcollection Equipment
Lancets are used to puncture the finger or heel.
Depths of puncture will vary depending on the type of lancet used. They are colored coded just as your tubes are for the depth and width they will puncture. Be sure you hold them tight to the heel or finger or you will not get a good puncture. Then have to do the puncture again.
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18. Microcollection Equipment (cont.)
Microcollection tubes are used to collect blood samples.
Anticoagulants in micro devices are the same as in evacuated tubes.
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19. Tourniquets
Tourniquets constrict the venous blood flow to make the veins more prominent.
Tourniquets can be latex or nonlatex.
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20. Tourniquet Use Soiled tourniquet must be discarded
Follow specific institution rules on tourniquet use between patients
NEVER leave tourniquet on patient or in patient room
There is just something about folks wanting your tourniquets. They seem to have all kinds of ideas about what they could do with one. Mostly you do not want to contribute to someones drug habit by leaving them your tourniquet. Always be sure to untie your tourniquet before you take your needle from your puncture site…otherwise you will have a bloody mess to explain.
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21. Tourniquet Use Apply 3 to 4 inches above venipuncture site
Slows blood flow, but should not stop!
Pumping of the hand should be avoided
Hemostasis (hemoconcentration) can occur.
Potassium (K+) levels affected
Most pts will think they should pump their hand…just them not to with a brief explanation that it could alter some of their lab results. The potassium level is most commonly affected esp if the tourniquet is on too long or the pt has pumped their hand.
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