November 17, 2023

Create a study guide for Chapter 9: Phlebotomy Collecting and Processing Patient Blood Specimens.? You will submit one document, either Word or PDF. You need to include an outline that s

Create a study guide for Chapter 9: Phlebotomy Collecting and Processing Patient Blood Specimens. You will submit one document, either Word or PDF.

You need to include an outline that shows a detailed explanation of each area, indicating you understand the concept. In addition, create a table or chart indicating the color of tubes, preservatives, and the standard test run from each tube.

In this summary, be sure you define the vocabulary and answer the objectives presented in this lecture. Show me your work, not something cut from the internet.

Chapter9PhlebotomyProcedures.pdf

206.e1CHAPTER 9 Phlebotomy: Collecting and Processing Patient Blood Specimens

Initiation of the Venipuncture Procedure

Selection of an Appropriate Site Obtaining a blood specimen from an intravenous (IV) line should be avoided because it increases the risk of mixing the fluid with the blood sample and producing incorrect test results.

Turgeon: Clinical Laboratory Science 9th Edition

Venipuncture: Evacuated Tube Technique

See Chapter 9 of Clinical Laboratory Science: Concepts Procedures and Clinical Applications 9th Edition, for a complete discussion of this procedure. Student Learning Outcomes After reading Chapter 9, and at the completion of this laboratory exercise and the review questions, the student will be able to:

• Correctly perform a venipuncture. • Complete the end-of-procedure review questions with a grade

of 80% or higher.

Reagents, Supplies, and Equipment 1. Test requisition 2. Tourniquet 3. Disposable gloves 4. Sterile disposable safety needle in needle holder 5. Various evacuated blood collection tubes 6. Alcohol (70%) disposable prep pads or alcohol and sterile

gauze squares 7. Adhesive plastic strips 8. Optional: Model practice arm

Read the list of required equipment and supplies and the procedural steps. Follow the procedural steps in exact order.

STUDENT PROCEDURE WORKSHEET 9-1

SEQUENCE PROCEDURAL STEP

INSTRUCTOR- OBSERVED ACCEPTABLE PERFORMANCE (CHECK IF ACCEPTABLE)

1 Properly identify the patient. Ask patient to spell his or her name. See General Protocol, #2.

2 Assemble all necessary equipment and evacuated tubes at the patient’s bedside.

3 Put on disposable gloves using proper technique (see Fig. 2.4).

4 The plastic shield on a needle is to remain on the needle until immediately before the venipuncture.

5 The evacuated tube is placed into the holder and gently pushed until the top of the stopper reaches the guideline on the holder. Do not push the tube all the way into the holder, or a loss of vacuum will result.

6 Visually inspect both arms. Choose a site that has not been repeatedly used for phlebotomy. In the arm, three veins are typically used for venipuncture: the cephalic, basilic, and median cubital (Fig. 9.12).

(Continued)

Instructions for the Procedure

Fig 9.12Fig 9.12

206.e2 PART II Basic Clinical Laboratory Specializations

8 To make the veins more prominent, ask the patient to make a fist. With the index finger, palpate (feel) for an appropriate vein. The ideal site is generally near or slightly below the bend in the arm.

Preparation of the Venipuncture Site

9 After an appropriate site has been chosen, release the tourniquet.

Turgeon: Clinical Laboratory Science 9th Edition

STUDENT PROCEDURE WORKSHEET 9-1

SEQUENCE PROCEDURAL STEP

INSTRUCTOR- OBSERVED ACCEPTABLE PERFORMANCE (CHECK IF ACCEPTABLE)

(Continued)

7 Apply the tourniquet (Fig. 9.13). Do not leave the tourniquet on for more than 1 minute. Prolonged tourniquet application can elevate certain blood chemistry analytes, including albumin, aspartate transaminase (AST), calcium, cholesterol, iron, lipids, total bilirubin, and total protein.

——————————————————————————————————————————————————————————————————————————————————————————————————————-

Fig 9.13Fig 9.13

206.e3CHAPTER 9 Phlebotomy: Collecting and Processing Patient Blood Specimens

Turgeon: Clinical Laboratory Science 9th Edition

——————————————————————————————————————————————————————————————————————————————————————-

STUDENT PROCEDURE WORKSHEET 9-1

Performing the Venipuncture Avoid touching the cleansed venipuncture site.

SEQUENCE PROCEDURAL STEP

INSTRUCTOR- OBSERVED ACCEPTABLE PERFORMANCE (CHECK IF ACCEPTABLE)

(Continued)

10 Using an alcohol pad saturated with 70% alcohol, cleanse the skin in the area of the venipuncture site. Using a circular motion, clean the area from the center and move outward. Do not go back over any area of the skin once it has been cleansed.

11 Allow the site to air-dry.

13 Hold the safety needle with attached holder about 1 to 2 inches below and in a straight line with the intended venipuncture site. Position the blood-drawing unit at an angle of about 20 degrees. The bevel of the needle should be upward (Fig. 9.14).

Termination of the Procedure

14 Insert the needle through the skin and into the vein. This insertion motion should be smooth. One hand should steady the needle holder unit while the other hand pushes the tube to the end of the plastic holder. It is important to hold the needle steady during the phlebotomy to avoid interrupting the flow of blood.

15 Multiple samples can be drawn by inserting each additional tube as soon as the tube attached to the needle holder has filled.

16 If required, gently invert tubes with anticoagulant or additive to mix.

17 The tourniquet can be released as soon as the blood begins to flow into the evacuated tube or syringe or immediately before the final amount of blood is drawn.

18 Ask the patient to open the hand.

12 Use one hand to hold the evacuated tube assembly. Position the patient’s arm in a slightly downward position. Use one finger or thumb of the opposite hand to secure the skin area of the forearm below the intended venipuncture site. This will tighten the skin and secure the vein.

Fig 9.14Fig 9.14

206.e4 PART II Basic Clinical Laboratory Specializations

(From Warekois RS, Robinson R: Phlebotomy: Worktext and procedures manual, ed 3, St Louis: Saunders;2012.)

Turgeon: Clinical Laboratory Science 9th Edition

STUDENT PROCEDURE WORKSHEET 9-1

SEQUENCE PROCEDURAL STEP

INSTRUCTOR- OBSERVED ACCEPTABLE PERFORMANCE (CHECK IF ACCEPTABLE)

19 Withdraw the blood-collecting unit with one hand, and immediately press down on the gauze pad with the other hand after the desired amount of blood has been drawn.

20 If possible, have the patient elevate the entire arm and press on the gauze pad with the opposite hand. If the patient is unable to do this, apply pressure until bleeding ceases.

21 Place a nonallergenic adhesive spot or strip over the venipuncture site. Failure to apply sufficient pressure to the venipuncture site could result in a hematoma (a collection of blood under the skin that produces a bruise).

22 Mix tubes with anticoagulant by inverting the tubes several times (see manufacturer's requirements in Table 4.5). Do not shake the tubes. Discard the used equipment into an appropriate sharps puncture-proof container.

24 Clean up supplies from the work area and phlebotomy tray, remove gloves (see Fig. 2.4 for correct method of glove removal), dispose of them in a biohazard container, and wash hands (see Chapter 2).

25 If the patient is an outpatient, wait a few minutes after the venipuncture is complete, and check to be sure the patient does not feel dizzy or nauseated before discharge. Disinfect the work area.

23 Label all test tubes as required by the laboratory.

(Continued)

206.e5CHAPTER 9 Phlebotomy: Collecting and Processing Patient Blood Specimens

1. How would you select an appropriate vein for a venipuncture procedure?

2. What is the proper order of draw for evacuated blood collection tubes?

3. Why is it important to gently mix evacuated blood tubes with anticoagulants or additives?

Turgeon: Clinical Laboratory Science 9th Edition

Venipuncture: Evacuated Tube Technique

Review Questions

STUDENT PROCEDURE WORKSHEET 9-1

Procedural Evaluation

Student’s Name _________________________________ Grade____________

Instructor’s Signature _____________________________ Date____________

Comments:

206.e6 PART II Basic Clinical Laboratory Specializations

Selection of an Appropriate Site

Turgeon: Clinical Laboratory Science 9th Edition

Blood Collection: Capillary Puncture

• Correctly perform a capillary puncture. • Complete the end-of-procedure review questions with a grade

of 80% or higher.

Reagents, Supplies, and Equipment 1. Test requisition 2. Disposable gloves 3. Sterile disposable blood lancets 4. Alcohol (70%) disposable prep pads 5. Sterile gauze squares 6. Adhesive plastic strips 7. Equipment specific for the test ordered: glass slides for blood

smears, microhematocrit tubes, microcollection vials 8. Optional: Practice model of foot

Read the list of required equipment and supplies and the procedural steps. Follow the procedural steps in exact order.

STUDENT PROCEDURE WORKSHEET 9-2

SEQUENCE PROCEDURAL STEP

INSTRUCTOR- OBSERVED ACCEPTABLE PERFORMANCE (CHECK IF ACCEPTABLE)

1 Assemble equipment and supplies.

2 Wash your hands and put on gloves and eye protection as directed.

3 Usually the fingertip of the third or fourth finger, and the heel are appropriate sites for the collection of small quantities of capillary blood. The earlobe may be used as a site of last resort in adults. NOTE: Do not puncture the skin through previous sites, which may be infected. The plantar surface (sole) of the heel is an appropriate site in infants or in special cases such as burn victims. The ideal site in infants is the medial or lateral plantar surface of the heel, with a puncture no deeper than 2 mm beneath the plantar heel skin surface and no more than half this distance at the posterior curve of the heel (Fig. 9.15). CLSI recommendations are not to use fingers of infants. The back of the heel should never be used because of the danger of injuring the heel bone, cartilage, and nerves in this area.

(Continued)

Instructions for the Procedure

Fig 9.15Fig 9.15

206.e7CHAPTER 9 Phlebotomy: Collecting and Processing Patient Blood Specimens

4 The site of blood collection must be warm to ensure the free flow of blood.

5 Hold the area to be punctured with the thumb and index finger of a gloved hand.

7 Wipe the area with a dry gauze square. If the area is not dry, the blood will not form a rounded drop and will be difficult to collect.

9 Securely hold the area, and puncture once (perpendicular) with a firm motion (Fig. 9.16). NOTE: The incision must be perpendicular to the fingerprint or heelprint.

8 Use a disposable sterile lancet once, and discard it properly in a puncture-proof container.

6 Wipe the area with a 70% alcohol pad and allow to air-dry.

Preparation of the Site

Puncturing the Skin

(Continued)

Turgeon: Clinical Laboratory Science 9th Edition

STUDENT PROCEDURE WORKSHEET 9-2

SEQUENCE PROCEDURAL STEP

INSTRUCTOR- OBSERVED ACCEPTABLE PERFORMANCE (CHECK IF ACCEPTABLE)

10 Wipe away the first drop of blood, because the first drop of blood is mixed with lymphatic fluid and possibly alcohol.

13 Remove gloves and discard into biohazard container.

14 Wash hands using proper procedure.

Optional: Clean any unused equipment and return to proper storage. If procedure is not performed bedside, clean work area with disinfectant solution.

11 Apply gentle pressure to the area to obtain a suitable specimen.

12 Discard used lancets in a sharps container and discard gauze and other contaminated supplies into a red bag biohazard container.

Fig 9.16Fig 9.16

206.e8 PART II Basic Clinical Laboratory Specializations

Turgeon: Clinical Laboratory Science 9th Edition

STUDENT PROCEDURE WORKSHEET 9-2

1. Describe appropriate sites for collection of capillary blood.

2. Why is the first drop of blood wiped away from the puncture site?

3. If a baby’s heel feels cold, what can you do to promote blood circulation in the foot?

Review Questions

Procedural Evaluation

Student’s Name _________________________________ Grade____________

Instructor’s Signature _____________________________ Date____________

Comments:

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Create a study guide for Chapter 9: Phlebotomy Collecting and Processing Patient Blood Specimens.? You will submit one document, either Word or PDF. You need to include an outline that s

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