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Fundamentals Of Phlebotomy
Second Edition
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Table of Contents
Phlebotomy: The Historical Perspective History Devices Used for Drawing Blood Universal Precautions & Biosafety Techniques Infection Prevention Human Anatomy & Physiology Skin Layers General Structure: Arteries and Veins The Tourniquet Assembling the Equipment Blood Collection: Routine Venipuncture & Specimen Handling Venipuncture Procedure Order Form/Requisition Form Labeling the Sample Equipment Order of Draw Venipuncture Site Selection Performance of a Venipuncture Troubleshooting Performance of a Fingerstick Blood Collection on Infants Additional Considerations Safety & Infection Control Possible Complications from Phlebotomy Problems Obtaining a Specimen Patient Complications Blood: Samples & Collection Types of Blood Samples Collection Tubes Special Procedures Crossmatches Blood Culture 4 4 5 7 8 10 10 14 20 22 24 24 25 27 27 28 31 31 33 39 40 41 42 43 43 43 45 45 45 53 53 54
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PHLEBOTOMY Oral Glucose Tolerance Test (GTT) General Collection Requirements Special Collection Techniques Collecting a Blood Sample Using a Butterfly Needle Syringe Drawing Blood Using a Lancet for Microdraw or Infant Heel Stick Measured Bleeding Time Arterial Puncture Glossary Resources Appendix A: Order of Draw for Multiple Tubes Appendix B: Sample Requisition Form Appendix C: Hepatitis Overview Appendix D: Proper Glove Removal 55 56 59 60 62 63 65 69 96 i ii iii xi Medtexx Medical Corporation -3- .
When the patient became faint. By the end of the 19th century (1875-1900). Meaning of 'Phlebotomy' The term 'Phlebotomy' suggests the taking of Blood only. The draining of 16-30 ounces (1-4 pints) of blood was typical. The pole itself represented the stick squeezed by the patient to dilate the veins.). This subject is not only concerned with "blood letting". The art of blood letting was flourishing well before Hypocrites in the fifth century B. By the Middle Ages. Bleeding was often encouraged over large areas of the body by multiple incisions. meaning incision. History 'Phlebotomy' comes from the Greek word phlebos. starving. The practice of bloodletting seemed logical when this foundation of all medical treatment was based on the four body humors: blood. died from a throat infection in 1799 after being drained of nine pints of blood within 24 hours. Tomb paintings from this time show the application of a leech to a patient. but rather the whole range of skills and knowledge necessary for the collection of viable specimens for later analysis in a laboratory. Health was thought to be restored by plugging.S.PHLEBOTOMY PHLEBOTOMY: THE HISTORICAL PERSPECTIVE Objective This lecture will concentrate on the historical perspective of phlebotomy. both surgeons and barbers were specializing in this bloody practice. The removal of this "excess" was thought to restore this balance. was responsible for early medical theory. and tome.C.C. phlegm. also known as the father of modern science. yellow bile. Historical evidence suggests the possibility of blood letting for therapeutic reasons may have begun in Egypt around 1400B. phlebotomy was declared quackery. Barbers advertised with a red (for blood) and white (for tourniquet) striped pole. Medtexx Medical Corporation -4- . meaning veins. and black bile. vomiting. The first U. the "treatment" was stopped. or blood letting. Blood was often caught in a shallow bowl. president. and show that man's initial fascination with his blood and body fluids has had a direct influence on the study of Biomedical Science today. which believed illness was caused by an "imbalance" in the body.C. George Washington. Hypocrites (460-377 B. The practice reached unbelievable heights in the 18th and early 19th centuries.
Holland. and much more. was also in vogue during the 18th century. Scarificator – The scarificator. The scarificator seems more merciful than other bloodletting instruments. It was he who discovered bacteria. Yet with skill. • • • Lancet – The lancet was first used before 5th century B.were simply powerful magnifying glasses. This practice was called 'cupping'. His researches. Compared to modern microscopes. a series of twelve blades. Once the leech was engorged. Sometimes a wooden "fleam stick" was used to hit the back of the blade and drive it into the vein. A drawing of one of Leeuwenhoek's "microscopes" is shown at the left. The Fleam – Used during the 18th century. not compound microscopes of the type used today.certainly all the ones that are known -. This would have been enough to exclude him from the scientific community of his time completely. • • • With this fascination came the need to "see" the components of the body fluids. and an open mind free of the scientific dogma of his day. freeliving and parasitic microscopic protists. had no fortune. A tradesman of Delft. The device was cocked and the trigger released spring-driven rotary blades that caused many shallow cuts. which were widely circulated. the little animal became quite scarce. sperm cells. The area was chosen and a drop of milk or blood was the bait. Blood was caught in shallow bowls. blood cells. Leeuwenhoek succeeded in making some of the most important discoveries in the history of biology. he came from a family of tradesmen.PHLEBOTOMY Devices Used for Drawing Blood A variety of devices were used to draw blood. Heated air inside the cup created a vacuum causing blood to flow into the cup. received no higher education or university degrees. The device was cocked and a "trigger" fired the spring-driven blade into the vein. Spring-Loaded Lancet – Came into use during the early 18th century. Many varieties existed. and leech farms were having difficulty keeping up with the demand. Leeches – (Hirudo medicinalis). probably all of Leeuwenhoek's instruments -. it Medtexx Medical Corporation -5- . a handy technique for drawing blood form a localized area. Leeuwenhoek is known to have made over 500 "microscopes." of which fewer than ten have survived to the present day. an endless curiosity. Therefore. diligence. "Antony van Leeuwenhoek (1632-1723)" was an unlikely scientist. In basic design. they became quite expensive. Leeches were "enticed" by "leeches" to attach themselves to the skin. the practitioner manually perforated the vein. Many shallow cuts were sometimes made.C. blood was also captured in small flint cups. opened up an entire world of microscopic life to the awareness of scientists. microscopic nematodes and rotifers. In the early 1800's. it was allowed to drop off. Flint Cup – During the 17th to 19th centuries. and knew no languages other than his native Dutch.
paved the way for the examination of blood as a diagnostic tool. it required good lighting and great patience to use. and had to be held up close to the eye. It is known that other body fluids have been examined since medieval times. The invention of the microscope in the 17th century. using only one lens. The entire instrument was only 3-4 inches long. and its position and focus could be adjusted by turning the two screws. It is open to debate when blood first began to be examined for diagnostic purposes. The specimen was mounted on the sharp point that sticks up in front of the lens. mounted in a tiny hole in the brass plate that makes up the body of the instrument.PHLEBOTOMY is an extremely simple device. coupled with advances in physiologic chemistry and cellular physiology on the 19th century. Medtexx Medical Corporation -6- .
HBV). splashing or open aerosolization of human blood or body fluids. Decontaminate laboratory protective garments. Wear latex gloves. Remember: The most susceptible route of laboratory infection for HIV and HBV is by accidental needle sticks. containment and laboratories when handling human materials where droplet and aerosol production are likely. Develop proficiency before beginning work. use biosafety cabinets or other containment and personal protective equipment. body fluids (semen. cerebrospinal and amniotic fluid..PHLEBOTOMY UNIVERSAL PRECAUTIONS AND BIOSAFETY TECHNIQUES 1. Medtexx Medical Corporation -7- .Be prepared: • Personnel should understand their risk categorization (per Depts. • Category I and II personnel should get the new. • Be familiar with the CDC/NIH Manual "Biosafety in Microbiological and Biomedical • Laboratories' view biosafety videos and are familiar with the company's Biosafety Manuals. Use appropriate biosafety level conditions (BL-2 or BL-3) when handling non-human primates and other animals inoculated with human pathogenic materials. Avoid spilling. 6. Dispose of human and animal biohazardous waste or materials contaminated with them in accordance with CDC/NIH biosafety and institutional guidelines. protective lab garments and face and eye shields when handling human materials. emergency biohazard spill management and proper use of biosafety equipment. Ask your supervisor to explain any procedures or concepts not clear to you before beginning work. serum. Category II: Personnel occasionally handle or work around such materials. saliva. When such procedures are necessary. proper decontamination procedures. 1:10 dilution of Clorox) when concluding work to protect personnel from accidental infection.g. contamination of the mucous membranes. gloves and protective equipment to render them non-infectious. 4. use Biosafety Level-3 (BL3) procedures. Handle them with appropriate care! 2. 5. Use appropriate caution and maximum protection to prevent such contact. Use Biosafety Level-2 work practices.. Assume ALL human blood. Category III: Personnel never work with or around such materials.g. milk and cervical secretions) and tissues to be contaminated with Human Immunodeficiency Virus (HIV) and/or Hepatitis Viruses (e. 9. Understand the principles of good microbiological practice before working with biohazardous materials. 10. 7. Avoid aerosol-generating activities in handling human materials. When culturing or manipulating known HIV or HBV. body fluids and issues. abraded or irritated skin. Examples include use of aseptic technique. safe and effective Hepatitis B vaccination. Gain knowledge . plasma. Any procedure which requires concentration of HIV or HBV or other human viruses from human materials should be handled under BL-3 containment and handling conditions. 3. Clean all work areas and equipment used in handling human biohazardous materials with proven disinfectant (e. of Labor and Health and Human Services) before initiating work: Category I: Personnel routinely handle blood. or through broken. tears. 8.
A susceptible individual inhales droplets of particles of dust containing infectious agents. 13. respiratory viruses. 2. Proper hand washing and strict adherence to Universal Precautions. HIV or HBV rests with the Laboratory Director or the designated Principal Investigator (PI). and pulmonary tuberculosis can be contracted. 2. Airborne or inhalation transmission. body substance isolation and general safety will minimize the risk of infection. training and monitoring of biosafety practices in laboratories handling human materials. centrifugation and the "popping" of specimen container tops are responsible for droplet formation. 4. Laboratory personnel have a clear responsibility to fully understand and consistently adhere to the biosafety practices detailed in the Biosafety and General Safety Manuals as well as to the biosafety guidelines detailed here and by the CDC and NIH. Responsibility for conscious or thoughtless non-compliance with or violation of these guidelines falls on the laboratory worker. 12. The specimens involved must be identified and tested for HIV and HBV and the procedures followed. INFECTION PREVENTION Approximately 100% of the infectious agents found in the clinical laboratory are spread by either airborne (inhalation) or contact transmission. antigen or antisera) used in the laboratory are contaminated with HIV or other viruses and handle them accordingly. biosafety procedures and training to employees accepting such work assignments to permit the safe conduct of the work. Apply solution of 50% isopropyl or ethyl alcohol. Understand your institution's medical surveillance program and be familiar with the appropriate standard operating procedures for accidental exposure to human materials. Wash again with the liquid soap and rinse well. These responsible individuals must ascertain the proficiency of the employee in performing the assigned task before permitting the work to begin. Report every accident to your supervisor and Occupational Medical Service personnel. Rinse well with water. provide facilities. biosafety equipment.. Example: coughing. the causative agent is passed from one individual directly to another. Note: Hand Washing Technique for Skin Exposure to Blood or body Fluids 1.g. These individuals must categorize positions. 1. 14. 3.PHLEBOTOMY 11. sneezing. 15. Responsibility for instituting. antibody. Infectious disease agents are most often transmitted in one of four methods. Infections with sexually Medtexx Medical Corporation -8- . May be direct or indirect. In direct contact. Assume that human serological and biological reagents (e. Specific measures must be followed as per CDC/NIH Guidelines in the Universal Precautions. Wash with a good liquid antimicrobial detergent soap. Contact Transmission. It is in this manner that streptococcal sore throat.
3. Hand contact. A person may be indirectly exposed by receiving blood infected with Hepatitis C or HIV. Salmonelosis and Hepatitis A are examples. A vector or arthropod (mosquitoes. Either accidental needle sticks or by the sharing of needles by drug users are other examples. Medtexx Medical Corporation -9- . of direct contact. respectively. Food or water containing pathogenic organisms is ingested. such as shaking hands with an infected person is also thought to be one of the ways that respiratory virus infections are spread. It is also possible to be infected by contact with an inanimate object (blood collection tubes etc. Vector Borne. including HIV are examples.PHLEBOTOMY transmitted diseases.).) are capable of transferring pathogens and resulting in malaria and encephalitis or Lyme disease. ticks etc. 4. Ingestion Transmission.
PHLEBOTOMY HUMAN ANATOMY AND PHYSIOLOGY Skin Layers Medtexx Medical Corporation .10 - .
PHLEBOTOMY Major Veins Medtexx Medical Corporation .11 - .
PHLEBOTOMY Major Arteries Medtexx Medical Corporation .12 - .
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very Elastic Adapted to carry blood under high pressure 3 layers Medtexx Medical Corporation . Tunica media. ENDOTHELIUM (simple squamous epithelium) and a layer of Elastic Tissue called the internal elastic membrane.14 - . called a lumen. thickest layer Elastic Fibers & Smooth Muscle Tunica externa (adventitia) Elastic & Collagenous Fibers Arteries • • • Strong. • • • Tunica interna (intima).PHLEBOTOMY General Structure: ARTERIES and VEINS The arteries and veins are composed pf three coats of tunics and a hollow core. through which the blood flows.
15 - . Elastic fibers o Tunica Adventitia Sympathetic branch of ans innervate smooth muscle in artery and arteriole Hold about 20% total blood volume.PHLEBOTOMY o Endothelium Smooth surface o Tunica Media Smooth muscle. • • Medtexx Medical Corporation .
16 - .PHLEBOTOMY Veins • • • • • • • Carry deoxygenated blood to the heart Three layers with middle layer poorly developed o Less muscle and elastic tissue Very distensible Carry about 60% of total blood volume Functions as blood reservoir Vein in limbs have valves like flaps Respond to falling BP by vasoconstricting Medtexx Medical Corporation .
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Dorsal digital vv. receives the thoracic duct. drains the adjacent sides of the two digits.. thymic v. Dorsal venous arch is visible through the thin skin on the dorsum of the hand Median antecubital v.. and the internal jugular v. communicated with deep veins of the forearm through perforating veins. anterior chest wall At its origin. the left brachiocephalic v. Cephalic Basilica Superficial part of the hand and forearm Medtexx Medical Corporation . unite to form the superior vena cava.. Brachiocephalic v. neck. tributaries. Superficial of the palm and anterior forearm Cephalic v. especially in cubital region. is variable in sizeit may be large or absent A median anterbrachial vein occurs occasionally and when present. or basilica v. forearm anterior Vein Ante median Basilic v. laterally. upper limb. vertebral v. is variable in size – it may be large or absent Basilica v. Median cubital v. Head. forearm anterior Dorsal metacarpal v. Superficial veins of the palm and anterior forearm Medial end of the dorsal venous arch of the hand. 1st posterior intercostals v. The left and right brachiocephalic v. receives the right lymphatic duct Cephalic v.PHLEBOTOMY Selected Veins of the Upper Limb – Listed Alphabetically Tributaries Drains Into Regions Drained brachial. internal thoracic v.. the right brachiocephalic v.18 - . And dorsal metacarpal vv. superficial veins of the forearm. Median cubital v. Superficial parts of the medial side of the hand and medial side of the forearm Notes Medium antecubital v. It unites with the brachial vein(s) to form the axillary v.. left superior intercostals v. at its origin. Formed by the union of the subclavian v. Median cubital v. to the basilica v. Dorsal venous arch of the hand Dorsal didgital vv. it may drain into the median cubital vein. medially Median antebrachial v. or basilica Palm. basilica v. of the hand Dorsal venous arch of the hand Median cubital vein usually shunts some of the blood collected by the cephalic v. Axillary vein Superficial parts of the lateral hand and lateral forearm Dorsal aspects of the digits of the hand Dorsal aspects of the digits and the superficial structures of the dorsal of the hand Palm. median cubital v.) Lateral side of the dorsal venous arch of the hand. Dorsal metacarpal v. inferior thyroid v. superficial veins of the forearm. (to the left brachiocephalic v..
Passes deeply into the popliteal fossa Dorsal metatarsal v. medially.PHLEBOTOMY Selected Veins of the Lower Limb – Listed Alphabetically Veins Dorsal metatarsal v. perineal region Skin and superficial fascia of the lateral side of the foot and leg Dorsal aspects of the digits of the foot Greater saphenous v. drains the adjacent sides of two digits Dorsal venous arch is visible through the thin skin on the dorsum of the foot Dorsal aspects of the digits of the foot Dorsum of digits and superficial structures of dorsum of foot the the the the Dorsal venous arch of the foot Dorsal digital vv. And dorsal metatarsal vv. Skin and superfiaicl fascia of the medial side of the foot and leg. perforating communications with deep veins. laterally Regions Drained Notes Dorsal metatarsal v. Greater saphenous v. is frequently used as graft material in coronary bypass surgery Lesser saphenous v. Drains into Dorsal venous arch of the foot Great saphenous v. Medial end of dorsal venous arch of foot. small saphenous v. skin and superficial fascia of most of the thigh. dorsal of the foot Dorsal venous arch of the foot Medtexx Medical Corporation . Femoral v. of the foot Tributaries Dorsal digital vv. superficial circumflex iliac v. drains the adjacent sides of two digits Metatarsal. Popliteal v.19 - . superficial external pudendal v. Lateral end of the dorsal venous arch of foot Dorsal digital vv. lower abdominal wall..
PHLEBOTOMY Proper Method for Tying a Tourniquet Medtexx Medical Corporation .20 - .
PHLEBOTOMY Medtexx Medical Corporation .21 - .
Equipment Used during a Venipuncture
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Note: This method of traction is discouraged due to an increased risk of the Phlebotomist sticking themselves rather than the patient!
Assemble the needle, the barrel, and the first tube you wish to use as in the figures above. The needle should not be uncovered until ready to perform venipuncture. Place any additional tubes to be used in a convenient location, keeping some spares handy. The gauze, alcohol pads, and bandages should be ready. (Note: some phlebotomists may elect to do this step before applying the tourniquet; this is preferable.)
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Describe and perform the venipuncture process including: 1. 2. 3. 4. 5. Proper patient identification procedures. Proper equipment selection and use. Proper labeling procedures and completion of laboratory requisitions. Order of draw for multiple tube phlebotomy. Preferred venous access sites, and factors to consider in site selection, and ability to differentiate between the feel of a vein, tendon and artery. 6. Patient care following completion of venipuncture. 7. Safety and infection control procedures. 8. Quality assurance issues.
Identify the additive, additive function, volume, and specimen considerations to be followed for each of the various color coded tubes. List six areas to be avoided when performing venipuncture and the reasons for the restrictions. Summarize the problems that may be encountered in accessing a vein, including the procedure to follow when a specimen is not obtained. List several effects of exercise, posture, and tourniquet application upon laboratory values.
VENIPUNCTURE PROCEDURE The venipuncture procedure requires both knowledge and skill to perform. Each phlebotomist generally establishes a routine that is comfortable for her or him. Several essential steps are required for every successful collection procedure: 1. Identify the patient. 2. Assess the patient's physical disposition (i.e. diet, exercise, stress, basal state). 3. Check the requisition form for requested tests, patient information, and any special requirements. 4. Select a suitable site for venipuncture. 5. Prepare the equipment, the patient and the puncture site.
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Assess the need for sample recollection and/or rejection. Medtexx Medical Corporation . 10.25 - . Patient's ID number. Equipment The following are suggested supplies for blood specimen collection. Source of specimen. cytology. This information must be given when requesting microbiology. or other testing where analysis and reporting is site specific. Date and time of collection. Promptly send the specimens with the requisition to the laboratory. Requesting physician's complete name. Recognize complications associated with the phlebotomy procedure. fluid analysis. 9. 11. Collect the sample in the appropriate container. Label the collection tubes at the bedside or drawing area. 8. Indicating the test(s) requested. Initials of phlebotomist. This requisition form must contain the proper information in order to process the specimen. 7. The essential elements of the requisition form are: • • • • • • • • Patient's surname. and middle initial. • • • • • • • • • Non sterile exam gloves Puncture resistant sharps container Alcohol wipes Tourniquet Appropriate specimen collection lab tubes 2 x 2 gauze Tape Evacuated tube holder Multisample blood collection needle ORDER FORM / REQUISITION A requisition form must accompany each sample submitted to the laboratory. Perform the venipuncture. first name.PHLEBOTOMY 6. Patient's date of birth and sex.
PHLEBOTOMY Figure: An example of a simple requisition form with the essential elements.26 - . Medtexx Medical Corporation .
Needles . Gauze sponges . The key elements in labeling are: o Patient's surname. Alcohol Wipes . o Patient's ID number. single draw or butterfly system. Various sizes are available. Blood should NEVER be poured from one tube to another since the tubes can have different additives or coatings (see illustrations at end). the smaller the needle bore. Tourniquet . The rubber stoppers are color coded according to the additive that the tube contains.70% isopropyl alcohol.needles should NEVER be broken.PHLEBOTOMY LABELING THE SAMPLE • A properly labeled sample is essential so that the results of the test match the patient. Syringes . bent. first and middle.may be used in place of the evacuated collection tube for special circumstances.Wipe off with alcohol and replace frequently. Holder/Adapter . etc. Needle disposal unit . Adhesive bandages / tape . First Name Patient ID: 1234-56 June 5. Medtexx Medical Corporation .27 - . Needles should be placed in a proper disposal unit IMMEDIATELY after their use. 2005 8:10 AM Initials: SM EQUIPMENT THE FOLLOWING ARE NEEDED FOR ROUTINE VENIPUNCTURE o o o o o o o o o o o Evacuated Collection Tubes . Povidone-iodine wipes/swabs . rubber. Gloves .use with the evacuated collection system.The tubes are designed to fill with a predetermined volume of blood by vacuum.protects the venipuncture site after collection.can be made of latex. o NOTE: Both of the above MUST match the same on the requisition form. or recapped. o Date.The gauge number indicates the bore size: the larger the gauge number. worn to protect the patient and the phlebotomist. vinyl.. Needles are available for evacuated systems and for use with a syringe.for application on the site from which the needle is withdrawn.Used if blood culture is to be drawn. time and initials of the phlebotomist must be on the label of EACH tube. Last Name.
PHLEBOTOMY ORDER OF DRAW Blood collection tubes must be drawn in a specific order to avoid cross-contamination of additives between tubes. then a single light blue stopper tube may be drawn.coagulation tube (light blue stopper). stopper). o Last draw . EDTA (lavender stopper) ACDA or ACDB (pale yellow stopper). The standard order of draw is: First .additive tubes in this order: SST (red-gray. Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive.28 - . Sodium heparin (dark green stopper) PST (light green stopper). Contains lithium heparin anticoagulant and a gel separator. Contains acid citrate dextrose. and then the light blue stopper tube. NOTE: For plastic tubes.non-additive tube (red stopper or SST) Third . If just a routine coagulation assay is the only test ordered. Oxalate/fluoride (light gray stopper) o o o NOTE: Tubes with additives must be thoroughly mixed. the order of draw for tubes 2 and 3 is reversed. Medtexx Medical Corporation .additive tubes in this order: Last draw . or gold.blood culture tube (yellow-black stopper) Second . then one may draw a non-additive tube first. Contains a gel separator and clot activator. If there is a concern regarding contamination by tissue fluids or thromboplastins.
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Know the identity and professional status of individuals providing service and to know which physician or other practitioner is primarily responsible for his or her care. national origin. or sources of payment for care.is essential. Considerate. Using the requisition for reference. The basic patient rights endorsed by the JCAHO follow in condensed form are given below. Medtexx Medical Corporation . DO NOT DRAW BLOOD IF THE ARMBAND IS MISSING. speak with the patient during the process. The patient has the right to. Obtain from the practitioner complete and current information about diagnosis. sex. Confidentiality of all communications and other records pertaining to the patient's care. The patient shall be informed if the hospital proposes to engage in or perform human experimentation or other research/educational profits affecting his or her care or treatment. Always thank the patient and excuse yourself courteously when finished. ask a patient to provide additional information such as a surname or birth date. Consult a specialist at the patient's own request and expense. Effective communication . in terms the patient can reasonably be expected to understand.both verbal and nonverbal . regardless of race. ask for a full name and always check the armband for confirmation.PHLEBOTOMY PROCEDURAL ISSUES PATIENT RELATIONS AND IDENTIFICATION The phlebotomist's role requires a professional. The patient has the right to refuse participation in such activity. If possible. An outpatient must provide identification other than the verbal statement of a name. PATIENT'S BILL OF RIGHTS The Patient's Bill of Rights has been adopted by many hospitals as declared by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Reasonable informed participation in decisions involving the patient's health care. treatment. If an inpatient is able to respond. respectful care. Proper patient identification is MANDATORY. Greet the patient and identify yourself and indicate the procedure that will take place. courteous. and understanding manner in all contacts with the patient. • • • • • • • • • Impartial access to treatment or accommodations that is available or medically indicated. The patient who is at ease will be less focused on the procedure. Expect reasonable safety congruent with the hospital practices and environment. and any known prognosis.30 - . Expect that any discussion or consultation involving the patient's case will be conducted discreetly and that individuals not directly involved in the case will not be present without patient permission. creed.
31 - . satisfactory samples may be drawn below the IV by following these procedures: 1. Regardless of the source of payment. Be informed of the hospital rules and regulations regarding patient conduct.tissue fluid accumulation alters test results. 2. collect the specimen distal to the hematoma. feel cordlike. 3. Medtexx Medical Corporation . request and receive an itemized and detailed explanation of the total bill for services rendered in the hospital. Provide for their comfort as much as possible. Edematous extremities . blood should not be drawn from an arm with a fistula or cannula without consulting the attending physician. wrist and hand veins are also acceptable for venipuncture. Otherwise. tap the site with index and second finger. VENIPUNCTURE SITE SELECTION Although the larger and fuller median cubital and cephalic veins of the arm are used most frequently.it is difficult to puncture the scar tissue and obtain a specimen. Select a vein other than the one with the IV. Turn off the IV for at least 2 minutes before venipuncture. or lower the extremity over the bedside to allow the veins to fill. Cannula/fistula/heparin lock . and roll easily. indicating the test(s) ordered. Properly fill out appropriate requisition forms. are most elastic. you can force blood into the vein by massaging the arm from wrist to elbow. If another site is not available. and have a thick wall. calm manner. damp washcloth to the site for 5 minutes. PROCEDURE FOR VEIN SELECTION • • Palpate and trace the path of veins with the index finger. and gain the patient's cooperation. If superficial veins are not readily apparent. so collect from the opposite arm if possible. Perform the venipuncture.test results may be affected because of lymphedema. Arteries pulsate. Identify the patient correctly. Hematoma .fluid may dilute the specimen. In general. Apply the tourniquet below the IV site.PHLEBOTOMY • • • Refuse treatment to the extent permitted by law. PERFORMANCE OF A VENIPUNCTURE Approach the patient in a friendly.hospitals have special policies regarding these devices. Thrombosed veins lack resilience. Intravenous therapy (IV) / blood transfusions . The upper extremity on the side of a previous mastectomy .may cause erroneous test results. Certain areas are to be avoided when choosing a site. apply a warm. Draw 5 ml of blood and discard before drawing the specimen tubes for testing. • • • • • • Extensive scars from burns and surgery .
Remove the needle from the patient's arm using a swift backward motion. medications. Fasting. Deliver specimens promptly to the laboratory. The patient should make a fist without pumping the hand. Hyperextend the patient's arm. When the last tube to be drawn is filling. Mix and label all appropriate tubes at the patient bedside. Position the patient. Prepare the patient's arm using alcohol prep. The bevel must always face upward. Cleanse in a circular fashion. Apply the tourniquet 3-4 inches above the selected puncture site. The needle should form a 15 to 30 degree angle with the surface of the arm.32 - .PHLEBOTOMY Verify the patient's condition. Do not place too tightly or leave on more than 2 minutes. Select the venipuncture site. timing. Press down on the gauze once the needle is out of the arm. Avoid trauma and excessive probing. applying adequate pressure to avoid formation of a hematoma. Allow to air dry. Dispose of contaminated materials/supplies in designated containers. dietary restrictions. lie down. Medtexx Medical Corporation . Grasp the patient's arm firmly using your thumb to draw the skin taut and anchor the vein. The patient should sit in a chair. Note: The Bevel The bevel of a needle is the angled opening at the tip of the needle. remove the tourniquet. or sit up in bed. so as to obtain a blood return. towards the person holding it. Swiftly insert the needle through the skin and into the lumen of the vein. beginning at the site and working outward. and medical treatment are all of concern and should be noted on the lab requisition.
Medtexx Medical Corporation .PHLEBOTOMY It is also very important to remember that if the bevel is exposed during a venipuncture. and apply pressure with cotton. especially children and psychiatric patients. change them between each patient and wash your hands frequently. When wearing gloves. and restarted elsewhere.33 - . leakage from the site may occur. Immediately dispose of the needle in the sharps container. and cannot be re-inserted into the patient. Practice hygiene for the patient's protection. Never panic. Always wear a clean lab coat or gown. Note that when the bevel is exposed. simply release the tourniquet. and not on other things around the room! PROTECT THE PATIENT • • Place blood collection equipment away from patients. This is another reason it is so important to keep your eyes on the needle. the needle is then considered contaminated. The whole procedure must be stopped. TROUBLESHOOTING GUIDELINES IF AN INCOMPLETE COLLECTION OR NO BLOOD IS OBTAINED Change the position of the needle. remove the needle. before manually withdrawing the needle at the completion of the entire procedure. Move it forward (it may not be in the lumen) Or move it backward (it may have penetrated too far).
After two unsuccessful attempts. Medtexx Medical Corporation . Try another tube. There may be no vacuum in the one being used. the rule for Phlebotomists is to call in another Phlebotomist to perform the venipuncture. Corrective Technique The corrective technique is performed when no there is no blood return.PHLEBOTOMY Adjust the angle (the bevel may be against the vein wall). The proper procedure to do this is called Corrective Technique. Re-anchor the vein. However. It may be obstructing blood flow. Veins sometimes roll away from the point of the needle and puncture site. you must try to successfully obtain the sample before giving up. Loosen the tourniquet.34 - .
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PHLEBOTOMY Medtexx Medical Corporation .36 - .
PHLEBOTOMY Medtexx Medical Corporation .37 - .
If this is not successful.38 - . Medtexx Medical Corporation . remove the needle. Apply firm pressure for more than 5 minutes. PROBLEMS OTHER THAN AN INCOMPLETE COLLECTION A hematoma forms under the skin adjacent to the puncture site . Apply firm pressure. re-secure the tourniquet to increase venous filling. The needle may have pulled out of the vein when switching tubes. take care of the puncture site.release the tourniquet immediately and withdraw the needle. The blood is bright red (arterial) rather than venous. and redraw.PHLEBOTOMY IF BLOOD STOPS FLOWING INTO THE TUBE The vein may have collapsed. Hold equipment firmly and place fingers against patient's arm. using the flange for leverage when withdrawing and inserting tubes.
The best locations for finger sticks are the 3rd and 4th fingers of the non-dominant hand. or covered with a rash. Fasting. timing. Label all appropriate tubes at the patient bedside. Avoid excessive pressure that may squeeze tissue fluid into the drop of blood. indicating the test(s) ordered. properly fill out appropriate requisition forms. rotate and invert the collection device to mix the blood collected. Wipe away the first drop of blood. The patient should sit in a chair.PHLEBOTOMY PERFORMANCE OF A FINGERSTICK Follow the procedure as outlined above for greeting and identifying the patient. Position the patient. The fifth finger tends to have less soft tissue overlying the bone. Do not use the tip of the finger or the center of the finger.39 - . which tends to contain excess tissue fluid. Dispose of contaminated materials/supplies in designated containers. and where the bone is closer to the surface. Hyperextend the patient's arm. The 2nd (index) finger tends to have thicker. As always. Medtexx Medical Corporation . callused skin. Deliver specimens promptly to the laboratory. medications. swollen. dietary restrictions. Have the patient hold a small gauze pad over the puncture site for a couple of minutes to stop the bleeding. Using a sterile lancet. The puncture should be made perpendicular to the ridges of the fingerprint so that the drop of blood does not run down the ridges. Collect drops of blood into the collection device by gently massaging the finger. make a skin puncture just off the center of the finger pad. Verify the patient's condition. Avoid puncturing a finger that is cold or cyanotic. and medical treatment are all of concern and should be noted on the lab requisition. Cap. where vessels and nerves are located. lie down or sit up in bed. scarred. Avoid the side of the finger where there is less soft tissue.
Dispose of contaminated materials in appropriate waste receptacles. When finished. which is close to the skin surface. Pre-warming the infant's heel (42 C for 3 to 5 minutes) is important to obtain capillary blood gas samples and warming also greatly increases the flow of blood for collection of other specimens. and hold it in place until the bleeding has stopped.40 - . However. Using a sterile blood lancet. The diagram below indicates in gray the proper area to use for heel punctures for blood collection. Dry the cleaned area with a dry cotton sponge. dry cotton on the puncture site.PHLEBOTOMY BLOOD COLLECTION ON INFANTS The recommended location for blood collection on a newborn baby or infant is the heel. Hold the baby's foot firmly to avoid sudden movement. do not use too high a temperature warmer. Remove your gloves and wash your hands. Medtexx Medical Corporation . Wipe away the first drop of blood with a piece of clean. place a piece of clean. Fill the capillary tube(s) or micro collection device(s) as needed. use gentle pressure to produce a rounded drop of blood. Clean the site to be punctured with an alcohol sponge. Make the cut across the heel print lines so that a drop of blood can well up and not run down along the lines. Do not use excessive pressure or heavy massaging because the blood may become diluted with tissue fluid. Do not puncture the outer sides of the heel. either. Do not use a previous puncture site. dry cotton. Do not use the central portion of the heel because you might injure the underlying bone. Since newborns do not often bleed immediately. Be sure to dispose of the lancet in the appropriate sharps container. puncture the area of the heel that is just "off center" from the very center of the heel. elevate the heel. because baby's skin is thin and susceptible to thermal injury.
iron Affects packed cell volume and other cellular elements Medtexx Medical Corporation . traumatic venipuncture Indwelling Lines or Catheters • • • Potential source of test error Most lines are flushed with a solution of heparin to reduce the risk of thrombosis Discard a sample at least three times the volume of the line before a specimen is obtained for analysis Hemoconcentration: An increased concentration of larger molecules and formed elements in the blood may be due to several factors: • • • • Prolonged tourniquet application (no more than 2 minutes) Massaging. or probing a site Long-term IV therapy Sclerosed or occluded veins Prolonged Tourniquet Application • • • Primary effect is hemoconcentration of non-filterable elements (i.41 - . (Partial penetration may allow blood to leak into the soft tissue surrounding the vein by way of the needle bevel) Apply pressure to the venipuncture site To prevent hemolysis (which can interfere with many tests) • • • • • Mix tubes with anticoagulant additives gently 5-10 times Avoid drawing blood from a hematoma Avoid drawing the plunger back too forcefully. Significant increases can be found in total protein.PHLEBOTOMY ADDITIONAL CONSIDERATIONS To prevent a hematoma • • • • • Puncture only the uppermost wall of the vein Remove the tourniquet before removing the needle Use the major superficial veins Make sure the needle fully penetrates the upper most wall of the vein. and avoid frothing of the sample Make sure the venipuncture site is dry Avoid a probing. aspartate aminotransferase (AST). squeezing. if using a needle and syringe. total lipids. The hydrostatic pressure causes some water and filterable elements to leave the extracellular space. proteins). cholesterol.e.
Anxiety that results in hyperventilation may cause acid-base imbalances. Effects of Exercise: Muscular activity has both transient and longer lasting effects. Do not bend. Stress: May cause transient elevation in white blood cells (WBC's) and elevated adrenal hormone values (cortisol and catecholamines). metabolism. iron. and increased lactate. Follow institution's guidelines regarding treatment and follow-up.PHLEBOTOMY Patient Preparation Factors • • • • • • Therapeutic Drug Monitoring: different pharmacologic agents have patterns of administration. Posture: Postural changes (supine to sitting etc. Diurnal Rhythms: Diurnal rhythms are body fluid and analyte fluctuations during the day. Squeeze puncture site to promote bleeding. Normal reference ranges are often noted according to age. and calcium are significantly increased with changes in position. Dispose of items in appropriate containers. it is important to follow safety and infection control procedures. aspartate aminotransferase (AST). Enzymes. PROTECT YOURSELF • • • • • • • • • • • • • Practice universal precautions: Wear gloves and a lab coat or gown when handling blood/body fluids. serum cortisol levels are highest in early morning but are decreased in the afternoon. therefore they are more concentrated in the blood. Serum iron levels tend to drop during the day. Record the patient's name and ID number. For example. or resheath needles to avoid accidental needle puncture or splashing of contents. Certain larger molecules are not filterable into the tissue. Medtexx Medical Corporation . Many drugs will have "peak" and "trough" levels that vary according to dosage levels and intervals. lipids. Other Factors: Age. SAFETY AND INFECTION CONTROL Because of contacts with sick patients and their specimens. Wash the area well with soap and water. The creatine kinase (CK). Dispose of needles immediately upon removal from the patient's vein. Wash hands frequently. recap.42 - . and platelet count may increase. and elimination that affect the drug concentration as measured in the blood. body distribution. lactate dehydrogenase (LDH).) are known to vary lab results of some analytes. If you stick yourself with a contaminated needle: Remove your gloves and dispose of them properly. proteins. break. and pregnancy have an influence on laboratory testing. Check for timing instructions for drawing the appropriate samples. Clean up any blood spills with a disinfectant such as freshly made 10% bleach. Change gloves after each patient or when contaminated. You must check the timing of these variations for the desired collection point. gender.
It is advisable not to attempt a venipuncture more than twice. Ø The needle may have pulled out of the vein when switching tubes. In most cases another puncture in a site below the first site. Apply firm pressure. Veins sometimes roll away from the point of the needle and puncture site. the new person must re--identify the patient. resecure the tourniquet to increase venous filling. Probing is painful to the patient.43 - . If this is not successful. Adjust the angle (the bevel may be against the vein wall). If blood stops flowing into the syringe/tube Ø The vein may have collapsed. Hold equipment firmly and place fingers against patient's arm. take care of the puncture site. Medtexx Medical Corporation . PATIENT COMPLICATION Problems other than an incomplete collection Hematoma A hematoma forms under the skin adjacent to the puncture site . remove the needle.PHLEBOTOMY POSSIBLE COMPLICATIONS FROM PHLEBOTOMY PROBLEMS OBTAINING A SPECIMEN Blood Sample That Cannot Be Obtained Probing is not recommended. or use of another vein on the other arm. is advisable. Re-anchor the vein. using the flange for leverage when withdrawing and inserting tubes.release the tourniquet immediately and withdraw the needle. If an incomplete collection or no blood is obtained Ø Ø Ø Ø Change the position of the needle. Move it forward (it may not be in the lumen) or move it backward (it may have penetrated too far). Notify the patient's Registered Nurse Another person should attempt to draw the specimen If another person is asked to draw a patient. and redraw.
whereas veins under scarred area are difficult to palpate. usually based on fear. ranging in size from pinpoint to several millimeters in diameter. Use ammonia only if patient is not responsive within 5 minutes and blood pressure remains low. Syncopy (fainting) Patients may become dizzy and fain at the thought or sight blood. Assist to upright position in stages (monitor B/P with each change in position) this is a gradual process. Protect head and neck from injury! Elevate feet above heart and monitor blood pressure.PHLEBOTOMY To prevent a hematoma • • • • • Puncture only the uppermost wall of the vein (just under the skin) Remove the tourniquet before removing the needle Use the major superficial veins (the large veins just under the skin) Make sure the needle fully penetrates the uppermost wall of the vein. If patient stands up to quickly. Treatment and safe handling of an unconscious patient is a necessity of any qualified Phlebotomist. An automatic nervous system reaction. It is caused because of rapid fall in blood pressure. keeping hand firmly behind the cervical spine area. This complication may be a result of a coagulation abnormality. Medtexx Medical Corporation . (psychosomatic trigger). such as a platelet defect and should be brought to the attention of the patient's healthcare provider. he will most likely to faint again due to drop in B/P. Burned area is very sensitive and susceptible to infection. Petechiae consist of extravasated blood. (partial puncture may allow blood to leak into the tissues just under the skin) Apply pressure to puncture site Petechiae Little red spots. slide patient to floor. etc. this is the most common complication phlebotomy. breathing. Scarred Vein Areas that have been burned or scarred should be avoided during phlebotomy. • • • • • • Abort draw: Remove tourniquet.44 - . needle and bend arm Call for assistance Using good body mechanics.
Serum The liquid portion of whole blood that has been allowed to clot.45 - . This sample is mixed 6-8 times and immediately centrifuged and plasma removed. COLLECTION TUBES SST. Centrifuge for 10 minutes to separate serum from clot and transfer the serum to a screw-capped. Gel separates serum from cells. gently invert the tube several times to activate clotting. One 10 ml tube of whole blood will yield about 3-4 ml of serum.Serum Separator Tube (two types): Gold/Red-Gray Marble Additive: Stopper Type: Tube Type/Size: Specimen Type: Draw Amount: Inversions: Laboratory Use: Polymer gel and powdered glass clot activator HemogardTM Gold top/Conventional Red-Gray Marble Plastic tube 13 x 100/16 x 100 Serum 5. The clotting factors are bound in the clot. 2. Draw a sufficient amount of whole blood into a plain.PHLEBOTOMY BLOOD: Samples & Collection TYPES OF BLOOD SAMPLES 1. red-top tube or serum separator (SST®) tube. 3. Allow blood to clot at ambient temperature for 20-30 minutes. Medtexx Medical Corporation . this should be completed within 1 hour of obtaining the specimen. Usually. allowing whole blood analysis to be accurate.0 ml/8. formed when freshly drawn blood is mixed with anticoagulants. The blood remains in liquid state. (Blood collected in a tube with no additive will clot within 15-45 minutes. Plasma The liquid portion of blood that has not been allowed to clot. The clotting factors are present in the plasma. Tube inversion ensures mixing of clot activator with blood and clotting within 30 minutes. This is the only tube that should not be inverted). plastic vial if required. If using an SST® tube. Whole Blood A blood sample that is drawn and mixed immediately with an anticoagulant to maintain the integrity of the blood cells and prevent clotting.5 ml 5 Sterile SST® brand tube for serum clot activator determinations that require serum in chemistry or infectious disease testing.
lead.0 ml (pediatric tube) 8 Dark Lavender 4. DO NOT USE FOR LITHIUM TESTING. Plasma 3.PST. Green Stopper Tube (two types): Dark Green/Clear Green Additive: Stopper Type: Tube Type/Size: Specimen Type: Draw Amount: Inversions: Laboratory Use: Sodium Heparin HemogardTM Plastic tube 13 x 75 Whole Blood.0 ml Sodium Heparin used for chromosome studies.0 ml (pediatric tube) 8 For plasma determinations in chemistry. RNA quantization determinations and for blood bank testing.46 - .PHLEBOTOMY Mint Green Stopper. Dark green 4. NOTE: After the tube has been filled with blood.0 ml/2. immediately invert the tube several times in order to prevent coagulation. NOTE: After the tube has been filled with blood.0 ml for whole hematology. Lavender Stopper Tube (two types): Dark Lavender/Clear Lavender Additive: Stopper Type: Tube Type/Size: Specimen Type: Draw Amount: Inversions: Laboratory Use: EDTA-K2 HemogardTM Plastic tube 13 x 75 Whole Blood. Plasma 4.0 ml 8 General chemistries and some therapeutic drugs.0 ml/2. immediately invert the tube several times in order to prevent coagulation. NOTE: After the tube has been filled with blood. Plasma 4. Medtexx Medical Corporation . ammonia. Polymer gel plasma separator HemogardTM Plastic tube 13 x 75 Whole Blood. HIV. Tube inversion prevents clotting. immediately invert the tube several times in order to prevent coagulation. Tube inversion prevents clotting. Plasma Separator Tube: HOSPITAL PATIENTS ONLY Additive: Stopper Type: Tube Type/Size: Specimen Type: Draw Amount: Inversions: Laboratory Use: Lithium Heparin.
47 - . Follow recommended procedures for collection and transporting of coagulation specimen. immediately invert the tube several times in order to prevent coagulation.8 ml (pediatric tube only) 4 (gently) For coagulation determinations of plasma specimens. Certain tests require chilled specimens. Can be used as sterile transport tube. NOTE: After the tube has been filled with blood.7 ml/1. Red Stopper Tube Additive: Stopper Type: Tube Type/Size: Specimen Type: Draw Amount: Inversions: Laboratory Use: Clot Activator (powdered glass) HemogardTM Plastic 13 x 75 Serum 6. NOTE: It is imperative that the tube be completely filled. Antiglycolytic additives stabilize glucose values for up to 24 hours at room temperature. Tube inversion prevents clotting. Medtexx Medical Corporation . toxicology determinations. Plasma 2.109M) HemogardTM Glass 13 x 75 Whole Blood.2%. invert the tube 6 to 10 times in order to activate the anticoagulant. serology and blood bank testing. Plasma 4.PHLEBOTOMY Light Blue Stopper Tube (two types): Solid Light Blue/Clear Light Blue Additive: Stopper Type: Tube Type/Size: Specimen Type: Draw Amount: Inversions: Laboratory Use: Note: Sodium Citrate (3. The ratio of blood to anticoagulant is critical for valid results. Tube inversion ensures proper mixing of additive and blood. 0. Immediately after draw.0 ml 5 For serum determinations in chemistry.0 ml 8 For glucose. Gray Stopper Tube Additive: Stopper Type: Tube Type/Size: Specimen Type: Draw Amount: Inversions: Laboratory Use: Sodium fluoride/Potassium oxalate HemogardTM Plastic 13 x 75 Whole Blood.
Refer to specific test for proper tube. Medtexx Medical Corporation .PHLEBOTOMY Royal Blue Stopper Tube: (two types): No additive/EDTA There are 2 types of royal blue top Monoject® tubes .5 ml 8 Tissue typing and some Red Cross testing. Additive: Stopper Type: Tube Type/Size: Specimen Type: Draw Amount: Inversions: Laboratory Use: ACD. Plasma 7.48 - . Yellow Stopper Tube: (two types) Additive: Stopper Type: Tube Type/Size: Specimen Type: Draw Amount: Inversions: Laboratory Use: ACD. These are used in the collection of whole blood or serum for trace metals analysis. Refer to specific test for proper tube.0 ml 8 Tissue typing. Additive: Stopper Type: Tube Type/Size: Specimen Type: Draw Amount: Inversions: Laboratory Use: None/EDTA HemogardTM Glass 13 x 100 Whole Blood. Special stopper formulation offers the lowest verified levels of trace elements available.one with EDTA anticoagulant and the other plain. solution A Conventional Glass 16 x 100 Whole blood 8.0 ml None For trace element. toxicology and nutrition determinations. solution B Conventional Glass 16 x 100 Whole blood 6. Refer to specific test for proper tube.
49 - . MODE OF Plasma is separated with PST gel at the ACTION bottom of the tube USES Chemistries Medtexx Medical Corporation . Blood Bank (Crossmatch) Gold Top ADDITIVE None Serum separator tube (SST) contains a gel MODE OF at the bottom to separate blood from ACTION serum on centrifugation USES Chemistries.PHLEBOTOMY COLLECTION TUBES FOR PHLEBOTOMY Red Top ADDITIVE None MODE OF Blood clots. and the serum is separated by ACTION centrifugation USES Chemistries. Immunology and Serology. Immunology and Serology Light Green Top ADDITIVE Plasma Separating Tube (PST) with Lithium heparin Anticoagulates with lithium heparin.
requires full draw .PHLEBOTOMY Red-Gray Top ADDITIVE Serum Separating Tube (SST) with clot activator Forms clot quickly and separates the MODE OF serum with SST gel at the bottom of the ACTION tube USES Chemistries Purple Top ADDITIVE EDTA liquid MODE OF Forms calcium salts to remove calcium ACTION Hematology (CBC) and Blood Bank (Crossmatch).50 - .invert 8 times to prevent clotting and platelet clumping USES Light Blue Top ADDITIVE Sodium citrate MODE OF Forms calcium salts to remove calcium ACTION USES Coagulation tests (protime and prothrombin time). full draw required Medtexx Medical Corporation .
lead. use sodium heparin For ammonia level. use sodium or lithium heparin Dark Blue Top ADDITIVE Sodium EDTA Forms calcium salts MODE OF Tube is designed to contain no ACTION contaminating metals USES For lithium level.PHLEBOTOMY Dark Green Top ADDITIVE Sodium heparin or lithium heparin MODE OF Inactivates thrombin and thromboplastin ACTION USES For lithium level.51 - . use sodium heparin Glucoses. use sodium heparin Trace element testing (zinc. copper. requires full draw (may cause hemolysis if short draw) Medtexx Medical Corporation . mercury) and toxicology Light Gray Top ADDITIVE Sodium fluoride and potassium oxalate MODE OF Antiglycolytic agent preserves glucose up ACTION to 5 days USES For lithium level.
52 - . anaerobes. paternity testing. requires full draw Orange Top ADDITIVE Thrombin MODE OF Quickly clots blood ACTION USES STAT serum chemistries Medtexx Medical Corporation . fungi Black Top ADDITIVE Sodium citrate (buffered) MODE OF Forms calcium salts to remove calcium ACTION USES Westergren Sedimentation Rate.PHLEBOTOMY Yellow Top ADDITIVE ACD (acid-citrate-dextrose) MODE OF Complement inactivation ACTION USES HLA tissue typing.aerobes. DNA studies Yellow Black Top ADDITIVE Broth mixture MODE OF Preserves viability of microorganisms ACTION USES Microbiology .
The definition of a compatibility test (crossmatch) is a series of procedures use to give an indication of blood group compatibility between the donor and the recipient and to detect irregular antibodies in the recipient's serum. 2. T & C). FDP or FSP Tubes: Special collection tubes are required for fibrin degradation products analysis. Red and yellow marbled stopper.PHLEBOTOMY Brown Top ADDITIVE Sodium heparin MODE OF Inactivates thrombin and thromboplastin ACTION USES Serum lead determination Specialized Collection Tubes 1. The tube should be inverted immediately. Medtexx Medical Corporation . A fibrin clot will occur within 30 seconds. These tubes maybe light blue or black stopper. CROSSMATCHES The Crossmatch is also known as compatibility testing.53 - . This tube contains EDTA as an anticoagulant and ascorbic acid as the preservative. pre-transfusion testing or type and Crossmatch (Type and Cross. Approxiamtely 2 ml of blood is collected into the tube. Ascorbic Acid Tube: Used exclusively for blood serotonin assay.
Follow this with an iodine swab using same technique Medtexx Medical Corporation . Hospital number d. There is also a label that has a preprinted ID number. Name b. This same ID number will be placed on the unit of blood that has been crossmatched. Clean the skin first using alcohol (using concentric rings from the inside out) 3. Date and time collected c. Crossmatch procedures should be designed for speed and accuracy . especially when patient has been transfused within past three months. 2. BLOOD CULTURE PURPOSE The detection of septicemia PREPEARTION OF THE PATIENT 1.PHLEBOTOMY PURPOSE The main purpose for performing a crossmatch is to promote (not ensure) the safe transfusion of blood. Most facilities have a type of identification band that is placed on the patient's wrist as soon as the specimen has been collected. identical to the one on the wrist band.54 - . A unit of blood given to the wrong person could kill. NOTE: Always double or triple check names and ID numbers where there is a possibility that blood will be transfused. Once donor blood is crossmatched with a potential recipient. This must be double checked prior to infusion by the practitioner. This label must be affixed to the tube of blood. Explain that the physician has ordered a series of test and you will have to perform several sticks. the results of the crossmatch is good only 3 days. Draw at least one red top tube (without polymer gel). Collect specimen carefully to avoid hemolysis of the red cells 4. Double check the patient's identity 2. PROCEDURE 1. If the physician wants the donor blood available longer. Initials of person collecting 3. Label the tubes with information below.get the safest blood reasonably possible available to the patient as soon as possible. This protocol helps detect new antibodies that may be forming. we must get a new recipient sample and repeat tests. a. two if possible. We are performing testing to the best of our ability that will demonstrate that the donor blood is compatible with the recipient's blood.
In subsequent cultures. PROCEDURE 1.PHLEBOTOMY 4. The growth of microorganisms in the blood is a life threatening situation. 2. collect a specimen from each arm. After completion of the draw. Check with the lab regarding the proper procedure to follow. 3. The amount of blood to be drawn depends on the culture system used. If this testing is to be done on an outpatient basis. ORAL GLUCOSE TOLERANCE TEST (GTT) PURPOSE To confirm diabetes mellitus. Several calculators and methods of calculation are available for this purpose. each one should be obtained from alternate arms. The patient should not eat. inform the patient of the time involved. Once the iodine is dry. 4. The protocol for the collection of cultures also varies from hospital to hospital. For the first culture. you may be required to "vent" one of the culture bottles if a two bottle system is used. (Patient must drink all the solution in a 5 minute time limit. to aid in diagnosis of malabsorption syndrome and hypoglycemia. Make sure solution is chilled. Allow iodine to dry before performing the venipuncture. PROCEDURE Each laboratory uses its own particular blood culture system. Paint the septum of the blood culture bottle(s) with iodine. do no palpate the vein again unless you have "sterilized" your own gloved finger as you did for site puncture. Also collect a fasting urine specimen. 2. VALUES: Normal blood cultures should be sterile. (usually 5-10 ml) Draw the blood in sterile syringes only. Inject the sample into the blood culture bottle and quickly. 1. Patient's height and weight if obtained to determine amount of glucose solution to give. smoke or exercise vigorously for at least 10 hours prior to or during the testing.) Medtexx Medical Corporation . if possible. After returning to the laboratory. The following are certain procedural steps that are common to all blood culture methods. however. replace the needle used to make the venipuncture with a new sterile one. Draw a fasting sample in a gray top tube. but gently mix to avoid clotting. drink coffee or alcohol. one venipuncture will be enough. 2. 3. 5. NOTE THE TIME. Give the patient the predetermined amount of glucose solution to drink. PREPARATION OF PATIENT 1.55 - .
Any other tubes drawn for that test would be determined by your facility. Draw a specimen at 30 minutes. If it is impossible to collect any specimen at the appointment time. note for vomiting and should this occur within the first 30 minutes of test. The section labeled "Tube" is the mandatory tube to be drawn for the test indicated. 1 hour. and serologic tests done in many laboratories. Encourage patient to drink more water during the test to promote adequate urine excretion. NOTE TIMES. hematological. Special Considerations: If the patient becomes nauseated or faint. Also collect urine samples at each blood collection. This test is considered a timed test and therefore the physician can make the most accurate diagnosis if the testing is followed as closely as possible. Avoid lipemic or hemolyzed serum Avoid hemolysis and protect from light Protect from light Medtexx Medical Corporation .0 ml clot Freeze if not delivered before 4 hrs. 2 hours. CODE B-Light blue top Gr-Grey Top Gn-Green Top L-Lavender Top NB-Navy Blue Top R-Red Top S-Use Syringe TEST ABO type Acid Phosphate (PAP) Albumin Alcohol Alkaline Phosphate Amylase Antinuclear antibodies ANA B-12. GENERAL COLLECTION REQUIREMENTS Below is an illustrative list of chemical.56 - . total or direct Blood urea nitrogen BUN Calcium Carcineombrynic antigen CEA Tube R R R L / Gr R R R R R R R R/L SPECIAL INSTRUCTIONS At least 7.PHLEBOTOMY 4. It is important that attention be paid to any special instructions required by the testing laboratory. In large labs many more tests are performed than those listed below. and 3 hours. notify the lab. whereas small labs may do very few in the list. discontinue and notify the physician. vitamin Bilirubin. Good phlebotomy technique includes more than just collecting a specimen in the proper evacuated tube.
immediately and freeze serum. do not freeze or refrigerate. C4 Complement. separate Avoid hemolysis Maximum Draw (exact draw) Avoid hemolysis 3 hr: 5 specimens. separate as soon as blood clots. Freeze serum Let clot in refrigerator. place in 37 degree C water bath and allow to clot Incubate blood at 37 degree C until clotted. total (CH50) Cortisol CPK enzymes C-reactive protein CRP Creatinine phosphokinase (CPK total) Digitoxin Dilantin Electrolytes (Na. CO) Febrile agglutination Ferratin Fibrinogen Folate serum Fungal serologies Gamma-glutamyl transpepsidase GGT Gentamicin Glucose. total Clot retraction Cold agglutinins Complement. HDL Cholesterol. 5hr: 7 specimens (urine sample for each interval) Medtexx Medical Corporation . record date and time collected Collect after 8 – 12 hours fast Place 3 m in 13x100 mm test tube.57 - . fasting Glucose. K. 2hr postprandial Glucose tolerance Glycosylated hemoglobin Hematocrit Hemoglobin Hemoglobin electrophoresis Hepatic profiles Beta-human chorionic gonadotropin HCG Human Immunodeficiency virus HIV Human leukocyte antigen Lactodehydrogenase LDH LDH isoenzyme Lead Lipase Lithium R L R R S R R R R R/L R R R R R R R R B R R R R R R R R L L L L R R R R & Gr R R R L R Gn-donor. C3 Complement.PHLEBOTOMY Cardiac enzymes CBC Cholesterol. CL. R-recipient.
PHLEBOTOMY Liver profile Magnesium Osmalality. do not freeze Protect from light Medtexx Medical Corporation . serum Partial tromboplastin time PTT Phenobarbital Phosphorus Platelet count Potassium Procainamide Prostate specific antigen PSA Prostatic acid phosphate PAP Prothombin time PT Quinidine Rapid plasma regain RPR Reticulocyte count Rheumatoid arthritis serology RA Rubella titer Salicylates Sedimentation rate SGOT (AST) SGPT (ALT) SMA profiles Streptozyme T.T T4 / t8 ratio Thioridazine (mellaril) Thyroid profiles Thyroid stimulating hormones TSH Total iron binding capacity TIBC Transferrin Triglycerides Uric acid Viral serologies Western blot Zinc R R R B R R L R R R R B R R/L L R R R L R R R R R L/Gn R R R R R R R R R NB Avoid hemolysis Maximum draw Avoid hemolysis Freeze specimen if not to lab in 4 hrs Freeze specimen if not to lab in 4 hrs Maximum draw Blood smear needed.58 - .
Begin in the center of the venipuncture site and extend the circle out 3 inches in diameter. Allow the alcohol or other skin prep to dry thoroughly. Assemble the needle and syringe. Repeat the cleansing procedure twice. 4. There are certain test that require specific handling of the specimen prior to testing if there is any delay in transporting to the lab. Select the proper supplies. Medtexx Medical Corporation . 5. 3. Collecting a Blood Culture Supplies needed. The phlebotomist should refer to the procedure manual provided by their laboratory. 6. • Sterile gloves • Disposal exam gloves • Face shield or goggles • Surgical mask • Fluid-resistant gown or lab coat • 2 x 2 gauze pads • Alcohol sponges or blood culture prep kit • Tourniquet • 20 ml syringe • Sterile needles: 20-22 gauge or 23-25 gauge butterfly • Blood culture collection tubes • Permanent black pen for labeling bottles • Laboratory requisition forms • Puncture-resistant needle disposal container • Plastic bag for used supplies • Bandage Procedure Guidelines 1. Check the requisition slip to determine what specimen to collect.59 - . Wipe in a circular motion. most stable vein in the area. This section does not attempt to cover all lab testing. The following section deals with the test most often encountered in a general care hospital or health care facility. 2. the site should feel firm and rebound slightly. When palpated. Perform your beginning procedure actions. Use a clean swab each time u cleanse the skin.PHLEBOTOMY SPECIAL COLLECTION TECHNIQUES General considerations: Most laboratory testing is routine blood collecting. Cleanse the site with alcohol. using the Evacuated system or in some instances needle and syringe. but is an excellent reference for basic test. that require special techniques or handling. Select the largest. Move the plunger back and forth to break the seal. Apply a tourniquet and locate a vein.
Withdraw the needleand repeat with the aerobic bottle. Perform your procedure completion actions. Insert the needle into the patient's vein at 35-45 degree angle. 21. Cleanse the rubber stoppers well. Place the 2 x 2 gauze pad 1 inch above the insertion site. Remove the needle cover. and then pull the upper end of tourniquet downward. Avoid pulling upward. Cotton balls tend to stick to the insertion site. holding the needle by the wings. using alcohol. in your dominant hand. 17. Snap the caps off culture bottles. Hold the collection device securely. face shield. Using a Kelly or other instrument. • • • • • 2 pairs of disposable exam gloves Face shield or goggles Surgical mask Fluid-resistant gown or lab coat 2 x 2 gauze pads Medtexx Medical Corporation . Rest your dominant hand on patient's arm. Slowly depress the plunger. and when removed. Label the bottles according to facility policy. 22. 14. Make sure that the needle does not move. Release the tourniquet when the lat drop of blood is obtained. Quickly withdraw the needle. You will feel a change of pressure when the needle enters the vein. and discard the needle in the puncture resistant container. carefully remove the needle from the syringe. 24. 13. Holding the syringe with the dominant hand.60 - . remove the platelet plug. Allow to dry thoroughly.PHLEBOTOMY 7. Blood should begin to flow into the hub of the needle. causing bleeding. 18. filling the bottle with the appropriate amount of blood. and apply pressure. 8. approximately 1 inch below the puncture site. 20. Inject slowly. and exercise slowly. Discard the needle and syringe in the puncture-resistant container. Apply a sterile needle. Use a new sponge for each bottle. mask and gloves. Remove the cap from the sterile needle and pierce the rubber stopper of the anaerobic bottle. Maintain pressure for 3-4 minutes. including gown. Immediately bring the gauze pad down over the site. Wipe in a circular motion. 11. Advance the needle at least ¼ inches. withdrawing the required amount of blood. with the bevel facing up. and exercise care to avoid injecting air into either bottle. Cover the puncture site with a bandage. Transport the samples to the laboratory immediately in a plastic transport bag. or according to facility policy. Stabilize the vein by holding it with your thumb. Apply full protective equipment. or until bleeding stops. 10. 15. 23. 9. as his may cause the needle to come out of the patient's arm. 16. slowly pull back on the plunger with the non-dominant hand. 12. Avoid using cotton balls. Collecting a Blood Sample Using a Butterfly Needle Syringe Supplies needed. 19.
4. Release the tourniquet when the last drop of blood is obtained. Allow the alcohol or other skin prep dry thoroughly. Place a 2x2 gauze pad 1 inch above the insertion site. 10. Maintain pressure for 3 to 4 minutes. and apply pressure. Quickly withdraw the needle. in your dominant hand. Make sure that the needle does not move. Remove the needle cover. most stable vein in the area. with the bevel facing up. causing bleeding. Begin in the centre if the venipuncture site and extend the circle out 2 inches in diameter. 2. 9. 5. Move the plunger back and forth to break the seal. slowly pull back on the plunger. Select the largest. the site should feel firm and rebound slightly. Cleanse the site with alcohol. Cotton balls tend to stick to the insertion site and when removed. Wipe in a circular motion. Holding the syringe with the dominant hand. Perform your beginning procedure actions. 15. You will feel a change of pressure when the needle enters the vein. Advance the entire length of the needle. 12. 13. 16. Rest your dominant hand on the patient's arm. Insert the needle into the patient's vein. Blood should begin to flow into the attached tubing. 14. Avoid pulling upward. Apply a tourniquet and locate a vein. 11. Uncoil the butterfly tubing. holding the needle by the wings. 3. Assemble the needle and syringe. as this may cause the needle to come out of patient's arm. 8. filling the syringe with blood. Avoid using cotton balls.resistant needle disposal container Plastic bag for used supplies Bandage Procedure Guidelines 1. Medtexx Medical Corporation . Pull the upper end of the tourniquet downward. 7. Check the requisition slip to determine what specimen to collect. Gently tape the butterfly wings against the skin to hold the needle in place. Immediately bring the gauze pad down over the site. or until bleeding stops. Select the proper tubes. remove the platelet plug. 6.PHLEBOTOMY • • • • • • • • • • • • • Alcohol or povidone-iodine sponges Tourniquet 10 ml syringe Sterile 23 gauge butterfly needle Sterile 20 gauge needle Bandage tape to secure the butterfly in place Blood collection tubes Labels for collection tubes Permanent black pen for labeling tubes Laboratory requisition forms Puncture. When palpated. Cover the puncture site with a bandage. Stabilize the vein by holding it with your non-dominant thumb. approximately 1 inch below the puncture site.61 - .
Transfer the blood to the vacuum tubes in a rack by inserting the needle through the rubber stopper. 21. following facility policy. 24. Medtexx Medical Corporation . Hold the lancet at 45 degree angle. Open the package for the 20 gauge needle and attach the needle to the syringe. 4. 22. 23. 20. After leaving the room. Carefully discard them in the punctureresistant container.62 - . 26. 25. Procedure Guidelines 1. pierce the skin. Drawing Blood Using a Lancet for Microdraw or Infant Heel Stick Supplies needed. You will need the rest to fill the containers. Fill the tubes in order of the draw. Avoid shaking. With the sharp of the lancet. Remove the lancet. break the plastic cover off the end to expose the needle. make the stick perpendicular to the lines in the fingerprints. Follow the directions for the type of lancet you are using. Perform your beginning procedure actions. Wipe the first drop of blood away with a sterile 2 x 2 sponge. 7. Begin in the center of the puncture site and extend the circle out 2 inches in diameter. Allow the rack to support the tube when the needle is inserted.resistant needle disposal container Plastic bag for used supplies Bandage or spot adhesive bandages. Allow the alcohol or other skin prep to dry. With your non-dominant hand. 5. Discard the needle and syringe in the puncture. Remove the butterfly tubing from the syringe. Select the proper tubes. 3. Avoid holding it with your hand. 8. Wipe in a circular motion. For an adult fingerstick. Discard it in the puncture-resistant sharps container. 19. Identify the specimen collection site.resistant container. 6. 18. Label the tubes according to the facility policy. apply full personal protective equipment. 2. Hold the plastic end of the lancet in your dominant hand.PHLEBOTOMY 17. If the lancet has a plunger. Check the requisition slip to determine what specimen to collect. Gently invert the tubes several times to mix the samples. Transport the blood to the lab. depress it to pierce the skin while holding pressure on the site. Cleanse the site with alcohol. allowing the tube to fill. • • • • • • • • • • • Disposable exam gloves Lancets Microvette collection devices 2 x 2 gauze pads Alcohol or povidone-iodine sponges Labels for collection Permanent black pen for labeling tubes Laboratory requisition forms Puncture. Perform your procedure completion actions.
Position the tube almost horizontally. 11. or other bandage Procedure Guidelines 1. 2. If blood does not flow freely. Do not squeeze hard. Wipe in a circular motion. Support the patient's arm on the bed or other surface. 5. 3.63 - . Squeeze the skin slightly. 7. causing bleeding. spring-loaded blade. as this forces tissue fluid into the sample.PHLEBOTOMY 9. create suction by placing your gloved finger over the end of the capillary tube. You must stat the test within 60 seconds of inflating the cuff. Cotton balls tend to stick to the puncture site. or by squeezing the small bulb. Do not inflate it. Wipe any remaining blood from the skin. • Tourniquet • Blood pressure cuff • Watch with second hand • Filter paper • 2 x 2 gauze pads • Puncture-resistant sharps container • Plastic bags for used supplies • Steri-strips. Apply gloves. 13. Begin in the center of the puncture site and extend the circle 3 inches in diameter. diluting it. Allow the alcohol or other skin prep to dry. Double-check the requisition slip. Label the sample while in the patient's room. allowing blood to flow into the tube. butterfly bandage. Remove the Surgicutt*. Perform your beginning procedure actions. Hold the collection tube near the collection site. Apply the blood pressure cuff to the upper arm. remove the platelet plug. Cleanse the site with alcohol or povidone-iodine. 6. template. 12. palm up. and cover with an adhesive bandage. or similar device. Usually. Perform your procedure completion actions. Taking care not to touch the blade or activate the trigger. Inflate the blood pressure cuff until the gauge reads 40mmHg. template. You will perform the test approximately 4 inches below the antecubital space. two or three tubes are filled. Twist off the tab on the site. 8. Avoid using cotton balls. Measure Bleeding Time Supplies needed: • Disposable exam gloves • Alcohol or povidone-iodine sponges • Surgicutt*. 4. Fill the tube approximately 2/3 to ¾ full. or other product from the package. with the end slightly down. Medtexx Medical Corporation . Make sure the patient is comfortable and can maintain this position for the duration of the procedure. and when removed. The patient can hold the gauze sponge in place until the bleeding stops. Apply a gentle pressure with the 2 x 2 gauze to the skin to prevent painful bleeding inside the tissues. 10.
Apply a Steri-strip. or dressing to the incision. Remove the gloves and discard in the plastic bag. Medtexx Medical Corporation . 14. 11. Discard the filter paper in the plastic bag. Deflate the blood pressure cuff. Wipe remaining blood from the skin. Record the time the test ended. butterfly bandage. Placing the paper directly on the incision will interfere with the results of the test. 10. approximately 4 inches below the antecubital space. Position the device so the blade is parallel to the bend in the elbow. With the filter paper. 12.64 - . 16. 17. Record the time. Remove the blood pressure cuff. 15. stop timing. blot the bleeding every 30 seconds. Apply the Surgicutt* or other device to the prepared skin. Depress the trigger while monitoring the second hand on your watch. Perform your procedure completion actions. Position the paper near the incision. 13. Discard the device containing the blade in the puncture-resistant container. 18. Absorb the blood with the edge of the filter paper.PHLEBOTOMY 9. When he blood no longer stains the paper. Remove the blade from the skin with one second of depressing the trigger. without touching the wound directly.
Level Two Phlebotomists who have undergone specific training involving theory. and the type of tissue surrounding the puncture site. It can also aid in the determination of poisonings (carboxyhemaglobinemia or methemaoglobinemia) and in the measurement of lactate concentration. edematous or close to a wound. and under supervision of a qualified ABG technician. The radial artery is located in the thumb side of the wrist. however. superficial and has good collateral circulation. This artery is easily accessible most of the time. and is smaller than arteries at other sites. Except under unusual circumstances (i. The radial artery – This is the first choice and most common site for ABG collection.PHLEBOTOMY ARTERIAL PUNCTURE Arterial puncture is a relatively straight forward technique that is easily performed at the bedside. irritated.65 - . An arterial blood gas sample reveals how well the lungs are functioning in terms of gas exchange. the criteria for the selection include the presence of collateral circulation. hematomas. the axillary and femoral arteries are potential alternate sites. severe peripheral vascular disease). vasovagal episodes. and acid-base homeostasis. It should be clearly explained to the patient that this procedure is more uncomfortable than a routine venipuncture and more difficult to accomplish. nurses (RNs). ventilation. Medtexx Medical Corporation . Never select a site in an area with an A-V shunt or fistula. and rarely aneurysyms. 1. Pulse oximetry will give a reasonable estimate of the adequacy of oxygenation in many circumstances but does not assess acid-base status or ventilation and should not be used alone in cases where these measurements are important. and respiratory technicians/technologists are the most trained and experienced at performing arterial blood gas samples. it is not necessary to routinely perform an Allen's test prior to arterial puncture. how large and accessible the artery is. Who should perform this test? Paramedics. Technique Percutaneous puncture of the artery should be performed using standard precautions. Contraindications to these alternate sites include severe coagulaopathy and bypass grafting of that limb.e. The radial artery is easily compressible. physicians. The radial artery is the most common and best site for arterial puncture. The site chosen should not be inflamed. In patients that are hypotensive. bleeding. Site Selection Several sites can be used. Complications include pain. An arterial blood gas (ABG) will help in the assessment of oxygenation.
Preparation Steady State The patient's temperature. To heparinize the syringe. Consider 1-2% lidocaine with a 25 gauge needle to make a wheal over the puncture site for patient comfort. Due it is location and close proximity to other vital sites. Medtexx Medical Corporation . 3. 6. 3. Procedure for radial arterial puncture 1. Necessary Equipment 1) Materials for skin cleansing (Alcohol and cotton) 2) Syringe with 3 to 5 mL of Lidocaine 1% and a 23. and then return all of the heparin to the original container. which all can affect the blood gas results. a physician and/ or ER Trauma Team specialists are most qualified to collect the sample from this artery.66 - . Clean the site with alcohol. suctioning or respirator for at least 30 minutes prior to obtaining blood gases. lateral to the pubis bone. 7. the patients may respond with breathing harder. It is located superficially in the groin. crying or hyperventilating. Wear gloves. Ideally. Withdraw the needle from the skin and compress the site for 5 minutes. Consider the use eye protection. The Femoral Artery – Although the largest artery used for arterial blood gas it is the final artery site to use. a patient should have been in a stable or steady state: meaning no exercise. This can be done with butterfly wings. holding the breath. Administration of anesthetics may be omitted for patients who had had the procedure before and are not apprehensive about it. 2. 3) Preheparinised 3 to 5 mL syringe with 23 to 25 gauge neddle.to 25-gauge neddle. hold the syringe upright. Enter the skin at a 30-45% angle with a heparinized ABG syringe.PHLEBOTOMY 2. Place the patient's palm upward and gently extend the wrist 10-20 degrees. 4. Anesthetics These help reduce the painful procedure of having an arterial blood draw. aspirate 0. Without this. breathing pattern and concentration of oxygen inhaled affect the amount of oxygen and carbon dioxide in the blood. 5. pull the plunger all the way out to the end.5 mL of heparin into the syringe. This artery is located in the medical anterior aspect of the antecubital fossa near the insertion of the biceps. The Brachial Artery – This is the second choice for ABG collection. 4) Gloves 5) Ice for transport.
Instruct the patient to make a tight fist. If the patient is unresponsive. Make sure all bleeding stops.PHLEBOTOMY 8. 2. If a local anesthetic is used check for medication allergies. keep the arm above the heart level. Apply direct pressure on the radial and ulner arteries to obstruct blood flow to the hand as the patient opens and closes his fist rapidly. Medtexx Medical Corporation . The site should be checked for a delayed hematoma and circulation to the extremity every 15 minutes for the first hour. Allen's Test 1. A positive Allen's test is when a blush indicates ulnar patency. A negative Allen's test indicates occlusion of the ulner artery. 9. 2. 4. Complications • • • • • • • • • • • False value Discomfort Delay in cooling Intraluminal clotting Hematoma Hemorrhage Impaired circulation to extremity Infection Arterial spasm Thrombosis Nerve injury. Do not recap the needle (except for specially designed hinged caps) and remove the needle from the syringe and secure a syringe cap. Always do an Allen's Test before puncture. 6. 5. Alternate sites for serial ABGs. Instruct the patient to open his hand. 3. Examined the Palmer surface of the hand for an errythematous blush or pallor within 15 seconds. 3. Place in an ice water slurry and transport to the lab expeditiously or 10. 2. Precautions 1. If the patient is unresponsive raise the arm above the heart for several seconds to force blood to leave the hand.67 - . 3. with the radial artery remaining compressed. Place a drop of blood in an ABG analysis cassette and insert into a bedside testing device. Assess the results of the arterial blood gases. Care after punctured 1. Maintain continuous firm pressure on the countryside for 10 minutes. This radial artery should not be punctured.
6. 3. 2. 4. and circulatory assessment after arterial puncture.68 - .PHLEBOTOMY 5. ease of puncher. Specimen Rejection 1. 7. Document decided puncher. 5. Inadequate volume of specimen for the test Clotted Incorrect or no identification Delay in delivering the sample for analysis Not placed in ice Air bubbles Wrong syringe used Medtexx Medical Corporation . site assessment. time of applied pressure.
Adsorb to attract and retain other material on the surface. Acid-citrate-dextrose (ACD) An anticoagulant containing citric acid. See: Factor VIII Medtexx Medical Corporation . Rapid and abbreviated in onset in reference to a disease process. Aerosol canisters Enclosed containers used to hold specimen tubes for centrifugation. a retrovirus that causes immune system failure and debilitation and is often accompanied by infections such as tuberculosis. Acquired Immunodeficiency Syndrome (AIDS) An epidemic disease caused by an infection of the human immunodeficiency virus (HIV-1. Aerobic Having molecular oxygen present. Absorb To suck up. In respect to phlebotomy. but is currently used for plateletpheresis. blood cultures are often drawn for the purpose of determining the presence and identification of aerobic microorganisms. sodium citrate and dextrose. Acute Of short duration. as through pores. HIV2). ABO Blood Group The major human blood type system which depends on the presence or absence of antigens known as A and B.69 - . This was formerly used primarily as a whole blood preservative.PHLEBOTOMY GLOSSARY A ABG Arterial Blood Gas. AIDS is spread through direct contact with bodily fluids. AHF Antihemophilic Factor.
70 - . develop palpitations. Albumin Main protein in human blood. therefore. Medtexx Medical Corporation . certain foods. abnormal hemoglobin formation (such as in sickle cell anemia). fatigue easily. appear pale. Patients can feel tired. As in phlebotomy. A local anesthetic causes loss of feeling in a part of the body. the drawing of blood cultures for the purpose of possible isolation and identification of anaerobic bacteria. Anaphylaxis An acute. There are many causes of anemia. Anaphylaxis can be caused by any allergen. pertaining to an anaerobe. including: bleeding. The oxygen-transporting units are. insect bites. a person who has previously been exposed to that particular allergen) who comes into contact with the same allergen again.e. B12 (pernicious anemia).PHLEBOTOMY AIDS See: "Acquired Immunodeficiency Syndrome" Airborne Precautions One of a number of newly proposed precautions recommended by the CDC which includes Standard Precautions plus special precautions for patients known or suspected to be infected with microorganisms transmitted by airborne droplet nuclei (small-particle residue {5µ or smaller in size} of evaporated droplets containing microorganisms that remain suspended in the air and that can be dispersed widely by air currents within a room or over a long distance). living or occurring in the absence of molecular oxygen. and become short of breath. and allergy injections. and bone marrow diseases. insufficient. generalized life-threatening allergic or hypersensitive reaction in a previously sensitized person (i. Reactions that occur almost immediately tend to be the most severe. iron. Anesthetic A drug that causes unconsciousness or a loss of general sensation. Anemia The condition of having less than the normal number of red blood cells or hemoglobin in the blood. Anaerobic Growing. Allergen An antigenic substance capable of producing an immediate-type hypersensitivity (allergy). or folate deficiency. rupture of red blood cells (hemolytic anemia). The most common allergens are medications.
Anticoagulants used to prevent clotting of blood specimens for laboratory analysis are heparin and several substances that make calcium ions unavailable to the clotting process. sodium citrate and oxalate. see germicide and disinfectant. for example a good platelet collection may be obtained from two or three donors in which the conventional method would involve up to ten donors. aseptic refers to the absence of microorganisms. See ventral. Apheresis A technique in which blood products are separated from a donor and the desired elements collected and the rest returned to the donor. By contrast. Antibody A molecule that has a specific affinity for and reacts with the antigen that was responsible for it's production or with one which is closely related.71 - . Medtexx Medical Corporation . citrate phosphate dextrose (CPD).PHLEBOTOMY Antecubital fossa That part of the arm opposing the elbow. • • Anticoagulant solutions used for the preservation of stored whole blood and blood fractions are acid citrate dextrose (ACD). Antigen A substance that is capable of producing a specific immune response with a specific antibody. Antiseptic Something that discourages the growth microorganisms. Anterior Toward the front or in front of. citrate phosphate dextrose adenine (cPDA 1) and heparin. Antihemophilic factor See: Factor VIII Anti-platelet agents Medications that. reduce the tendency of platelets in the blood to clump and clot. Also. including EDTA (ethylenediamintetraacetic acid). like aspirin. Anticoagulant Any substance that prevents blood clotting. This has the advantage of specificity and a good harvest.
Larger arteriovenous shunts can place strain on the heart since arterial blood is diverted back to the venous circulation before it has a chance to deliver nutrients and oxygen to the body tissues.72 - . approximately 12 hours after the last ingestion of food or other nutrition. Autohemolysis Hemolysis of red blood cells of a person by his own serum. Diagnosed with blood cultures. Arteriovenous fistula The surgical joining of an artery and a vein under the skin for the purpose of hemodialysis. By contrast. Also. Aseptic The absence of microorganisms. Arteries are routinely accessed to retrieve arterial blood samples for blood gas measurements (ABG). Basal state As it pertains to phlebotomy. This is the base state of the body during which fasting blood work is drawn. B Bacteremia The presence of viable bacteria circulating in the bloodstream. Aseptic technique A method used by microbiologists and clinicians to keep cultures. SYN: arteriovenous shunt. Aspirate As it relates to blood drawing. The oxygenated hemoglobin (oxyhemoglobin) makes it look bright red. Arterial blood is normally full of oxygen. Artery Blood vessel carrying blood away from the heart. and people free of microbial contamination. the material that is withdrawn with a negative pressure apparatus (syringe). something that just discourages the growth of microorganisms is antiseptic. the basal state is the state of the body early in the morning. sterile instruments and media.PHLEBOTOMY Arteriole A small branch of an artery that leads to a capillary. Medtexx Medical Corporation . see capillary.
" Blood cell There are three main types of cell in the blood stream. which helps prevent bleeding. peripheral blood. These pathogens include. The correct balance between each cell type must be maintained for the body to remain healthy. Bleeding-time A test which measures the time it takes for small blood vessels to close off and bleeding to stop. which carries oxygen. but are not limited to.73 - . For more information. Blind stick Performing a venipuncture with no apparently visible or palpable vein. Blood The fluid in the body that contains red cells and white cells as well as platelets. Arterial blood is the means by which oxygen and nutrients are transported to tissues. venous blood is the means by which carbon dioxide and metabolic byproducts are transported for excretion. The red cell. bluish-black granules of variable size.PHLEBOTOMY Basilic vein Large vein on the inner side of the biceps. plasma and other elements. it is occasionally necessary requiring a skilled phlebotomist who is experienced and well versed in vascular anatomy. which fights infections and the platelet. the white cell. Abnormal results can be seen in those with congenital or acquired platelet function disorders or thrombocytopenia. See also: whole blood. Often chosen for intravenous injections and blood drawing Basophil A granular leukocyte with an irregularly shaped nucleus that is partially constricted into two lobes. Though this technique is discouraged. Blood-borne pathogens Any disease producing microorganism which is spread through direct contact with contaminated blood. OSHA defines blood-borne pathogens as "pathogenic microorganisms that are present in human blood and can cause disease in humans. proteins. BetadineT A popular tradename iodine-containing topical antiseptic agent. povidone-iodine. hepatitis B virus (HBV) and human immunodeficiency virus (HIV). Some medications. It is transported throughout the body by the Circulatory System. including aspirin will prolong a bleeding time. and with cytoplasm that contains coarse. Medtexx Medical Corporation . defibrinated blood.
or by cupping or leeches. Blood culture A test which involves the incubation of a blood specimen overnight to determine if bacteria are present. SYN: blood film Blood transfer device A safety device designed to transfer blood from one container into another. If that clot moves inside the vessel it is referred to as an embolus (embolism). Blood smear A sample of blood is applied to a microscope slide and then studied under the microscope. The factors have Roman numeral names. Blood count The determination of the proper number of red blood cells. like VII. VIII. especially applied to venesection. Blood letting The act or process of letting blood or bleeding. white blood cells and platelets are present in the patient's blood. Medtexx Medical Corporation .PHLEBOTOMY Blood clot The conversion of blood from a liquid form to solid through the process of coagulation. Blood clotting factor Any of a number of different protein factors which. X. See also: ABO blood group. Blood is collected in a special media which enhances the growth of both aerobic and anaerobic microorganisms. Defects in the genes which code for any of these factors result in genetic diseases like hemophilia. IX. can form a blood clot shortly after platelets have broken at the site of the wound. Blood film See: "blood smear" Blood group An inherited feature on the surface of the red blood cell. XI. which results from a defect in the gene for factor VIII or IX. Also known as complete blood count (CBC). when acting together. In phlebotomy. these devices are most often used in the transfer of blood from a syringe into a blood culture bottle or evacuated sample tube.74 - . A thrombus is a clot which forms inside of a blood vessel. A series of related blood groups make up a blood group system such as the ABO system or the Rh system. and XIII. as by opening a vein or artery.
or blood products. In the skin it can be seen as a reddish-purple discoloration which does not blanch when pressed upon. between the blood and tissue fluid Carbamate hemoglobin The hemoglobin compound bound with carbon dioxide in the red blood cells. Carbon monoxide poisoning. nutrients. forming a network in nearly all parts of the body. which has an affinity for hemoglobin 200 times greater than oxygen. C Cannula A tube for insertion into a duct or cavity. flexible tube. CBC See: "complete cell count" Medtexx Medical Corporation . including fluids. through the venous blood system. to the lungs for exchange with oxygen. Their walls act as semipermeable membranes for the interchange of various substances. it provides a pathway for giving drugs. Butterfly A small needle with two plastic wings attached which are squeezed together to form a tab that is used to manipulate the needle. Also see hematoma. The carbon dioxide is transported from body cells. Catheter A thin. This assembly is then attached to a syringe or Evacuated tube holder for the purpose of drawing a blood sample. blood samples can be withdrawn through the catheter.PHLEBOTOMY Blood vessel All the vessels lined with endothelium through which blood circulates. When it fades it becomes green and brown as the body metabolizes the blood cells in the skin. Capillary Any one of the minute vessels that connect the arterioles and venules. When a catheter is placed in a vein. Also. It is best treated with local application of a cold pack immediately after injury. A long 6-12" plastic tubing is attached which again offers better manipulation. (see oxyhemoglobin) Carboxyhemoglobin Hemoglobin which has been bound with carbon monoxide. fluids.75 - . Bruise A bruise or "contusion" is an traumatic injury of the soft tissues which results in breakage of the local capillaries and leakage of red blood cells.
through which drugs and blood products can be given and blood samples withdrawn painlessly. Citrate A compound that is an intermediate in the citric acid cycle (Krebs cycle or glycolysis). Chromatin The more readily stainable portion of the cell nucleus.76 - . Chelate Combining with a metallic ion into a ring complex. It is a DNA attached to a protein structure and is the carrier of genes in inheritance. Heart failure is an example of a problem with the circulation. is an effective anticoagulant. Citrate phosphate dextrose (CPD) An anticoagulant Citrate phosphate dextrose adenine (CPDA-1) An anticoagulant used for the preservation of whole blood and red cells for up to 35 days Medtexx Medical Corporation . SYN: Hickman catheter. Although the noun "circulation" does not necessarily refer to the circulation of the blood. arteries. capillaries and veins. blood cultures and surgical procedures. Preparation contains chlorhexidine gluconate 2% w/v and isopropyl alcohol 70% v/v. preventing blood clotting and. flexible plastic tube inserted into the large vein above the heart. It serves to transport blood low in oxygen from the body to the lungs and heart (veins) and oxygenated blood from the lungs and heart throughout the body (arteries). Different constituents of body fluids can be separated on the basis of their density by artificially increasing gravity in a centrifuge. for all practical purposes today it does. Citrate chelates (binds) calcium ions. Circulatory System The circulatory system is composed of the heart. thus. Chlorhexidine gluconate Antiseptic used in bleeding times. Circulation The movement of fluid in a regular or circuitous course.PHLEBOTOMY Central venous catheter Small. Centrifuge A laboratory apparatus that separates mixed samples into homogenous component layers by spinning them at high speed.
Citric Acid Cycle A group or series of enzymatic reactions in living aerobic organisms that results in the production of energy. Also known as the tricarboxylic acid cycle and the Krebs cycle. For a much more detailed and interactive explanation. Clot A semisolid mass of blood found inside or outside the body. Coagulate The process of clot formation. Part of an important host defense mechanism call homeostasis. Coagulation factors Group of plasma protein substances (Factor I thru XIII) contained in the plasma, which act together to bring about blood coagulation. For an in-depth explanation of blood coagulation. Cohorting In epidemiology, a group of individuals who share common characteristics; for example, patients in isolation may share the same airspace if the infectious agent is the same. Collateral circulation Blood which infuses an area through a secondary or accessory route. Blood which is carried through secondary channels after the primary vessels of that part have been obstructed or removed. Complete blood count (CBC) The number of red blood cells, white blood cells and platelets (per cubic millimeter) that are present in the patients sample of blood is determined. Also included is the hematocrit (%), hemoglobin concentration (gm%) and the differential. Most common test done on the blood. Contagious Infectious. May be transmitted from person to person. Contamination The soiling by inferior material, as by the introduction of organisms into a wound. Contusion A bruise or injury without a break in the skin.
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Coumadin™ Trademark for the preparation of warfarin sodium. Cytoplasm The liquid portion of a cell including organelles and inclusions suspended in it. It is the site of most chemical activities of the cell. D Defibrinated blood Blood which has been deprived of fibrin. Dialysis The process of cleansing the blood by passing it through a special machine. Dialysis is necessary when the kidneys are not able to filter the blood. Dialysis allows patients with kidney failure a chance to live productive lives. There are two types of dialysis: hemodialysis and peritoneal dialysis. Each type of dialysis has advantages and disadvantages. Patients can often choose the type of long term dialysis that best matches their needs. For more information on dialysis. Diaphoretic Formation of profuse perspiration (sweat). A symptom of syncope or vasovagal response Differential A count made on a stained blood smear of the proportion of the different leukocytes (WBC's) and expressed as a percentage. A differential is a normal part of a complete blood count (CBC). Disinfectant An agent that disinfects, applied particularly to agents used on inanimate objects. Distal Remote, farther from any point of reference, opposed to proximal. Dorsal Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy. E Ecchymosis The skin discoloration caused by a bruise (contusion).
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Edema The swelling of soft tissues as a result of excess fluid accumulation. Edema may be localized, due to venous or lymphatic obstruction or to leakage of fluids from the vascular system into the intercellular tissue spaces. It can also be systemic and generalized due to heart or renal disease. Development of collateral circulation will result in a reduction of water accumulation. EDTA Ethylenediaminetetraacetate. A calcium chelating (binding) agent that is used as an anticoagulant for laboratory blood specimens. Also used in treatment of lead poisoning. Efferent Carrying away. An artery is an efferent vessel carrying blood away from the heart. Effluent An outflow, usually of fluid. Electrolyte A substance that will acquire the capacity to conduct electricity when put into solution. Electrolytes include sodium, potassium, chloride, calcium and phosphate. Informally called "lytes". Embolus A sudden blockage of a blood vessel by a blood clot or some other obstruction which has been transported through blood vessels and lodged at a site too small for passage. Examples of emboli are a detached blood clot, a clump of bacteria, or other foreign material, such as air. Contrast to thrombus. EMLA cream Also "Eutectic Mixture of Local Anesthetics". A cream mixture of lidocaine and prilocaine, this topical anesthetic is often used locally on children for mildly invasive procedures such as venipunctures and intramuscular injections. The cream is placed on the skin in the area where the procedure is to be performed. After 30-60 minutes, the cream is removed and the procedure completed. Endothelium The layer of cells lining the closed internal spaces of the body such as the blood vessels and lymphatic vessels. Engineering control controls (e.g., sharps disposal containers, self-sheathing needles) that isolate or remove the bloodborne pathogens hazard from the workplace.
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the rubber sheath covers the needle bevel. enclosed by a rubber sheath. Epidermis The upper or outer layer of the two main layers of cells that make up the skin. round granules that are uniform in size. open surfaces of the body including the skin. See image Epidemiology The science concerned with the study of factors influencing the distribution of disease and their causes in a defined population to establish programs to prevent and control their development and spread. used to draw multiple tubes of blood with one venipuncture. The needle has a male thread on one end which screws into the holder. See: red blood cells. stopping the flow of blood. Thus. Evacuated Tube Holder A cylindrical shaped holder that accepts an Evacuated tube on one end and a Evacuated tube needle on the other. Etiology The cause or origin of a disease or disorder. Medtexx Medical Corporation . and mucous membranes that communicate with the outside of the body. Evacuated Tube Needle The needle used to attach to a Evacuated tube holder. Evacuated tube. The threaded end also has a large gauge needle. This needle will puncture the stopper of a Evacuated tube tube allowing blood to enter the tube. The holder. The concept was first devised and produced by Becton Dickinson under the trademark. Epithelium The outside layer of cells that covers all the free. Erythrocyte Cells that carry oxygen to all parts of the body.80 - . and cytoplasm containing coarse. Upon withdrawal of this needle from the tube.PHLEBOTOMY Eosinophil An eosin (red) staining leukocyte with a nucleus that usually has two lobes connected by a slender thread of chromatin. tube and needle comprise the Evacuated tube System (see illustration). any number of tubes may be drawn with only a single venipuncture. Evacuated tube An often generic term used to describe equipment used to automatically aspirate blood from a vessel by venipuncture.
Fistula An abnormal passageway usually between two internal organs. (see Illustration) Evacuated tube Blood sample tubes containing a vacuum. Fibrin The protein formed during normal blood clotting that is the essence of the clot. For example. When the tube stopper is pierced by a Evacuated tube needle which has been properly positioned in a vein. lactose and dextrose. Classic hemophilia (hemophilia A) is due to a congenital deficiency in the amount (or activity) of factor VIII. When a multi-sample needle is used the system will allow for the aspiration of any number of sample tubes with only one venipuncture. the vacuum draws blood into the tube. see arteriovenous fistula. Medtexx Medical Corporation . F Factor VIII One of a number of coagulation (clotting) factors. Fibrinogen The protein from which fibrin is formed/generated in normal blood clotting. Factor VIII is also known as antihemophilic factor (AHF) or antihemophilic globulin (AHG). The gene for factor VIII (that for classic hemophilia) is on the X chromosome so females can be silent carriers without symptoms and males can be hemophiliacs. A number of laboratory tests are performed on "fasting" blood specimens such as sugar (glucose) levels and tolerance tests such as glucose. Flash-back Relative to venipunctures. Specimens are usually taken after overnight fasting. Faint See: syncope Fasting Without eating. Such passages may be created experimentally for the purpose of obtaining body secretions for study. needle and sample tube which allows for a more automated method of drawing blood. the appearance of a small amount of blood in the neck of a syringe or the tubing of a butterfly.81 - . This is a sign that the vein has been properly accessed.PHLEBOTOMY Evacuated Tube System The combination of a Evacuated tube holder.
) would be used to draw blood for laboratory testing. the smaller the gauge. Hematoma A localized collection of blood within tissue due to leakage from the wall of a blood vessel. Flexion of the fingers results in a clenched fist.82 - . Caused by a filtration of plasma into body tissues and often created by dehydration. Hematocrit The ratio of the total red blood cell volume to the total blood volume and expressed as a percentage. H Harvesting The collection and preservation of tissues or cells from a donor for the purpose of transplantation.PHLEBOTOMY Flexion The process of bending or the state of being bent. For example. G Gauge Needle diameter is measured by gauge. Hemoconcentration A decrease in the fluid content of the blood (plasma). producing a bluish discoloration (ecchymosis)and pain. whereas a much smaller needle (23 ga. Glucose is the end product of carbohydrate metabolism and is the chief source of energy for all living organisms. This is determined by an increase in the hematocrit. the larger the needle diameter. Graft An implant or transplant of any tissue or organ. resulting in an increase in concentration. a very large diameter needle (16 ga.) may be used for hemodialysis. Germicide An agent that kills pathogenic microorganisms Glucose The sugar measured in blood and urine specimens to determine the presence or absence of diabetes. Medtexx Medical Corporation .
• • • hepatitis A: usually a self limited viral disease caused by the hepatitis A virus. Hemolysis The breaking of the red blood cells membrane releasing free hemoglobin into the circulating blood. Symptoms are generally mild and the disease may revert from acute to chronic in a large percentage of patients. rubber-like material) tube inserted and secured into a large vein in the chest for long-term use to administer drugs or nutrients. Transmission is primarily by blood transfusions. needlestick injuries by health care workers and sharing of needles by drug abusers. Symptoms include fever. Most recently implicated in numerous outbreaks at restaurants where employee hygiene is suspect. Cirrhosis may occur.PHLEBOTOMY Hemodialysis The removal of certain components of the blood by virtue of the difference in their rates of diffusion through a semipermeable membrane. The virus is shed in body fluids of chronic and acute patients as well as asymptomatic carriers.83 - . Transmission is usually the result of poor hygiene and most often through the fecal-oral route. Hickman catheter A hollow silicone (soft. hepatitis B: An acute form of hepatitis caused by hepatitis B virus. In phlebotomy. Usual symptoms include mild flu-like distress and possible mild jaundice. either by vasoconstriction and coagulation or by surgical means. The catheter is inserted through a small Medtexx Medical Corporation . nausea. It is also the most prevalent form resulting from needle sharing by drug abusers and is occasionally implicated in health care worker involving parenteral transfer through needlesticks or scalpel injuries. hepatitis C: Caused by hepatitis C virus. It has also been known to be transferred from mother to neonate and by intimate sexual contact. vomiting and jaundice. A method often used for removing undesirable elements from the blood in kidney patients. Heparin An anticoagulant that acts to inhibit a number of coagulation factors. Hemoglobin The oxygen carrying pigment of the red blood cells. this is usually the result of mechanical damage due to poor technique. especially factor Xa. Heparin is formed in the liver. This is usually self-limiting but the range varies extensively. this is the most common for of hepatitis after blood transfusion. Hemostasis The cessation of bleeding. Hepatitis Inflammation of the liver.
Medication. Implant An object or material. Hypodermic needle A needle that attaches to a syringe for the purpose of injections or withdrawal of fluids such as blood. and new bone marrow can be delivered through the catheter. partially or totally inserted or grafted into the body of a recipient. humoral immunity from antibodies in the blood as opposed to cellular immunity. Humoral Pertaining to elements dissolved in blood or body fluids. base their reimbursements on the ICD9 codes. Hypoglycemia An abnormally low glucose level in the blood.. A growing number of managed care and other insurance companies. HIV See: Human Immunodeficiency Virus Human Immunodeficiency Virus The virus known to be responsible for producing Acquired Immunodeficiency Syndrome (AIDS). Medtexx Medical Corporation . blood products. Hyperglycemia An abnormally high glucose in the blood. however.PHLEBOTOMY incision made near the collarbone.84 - . nutritional support. Reactions are classified as delayed or immediate types.g. I ICD9 code ICD9 codes describe medical or psychiatric procedures performed by physicians and other health providers. e. such as tissue. Hypersensitivity A state in which the body reacts with an exaggerated immune response to a foreign substance. The ICD9 codes were developed by the Health Care Financing Administration (now CMS) to assist in the assignment of reimbursement amounts to providers by Medicare carriers.
"Biosafety in Microbiological and Biomedical Laboratories". inside a glass. this can be a major complication of mastectomies. A discussion of biological safety cabinets is provided in the CDC publication. observable in a test tube Invivo Inside the living body. Lymphedema Lymphedema is a type of swelling which occurs in lymphatic tissue when excess fluid collects in the arms or legs because the lymph nodes or vessels are blocked or removed. nonphagocytic leukocytes. found in the blood and lymph. 7-10µ in diameter with a round or Medtexx Medical Corporation . Leukocyte See: "white blood cells". Lymph is collected from all parts of the body and returned to the blood by the lymphatic system. which are the body's immunologically competent cells.PHLEBOTOMY Invitro Outside the living body. Lancet A small pointed blade usually with two edges used for incising or puncturing. Lymphocyte Any of the mononuclear. Most are small. K Krebs Cycle See: Citric Acid Cycle L Laminar flow hood Safety cabinets with air flow in such a direction as to carry any harmful materials or fumes away from the worker.85 - . Regarding phlebotomy. Lymph Fluid found in lymphatic vessels and nodes derived from tissue fluids. Lateral A position farther from the midline of the body or another reference structure.
M Macrophage Any of the many forms of mononuclear phagocytes found in tissues and originating from stem cells in the bone marrow. containing various hydrolytic enzymes and normally involved in the process of localized digestion inside the cell. In normal circulation.Mean Corpuscular Volume Average volume of red blood cells (erythrocytes). Calculation: Medtexx Medical Corporation .Mean Corpuscular Hemoglobin The average hemoglobin content in a red blood cell (erythrocyte). expressed in cubic micrometers (µm3) or femtoliters. Lysosome One of the minute particles seen with the electron microscope in many types of cells. Lytes Short for "electrolytes".Mean Corpuscular Hemoglobin Concentration The average hemoglobin concentration in red blood cells (erythrocytes). This is the average amount of hemoglobin per RBC. MCH . This is the average RBC size. Calculation: MCHC = Hgb ÷ Hct Where: Hgb = blood hemoglobin concentration (g/dL) Hct = hematocrit (%) MCV . the monocyte may be categorized as a macrophage.86 - .PHLEBOTOMY slightly indented nucleus that almost fills the cell with a thin rim of cytoplasm that may contain a few granules. expressed in picograms/RBC. This is the amount of hemoglobin relative to the size of the cell per RBC. Calculation: MCH = (Hgb x 10) ÷ RBC Where: Hgb = blood hemoglobin concentration (g/dL) RBC = Red cell count (millions/mL) MCHC . expressed in "percent" (g/dL).
phagocytic leukocyte. Medtexx Medical Corporation . An infection whose origin is from within the hospital environment.PHLEBOTOMY MCV = (Hct ÷ RBC) x 10 Where: Hct = hematocrit (%) RBC = Red cell count (millions/mL) Medial Pertaining to the middle aspect. N Negative air pressure Pressure less than that of atmosphere. Multi-sample adapter A device used with a butterfly and evacuated tube holder (see illustration) to allow for the withdrawal of multiple tubes of blood during a venipuncture. closer to the midline of the body or structure. when the rooms door is open. sometimes containing fine reddish granule. Neutrophils are the major phagocytes in the circulation. Nosocomial infection A hospital-borne infection. See image. considering an isolation unit where the room air is under negative pressure. In blood circulation. monocyte and lymphocyte. Mononuclear A cell containing but one nucleus.87 - . 13-25µ in diameter. Neutrophil A polymorphonuclear granular leukocyte having a nucleus with 3-5 lobes connected by slender threads of chromatin. air from outside the room is brought into the room which restricts any contaminated air from exiting. For example. usually in the heel of infants or the fingers of children and adults. lacey chromatin and abundant gray-blue cytoplasm. Monocyte A mononuclear. with an oval to kidney shaped nucleus. and cytoplasm containing fine inconspicuous granules. This procedure is limited to collection of very small quantities of sample. Microcapillary Referring to collection of blood specimens by puncturing capillaries.
this technique is used to determine the position and depth of an artery. depth and direction of a vein. peritoneal fluid. and blood. (2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead). decrease of absence of skin color. means (1) The following human body fluids: semen. Pathogen Any microorganism that produces disease. cerebrospinal fluid. and all body fluids in situations where it is difficult or impossible to differentiate between body fluids.or HBV-containing culture medium or other solutions. In relation to arterial punctures. organs. In the cells oxygen is exchanged for carbon dioxide (see carbamate hemoglobin). Palmar Referring to the palm surface or side of the hand Palpate To examine or feel by the hand. ParafilmT A thin film of paraffin used primarily in the laboratory to seal open containers such as test tubes.PHLEBOTOMY O Order of Draw Terminology used to define the order in which blood sample tubes should be drawn using a multisample technique such as the Evacuated tube System.88 - . and (3) HIV-containing cell or tissue cultures. this technique is used to "feel" a vein which will tend to rebound when slight pressure is applied with the finger. go here. saliva in dental procedures. Other Potentially Infectious Material (OPIM) OPIM. In relation to venipunctures. and HIV. amniotic fluid. For excellent educational materials provided by BD. vaginal secretions. P Pallor Paleness. The technique is used to help determine the size. Evacuated tube is a trademark of Becton Dickinson. or other tissues from experimental animals infected with HIV or HBV. pleural fluid. synovial fluid. as defined by the OSHA Bloodborne Pathogens Standards. any body fluid that is visibly contaminated with blood. Oxyhemoglobin Hemoglobin that has been bound with oxygen in the lungs for the purpose of transport of oxygen to cells of the body. Medtexx Medical Corporation . organ cultures. pericardial fluid.
acidity. heel pad. pH The symbol used to depict the hydrogen ion concentration of a solution. above 7.89 - .PHLEBOTOMY Pathogenic Having the capability of producing disease. pH 7. It produces edema. The term usually refers to WBC's.0 is neutral. The particulate is taken into the cell in a membrane-bound vacuole called a phagosome. Phagocytosis A phagocyte is any cell capable of ingesting particulate matter. The phagosome combines with lysosomes within the cell cytoplasm forming phagolysosomes which then digest and destroy the particulate. i. below is acid. The condition is marked by infiltration of the layers of the vein and the formation of a clot.e.0 is alkaline. Medtexx Medical Corporation . stiffness and pain in the affected area. needle puncture of a vein for the purpose of drawing blood (venipuncture). Phlebotomist One who practices phlebotomy Phlebotomy The incision of a vein as for blood letting (venesection). earlobe or from an antecubital vein. Pipet A glass or transparent plastic tube used to accurately measure small amounts of liquid. such as from the fingertip. (See illustration) Phlebitis Inflammation of a vein. Peripheral blood Blood obtained from the circulation away from the heart. Peritoneal dialysis Dialysis through the peritoneum. Peritoneum The membrane lining the abdominal and pelvic wall. monocytes and macrophages in tissues. specifically polymorphonuclear leukocytes .
Leukocytes so categorized include neutrophils. Normal platelet counts range from 150. Protoplasm The viscid. platelets will aggregate at the site of a break in vascular integrity. Under normal conditions. bleeding times and for patients with allergies to alcohol. which has no nucleus or DNA. Prophylaxis A preventative treatment. approximately 2-4 microns in diameter and known for its involvement in blood coagulation.90 - . Plateletpheresis The selective separation and removal of platelets from withdrawn blood. The protoplasm surrounding the nucleus is called cytoplasm and that composing the nucleus is nucleoplasm. Medtexx Medical Corporation . BetadineT. povidone-iodine is routinely used as the antiseptic of choice for blood cultures.PHLEBOTOMY Plasma The fluid portion of the blood in which the cellular components are suspended. eosinophils and basophils. Posterior Situated at the back (dorsal) part of a structure. this is a particulate component of the blood. this is a compound made by reacting iodine with povidone which slowly releases iodine. This structure. forming the beginning stages of a clot. Platelet Also known as a thrombocyte. Plasma contains coagulation factors used in the clotting of blood as opposed to serum. and to a lesser degree. known as a megakaryocyte in the bone marrow. opposed to supine. Povidone-iodine Used as a topical antiseptic. Polymorphonuclear A white blood cell with a nucleus so deeply lobed so as to appear to have multiple nuclei. translucent fluid that makes up the essential material of all plant and animal cells. is formed by breaking off from the cytoplasm of the parent cell. Prone Lying face down. Also: thrombapheresis and thrombocytapheresis.000-450.000/cm³. As related to phlebotomy. The remainder of the blood is re-transfused back into the donor.
000-5.PHLEBOTOMY Proximal Nearest to any other point of reference. Rh System The most complex of all human blood groups and is responsible for serious hemolytic disease of the newborn. Red Blood Cell Indices See: • • • mean corpuscular hemoglobin (MCH) mean corpuscular volume (MCV) mean corpuscular hemoglobin concentration (MCHC) Reverse isolation An isolation procedure designed to protect the patient from contracting disease.91 - . Frequently used for transplant patients or for patients whose immune response has been greatly reduced.000 RBC's per cubic millimeter. Medtexx Medical Corporation . Though sclerosis may occur in many areas of the body.500. Q QNS "Quantity Not Sufficient" R Red blood cell (RBC) One of the solid components of the blood which is normally a biconcave disc with no nucleus.000. S Sclerosis A hardening. the term is most often associated with blood vessels. This is the component of the blood that contains hemoglobin which is responsible for oxygen and carbon dioxide exchange. Semipermeable Permitting the passage of certain molecules and hindering others. especially from inflammation and certain disease states. A red cell count is performed as part of a complete blood count and ranges from 4.
92 - . meaning immediately. the clear liquid portion of blood that separates out after clotting has taken place. the barrel and the plunger and works much as the piston of an automobile. if the plunger is pushed down a positive pressure is exerted and any fluid in the barrel is expelled. T Therapeutic Pertaining to results obtained through treatment. Go directly to the CDC for the complete recommendation. Stat Abbreviation for the Latin word statim. Standard Precautions The most important of two categories of precautions under new CDC recommendations to replace the current "Universal Precautions" guidelines. Thrombocyte See: Platelet Thrombocytopenia Decrease in the number of blood platelets below normal values.PHLEBOTOMY Serum Referring to blood. A hypodermic needle is normally affixed to the end of the syringe for injections and a butterfly for a venipuncture. A syringe generally consists of two parts. Syringe An instrument used to inject fluids into or aspirate fluids from any vessel or cavity. Since clotting has occurred. Medtexx Medical Corporation . a temporary loss of consciousness due to a reduction of blood to the brain. having medicinal or healing properties. Compare to "Transmission-Based Precautions". These precautions are designed for the care of all patients in hospitals regardless of their diagnosis or presumed infection status and is the primary strategy for successful nosocomial infection control. For a much more in-depth explanationgo here. Supine Lying down with the face up. As the plunger is pulled up a negative pressure is created which draws fluids up into the barrel. a healing agent. The use of a syringe and straight hypodermic needle for phlebotomy is no longer considered an acceptable procedure. serum is fibrinogen deficient. Syncope (vasovagal syncope) Fainting. opposed to prone. Contrast to plasma.
Transmission-Based Precautions A new category of precautions as proposed by the CDC to replace the current "Universal Precautions". A blood pressure cuff may also be used. See the section "Infection Control" in this site for further details.PHLEBOTOMY Thrombosis The formation of a blood clot (thrombus) within a vessel. The vascular system is composed of the heart. Medtexx Medical Corporation . lymphatics and their parts considered collectively. latex or other synthetic elastic material. blood vessels. This category is used for patients known or suspected to be infected or colonized with epidemiologically important pathogens that can be transmitted by airborne or droplet transmission or by contact with dry skin or contaminated surfaces. V Vacuole Any small space of cavity formed in the protoplasm of a cell. Transplant An organ or tissue taken from the body for grafting into another part of the same body or into another individual. Heparin and Coumadin™ are being used to assist in dissolving or preventing clot formations. a constrictive band. placed over an extremity to distend veins for the purpose of blood aspiration or intravenous injections. SYN: graft U Universal (Standard) Precautions A set of procedures and protocols designed to protect the healthcare worker which uses the basic concept that each patient must be treated as though they were infected with an infectious disease such as AIDS or hepatitis.93 - . Materials used may be rubber. Compare to "Standard Precautions". Vascular Pertaining to or composed of blood vessels. Tourniquet In regards to venipuncture. Thrombus A blood clot obstructing a blood vessel or a cavity of the heart.
SYN: vasovagal syncope. this time with oxygenated blood (no carbon dioxide). Vasoconstriction Decrease in the inside diameter of especially arterioles leading to a decrease in blood flow to a part. Vasovagal response a transient vascular and neurogenic reaction marked by pallor. vasovagal attack. Venesection Opening of a vein for the purpose of collecting blood. W Medtexx Medical Corporation . Volar Pertaining to the palm or sole. wrist or hand. Vein Blood vessels carrying blood to the heart. SYN: Blood letting Venipuncture The puncture of a vein for any purpose Venous Pertaining to the veins.94 - . The presence of carbon dioxide and the absence of oxygen accounts for the dark red appearance of the blood in venous circulation. vasodepressor syncope. nausea. continuous with the capillaries. indicating the flexor portion of the forearm. sweating. Blood contained within these vessels is generally bound with carbon dioxide which will be exchanged for oxygen in the lungs. SYN: anterior Venule A very tiny vein. Compare with arteriole. or blood passing through them. Ventral Pertaining to the front side of the body.PHLEBOTOMY Vascular graft Type of an arteriovenous fistula consisting of either a venous autograft or synthetic tube which is grafted to the artery and vein. The only exception to this is the pulmonary vein which is the vein returning to the heart from the lungs. It is most often the result of emotional stress associated with pain or fear. slowing heart rate and a rapid fall in arterial blood pressure which may result in loss of consciousness.
See also complete blood count.95 - .PHLEBOTOMY Warfarin sodium The sodium salt of warfarin. one of the synthetic anticoagulants. lymphocytes . Medtexx Medical Corporation . White blood cell count The number of white blood cells (leukocytes) found in the peripheral blood and measured per cubic millimeter. A variety of cells within the blood and bone marrow whose general purpose is to help in fighting infection. collected from a donor and anticoagulated for the purpose of blood replenishment for a recipient. Whole blood Blood from which none of the elements have been removed. The five general cells thus distinguished are neutrophils. Coumadin™. Each type is differentiated by use of a stained preparation (see differential) and is separated based on how the cells and their components take up the stain. monocytes . White blood cell Also leukocyte. It is usually referred to as that blood. basophils and eosinophils all of which are nucleated cells.
S-4. April 1. a medical and health information resource containing outstanding database of health articles and reference materials. MD Deaconess Billings Clinic. AABB advancing transfusion and cellular therapies MoonDragon's Health Information UHS and UTHSCSA Department of Pathology Capital Health Arterial Puncture.96 - . 1988 AllRefer Health. Improving patient outcomes from better transfusion practice.1-19. Health care and Laboratory Services (2000) Becton.PHLEBOTOMY RESOURCES • • • • • • • • • • • • • • • • The Internet Pathology Laboratory for Medical Education (1994-2005) Morbidity and Mortality Weekly Reports 37: No. David Chong Legacy Health System Phlebotomy. Discovery Health Heal Central Blood Matters. the art of drawing blood by Jack Gray Radial Artery Puncture by Carlos Eduardo Reis. Dr. Dickinson and Company Medtexx Medical Corporation .
{Order of Draw (NCCLS H3-A5. 8.k. The discard tube must be used to fill the blood collection set tubing's "dead space" with blood but the discard tube does not need to be completely filled. This important step will ensure maintenance of the proper blood-to-additive ratio of the blood specimen. ~i~ .10. No 32. Gr/Dk. The discard tube should be a nonadditive or coagulation tube. PST Gel Separator Tube EDTA Tube Fluoride (Glucose) Tube Purple (Lavender) Lt. a discard tube should be drawn first.2)} Color Yellow Type Blood Cultures—SPS Citrate Tube Red/Gray Light Blue Gold or Red SST Gel Separator Tube Serum Tube Heparin Tube Dark Green Light Gray or or Lt.a. Butterfly) for venipuncture and a coagulation (citrate) tube is the first specimen to be drawn. This includes the change in which CLSI (formerly NCCLS) recommended. Gr. Lavender) Gray Note: Always follow your facility's protocol for order of draw! * When using a winged blood collection set (a.Appendix A—Order of Draw: Multiple Tube Collections The following chart reflects the most current standard for the order in which blood samples are collected in tubes. Vol 23. Purple (Lt.
C) 87045 87324 87045 82270 87177 87425 87070 82947 82947 82947 83036 84702 86706 87340 86803 80076 80074 82746 Iron 82977 Iron & TIBC LDH Lipase Magnesium Mono Screen Phosphorus Protein Electrophor. M) Test Name CPT 87536 82131 82784 83883 Test Name ANA Alkaline Amylase Basic Metabolic Prof. Hem.Direct/Total Blood Culture X1 X2 BNP BUN Cardio CRP CRP (C-Reactive prot. Serum GGTP Culture.o. Box 845 Gotha. Neo. Coronary Risk Lipids Creatinine Digoxin CPT 86038 84075 82150 80048 82247 82247 82248 87040 83519 84520 86140 86140 82310 86147 80156 85025 85007 85021 82378 82465 82550 80053 80061 82565 82565 Test Name Dilantin Electrolytes.coli Stool. Potassium PSA Total & Free PSA PT PTT Reticulocyte Count Sed Rate.O. Do Not Include A "Rule Out" Diagnosis. When Ordering Multiple Tests On The Same Order Form.) Calcium Cardiolipin Antibody Carbamazepine CBC w/plts. Stool. swab ~ii~ . Please Indicate A Sign Or Symptom/Diagnosis For Each Test/Treatment). Serum 2 Hr. GTT (Standard) Glycohemoglobin. auto diff CBC Manual diff Hemagram CEA Cholesterol.b. Adult Total Bili. Rotavirus Culture. GTT (Pregnancy) 3 Hr. Ova & Parasite Stool. A1C HCG Beta Quant Hepatitis B surface AB Hepatitis B surface AG Hepatitis C AB Hepatic Function Hepatitis Profile (A. Free TSH Theophylline 83550 83615 83690 83735 86308 84100 84165 84132 84154 84153 85610 85730 85045 85651 84460 84450 84480 84439 84443 80198 83540 HIV Homocysteine Immunoglobulin (A. Serum Ferritin. Total Comprehensive Meta. ESR SGPT (ALT) SGOT (AST) T3 Total T4. B. Throat. Wound Glucose. FL 34734 Medical Record #_______________________d.E. Stool Stool. RAPID Culture.Appendix B—Sample Requisition Form Patient Information Medtexx Medical Corporation P. Total CK. Occult Blood Stool. Serum Flu AB A&B. Routine □ STAT □ ICD-9 CODE(S)/Reason for Tests: _______________________________ Call Results to:________________________________ _______________________________ Fax Results to:________________________________ CPT 80185 80051 82728 87400 Immunoelectrophoresis Folate. G.____________ Patient Name___________________________________________ Phone: 407-905-0203 Address _______________________________________________ Fax: 321-221-9423 City______________________State_______Zip_______________ Home (______)______________ Work (______)_____________ Phlebotomy Requisition Form Ordering / Referring Physician Name:___________________________________________________________ Ordering / Referring Physician Signature:________________________________________________________ Signs or Symptoms (Please Note: Diagnosis Codes Necessitating Reason For Visit Must Be Provided Prior To Rendering Lab Service. Throat. Bilirubin Bili. Clostridium difficile Culture. Routine Culture.
or other food that may have become contaminated during handling o Eating raw shellfish harvested from sewage-contaminated water o Swallowing contaminated water or ice Persons with HAV can spread the virus to household members or to sexual partners. vegetables. It is a liver disease caused by the hepatitis A virus.Appendix C: Hepatitis Hepatitis is a disease or condition marked by inflammation of the liver. In addition to getting HAV directly from infected people. Who is more likely to get Hepatitis A? Persons who share a household or have sexual contact with someone who has HAV Men who have sexual intercourse with men Persons who use street drugs Children and employees in child care centers (especially centers that have children in diapers) where a child or an employee has HAV Travelers to countries where HAV is common Persons with clotting factor disorders who receive factor concentrates ~iii~ . but the most common forms of viral hepatitis are Hepatitis A. Young children can be infected with the virus but not show the symptoms. HAV is found in the stool (feces) of persons with hepatitis A. factory or school setting. Three of the variations are major concerns for healthcare workers: • • • Hepatitis A Hepatitis B Hepatitis C Hepatitis A Hepatitis A virus. These children often spread the virus to older children and adults. does not spread the virus. Hepatitis B. Casual contact as in the usual office. also known as HAV. you can get it by: o Eating fruits. It is still considered a common disease in the United States. The virus can easily spread in areas where there is poor sanitation or poor personal hygiene. There are several variations of the virus. can affect anyone. It is spread from person to person by putting anything in the mouth that has been contaminated with the stool of a person with hepatitis A. Hepatitis C. and Hepatitis D.
You will either need two shots of Hepatitis A vaccine or three shots of the combination Hepatitis A and Hepatitis B vaccine. Vaccines are also available for long-term prevention of Hepatitis A virus infection in person 2 years of age and older. Symptoms usually develop over a period of several days. IG might be used for short-term protection in two situations: ~iv~ . Recovering from the disease produces lifelong immunity from future HAV infection. Once a person recovers from Hepatitis A. or before preparing or eating food. they will never get it again. This often happens with young children who unknowingly spread HAV to older children and adults. There is no chronic (long-lasting) infection with HAV. Three of every four adults who get HAV have symptoms. Persons with no symptoms can still spread the virus. Residents and staff of institutions for developmentally disabled persons when a resident or employee has HAV Workers who handle HAV-infected animals or work with HAV in a research laboratory setting Symptoms of HAV Children who are infected often have no symptoms. HAV usually does not cause death. After getting your first shot. changing a diaper. How to Prevent HAV Good personal hygiene and proper sanitation can help prevent HAV. Immune globulin (IG) is available for short-term prevention of HAV infection in all ages. your doctor or nurse will tell you when to return for the second shot. Always wash your hands after using the bathroom. Symptoms may include: Yellow eyes Dark urine Nausea Fever Tiredness Loss of appetite Stomach ache Vomiting A person can spread HAV about one week before symptoms appear and during the first week of symptoms.
also known as HBV. Currently. such as hemophilia Persons who work with HAV-infected animals or work with HAV in a research setting Hepatitis B Hepatitis B. Hepatitis B is the most common serious liver infection in the world. is a serious disease caused by the Hepatitis B virus. 400 million people are chronically infected. HBV is 100 times more infectious than the AIDS virus. who have recently been exposed to HAV IG must be given within two weeks of exposure to HAV in order to work. 2 billion people have been infected (1 out of 3 people) worldwide. However. first dose should be given at least 4 weeks before travel) Persons with chronic liver disease Persons with clotting factor disorders. the vaccine is of no use. liver failure. Who Should Receive Hepatitis A Vaccine? Children in states and countries with consistently increased rates of HAV (county and state health departments can tell you whether your areas have these higher HAV rates) Men who have sexual intercourse with men Persons use street drugs Persons who work in or travel to countries where infection with HAV is common (for the most protection. A simple blood test can determine whether a person has been infected with the virus or not. It cannot be cured. It can cause lifelong infection. yet it can be prevented with a safe and effective vaccine. there is a Hepatitis B vaccine available for all age groups to prevent HBV infection. and 10 – 30 million people will become infected each year. For the 400 million people worldwide who are already chronically infected with HBV. dies each day from HBV.o For travelers instead of. HBV is an infection of the liver. An estimated 1 million people die each year from HBV and its complications. As for those in the healthcare field. or in addition to Hepatitis A vaccine o For unvaccinated persons. cirrhosis (scarring) of the liver. and death. There are also promising new treatments available for those who have developed chronic Hepatitis B infections. approximately 1 healthcare worker. It is transmitted through blood and infected bodily fluids. in America. liver cancer. Approximately 2 people die each minute from Hepatitis B. ~v~ .
or born to parents who emigrated from these countries (see above) Families adopting children from countries where HBV is common (see above) Individuals with early kidney disease or undergoing kidney dialysis Individuals who use blood products for medical conditions (i.e. the Pacific Islands. Even if there are no signs. or toothbrushes By piercing your body or getting a tattoo or through acupuncture when infected tools are used Touching infected blood or bodily fluids From an infected mother to her infant during the delivery process HBV is not transmitted casually. It cannot be spread through sneezing. South America. About 69% of infected people do not have noticeable symptoms when they are first infected. nail clippers. razors. This is why it is called a "silent infection". Africa. and the Middle East) Individuals emigrating from countries where HBV is common. hugging or eating food prepared by someone who is infected with HBV. HBV can be spread to others. popping pills) Men who have sexual intercourse with men Individuals who received a blood transfusion prior to 1992 Individuals who get tattoos or body piercing Individuals who travel to countries where HBV is common (Asia. Eastern Europe. or they may just feel like they have the flu.How HBV is Spread HBV is transmitted through blood and infected bodily fluids. Everyone is at some risk for Hepatitis B infection. This can occur through: Having unprotected sexual intercourse with someone who has the virus Sharing needles or drugs Needle sticks or sharps exposures on the job Sharing earrings. They may feel fine. coughing. past or present Individuals who have been diagnosed with a sexually transmitted disease Illicit drug users (injecting. snorting. ~vi~ . hemophilia) Residents and staff of correctional facilities and group homes Symptoms of HBV People can have HBV without experiencing any symptoms. inhaling. but some groups are at higher risk because of their occupation or life choices. Who is more likely to get Hepatitis B? Healthcare workers and emergency personnel Infants born to mothers who are infected at the time of delivery Partners or individuals living in close household contact with an infected person Individuals with multiple sex partners.
then the baby will need special treatment immediately after birth. this is not true for infants and young children – 90% of infants and up to 50% of young children infected with Hepatitis B will develop chronic infections. If this is the case. There is also medicine available that can help the liver of people who have chronic hepatitis. Unfortunately. A small number (5 – 10%) will be unable to get rid of the virus and will develop chronic infections. ~vii~ . it can go away on its own. The infected person should inform their partner(s) and anyone they live with that they have HBV. Most healthy adults (90%) who are infected with HBV will recover and develop protective antibodies against future Hepatitis B infections. If a woman has HBV while she is pregnant. muscles. and joints Bloated or swollen stomach Long Term Effects Though there is no cure for HBV. Therefore. It can lead to cancer and even death. Treating HBV Treatment for HBV is customized to the infected individual by their physician. she should tell her doctor immediately. in some people.Symptoms include: Yellow skin or eyes Loss of appetite Tiredness Dark urine Light or gray stool Fever Mild nausea Vomiting May experience pain in the stomach or abdomen. The virus can be spread to the infant. vaccination is essential to protect infants and children. Their partner(s) and/or people living with them will need to get the vaccine. Long term effects include: o The virus can be spread o A higher chance of getting HIV (the virus that causes AIDS) o Chronic hepatitis can badly damage the liver.
primarily through contaminated water. Signs and symptoms are the same as HAV. Most adults will recover and get rid of the virus without any problems. Only people who are already infected with HBV can be infected with HDV.Acute vs. Transmission occurs in the same way as HBV. There is really no effective treatment for HDV. which needs the Hepatitis B virus to exist. but this may only slow disease progression. However. There is no chronic (long-term) infection. If the virus remains in the blood for more than six months. There is no vaccine. Hepatitis E Hepatitis E is transmitted in much the same way as Hepatitis A. Ultimately. ~viii~ . A co-infection may result in a more severe acute disease and a higher risk (2% 20%) of developing acute liver failure compared with those infected with HBV alone. A person may not have any symptoms or they could become seriously ill. Progression to cirrhosis is believed to be more common with HDV – HBV chronic infections. HDV – HBV Super-infection Chronic HBV carriers who acquire HDV super-infections usually develop chronic HDV infection. HDV Co-infection occurs simultaneously when first infected with the Hepatitis B virus. it is called an "acute infection". For a chronic HDV infection. a liver transplant may be required. also known as HDV Co-infection. some doctors may try interferon-alpha. Chronic Hepatitis B When a person is first infected with HBV. then a person is diagnosed as having a "chronic infection". For an acute HDV infection. HEV does not occur in the United States frequently. as well. HDV Super-infection occurs in persons with an existing chronic Hepatitis B infection. FYI: What is Hepatitis D? Hepatitis D. The only way to prevent HDV is to prevent HBV. only supportive care for symptoms can be provided. is a type of viral hepatitis caused by the Hepatitis D virus (HDV).
5% of infected persons may die from chronic liver disease.85% of infected persons. How HCV is spread Hepatitis C virus is a blood borne pathogen. Symptoms Include: Jaundice (Yellow skin) Fatigue (Feeling tired) Dark urine Abdominal pain Loss of appetite Nausea Long Term Effects Chronic infection occurs in 55% . much like Hepatitis B. Like all forms of hepatitis. razors. 1% . it attacks the liver. The number of new infections per year has declined from an average of 240. This means the virus is spread when blood from an infected person enters the body of a person who is not infected. This can occur through: Having unprotected sexual intercourse with someone who has the virus Sharing needles or drugs Needle sticks or sharps exposures on the job Sharing earrings.000 in the 1980's to about 30. or toothbrushes By piercing your body or getting a tattoo or through acupuncture when infected tools are used Touching infected blood or bodily fluids From an infected mother to her infant during the delivery process Who is more likely to get Hepatitis C? Injecting drug users Recipients of clotting factors made before 1987 ~ix~ .9 million Americans have been infected with HCV. HCV is the nation's leading indication for liver transplant. 70% of chronically infected persons experience chronic liver disease. 80% of infected persons have no signs or symptoms. Most infections are due to illegal injection drug use. An estimated 3.Hepatitis C Hepatitis C (HCV) is another hepatitis virus.000 in 2003. nail clippers. of whom 2.7 million are chronically infected.
using pegylated interferon and ribavirin. water. do not donate blood. Do not share personal care items that might have blood on them (razors. use condoms correctly and every time to prevent the spread of sexually transmitted diseases. You should also get vaccinated against Hepatitis B. if you can't stop. stop and get into a treatment program. Interferon and ribavirin are two drugs licensed for the treatment of persons with chronic Hepatitis C. or tissue. never share needles. etc. Consider the risks if you are thinking about getting a tattoo or body piercing. get vaccinated against Hepatitis B. If you are a healthcare or public safety worker.). Interferon can be taken alone or in combination with ribavirin. If you are HCV positive. Drinking alcohol can make your liver disease worse. If you are having sex with more than one steady partner. syringes. always follow routine barrier precautions and safely handle needles and other sharps. if you do shoot drugs. but this is rare. You might get infected if the tools have someone else's blood on them or the artist or piercer does not follow good health practices. and get vaccinated against Hepatitis A & B. toothbrushes. is currently the treatment of choice. HCV can be spread by sexual intercourse. Hemodialysis patients Recipients of blood and/or solid organs before 1992 People with undiagnosed liver problems Infants born to infected mothers Healthcare/public safety workers People having sex with multiple partners People having sex with an infected steady partner People at risk for HCV infection might also be at risk for infection with HBV or HIV How to Prevent HCV Currently. ~x~ . there is no vaccine to prevent or to cure Hepatitis C. Combination therapy. The best way to avoid contracting HCV and to prevent the spread of the virus is to: Do not shoot drugs. Combination therapy can get rid of the virus in up to 5 out of 10 persons for genotype 1 and in up to 8 out of 10 persons for genotype 2 and 3. organs. or "works". Treating HCV Hepatitis C positive persons should be evaluated by their doctor for liver disease.
Appendix D: Glove Removal ~xi~ .
.Finally. completely pull the gloves off & properly dispose of them.
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