Transcript Slide 1

‫به نام خالق هستي‬
‫دكتر كتايون خداورديان‬
‫آزمايشگاه مرجع سالمت‬
‫دستورالعمل نمونه گيري وريدي ومويرگي‬
VENIPUNCTURE
Pre collection: smoking, physical activity, stress
During collection:
-different time of day
-posture: lying/standing/sitting
-haemoconcentraction: prolong tourniquet
Handling of specimen :
- Insufficient or excess anticoagulant
-Inadequate mixing of blood with anticoagulant
-pat./or specimen identification error
-delay to transit to Lab.
Room Facilities
 Venipunture
chair& Bed
 Blood collecting Trays
 Gloves
 Needles&Holders
 Sterile Syrings
 Venous Blood collection Tubes
 Tourniquets
 Antiseptices
 Guase Pads→5*5cm,7.5*7.5cm
–Resistance Disposal Container
 Ice or refrigerator
 Adhesive Bandages
 Warming Devices
 Test Reference Manual
 Punture
Venipuncture Procedure
1- Identify the patient
2-Assess the patient physical disposition (diet, exercise
,stress,basal state)
3-Equipment→ necessary supplies&Tubes
4-Position the patient
5-put on gloves
6-Apply Tourniquent →7.5-10cm above ven. Site , Not
too tightly No more than 1 min.
Patient should make a fist without pumping the hand
7-Select the vein site Median cubital & Cephalic Vein
*Extencive scaring from burns & surgery
Mastectomy * Hematoma * IV therapy →below IV site
* Cannula,Fistula * Edematous
VENIPUNCTURE SITES
8- Clean the site →Isopropyl or Ethyl Alcohol 70%
►guaze pad → 5*5-7*7cm
-Circular motion from center to the periphery
* allow to air dry
9-Insert needle ≤ 30degree
10- Drawing the spec. * open the hand
11- Release Tour niquet
12- Place gauze pad over the vein
13- Re move the Needle
14- Applying pressure to the site, making sure bleeding
has stopped
15- Collect the sample in the appropriate tubes
(Blood culture - coagulation Tube- non additive Tube-
15- Disposing needles
16-Lable the tubes and record the time of
collection:
name ,age,ID no.,Dr. name,other Inf.(Iv site …)
‫ ٭‬All Tubes must Labeled Immediately after blood
specimen has been drawn.
17-Chill the specimen (if required)
18-Send to Labs.
‫٭‬Children→ syringe gauge 20-23, winged blood
collection set
Safety& Infection Control
 Wear
gloves &lab coats when handling
bloob/body fluids
 Change gloves frequently or if contaminated
 Wash hands frequently
 Dispose of needles immediately Do not bend,
recap,break,resheath needles
 Clean up any blood spills with a disinfectant as
freshly made 10%bleach
# Prolonged Tourniquet:
Hb, HCT, RBC ↑ 2-3%
# Prior rest:
- Hb, HCT, RBC ↓ 5-8% (1.5 hr bed rest)
- Lymphocytes ↓
# Position of Arm :
H b, H C T, R B C ↑ 2-3% in hanging down arm
# Diurnal Variation :
Hb, HCT higher in the morning than evening
WBC & Neutrophil counts higher in the afternoon
Lymphocyte lowest in the morning and highest in the
evening .
PLT is higher in the afternoon and evening
Cortisol, Fe
# Excersise :
- WBC, RBC, Hb, HCT rise
- intensive tranning ↓ lymphocyte count
-↑ CK, AST, LD, Fibrinolysis,&Activate coag.
- physical training: ↑sexial hormons
Skin Puncture
1- Equipment
2- Choose the puncture site
¤ distal digit of third or fourth finger
¤ lateral or medial planter surface of
heel(pre warming 420 3-5 min)
3- Puncture with sterile Lancet (No deeper than
2mm)
4- Wipe the first drop
5- Collecting the specimen
Punture must be on palmar surface of distal
phalanx across the fingerprints,of the
middle&Ring finger.
 Blood
must not be obtain from the:
-Ear lobe
-Central area of an infant heel
-Swollen or previously punctured site
Difference between capillary and Venous
Blood
- RBC, Hb, HCT capillary blood are slightly greater
than venous – leucocyte and PMN are higher 8%
Monocyte 12%
-PLT count higher in Venous blood 9%
-Glucose is higher in capillary blood, K,
Protein,Ca is lower
✽ Smears prepared from capillary blood shows
PLT aggregation
STORAGE
CBC→up to 4 h.(max. 6 h.) at room Tem.
 Cell counts & Indices are stable for 24 h. at 4c
 Blood smear→1 h. at room Tem.
by 3 h. blood cell morphpology starts:
- vacuolisation & irregular lobulation of nucleos
-crenation &sphering of RBC(after 6 hours)
 Quantitative effect (>4-6 h.at room tem):
-RBC swelling→MCV, ↑HCT, ↓ESR
- Leucocytes & plt→gradually fall (count with 2 h.)
- Hb remains un changes for days
 ESR:up to 4 hours at room tem.
up to 12 hours at 4 degree

 Reticolocyte:EDTA
sample up to 6 hour at
room tem.
up to 24 hours at 4 degree
 Blood grouping sample:48 hour at room
tem.
up to 7 days at 4 degree
Rejection of Samples
1.
2.
3.
4.
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6.
Hemolysis - this is usually caused by a procedural error such as using too
small of a needle, or pulling back to hard on the plunger of a syringe used
for collecting the sample. The red cells rupture resulting in hemoglobin
being released into the serum/plasma, making the sample unsuitable for
many laboratory tests. The serum/plasma will appear red instead of straw
colored.
Clotted - failure to mix or inadequate mixing of samples collected into an
additive tube. The red cells clump together making the sample unsuitable
for testing.
Insufficient sample (QNS) - certain additive tubes must be filled
completely. Incorrect blood to additive ratio will adversely affect the
laboratory test results. When many tests are ordered on the same tube be
sure to know the amount of sample needed for each test.
Wrong tube collected for test ordered. Always refer to procedure manual
when uncertain.
Improper storage - certain tests must be collected and placed in ice,
protected from light, or be kept warm after collection.
Improperly labeled
Thanks for your attention