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• PHLEBOTOMY • REVI EW f r o m An a t omy& Ph y s i o l o g y • Bl o o di sma deu po ff or me de l e me n t s( RBCs , WBCs ,p l a t e l e t s )s u s p e n d e d i nt h el i q u i dp o r t i o no fb l oo dc a l l e dPLASMA • PLASMAc on t a i nswa t e r ,nu t r i e n t s , h o r mo n e s , e l e c t r o l yt e s , p r o t e i n s , wa s t e p r o d uc t s , a n dp r o t e c t i v es ub s t a n c e soft h ei mmu nes y s t e m • VEI NSa n dARTERI ESRe vi e w • Ve i n s • Ca r r ybl oo dTOt h eh e a r t • Ca r r yde o x y g e n a t e db l o od • Lo wp r e s s ur ev e s s e l s • Thi nwa l l e d • Ve n ou sbl oo dda r k e ri nc ol or • Bl o o dflo wsi ns l o w, o o z i n gma nn e r • Ar t e r i e s • Ca r r ybl oo dAWAYf r o mh e a r t • Ca r r yo x y g e n a t e db l o od • Hi g hp r e s s u r ev e s s e l s • Thi c k e rwa l l s • Ar t e r i a l bl oo db r i g h tr e d • Bl o o dflo wsi nf a s t , p u l s a t i n gma n ne r • p h l e bo t o my • Phl e bo t o myl i t e r a l l yme a nst oc u ti n t oav e i n • Pu r p o s ei st oo b t a i nb l o o ds p e c i me n sf o rdi a gn o s t i ct e s t i n gv i a : • Ve n i pu n c t u r e • De r ma lp u n c t u r e • Comp e t e nc yr e c e nt l ya dd e dt ot h eLPNs c o p eo fp r a c t i c ei nAl be r t a • I sas p e c i a l i z e dc l i n i c a l c o mpe t e nc yr e q u i r i n ga d d i t i on a lt r a i n i n ga n d c e r t i fic a t i o na c c or di n gt oa g e n c yr e q u i r e me n t s • COMMONVEI NSu s e df o rVENI PUNCTURE • An t e c u bi t a lv e i nsa r eb e s t–t h e s eg e n e r a l l yh a v eawi del u me n ,a r ec l os et o t h es u r f a c e , a n dh a v et h i c kwa l l s( l e s sl i k e l yt oc o l l a p s e ) • Ski ni sl e s ss e n s i t i v et ha no t h e rs i t e ss u c ha sb a c kofh a n d=l e s sp a i nf or p a t i e n t • Be s tv e i ni sme d i a nc u b i t a l • p r o mi ne n tv e i ni nmi d d l eo fa nt e c ub i t a ls p a c e • I swe l la nc h or e d , d o e sno tr o l l ,b r ui s e sl e s s , s ma l l e s tr i s kofi n j u r i n g u n de r l yi n gs t r uc t u r e s • Al t e r n a t i v e sa r ec e p h a l i ca ndb a s i l i cbu tt h e s et e n dt or ol l • VEI NSELECTI ON • Ap p l yt o ur n i q u e ta n de x a mi nea n t e c ub i t a lv e i nso fb o t ha r ms • Us ei ns p e c t i ona n dp a l pa t i ont os e l e c tav e i n • Pa l pa t ea ndt r a c ep a t ho fv e i na n dr o l ly o u ri n de xfin g e rba c ka n df o r t ho v e r v e i nt ode t e r mi n ei t ss i z e • DONOTLEAVETOURNI QUETONFORLONGERTHAN1MI NUTE

• AVOI Dp a i nf u la r e a s , s ki na r e a st h a ta r es c a r r e d ,br ui s e d , bu r ne do r a d j a c e ntt oa r e a so fi nf e c t i on • DONOTu s ea r m wi t he d e maorons a mes i dea sma s t e c t o my • ALTERNATI VESI TES • I NNERFOREARM • WRI STAREA ABOVETHUMB • BACKOFHAND( l e a s td e s i r a b l ea smo r en e r v e sa ndmor eP AI N) • TOURNI QUETAPPLI CATI ON • Ap p l yt o ur n i q u e t3t o4i n c he sa b o v eb e n di ne l b o w • I fn e c e s s a r yt opa l p a t ev e i n, a s kp a t i e ntt oc l e n c hfis tac o up l eoft i me s • Ne v e rl e a v et o ur n i q u e tonf o rl o n g e rt ha n1mi nu t e • Ca nc a u s eh e mo c o n c e n t r a t i ona ndi na c c u r a t er e s u l t s • Ca nb eun c o mf o r t a b l ef ort h ep a t i e nt • Ap p l yt o ur n i q u e ta n dl oc a t ev e i n,r e mo v et o ur n i q ue t , c l e a ns es ki na n d p r e pa r ee q u i p me n t , t he nr e a pp l yt ou r ni q ue tt oa v o i da p p l i c a t i onl o n g e rt ha no nemi n u t e • To u r n i q u e tApp l i c a t i onf o rAl t e r n a t i v eSi t e s • VENI PUNCTUREEQUI PMENT • VENI PUNCTUREEQUI PMENT • BLOODTUBES • MUSTus et h ec or r e c tt u b ef ort h es p e c i me nr e q u i r e d( c he c ko rASK! ! ) • I n s pe c te a c ht u bet oe n s ur ei ti sn o tb r o k e n, c h i pp e d , c r a c k e d, o rda ma g e d • Ch e c kt u b ee x pi r yda t e • Bl o o dt u beMUSTb el a b e l l e dwi t ha tl e a s tt wou ni q uep a t i e n ti d e nt i fie r s • BLOODTUBES • TUBESa r ec ol orc o d e dde p e nd i n go nt hec he mi c a la d di t i v e • TUBESa r ee i t h e r : • r ub b e rs t op p e rt u be s • h e mo g a r dt u be s • MUSTus ec o r r e c tORDEROFDRAW t op r e v e ntc o n t a mi na t i ono f c he mi c a la d di t i v e sbe t we e ndi ffe r e ntt u be s • TUBESha v ev a c u u mt h a tp ul l sc or r e c tv o l umeo fb l o odi n t ot h et u be • Al wa y sa l l o wt u b et ofil lc omp l e t e l y • MOSTCOMMONTUBESUSED • Li g h tbl ue–a dd i t i v ei ss o di umc i t r a t e • Us e df orc o a g ul a t i o ns t ud i e s , i . e . , PT, PTT • I n v e r t3t o4t i me sr i gh ta f t e rc o l l e c t i on • Go l dt o p–SST( s e r u ms e pa r a t ort u be s ) • Co nt a i ng e lt ha tf o r msab a r r i e rbe t we e nc l o ta n ds e r u ma f t e r c e nt r i f u g a t i o n • I n v e r t5t i me sr i gh ta f t e rc o l l e c t i on • Li g h tgr e e n–PST( pl a s mas e p a r a t o rt u b e ) • Co nt a i ng e lt ha tf o r msab a r r i e rbe t we e nb l oo dc e l l sa n dp l a s ma a f t e rc e n t r i f u g a t i o n • La v e nd e r–a d d i t i v ei sEDTA( a n t i c o a g ul a n t ) • Us e df orh e ma t o l o gy , i . e . , CBC, Hg A1 C

• I MPORTANTPOI NTS • Ma n yt e s t st ha tc a l lf orPST( p l a s mas e pa r a t ort ub e s )c a na l s ob ec o l l e c t e d wi t ha nSST( s e r u ms e pa r a t o rt u be ) • Che c kt h eCa l g a r yLa bSe r v i c e ss i t ei fy oua r eun s ur e • Ma n yt e s t sonpl a s mac a na l s ob et e s t e do ns e r u mb ut no tt h eo t h e rwa y a r o u nd ! • Yo uc a n no tr unat e s to ns e r u mt h a tr e q u i r e sap l a s mas a mpl e • ORDEROFDRAW • Bl o o dc o l l e c t i ont ub e sc o nt a i nc h e mi c a l a d di t i v e s • Mu s tb efil l e di nas p e c i fics e q ue n c et omi ni mi z ec o n t a mi na t i ona ndt e s t r e s ul te r r o r • Al l o wt u bet ofil lc o mp l e t e l yt oe n s ur er e q ui r e db l o odt oa d d i t i v er a t i o • Ge n t l yi n v e r te a c ht u b et h er e q u i r e dn umb e ro ft i me si mme di a t e l ya f t e r c o l l e c t i ont oa de q ua t e l ymi xbl oo da n da d d i t i v e • Ne v e rpo u rb l oo df r o mo n et u bei n t oa no t h e rt u be • GENERALGUI DELI NESf o rVe ni pu n c t ur e • Ad v a n c ePr e p a r a t i on • Re vi e wr e q u i s i t i o na n ds p e c i ficc o l l e c t i ono rh a n dl i n gr e q u i r e me nt s • I d e nt i f ypa t i e n t • Re a s s u r epa t i e n t • As s e mb l ee q ui pme n ta nds up pl i e s • Po s i t i onp a t i e n t • Ap p l yt o ur n i q u e t • Se l e c tv e i n • Ob t a i ns p e c i me n • P ATI ENTS AFETYc o n s i d e r a t i on s • Mo s tI mp or t a n tSt e pi nBl oo dCo l l e c t i oni s : • P ATI ENTI DENTI FI CATI ON • Ane r r o ri ni de n t i fic a t i o no rl a be l l i n go fs p e c i me nc a nr e s ul ti n : • WRONGp a t i e n tr e c e i v i n gt heWRONGt r e a t me n t • De l a yi nne e d e dt r e a t me nt • P ATI ENTHARM o re v e nDEATH • COLLECTI ONANDHANDLI NGRe q u i r e me nt s • Re vi e wt y p eo fs p e c i me nt ob ec o l l e c t e d( s e r u m, p l a s ma , wh ol eb l o ode t c . ) • Re vi e wa mo u n to fb l oo dn e c e s s a r yf o rl a ba n a l y s i s( wh i c hs i z et u bei s n e c e s s a r y ) • Con s i de ra n ys p e c i fict e c hn i q u e sne c e s s a r yf o rc o l l e c t i on • E. g . ,b l o odc ul t u r e sr e q u i r es p e c i a lp r o c e d ur e sf ors ki nc l e a ns i n g a n dc ol l e c t i on • Re vi e wp r o p e rha n d l i n ga n ds t o r i n go fs p e c i me n • Thi si nf or ma t i o ni sr e a d i l ya v a i l a b l eo nt h eCa l g a r yLa bSe r v i c e swe b s i t e • PERFORMI NGVENI PUNCTURE u s i n gVa c u u m Tu beMe t ho d • Va c uu mt u b eme t h o dmo s tf r e q u e nt l yu s e d–i d e a lf o rc o l l e c t i onf r o m n o r ma l , h e a l t h yv e i nst h a ta r ea d e q u a t ei ns i z et owi t h s t a n dt h ep r e s s u r ef r o mt he

e v a c u a t e dt u be • Do u b l e p oi nt e dn e e d l e • An t e r i o rne e d l eb e v e l e d( 2 0 2 2 G)-mo s tc ommo ni s21 G f o rr o u t i nev e n i pu n c t u r e • Comei n1 ”or1 . 5 ”-mo s tn ur s e spr e f e r1 ”a si ti sl e s s i n t i mi d a t i n ga n dp r o vi de smor ec o n t r ol ) • Ve n i pu n c t ur eVI DEO • Va c uu m Me t h o dVI DEO • PERFORMI NGVENI PUNCTURE u s i n gBut t e r flyMe t h od • Gi v e smo r ec o nt r o lwh e nma ki n gpu n c t u r e • Le s ss u c t i o np r e s s u r ei se x e r t e do nv e i n s • Us e do na d u l t swi t hs ma l lv e i nsa n dc h i l dr e n • Us e dwh e nc o l l e c t i n gf r o ma l t e r n a t i v ev e i nsi nh a n ds , wr i s t se t c . • KEYPOI NTSDURI NGVENI PUNCTURE • I fu n s u c c e s s f u li nv e n i p un c t u r e , don o td i ga r o un df o rt h ev e i n • Cl e a ns es ki nwi t ha n t i s e p t i cwi p e si nc i r c u l a rmo t i o n , s t a r t i n gf r o mi n s i de a n dmo v i n ga wa yf r omp un c t ur es i t e ,a l l o wt od r y • I n s e r tn e e d l ea t1 5°a n gl ewi t hb e v e lu p • ALWAYSr e l e a s et o ur n i q ue tp r i o rt or e mo v a lofne e dl et op r e v e nt h e ma t o maf or ma t i o n • Wi t hv a c u t a i ne r , o nl yi n s e r tt u b eo n t oh ol de ra f t e rn e e dl ei si nv e i n • Whe nu s i n gab u t t e r flys y s t e m, y o umu s tu s ead i s c a r dt u b e( c l e a rpl a s t i c ) t oe n s ur ea l la i ri sr e mo v e df r o mt het ub i n g • PREVENTRe c o l l e c t i o ns o rPa t i e n tBe i n gRe c a l l e dt oHos p i t a l • Col l e c t i n gt her i g h tt u b et h efir s tt i mei st heo nl ywa yt oma k es u r eat e s ti s n o tc a n c e l l e dd u et oi nc o r r e c ts pe c i me n • Nu r s e sn o ti n v e r t i n gt u be si son eo ft h emos tc o mmo np r o b l e ms–t hi sc a n l e a dt oc l o t t i n gi nt u be swi t ha nt i c o a g ul a n t s–r e me mb e ri fc ol l e c t i n gv i as y r i n g ey o umu s t t r a n s f e rt ot ub e si nat i me l yma nn e rt opr e v e ntc l o t t i n gi nt h es y r i n g e • An t i c oa gu l a n t so n l yPREVENTc l o t t i n g ,t h e yd on o tdi s s ol v ea l r e a d y f o r me dc l o t s • LABELLI NGa n dTRANSPORTI NGSp e c i me n s • Bl o o dt u beMUSTb el a b e l l e dwi t ha tl e a s tt wou ni q uep a t i e n ti d e nt i fie r s • Pl a c er e q u i s i t i oni nou t s i d ep oc k e tofb i o ha z a r dba g • Don o tc o v e rc ol or e ds t r i peo nt u bewi t hI Dl a b e l • POTENTI ALCOMPLI CATI ONS • Sc l e r o s e d, r o l l i n g , orc o l l a ps i n gv e i ns • I n a bi l i t yt oob t a i nav e i n • Co ns i de ra l t e r n a t i v es i t e s , wa r mc o mp r e s s • Fo l l o wp ol i c yonma xi mumnu mb e ro fa t t e mp t s • Ph y s i c i a n ’ so r d e rREQUI REDt ous ev e i n so ft h ef e e t • HEMATOMAf o r ma t i on • Re me mb e ri ft h e r ei ss we l l i n ga tv e n i pu nc t u r es i t e , fir s tRELEASE

TOURNI QUET, t h e nr e mo v en e e d l ef r omv e i n • HEMOL YSI S–b r e a k d o wno fbl oo dc e l l s • h a n dl es a mp l e sc a r e f ul l ya ta l lt i me s • F AI NTI NG–p r o t e c tpa t i e n tf r o mi n j u r y • THERAPEUTI CPHLEBOTOMY • WHYwo ul ds ome on er e q ui r er e mo v a lo fb l o oda sat h e r a p y ? ? • Tor e d u c es t r e s sonbo d ys y s t e msdu et od i s o r d e r sc a us i n ga n o v e r p r o du c t i o no fi r o n( he moc h r o ma t o s i s )o rr e db l o odc e l l s( p o l y c y t he mi av e r a ) • Te c hn i q uei se s s e n t i a l l yt h es a mea sbl oo ddo n a t i on • Of t e nd on ea sa nou t p a t i e n ti nERo v e r2 0t o30mi n ut e s • VSt a k e np r ea ndpo s tph l e bo t omy • Pa t i e n tu s u a l l yr e q u i r e dt os t a yo nu ni tf orami no f2 0mi n ut e s p o s t p hl e bo t o my • Re f e rt of a c i l i t ypo l i c i e sa n dp r o c e du r e s • Re f e r e nc e s t h • Bo n e wi t We s t , K. ( 2 0 1 2) .Cl i n i c a lp r o c e du r e sf orme d i c ala s s i s t a nt s( 8 e d . ) . St . Lo u i s , MO:El s e vi e rSa un de r s . • Bo o t h, K. A. ,Wa l l a c e , A. C. ,&Fi t z g e r a l d , D. T. ( 2 00 9) .Ph l e b o t omy :Fo r n d h e a l t hc a r ep e r s on n e l( 2e d . ) .Bos t on :Mc Gr a wHi l l . • Ca l g a r yLa b or a t o r ySe r v i c e s( 20 1 6 ) .Lab o r a t or ys e r v i c e se d uc a t i on r e s o ur c e sf o rme di c a lpr o f e s s i on a l s . Re t r i e v e df r o m h t t p: / / www. c a l g a r y l a b s e r v i c e s . c om/ e du c a t i on r e s e a r c h / me di c a l pr of e s s i o na l s e d u c a t i on / • Po t t e r , P . A. , Pe r r y , A. G. ,Ro s s Ke r r , J . C. ,Wo o d,M. J . , As t l e , B. J . , Du g g l e b y , W.( 2 0 14 ) .Can a d i anf u n da me n t al sofn u r s i n g( 5the d . ) . To r o nt o:El s e vi e r Ca n a d a . • Tho mp s o n , G. S. ( 2 0 15 ) . Und e r s t a nd i n ga n at omy&ph y s i ol o gy :Av i s ua l , a u di t or y , i n t e r a c t i v ea pp r o a c h( 2n de d . ) . Ph i l a d e l p h i a :F . A. Da v i s ....