Phlebotomy Part 2 PDF

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Summary

Part Two of Phlebotomy notes for Medical Assistant Certification....

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•Phlebotomy Technicians –Collect and prepare blood and other body fluid samples for medical laboratory testing –Can be a Certified Phlebotomy Technician (CPT) or a Registered Phlebotomy Technici –To become a phlebotomy technician, the MA must meet standard qualifications and mu written exam. –Accrediting agencies: AMT, NCCT, and NHA. •Vacuum Container Method –Most common method of venipuncture is vacuum container or evacuated tube method. –Multiple samples can be obtained at the same time. –Important to use a large vein, because the vacuum can collapse smaller veins. –If patient has no accessible veins, use a small needle with a syringe or a butterfly obtain specimen. •Sterile Syringe and Needle Method –Biggest drawback is that the amount of blood that can be collected for testing is li the size of the syringe used. –Has a higher incidence of injury or contamination than the vacuum container method. •Butterfly Needle Method –Winged infusion or butterfly method uses a needle that is attached to 6- to 12-inc –Can be used as a temporary intravenous (IV) infusion. –Used for small veins that are difficult to draw from with the standard vacuum conta method or syringe and needle method. –Needle used for this method is a small 21-, 23-, or 25-gauge needle. S ll d h ld d l h l d

–Small device is easier to hold and manipulate than larger devices. –Smaller needle is less uncomfortable for the patient. –Smaller needle is more likely to result in hemolysis –More expensive than a standard needle. –Winged infusion set is not typically the first choice for phlebotomy. –Several types designed for safety and ease of use. •Equipment –Blood Collection Tubes ●Designed to automatically draw in the exact amount of blood required for testing ●Color coded according to chemicals or preservatives within the container –Wait until the flow of blood stops before removing the tube ●Made of glass or plastic; come in a variety of sizes –Plastic tubes always safer to work with –Glass is best for testing medication levels ●Always check the expiration date. ●Visually inspect the contents for abnormalities. ●Always use the same manufacturer for a tube, holder, and needle to ensure proper fit and to prevent complications. –Tourniquet ●Applied to an extremity to impair the circulation. ●Standard tourniquet is a large strip of disposable latex that can be tied around the arm (rubber used for those with latex allergies).

●Blood pressure cuff may be used for the patient whose veins are difficult to locate. ●Should not be left in place for more than 60 seconds, otherwise blood will begin to hemolyze. ●New phlebotomists –Apply tourniquet first. –Remove it to allow for setup and cleansing of skin. –Reapply tourniquet after the alcohol has dried. ●Advanced phlebotomists –Choose the one-tie method. –Tube Holders and Needles ●Typically made of plastic ●Threaded end ●Pointed end of the needle on the outside of the holder is inserted directly into the patient's vein ●Hollow needle ●Always insert the needle with the bevel facing up ●Made in many different sizes, including different lengths and gauges ●Gauge or bore is the diameter of the space inside the hollow area of a needle. ●The smaller the gauge number, the larger the hole within. ●General phlebotomy typically requires 20- to 21-gauge needles. ●Larger 18-gauge needles are used for the collection or administration of significant quantities of blood or viscous fluids. ●Safety devices may be attached to needles or to holders

–Do not use two safety devices in a system. –Avoid using a part of your body part as a lever. –Use the edge of a counter to push the safety into the locking position. •Syringes –Useful in collecting blood specimens from small or fragile veins that cannot withstand pressure of an evacuated tube –Size depends on the amount of blood needed for all tests being performed –Drawbacks ●Multiple needle insertions may be required depending on amount of blood needed. ●Plunger must be pulled back while the needle is inserted. ●Transferring the blood from the syringe to the evacuated tube provides opportunities injury or contamination. ●Least favorable option for venipuncture. ●Preferred Methods –Use a safety transfer device after the needle is properly removed and discarded int sharps container. –Place the evacuated tube in a standing rack and insert the needle into the tube wit holding it. •Order of the Blood Draw –Fill the tubes in the order of draw recommended by CLSI to prevent contamination –Many lab requisition forms state the tube color to use for each test –If multiple tests are ordered and the same color tube is used for each, often just o tube is needed –Blood culture (golden yellow topped tube) always should be drawn first...