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قسم استقبـال وجمع العينات الطبية [ Reception ] هنا استقبال العينات الطبية الداخلي والخارجي



Obtain a blood specimen

قسم استقبـال وجمع العينات الطبية [ Reception ]


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قديم 12-03-2009   رقم المشاركة : ( 1 )
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Hjonv32n Shosho Obtain a blood specimen



[فقط الأعضاء المسجلين والمفعلين يمكنهم رؤية الوصلات . إضغط هنا للتسجيل]


. GENERAL
Venipuncture is the act of puncturing a vein with a needle, usually for the
purpose of withdrawing a specimen of blood. This may be accomplished by using either
a needle and syringe or by using the Vacutainer® system.
a. The Vacutainer® is a blood-
drawing system using a double-ended needle, a
plastic holder, and vacuum tubes. The tubes may be empty or they may contain a
measured amount of anticoagulant or other material.
b. Since most blood specimens do not need to be sterile, the stopper on the
glass tube is not sterile. However, the needle that is inserted into the vein must be
sterile to avoid the spread of infection. The Vacutainer® is not used when a sterile
blood specimen is needed such as that needed for a blood culture.

(1) Vacutainer® system advantages.
(a) Provides a rapid way to collect several blood specimens from the
same patient.
(b) Enables filling of several tubes to obtain multiple
samples with only
one needle stick.
(2) Vacutainer® system disadvantages.
(a) Vacuum tube makes it impossible to draw back on the plunger to
determine if the needle is in the vein. If the vacuum is broken in the tube, another tube
must be used.
(b) The amount of suction
created by the Vacutainer® can collapse a
small or fragile vein.

. TERMS
The following are terms used in this section with comments that may
help you
understand the procedures for obtaining a blood specimen.
a. Palpate. To feel or to examine with the fingertips.
b. Antecubital Fossa. Hollow or depressed area in the joint between arm and forearm.
c. Median Cubital Vein.
First choice for venipuncture (in antecubital fossa).
d. Cephalic Vein. Second choice for venipuncture (lateral portion of forearm).
e. Basilic Vein. Least desirable for venipuncture (inside of forearm).
f. Anticoagulant. A substance which prevents or reduces clotting of the blood.
Patients receiving anticoagulents tend to bleed longer than others.
g. Hematoma. A collection of blood under the skin. These are the most
common complications resulting from venipuncture attempts.
2-3. PROCEDURE FOR OBTAINING A BLOOD SPECIMEN
a. Verify Request to Obtain Blood Specimen. The following may be used to
verify an order to obtain a blood specimen.
(1) Therapeutic Documentation Care Plan (Non-medication), DA Form
4677.
(2) Provider's orders.
(3) Supervisor's directive.
b. Gather Equipment. Collect the following equipment (see figure 2-1).

(1) Blood specimen tube.
Obtain the proper blood specimen tube based
upon your supervisor's directive, ward SOP, or laboratory SOP. The type of tube
needed will depend on the specific test to be performed. Some
tests require a blood
specimen that has not been allowed to clot. In this case, a blood specimen tube
containing a powdered or liquid anticoagulant is used. If coagulated (clotted) blood is
acceptable, other types of tubes are used. Many laboratories use a color code for tubes
or bottles required for different tests.

(2) Vacutainer®.

The Vacutainer® consists of a plastic holder into which a
sterile disposable double-ended needle is inserted. A vacuum tube with a rubber
stopper slips into the barrel of the holder. The needle should not penetrate the stopper
until the vein end of the double-ended needle has been inserted into the vein. After the
needle
enters the vein, the tube is pushed the remaining distance into the barrel. The
vacuum in the tube will withdraw blood from the vein.

(3) Constricting band or tourniquet.

Constricting bands commonly used are
made of soft, flat, or round, latex rubber. Commercial types of constricting bands have
a Velcro fastening device.

(4) Vacutainer® needle.
There are two types of needles available for use
with Vacutainers®. One is designed for drawing single specimens, the other for use in
drawing multiple blood samples. A rubber sheath covers the shaft of the multiple
needle. As the needle is removed from the rubber stoppered tube, the sheath slips
back to cover and seal the end of the needle, preventing blood from dripping into the
holder.
(5) Antiseptic sponge or pledget
such as Betadine or alcohol. These are
used to clean the skin before the venipuncture is done. Betadine has been
demonstrated to be more effective in reducing the number of skin pathogens than
alcohol.
(6) Other items.
Other items include a protective pad, sterile 2-inch by 2-
inch gauze sponge(s), a self-adhesive bandage, a rubber band, and labels to identify
the blood specimen tube(s).
c. Label Specimen Tube(s). Stamp the label with the patient's addressograph
plate or clearly write the patient's identifying information on the label and apply it to the
specimen tube. The following information should be printed on the label.
(1) Name of patient.
(2) Hospitalization number.
(3) Social Security number.
(4) Date and time specimen was drawn.
(5) Other data as required by local SOP.
d. Perform Handwash. Perform patient care handwash.
e. Assemble Vacutainer® and Needle.
(1) Remove Vacutainer® needle from package as you did when you were
assembling a needle and syringe.
(2) Insert the short end of needle into the threaded end of the Vacutainer®,
screwing it tightly using a clockwise motion.
f. Explain Procedure. Explain the procedure to the patient.
g. Expose Area for Venipuncture. Expose the area. Usually, the inner elbow
is used to obtain a specimen, although the forearm, wrist, or the hand can be used (see
figure 2-2).
(1) Assist the patient to expose elbow area of arm by rolling the sleeve to
above the elbow (if applicable). In some instances, it may be necessary to have the
patient remove his garment.
(2) Fully extend the patient's arm with the palms up.

[فقط الأعضاء المسجلين والمفعلين يمكنهم رؤية الوصلات . إضغط هنا للتسجيل]


h. Select Vein for Venipuncture. Select the vein as follows:
(1) Palpate or feel the arm by using your fingers to locate an appropriate
vein.
(2) Select one of the prominent veins in the antecubital fossa of the arm.
The antecubital fossa is the hollow or depressed area located in the joint between the
arm and the forearm.
(a) The median cubital vein, though not always visible, is usually large
and palpable. Since it is well supported and the least apt to roll (or move away from
pressure), it is the vein of choice for venipuncture.
(b) The second choice is the cephalic vein. The basilic vein, though
oftentimes the most prominent, is apt to be the least desirable because it tends to roll
easily, making venipuncture difficult.
i. Position Protective Pad. Place the protective pad under the patient's
extended elbow and forearm to protect his clothing and the work surface.
j. Prepare Sponge and Pledget (Sponge) for Use. Open the betadine or
alcohol pledget (sponge) and 2-inch by 2-inch gauze and place the open package within
easy reach.
k. Apply Constricting Band. Use the following procedures to apply the band.
(1) Place the constricting band around the limb approximately two inches
above the proposed venipuncture site


[فقط الأعضاء المسجلين والمفعلين يمكنهم رؤية الوصلات . إضغط هنا للتسجيل]
(2) The constricting band must be applied with sufficient pressure to stop
venous return without stopping the arterial flow.
l. Prepare the Vein. Instruct the patient to form a fist and clench and unclench
his fist several times, then hold the hand in a clenched position. Clenching and
unclenching the fist with an applied constricting band in place forces the blood to be
trapped in the veins and causes them to distend. If the vein does not distend, gently
tapping the site with your fingers may assist in raising the vein.
m. Palpate Selected Vein. Palpate the vein lightly with the index finger, moving
an inch or two above and below the site so that the size and direction of the vein can be
determined (figure 2-4). The vein should feel like a spongy tube.
n. Cleanse Skin. Cleanse the skin with the pledget (sponge) starting on the site
and cleansing in a spiral motion outward and away from the selected venipuncture site.
Do not retrace your motion. Cleansing the skin in this manner will move the surface
skin contaminants away from the proposed venipuncture site.
CAUTION: After cleansing the skin, do not repalpate the area.
[فقط الأعضاء المسجلين والمفعلين يمكنهم رؤية الوصلات . إضغط هنا للتسجيل]


o. Prepare to Puncture Vein.
(1) Grasp the Vacutainer® unit and remove the protective cover from the
needle.
(2) Position the needle parallel to and above the vein and grasp the patient's
arm below the point of entry with the free hand.
(3) Place the thumb approximately one inch below the expected point of
entry and pull the skin taut and toward the hand.
p. Puncture Vein. Puncture the vein in the following manner.
(1) Place the needle bevel up in line with the vein and pierce the skin at
approximately a 15 to 45 degree angle. (Entering the vein with the bevel down will
cause painful tearing of the skin. Entering with the bevel up causes the sharp tip to
pierce the skin first, paving the way for the rest of the needle.)
(2) Decrease the angle until almost parallel to the skin surface and direct it
toward the vein, piercing the vein wall.
(a) A faint "give" will be felt when the vein is entered and the tube will
begin filling with blood.
(b) If venipuncture is unsuccessful, pull the needle back slightly (not
above the skin surface) and attempt to direct the needlepoint into the vein again.
(c) If the venipuncture is still unsuccessful, release the constricting
band, place a 2-inch by 2-inch sponge lightly over the venipuncture site, quickly
withdraw the needle, and immediately apply firm pressure over the site.
(3) Once the needle is withdrawn from under the skin surface, do not reuse
it. If a second attempt at venipuncture is required, notify the supervisor, obtain a
needle, and repeat the procedure.
q. Collect Specimen. When you have successfully punctured the vein,
complete the following steps to collect the blood sample.
(1) Hold the Vacutainer® unit and needle steady with your dominant hand.
If the unit and needle are not held steady while pushing in the tube, the needle may
either slip out of the vein or puncture the opposing vein wall.
(2) Place the tips of the index and middle fingers behind the flange of the
Vacutainer®. Push the tube all the way into the Vacutainer® with your thumb until the
needle completely punctures the rubber stopper.
(3) If the needle is in the vein, the vacuum will draw the blood into the tube.
(4) Instruct the patient to relax and unclench his fist after the needle has
entered the vein. Release the constricting band when the tube is full.
(5) Carefully pull the tube downward, off the tube end of the needle and out
of the Vacutainer®. Make sure to stabilize the Vacutainer® and needle with your other
hand during the process. If more than one specimen is needed, push another tube onto
the needle; continue exchanging the tubes until the required number have been filled.
NOTE: After venipuncture technique has been mastered and manual dexterity is
present, either hand may be used in completing blood drawing as long as the
needle is securely stablized.
(6) After obtaining the blood required and the last tube is approximately twothirds
full of blood or blood stops, prepare to withdraw the needle.
r. Withdraw Needle. Withdraw the needle in the following manner.
(1) Release the constricting band by pulling on the long, looped end of the
tubing or pull the Velcro® fasteners open. Never withdraw the needle prior to removing
the constricting band as this will cause blood to be forced out of the venipuncture site
with resulting blood loss and/or hematoma formation.
(2) Place the sterile 2-inch by 2-inch sponge lightly over the venipuncture
site.
(3) Withdraw the needle smoothly and quickly and immediately apply firm
manual pressure over the venipuncture site with the 2-inch by 2-inch sponge. Keeping
the patient's arm fully extended will minimize leakage around and through the
venipuncture site. This aids in the prevention of bruising and hematoma formation.
(4) Instruct the patient to elevate the arm slightly; keep the arm fully
extended and continue to apply firm manual pressure to site for two to three minutes.
(a) If the patient is unable to apply pressure and elevate the site, the
pressure and elevation must be done by the medical specialist.
(b) Continued bleeding is a complication of a patient receiving
anticoagulant therapy. Anticoagulants are usually given to prevent the development of
blood clots in the circulatory system. Anticoagulant patients may bleed longer than
other patients. Manual pressure for a longer time will be required to stop the bleeding.
(c) A hematoma is a swelling caused by the collection of blood under
the skin or in damaged tissues caused by an injured or broken blood vessel. They are
the most common complication of routine venipuncture for withdrawing blood. They
may result from puncturing and exiting the other side of the vein or from incomplete
insertion of the needle into the vein. Hematomas can also result from continued
application of the constricting band after a successful or unsuccessful attempt has been
made to draw blood. Hematomas most frequently result from insufficient time spent in
applying pressure following venipuncture and from flexing the arm.
s. Remove Specimen Tube from Vacutainer®. Pull the tube out of the
Vacutainer® and remove the needle from the holder using an approved safety device
such as a toothed grip on the sharps disposal box. Do not recap the needle. If the
specimen tube contains an anticoagulant or other fixing agent (as evidenced by white
powder particles or liquid in tube), gently invert tube several times to mix it with the
blood. Label all tubes promptly with patient identification and other information as
required by local SOP.
t. Apply Bandage. Apply a self-adhesive bandage to the venipuncture site
after the bleeding has stopped. Self-adhesive bandages do not take the place of
pressure.
u. Provide for Patient's Safety and Comfort. Provide for patient's safety and
comfort as follows:
(1) Remove protective pad.
(2) Assist patient to roll down sleeve, if applicable.
(3) Assist patient to assume a position of comfort, if applicable.
(4) Place personal items and call-light within easy reach, if applicable.
(5) Raise siderails, if applicable.
v. Dispose of and/or Store Equipment. Take care of equipment
storage/disposal as follows:
(1) Collect all equipment and dispose or store IAW local SOP.
(2) Do not recap needle at any time; dispose of it in an approved, punctureproof
container as close to the work area as possible.
w. Perform Handwash. Perform patient care handwash.
x. Check Completeness of Laboratory Request. Obtain completed laboratory
request from the supervisor and check the request. (There may be many lab request
slips that are used for requesting specific blood tests). All slips must be checked for
minimum information as given:
(1) Complete patient identification.
(2) Requesting provider's signature.
(3) Ward number, clinic, or dispensary designation
(4) Date and time of specimen collection.
(5) Test(s) requested.
(6) Admission diagnosis or type of surgery in the "REMARKS" section, if
applicable.
(7) "URGENCY" box completed.
y. Forward Specimen to Laboratory. Prepare the specimen, request for
transport, and forward to laboratory IAW local policy.
z. Report and Record. Report accomplishment of procedure to the supervisor
and document the date, time, type of specimen collected, and the disposition of the
specimen on appropriate records IAW local policy..
2-4. OBTAIN A BLOOD SPECIMEN WITH AN ASSEMBLED SYRINGE
An alternate method of drawing blood is to use an assembled needle and
syringe.
a. Either a straight needle or a butterfly device may be used. The size of the
syringe will be determined by the amount of blood required. The syringe volume should
not exceed 20 cc; the vacuum created during collection of the blood sample with a
larger syringe may cause the vein to collapse. Smaller volume syringes should be used
with pediatric patients or others with fragile veins.
b. After placing the constricting band and penetrating the vein, with the needle
as described above, slowly pull back on the plunger to withdraw the required amount of
blood. Excessive vacuum will be created if the plunger is pulled back too forcefully, and
the vein may collapse.
c. If the blood volume required is greater than the volume of the syringe, the
filled syringe may be removed from the needle and a new one attached. The process
described above will be continued until the required volume is obtained. Extreme care
must be taken to assure the needle is stabilized during blood drawing and syringe
exchange.
d. If you have used a needle and syringe to obtain the blood, you will need to
transfer the specimen into the tubes. Insert the needle into the rubber stopper of the
tube, and the vacuum will draw the specimen in and fill the tube. Transfer must be done
promptly to prevent clotting of the blood in the syringe. Label tubes as in the
instructions above.
Continue with Exercis
1. List the three parts of the Vacutainer® system.
2. List the steps required to obtain a blood specimen with a Vacutainer®. (Begin
after the Vacutainer® and needle have been assembled.)
3. Describe the steps to follow to position and insert a needle in a vein to obtain a
blood sample.
4. What items must be included on the Laboratory Request slip?

5. List the steps to follow to obtain a blood sample with an assembled syringe.

Check Your Answers
SOLUTIONS TO EXERCISES, LESSON 2
1. Double-ended needle,
Plastic holder
Vacuum tubes marked with a guideline (para 2-1a)
2. Expose area for venipuncture.
Select vein.
Position protective pad.
Prepare pledget (sponge) for use.
Apply constricting band.
Palpate selected vein.
Cleanse the skin.
Position needle.
Puncture vein.
Collect specimen.
4. The Laboratory Request form should contain the following:
Complete patient identification.
Requesting physician's signature.
Ward number, clinic, or dispensary designation.
Date and time of specimen collection.
Test(s) requested.
"URGENCY" box completed.
5. Syringe volume should not exceed 20 cc.
Place constricting band and penetrate vein as with Vacutainer.
Pull plunger back slowly.
Filled syringe may be removed from needle and a new one attached.
Insert the needle into the rubber stopper of the tube to transfer the specimen
into the tube. (para 2-4a, b, c, d)
MD0553 2-Withdraw the needle.
Remove specimen tube from vacutainer.
Apply self-adhesive bandage.
Provide for patient's safety and comfort.
Dispose of and/or store equipment.
Perform patient care handwash. (para 2-3)
3. Position the needle directly in line with the vein and grasp the patient's arm below
the point of entry with the free hand.
Place the thumb approximately one-inch below the expected point of entry and
pull the skin taut and toward the hand.
Place the needle bevel up in line with the vein and pierce the skin approximately at
a 15 to 45 degree angle.
Decrease the angle until almost parallel to the skin surface and direct it towards
the vein.
Pierce the vein wall.



 |~   تـوقـيـع:  

الفيس بوك
[فقط الأعضاء المسجلين والمفعلين يمكنهم رؤية الوصلات . إضغط هنا للتسجيل]


تويتر

[فقط الأعضاء المسجلين والمفعلين يمكنهم رؤية الوصلات . إضغط هنا للتسجيل]




طرق جمع العينات الطبية ونقلها ومعالجتها

متوفر في جميع فروع مكتبات جرير والعبيكان

للاستفسار
[فقط الأعضاء المسجلين والمفعلين يمكنهم رؤية الوصلات . إضغط هنا للتسجيل]


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قديم 12-06-2009   رقم المشاركة : ( 2 )
:: المشرف العام ::


 
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 بينات الاتصال بالعضو
 اخر مواضيع العضو

hemato غير متواجد حالياً

افتراضي



رائع جداً بارك الله فيك .



 |~   تـوقـيـع:  



للإستفسار

[فقط الأعضاء المسجلين والمفعلين يمكنهم رؤية الوصلات . إضغط هنا للتسجيل]

  رد مع اقتباس
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مشرف قسم أمراض وعلوم الدم


 
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HEMATOLOGIST 4 EVER
 
 
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الله يعطيك العافية يا اخ ظل العيون .....



 |~   تـوقـيـع:  

[فقط الأعضاء المسجلين والمفعلين يمكنهم رؤية الوصلات . إضغط هنا للتسجيل]
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مشرف سابق


 
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يعطيك الف عافيه يا ظل العيون على ابداعاتك


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مشكوووووور والله يعطيك الف عافيه


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الأقــســـام الــعـــامــة @ منتــدى المواضيــع العامــة @ منتــدى الشريعــة الإســلاميــة @ قســم القــرآن الكريــم وعلومــه @ قســم الصوتيــات والمرئيــات الإسلاميــة @ المنتـدى التقـني @ قسـم الكمبيـوتر والبرامج @ قسـم الاتصالات وتطبيقات الجيل الثالث @ منتــدى التهاني والتبريكات و الترحيب بالأعضــاء الجــدد @ الأقسـام الأكاديـمية @ المنتــدى الأكاديمي [ Academic Forum ] @ قسـم المؤتمرات و اللقاءات [Conferences and Meetings] @ الكتب والمراجع الطبية [Medical Books and References] @ أقســام المختبرات [LABs] @ قسم استقبـال وجمع العينات الطبية [ Reception ] @ قسم المختبر العام [General Lab] @ قسم أمراض وعلوم الدم [Hematology] @ قسم الكيمياء الحيوية والهرمونات [Biochemistry & Hormones] @ قسم الطفيليات الطبية [ Parasitology ] @ قسم الأحياء الدقيقة [Microbiology] @ قسم المناعة و المصليات [Immunology & Serology] @ قسم بنك الدم [Blood Bank] @ قسم الأنسجة [Histology] @ قسم الجينات [Genetics] @ الأقســام الطبية المسـاعـدة @ قسم التمريض العام [ General Nursing Section ] @ قسم الأشعة [ Radiology Section ] @ الأقســام الإداريــة @ المــلاحظات والمقـترحـــات @ أرشيـــف المواضيـــع @ قسم الصيدلة [ Pharmacy Section ] @ قسم العلاج الطبيعي [ Physiotherapy Section ] @ العيــادة الطبيـة [Medical Clinic] @ قسم الجودة في المختبرات [Lab Quality Control] @ قسم المشرفين @ قسم الفلاشات العامة والطبية الترفيهية @ أقسام الفلاشيات @ قسم فلاشيات أمراض وعلوم الدم @ قسم فلاشيات الكيمياء الحيوية والهرمونات @ قسم فلاشيات الأحياء الدقيقة @ قسم فلاشيات الأنسجة @ قسم فلاشيات الجينات @ قسم فلاشيات الأطباء @ قسم الفلاشات الإسلامية والتربوية @ حوار الطلاب [Students Dialog] @ قسم تحليل البول وسوائل الجسم [Urine Analysis and Body Fluids] @ انفلونز الخنازير H1N1 @ الإسعافات الأولية First Aid @ قسم المختبرات الصناعية ومختبرات الأغذية [Industrial and Nutritional LABS] @ المنتــدى الرمضــاني 1431هـ @ YouTube @ أقسام الفيديو ( YouTube ) @ قسم فلاشيات المناعة و المصليات @ مكتبة علوم وأمراض الدم @ مكتبة الكيمياء الحيوية والهرمونات @ مكتبة علم المناعة والمصليات @ مكتبة بنك الدم @ مكتبة الأحياء الدقيقة والطفيليات @ مكتبة الصيدلة @ قسم مناقشات ادارة المنتدى @ الخيمة الرمضانية لعام 1433 هـ @



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