Vacuum-Blood-Collection静脉采血英文课件.ppt

VacuumBloodCollection,Introduction,Thevacuumbloodcollectionsystemconsistsofadouble-pointedneedle,aplasticholderoradapter,andaseriesofvacuumtubeswithrubberstoppersofvariouscolors.Theevacuatedtubecollectionsystemwillproducethebestbloodsamplesforanalysis.Thebloodgoesdirectlyfromthepatientveinintotheappropriatetesttube.,Multi-SampleNeedle,Thebevelistheslantedopeningattheendoftheneedle.Needlelength(shaft)rangesfrom1to1inches.ThreadedhubscrewsintoneedleholderTherubbersheathmakesitpossibletodrawseveraltubesofbloodbypreventingleakageofbloodastubesarechanged.,Bevel,Bevelisslantedopeningatendofneedle.Needlemustbeorientedsothatbevelfacesuppriortoinsertion.,NeedleGauge,Thegaugeofaneedleisanumberthatindicatesthediameterofitslumen.Thelumen,alsocalledthebore,isthecircularhollowspaceinsidetheneedle.Thehigherthegauge,thesmallerthelumen.Themostfrequentlyusedgaugesforphlebotomyare20,21and22,Holder,Theholderforvacuumbloodcollectionisaplasticsleeveintowhichthephlebotomistscrewsthedoublepointedneedle.Themostcurrentguidelinesrequirethatallholdersareforsingleuseonly.,VacuumCollectionTubes,Vacuumcollectiontubesareglassorplastictubessealedwithapartialvacuuminsidebyrubberstoppers.Theairpressureinsidethetubeisnegative,lessthanthenormalenvironment.Afterinsertingthelongerneedleintothevein,thephlebotomistpushesthetubeintotheholdersothattheshorterneedlepiercesthestopper.Thedifferenceinpressurebetweentheinsideofthetubeandtheveincausesbloodtofillthetube.Thetubesareavailableinvarioussizesforadultandpediatricphlebotomies,Additives,Differentbloodtestsrequiresdifferenttypesofbloodspecimens.Mosttubeshaveadditivescalledanticoagulantswhichpreventclotting/coagulationoftheblood.Plastictubesmayhaveanadditivetoenhanceclottingoftheblood,Anticoagulants,Anticoagulantsarealreadyinthetubesinthepreciseamountneededtomixwiththeamountofbloodthatwillfillthetube.Thecolorofthestopperoneachtubeindicateswhat,ifany,anticoagulantthetubecontains.Itisimportanttocompletelyfilleachtubesothattheproportionofbloodtochemicaladditiveiscorrect,otherwise,thetestresultsmaynotbeaccurateorthespecimenwillberejectedandwillneedtoberecollected.Itisalsoimportanttothoroughlymixthebloodwiththeadditivebygentleinversion,Red,NoadditiveinglasstubeClotactivatorinplastictubeNoanticoagulantpresentTestsusingserumwhichinclude:mostbloodchemistries,AIDSantibody,viralstudies,serologytests,BloodBanktesting.,Redandblackmottled(SST)Hemogard=Gold,SST=SerumSeparatorTubesilicone/gel(serumseparatingmaterial)AlltestsusingserumexceptBloodBank,Redandblackmottled(SST),UsingBDSSTTubesPurposeofgelistoseparateserumfromcellspermanently,(Light)Blue,Additive-SodiumCitrateTestsdrawn:Coagulationstudies:PT,PTTandfibrinogenMUSTBEFILLEDCOMPLETELY!NOEXCEPTIONS,LavenderTopTube,Additive=EDTA(ethylenediaminetetraacetic)Hematologystudies:CBC,WBCcount,Hemoglobin,Hematocrit,Plateletcount,Reticulocytecount,differential.,Green,Oneofthefollowing:sodiumheparin,lithiumheparinorammoniumheparin.STATbloodchemistriesutilizingplasma.,GreenPST,AdditiveisheparinPST=PlasmaSeparatorTubeHasgelwhich,aftercentrifugation,permanentlyseparatesplasmafromredbloodcells,Gray,Additive(readlabel):Potassiumoxalateandsodiumfluoride,orlithiumiodacetateandheparinGlucose,BloodAlcohol(ethanol)levels,lacticacid,Black,BufferedSodiumCitrateWestergrensedimentationratedeterminationMUSTBEFILLEDCOMPLETELY!NOEXCEPTIONS,RoyalBlue,Coloroftubelabelindicatesadditive,ifany:purple-EDTAgreen-heparinrednoneTracemetalanalysis,nutrientsandtoxicologystudies.AntimonyArsenic,Cadmium,Calcium,Chromium,Copper,Iron,Lead,Magnesium,Manganese,andZincareexamples.,Brown/Tan,Additive=SodiumHeparinorK2EDTASpecificallyforleadanalysisalthoughroyalbluecanbeused.,Yellow,Sodiumpolyanetholsulfonate(SPS)SPSforbloodculturespecimencollectionsinmicrobiology.Tubeinversionspreventclotting.Acidcitratedextroseadditives(ACD)ACDforuseinbloodbankstudies,HLAphenotyping,DNAandpaternitytesting.,BloodCultures,Notforlaboratoryanalysis,specialcollectiontodetectbacteriagrowinginblood.SitepreparationVERYimportant.Willbecoveredlater.,OrderoftheDraw,1.Sterile/Bloodcultures2.Bluecoagulationtube3.Red4.OtheradditivesGreenLavenderGray,PatientIdentification,Itisvitallyimportantthatthephlebotomistcorrectlyidentifiesthepatient.Donotofferthepatientanametorespondto.Allhospitalizedpatientshaveanidentificationarmbandwiththeirname,hospitalidentificationnumberandotherpertinentinformation.AlwayscomparethelaboratorytestrequestslipnameandIDnumberwiththenameandIDnumberonthepatientshospitalarmband.Ifthereisanydiscrepancy,donotdrawthepatientsblood.Foranout-patient,verifythepatientsidentitybyhavingthepatientgiveyouadditionalidentifyinginformationsuchasasocialsecuritynumber,dateofbirthoraddress.,Preparation,washordisinfecthisorherhandsIdentifypatientIntroduceyourself,stateyourmissionHaveyoueverhadyourblooddrawnbefore?Ifno,explaintheprocedureChoosetheappropriatetubesforthetestsrequested,TourniquetApplication,Applyapproximately3-5inchesaboveantecubitalfossa.Iftheskinappearsblanchedaboveandbelowthetourniquetitistootight.Ifyourfingercanbeinsertedbetweenthetourniquetandthepatientsskinitistooloose.,Palpate,Aftertourniquetapplicationhavepatientclenchfist.Feelforaveinthatrebounds(bounces)whenpushedortappedon.PALPATEanypotentialveintohelpdeterminesize,directionanddepth.Aslightrotationofthearmmayhelptobetterexposeaveinthatmayotherwisebehidden.,VeinSelection,Choosetheveinsthatarelargeandaccessible.Largeveinsthatarenotwellanchoredintissuefrequentlyroll,soifyouchooseone,besuretosecureitwiththethumbofyournondominanthandwhenyoupenetrateitwiththeneedle.Avoidbruisedandscarredareas.,CantFeeltheVein?,TrickstoHelpDistendVeins:Havethepatientpumpthehand3times.Dontoverdueitbecauseover-pumpingcancreatehemoconcentrationHavethepatientdanglearmbelowtheheartlevelfor1-3minutes.Warmtheareawithahotpackorwarm,moistclothheatedtoapproximately42C.Ifallelsefails,consultanothertechnicianfortheiropinionand/orintervention.,SelectionofVein,VeinsforVenipuncture,Veinsusedfordrawingblood,Mediancubitalvein-firstchoice,wellsupported,leastapttorollCephalicvein-secondchoiceBasilicvein-thirdchoice,oftenthemostprominentvein,butittendstorolleasilyandmakesvenipuncturedifficult,MedianCubitalfirstchoice,Thisveinislocatedintheantecubitalfossa.(theareaofthearminfrontoftheelbow)Wellanchoredvein,usuallylargeandprominent.Veryfewproblems.Offeringthebestchanceforaclosetopainlesspuncture,astherearefewnerveendingsclosetothisvein.,CephalicVein-SecondChoice,Cephalicveinwhichislocatedontheupperorshouldersideofthearm.Thisveinisusuallywellanchored.Thecephalicveinmaylieclosetothesurface.Alowangleofneedleinsertionmustbeusedtoavoidpossiblespurtingorbloodformingadropatthepuncturesite.(15),BasilicVein-ThirdChoice,Locatedontheundersideofthearm.Inmanypatientsthisveinmaynotbewellanchoredandwillroll,makingitdifficulttoaccesswiththeneedle.Syringedrawshouldbeconsideredasitgivesthephlebotomistmorecontroloverarollingvein.Poolingofbloodandhematomaformationpossible.Thebasilicveinisclosetothebrachialarterysothereismoreriskofhittinganartery.Exercisecautionwhendrawingfromthisarea.Additionally,thisareaisoftenmoresensitive,thusastickisslightlymorepainfulforthepatient,CleansingtheSite,Afterselectingavein,cleanthepuncturesitewithacottonballsaturatedwith70%isopropylalcoholorprepackagealcoholswabs.RubthealcoholswabinacircularmotionmovingoutwardfromthesiteUseenoughpressuretoremoveallperspirationanddirtfromthepuncturesite.Discreetlylookattheswabwhenfinished,ifitappearsexcessivelydirtyrepeatthecleansingprocesswithafreshalcoholswab.Aftercleansingdonottouchthesite,iftheveinmustberepalpatedtheareamustbecleansedagain.Someexpertsallowcleansingoftheindexfingerbeforerepalpatingbutthistechniqueisdebatable.,AssembleEquipment,Twistneedleintoholder.Selectappropriatetubesandinsertfirsttubeintoholder.DONOTremovecapuntilrightbeforeyouarereadytostick.,Re-ApplyTourniquetandPreparetoStick,PerformingtheStick,Holdthepreparedholderwiththebevelup.Usethethumbofthenondominanthandbelowthepuncturesitetoanchortheveinandpulltheskintaut.Theneedleenteringthesiteshouldnottouchthethumbofthephlebotomist.Positiontheneedleinthesamedirectionasthevein,entertheskinandpenetratetheveinata15degreeangleinoneswift,smoothmotiontodecreasethepatientsdiscomfort.Ifyouentertoslowlybloodwillleakoutatthepuncturesitecreatingabiologicalhazardaswellasobstructingyourviewofthepuncturesite.Thebeveloftheneedleshouldenterandremaininthecenterofthevein.,PerformingtheDraw,EndingDraw-ReleaseTourniquet,Tourniquetcannotbeinplacemorethan1minute.Releasethetourniquetasthelasttubeisfilling.Useonehandedmethodofrelease.,EndingDraw,Releaselasttubefromneedle.Holdgauzespongeorbiowipeaboveneedle.Swiftlywithdrawneedle.Assoonasneedleiswithdrawnapplypressuretopuncturesite.Ifpossible,havepatientcontinuetoapplypressure.,EndingtheDrawTTN,ActivatingSafetyDevice,Assoonasyouremoveneedleandapplypressureactivatethesafetydevice.DONOTUSEYOUROTHERHANDTOSNAPDEVICEINTOPLACEEVER!,NeedleDisposal,Assoonasneedlesafetydeviceisactivateddisposeofentireassemblyinabiohazardsharpscontainer.,LabelingTubes,Labelalltubesappropriatelyatthepatientsside.Donottakeunlabeledtubesfromthepatientspresence.Minimuminformation:Patientsfullname,lastnamefirstIDnumberDate,timeandyourinitials,CheckingSite,Gentlyremovegauzeorbiowipe.Inspectareaforcontinuedbleedingorswelling.Ifallokplacebandaidoversite.Tellpatienttoremovein10-15minutes.IfpatientstillbleedingDONOTleave,continuetoapplypressure.,Leaving,Discardallusedmaterialshint-placeallwrappers,alcoholswab,needlecapinpalmofglovedhand,removeglove.Thankpatient.Washhands.Leave,BDEclipse,TheBDVacutainerEclipseBloodCollectionNeedleisasafety-engineeredmulti-samplebloodcollectionneedle.Itfeaturesapatentedsafetyshieldthatallowsforone-handedactivationtocovertheneedleimmediatelyuponwithdrawalfromtheveinandconfirmsproperactivationwithanaudibleclickWewillusethisdevicenextweek.,ProblemswithNeedleInsertion,ProblemswithNeedleInsertion,SourcesofError,Failuretoinserttheneedlecompletelyintothevein.Thephlebotomistshouldfeelresistanceinitiallyfollowinginsertionoftheneedle.Theresistanceisalmostimmediatelyfollowedbyasensationoffreeoreasiermovementastheneedleentersthevein.Puncturingthestopperbeforeenteringthevein.Ifthephlebotomistpartiallypushestheevacuatedtubeontotheneedlebeforeinsertingtheneedleintothevein,he/sheriskspuncturingthestopperandreleasingthevacuum.Notanchoringtheveinbeforeinsertingtheneedle.Theveinmustbeheldinplaceforsuccessfulneedlepenetration.Bouncingtheneedleontheskinbeforeguidingitintothevein.Duringvenipuncture,thepatientshouldonlybestuckoncewiththeneedle.Notkeepingtheholderstationary,causingtheneedletodislodgefromthevein.,RejectionofSamples,Hemolysis-thisisusuallycausedbyaproceduralerrorsuchasusingtoosmallofaneedle,orpullingbacktohardonthe