© 2009 the mcgraw-hill companies, inc. all rights reserved collecting, processing, and testing...
TRANSCRIPT
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Collecting, Processing, Collecting, Processing, and Testing Blood Specimensand Testing Blood Specimens
PowerPoint® presentation to accompany:
Medical AssistingThird Edition
Booth, Whicker, Wyman, Pugh, Thompson
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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Learning Outcomes
48.1 Discuss the composition and function of blood.
48.2 Describe the process for collecting a blood specimen.
48.3 Explain the importance of confirming patients’ identities and correctly identifying blood samples.
48.4 Describe how to perform venipuncture and capillary puncture procedures.
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Learning Outcomes (cont.)
48.5 Identify the equipment and supplies required for blood-drawing procedures.
48.6 Discuss the correct procedures for disposing of waste generated during blood-drawing procedures.
48.7 Discuss common fears and concerns of patients and how to ease these fears.
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Learning Outcomes (cont.)
48.8 Develop techniques for helping patients with special needs, including children, the elderly, patients at risk for uncontrolled bleeding, and difficult patients.
48.9 Identify common blood tests and explain their purposes.
48.10 Perform certain blood tests.
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Introduction
Medical assistant Collects blood specimens
Performs waived testing
Knowledge needed Understand circulatory system and function of blood Appropriate supplies and equipment How to perform and screen common blood tests
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Role of the Medical Assistant Phlebotomy – insertion of a
needle or cannula into a vein to withdraw blood
Put the patient at ease during procedure
Process specimens and conduct testing
Complete necessary paperwork and make sure specimens are handled properly
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Circulatory system transports blood Heart pumps 8–12 pints of
blood through 70,000 miles of vessels / day
Hematology – the study of blood
Functions and Composition of Blood
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Functions of blood Distributes oxygen, nutrients,
and hormones Eliminates waste products Attacks infecting pathogens Maintains acid-base balance Regulates body temperature
Functions and Composition of Blood (cont.)
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Red blood cells – erythrocytes Internal respiration
Transport oxygen to cells Hemoglobin – 98% Dissolved in plasma – 2 to 3 %
Hemoglobin Main component of RBCs Protein containing iron
Functions and Composition of Blood (cont.)
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White blood cells – leukocytes Protect against infection Granular
Basophils Eosinophils Neutrophils
Agranular T and B lymphocytes monocytes
Functions and Composition of Blood (cont.)
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Platelets – thrombocytes Fragments of
cytoplasm Essential for clot
formation
Plasma Clear, yellow liquid Contains formed
elements of blood 90% water
Serum Clear, yellow liquid
remaining after clot formation
Functions and Composition of Blood (cont.)
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Blood types or groups Presence of antigens A and B
determines type Blood also carries antibodies
Transfusions require careful matching to prevent hemolysis
Functions and Composition of Blood (cont.)
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Apply Your Knowledge
1. What is the role of the medical assistant related to collecting blood samples?
ANSWER: The medical assistant will put the patient at ease during the procedure, process specimens, conduct testing, complete necessary paperwork, and make sure specimens are handled properly.
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Apply Your Knowledge
ANSWER: Functions of the blood are: (list any 3)
1. Distributes oxygen, nutrients, and hormones
2. Eliminates waste products3. Attacks infecting pathogens4. Maintains acid-base balance5. Regulates body temperature
2. What are three functions of blood?
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Collecting Blood Specimens Reading and
interpreting the test order Review order
Assemble equipment and supplies
Preparing the patient Greet and identify the
patient
Confirm pretest preparation
Explain the procedure and safety precautions
Establish chain of custody
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Collecting Blood Specimens (cont.)
Use Standard Precautions and PPE as needed
Handling exposure incident Needlestick or other exposure to blood / blood
products Report to appropriate person immediately Wash area and apply bandage Document date, time, people involved, type of
exposure
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Collecting Blood Specimens: Drawing Blood
Not all states permit medical assistants to draw blood
Venipuncture Puncture of a vein Most common sites are
in the anticubital fossa and forearm Common Sites for
Venipuncture
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Collecting Blood Specimens (cont.)
Venipuncture complications Hematoma
Hold needle still Hold pressure on site
after removal of needle
Latex allergy Ask patient Use non-latex gloves,
tourniquet, and bandages
Nerve injury Know anatomy
Infections Rare Clean site prior to
venipuncture May not be evident
for several days
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Collecting Blood Specimens (cont.)
Equipment Evacuation systems – use special double-pointed
needle, needle holder Needle and syringe systems Butterfly system – winged infusion set and
syringe Collection tubes
Sealed to create a vacuum Color-coded to identify appropriate additive
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Collecting Blood Specimens (cont.)
Engineered safety devices Reduce the possibility of needlestick
injuries Types
Retracting needles Hinged or sliding shields Self-blunting needles Retractable lancets
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Collecting Blood Specimens (cont.)
Capillary puncture Superficial puncture of
skin with sharp point
Lancets / automatic puncturing devices
Micropipettes – small calibrated glass tubes that hold a small, precise volume of fluid
Reagent products Chemically treated
paper or dipstick Smear slides
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Apply Your Knowledge
What precautions should you take when collecting a blood specimen?
ANSWER: You should use Standard Precautions and appropriate personal protective equipment.
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Responding to Patient Needs
Respond with sensitivity and competence
Fears and concerns Pain
Bruises or scars
Serious diagnosis
Contracting a disease from the procedure
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Responding to Patient Needs: Special Considerations Children
Talk with parent or caregiver first Address child directly Speak in a calm, soothing voice Explain the procedure briefly in
terms they can understand Keep child informed of status
during the procedure
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Elderly Prone to bruising Difficult to obtain an adequate
sample Speak clearly in a low-pitched
voice Allow adequate time for patient to
respond to questions
Responding to Patient Needs: Special Considerations (cont.)
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Risk of bleeding Hemophilia or taking
blood-thinning medication
Hold site for at least 5 minutes
Contact physician if bleeding does not stop
Responding to Patient Needs: Special Considerations (cont.)
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Difficult patients Difficult
venipuncture – do not stick more than twice
Fainting patients – Reaction to blood
draw Position to avoid
injury
Angry or violent patients Explain need for
testing Avoid arguing Do not force patient Document behavior
and if patient refuses
Responding to Patient Needs: Special Considerations (cont.)
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Apply Your Knowledge
ANSWER: After drawing blood on a patient taking anticoagulants, you should hold a cotton ball over the puncture site for at least 5 minutes, monitor the site carefully, and notify the physician if bleeding does not stop.
What is one precaution you can take when drawing blood from a patient who is taking anticoagulants?
Correct!
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Performing Common Blood Tests Results aid in diagnosis
POLs often only perform waived tests
Know office policy
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Performing Common Blood Tests (cont.)
Chemicals in lab Anticoagulants – keep blood in uncoagulated
state
Serum separators – form a gel-like barrier between serum and clot in coagulated sample
Stains – color particular cells
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Performing Common Blood Tests: Hematologic Tests
Blood counts RBC count White blood cells Differential white blood cell Platelet Hematocrit Hemoglobin
Centrifuged Capillary Sample
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Morphologic studies Morphology – study of shape and form of objects Requires special training
Coagulation tests Identification of potential bleeding problems Monitor therapeutic drug levels for anticoagulants PT and PTT
Performing Common Blood Tests: Hematologic Tests (cont.)
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Erythrocyte sedimentation rate Measures rate of RBCs falling to the bottom of
the blood sample
Must be performed on a fresh sample
Tube must contain an anticoagulant
Read after one hour
Recorded as mm/hr
Performing Common Blood Tests: Hematologic Tests (cont.)
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Performing Common Blood Tests: Chemical Tests
Rarely performed in
the POL
Waived tests Blood glucose
monitoring
Hemaglobin A1c
Cholesterol tests
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Performing Common Blood Tests: Serologic Tests Introduction of an antigen or antibody into a
specimen and detection of a reaction to it
Immunoassays Western blot Radioimmunoassay
(RIA) Enzyme-linked
immunosorbent assay (ELISA)
Immunofloruescent antibody (IFA) test
Rapid screening tests Infectious
mononucleosis HIV Helicobactor pylori
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Apply Your Knowledge
Matching:
___ Hemoglobin A1c A. ESR
___ Lysing RBCs / evaluating the color B. Serology test
___ Shape or form of objects C. Coagulation tests
___ Identify bleeding problems D. Chemical test
___ Rate at which RBCs fall E. Differential
___ Percentage of each type of WBC F. Morphology
___ ELISA G. Hemoglobin
ANSWER:
G
F
E
D
C
B
A
Super!
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In Summary
Phlebotomy procedures require Technical skills Interpersonal communication skills
Medical assistant Patient instructions Completion of testing procedures
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End of Chapter
Blood will tell, but
often it tells too much.
~ Don Marquis