Collecting processing and testing blood specimens
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5. Collecting, Processing, and Testing Blood Specimens. 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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Collecting processing and testing blood specimens

5

Collecting, Processing, and Testing Blood Specimens


Introduction

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


Role of the medical assistant

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


Functions and composition of blood

Functions and Composition of Blood

  • 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 cont

Functions and Composition of Blood (cont.)

  • 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 cont1

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.)


Functions and composition of blood cont2

White blood cells – leukocytes

Protect against infection

Granular

Basophils

Eosinophils

Neutrophils

Agranular

T and B lymphocytes

monocytes

Functions and Composition of Blood (cont.)


Functions and composition of blood cont3

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.)


Functions and composition of blood cont4

Functions and Composition of Blood (cont.)

  • Blood types or groups

    • Presence of antigens A and B determines type

    • Blood also carries antibodies

  • Transfusions require careful matching to prevent hemolysis


Apply your knowledge

Apply Your Knowledge

  • 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.


Apply your knowledge1

Apply Your Knowledge

What are three functions of blood?

ANSWER: Functions of the blood are: (list any 3)

Distributes oxygen, nutrients, and hormones

Eliminates waste products

Attacks infecting pathogens

Maintains acid-base balance

Regulates body temperature

Very Good!


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

Collecting Blood Specimens


Collecting blood specimens cont

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


Drawing blood

Common Sites for Venipuncture

Drawing Blood

  • Not all states permit medical assistants to draw blood

  • Venipuncture

    • Puncture of a vein

    • Most common sites are in the antecubital fossa and forearm


Collecting blood specimens cont1

Venipuncture complications

Hematoma

Hold needle still

Hold pressure on siteafter 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

Collecting Blood Specimens (cont.)


Collecting blood specimens cont2

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


Collecting blood specimens cont3

Engineered safety devices

Reduce the possibility of needlestick injuries

Types

Retracting needles

Hinged or sliding shields

Self-blunting needles

Retractable lancets

Collecting Blood Specimens (cont.)


Collecting blood specimens cont4

Capillary puncture

Superficial puncture of skin with sharp point

Lancets– small, disposable instruments

Automatic puncturing devices

Micropipettes – small, calibrated glass tubes that hold a precise volume of fluid

Reagent products –chemically treated paper or dipstick

Smear slides

Collecting Blood Specimens (cont.)


Apply your knowledge2

Apply Your Knowledge

What precautions should you take when collecting a blood specimen?

ANSWER: You should use Standard Precautions and appropriate personal protective equipment.

excellent!


Responding to patient needs

Responding to Patient Needs

  • Respond with sensitivity and competence

  • Fears and concerns

    • Pain

    • Bruises or scars

    • Serious diagnosis

    • Contracting a disease from the procedure


Special considerations

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


Special considerations cont

Special Considerations (cont.)

  • 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


Special considerations cont1

Special Considerations (cont.)

  • Risk of bleeding

    • Hemophilia or taking blood-thinning medication

    • Hold site for at least 5 minutes

    • Contact physician if bleeding does not stop


Special considerations cont2

Difficult patients

Difficult venipuncture – do not stick more than twice

Fainting patients –

Reaction to blood draw

Position to avoid injury

Special Considerations (cont.)

  • 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


Apply your knowledge3

Apply Your Knowledge

What is one precaution you can take when drawing blood from a patient who is taking anticoagulants?

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.

Correct!


Performing common blood tests

Performing Common Blood Tests

  • Results aid in diagnosis

  • POLs often only perform waived tests

  • Know office policy


Performing common blood tests cont

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


Hematologic tests

Centrifuged Capillary Sample

Hematologic Tests

  • Blood counts

    • RBC count

    • White blood cells

    • Differential white blood cell

    • Platelet

    • Hematocrit

    • Hemoglobin


Hematologic tests cont

Hematologic Tests (cont.)

  • 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


Hematologic tests cont1

Hematologic Tests (cont.)

  • 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


Chemical tests

Chemical Tests

  • Rarely performed in the POL

  • Waived tests

    • Blood glucose monitoring

    • Hemoglobin A1c

    • Cholesterol 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)

Immunofluorescent antibody (IFA) test

Rapid screening tests

Infectious mononucleosis

HIV

Helicobacter pylori

Serologic Tests


Apply your knowledge4

Apply Your Knowledge

Matching:

___ Hemoglobin A1c A.ESR

___ Lysing RBCs/evaluating the colorB.Serology test

___ Shape or form of objectsC.Coagulation tests

___ Identify bleeding problemsD.Chemical test

___ Rate at which RBCs fallE.Differential

___ Percentage of each type of WBC F.Morphology

___ ELISAG.Hemoglobin

ANSWER:

D

G

F

C

A

E

B

Super!


End of chapter 48

End of Chapter 48

  • Blood will tell, but often it tells too much.

    • ~ Don Marquis


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