Skills Required in Phlebotomy

Skills Requi ruby-red in PhlebotomyObjectivesTo acquire the knowledge and skills to perform phlebotomy and finger prick.To teach the assemble of snuff it and its signifi quarterce.To learn various devices and preparation techniques before phlebotomy. entrancePhlebotomy is referred to the cutting of a venous derivation vessel. It is a procedure often involving invasion that invades the body through cutting or puncture norm anyy carried forbidden by professionals called phlebotomists. Among the major roles involving a phlebotomist is to obtain stemma specimens for diagnostic riddleing. This can be do either by dermal puncture which is done by puncturing the skin or venepuncture which is done by puncturing the veins. former(a) than that, a phlebotomist is too responsible in redrawing pedigree from donors during blood transfusion of from both patients having polycythemia which is known for overproduction of blood cells. Phlebotomist atomic number 18 also responsible for la y in and properly packaging urine specimens, accepting incoming specimens (blood and body fluids, etc.), and routing specimens to the proper departments to be tested and analysed. In order for a phlebotomist to withdraw blood from a patient, he should make sure that the tubes argon labelled and all the materials ar prepared before carrying out the procedure. The best situates for venipunture are unremarkably the superficial veins of the upper limbs. The superficial vein most putting greenly apply for venipuncture is the median Cubital Vein which lies over the cubital fossa and serves as an anastomosis between the basilica veins and the cephalic veins. The next most common vein is the cephalic vein where it can be followed proximally where it empties into the axillary vein. The basilic vein is also a location for venipunture as it divides to join the brachial vein. The customary sites for capillary puncture or finer prick in adults and children are the fingertip. In adults, th e ring finger is often selected beca drug abuse it usually is not calloused. hairlike blood can be obtained from the great toe in infants and babies. In new-borns, the lateral or side portion of the end of the heel pas is used.The BD banterAmong the inappropriate sites for venipuncture are the site affected by a mastectomy. This is because mastectomy causes lymphostasis which mean stoppage of lymph flow where the bodys ability to fight infection is compromised if lymph nodes are removed therefore patients are more prone to infections. Edematous sites, an abnormal appeal of fluid on the intracellular space of the tissue must also be avoided as it can cause difficulty in palpating the veins delinquent to the excess fluid. The specimen can also be contaminated with the fluid. Venipuncture performed at sites of scars and burns are also inappropriate as it causes unusual unhinge for the patients. This is caused by the veins that are very difficult to palpate and also open to infe ctions as the protective barrier (epidermal layer) has been disrupted. Other than that, patients who have IV rivulet in their arm should not be used for venepuncture as it whitethorn be a contaminant to the blood collected. Lastly, dermal punctures must never be performed on the fingers of a new-born or very young infant. This is because there is very little distance between the skin and the bone. Therefore, the bone could be easily pierced during the puncture, ca employ injury to the bone, infection, or gangrene.The order of draw is as follows,Blood CulturesCoagulation tube-shaped structure (light blue top)Plain red AND/OR Serum Separator Tube (red gel/SST)Heparin Tube (green top)Plain Sodium HeparinPlain lithium HeparinLithium Heparin GelEDTA Tube (purple and pink top)Fluoride/ Oxalate Tube (grey top)Miscellaneous tubes (these are drawn in no specific order)Heavy metal fateful blue top (EDTA and plain red)b. ACD yellow topThe purpose of the order of draw is to avoid possible test result error callable to cross contamination from tube additives. Potassium results can be wrongly elevated as EDTA is rich in thou. Therefore test for potassium must be collected before tubes containing EDTA. Other than that, the microscopic appearing of the red blood cells on a WBC differential test will be distorted due to the additives in the Fluoride/ Oxalate tube as oxalate interferes the red blood cell membrane and fluoride alter its morphology. Moreover, coagulation tests such as Activated partial thromboplastic time (aPTT) and prothrombin (PT) can be affected with the presence of clot activators by shortened test results. bacterium from non-sterile tube stoppers/shields can contaminate blood collected into bottles/tubes used for blood cultures, resulting in the growth of bacteria erroneously leading a doc to think his/her patient has a blood infection.A hematoma is a collection of blood beneath the skin. Hematomas are the most common unfavorable reaction to veni puncture. Precautions that can be taken to prevent hematoma in phlebotomy are by puncturing only the uppermost wall of the vein. Other than that, the phlebotomist can also remove the tourniquet before removing the needle. The needle should full penetrate the upper-most wall of the vein as partial penetration may allow blood to leak into the tissue surrounding the vein. Lastly, adequate air pressure should be applied to stop the bleeding once the phlebotomy is complete.Haemolysed blood specimens are not be acceptable for testing. Hemolysis occurs when the red cells burst and haemoglobin and other intracellular components spill into the serum. Hemolyzed serum or plasma is pink or red, rather than the normal clear straw or pale yellow colour. Steps that can prevent haemolysis are by mixing tubes gently or about 5 10 times after collection. The tubes should not be shaken too cleverly and drawing blood should be performed on hematoma individuals. Other than that, when using a needle or syringe, avoid drawing back the loon to forcefully. Moreover, if a blood transfer device is used to fill vacutainer tubes, ever allow the vacuum to pull the blood into the tubes. Do not use he plunger or syringe to force the blood into the tubes quickly.ReferencesAkron Childrens Hospital, 2015, research laboratory Test Procedure Performing A Venipuncture. Online. ready(prenominal) at https//www.akronchildrens.org/cms/lab_procedures/9179c8cb8f877ee3/ Accessed 29/01/2015.Johnson. L, 2013, National Center for Competency Testing Phlebotomy order of draw, Online. Available at https//www.ncctinc.com/documents/Phlebotomy%20Order%20of%20Draw.pdf Accessed 29/01/2015.MediaLab incorporated, 2015, Hematoma, Online. Available at https//www.medialabinc.net/spg549505/hematoma.aspx, Accessed 29/01/2015.Turgeon., M,. L, 2005, clinical Hematology Theory and Procedures, Volume 936, Online, Available at https//books.google.com.my/books?id=cHAjsUgegpQCpg=PA26lpg=PA26dq=edematous+site+veni puncturesource=blots=qxLCqzHsO2sig=OaKkj33lflGKFvorZweYFnb4RHUhl=ensa=Xei=n1bHVI-VM4yD8gW29IKoBgved=0CDIQ6AEwAwv=onepageq=edematous%20site%20venipuncturef=false , Accessed 29/01/2015