Phlebotomy: Selecting a Puncture Site on an Infant

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Posted on 29th April 2011 by admin in Uncategorized

The guidelines for selecting a puncture or incision site for adults and older children over the age of 1 year is different from the guidelines you would use to determine a capillary puncture site on an infant. For adults and children, the best location for capillary punctures is the palmar surface of the distal or end segment of the middle or ring finger of the nondominant hand. As a phlebotomist how you select a puncture site for infants is important and the heel is the most recommended site for collection of capillary blood specimens.

Although the heel is the most recommended location there are still precautions you should take when using this location for capillary collection. It is important that the puncture is performed in an area of the heel that will not cause a risk of puncturing the bone. If an infant’s bone is punctured a very painful bone inflammation called osteomyelitis can result. This is caused from the inflammation of the bone marrow and any adjacent none. Osteochondritis is another type of inflammation that affects the bone and cartilage because of infection in the puncture area. Infections can be spread from additional punctures that occur in the same area.

The heel bone of small or premature infants is not far below the surface on the bottom of the heel. The depth of the heel bone has been found to be as shallow as 2.0 mm below the skin surface in very young infants. If a puncture is deeper than this at the back of the heel, bone damage can result.

To avoid puncturing bone the best place for heel puncture are located on the sides of the heel. A puncture on either side will usually have less risk to bone, nerve, tendon and cartilage. Do not puncture directly behind the heel.

Here is a list of capillary puncture precautions for infants:

-Do not puncture the earlobes.

-Do not puncture deeper than 2.0 mm.

-Do not puncture a previous puncture site.

-Do not puncture anywhere other than the recommended puncture sites.

-Do not puncture the posterior curvature of the heel.

-Do not puncture the arch of the foot.

-Do not puncture an area that is bruised.

Capillary Puncture Equipment

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Posted on 28th April 2011 by admin in Uncategorized

Allied HealthSkin puncture procedures often require the use of special equipment. The following devices and supplies are commonly used for capillary punctures.

Lancet/Incision Device

A lancet is a sterile, sharp-pointed or bladed instrument. All lancets are disposable and are used to obtain capillary blood specimens by puncturing the skin. Lancets are available in several different lengths and depths. A specific lancet length or depth is used for particular collection sites, to obtain specific specimen volume and to collect enough of specimen without injuring bone. Lancets are designed to puncture the fingers or the heel of the foot. All lancets must have OSHA-required safety features to reduce accidental injuries.

Collection Devices

Microcollection containers are small plastic tubes that are used to collect small amounts of blood from capillary punctures. These types of containers are often color-coded to correspond to ETS blood collection tubes and markings for minimum and maximum fill levels that are usually measured ion microliters.

Microhematrocrit tubes are disposable, plastic or plastic-clad glass capillary tubes can typically hold 50 to 75 microliters of blood. These collection devices are commonly used to determine the manual hematocrit, which is also called the packed cell volume. The tubes will either be coated with ammonium heparin, for collecting hemotocrit, or they will be plain for use when a hemotocrit tube is filled with blood from a lavender-top tube. A red band is usually found on the end of a heparin tube. A blue band is on a nonadditive tube.

Capillary Blood Gas Equipment

Capillary blood gas can be collected using several different types of equipment.

CBG collection tubes: These tubes are normally plastic, thin narrow-borer capillary tubes that come in different sizes. The most common CBG tube has a capacity of 100 microliters. An anti-coagulant coats the inside of the tube and can be identified by the color-coded band on the tube. Sodium heparin is the commonly used anti-coagulant that is identified by a green band on the collection tube.

Stirrers: Stirrers are small metal bars that inserted into the tube after a CBG specimen is collected. The stirrers are used to help mix the anti-coagulant in the CBG collection tubes.

Magnet: A magnet is used to mix the specimen by pulling the metal stirrer in the CBG specimen back and forth along the tube length.

Plastic caps: Plastic end caps are used to seal CBG tubes. Most CBG tubes come with their own caps.

Nutrition and Blood Pressure

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Posted on 26th April 2011 by admin in Uncategorized

The amount of force your blood exerts on your artery walls is commonly called blood pressure.  A normal adult blood pressure should fall below 140/85.  The higher number is the systolic pressure, which is the peak force when the heart contracts and pumps blood into circulation.  The lower number is the diastolic pressure, which measures the pressure that is exerted when the hear rests between beats.  If a person’s blood pressure is high, they are classified as having hypertension.  There are specific dietary guidelines established by nutritionists and dietitian that a person with hypertension should follow to help reduce high blood pressure and any complications that can result.

Experts agree that diet can directly affect high blood pressure.  A healthy diet can prevent and treat high blood pressure.  One of the best ways to improve your diet to reduce or prevent hypertension is to cut back on eating processed foods, which contain large quantities of salt and unhealthy preservatives and fats.  Not all salts are the same.  Processed foods contain salts that are toxic to the body and have no beneficial minerals.  Natural sea salt is full of important minerals the body needs to function properly.  Cutting out processed foods and pickled foods can help to reduce unhealthy sodium.

A high fat diet can cause weight gain and high blood pressure.  No more than 30 percent of your caloric intake should come from fat.  Of the 30 percent, only 10 percent should come from saturated animal fats.  Cutting back on butter, margarine; drinking skim milk; choosing lean cuts of meat; and cooking your foods by broiling instead of frying or sautéing can help to reduce calories.

Excess weight can also contribute to hypertension.  Even a few extra pounds can increase your risk for high blood pressure.  One of the best ways to return blood pressure to normal is to reduce any excess weight you may have gained.  Do not use crash diets because they can cause you to gain more weight later on and could lead to a heart attack.  A sensible eating plan and exercise is the best way to loose weight safely and to maintain a healthy blood pressure.

Phlebotomist: Dialysis, Long-Term-Care, and Home Care Patients

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Posted on 25th April 2011 by admin in Uncategorized

A phlebotomist will come into contact with many different types of patients.  This profession often services patients with particular needs such as dialysis, long-term care and home care patients.  While studying how to become a phlebotomist, you will examine each option more thoroughly.

A patient whose kidneys do not function adequately will likely have to have their blood artificially filtered in order to remove any waste products. End stage renal disease is the most common reason why a patient may need dialysis and occurs when a patient’s kidneys have severely deteriorated and can no longer function properly. Diabetes is the most common cause of end-stage renal disease. The second leading cause is high blood pressure. Patients with end-stage renal disease will require ongoing dialysis or a kidney transplant.

Long-term care patients usually consist of patients who require a variety of healthcare and social services. These patients may have functional disabilities and are usually unable to care for themselves but do not need to be hospitalized.  A long-term care patient can be any age, although the majority of patients are elderly.  Long-term care is provided at adult daycare facilities, nursing homes, assisted living facilities, rehabilitation facilities and private homes.

Care can be provided to patients in their home.  Advances in technology have made it possible for patients who were once required to stay in healthcare institutions.  Now these patients are able to remain at home.  Research has shown that patients who can receive care at home are generally happier and either recover faster or survive longer than patients who were confined to a traditional institution.  There are many different agencies that provide professional home care services such as nursing; home health aid; physical, occupational, and respiratory therapy; and laboratory services.  Laboratory services in a home care environment are usually collected by a mobile phlebotomist who collects specimens in the patient’s home and delivers them to the laboratory for testing.  A home care phlebotomist must have several important traits.  She should have exceptional skills as a phlebotomist.  It is important that she also have good interpersonal skills and be highly organized.  Because this mobile job allows for more freedom, she should be able to function independently and be able to adapt to different situations and circumstances.

Phlebotomy: Blood Bank Specimens

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Posted on 21st April 2011 by admin in Uncategorized

Blood bank specimens are one of the most commonly encountered special test procedures.  Due to the vast number of people who could be affected by a single unhealthy blood donor, blood bank specimens are highly scrutinized in order to determine which blood products can be safely transfused into a patient.  There are special protocols for phlebotomist technicians in place to ensure that only safe specimens are collected and transfused.

Blood bank specimens must be strictly labeled with patient identification and specimen labeling procedures.  If a specimen is ever mislabeled, incompletely or inaccurately labeled, or even unlabeled, it will not be accepted for testing.  Any errors in the collection or labeling process will cause the specimen to be forfeited and require a new specimen to be collected.  This could cause a delay in patient treatment and should be avoided.  Strict collection protocols are in place to reduce the need for recollection.  Undetected errors could possibly cause a fatal transfusion reaction.  There is specific information that should be labeled on all blood bank specimens.  The following is a list of common requirements.

-The patient’s full name and middle initial.

-The patient’s hospital identification number or social security number for outpatients.

-The patient’s date of birth

-The date and time of collection

-The phlebotomist’s initials

-The room number of the patient.

There are special identification systems that are used to confirm the patient’s identity against a blood specimen.  A special identification bracelet may be attached to the patient’s wrist.  The typenex Blood Recipient Identification Band is one example of the type of identification band that might be used.  Generally the band system allows for a unique ID number to be associated with the patient.  This number is used to identify the specimen in the crossmatch process or eventually attached to blood products that might be used for transfusion.

The electronic blood bank ID system is a portable bedside bar code scanning system that creates an electronic verification system and tracing of blood transfusions.  A bar code is created for the patient and is attached to the patient’s wrist.  The bar code is also attached to all of the patient’s blood specimens.  The patient’s wristband with the bar code and the unit of blood with the bar code are scanned and must be electronically verified before a transfusion of the blood unit can begin.

How To Become an EMT: Using A Short Backboard For Spinal Injuries

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Posted on 20th April 2011 by admin in Uncategorized

A short backboard is an immobilization device that is commonly used support a patient who may have potential head, neck or spinal injures.  There are many different types of short backboard immobilization devices that can be used.  The purpose of the different devices is to provide support for the head, neck and torso when the patient is in a sitting position.

A short backboard immobilization device should always be used if a patient is found in a seated or semi-seated position and is suspected of having any cervical spine injuries.  The only time a short backboard would not be used in this situation is if the patient must be extracted or moved rapidly.  In all other circumstances, a short backboard should always be used.

When using the short backboard be sure to take appropriate body substance isolation precautions.  This precaution is used to ensure that all bodily substances such as urine, feces, tears and blood are isolated, reducing the chances of transmitting illnesses.

The patient should be asked to not move their head and to remain very still.  It is important to explain each step of the process so that the patient knows what to expect and does not move suddenly.  Sudden movements can cause additional damage to an injured head, neck or spine.

Someone on the rescue team will need to provide manual stabilization until the short backboard is in place.  To do this, a team member should stand behind the patient and maintain inline stabilization of the cervical spine.  An appropriately sized cervical collar should be applied around the patient’s neck.  The patient’s chin should rest comfortably in the chin rest and the patient’s neck should be in a neutral position.  The patient’s pulse, motor, and sensory skills should be assessed regularly.

The short board should be prepared by ensuring that all of the straps are untangled and in working order.  The short board will need to be slid between the rescuer, who is maintaining the cervical alignment of the patient’s head and the back of the patient.  This can be accomplished by having the patient lean slightly forward and sliding the backboard between the rescuer’s arms and the patient’s back. When the backboard is positioned correctly the straps should be snuggly tightened around the patient’s torso.

Assessing Spinal Injuries

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Posted on 18th April 2011 by admin in Uncategorized

Once an emergency medical technician (EMT) or other allied health professional has sized-up a scene, he or she should first identify patients who suffer from serious or life-threatening conditions.  Patients with massive bleeding, or airway obstructions should be treated immediately.  After identifying any life-threatening conditions, the EMT should try to obtain additional information about the patient by asking questions to obtain a focused history or by performing a physical examination.

During the physical examination, the EMT may observe specific signs or symptoms that may cause the EMT to suspect that the patient has a spinal injury.  This is commonly assumed if the patient feels tenderness in the area of the injury or if there is pain when the area is moved.  In some instances a patient may feel pain even when there is little to no spinal movement.  Pain may be felt when the spine is palpated along the spinal column or the extremities.  The pain may even be intermittent.  When assessing the patient, stay within the patient’s field of vision and ask the patient to not move.

Soft tissue injuries can occur when there is spinal trauma.  Other areas of the body, like the head and neck or shoulder, back or abdominals can become injured if different areas of the spine are injured.  For example, soft tissue damage to the lower extremities may indicate lumbar or sacral spine injuries.  Damage to the shoulder, back or abdominals may indicate a thoracic or lumbar spine injury.

The level of severity of a spinal injury may cause numbness, weakness, or tingling in the extremities.  A patient may have a complete or partial loss of sensation to an area of the body.  Or there may be paralysis below the area of an injury.  Patients with spinal injuries may also lose bowel control.

How To Become an EMT: Assessing Spinal Injuries

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Posted on 15th April 2011 by admin in Uncategorized

Paramedic or EMTWhenever an emergency medical team approaches an accident scene, quick and concise observations should be made about the possible mechanisms of injury that may have occurred.  Identifying the possible mechanisms of injury can help the medical crew to determine if significant force was inflicted upon the patient’s body.  The following are several significant mechanisms of injury to be aware of.

-Motor vehicle crash

-Pedestrian injured in vehicle collision

-Blunt trauma to the head, chest, abdomen, or pelvis

-Fall from a significant height

-Penetrating trauma to the head, neck, or torso

-Motorcycle crash

-Hanging

-Driving accident

-Any trauma that causes an unresponsive patient

A Paramedic or EMT should always assume that a patient has significant life-threatening injuries if it is difficult to determine the mechanism or injury.  By assuming a significant injury, the patient will be monitored closely and handled extremely carefully.  It is always best to be more careful than less careful.

Compression injuries to the spine can occur from falls, motor vehicle accidents, and diving injuries.   When assessing a patient, determining if a compression injury is a possible concern can be figured out quickly by identifying if the mechanism of injury was associated with a fall, car accident or diving injury.

Lateral bending of the spine is also called excessive flexion, extension, or rotation.  This type of injury is often seen in motor vehicle accidents and is commonly referred to as “whiplash.”  If you come to a scene where a patient was in a car that was hit from behind, you can safely assume that the patient will probably experience significant injury to the cervical spine.

Distration is another spinal injury that is caused by the pulling apart of the spine.  It is commonly seen in hanging victims, if the head is snapped away from the body.

Being able to identify significant mechanisms of injury can help the emergency medical team to stabilize, monitor and assess patients with signs and symptoms of trauma.

Phlebotomist: Problem Sites For Blood Collection

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Posted on 12th April 2011 by admin in Uncategorized

There are several problem sites that are not optimal for blood collection.  A phlebotomist should be familiar with these problem areas in order to avoid them.

Burns, scars and tattoos are very common problem sites for blood collection.  This is because the veins are difficult to palpate or penetrate in these areas.  Scared or burned areas may have impaired circulation and could cause inaccurate or false test results.  Tattooed also have impaired circulation and may be more susceptible to infection.  The dyes from the tattoo could possible interfere with test results.

Damaged veins appear to be hard and cordlike.  These types of veins usually lack resiliency from being obstructed and may even be hardened or clotted because of inflammation, disease or chemotherapy drugs.  These types of veins are very difficult to puncture and can cause invalid test results.

Edema swelling that occurs when fluid accumulated in the tissues.  Blood specimens should not be collected from areas with edema because the tissue fluid could cause inaccurate results.  Veins are also more difficult to locate.

Hematoma is a swelling or mass of blood that is caused by a leaking blood vessel.  A hematoma occurs following a venipuncture and can cause a bruise in the surrounding area.  A specimen that is collected from a site with a hematoma can become contaminated with hemolyzed blood.  Collecting a blood specimen in this area is usually very painful.

Blood should not be drawn from an arm that is on the same side as a mastectomy, unless the patient’s physician has requested it.  This area should be avoided because impaired lymph flow form the mastectomy makes the arm susceptible to swelling and infection.  The effects of lymphostasis can also cause inaccurate test results.

Physiologic Variables That Can Affect Blood

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Posted on 8th April 2011 by admin in Uncategorized

There are many physiologic variables that can affect a blood draw or blood specimen.  A phlebotomist technician should be aware of these variables in order to obtain good specimens for testing.  The following variables should always be considered:

The age of a patient can cause some values for blood components to vary.  Red blood cells and white blood cells are normally higher in newborns than in adults.  Physiologic functions often decrease with age.  For example, kidney function is directly related to the age of a patient and should be factored when determining test results.

The altitude can also affect blood collection.  Higher altitudes can affect the production of red blood cells.  The higher the altitude is the greater the increase in red blood cells.  This will also relate to the amount of hemoglobin and hematocrit observed in blood specimens collected at higher elevations.

Dehydration can occur from persistent vomiting and diarrhea.  When dehydration is present, hemoconcentration may exist.  Hemoconcentration is a condition that causes blood components to become concentrated in a smaller plasma volume.  Blood collected under these circumstances usually do not reflect the patient’s true status.

Diet can significantly alter blood composition.  For example, eating too much carbohydrates or sugar can dramatically increase the glucose levels.  These levels may return to normal within 2 hours if the patient has a normal glucose metabolism.  High fat consumption can cause a condition called lipemia.  A blood specimen collected under these conditions will appear milky or turbid.  This condition can be present for up to 12 hours.

Drug therapy can cause changes in the concentrations of certain blood analytes.  Certain drugs can interfere with test procedures by causing false increases or decreases in the test results.  A drug may also compete with a test causing false results.