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PMLS Lab and Lec Reviewer
PMLS Lab and Lec Reviewer
MIDTERM REVIEWER
(S.Y. 2018-2019)
- Gloves are always necessary. more efficient than a dry heat or heat pack
- Wear additional PPE. ideal temperature: 42 degrees Celsius
Lab coat or gown when appropriate or wrap around patient’s hands for only 3-5
required minutes
Safety goggles and surgical mask may
(Heat enlarges the capillaries, blood flows faster,
be needed if there are potential for
better bleeding.)
splashes or sprays of blood
- Only have the equipment needed for this (Warming the site can increase the blood flow
procedure at hand and additional equipment sevenfold.)
out of the reach of the patient.
Puncture sites:
CAPILLARY BLOOD
- infant heel (lateral plantar)
Is obtained from capillary beds that consist of - ring finger and great (middle) finger
the smallest veins (venules) and arteries - earlobe (least preferred site)
(arterioles) of the circulatory system.
Venules and arteries join together in capillary Side or tip of the finger should not be
beds forming a mixture of venous blood punctured
along with interstitial and intracellular fluids. Site must be warm or have been warmed
Must not be edematous (build up of tissue
Clinical applications of capillary puncture:
fluids)
burnt patients
(Always cut across (perpendicular) the fingerprint
cancer patients
line.)
obese patients
geriatric patients
PRINCIPLES OF MEDICAL LABORATORY SCIENCE LAB & LEC
MIDTERM REVIEWER
(S.Y. 2018-2019)
Use 70% isopropyl alcohol After blood touches the surface of the
Allow to dry thoroughly before any puncture device…
Do not use povidone-iodine (betadine) to - Tap the device on a hard surface to
clean - ↑ potassium, phosphorus or uric acid facilitate blood flow.
- Rotate the tube after every drop – AC
Puncture devices:
contact
All devices must have the ability to retract the - Mix by inverting 8-10 times once
blade after have been used. capped.
Devices for glucose monitoring – produce CAPILLARY TUBES OR MICROHEMATOCRIT TUBES
only 2 to 3 drops, insufficient amount.
The depth of cut of varies depending in the Are disposable, narrow bore plastic or plastic-
device used – toddler device does not clad glass capillary tubes that fill by capillary
puncture as deeply as adult device. action or typically hold 50-70 ul of blood.
Are primarily used for hematocrit (packed red
2 principles used in retractable device:
cell volume determinations)
- Straight down puncture with guillotine-type - RED BAND – ammonium-heparin-
action coated tube
- Slicing motion that produces half-moon cut. - BLUE BAND – plain tube
These tubes are very delicate and must be
Collection of sample:
used with great caution.
Hold the patient’s hand downwards – gravity As soon as the tube is two thirds to three
helps the blood flow into the collector. fourths filled, one end is sealed to prevent
Before the blood is collected, first drop of blood from leaking out.
blood must be wiped off – interstitial fluid is Plastic or clay sealant are commonly used to
released into the first drop. seal one end of microhematocrit tubes.
Adequate puncture – 0.5 ml can be collected.
GLASS MICROSCOPIC SLIDES
As the drop forms, touch the tip of the
microcollection device. A drop of blood is placed directly on a glass
Blood flow can be enhanced by gentle, slide and spread to create an area of cell
continuous pressure. examination.
Excess pressure – hemolysis or contamination Puncture site:
with tissue fluid
Scraping of the blood – hemolysis Plantar surface
- Medial to a line drawn posteriorly
from the middle of great toe to the
heel
PRINCIPLES OF MEDICAL LABORATORY SCIENCE LAB & LEC
MIDTERM REVIEWER
(S.Y. 2018-2019)
Puncture depth:
Optimal depth:
- 0.85mm (premature infants) to 2mm
(full-term infants)
- Capillary bed of a preterm full-infant
on 0.35 to 1.6mm beneath the skin
surface.
- Puncture to a depth of 2mm on full-
term infant punctures majority of the
capillary bed and does not injure the
bones or nerves.
Excessive crying: ↑ WBC count One of the oldest methods known that DOES
WBC count does not return to normal up to NOT DESTROY THE INTEGRITY OF THE VEIN.
60 minutes. Purpose of this system then was possibly used
HEMOLYSIS – greatest concern with as PUS EXTRACTOR or a MINIATURE FLAME
microcollection samples: ↑ potassium THROWER.
Causes: Made of either glass or plastic (with majority
- Alcohol used was not allowed to dry of being plastic).
- Finger was squeezed too vigorously BARREL and PLUNGER varies in volume from
- Newborns have increased RBC fragility 1ml up to 60ml.
- Blood was scraped off Barrel: graduated into milliliters
Order of draw:
Sometimes may stick and hard to pull. Gauge 22 Used for small veins and
BREATHING THE SYRINGE is needed before pediatric patients
use of syringe by pulling the back of the Gauge 23 Can be used in
plunger to about halfway up to the barrel and combination with
push it back. butterfly collection set
Pulling the plunger creates a vacuum with the Gauge 25 Can’t be used in
barrel. venipuncture (RBC’s
By breathing the syringe, it makes the plunger may be destroyed)
pull more smoothly and not have tendency to Used for intermuscular
JERK when first pulled. infections
Gauge 27 Used for administration
(The larger the size of a syringe = greater amount of
of a purified protein
vacuum obtained.)
derivative (PPD)
(Larger amount of vacuum has the tendency to pull tuberculosis skin test
TOO HARD and COLLAPSE the vein.) Gauge 18 and 16 Used for intravenous
infusion or blood
Syringe are used for the difficult-to-draw
donation
patients who have veins that are:
1. Fragile
2. Thin NEEDLE
3. Rolly
Needle bevel is the angle of the needle on the
(Tend to collapse when using ETS esp. pediatric and tip.
geriatric patients.) The sharper the bevel: less pain
Silicon-coated for easy insertion
Surface veins on the FEET and BACK OF THE
Walls of needle are thinner = outside
HANDS may also require the syringe
diameter is thinner = smaller hole as it enters
technique.
the patient’s arm
Use of this method is limited to the capacity
of the syringe. EVACUATED TUBE SYSTEM
Syringe with 10-15ml is not recommended,
Often called “vacutainer” system.
instead, use BUTTERFLY COLLECTION SET.
Vacutainer – brand name for evacuated tube
Recommended length of needle: 1 inch to 1 ½
system manufactured by Becton Dickinson
inch.
Company.
Gauge is determined by the DIAMETER OF
A tube with a vacuum already in it attaches to
THE LUMEN or the opening of the bevel end.
the needle and the tube’s vacuum is replaced
by blood.
4) Lipemic specimens
- The presence of lipid or fats in serum
or plasma can cause this abnormal
appearance.
PRINCIPLES OF MEDICAL LABORATORY SCIENCE LAB & LEC
MIDTERM REVIEWER
(S.Y. 2018-2019)
TRUE STAT – ex. A patient comes into the the patient’s anxiety and
hospital emergency department with massive improve patient compliance.
injuries.
TIMING REASONS – ex. The physician may (Always greet the patient in a positive manner.
need the results before the patient is sent Establish eye contact.)
home, or someone forgot to order the test
Introduce yourself to the patient, giving
and the physician needs those test results
your name and your immediate role in his
before the next dose of medicine can be
or her care. This is a way to create a
given.
personal connection with the patient.
ASAP Explain how long will the procedure take
and explain what you are going to do.
Is sometimes used to indicate that the sample
Listen closely to the patient with your
needs to be collected generally within an
eyes and ears.
hour of the order time.
Always be attentive to the patient’s tone
Results of ASAP requests are typically
of voice and body language.
available within 2 to 4 hours.
After a positive greeting, start verifying
AM/PM or TODAY you have the correct patient.
DO NOT TRUST that he/she is the patient
Lesser priorities.
when he/she allowed you to come.
(Certain types of tests determine when the Verifying the identification bracelet
phlebotomists collects the sample. confirms the patient’s full name and that
is acceptable identification.
Ex. Blood test for Ammonia, sample must be placed
Hospital patients have a hospital
on ice and then delivered to the laboratory within 20
identification bracelet that includes their
minutes of collection.)
FIRST and LAST names, hospital numbers
If the phlebotomist has several patients to (often two sets of numbers), birth date,
draw and one of those patients has an and physician.
ammonia test ordered, the ammonia test Patient will often have been asleep or not
must be drawn last and then delivered paying attention and will answer yes.
IMMEDIATELY to the laboratory. Ask the conscious patient to STATE his her
IMPORTANCE OF PATIENT IDENTIFICATION FULL NAME and SPELL THE LAST NAME.
This helps patients realize that someone is
GREET THE PATIENT in the room and it gets them thinking so
BEFORE any attempt is made to collect a they will be awake when their blood is
sample from the patient, you must gain the collected. However, the phlebotomist still
patient’s trust. needs to check the identification bracelet
with the others or labels to verigy that the
Gaining the patient’s trust is done through
properly greeting the patient. It will decrease
PRINCIPLES OF MEDICAL LABORATORY SCIENCE LAB & LEC
MIDTERM REVIEWER
(S.Y. 2018-2019)
- Do not give hospital patients food or tell them Drug may be given
they can eat without first checking with the ORALLY or injected INTRAMUSCULARLY or
nurse. INTRAVENOUSLY.
- The fasting test just drawn may be only one of Timing of collection of the samples is critical
several tests for which the patient must to the proper determination of the level of
remain fasting. drug in the patient.
- The patient may be going to surgery or
radiology and may be fasting for those areas. Many variables influence the effectiveness of the
- The outpatient who has come in only for drug:
blood tests may be released from restrictions
1. Drug half-life
once the phlebotomist obtains the sample.
2. Concentration of medication
TIMED SAMPLES 3. Form of drug administration
4. Age of the patient
These samples should be collected at the 5. Weight of the patient
precise time intervals required. 6. Liver function
Phlebotomist must have specific directions on 7. Kidney function
how the sample should be collected and at 8. Disease state
what intervals. 9. Interacting drug therapy
Tests that exhibit a DIURNAL effect, where 10. Patients metabolism
values in the patient vary throughout the day,
are serum iron, corticosteroids, and other Patient is tested for a presample before the
hormones – these are often drawn 12 hours drug is given and then for a postsample after
apart in the early morning and evening. the drug has been administered.
Monitoring of a patient’s drug therapy also
requires a timed sample. Aminoglycosides, TROUGH LEVEL (PREDOSE)
coagulation therapy monitoring, digoxin, and
Pre-sample collected when drug is at LOWEST
other types of drugs are monitored at a
LEVEL in the patient. It is usually drawn 30
particular time of day or a time interval after
minutes BEFORE the next dose of drug is
the dose of drug.
administered – drug is usually administered
All these are tracked through THERAPEUTIC
through an INTRAVENOUS (IV) injection.
DRUG MONITORING (TDM), the goal of TDM
is to provide information that will allow the PEAK LEVEL (POSTDOSE)
dose given to the patient to be effective but
not toxic. Collected once the drug has been
Every patient has a different metabolic rate COMPLETELY administered for a specific
for each drug given. The method of period. Should be collected when the drug is
administration of the drug also affects the at its HIGHEST level in the patient. This peak
metabolism, of the drug. level SHOULD fall somewhere in the
therapeutic range.
PRINCIPLES OF MEDICAL LABORATORY SCIENCE LAB & LEC
MIDTERM REVIEWER
(S.Y. 2018-2019)
UPPER BEND OF THE ARM (Antecubital area). (Deep punctures can not only cause nerve damage
but can also result in puncture of an artery.)
Order for checking for the best available site:
SYNCOPE (FAINTING)
1. Upper arm
2. Hand 1. Pale
3. Wrist 2. Perspiring
4. Ankle or foot 3. Starting to breathe shallowly
4. Followed by drooping eyelids
PATIENT REACTIONS
5. Weak, rapid pulse
PAIN 6. Unconscious
NERVE DAMAGE
PRINCIPLES OF MEDICAL LABORATORY SCIENCE LAB & LEC
MIDTERM REVIEWER
(S.Y. 2018-2019)
SKIN ALLERGIES
PRINCIPLES OF MEDICAL LABORATORY SCIENCE LAB & LEC
MIDTERM REVIEWER
(S.Y. 2018-2019)
Notes to remember: