UNIT 6
Pre-analytical lab phase:
- test requisition
- test acquisition
- patient identification
- specimen collection
- specimen handling/transport
-proper control measure
1. Age: RBC, WBC, Creatinine clearance
Liver: source of blood of babies
Aging = decrease production of RBC and WBC
Creatinine = produced when exercising and
hard to be filtered by the kidney
Sedentary Lifestyle – no exercise (increase Na
levels)
2. Altitude: RBC
High Al = decrease RBC
3. Dehydration: RBC, Hemoconcentration,
enzymes, Iron, Na, Ca
Hemoconcentration: low serum levels
RBC: concentrated in the bloodstream
Enzymes, Fe, Na, Ca = decrease
4. Diet: Lipid, Electrolytes, Glucose
Lipids = increase cholesterol
Glucose normal value: 70 g/dL
120 g/dL = diabetes mellitus
5. Drug Therapy: Hormones, enzymes
6. Diurnal Variation: Cortisol, TSH, Iron
Peak levels: waking up in the morning
7. Exercise/IM injection: PCO2, CK, LDH, pH,
glucose
Glucose= decrease after exercise
8. Fever: hormones, cortisol = both increase
Electrolytes = decrease
9. Gender: RBC, Hct, Hgb
F: 5L (high progesterone)
M: 6 L (high testosterone)
Testosterone trigger blood cell formation
10.Jaundice: bilirubin
Bilirubin (light sensitive when exposed to light
turns into bilverdin (green)
11. Intramuscular injection: CK, skeletal muscle
fraction of LDH
LDH = highest after exercise
12. Position: Protein, K = increase
Potassium = increase in hemolyzed specimen
13. Pregnancy: RBC (low)
14. Smoking: cholesterol, cortisol, glucose,
growth hormones, TAG, WBC
GH = decrease
15. Stress: WBC, Fe, Adrenocorticotropic
Hormone, Catecholamine, Cortisol = increase
16.Temperature and Humidity:
Hemoconcentration
PROBLEM AREAS
1. Burns, Scars, and Tattoos
2. Damaged Veins: could be sclerosed/
thrombosed/ clotted
3. Edema/ Oedema: accumulation of fluid
4. Hematoma: solid swelling/ mass of
blood in tissues caused by leakage from
a vessel
5. Mastectomy: breast removal; lymph
flow is obstructed
6. Obesity: hard to locate; use a longer
tourniquet or locate cephalic vein
VASCULAR ACCESS SITES AND DEVICES
1. Arterial Line
- ABG and lab studies
- bp monitoring
2. Arteriovenous Shunt or Fistula
- passageway created through surgery
- directly connect the vein and artery
- hemodialysis treatment or
pathological processes (erosion of
arterial aneurysm)
3. Blood-Sampling Device
- avoid the use of needle sticks, prevent
infections, and reduce wastage from
line draws.
- collect from arterial or central venous
catheter
4. Heparin or Saline Lock (Hep Lock)
- IV catheter attached to a stopcock or
cap with diaphragm
 - provide access for administering
medicine
- threaded in the peripheral vein for 48
hrs.
5. Intravenous (IV) Sites
- inserted into vein to inject a volume of
fluids into the blood stream
- previously known IV sites should be
avoided for 14 to 48 hours
6. Central Vascular Access Devices (CVADs)
- indwelling line
- inserted to the main vein or artery
a. bp monitoring
b. blood collection
c. administering medications
3 types:
1. Central Venous catheter: central
line; large vein/subclavian
2. Implanted Port: implanted disk-
shaped
3. Peripherally inserted Central
Catheter: inserted into the veins of
extremities and the central veins
HANDLING PATIENT COMPLICATIONS
1. Allergies to equipment and supplies
- place gauze, remove after 15 minutes
- alternative antiseptic and non-latex
equipment
2. Excessive Bleeding
- apply pressure for 5 minutes until the
bleeding stops
3. Nausea and Vomiting
- wait until the patient is comfortable with
the procedure
- provide emesis basin or water basket
4. Fainting
- lie the patient down
- elevate feet
5. Pain
- apply ice and notify the physician
6. Petechiae
- small red or purple spots
7. Seizures/ Convulsion
- discontinued quickly
- first aid personnel must be notified
immediately
Hematoma Formation
- there is excessive or blind probing
- there is inadvertent arterial puncture
- The size of the vein is too small
- needle penetration has gone all through the
vein
- needle is not completely inserted
- tourniquet is still on when the needle is
removed
- the pressure is not adequate
Iatrogenic Anemia
- blood loss due to blood draw
- 10 % of blood removed could face a threat
Inadvertent Arterial Puncture
- blood is filling the tube rapidly and there is
hematoma formation
Infection
- tapes or bandages are not opened ahead of
time
- needle are preloaded in the tube holder
- the cap is removed long before venipuncture
- insertion site of the needle is touch after
sterilization
Nerve Injury
- improper site collection
- rapid needle insertion
- excessive needle insertion and blind probing
Reflux of Anticoagulant

- adverse rxn on patient

- unreliable test results

- arm should be kept in downward position just

below the venipuncture site.

Vein Damage

- follow proper technique and avoid blind

probing

SPECIMEN QUALITY

1. Hemoconcentration: decrease fluid/plasma

volume.
2. Hemolysis: rupture of RBC
3. Partially filled-tube or Short Draw: pulling a
tube before reaching the required volume;
incorrect blood additive ratio.
4. Specimen contamination: incorrect
handling (glove powder, perspiration
alcohol)
5. Wrong or Expired collection tube: quality of
seal and pressure

FAILED VENIPUNCTURE:

a. Needle not inserted far enough

b. Bevel partially out of skin
c. Bevel partially into vein
d. Bevel partially through vein
e. Bevel completely through vein
f. Bevel against vein wall
g. Needle Beside Vein
h. Undetermined position

Collapsed Vein: veins being blocked =

insufficient blood flow. Strong pressure in the
vacuum of the tube, tourniquet is too close or
too tight, tourniquet is removed during the
draw.

Tube Vacuum: bevel is not partially out of skin

and the tube is not damaged