Professional Documents
Culture Documents
Quality Assurance
Over all program or system that ensures that the
final results generated by the laboratory has
achieved and maintained a specified quality.
Quality Control
reliability of laboratory results in terms of accuracy
and precision:
Machine
Reagents
techniques
Fasting
Diet
Exercise
Smoking
Alcohol ingestion
Drugs
Circadian rhythm
1.AST
2. TESTOSTERONE
3. AMMONIA
4. LDH
5. CPK
1.AST
2. TESTOSTERONE
3. AMMONIA
4. LDH
5. CPK
A. 1,2 AND 3
B. 2 AND 4
C. 2, 3 AND 4
D. 1,3 AND 5
E.1,2,3,4 AND 5
A. 1,2 AND 3
B. 2 AND 4
C. 2, 3 AND 4
D. 1,3 AND 5
E.1,2,3,4 AND 5
11/10/2014
5 DAYS
Specimen Collection
Public Relations
Phlebotomy
Related Vascular
Anatomy
Professionalism
Appearance
Attitude
10
11
12
11/10/2014
H-pattern
M-Pattern
Median Vein
MCV
At the center of antecubital fossa
First choice for venipuncture
Cephalic vein
Lateral
Second-choice in H-pattern
Often hard to palpate
Obese patients
Median Cephalic
Median Basilic
Basilic vein
Medial of antecubital fossa
Not well anchored,rolls easily
Accidentaly puncture the brachial artery
and the median cutaneous nerve branch
13
14
Venipuncture Equipment
Tourniquet
Restricts venous blood
flow
Distends the vein,
making them prominent
Not more than 1 minute
Whole blood
Plasma
Anticoagulated blood, Clear to slightly hazy, pale yellow
With fibrinogen
Serum
Pale yellow, Separated from cells after clotting
Usually used in blood chem
No fibrinogen
15
Venipuncture Equipment
16
Syringe System
Needles
Sterile, disposable
Sized by length and gauge
(the # that relates to the
needle diameter)
Gauge inversely related to
diameter
If too large= damage the vein
If too small= hemolyze the
rbc
Gauge 21-23
17
18
11/10/2014
Evacuated Tubes
19
20
VENIPUNCTURE
Deoxygenated blood;
Dark red
antecubital fossa, dorsal (hand), Wrist, ankle
Pointers:
Tourniquet application
60mmHg pressure
Alcohol must not remain on the skin
15 to 30-degree angle
Drawing of blood with IV line
IMPORTANT REMINDERS
VENIPUNCTURE TECHNIQUE-ETS
21
Order of Draw
11/10/2014
Complications
STEPS IN DOING
VENIPUNCTURE
STEPS IN DOING
VENIPUNCTURE
STEPS IN DOING
VENIPUNCTURE
Identify yourself
Who you are
Where you are from
What you are going to do
STEPS IN DOING
VENIPUNCTURE
11/10/2014
STEPS IN DOING
VENIPUNCTURE
Sanitize hands
Put on gloves
Recommended:
Do not touch the patient without
gloves on.
STEPS IN DOING
VENIPUNCTURE
STEPS IN DOING
VENIPUNCTURE
STEPS IN DOING
VENIPUNCTURE
STEPS IN DOING
VENIPUNCTURE
STEPS IN DOING
VENIPUNCTURE
11/10/2014
Apply tourniquet:
Used to increase intravascular pressure (single use only)
Helps
Palpating the vein and filling of the tubes
STEPS IN DOING
VENIPUNCTURE
BP cuff
40mmHg
Pump hand one to two times
STEPS IN DOING
VENIPUNCTURE
STEPS IN DOING
VENIPUNCTURE
VENIPUNCTURE
Difficult veins
If you MUST re-touch, then you
MUST re-CLEAN
STEPS IN DOING
VENIPUNCTURE
11/10/2014
STEPS IN DOING
VENIPUNCTURE
SPECIAL HANDLING
Examples of tests that require chilling of
specimen
Gastrin
Ammonia
Lactic acid
Catecholamines
Pyruvate
PTH
SPECIAL HANDLING
Examples of tests requiring transport of
specimens at 37 deg C.
Cold agglutinins
Cryofibrinogen
Cryoglobulins
11/10/2014
SPECIAL HANDLING
Tests requiring protection from light:
Bilirubin
All Vitamin levels
Beta carotene
Porphyrins
Both from sunlight and artificial light (with UVL)
SPECIAL HANDLING
Serum
Specimens should be clooted before
centrifugation
30-60 min for complete clotting at 20-25 deg C
NOTE: The use of wooding applicator stick for
rimming the sides of the tube is NOT
RECOMMENDED!.
Clotting time of sample is prolonged if:
Sample is chilled
Patient is in AC therapy
SPECIAL HANDLING
SPECIAL HANDLING
Plasma
Use the appropriate collection tube
Centrifuge immediately after collection
Notes on Venipuncture:
Complete Order of
draw
Stop, light red, stay
put, green light, go
Multiple
venipuncture
attempts
Try again below the
first site, other arm,
hand or wrist veins
Ask someone else
54
11/10/2014
Notes on Venipuncture
Pediatric venipuncture
Superficial veins of the
antecubital fossa, never
deep, hard-to-find veins.
Wrap in blanket or ask to
sit on parents lap to
immobilize
Use 23 G (butterfly,
syringe needle)
55
56
Procedural Errors
Hematoma
Iatrogenic anemia (10% of
blood volume)
Inadvertent arterial
puncture
Infection of the site
Nerve injury
57
58
CAPILLARY PUNCTURE
Indications for skin puncture
CAPILLARY PUNCTURE
No accessible veins
Fragile veins
Thrombotic veins/ those with clot-forming
tendencies
POCT samples
Newborns and infants
59
10
11/10/2014
Centrifugation
Unacceptable Specimen
11
11/10/2014
Temperature:
Room temp.
Refrigeration temp.
Ice packs
Freezing temp.
Solid CO2
Nitrogen gas
Anaerobic condition
ABG
Ionized and non-ionized calcium
ACP
MD AND RT
5 SITES FOR
ARTERIAL
PUNCTURE
12
11/10/2014
5 SITES FOR
ARTERIAL
PUNCTURE
BEVEL
ACCIDENTALLY
COMES OUT
NEEDLE IS
PULLED OUT
BEFORE
RELEASING
THE
TOURNIQUET
TUBE HOLDER
Radial artery
Brachial artery
Femoral artery
Scalp artery
Umbilical artery
IDENTIFY
WHAT IS
WRONG IN
THIS
PICTURE?
IDENTIFY THE
ENCIRCLED PART
BASILIC VEIN
13
11/10/2014
CEPHALIC VEIN
Objective:
Check reagents
Monitor stability of machine
Monitor personnel errors
External QC
Accuracy of laboratory tests
Proficiency testing
interlaboratoryperformance
14
11/10/2014
QC materials:
Statistical Quality Control system
Standards
sample of known quantity
Specific analyte is present
Used to establish units
Controls
Sample of known quantity
Several analytes are present
Types of Variations
Stages:
Establish statistical limits
Use these limits to evaluate the quality control data
Taking remedial action when indicated
Levey-Jennings Chart
RANDOM ERRORS
Present in all measurements
Due to chance
Influenced by personnel and environment
Dispersed data
SYSTEMATIC ERRORS
Control values consistently in one direction
Trend or shift data
15
11/10/2014
16