PRINCIPLES OF

MEDICAL TECHNOLOGY
PRACTICE 2

Faculty of Pharmacy
Department of Medical Technology
 PREANALYTICAL
CONSIDERATIONS IN
PHLEBOTOMY
6 UNIT SIX

2
Course Content
Unit VI: Pre-analytical Considerations in
Phlebotomy (2 hrs)

▪ Physiological variables that influence

laboratory test results
▪ Problem areas and troubleshooting in site
selection
▪ Vascular access sites and devices
▪ Handling patient complications associated
with blood collection
Course Content
Cont. Unit VI: Pre-analytical
Considerations in Phlebotomy (2 hrs)

▪ Avoiding and handling Procedural

error risks and failure to Draw blood
▪ Specimen quality
 LEARNING OUTCOMES
1. Discuss the 2. List and 3. Identify and
physiological describe the describe
variables that problem areas vascular access
influence and sites and devices
laboratory test complications
results associated with
blood
collection
 LEARNING OUTCOMES

4. Discuss the 5. Enumerate

procedural and discuss the
error risks and issues
failure to draw concerning
blood. specimen
quality.
 OVERVIEW
Pre- examination phase

First-line to ensure quality laboratory results

Considerations:

- physiological variables
- punctures sites
- complications and special conditions
- specimen quality
 Specimen Variables
Prepare materials
• Pre-analytical
•
& collect blood
Analytical
Receipt of
Label specimen • Post-analytical
lab. request
Forward blood
inside the lab

Patient ID
Inside the lab

YES

Patient confirmation
NO
Encode
Check request & results & sign
Technologist
patient preparation places specimen
in CC racks

yes
Meet patient prep

no
Politely explain why & Release results
give correct instructions
end
end

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 PHYSIOLOGICAL VARIABLES
AGE
PARAMETERS Effects on Age
RBC COUNT Higher in younger patients
WBC COUNT Higher in younger patients
RENAL FUNCTION TEST Decrease with age
 PHYSIOLOGICAL VARIABLES
ALTITUDE
PARAMETERS Effects
RBC COUNT Elevated in higher altitude
HEMOGLOBIN Elevated in higher altitude

HEMATOCRIT Elevated in higher altitude

C-REACTIVE PROTEINS Elevated in higher altitude

URIC ACID Elevated in higher altitude

CREATININE Decreased in higher altitude

 PHYSIOLOGICAL VARIABLES
DEHYDRATION
PARAMETERS Effects
RBC COUNT Elevated
IRON Elevated

CALCIUM Elevated
 PHYSIOLOGICAL VARIABLES
DIET
TYPES OF FOOD/DRINK TAKEN IN EXCESS AFFECTED PARAMETERS
HIGH PROTEIN Elevated NPN compounds
CAFFEINE Elevated Cortisol and ACTH and
NEFA
CARBOHYDRATES Elevated glucose and insulin

EXCESSIVE WATER AND OTHER Decreased Hemoglobin

FLUIDS
FATTY FOODS Elevated Lipid Profile
PHYSIOLOGICAL VARIABLES

DIURNAL/CIRCADIAN VARIATION
PHYSIOLOGICAL VARIABLES

DRUG THERAPY
DRUG EFFECTS

CHEMOTHERAPY DRUGS Decreased in Blood Cells (WBC,Platelets)

NSAID, Anti-TB Elevated Liver enzymes

Decreased clotting factors

Opiates Elevated Liver and Pancreatic Enzymes

Oral contraceptives Elevated ESR

Decreased levels of Vitamin B12

Steroids and Diuretics Elevated amylase and Lipase

Thiazide Diuretics Elevated calcium and glucose

Decreased sodium and potassium
 Inappropriate venipuncture sites
• Arm on side of mastectomy
• Edematous areas
• Hematomas
• Arm in which blood is being transfused
• Scarred area
• Arms with fistulas or vascular grafts
• Sites above an IV cannula

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 VASCULAR ACCESS
DEVICES AND SITES
ARTERIAL LINE
- catheter that is placed in an artery
- used to provide accurate and continuous measurement of
patients blood pressure
ARTERIOVENOUS SHUNT, FISTULA, OR GRAFT
- permanent surgical connection of an artery and vein by
direct fusion
- created to be used for dialysis
BLOOD SAMPLING DEVICE
- needleless closed blood sampling devise
- reduces the chance of infection, prevent needlesticks, and
minimize waste associated with line draws
 HEPARIN OR SALINE LOCK
- Catheter or cannula connected to a stopcock or a
cap with diaphragm
- Access for administering medication or drawing
blood
 INTRAVENOUS SITES
- Simply as an IV-catheter inserted in a vein to
administer fluids
- NOT TO BE USED TO OBTAIN BLOOD SAMPLE
 PROCEDURAL RISKS , PATIENT
COMPLICATIONS AND CONDITIONS
◉ Hematoma: rapid swelling at or near the venipuncture site
due to blood leaking into the tissues
◉ Iatrogenic anemia: anemia as a result of treatment
◉ Inadvertent arterial puncture
◉ Infection
◉ Nerve injury
◉ Reflux
◉ Vein damage
• Allergy

• Excessive bleeding

• Fainting/syncope

• Nausea or vomiting

• Pain

• Petechiae

• Seizures/convulsion
TYPES OF BLOOD SPECIMEN
1. Serum
▪ liquid portion of clotted
blood
▪ clearer than plasma
2. Plasma
▪ Liquid portion of unclotted
blood
3. Whole Blood
▪ plasma and red cells
Taken from Bishop et al., 7th Edition, 2013, p. 29
▪ with anticoagulant
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SPECIMEN QUALITY
CONCERNS
 Changes that occur if there is delay in
separation
1. Glycolysis
2. Enzymatic degradation: self destruction
of enzymes (ACP)
3. Hemolysis
4. Extravascular interchange/Electrolyte
shift
extracellular: Na+, Cl-
intravascular: K+, Mg2+
enzymes: ACP, AST, LDH
(red cells) 28
 Changes that occur if there is delay in
separation
5. Changes in Lipid Concentration (Lipolysis)
6. Increase Plasma Protein
7. Blood gas changes
Open system: ↑pO2, ↓pCO2, ↑pH
Closed system: ↓pO2, ↑pCO2, ↓pH
8. Changes in PO43- due to hydrolysis of organic
phosphate esters
9. Bacterial changes
▪ glycolysis
▪ decreased Urea concentration
▪ increased NH3

29
TROUBLE SHOOTING /
NEEDLE POSITION