A1)

A doctor/phlebotomist who operates without the consent of his patient, save in cases of
emergency or mental disability, is guilty of the civil wrong of trespass to the person; he is
also guilty of the criminal offence of assault. Patient consent is required whenever a doctor
wishes to examine or treat a patient. The only exceptions to this are some emergencies where
it may be difficult to get consent or where treatment is being provided under mental health
legislation. Consent can be explicit, given either orally or in writing, or implied, where it
may be signalled by the behaviour of an informed patient.

A2)

How do infections spread?

Direct contact infections spread when disease-causing microorganisms pass from the infected
person to the healthy person via direct physical contact with blood or body fluids. Examples
of direct contact are touching, kissing, sexual contact, contact with oral secretions, or contact
with body lesions. Indirect contact infections spread when an infected person sneezes or
coughs, sending infectious droplets into the air. If healthy people inhale the infectious
droplets, or if the contaminated droplets land directly in their eyes, nose or mouth, they risk
becoming ill. Droplets generally travel between three and six feet and land on surfaces or
objects including tables, doorknobs and telephones. Healthy people touch the contaminated
objects with their hands, and then touch their eyes, nose or mouth.

A3)

Arteries Vs. Veins: How to Tell the Difference and Stop the Bleeding

Arteries flow away from the heart (red). Veins flow back toward it (blue). When trying to
stop a cut from bleeding, you need to know how to tell the difference between a bleeding vein
and a bleeding artery. Arteries carry oxygen-rich blood from the heart to tissue. Veins drain
the blood back to the heart to resupply it with oxygen.

Arteries pump. Veins dump.

Step 1: Apply pressure.

 Use gauze or a clean cloth. If you don’t have anything else, use a gloved hand. If it’s
yourself, as a last resort, use your bare hand. If it’s others, beware you could be
exposing yourself to a blood-borne disease. Stuff a gash with a cloth (the cleanest you
have) or gauze, and hold pressure. A shirt will do.

Step 2: Determine whether it’s an artery or vein.

 If the blood is oozing, it’s a vein. The blood is probably also a darker color because
it doesn’t have as much oxygen. The bleeding usually stops after about five minutes
of pressure. If you can’t apply direct pressure, apply pressure just distal (toward
fingers or toes) to the wound. Remember, it’s draining back to the heart.
 If the blood is spurting, it’s an artery. Arteries contract and expand to aid in
pumping the flow. They may need more pressure to stop the bleeding. If pressure does
stop it, hold the wound for up to fifteen minutes if you can. Then pack it with clean
cloth and apply a bandage. The bleeding should be under control before closing the
wound with suture or tape.

 If you can’t apply enough pressure to stop the bleeding, try pressing down just
proximal to the wound (the side of that’s closer to the heart). Remember, the blood is
coming from the heart. Arteries are too deep to see them from your skin surface, but
sometimes you can feel the pulsing. If you can’t, just press in different areas
proximally until the bleeding stops. Then pack and bandage.

 A tourniquet placed proximal to the arterial bleeding (toward the heart) will stop
it, but could cut off enough blood supply that you could lose limb. If you must, use
material about two inches wide and wrap just tight enough to stop the bleeding. (The
same goes for wrapping any bandage.) If you can wedge two fingers under it you’re
probably okay, but still loosen it every few minutes to let the blood flow distally.
A4)

Explain how the S-monovette system is prepared before the procedure?

The S-Monovette is an innovative enclosed blood collection system that allows the user to
draw blood from the patient using the syringe or vacuum method, uniting the advantages of
both techniques in a single product.

When used as a syringe, the phlebotomist has full control over the speed at which the blood is
drawn into the tube. This is particularly useful for patients with fragile veins, such as the very
young or elderly, where the use of the aspiration technique prevents even the most fragile
veins from collapsing. When the tube has been filled, the plunger is simply snapped off to
leave a primary sample tube which can be centrifuged and is compatible with all major
analysers.

The S-Monovette can also be used as an evacuated tube by drawing the plunger fully down
and snapping it off immediately prior to blood collection. This creates a fresh vacuum and
ensures a precise filling volume, ensuring a correct dilution ratio.

The reduced vacuum pressure in the S-Monovette drastically reduces the rate of haemolysis
and vein collapse, meaning increased sample quality and reduced costs associated with repeat
collections. Furthermore, unlike pre-evacuated tubes, the S-Monovette does not have to hold
a vacuum for many months after manufacture, which allows the membrane stopper to be
thinner and more easily penetrated by the needle sheath. This minimises the movement of the
needle in the vein when attaching the tube, ensuring optimum patient comfort.

The S-Monovette needle is ready to use so that there is no need for assembly to a holder. The
needle is of a compact, low profile design, which reduces the chance of haematoma by
allowing for a reduced angle of puncture and eliminates the possibility of needle stick injury
caused by assembly of the needle and holder. The compact design also results in
approximately one sixth of the sharps volume caused by using a pre-evacuated system, giving
significant cost savings.
How the needle attached to the bottle?

The needle is attached to the tube holder by the phlebotomist prior to collection, or may come
from the manufacturer as one unit. the needle protrudes through the end of the tube holder,
and has a needle on each end. After first cleaning the venepuncture site and applying a
tourniquet, the phlebotomist uncaps the needle attached to the tube holder, inserts the needle
into the vein, then slides evacuated tubes into the tube holder, where the tube's stopper is
pierced by the back end of the needle. The vacuum in the tube then automatically draws the
needed blood directly from the patient's vein.

Explain the two different ways in which you can take blood using the
S-Monovette® System

1) Aspiration Method:

a- The S-Monovette and Safety-Needle are assembled immediately prior to blood collection.
Venepuncture to follow.
b- Slowly withdrawing the plunger ensures gentle blood flow. For multiple sampling, the
next S-Monovettes are connected to the Safety-Needle and samples collected as
described.
c- When blood collection is complete, the last S-Monovette is removed from the Safety-
Needle and the needle withdrawn from the vein.
d- For enhanced security during transport and centrifugation, the piston is locked in the base
of the S-Monovette and the plunger broken off.

2) Vacuum Method:

a- Locking the piston in the base of the S-Monovette ensures a “fresh” vacuum immediately
prior to blood collection. The plunger is broken off.
b- Immediately prior to blood collection, the vein is punctured with the Safety-Needle or
Safety Multifly.
c- The evacuated S-Monovette is assembled with the Safety-Needle located in the vein and
filled. For multiple sampling, the next evacuated S-Monovettes are connected to the
Safety-Needle and samples collected as described.
d- When blood collection is complete, the last S-Monovette is detached from the Safety-
Needle/Safety-Multifly and the needle withdrawn from the vein.

How safety device is used?

A safety device is required on either the holder or the needle to comply with current standards
for needle safety. Consider the use of safety (i.e. engineered) devices such as retractable
lancets, needles with needle covers or retractable needles. Before selecting a safety
engineered device, users should thoroughly investigate available devices to determine their
appropriate use, compatibility with existing phlebotomy practices, and efficacy in protecting
staff and patients.

A5)

In my clinical exam I had to take blood samples from a fake blood pad that was attached to a
real person. Even though I was nervous at first, but with the help of my trainer I got the hang
of it at the end and I was very pleased.