University of Santo Tomas

Department of Medical Technology

Clinical Internship- LFTF
Clinical Chemistry

Name: MALIGAYA, Fiona Justin B. Date Submitted:

Section/Group No. 4EMT Group 5 Score:

POST- LAB ACTIVITY (PRE-INTERNSHIP ROTATION CLB):

Guide Questions:
1. Explain the importance of practicing proper pipetting techniques. (5 points)
— Practicing proper pipetting technique is important because the volume of samples is
essential for the accuracy of the results of laboratory tests. The table below enumerates the
proper pipetting techniques and the importance of each techniques

Pipetting Technique Importance

Pipette must be held vertically and straight when For a more accurate volume of sample. When
aspirating and dispensing sample pipette is diagonal when dispensing sample,
chances are there would be residue on the sides
of the pipette causing a discrepancy in the
volume

Observe proper meniscus level when aspirating
samples. For colored sample, upper meniscus,
and for colorless samples, lower meniscus
Meniscus is the curvature of the water. Lower
meniscus is often easy to observe in clear
solutions. However, for some colored samples,
lower meniscus is not visible so upper meniscus is
considered for reading measurement. If not
followed, there might be discrepancy in the
volume

Pre-wet the pipette tip and expel liquid a few This is to ensure that there is no cross
times before aspirating a new sample contamination of samples and not pre-wetting
will result to lower volume in the first aspiration

Use appropriate type of pipette needed as well as For better accuracy and precision
the right volume of pipette

Immerse the tip off the pipette with the correct
depth. Ideally, pipettes with 1-5mL volume should
be immersed to 5-6mm and pipettes with smaller
volume should be immersed to 2-3mm.
Wrong tip immersion depth can cause
discrepancy in the volume. If immersion is too
little, chances are air will be aspirated – there will
be air bubbles/space in the pipette. If the
immersion is too much, the volume of gas in the
tip is compressed, causing too much liquid to be
aspirated, and the sample may stick to the
outside of the tip. If the tip is touching the
bottom of the container, it may be difficult to
aspirate
University of Santo Tomas
Department of Medical Technology
Clinical Internship- LFTF
Clinical Chemistry

2. State the differences between air displacement, positive displacement and dispenser pipets. (5
points)
— Air displacement, positive displacement, and dispenser pipettes are all types of automatic
pipettes.
● Air displacement pipettes have a plunger piston that creates suction and draws the
sample into the tip. The tip used is a one-time use disposable tip so it must be discarded
and changed after use.
● Positive displacement pipettes also have a piston but they are moved in the pipette tip
or barrel for suction, similar when using a syringe. The tip used here is made of straight
columns of glass or plastic. Unlike air-displacement pipette, tip of the positive
displacement pipette does not require changing every after use. However, tips may be
needed to be rinsed or blotted between samples to avoid cross contamination.
● Dispenser pipettes are used to obtain a liquid form of a common reservoir and dispense
it repeatedly. Dispenser pipettes can either be a bottle-top, motorized, hand-held, or
attached to a dilutor. A dilutor can combine functions of sampling and dispensing.

3. Why do you have to use the forefinger or index finger in controlling the rate of delivery? (5
points)
— Forefinger or index finger is used to control the sample when using a manual pipette because
it is more flexible – releasing the pressure of the index finger can be controlled easily and slowly,
therefore proper volume can be achieved. Additionally, the index finger is the closest to the
mouth of the pipette, and since the thumb and middle finger are placed on the opposite side of
the pipette, they can rotate the pipette without disrupting the pressure of the index finger on
the mouth of the pipette.

4. Identify 3 sources of error in pipetting (provide 3 for each- Manual and Automatic) (5 points)

ERRORS IN MANUAL PIPETTING ERRORS IN AUTOMATIC PIPETTING

1. Not pre-wetting prior to aspiration 1. Dispensing sample too quickly

2. Pipetting and Dispensing at an angle 2. Cross contamination – using same pipette
3. Using a glass pipette with a broken tip tip when aspirating different sample
3. Not calibrating pipettes on established
deadline
University of Santo Tomas
Department of Medical Technology
Clinical Internship- LFTF
Clinical Chemistry

II. Provide the answers for the following questions associated with Blood Collection. (20 points)
What is the best approach to Performing a venipuncture on an 8-year-old child can be challenging,
use on an 8-year old child not only because their veins may not be that accessible compared to
who needs to have blood that of an adult, but also challenging on their attitude towards needles
drawn? and punctures. First of all, it is important to get the consent of the
parent or guardian of the patient. The best way to approach this is to
explain to the child themself about the procedure and assure the
patient’s safety. It is important to get the child to cooperate. Parents or
guardians can also play an important role in making the child
cooperative if the medical technologist cannot seem to do so.
You are asked to collect a Ask the patient for their name and other necessary information
blood specimen from an depending on the protocol of the institution, such as but not limited to,
inpatient. The patient is not birthdate and date of confinement, and put on a new ID band or ask
wearing an ID band. What is the nursing station to give the patient a new one. It is very important to
the best thing to do? identify the patient properly before proceeding with blood extraction
An inpatient is eating Fasting glucose requires 8-10 hours of fasting. In his case, it is
breakfast when you arrive to important to consult first with the patient's nurse to know if the
collect a fasting glucose. What specimen should be collected. If not, the collection needs to be
is the best thing to do? postponed and the patient needs to strictly observe the proper fasting
What are the complications ● Hematoma is the most common complication that occurs in
that can occur with an venipuncture. This is the swelling of the puncture site. Some of
improper venipuncture the improper venipuncture procedure that causes this are:
procedure? (Give at least 3) puncturing a small vein, too much probing to find a vein,
needle passing through and through a vein, removing the
needle before releasing the tourniquet, the tourniquet is too
tight or has been in the arm for too long, and applying pressure
to the gauze in the puncturing site before removing the needle
● Hemoconcentration means the concentration of the blood is
too high and can cause false results such as a false increase in
potassium ion, phosphorus, ammonia, and total protein. This
happens when the tourniquet is prolonged in the arm of the
patient
● Thrombophlebitis is the swelling or inflammation of the vein
that is caused by a blood clot. Though in phlebotomy, this
commonly occurs when extracting blood in the lower extremity
What are the most common ● Wrong angle of needle insertion. This can cause an inability to
errors encountered during extract blood and having to fish out for vein or re-puncture
phlebotomy? (Give at least 2) ● Unstable grip of the syringe and pulling out of needle from the
arm when pulling out the plunger to extract blood. This can
cause air aspiration or needle out of vein resulting to having to
fish out for vein or re-puncture
University of Santo Tomas
Department of Medical Technology
Clinical Internship- LFTF
Clinical Chemistry

Case Study. Answer the questions below. (10 points)

Anna and Elsa, both on-duty phlebotomists for the afternoon shift, went to the Children’s Ward
to extract blood from a young girl they had drawn many times before. The request was from a Q8 CBC
(recurring request, every 8 hours for Complete Blood Count). When they reach bedside, the girl asked
them to leave and told them she was not supposed to have any more blood tests. The girl’s parents were
not around, but in the past they had always given permission for blood draws over the child’s objections.
Anna and Elsa ignored the girl and continued the blood collection. Anna performed venipuncture while
Elsa restrained the crying child. It was later determined that the girl’s parents had earlier filed a written
request that the child was to have no more blood drawn.

Questions:
1. What error did Anna and Elsa make in this blood collection request?
— They ignored the child and did not wait for her parent’s consent. They extracted blood from
the child forcefully and even restrained her despite her objectification. They did not check the written
request of the parents to have no more blood extraction.

2. What assumptions were made in deciding to draw blood from the child over his objections?
— They assumed that the child has no right to decide for herself and that they can ignore her
and continue extracting blood. They also assumed that because the parents have given them consent in
the past means that they also had consented at that moment despite the parents not being present.
They assumed that it is okay to restrain a child and extract blood without any parent or guardian around.

3. What might be the consequences of the phlebotomists’ actions?

— In the Philippine setting, based on RA 5527 or The Medical Technology Act, in Sec. 24, the 2
medical technologists will undergo an administrative investigation. This is to be conducted by at least 2
members of the Board and 1 legal officer. After the investigation, the license or certificate of registration
(COR) may be revoked or suspended for their unprofessional conduct, malpractice, and gross negligence
in the practice of medical technology. Their COR must be surrendered within 30 days after the
promulgation. A penalty may be imposed if there is a unanimous vote of all the 3 Board members. Based
on Sec. 29 of RA 5527, the penalty can be a fine of not less than 2000 PHP nor more than 5000 PHP, or
imprisonment for not less than 6 months nor more than 2 years, or both.
University of Santo Tomas
Department of Medical Technology
Clinical Internship- LFTF
Clinical Chemistry

REFERENCES:

An Act Requiring the Registration of Medical Technologist, Defining Their Practice, and for Other
Purposes, Rep. Act No. 5527, 24, 29 (June 21, 1969) (PH),
https://www.prc.gov.ph/sites/default/files/Medical%20Technology%20-%20Board%20Law_0.PDF

Complications of venepuncture - scientific research publishing . (n.d.). Retrieved August 5, 2022,

from https://file.scirp.org/pdf/ABB_2013013114170934.pdf

12 easy tips to improve your pipetting technique (guide). BioSistemika. (2022, August 2). Retrieved
August 4, 2022, from https://biosistemika.com/blog/tips-to-improve-pipetting-technique/

Guide to Pipetting. Pipettes and Pipette Tips. (n.d.). Retrieved August 4, 2022, from
https://www.pipette.com/public/staticpages/guidetopipetting.aspx?menuid=493

Mettler-Toledo International Inc. all rights reserved. (2022, March 14). Good pipetting practice.
Pipetting Technique | Good Pipetting Practice | Pipetting Procedure. Retrieved August 4, 2022,
from https://www.mt.com/id/en/home/products/pipettes/pipette/pipetting-techniques.html