PRINCIPLES IN MEDICAL CARDIAC ARREST

LABORATORY SCIENCE
 Px falls into unconsciousness no pulse or
LESSON 1 respiration, dilated eyes and pale skin
PROBLEMS ENCOUNTERED IN VENIPUNCTURE  Immediate CPR

------------------------------------- CONTINUOUS BLEEDING

PAIN  Some patients take more than 5 minutes

 Reposition the needle
 Release the tourniquet
 Discontinue venipuncture
 Avoid deep, probing venipunctures
for the site to stop bleeding.
 Continue to wrap an elastic gauze around
the arm with a pad
 Leave it on for 15 min or until the bleeding
stops.

NERVE DAMAGE SKIN ALLERGIES

 If nerve is only touched, not damaged, it  Some px are allergic to latex, tape or
may be gone in a few hours or days. iodine
 If damage, numbness could be permanent  Use hypoallergenic tape and non- latex
 Discontinue venipuncture elastic wrap.

NAUSEA - - - - - - - - - - - -- -- - - -- - - - -- - - - - - - - - - - - - -

 Make the px as comfy as possible HEMATOMA

 Instruct him/her to breath slowly
 Apply cold compress if necessary Discontinue venipuncture and apply heavy
 Give waste basket or container and have pressure.
tissues and water ready
HEMATOMA FORMED
SYNCOPE

 Warning signs:persipiration beads on the

forehead, hyperventilation, loss of color
 Vasovagal syncope- fainting due to abrupt
pain or trauma
 Discontinue venipuncture
 Lower the head and arms

DIABETIC SHOCK
NEEDLE PASSED THROUGH VEIN
 Experience hypoglycemia because they
fasted
 If conscious, let them drink a glass of
orange juice or cola will temporarily help
 If unconscious, call a physician

CONVULSIONS

 Px become unconscious and exhibit mild to

violent uncontrollable movements
 Do not restrain the px BEVEL NEAR OR IN VEIN WALL
 Move objects out of the way. Protect the
head.
 Px will usually recover after a few minutes
 2. Bevel against the vein wall
3. Bevel inserted too far
4. Needle partially inserted
5. Needle slipped beside the vein
6. Collapsed vein
7. Undetermined needle position
VEIN COLLAPSED
IMPROPER TECHNIQUE

A. Bevel on lower wall of vein

(Does not allow blood to flow)

B. Needle rotated 45 degrees

( Allows blood to flow)

------------------------------------- C. Needle inserted too far

D. Needle partially inserted

UNUSUAL BLOOD SPECIMENS (Causes blood to leak into tissue)

ICTERIC TECHNIQUES TO ENHANCE VEIN AND

 Serum/Plasma that contains large amounts
of bilirubin
 Px presents with Jaundice
LIPEMIC
 Serum/Plasma that contains large amounts
of fats and lipids
 May be due to px not fasting
HEMOLYZED
 Serum/ Plasma contaminated with RBC
contents
----------
CAUSES OF HEMOLYSIS
A. Drawing form a hematoma
B. Rupturing of RBC’s by using a needle that is
too small
C. Alcohol on the site of venipuncture that
entered the blood sample
D. Pulling the plunger too forcibly
E. Fast drip/ expelling blood vigorously as it is
transferred to the tube
F. Redirecting
G. Mixing tubes vigorously
----- ----- - --------- -------------- -
POSSIBLE CAUSES FOR FAILED
VENIPUNCTURE
RECOVER A FAILED VENIPUNCTURE
 Retie the tourniquet
 Use a blood pressure cuff in place of a
tourniquet
 Massage the arm or warm the location
 Lower the patient’s arm
 Reseat the tube holder
 Use a different tube
 Place your finger below the venipuncture
site and stretch the vein slightly
 Pull back or advance the needle slightly
 Rotate the needle one quarter to one half
turn. Make sure to pull a little backward
before redirecting.
 Venipuncture attempts should be up to 2
tries only. Ask someone to do it (Endorse
to another staff)
------------- ------------------------
MOST COMMON ERRORS IN SPECIMEN
COLLECTION
 Misidentification of patient
 Mislabeling of specimen
 Short draws/wrong AC/ blood ratio
 Mixing problems/ Clots
 Hemolysis/ Lipemia
 Hemoconcentration from prolonged
tourniquet time
 Exposure to light/ Extreme temperatures
 Improperly timed specimen/ Delayed
delivery to the laboratory

1. Vacuum in tube is not working

 Processing errors: incomplete
centrifugation, improper storage  Affects hematological tests such as
hemoglobin, hematocrit and blood counts
POSSIBLE SOURCE OF LAB ERRORS
ALCOHOL INGESTION
- SPECIMEN COLLECTION
- PATIENT PREPARATION  Increase plasma concentration of lactate,
-SPECIMEN HANDLING urate, acetate & acetaldehyde, GGT
-CHEMICAL ANALYSIS concentration.
- REPORTING RESULTS  May affect blood sugar and fat levels

STRESS (ANXIETY)

SPECIMEN CONSIDERATIONS  Affects hormone secretion results to

LESSON 2 hyperventilation leading to a disturbance
in acid-base balance in the blood.
FACTORS CONTRIBUTING TO THE VARIATION DRUGS
OF RESULTS
 May interfere with liver-function tests.
EXERCISE
- - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - -
 Moderate exercise can increase:
Blood glucose, lactic acid, serum proteins,
muscle enzymes PATIENT INTERACTION
FASTING  Appearance
 Communication skills
 Did not undergo fasting:  Bedside Manner
Elevated blood glucose, potassium, and lipids  Attitude

 Prolonged Fasting Elevated serum bilirubin, ATTITUDES OF A PROFESSIONAL

TAG, glycerol, free FA, and decreased
plasma glucose  Integrity
 Compassion
DIET  Motivation
 Work Ethic
 High protein diet= increased urea,  Diplomacy
ammonia, urates  Motivation
 Long time vegetarian = decrease LDL, VLDL,  Dependability
total lipid, phospholipid cholesterol, TAG
 Hyperchylomicronemia = increase turbidity
or latescene (TAG level exceeds 4.6 TYPES OF PATIENT CONSENT
mmol/L (4.0g/L)
INFORMED
POSITION OR POSTURE
 Voluntary permission
 Preferably supine or upright sitting
position EXPRESSED

TOURNIQUET  May be given verbally or in writing

 One-minute application IMPLIED

Prolonged application = venous stasis or
hemoconcentration  Actions that imply consent

SMOKING HIV
 Laws specify what type of info must be
given

FOR MINORS

 Parent or guardian consent is required

REFUSAL

 An individual has a constitutional right to

refuse a medical procedure

LEGAL ISSUES
 CONFIDENTIALITY
 BATTERY
 NEGLIGENCE
 MALPRACTICE

CLASSIFICATION OF METHODS AS TO
SAMPLE REQUIREMENTS
MACROMETHOD

1mL and Above

MICROMETHOD

0.1 to 0.9 mL

ULTRAMICROMETHOD

0.01 to 0.09 mL

NANOLITER METHOD

0.001 to 0.009 mL