MEDLAB2: PRINCIPLES OF MEDICAL LABORATORY SCIENCE 2
LESSON 11: Special Procedure: Arterial Puncture
2ND SEMESTER | SY. 2021-2022
PROF: MR MICHAEL JAMES Z. LAT
Overview of Arterial Puncture
Arterial Puncture
⮚ It is used to collect blood specimen for
arterial blood gas (ABG) analysis to manage
cardiopulmonary disorders and maintain the
acid base balance of the body.
Arterial Blood
⮚ It is the ideal specimen for respiratory
function evaluation due to the consistency
of its composition and its high oxygen
content.
Arterial Blood Gas
⮚ The evaluation of the arterial blood gas is
performed to diagnose respiratory disorders
⮚ Patients with diabetes or other metabolic
disorders is also use ABG to manage
electrolyte and acid-base balance.
⮚ The testing provides information about:
o Oxygenation
o Ventilation
o Acid-base Balance
Commonly Measured ABG Analytes
TRANSCRIBED BY: Sandra Mhay D. Rodillo
Sites and Criteria Used for Arterial Puncture
The following criteria are used in selecting the site
for an arterial puncture:
1. There is collateral circulation, or the site
gets its blood supply from more than one
artery. The potential site can be evaluated
by using a portable ultrasound instrument or
by modified Allen test.
2. The artery should be accessible and large
so that the puncture is easy.
3. The surrounding tissue of the puncture site
should have little risk of being injured during
the procedure. The area should also help in
keeping the artery from rolling and the
pressure can be applied easily in the
procedure.
4. The area should be free from inflammation,
irritation, edema, hematoma, lesion, and
wound. There should be no arteriovenous
(AV) shunt near the site there is no recent
arterial puncture.
ABG Specimen Collection
The ABG test results will be more useful
and meaningful with the necessary requisition
information includes the current body
temperature, respiratory fate, ventilation status,
fraction of inspired oxygen (FIO2),
prescribed flow rate in liters per minute.
The phlebotomist or blood drawer needs to
wear the proper personal protective equipment
consisting of gloves, masks, lab gowns, coats,
or aprons. The following specimen collection
equipment and supplies must be ready before
the procedure:
1. Antiseptic for site cleaning
2. Local anesthetic to numb the site
3. Sharp, short-bevel hypodermic needle with
safety feature
4. 1- to 5-mL self-filling syringe
5. Luer-tip normal or bubble removal cap to
cover the end of the needle after needle
removal
6. Coolant (when applicable) to maintain the
temperature of the specimen
7. 2x2- inch gauze squares to hold pressure
8. Self- adhering gauze bandage to wrap the
site
9. Identification and labeling materials
10. Puncture- resistant sharps container for
proper disposal
Patient Preparation
1. Identify of the patient is confirmed before
the start of the test and explain the
procedure to the patient
2. The patient should be resting
comfortable position (lying in bed or seated
on a chair) for at least 5 minutes or until the
breathing of the patient becomes stable and
verify if the patient is on anticoagulant
therapy or has any allergies to anesthesia.
and 3. The patient should be stable or in steady
state for 20 to 30 minutes before the test is
performed.
4. To determine has collateral circulation, the
modified Allen test is performed prior to
collection.
5. Administration of local anesthesia (optional)
Preparing and Administering Local Anesthetic
It prevents adverse reaction from young
patients who are afraid of the procedure. It is one
way of preventing vasoconstriction.
Listed below are the steps in preparation and
administration of local anesthesia:
1. Ask the patient for history of allergic
reactions to anesthetic or its derivatives.
2. Follow hand hygiene and wear gloves
3. Attach the safety needle to the syringe
4. Clean stopper of the anesthetic bottle using
isopropyl alcohol wipes.
5. Insert needle through the bottle stopper to
withdraw the anesthetic
6. Replace needle cap and keep the syringe in
a horizontal position
7. Clean the site and air-dry
8. Insert needle into the puncture site at a 10-
degree angle
9. Pull back the plunger slightly
10. Slowly expel contents into the skin. It should
in a form a raised wheal
11. Wait for about 2 minutes before continuing
with the arterial puncture
12. Note the anesthetic application on the test
requisition
Radial Arterial Blood Gas (ABG) Procedure
 The phlebotomist may proceed with the
puncture of the radial artery if there is collateral
circulation. The steps in obtaining the ABG
specimen using the radial artery through the
use of the syringe are as follows:
1. Review the accession test request for
completeness
2. Approach and identify the patient. Explain
the procedure clearly
3. Ask for any sensitivity o latex and other
substances
4. Assess if the patient is on a steady state
5. Observe proper hand hygiene and wear
gloves
6. Verify collateral circulation by modified Allen
test or use an ultrasonic flow indicator
7. Position the arm, palm up, and wrist
extended to approximately a 30-degree
angle
8. Use the index finger to locate the radial
artery. Clean the site.
9. Administer local anesthesia
10. Assemble the ABG equipment. Clean the
gloved non-dominant finger
11. Pick up the equipment. Remove the cap
and inspect the needle
12. Relocate radial artery by placing non-
dominant index finger over the vein. Gently
warn the patient of the imminent puncture to
avoid startle reflex.
13. Insert needle at 30- to 45- degree angle.
Slowly direct it toward pulse and stop when
a flash of blood appears.
14. Let the syringe fill to a proper level
15. Place the gauze pad and remove the
needle. Activate the safety feature and
apply pressure on the site
16. Remove and discard the syringe needle in
the sharp container
17. Expel air bubbles. Cap the syringe and mix
thoroughly. Label the specimen with the
necessary information.
18. Check the patient’s arm for swelling or
bruising. Apply pressure bandage.
19. Disposed used and contaminated materials
properly. Remove gloves and sanitize
hands as a precaution
20. Thank the patient courteously. Transport the
specimen to the laboratory immediately
Hazards and Complications of Arterial
Puncture
Arteriospasm – involuntary contraction of the
artery
Artery Damage – results from repeated punctures
on the same site
Discomfort – can be avoided by using local
anesthesia as ordered by the physician
Infection – observe proper preparation in the pre-
analytical phase
Hematoma – avoid multiple punctures on a single
site
Numbness - should be addressed and reported
immediately to the nurse or physician
Thrombus formation – must be reported to the
nurse or physician immediately
Vasovagal Response – remove the needle,
activate the safety device, maintain pressure over
the site, and follow the syncope procedure
Sampling Errors
 The integrity of the blood sample and the (7) It took so much time for the specimen to
accuracy of the test are compromised when: reach the laboratory
(8) The wrong type of syringe
(1) Air bubbles were not expelled from the
sample Arterial Puncture Sites
(2) Processing exceeded optimal time, which is
within 10 minutes from collection
(3) The sample was not mixed properly or
immediately
(4) Syringe was used improperly
(5) Venous blood was obtained by mistake
(6) Improper anticoagulant was used
(7) Incorrect volume of heparin was used

Criteria for Rejection of ABG Specimen

(1) Air bubbles are found in the specimen

(2) The specimen has clotted
(3) The specimen ha hemolyzed
(4) The submitted specimen did not comply
with the proper labeling requirement
(5) The prescribed transportation temperature
for the specimen was not met
(6) The specimen did not meet the required
volume or QNS
 MEDLAB2: PRINCIPLES OF MEDICAL LABORATORY SCIENCE 2

LESSON 12: Blood Donor Phlebotomy

2ND SEMESTER | SY. 2021-2022 TRANSCRIBED BY: Sandra Mhay D. Rodillo

PROF: MR MICHAEL JAMES Z. LAT

trained and qualified to do the venipuncture
procedure for blood donation.
Blood Dononation
The Blood Donation Process
 Is the collection, testing, preparation, and
storage of blood from donors who are  Usually takes 45 to 60 minutes
usually volunteers.  Donors should be 16 years old weighing
 Ensures the steady supply of blood for 110 pounds or 50 kg at the minimum
patients needing surgery, those who are  Should generally healthy
suffering from certain diseases, and those
who have been victims of accidents
 Venipucture for blood donation is part of the
entire process of handling blood collection
from donors.
 Additonal measures such as donor
screening and deferral should be
undertaken to ensure safety of the blood
supply and prevent infections and
contamination.
 May be directed or autologous
Directed Blood Donation
 Type of blood donation wherein blood is
donated by an individual for use by the
recepeint; a patient gets opportunity to
provide his blood donor
Donor Screening
Autologous Blood Donation
- The donor is asked about his/her health,
 Type of donation wherein blood is donated lifestyle, and disease risk factors.
for an individual’s own use
Donor Registration
The Goals of Performing Blood Donor
- The donor needs to complete a donor
Phlebotomoy
registration form which includes his/her
A well-trained and qualified phlebotomist is the best name, address, and and other demogrphic
service personnel to perform the venipuncture for information.
blood donation. He/she must follow the rules in
Medical History
screening blood donors to be able to accomplish
the following goals: - The donor will have to confirm if he/she has
any health issues and disease risk factors.
(1) Ensure the safety of the donors
(2) Minimize and prevent contamination in the Donor Interview
donated blood which may from external
sources - The donor will have a brief interview with
(3) Conduct safe collection of donated blood for the health personnel to ensure that the
therapeutic purposes espescially during its donor has me the general donor
shell life requirments.
(4) Make sure the other personnel are well- Physical Examination
 - A short health exam (pulse, temperature,
and blood pressure) will be conducted and a
drop of blood form the donor’s finger will be
tested to ensure that his/her blood level is
sustainable for donation.
Guidance on Venipuncture for Blood Donation
- A short briefing on the procedure will be
given by the health personnel
Preparing Venipuncture Site
- The donor will be led to the donor area
where the arm is cleaned with the antiseptic
and the vein for venipucture is selected.
Collecting the Unit
- The unit of blood will be collected by the
health personnel.
Adverse Events in Blood Donation
- The healthcare personnel have to montior
the donor for adverse effects during and
after the blood collection.
Donor Care Post Phlebotomy
- The venipuncture site should be inspected
and refreshments should be offered to the
donor before he/she leaves the area.
Donor Blood Processing
- The collected blood unit is prepared and
placed in the proper container for trasport to
the processing area.
Donated Blood Labeling
- The information indicated on the label found
in the blood unit must be double-checked. It
should be complete and accurate
The Minimum Requirements for Venipunture for
Blood Donation
- The pieces of equipment required include
the:
o Blood pressure monitor
o Scales
o Donor couches
o Chairs
o Beds
o Blood Collection Mixers
o Blood bag sealers
o Blood transformation boxes
o Blood bank refrigerators
Blood Donor Phlebotomy Procedure
1. Identify the donor and labal the collection
bag and test tubes.
2. Select the vein
3. Perform hand hygiene and wear well-fitting
gloves
4. Disinfect’s donor’s skin
5. Perform venipucture
6. Monitor the donor and the donated unit
7. Remove the needle and collect the
laboratory samples
Blood Collection
 It is a closed system
o Consisting of main bag with needle
tubing, and up to four satellite bag
attached
o The entire system is sterile
 Standard Phelbotomy
1. 450 mL + 45 mL (with 63 mL
anticoagulant)
Blood Preservation
(Anticogualants/Preservatives)
 Adenine: Used in ATP synthesis
 Citrate: Binds calcium to prevent
coagualation
 Dextrose: Food for the cells
 Phosphate: Source of 2,3-DPG which
promotes oxygen release to tissues
 ACD: Acid-Citrate-Dextrose (21 days)
 CPD: Citrate-Phosphate-Dextrose (21
days)
 CP2D: Citrate-Phosphate-Double Dextrose
(21 days)
 CPDA-1: Citrate-Phosphate-Dextrose-
Adenine (35 days)
Lesion of Storage
 Biochemical changes in stored blood that
can lead to decreased RBC viability
 Glucose, ATP, 2,3,-DPG, pH, and plasma
sodium decrease as RBC’s are stored. After
cell are transfused, ATP and 2,3-DPG levels
are restored in about 24 hours.
  Substances that increase during storage
include plasma hemoglobin, plasma
potassium, ammonium, and lactic acid.
Additive Solutions
 These are added to RBC’s after removal of
plasma with or without platelets.
 They contain MAGS (Mannitol, Adenine,
Glucose, Saline)
 These must be added within 72 hours of
collection
 Additives extend the shelf life to 42 days
and reduce RBC viscosity during
transfusion.
Rejuvenation Solutions
 These are used to restore ATP and 2,3-
DPG levels, before freezing or transfusing a
unit, and may be necessary for autologous
or rare units
 They contain PIGPA (phosphate, Inosane,
Glucose, Pyruvate, Adenine)
 RBCs can be rejuvinated up to 3 days past
the expiration date (stored up to 24 hours at
1-6 °C, and transfused) and can then be
frozen for future use.
Whole Blood
 Used in actively bleeding patients, patients
who have lost at least 25% of their blood
volume, or patients requiring exchange
transfusions
 Substitute: Reconstituted WB (RBCs mixed
with thawed type AB FFP from a different
donor)
 Expiration: ACD, CPD, CP2D in 21 days,
CPDA-1 in 35 days
 Storage: 1-6 Celcius
 QC: Hct = 40%
Packed RBCs
 Used in oncology patients undergoing
chemotherapy or radiation theraphy, trauma
patients, surgery patients, dialysis patients,
and premature infants, and patients with
sickle cell anemia
 One unit usually increases the patient’s
hemoglobin approximately 1g/dL and the
hematocrit by 3%
 Storage: 1- 6 Celcius
 Expiration: ACD, CPD, CP2D in 21 days,
CDA-1 in 35 days; id open system, 24 hours
 QC: Hct ≤ 80 %
Platelet Concentrate
 Used to control or prevent bleeding
 Not indicated in patients with
chemotheraphy, DHF, post-bone marrow
transplant
 Transfused platelets have a life span of 3 to
4 days
 Storage: 20-24 °C with constant agitation
 Expiration: after 5 days
 QC: RDP (5.5 x 1010platelet/unit)
SDP (6.0x 1011platelets/unit)
Fresh Frozen Plasma (FFP)
 Indicated in patients with deficiency of
coagulation patients on anticoagulants who
are bleeding or will undergo surgery
 Must be prepared within 6 hours after
collection (ACD) or within 8 hours after
collection (CP2D, CPD, CPDA-1)
 Storage: -18°C for 1 year or -65°C for 7
years
 Thawed in water bath at 30-37°C for 30-45
minutes before transfusion and stored within
1-6 °C for 24 hours once thawing is
completed
Cryoprecipitate
 it is used for patients with factor XIII
deficiency, von Willebrand disease, and
fibrinogen deficiency, and as a fibrin sealant
1. FFP is thawed (1-6°C for 14-16 hours using
a 4°C water bath for 4 hours)
2. Centrifuge using hard spin leave 10-15 mL
of plasma on the precipitate
3. Freeze within 1 hour from the time the
plasma reached the “slushy stage”. The unit
can then be stored at -18°C for 1 year
4. Thaw using a 37°C water bath for 15
minutes and should be used within 6 hours
 after thawing. Onced thawed, it may not be  10-20% of RBCs are lost in the process of
refrozen washing the RBC unit with normal saline
 Fibrin glue from cryoprecipitate: 1-2 units of
RBC Aliquot
cryoprecipitate arre mixed with thrombin
and applied typically to the bleeding area  Most often transfused during the neonatal
 QC: must contain at least 150 mg/dL of period or infants younger than 4 months of
fibrinogen and 801U of factor VIII age.
 Transfusion for neonates often require only
Special Blood Components
a small volume of RBCs (10 to 25 mL)
Modified Whole Blood
Granulocyte Concentrate
 With 50 mL of plasma removed in
 Given to patients with severe neutropenia
preparation of platelets or 10 to 15 mL in the
who have a life-threatening systemic
preparation of cryoprecipitate
infection uncontrolled by antibiotics
Irradiated Components  Granulocyte transfusion are rare and limited
to septic infants
 It is used for intrauterine transfusions,
 The pheresis bag contains >1.0x1010
immunodeficient recipient, premature
granulocytes, platelets, and 20-50 mL of
infants, chemotheraphy and radiation
RBCs
patients, and bone marrow or progenitor
 The cells deteriorate rapidly must be
cells transplant patients (to prevent GVHD)
transfuseed within 24 hours of collection
 AABB Standards require irradiation of
 Stored at 20-24°C with no agitation until
cellular components (RBCs and platelets), if
transfused
a donor is a blood relative of the intended
 Crossmatching is required becayse of RBS
recipient or donor unit is HLA matches for
contamination
recipient.
Leuko-Poor or Leuko-Reduced Components
Shipment of Blood and Blood Products
 Intended to prevent febrile transfusion
reactions caused by WBCs or WBC  Temperature for RBCs of 1-10°C is required
products; (1) Pre-storage leuko-reduction & during transport
(2) post-storage leuko-reduction  Frozen components are shipped on dry ice
 AABB Standards for leukocyte reduction  Platelets are shipped at room temperature.
states that 85% of RBCs must remain and Platelets can survive without agitation for a
leukocytes must be reduced to less than 5x maximum of 24 hours
6
10 WBCs/unit  When component shipments are received,
observe and record the temperature and
Frozen RBCs
appearance of units.
 Used to stor rare blood units, or units for
autologous transfusion
 RBCs are frozen by adding glycerol to
prevent cell hydration and the formation of
ice crystals that can cause cell lysis (40%
weight per volume)
 Initila freezing temp is -80°C, then for long
term storage at -65°C for 10 years
Washed RBCs
 Used for patients who have a reaction to
plasma proteins (allergic, febrile, and/or
anaphylactic)
 Used in infant or intrauterine transfusions
 MEDLAB2: PRINCIPLES OF MEDICAL LABORATORY SCIENCE 2

LESSON 13: The Functions and Activities of the Laboratory Sample

Reception Area
2ND SEMESTER | SY. 2021-2022 TRANSCRIBED BY: Sandra Mhay D. Rodillo

PROF: MR MICHAEL JAMES Z. LAT

features of the telephone system in holding
The Function of the Laboratory Sample and tranferring calls to the different sections
Reception Area and offices of the laboratory.
7. Keep himself/herself updated on the current
 Flow of work in the laboratory usually starts
trends related to the performance of his/her
in the sample reception area
duties
 Various types of samples from blood to
8. Maintain the level of service or
other non-bloo specimens are received in
professionalism by ensuring the
this area.
completeness and timeless of all
 Medical laboratory assistant or laboratory
procedures through regular documentation
receptionist is usually assigned in this
9. Attend to and handle queries abour the
department to process the receipt and
samples and request in a timely and
identify & prepare the laboratory request of
professional manner
sample for testing.
10. Acquire knowledge on how to operate the
The Specifc Duties of the Laboratory pieces of equipment that are used in the
Receptionist laboratory reception area.

 The laboratory assistant assigned in the

sample reception area is usually called the
“laboratory receptionist”. He/she performs
office tasks related to handling laboratory
test results and other reports completed in
the laboratory or those who received from
other laboratories. His/her primary duties
include but not limited to the following:

1. Process the receipt, identification,

preparation of samples, and request
entering. The medical laboratory.
2. Maintain an accurate log (using a specimen
tracker system) after identification,
preparation, and dispatch to the proper
laboratory section
3. Advise and alert the appropriate laboratory
section about the urgent samples. Frozen
samples, and samples that require special
handling.
4. Be knowledgabe in handling the laboratory
computer system and confidently use test
libraries, intranet, and refferal data during
dat entry
5. Take care of the scanning , filing and
archiving of laboratory request forms and
other pertinent documents and records
6. Be able to handle incoming calls and use
the