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COMPLICATIONS IN BLOOD COLLECTION
Failure to obtain bloodThis is the primary causePossible causes include: bevel on lower wall of vein,
needle inserted too far, needle partially inserted, collapsed vein, needle slipped to side of vein from rolling veins
Simple maneuver will correct the problem; rotate 45 degrees allow blood to flow
COMPLICATIONS IN BLOOD COLLECTION
HematomasCaused by leakage of blood into the tissues around the
venipuncture siteResult in swelling and discolorationMay cause anxiety, discomfort, pain to the patient, and even
nerve injuriesPossible causes are:
Failure to remove the tourniquet prior to remove the needle
Apply inadequate pressure to site after needle removalExcessive probing to obtain bloodInsert needle through the veinBending the arm while applying pressureUsing veins that are too small or fragile
COMPLICATIONS IN BLOOD COLLECTION
Nerve InjuryUsually caused by incorrect technique and site
selectionPossible causes are:
Improper vein selectionUsing jerky movementsInserting the needle too farMovement by the patient while needle is in veinLateral redirection of the needleBlind probing
COMPLICATIONS IN BLOOD COLLECTION
Hemolyzed specimensRed cells are rupturedTests seriously affected: K, LD, AST, CBCTests noticeably affected: Fe, ALT,
Thyroxine (T4)Tests slightly affected: Phosphorus, TP, Alb,
Mg, Calcium, Acid phosphatase
COMPLICATIONS IN BLOOD COLLECTION
Causes of hemolyzed specimens are:
Using too small diameter needle (above 23 gauge)Using small needle with large evacuated tubeUsing improperly attached needle on a syringe,
causing frothing of specimenPulling back plunger of syringe too fastDrawing blood from site that contain hematoma
COMPLICATIONS IN BLOOD COLLECTION
Causes of hemolyzed specimens are:Vigorously missing tubesForcing blood from syringe into evacuated tubeApply tourniquet too close to puncture site or for too
longUsing fragile hand veinsPerform venipuncture before alcohol is driedPartially filled sodium fluoride tubesReadjustment of needle in veins or using occluded
veins
COMPLICATIONS IN BLOOD COLLECTION
Other factors that cause hemolysis are:
Rimming clots
Centrifuge at higher than recommended speed
Elevate or decrease temp of blood
Using pneumatic system without shock absorber
COMPLICATIONS IN BLOOD COLLECTION
Specimen contaminationMay include carryover, draw from edema or hematoma
sites, arms containing IV, site contaminated with alcohol or iodine
Technical problemsProblems with equipment, tubes, syringes, etc
Patient ComplicationsDifficult patient, geriatric population, pediatric
population, obese patientMust use the right equipment – appropriate size needle
OTHER COMPLICATIONS
Vascular – bleeding from site and hematoma formationInfections – introducing bacteria into the blood streamAnemia – as a result of significant blood draw for
testingNeurologic – seizures or painCardiovascular – orthostatic hypotension, syncope,
shock, cardiac arrestDermatologic – localized reaction to iodine or cleaning
agentsGastrointestinal – nausea and vomiting
Quality Assurance in Specimen Collection
Perform QC on all equipment – run controls, maintenance, keep logs
Check all equipment
Follow facility protocol
Quality Assurance Terminology
Quality control – a process that monitors the accuracy and reproducibility of results through the use of control specimens
Control – a specimen with a known value to the analyte/determinant
Standards – highly purified substances of a known composition
Accuracy – closeness of the result to the true valuePrecision – represent how close repeated results
are to each other
POINT OF CARE TESTING
Done at the bedside
Advantages are shorter turn around time, smaller quantity of specimen, convenience for patient, shorter patient care stay and improved patient care management
Disadvantages are higher costs, integrating the results into charts and quality controls
POINT OF CARE TESTING
THINGS TO CONSIDER
Cost of maintenance of competency and training personnel
Labor associated with processing specimen and maintaining the machine/equipment
Reagents, controls, maintenance and depreciation costs
Proficiency testing and any state licensing costs
POINT OF CARE TESTING
REGULATION
All laboratory and sites performing testing are regulated by Clinical Laboratory Improvement Amendments of 1988 (CLIA ‘88)
States and city (government) may enact mandatory regulations which may include the qualification of personnel performing the test
If a site is only performing ‘waived tests’ they must have ‘certificate of waiver’ license. These sites will not be routinely inspected
They must follow the manufacture instructions on performing the tests Agencies such as the Joint commission, College of American
Pathologists and Veteran Administration does not recognize the waive category of testing – as they are not regulated
POINT OF CARE TESTING
CATEGORIES OF POINT OF CARE TESTING
WAIVED TESTSSimple procedures. If performed incorrectly will have little or no negative outcomes
MODERATELY COMPLEX TESTSUsually automated, more complex than waived tests.Example: routine chemistries, blood counts
HIGHLY COMPLEX TESTSUsually manual testing that require considerable judgment for interpretation of resultsExample: microbiology tests and cross match
PROVIDER PERFORMED MICROSCOPY (PPM) TESTSExamination of slides from freshly collected body fluids
POINT OF CARE TESTING
POCT can be automated and non automated
Automated – glucose, electrolytes, PT, PTT, hematocrit, blood gases, urea, cardiac enzymes
Non automated – fecal occult blood, pregnancy tests, rapid strep, HIV
With today’s advance technology (wireless connectivity) the use of handheld POCT is increasing
SPECIAL PROCEDURES
BLOOD BANK SPECIMENS
Strict patient identification and labeling is requiredAny doubt or mislabeling requires a re-drawUndetected errors may result in the patient receiving
incompatible blood or blood products – which could be fatal
Specimens include: type, screen, cross match and donor specimens
SPECIAL PROCEDURES
BLOOD CULTURES
Usually requires two sets which should be drawn 30-60 minutes apart
Must be drawn before antibiotic is given. However, if antibiotics must be given urgently, both sets of blood cultures must be drawn immediately from two different sites
Skin antiseptic is the most critical part of collectionIodine, chlorhexidine and 70% ethyl alcohol are most
commonly used. A 30 -60 seconds friction scrub is most appropriate
SPECIAL PROCEDURES
COAGULATION SPECIMENSRemember the 9:1 ratioDiscard tube if using butterfly and blue top is the
first tube
GLUCOSE TOLERANCE TESTMake sure patient is fasting, except drinking water.
Usually 10-12 hoursCollect fasting, given 100g of glucose, collect 1 hour
and 2 hours post finish drinking glucose drink
SPECIAL PROCEDURES
LACTOSE TOLERANCE TESTSimilar to GTT but uses Lactose instead of glucose
PATERNATY TESTINGRequires chain of custodySpecific identification and fingerprinting may be necessaryUsually include ABO and Rh typing, cheek swab to collect
DNA
DRUG/FORENSIC MONITORINGUrine or bloodChain of custody