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Identical for ABG Venous blood : Venous blood Blood Transferred from other parts of body to heart except pulmonary vein. Easy to identify Better control on flow of blood Blood can be stopped Identical routine blood testing parameters. Closed Collection : Closed Collection Blood collection made through Needle, Needle Holder and an Evacuated tube. No Spillage No Micro clots Hemolysis is minimized or nil Needle Stick Injuries is minimized or nil Blood to Additive ratio is maintained Not exposed to the environment Ensures safety collection. - And solution to all Preanalytical Errors. Vernipuncture technique system using Evacuated system : Vernipuncture technique system using Evacuated system Site selection in Arm : Site selection in Arm Median cubital vein is the first choice because it is large, well-anchored and very less pain. Cephalic vein is the second choice. It is large, but not as well anchored but may be more painful when punctured than the median cubital. Basilic vein is the third choice. It is generally large and easy to palpate, but often not well anchored. It lies near the brachial artery and the median nerve, either of which could accidentally be punctured Phlebotomy Technique step by step : Phlebotomy Technique step by step Wash Hands and Apply Gloves : Wash Hands and Apply Gloves Before starting the day’s work, wash hands, dry and wear gloves & lab coat. The most important means of preventing and controlling the spread of infection is proper hand washing: Without touching the sink, wet hands under warm, running water. Apply soap and work up a lather, rubbing hands together to create friction for at least 20 seconds. Rinse hands in a downward motion from wrists to fingertips. Repeat steps 2 and 3. Dry hands with a clean paper towel Turn the tap off using another clean paper towel. Patient introduction : Patient introduction Introduce yourself by name. Describe the procedure to be performed, providing reassurance to the patient. Patient Identification : Patient Identification This is the most important step in the venipuncture procedure* For out-patients, ask the patient to state his/her full name, spell the last name, and state his/her date of birth. For in-patients, check the patient's identification band to verify the name and hospital identification number match the order. Verify patient ID with ward staff if identification band is not available Verify the requisition (order) and sample labels, if applicable, have the same identifiers. * patient ID error is the ultimate pre-analytical error! Assemble Equipment : Assemble Equipment Prior to initiating Vernipuncture, gather all required equipment. Place the necessary evacuated tubes in the proper sequence (‘order of draw’) for specimen collection together with other required equipment (needle, holder, alcohol swab, cotton swab and tourniquet etc ) A sharps container should be easily accessible for immediate needle disposal following completion of the Vernipuncture. Recommended order of draw : Recommended order of draw Sterile samples (eg: Blood Cultures) Citrate tubes* [ ] Plain Serum tubes [ ] Heparin tubes [ ] EDTA tubes [ ] Fluoride Oxalate (glucose tubes) [ ] Patient position : Patient position The patient should be made to sit comfortably in a chair and should position his arm on a slanting armrest, extending the arm straight from the shoulder without bending at the elbow. Ensure patient's hand is closed, which makes the veins more prominent. Do not ask the patient to ‘pump’ his/her hand1. 1.Muscle contraction can introduce pre-analytical errors (eg elevated potassium) Apply Tourniquet : Apply Tourniquet Position tourniquet around the arm 3 to 4 inch (100mm) above the venipuncture site. The tourniquet will cause the veins to enlarge, making them easier to palpate and penetrate with a needle. More on Tourniquet…………. : More on Tourniquet…………. Aim for a maximum application time of one minute. Application beyond this time may affect some test results (alteration in relative concentrations of small and large molecules in the specimen) Do not apply a tourniquet over an open wound. Select the site for Vernipuncture : Select the site for Vernipuncture Use the tip of the index finger to palpate (examine by feel) the vein. This helps determine the size, depth, and direction of the vein. Select a vein that is easily palpated, large enough to support good blood flow, and well-anchored by surrounding tissue. Cleanse the Site : Cleanse the Site Clean the Venipuncture site with alcohol prep. pad (or alternative) to help prevent microbial contamination of the specimen and patient. Cleaning should be done with gloved hands. Cleanse the vein puncture site with sprit cotton swab. Begin at puncture site cleanse outward in a circular motion. Repeat the process with a fresh alcohol prep pad if the site remains dirty. Let the site air dry (30 seconds) prior to beginning the Venipuncture. Do not wipe, blow on, or fan the site, as these actions may re-introduce contaminant micro-organisms Needle Insertion Angle : Needle Insertion Angle Insertion at an angle of incidence of 15 – 30 degrees is recommended Top Picture: Bevel of the needle is fully inserted in the lumen of the vein within 15-30 degree angle. Middle Picture: Needle angle is too steep. Increased potential for needle to completely penetrate the vein, resulting in formation of hematoma. X Lower Picture: Needle angle is too shallow, causing bevel to rest on the wall of the vein. Increased potential for needle placement partially in the vein lumen and partially in tissue, again resulting in formation of hematoma. X Recommended order of draw Needle Removal : Needle Removal Check tourniquet is fully released and ensure patient's hand is open and relaxed After the last tube is removed from the holder, hold a clean gauze pad in position over the entry site. Gently and quickly remove needle from the arm. Keep arm extended and preferably raised; arm should not be bent as this increases the risk of hematoma formation. Needle Disposal : Needle Disposal Needle Disposal : Needle Disposal Allow one-handed activation. Audible Click sound on locking. The immediate, one-handed activation of the safety shield allows users to help protect themselves from accidental needle stick injuries while continuing to maintain contact with their patients with their other hand. Needle Disposal : Needle Disposal 1. The used and contaminated needles must be safely removed from the holder and discarded in a suitable ‘sharps container’ 2. Never cut, bend, break, burn, or re-cap needles. Hard Facts of Vaccutainer, : Hard Facts of Vaccutainer, Improves Specimen Quality Streamlines Laboratory Process Protects Your Patients and Employees Improves Employee Satisfaction SAFETY ( N.S.I) : SAFETY ( N.S.I) What can you contract from a needlestick?30 known blood borne pathogens : What can you contract from a needlestick?30 known blood borne pathogens What is your Risk? : What is your Risk? Accidental needlestick injuries (NSI s) account for 86% of all occupationally related infectious disease transmission. (Source: ICN on Preventing NSI) Approximately 2 million needle sticks occur each year globally resulting in infections with (Source: WHO Environmental Burden of Diseases Series No. 3) They say.. “Prevention is better than Cure” : They say.. “Prevention is better than Cure” Arterial Blood collection : Arterial Blood collection Understanding the Pre-analytical issues – Affecting Quality of ABG results, Liquid Heparin vs Dry Heparin Heparin Concentration Electrolyte binding to Heparin Type of heparin Used Syringe Permeability Safety to Health care workers BD Arterial Blood Collection : BD Arterial Blood Collection BD offers a range of syringes for Arterial Blood Gas analysis which are designed to minimise Preanalytical variability in sample collection, handling and transportation. Step by step to Reliable Blood gas analysis : Step by step to Reliable Blood gas analysis Step by step to Reliable Blood gas analysis : Step by step to Reliable Blood gas analysis Step by step to Reliable Blood gas analysis : Step by step to Reliable Blood gas analysis Step by step to Reliable Blood gas analysis : Step by step to Reliable Blood gas analysis Step by step to Reliable Blood gas analysis : Step by step to Reliable Blood gas analysis THANK YOU : THANK YOU You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.