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Basic procedures in healthcare 1
(SOL / VCA81)
TOPICS:
 7a) Sampling of biological material – principles, safety
and health protection during work
 7b) Characteristics of blood sampling
 7c) Blood sampling - arterial
 7d) Blood sampling - venous
 7e) Blood sampling - capillary
 7f) Types of blood tests
7a) Sampling of biological material
 terms
 the general principles of proper sampling of biological
material
 principles of safety and health protection during work
when sampling of biological material
 characteristics of blood sampling
7a) Sampling of biological material
Terms:
 biological material – material of biological origin, i. e. derived
from a human organism,
 body fluids (blood, cerebrospinal fluid, gastric and duodenal
juice),
 secretions (of the skin and mucosal bearings, vaginal mucosa,
punctate),
 excreta (urine, faeces, vomit, sputum, sweat),
 organ tissues,
 pathology form of tissue.
7a) Sampling of biological material
 Sampling of biological material, its transportation and laboratory
processing is essential for proper diagnosis determination, early
initiation of therapy and control of the effectiveness of the
treatment.
biological material
sampling of biological material
7a) Sampling of biological material
The general principles of proper sampling of biological material:
 to sample the material according to lab requirements,
 to sample it into the labelled containers) (name, personal identification
number, department, date and time, or an examination on STATIM),
 to give a dispatch/requisition to each sampling,
 to follow the requirements for transportation, to ensure it against
destruction,
 to record examination results,
 to follow the principles of safety and health protection during work.
7a) Sampling of biological material
The general principles of proper sampling of biological material:
 biological material is ALWAYS considered as a potentially
infectious,
 proper hands disinfection – before and after the sampling
in individual patients + before we start with sampling,
 we ALWAYS use the gloves,
 we use disinfection after we take the gloves off,
 we wash and disinfect hands immediately after a contamination
of biological material,
7a) Sampling of biological material
 we use a mask, protective shield in necessary cases,
 it is necessary to prevent contamination of the outside
of the sample container with biological material,
 we care about
the noninfectiousness
of the environment
(ventilation, disinfection,
cleaning).
7b) Biological material sampling –
characteristics of blood sampling
It is examined the WHOLE BLOOD or PLASMA or SERUM
 plasma – necessary to add anticoagulant solution
 serum – sampling of coagulate blood  serum is aspirated
 coagulated blood is used for laboratory analysis,
 blood coagulates after the sampling, blood clot is separated
from blood serum,
 blood serum has to be hardened quickly to avoid
haemolysis  distortion  quick transportation
to the laboratory.
7b) Biological material sampling –
characteristics of blood sampling
 anticoagulated blood  sample container containing
an anticoagulant means
 The most commonly used anti-coagulating agents:
 Wintrobe method (on the walls of the tube as white crystals
of oxalate),
 heparin,
 sodium citrate
 K2 EDTA (ethylenediamine, tetracel salt – a thin film
on the walls of the tube).
7c) Blood sampling - arterial
 indication
 suitable sites for sampling
 sample container
 persons competent to arterial blood sampling
7c) Blood sampling - arterial
 Sampling of arterial blood is most often performed as disposable
puncture or a puncture from a central arterial catheter.
Indication:
 examination of arterial blood for acid-base balance (ABB),
 burn injuries
 polytrauma / multiple trauma.
7c) Blood sampling - arterial
Suitable sites for sampling:
 arteria radialis,
 arteria brachialis,
 arteria femoralis,
 arteria dorsalis pedis.
The best are the arteries on the nondominant upper limb.
After sampling, we cover a site with sterile swab, we plaster it
and compress.
7c) Blood sampling - arterial
Sample containers:
 special sampling arterial microset,
 syringes and needles.
syringes for arterial blood sampling
syringes with needles
7c) Blood sampling - arterial
Persons competent to arterial blood sampling:
 ONLY a physician when a nurse assists,
 nurse specializing in anaesthesia, resuscitation, intensive
care (ARIC).
7c) Blood sampling - arterial
 Videos with arterial blood sampling procedure:
https://www.youtube.com/watch?v=UEVVUpz30RQ
https://www.youtube.com/watch?v=71LlfdW548U
7d) Blood sampling – venous
 suitable sites for sampling
 open method for blood sampling
 closed method for blood sampling
 tools
 sampling containers
 sampling procedures
 sampling principles
 the most common mistakes when sampling
7d) Blood sampling – venous
Suitable sites for sampling:
 veins in the parietal and temporal areas (infants, toddlers),
 veins in the instep and ankle (in children),
 v. mediana,
 v. basilica,
 v. cephalica,
 back of the hand,
forearm.
7d) Blood sampling – venous
Open method for blood sampling:
 using a needle and syringe,
 using a needle, the blood let drip directly into the tube,
 patients with weak veins and children,
 less safe in terms of handling
and contact of medical
staff with biological material.
open method for sampling
7d) Blood sampling – venous
Closed method for blood sampling:
 it enables accurate sampling,
 using sampling systems (Vacuette-Vacutainer, Sarsted),
 possibility of contamination of medical staff by biological
material is minimized.
7d) Blood sampling – venous
TOOL:
CLOSED SYSTEM
OPEN SYSTEM
- disposable gloves
- disposable gloves
- disinfection (Septoderm)
- disinfection (Septoderm)
- tourniquet
- tourniquet
- special needle
- needle
- adapter (cap)
- syringe
- vacuum tubes
- blood sampling tubes (e. g., vacuum)
- vomit bowl
- vomit bowl
- cellulose wadding squares, swab
- cellulose wadding squares, swab
- adhesive plaster
- adhesive plaster
7d) Blood sampling – venous
needle with a cap for closed
venous blood sampling
Esmarch tourniquet
tools for venous blood sampling
7d) Blood sampling – venous
disposable non-sterile gloves
disinfection of the skin
cellulose wadding squares
7d) Blood sampling – venous
Sampling containers:
 color-coded,
 prepared for given kind of sampling (including anticoagulant
agent),
 according to the chosen sampling system.
7d) Blood sampling – venous
Sampling procedure - the initial phase common to both methods:
 completing the request form,
 label tubes with identification label,
 tools preparation,
 checking the identity of the patient (ask him / her + through the identification
label),
 familiarization the patient with the performance,
 positioning of the patient, choice of the proper limb,
 putting cellulose wadding squares under the limb,
 assess the quality of the venous system on upper limb, possibly lower limb,
7d) Blood sampling – venous
 hygienic hand disinfection,
 applying a tourniquet,
 the selection of a suitable vein for venepuncture (sight, palpation),
 disinfection of skin, dry disinfectant,
 put on the non-sterile disposable gloves (we do not feel the vein
again),
 alerts the patient to injection.
We continue according to the method of sampling (closed, open).
7d) Blood sampling – venous
A) Using closed sampling method:
 put the adapter to a sterile needle,
 perform venepuncture, firm gripping of the adapter,
pushing the tube on adapter,
 removing the tourniquet,
 filling tubes in the pressure balance („to the mark“),
 removing the tube from the adapter,
 gentle flipping tubes for mixing blood with anti-coagulant agent,
 covering the injection site and the needle with a swab, gentle
pressure to the swab with slow removing of the needle from
the vein – carefully to the patient´s injury, using adhesive plaster,
eventually compression of injection site.
7d) Blood sampling – venous
B) Using open sampling method:
 deploy the appropriate needle to the syringe,
 perform venepuncture,
 removing the tourniquet, when the first blood is filled in the syringe,
 blood sucking gently with pulling the syringe plunger,
 covering the injection site and the needle with a swab, gentle
pressure to the swab with slow removing of the needle from the vein
– carefully to the patient´s injury, using adhesive plaster, eventually
compression of injection site,
 perforate the cap of the tube with the needle in case of application
of blood into vacuum tube and the tube is automatically filled.
 an application of blood with gentle pressure through the needle.
7d) Blood sampling – venous
Sampling procedure - the final phase common to both methods:
 check the patient for the whole time of the procedure,
 safe disposal of these materials begins immediately after
the sampling (container for sharps and biological material),
tools cleaning,
 record of the procedure into the patient´s documentation,
 ensure correct and timely transportation of blood and requisition
in the laboratory.
7d) Blood sampling – venous
closed method for blood sampling
7d) Blood sampling – venous
venous blood
sampling procedure
7d) Blood sampling – venous
 Videos with venous blood sampling procedure:
https://www.youtube.com/watch?v=nxky8rsezlU
https://www.youtube.com/watch?v=1Wv82hQCjrE
https://www.youtube.com/watch?v=u8yh5qjA_Yo
7d) Blood sampling – venous
Sampling principles:
 sampling is performed most often in the morning on empty
stomach,
 blood is sampled into a pre-labelled clean and dry containers,
 sampling container must be labelled with an identification
label,
 we write a requisition to each sampled material,
 if the patient is taking medications that can affect the outcome
/ effect, we record it to the requisition,
 we ensure timely transport to the laboratory.
7d) Blood sampling – venous
The most common mistakes when sampling:
 haemolysis of blood when:
 needle contamination
 using of wet or contaminated blood sampling system
 rapid injection of blood from the syringe into a test tube
and its foaming
 rapid shaking of tube with blood
 dripping of blood from the skin surface
 storage of blood in the fridge without former hardening
of serum
 storing the sampled blood on the radiator or the sun
 contamination of glass (blood sampling system)
7d) Blood sampling – venous
The most common mistakes when sampling:
 too long contraction of the limb with the tourniquet,
 late delivery to the laboratory,
 tubes exchange,
 contaminated sampling.
7e) Blood sampling – capillary
 indication
 tools
 sampling containers
 sampling procedure
 sampling principles
7e) Blood sampling – capillary
Indication:
 blood sampling at blood glucose, blood count, acid-base
balance examination.
procedure for measuring
blood glucose using a meter
glucometer
7e) Blood sampling – capillary
lancets for capillary sampling
Tools:
 disposable gloves,
 disinfection (Septoderm),
 swabs,
 needle, lancet...
 sample container,
 adhesive plaster.
glucometer
lancets
7e) Blood sampling – capillary
Sample container:
 capillary,
 tube (kep)
 sampling strips (e. g. into the meter).
microtube
7e) Blood sampling – capillary
capillary tube holder and capillary
test strips into the glucometer
7e) Blood sampling – capillary
Sampling procedure:
 it is performed by inserting from the side of fingertip on
the hands of adult, into the earlobe in children and footers
in infants,
 disinfection of the selected sites,
 puncture,
 wipe the first drop,
 sampling,
 treatment of injection site.
7e) Blood sampling – capillary
Sampling principles:
 good blood circulation finger (heating, gentle rubbing),
 perform puncture FROM THE SIDE of the fingertip,
 collect blood WITHOUT AIR BUBBLES into the capillaries,
 let the blood drip free.
7e) Blood sampling – capillary
 Videos with the procedure of capillary blood into a glass
capillary:
https://www.youtube.com/watch?v=ibU5PYOF2qg
https://www.youtube.com/watch?v=Wg-U7GlSGAk
7f) Types of blood tests
 biochemical examination
 haematological tests
 microbiological testing
 serological tests
7f) Types of blood tests
 Biochemical tests:
 detecting the presence of inorganic and organic compounds
in serum,
 mineralogram (iontogram) – basic, extended,
 renal complex

hepatic complex,
 proteins,

enzymes,
 lipids,

glucose,
 tumour markers,

cardiac markers,
 hormones,

blood gases.
7f) Types of blood tests
 Haematological tests:
 used to detect the properties of blood,









blood group and Rh factor,
Quick test,
APTT (activated partial thromboplastin time),
detect of bleeding,
blood count (CBC),
erythrocyte sedimentation rate (ESR),
LE cells,
sample to fibrinogen,
D-dimers.
7f) Types of blood tests
erythrocyte sedimentation
7f) Types of blood tests
 Microbiological tests:
 detection of disease pathogens (bacteriology, mycology,
virology),
 blood sampling
for haemo cultivation
(haemo culture).
7f) Types of blood tests
 Serological tests:
 determining the level of certain antibodies, which arise as
a response to the action of microbes,





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BWR – Bordet-Wasserman reaction (dg. of syphilis),
VR – Widal reaction (dg. of typhoid fever),
PBR – Paul-Bunnel reaction (dg. of infectious mononucleosis),
EBV – Epstein-Barr virus (dg. of infectious mononucleosis),
CMV – cytomegalovirus infection,
chlamydia,
 mycoplasmas,
 rheumatoid tests - ASLO, LFR, CRP, HbsAg, lyme, Anti HIV.
Revision
 What does the term biological material mean?
 Which places on the human body is best suited for capillary blood
sampling?
 List the tools necessary for the sampling of venous blood.
 Describe what is the Esmarch tourniquet for.
 List the types of blood tests (including physiological range).
 What principles must be followed
for the sampling of biological material?
 How will you react if you puncture
patient´s vein during venous blood sampling?
 List the indications for arterial blood sampling.
 What is the procedure for sampling of venous / capillary blood?
*
Reference:

LF3 – CUNI. Studijní materiály – Odběry biologického materiálu. [online]. 2015 [cit. 2015-04-05]. Dostupné z:
http://www2.lf3.cuni.cz/opencms/export/sites/www.lf3.cuni.cz/cs/pracoviste/osetrovatelstvi/vyuka/studijnimaterialy/CNPAZO42/studijni-materialy/Odbxry_krve.pdf

MIKŠOVÁ, Zdeňka, Marie FROŇKOVÁ a Marie ZAJÍČKOVÁ. Kapitoly z ošetřovatelské péče 2. Aktualiz. a
dopl. vyd. Praha: Grada, 2006, 171 s. ISBN 8024714434.

SZSCB. Šablony. Odběry krve – obecně. [online]. 2015 [cit. 2015-04-05]. Dostupné z:
http://www.szscb.wz.cz/info/projekty/sablony/os4/vy_32_inovace_os4-sk-08.pdf

VELKÝ LÉKAŘSKÝ SLOVNÍK [online]. 2015 [cit. 2015-04-05]. Dostupné z: www.lekarske.slovniky.cz

PICTURES * (if not specified differently): pinterest.com, google.com + using keywords („question“)