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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, 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“)