Download The Profession of Medical Assisting - Higher Ed - McGraw

CHAPTER
48
Collecting, Processing,
and Testing Blood
Specimens
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
48-2
Learning Outcomes
48.1 Discuss the role of the medical assistant
when collecting, processing, and testing
blood samples.
48.2 Carry out the procedure for collecting a blood
specimen.
48.3 Discuss ways to respond to patients’ needs
when collecting blood.
48.4 Carry out the procedure for performing blood
tests.
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48-3
Introduction
• Medical assistant
– Collects blood specimens
– Performs waived testing
– Knowledge needed
•
•
•
•
Dealing with patients
How to obtain a blood sample
Appropriate supplies and equipment
How to perform and screen common blood tests
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48-4
The Role of the Medical Assistant
• Phlebotomy
• Putting the patient at ease
• Processing specimens and
conduct testing
• Completing necessary
paperwork
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48-5
Apply Your Knowledge
What is the role of the medical assistant related to
collecting blood samples?
ANSWER: The medical assistant will put the
patient at ease during the procedure, process
specimens, conduct testing, complete necessary
paperwork, and make sure specimens are
handled properly.
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
48-6
Collecting Blood Specimens
• Review the test order
• Assemble equipment and supplies
– Varies with test type
– Collection devices ~ label correctly
– Alcohol wipes; adhesive bandage
– Tourniquet for venipuncture
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48-7
Collecting Blood Specimens
• Preparing the patient
– Greet and identify the patient
– Confirm pretest preparation
– Explain the procedure and safety precautions
– Establish chain of custody
– Handle an exposure incident
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
48-8
Drawing Blood
• Know your scope of practice for your state
• Phlebotomy
– Use Standard Precautions
– Use appropriate PPE
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
48-9
Drawing Blood (cont.)
• Venipuncture
• Evacuation systems
– Double-pointed needle
and collection tube holder
– Decreased chance of
accidental exposure
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
48-10
Drawing Blood (cont.)
• Needle and syringe
systems
• Butterfly system
– Winged infusion set
– Less trauma to vein
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
48-11
Drawing Blood (cont.)
• Collection tubes
– Color-coded to identify appropriate
additive such as EDTA
– Be sure to select the
correct tubes
– Draw in correct order
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
48-12
Drawing Blood (cont.)
•
Engineered safety devices
– Reduce the possibility of needlestick injuries
– Types
• Retracting needles
• Hinged or sliding shields
• Self-blunting needles
• Retractable lancets
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48-13
Drawing Blood (cont.)
• Capillary puncture
– Superficial puncture of the skin
– Sites ~ outer edge of finger or heel
• Lancet
• Automatic puncturing
device
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
48-14
Drawing Blood (cont.)
• Micropipettes
• MICROTAINER tubes
• Reagent products
• Smear slides
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48-15
Apply Your Knowledge
What precautions should you take when collecting
a blood specimen?
ANSWER: You should use Standard Precautions and
appropriate personal protective equipment.
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
48-16
Responding to Patient Needs
• Respond with sensitivity and competence
• Provide information appropriate to
patient’s needs
• Answer questions that are within your
scope of practice
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48-17
Patient Fears and Concerns
• Pain
• Bruises or scars – hematoma
• Serious diagnosis
• Contracting a disease from the procedure
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48-18
Special Considerations (cont.)
• Patients at risk for uncontrolled bleeding
– Hemophilia or taking blood-thinning
medication
– Hold site for at least
5 minutes
– Contact physician
if bleeding does
not stop
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48-19
Special Considerations (cont.)
• Difficult patients
– Difficult venipuncture ~ do not stick more than
twice
– Fainting patients ~ position to avoid injury
– Angry or violent
patient ~ do not argue
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
48-20
Apply Your Knowledge
What is one precaution you can take when drawing
blood from a patient who is taking anticoagulants?
ANSWER: After drawing blood on a patient taking
anticoagulants, you should hold a cotton ball over
the puncture site for at least 5 minutes, monitor the
site carefully, and notify the physician if bleeding
does not stop.
Correct!
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48-21
Performing Common Blood Tests
•
Results aid in diagnosis
•
POLs – waived tests
•
Be familiar with other tests also
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48-22
Performing Common Blood Tests (cont.)
• Chemicals in lab
– Anticoagulants
• Range of normal
test values
– Serum separators
– Stains
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48-23
Hematologic Tests
• Venous or capillary • Physician can order
blood
– Individual tests
• Whole blood
– Formed elements
– Complete blood (cell)
count
– Plasma
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48-24
Hematologic Tests
• Complete blood (cell) count
– RBC count
– White blood cells
– Differential WBC
count
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
48-25
Hematologic Tests
• Complete blood (cell) count
– Platelet
– Hematocrit
– Hemoglobin
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48-26
Hematologic Tests
•
Differential Cell count
– Prepare a smear slide
and stain the smear
– Staining kits
– Cell type / 100
leukocytes counted
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48-27
Hematologic Tests (cont.)
•
Hematocrit
– Centrifuge microhematocrit
tube
• Packed red blood cells
• Buffy coat
• Plasma
– Compare column of packed
RBCs to hematocrit gauge
– Automated Hematocrit readers
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48-28
Hematologic Tests (cont.)
•
Hemoglobin
– Sample must undergo hemolysis
– Color then evaluated
– Automated hemoglobin analyzers
• Measure amount of hemoglobin in whole blood
• Follow manufacturer’s instructions
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48-29
Hematologic Tests (cont.)
•
Cell morphology – requires special
training
•
Coagulation tests
– PT and PTT
– Automated devices ~ calculate International
Normalized ratio (INR)
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48-30
Hematologic Tests (cont.)
• Erythrocyte sedimentation rate (ESR)
– Measures rate of RBCs falling to the bottom of
the blood sample
– Tube must contain an
anticoagulant
– Read after one hour
– Record as mm/hr.
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48-31
Chemical Tests
• Specialized equipment and techniques
• Subject to CLIA ‘88 regulations
• New automated equipment
– More readily available
– Simpler to operate
– Development of new waived tests
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48-32
Chemical Tests (cont.)
• Blood glucose
monitoring
– Routinely performed in
POL
– Glucometer
– Patient education
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48-33
Chemical Tests (cont.)
• Hemoglobin A1c
– Glucose molecules bind to hemoglobin
– Provides overall picture of effectiveness of
diabetes treatment
– Options
• Sent to outside laboratory
• Perform in office
• Home testing
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48-34
Chemical Tests (cont.)
• Cholesterol tests
– Routinely performed in POL
– Automated devices
• POL
• Home testing
– Use a capillary sample
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48-35
Serologic Tests
• Detection a reaction to an antigen or
antibody
• Immunoassays
– Western blot
– Radioimmunoassay (RIA)
– Enzyme-linked immunosorbent assay (ELISA)
– Immunofluorescent antibody (IFA) test
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48-36
Serologic Tests (cont.)
• Rapid screening tests
– Detect antibodies to certain infections
• Infectious mononucleosis
• HIV
• Helicobacter pylori
– Follow manufacturer’s instruction
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48-37
Apply Your Knowledge
Matching:
ANSWER:
D Hemoglobin A1c
___
A. ESR
G Lysing RBCs/evaluating the color
___
B. Serology test
___
F Shape or form of objects
C. Coagulation tests
___
C Identify bleeding problems
D. Chemical test
___
A Rate at which RBCs fall
E. Differential
E Percentage of each type of WBC
___
F. Morphology
B ELISA
___
G. Hemoglobin
Super!
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48-38
In Summary
48.1 As a medical assistant, you will collect and
process blood specimens for examination,
make sure the test results are handled
efficiently and accurately, and complete the
necessary paperwork before and after each
test.
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
48-39
In Summary (cont.)
48.2 Blood is collected by venipuncture or
capillary puncture.
When collecting blood specimens, it is
essential that you:
• confirm the patient’s identity
• cleanse the skin prior to collection
• follow standard precautions
• collect the sample needed in the
appropriate tube or container
• ensure the patient’s safety.
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
48-40
In Summary (cont.)
48.3 Patients may have concerns when having
blood drawn. Good communication by the
medical assistant is the key to easing these
fears.
There are always patients who will have
special needs. Each patient will present a
special set of challenges and should be
treated with the utmost care and concern.
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48-41
In Summary (cont.)
48.4 Hematologic, chemical, and serologic tests
require special care when performing them.
The medical assistant should review the
manufacturer’s instructions carefully for
important information about correctly
performing each test.
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
48-42
End of Chapter 48
Blood will tell,
but often it tells
too much.
~ Don Marquis
© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution
in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.