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CHAPTER 48 Collecting, Processing, and Testing Blood Specimens © 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. 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. © 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. 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 © 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. 48-4 The Role of the Medical Assistant • Phlebotomy • Putting the patient at ease • Processing specimens and conduct testing • Completing necessary paperwork © 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. 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. © 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. 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 © 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. 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 © 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. 48-8 Drawing Blood • Know your scope of practice for your state • Phlebotomy – Use Standard Precautions – Use appropriate PPE © 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. 48-9 Drawing Blood (cont.) • Venipuncture • Evacuation systems – Double-pointed needle and collection tube holder – Decreased chance of accidental exposure © 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. 48-10 Drawing Blood (cont.) • Needle and syringe systems • Butterfly system – Winged infusion set – Less trauma to vein © 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. 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 © 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. 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 © 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. 48-13 Drawing Blood (cont.) • Capillary puncture – Superficial puncture of the skin – Sites ~ outer edge of finger or heel • Lancet • Automatic puncturing device © 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. 48-14 Drawing Blood (cont.) • Micropipettes • MICROTAINER tubes • Reagent products • Smear slides © 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. 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. © 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. 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 © 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. 48-17 Patient Fears and Concerns • Pain • Bruises or scars – hematoma • Serious diagnosis • Contracting a disease from the procedure © 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. 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 © 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. 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 © 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. 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! © 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. 48-21 Performing Common Blood Tests • Results aid in diagnosis • POLs – waived tests • Be familiar with other tests also © 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. 48-22 Performing Common Blood Tests (cont.) • Chemicals in lab – Anticoagulants • Range of normal test values – Serum separators – Stains © 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. 48-23 Hematologic Tests • Venous or capillary • Physician can order blood – Individual tests • Whole blood – Formed elements – Complete blood (cell) count – Plasma © 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. 48-24 Hematologic Tests • Complete blood (cell) count – RBC count – White blood cells – Differential WBC count © 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. 48-25 Hematologic Tests • Complete blood (cell) count – Platelet – Hematocrit – Hemoglobin © 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. 48-26 Hematologic Tests • Differential Cell count – Prepare a smear slide and stain the smear – Staining kits – Cell type / 100 leukocytes counted © 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. 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 © 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. 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 © 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. 48-29 Hematologic Tests (cont.) • Cell morphology – requires special training • Coagulation tests – PT and PTT – Automated devices ~ calculate International Normalized ratio (INR) © 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. 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. © 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. 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 © 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. 48-32 Chemical Tests (cont.) • Blood glucose monitoring – Routinely performed in POL – Glucometer – Patient education © 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. 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 © 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. 48-34 Chemical Tests (cont.) • Cholesterol tests – Routinely performed in POL – Automated devices • POL • Home testing – Use a capillary sample © 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. 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 © 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. 48-36 Serologic Tests (cont.) • Rapid screening tests – Detect antibodies to certain infections • Infectious mononucleosis • HIV • Helicobacter pylori – Follow manufacturer’s instruction © 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. 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! © 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. 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. © 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. 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. © 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. 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. © 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. 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. © 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. 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.