Lecture Medical assisting: Administrative and clinical procedures with anatomy and physiology (4e) – Chapter 48

CHAPTER 48 Collecting, Processing, and Testing Blood Specimens © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-2 Learning Outcomes 48.1 Discuss the composition and function of blood 48.2 Describe the process for collecting a blood specimen 48.3 Explain the importance of confirming patients’ identities and correctly identifying blood samples 48.4 Describe how to perform venipuncture and capillary puncture procedures © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-3 Learning Outcomes (cont.) 48.5 Identify the equipment and supplies required for blood-drawing procedures 48.6 Discuss the correct procedures for disposing of waste generated during blood-drawing procedures 48.7 Discuss common fears and concerns of patients and how to ease these fears © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-4 Learning Outcomes (cont.) 48.8 Develop techniques for helping patients with special needs, including children, the elderly, patients at risk for uncontrolled bleeding, and difficult patients 48.9 Identify common blood tests and explain their purposes 48.10Perform certain blood tests © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-5 Introduction • Medical assistant – Collects blood specimens – Performs waived testing – Knowledge needed • Understand circulatory system and function of blood • Appropriate supplies and equipment • How to perform and screen common blood tests © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-6 Role of the Medical Assistant • Phlebotomy – insertion of a needle or cannula into a vein to withdraw blood • Put the patient at ease during procedure • Process specimens and conduct testing • Complete necessary paperwork and make sure specimens are handled properly © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-7 Functions and Composition of Blood • Circulatory system transports blood – Heart pumps 8–12 pints of blood through 70,000 miles of vessels/day • Hematology – the study of blood © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-8 Functions and Composition of Blood (cont.) • Functions of blood – Distributes oxygen, nutrients, and hormones – Eliminates waste products – Attacks infecting pathogens – Maintains acid-base balance – Regulates body temperature © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-9 Functions and Composition of Blood (cont.) • Red blood cells – erythrocytes – Internal respiration – Transport oxygen to cells • Hemoglobin – 98% • Dissolved in plasma – to % – Hemoglobin • Main component of RBCs • Protein containing iron © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-10 Functions and Composition of Blood (cont.) • White blood cells – leukocytes – Protect against infection – Granular • Basophils • Eosinophils • Neutrophils – Agranular • T and B lymphocytes • monocytes © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-29 Performing Common Blood Tests • Results aid in diagnosis • POLs often only perform waived tests • Know office policy © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-30 Performing Common Blood Tests (cont.) • Chemicals in lab – Anticoagulants – keep blood in uncoagulated state – Serum separators – form a gel-like barrier between serum and clot in coagulated sample – Stains – color particular cells © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-31 Hematologic Tests • Blood counts – RBC count – White blood cells – Differential white blood cell – Platelet – Hematocrit – Hemoglobin Centrifuged Capillary Sample © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-32 Hematologic Tests (cont.) • Morphologic studies – Morphology – study of shape and form of objects – Requires special training • Coagulation tests – Identification of potential bleeding problems – Monitor therapeutic drug levels for anticoagulants – PT and PTT © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-33 Hematologic Tests (cont.) • Erythrocyte sedimentation rate – Measures rate of RBCs falling to the bottom of the blood sample – Must be performed on a fresh sample – Tube must contain an anticoagulant – Read after one hour – Recorded as mm/hr © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-34 Chemical Tests • Rarely performed in the POL • Waived tests – Blood glucose monitoring – Hemoglobin A1c – Cholesterol tests © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-35 Serologic Tests • Introduction of an antigen or antibody into a specimen and detection of a reaction to it • Immunoassays • Rapid screening tests – Infectious mononucleosis – HIV – Helicobacter pylori – Western blot – Radioimmunoassay (RIA) – Enzyme-linked immunosorbent assay (ELISA) – Immunofluorescent antibody (IFA) test © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-36 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! © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-37 In Summary 48.1 Blood is composed of plasma (the liquid portion) and formed elements Blood serves as a transport medium for oxygen, nutrients, hormones, and waste products and also attacks infecting organisms, maintains acid-base balance, and regulates body temperature 48.2 Blood is collected by one of two means: venipuncture or capillary puncture Venipuncture is the process of obtaining a blood sample from a vein, and capillary puncture is the process of obtaining blood from a superficial skin puncture © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-38 In Summary (cont.) 48.3 It is essential that a patient’s identity be confirmed before a blood sample is collected Correctly identifying the blood sample with the patient’s name ensures that the correct test will be done for the correct patient 48.4 Venipuncture is performed by cleansing the skin in the antecubital space, applying a tourniquet above the space, inserting a needle into the vein in the space, and withdrawing blood by way of an evacuated tube Capillary puncture involves cleansing the skin on the finger, sticking the finger with a safety lancet, and applying the drop of blood to a slide or in a small tube © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-39 In Summary (cont.) 48.5 The supplies needed to perform a venipuncture include VACUTAINER components (safety needle, needle holder/adapter, collection tubes), antiseptic and cotton balls or antiseptic wipes, tourniquet, sterile gauze squares, and sterile adhesive bandages Capillary puncture requires capillary puncture device (a safety lancet or an automatic puncture device such as Autolet or Glucolet), antiseptic and cotton balls or antiseptic wipes, sterile gauze squares, sterile adhesive bandages, reagent strips, micropipettes, and smear slides © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-40 In Summary (cont.) 48.6 All waste generated during blood-drawing procedures should be disposed of immediately Sharps should be placed in the sharps container after activating the safety device, and gloves, gauze, and other disposable supplies should be placed in a biohazard container 48.7 Patients are often concerned about pain, bruising, and scarring when having blood drawn They are sometimes afraid that they may have a serious disease, especially if large amounts of blood are drawn Good communication by the medical assistant is the key to easing these fears © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-41 In Summary (cont.) 48.8 There are always patients who will have special needs, including children, the elderly, patients who have bleeding disorders, and difficult patients Each patient will present a special set of challenges and should be treated with the utmost care and concern 48.9 The most common tests performed in a physician’s office laboratory include hematologic tests, chemical tests, and serologic tests © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-42 In Summary (cont.) 48.10 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 © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48-43 End of Chapter 48 Blood will tell, but often it tells too much ~ Don Marquis © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d [...]... 48- 15 Collecting Blood Specimens • Reading and interpreting the test order – Review order – Assemble equipment and supplies • Preparing the patient – Greet and identify the patient – Confirm pretest preparation – Explain the procedure and safety precautions – Establish chain of custody © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48- 16 Collecting Blood Specimens (cont.) • Use Standard... gloves, tourniquet, and bandages Know anatomy • • Rare Clean site prior to venipuncture May not be evident for several days © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48- 19 Collecting Blood Specimens (cont.) • Equipment – Evacuation systems – use special doublepointed needle, needle holder – Needle and syringe systems – Butterfly system – winged infusion set and syringe – Collection tubes... Anticoagulants – keep blood in uncoagulated state – Serum separators – form a gel-like barrier between serum and clot in coagulated sample – Stains – color particular cells © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48- 31 Hematologic Tests • Blood counts – RBC count – White blood cells – Differential white blood cell – Platelet – Hematocrit – Hemoglobin Centrifuged Capillary Sample ©.. .48- 11 Functions and Composition of Blood (cont.) • Platelets – thrombocytes – Fragments of cytoplasm – Essential for clot formation • Plasma – Clear, yellow liquid – Contains formed elements of blood – 90% water • Serum – clear, yellow liquid remaining after clot formation © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48- 12 Functions and Composition of Blood... and appropriate personal protective equipment © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48- 23 Responding to Patient Needs • Respond with sensitivity and competence • Fears and concerns – Pain – Bruises or scars – Serious diagnosis – Contracting a disease from the procedure © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48- 24 Special Considerations • Children –. .. Precautions and PPE as needed • Handling exposure incident – Needlestick or other exposure to blood/blood products – Report to appropriate person immediately – Wash area and apply bandage – Document date, time, people involved, type of exposure © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48- 17 Drawing Blood • Not all states permit medical assistants to draw blood • Venipuncture – Puncture... d 48- 32 Hematologic Tests (cont.) • Morphologic studies – Morphology – study of shape and form of objects – Requires special training • Coagulation tests – Identification of potential bleeding problems – Monitor therapeutic drug levels for anticoagulants – PT and PTT © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48- 33 Hematologic Tests (cont.) • Erythrocyte sedimentation rate – Measures... Children – Talk with parent or caregiver first – Address child directly – Speak in a calm, soothing voice – Explain the procedure briefly in terms they can understand – Keep child informed of status during the procedure © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48- 25 Special Considerations (cont.) • Elderly – Prone to bruising – Difficult to obtain an adequate sample – Speak clearly... products – chemically treated paper or dipstick – Lancets – small, disposable instruments – Smear slides – Automatic puncturing devices – Micropipettes – small, calibrated glass tubes that hold a precise volume of fluid © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48- 22 Apply Your Knowledge What precautions should you take when collecting a blood specimen? ANSWER: You should use Standard... blood sample – Must be performed on a fresh sample – Tube must contain an anticoagulant – Read after one hour – Recorded as mm/hr © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48- 34 Chemical Tests • Rarely performed in the POL • Waived tests – Blood glucose monitoring – Hemoglobin A1c – Cholesterol tests © 2011 The McGraw -Hill Com panies, Inc A ll rights reserv e d 48- 35 Serologic