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Introduction You will be responsible

for collecting blood specimens and doing some testing in the waived category.

You will be introduced to venipuncture and capillary collection procedures.

You will also learn techniques for dealing with difficult types of patients and how to efficiently and effectively obtain blood

samples.

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Role of the Medical Assistant Examination of blood

can provide extensive information about a patient’s condition.

Basic understanding of the anatomy and physiology of the circulatory system will help you perform these tasks.

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Functions of Blood Heart pumps 8 to 12

pints of blood through more than 70,000 miles of veins, arteries, and capillaries.

Hematology Hematology – the study of blood

HematologistsHematologists – study its function and composition

Blood has many functions, all of which are important to overall health of the body.

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Functions of Blood (cont.)

Blood does all the following:Blood does all the following: Distributes oxygen, nutrients, and

hormones to body cells Eliminates waste products Maintains acid-base balance Regulates body temperature Attacks infecting pathogens

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Composition of Blood PlasmaPlasma – liquid in which other components

are suspended Red blood cells (erythrocytes)Red blood cells (erythrocytes) – vital role in

internal respiration White blood cells (leukocytes)White blood cells (leukocytes) – protect the

body against infection Platelets (thrombocytes)Platelets (thrombocytes) – crucial to clot

formation

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Apply Your KnowledgeWhat are three functions of blood?

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Apply Your Knowledge -AnswerAnswer

1. Distributes oxygen, nutrients, and hormones to body cells

2. Eliminates waste products3. Maintains acid-base balance4. Regulates body temperature5. Attacks infecting pathogens

What are three functions of blood?

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Collecting Blood Specimens Reading and interpreting the test order Assembling the equipment and supplies Preparing the patient Greeting and identifying the patient Confirming pretest preparations Explaining the procedure and safety precautions Establishing chain of custody Handling exposure incident

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Identifying the Patient Ask patient to state

their full name. Be sure you hear

both the first and last names correctly.

Verify that the name the patient gives is the name on the order.

Some places, the phlebotomist may ask for social security, patient ID, or chart number to further identify the patient.

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Drawing Blood Some states permit

medical assistants to obtain blood samples.

Your office will clarify your duties

Venipuncture – puncture of a vein

Phlebotomy – puncturing a vein with a needle to collect blood into a needle or tube

Common Sites for Venipuncture

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Venipuncture Equipment Evacuation system (VACUTAINER)Evacuation system (VACUTAINER) –special

double-pointed needle, needle holder, and collection tubes

Needle and syringe systemNeedle and syringe system – use a sterile needle and a syringe to draw blood specimen

Butterfly systemButterfly system – winged infusion set and syringe Collection tubes –Collection tubes – must mix blood with appropriate

sample containers

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VACUTAINER

The VACUTAINER system uses interchangeable collection tubes that allow you to draw several blood specimens from the same venipuncture site.

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Capillary Puncture Superficial puncture

of skin with sharp point to draw small amount of blood.

Collected in small, calibrated glass tubes, slides, or reagent strips.

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Patient Needs Alleviate patients fears or concerns Provide more information about:

Pain Bruises or scars Serious diagnosis Contracting a disease from procedure

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Children: Talk with patient or caregivers before

working with child Address them directly Speak calmly in soothing voice Explain the procedure briefly in terms they

can understand Keep child informed of status of procedure

Special Considerations

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Special Considerations (cont.)

Elderly Patients: Changes in skin conditions make

elderly patients prone to bruising Decreased circulation makes it

difficult to collect enough blood Speak in clear, low-pitched tone Give the patient time to respond to

questions

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Patients at risk of uncontrolled bleeding such as hemophilia or taking blood-thinning drugs Be careful and alert Hold cotton ball over the puncture site for

at least 5 minutes Notify physician if bleeding is

uncontrollable

Special Considerations (cont.)

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Special Considerations (cont.)

Difficult venipuncture: Try a second

time and then give the patient a rest

Fainting patient: Position before

venipuncture so no injury will occur

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Angry or violent Angry or violent patients:patients: Encourage patient to

submit to test and then talk with doctor

Do not force the issue Patient has the right to

refuse

Special Considerations (cont.)

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Apply Your KnowledgeWhat is one precaution you can take when drawing blood from a patient who had hemophilia?

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Apply Your Knowledge -AnswerAnswer

Hold cotton ball over the puncture site for at least 5 minutes

Be careful and alert Notify physician if bleeding is uncontrollable

What is one precaution you can take when drawing blood from a patient who had hemophilia?

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Performing Common Blood Tests Results can aid in the

diagnosis of specific conditions, disease, and disorders

Chemicals in lab:Chemicals in lab: Anticoagulants Serum separators Stains

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Hazardous Waste Hazardous waste products include:

Blood and blood products Body fluids and tissue Cultures Vaccines Sharps Gloves Specula Inoculating loops Paper product contaminated with body fluids

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Hematologic Tests Performed on venous or capillary blood

specimens Blood countsBlood counts

Red blood cells White blood cells Platelets Hematocrit Hemoglobin

Centrifuged Capillary Sample

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Erythrocyte sedimentation rate (ESR)Erythrocyte sedimentation rate (ESR) –measures rate at which red blood cells settle to the bottom of blood sample Put freshly collected blood into calibrated tube

and place in sedimentation rack In one hour determine how far the red blood cells

have fallen Record in mm/hr

Hematologic Tests (cont.)

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Chemistry Tests Highly detailed tests are not

performed in POL labs because of expensive, sophisticated equipment and techniques.

Some tests such as blood glucose monitoring are often performed by medical assistant.

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Serologic Tests Detect presence of specific substances in

blood samples. Refer to the introduction of an antigen or

antibody into the specimen and to detect specific reaction to the antigen or antibody.

Used to detect disease antibodies, drugs, hormones and vitamins.

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Immunoassays Western blotWestern blot –

used to confirm HIV

Radio-Radio-immunoassay immunoassay (RIA)(RIA) – usually performed in reference labs

Enzyme-linked Enzyme-linked immunosorbent immunosorbent assay (ELISA) –assay (ELISA) – used to diagnose HIV infections

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Apply Your KnowledgeHow is a serological test different from a

chemistry test?

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Apply Your Knowledge -AnswerAnswer

Serological tests use the introduction of an antigen or antibody into the specimen to detect specific reactions to the antigen or antibody.

How is a serological test different from a

chemistry test?

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Summary

Medical Assistant Successful phlebotomy procedures require not only

superior technical skills but also excellent interpersonal communication skills.

You may be called on to complete certain testing procedures or to explain the purpose of tests to

patients.