1. به نام خالق هستي دكتر كتايون خداورديان آزمايشگاه مرجع سلامت

2. دستورالعمل نمونه گيري وريدي ومويرگي

3. VENIPUNCTURE  Pre collection: smoking, physical activity, stress  During collection: -different time of day -different time of day -posture: lying/standing/sitting -posture: lying/standing/sitting -haemoconcentraction: prolong tourniquet -haemoconcentraction: prolong tourniquet  Handling of specimen :  Handling of specimen : - Insufficient or excess anticoagulant - Insufficient or excess anticoagulant -Inadequate mixing of blood with anticoagulant -Inadequate mixing of blood with anticoagulant -pat./or specimen identification error -pat./or specimen identification error -delay to transit to Lab. -delay to transit to Lab.

4. Room Facilities  Venipunture chair& Bed  Blood collecting Trays  Gloves  Needles&Holders  Sterile Syrings  Venous Blood collection Tubes  Tourniquets  Antiseptices  Guase Pads→5*5cm,7.5*7.5cm

5.  Punture –Resistance Disposal Container  Ice or refrigerator  Adhesive Bandages  Warming Devices  Test Reference Manual

6. Venipuncture Procedure 1- Identify the patient 2-Assess the patient physical disposition (diet, exercise,stress,basal state) 3-Equipment→ necessary supplies&Tubes 4-Position the patient 5-put on gloves 6-Apply Tourniquent →7.5-10cm above ven. Site, Not too tightly No more than 1 min. Patient should make a fist without pumping the hand Patient should make a fist without pumping the hand 7-Select the vein site Median cubital & Cephalic Vein * Extencive scaring from burns & surgery * Extencive scaring from burns & surgery Mastectomy * Hematoma * IV therapy →below IV site * Cannula,Fistula * Edematous

7. VENIPUNCTURE SITES

8. 8- Clean the site →Isopropyl or Ethyl Alcohol 70% 8- Clean the site →Isopropyl or Ethyl Alcohol 70% ►guaze pad → 5*5-7*7cm ►guaze pad → 5*5-7*7cm -Circular motion from center to the periphery -Circular motion from center to the periphery * allow to air dry * allow to air dry 9-Insert needle ≤ 30degree 9-Insert needle ≤ 30degree 10- Drawing the spec. * open the hand 11- Release Tour niquet 12- Place gauze pad over the vein 13- Re move the Needle 14- Applying pressure to the site, making sure bleeding has stopped 15- Collect the sample in the appropriate tubes (Blood culture - coagulation Tube- non additive Tube- Heparin - EDTA Tubes)

9. 15- Disposing needles 16-Lable the tubes and record the time of collection: name,age,ID no.,Dr. name,other Inf.(Iv site …) name,age,ID no.,Dr. name,other Inf.(Iv site …) ٭ All Tubes must Labeled Immediately after blood specimen has been drawn. ٭ All Tubes must Labeled Immediately after blood specimen has been drawn. 17-Chill the specimen (if required) 17-Chill the specimen (if required) 18-Send to Labs. 18-Send to Labs. ٭Children→ syringe gauge 20-23, winged blood collection set

10. Safety& Infection Control  Wear gloves &lab coats when handling bloob/body fluids  Change gloves frequently or if contaminated  Wash hands frequently  Dispose of needles immediately Do not bend, recap,break,resheath needles  Clean up any blood spills with a disinfectant as freshly made 10%bleach

12. # Prolonged Tourniquet : Hb, HCT, RBC ↑ 2-3% Hb, HCT, RBC ↑ 2-3% # Prior rest: - Hb, HCT, RBC ↓ 5-8% (1.5 hr bed rest) - Hb, HCT, RBC ↓ 5-8% (1.5 hr bed rest) - Lymphocytes ↓ - Lymphocytes ↓ # Position of Arm : H b, H C T, R B C ↑ 2-3% in hanging down arm H b, H C T, R B C ↑ 2-3% in hanging down arm # Diurnal Variation : Hb, HCT higher in the morning than evening Hb, HCT higher in the morning than evening WBC & Neutrophil counts higher in the afternoon WBC & Neutrophil counts higher in the afternoon Lymphocyte lowest in the morning and highest in the evening. Lymphocyte lowest in the morning and highest in the evening. PLT is higher in the afternoon and evening PLT is higher in the afternoon and evening Cortisol, Fe Cortisol, Fe # Excersise : - WBC, RBC, Hb, HCT rise - WBC, RBC, Hb, HCT rise - intensive tranning ↓ lymphocyte count - intensive tranning ↓ lymphocyte count -↑ CK, AST, LD, Fibrinolysis,&Activate coag. -↑ CK, AST, LD, Fibrinolysis,&Activate coag. - physical training: ↑sexial hormons - physical training: ↑sexial hormons

13. Skin Puncture 1- Equipment 2- Choose the puncture site ¤ distal digit of third or fourth finger ¤ distal digit of third or fourth finger ¤ lateral or medial planter surface of heel(pre warming 42 0 3-5 min) ¤ lateral or medial planter surface of heel(pre warming 42 0 3-5 min) 3- Puncture with sterile Lancet (No deeper than 2mm) 4- Wipe the first drop 5- Collecting the specimen

14. Punture must be on palmar surface of distal phalanx across the fingerprints,of the middle&Ring finger.

15.  Blood must not be obtain from the: -Ear lobe -Ear lobe -Central area of an infant heel -Central area of an infant heel -Swollen or previously punctured site -Swollen or previously punctured site

16. Difference between capillary and Venous Blood - RBC, Hb, HCT capillary blood are slightly greater than venous – leucocyte and PMN are higher 8% Monocyte 12% - RBC, Hb, HCT capillary blood are slightly greater than venous – leucocyte and PMN are higher 8% Monocyte 12% -PLT count higher in Venous blood 9% -PLT count higher in Venous blood 9% -Glucose is higher in capillary blood, K, Protein,Ca is lower -Glucose is higher in capillary blood, K, Protein,Ca is lower ✽ Smears prepared from capillary blood shows PLT aggregation ✽ Smears prepared from capillary blood shows PLT aggregation

17. STORAGE  CBC→up to 4 h.(max. 6 h.) at room Tem.  Cell counts & Indices are stable for 24 h. at 4c  Blood smear→1 h. at room Tem. by 3 h. blood cell morphpology starts: by 3 h. blood cell morphpology starts: - vacuolisation & irregular lobulation of nucleos - vacuolisation & irregular lobulation of nucleos -crenation &sphering of RBC(after 6 hours) -crenation &sphering of RBC(after 6 hours)  Quantitative effect (>4-6 h.at room tem): -RBC swelling→MCV, ↑HCT, ↓ESR -RBC swelling→MCV, ↑HCT, ↓ESR - Leucocytes & plt→gradually fall (count with 2 h.) - Leucocytes & plt→gradually fall (count with 2 h.) - Hb remains un changes for days - Hb remains un changes for days  ESR:up to 4 hours at room tem. up to 12 hours at 4 degree up to 12 hours at 4 degree

18.  Reticolocyte:EDTA sample up to 6 hour at room tem. up to 24 hours at 4 degree up to 24 hours at 4 degree  Blood grouping sample:48 hour at room tem. up to 7 days at 4 degree up to 7 days at 4 degree

19. Rejection of Samples 1. 1. Hemolysis - this is usually caused by a procedural error such as using too small of a needle, or pulling back to hard on the plunger of a syringe used for collecting the sample. The red cells rupture resulting in hemoglobin being released into the serum/plasma, making the sample unsuitable for many laboratory tests. The serum/plasma will appear red instead of straw colored. 2. 2. Clotted - failure to mix or inadequate mixing of samples collected into an additive tube. The red cells clump together making the sample unsuitable for testing. 3. 3. Insufficient sample (QNS) - certain additive tubes must be filled completely. Incorrect blood to additive ratio will adversely affect the laboratory test results. When many tests are ordered on the same tube be sure to know the amount of sample needed for each test. 4. 4. Wrong tube collected for test ordered. Always refer to procedure manual when uncertain. 5. 5. Improper storage - certain tests must be collected and placed in ice, protected from light, or be kept warm after collection. 6. 6. Improperly labeled

20. Thanks for your attention