Question

1: what procedural errors did Bob commit?

2: How should the specimen be mixed during collection?

Case Study 3 Bob has been an MA, working on a Med Surg unit for approximately one year. He has a request to collect STAT electrolytes on a patient. A CBC is also ordered; this is not STAT. After properly identifying the patient, Bob checks for an appropriate site. The patient had an IV just above the wrist in the left arm. The right antecubital area was badly bruised, and the patient did not have any suitable veins in either hand. Consequently, Bob decided to collect the specimens by capillary puncture, choosing the right middle finger as the collection site. After making the puncture, Bob decided to collect the electrolytes first because they are STAT and he was having difficulty getting a good blood flow. He was able to fill the serum microtainer and proceeded to collect the CBC. He had to use a lot of pressure on the finger to keep the blood flowing, but he eventually filled a lavender microtainer for the CBC. After the samples had been submitted to the lab he was told to recollect the CBC because the results were questionable. QUESTIONS

Answer 1

13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 THURSDAY Capillary sampling • Capillary sampling from a finger, had or an ear lobe may be performed on patients 10 of any age, for specific tests that require small quanties of blood. However, because, the procedure is commonly wed in paediatric patients. The finger is usually the preferred site for ' capillary testing in and adult patient. Order of draw. 3 with skin punctures, the haematology, specimen is collected fint, followed by the chemistry and blood bank specimens This order of drawing is essental to 5 minimize the effects of platelet clumping. The order used for skin punctures is the o reverse of that used for venepuncture colection. * with skin puncturer collect the specimen in the order below, stasting with - haematology specimensi - Chemistry specimens) - blood bank specimens. That which a man willingly shares, he keeps

23 24 25 26 27 28 FRIDAY o TO FRIDAY 0 Procedural erron did Bob commit- f Bob decided to collect the ecto electrolul first becaure they are STAT. This was the 10 his fint error. * Haematology specimens should be collect fint. * Second enor was he was having difficulty getting a good blood how * Third enor was he had to use a lot of pressure on the finger to keep the blood flowinga. 2. How should the specimen be mixed during collection, Avoid squeezing the finger too tightly s became this diluter the specimen with tissue fluid cplasma) and increase the probability of haemolysis. Slow on traumatic ven puncture can precipitate platelet clumping and induce small microclots within the sample on even clothing of the sample. Scanned with CamScanner

JANUARY 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 SATURDAY & * clotting of the all blood count if severe. sample will decrease and invalidate the count, 9 10 * Microcot can also be drawn into hematology analyzen and can plug the telbing, causing the machine to malfunction. 12 * Difficult venipuncture, particularly through a small gauge needle can result in a shearing of RBC which atheets cell counts and hihnica true Intravascular hemolysis. * The blood should be thoroughly mixed with anticoagulant during or immediatly after sample collection. J * Inadequate mixing will result in sampleclothing, which may not be visible to the naked eye. o # shaking of blood tubes, foning blood through needles vigorous explulsion into tubes, can cause shearing of RBC and Sunday 15 platelet clumping, SLITE

119 20 21 22 23 24 25 Thu 26 27 28 29 Week 01.005-3611 2012 - Immediate mireing of the Sarople upon biood 691ecleon insures that the anticoagulant in the specimen contanes has dissolved with the Blood. This maintaining not only effective the anticoagulant to blood oratio but also providing a en free from any blood clots. hack of homogeneity of a blood scumple con lead to incorect resuld. ishther The process of miring should be such as not to result in the alterxadion of the integdidy obce Sample such as hemolys is and thus affeed the quality of resuld. ICS Scanned with CamScanner

2012 Week 01.000-360 How is a CB C Done ? 1. clean the skin 2. put an elastic band above the area to get the Vein to Swell with blood. 3. insert a needle into a vein Cusually in the arm inside of the elbow or on the back. of the hand s. Pull the blood sample in to a vial on Syringe. 6. Take of the elastic band and remove the needle from capillary blood composed of ? capillary blood is obtained from capillary beds that consist of the Smallest veins (venales and arteeies Caldeeioles) of the Cixulatory system. The venules and asterides sain togela in Capillary beds polming a mixture CS Schned with and ardesiaublood CamScanner