Question

1. Susan, a medical assistant, is having trouble finding a venipuncture site on the left arm of her patient, Gabel, although Susan has thoroughly assessed and palpated the antecubital veins, including the bigger median cubital vein. Gabel doesn’t want Susan to draw blood from her right arm. What techniques are available to Susan to make the veins on Gabel’s left arm more prominent?

2. When should the medical assistant consider using the butterfly method of venipuncture?

3. Debbie brings her newborn, who has a fever, into the medical office for a blood test. Will the baby’s blood be collected by venipuncture? If so, by which method?

4. Melanie, a breast cancer patient receiving chemotherapy, comes into your office for her normal treatment. Upon examination, it is revealed that Melanie is experiencing flulike symptoms. The physician asks you to order a CBC. What results might you expect for a patient with Melanie’s characteristics, and why? Why might Melanie be experiencing flulike symptoms?

5. How does diet affect the course of diabetes mellitus and coronary heart disease?

6. Is the everyday use of antibacterial soap a good idea, given that most microorganisms residing on the human body are harmless?

7. It is a busy day at the doctor’s office, and the medical assistant has been struggling for more than 10 minutes to convince a 6-year-old child to open his mouth and allow the medical assistant to collect a throat culture specimen. The child is becoming enraged and refuses to open his mouth, and his mother appears helpless to get him to follow instructions. After refocusing the child’s attention on his school and activities, which calms him down, the medical assistant is finally able to persuade him to open his mouth slightly. But just as she is about to swab his mouth, the child swipes her hand away and starts to become upset again. The swab has touched the inside of the child’s mouth. Does the medical assistant continue with the collection procedure or begin the process again?

7. What is serology and what are some of its practical uses to medicine?

Answer 1

1. The techniques that are available to Susan to make the veins more prominent on the left arm of Gabel's arm are as follows:

a. The arm should be inclined in a downward position and the vein should be stroked in distal direction.The patient is then asked to clench his/her fist in order to help the phlebotomist locate the vein clearly. The area is then warmed with the help of a heating pad or a bathe arm. Local anaesthetic is applied to the area and then blood is drawn.

b. The patient can be advised to drink plenty of water an hour before the drawing of blood. Light exercise also can be tried like push-ups or jumping jacks to make the veins more prominent. However, most patients fail to follow these procedures.

c. It is very clear that veins become more prominent when blood is forced through them. A gentle massage on the arm will help blood flow increase thereby causing the vein to pop out.

d. A tourniquet is a device that most people use during difficulties in blood collection. In order to use it correctly, the phlebotomist should tie the device around 3-4 inches directly above the puncture site. It should be tied loose at first because in some cases, this makes the vein more prominent. It can only be tightened if necessary. A safety measure is to never leave the tourniquet on for more than a minute as it may lead to loss of plasma in the blood and the sample could be a misfit for usage.

2. A butterfly needle is used for drawing blood or giving medications. It is also called as a 'winged infusion set' or a 'scalp vein set'. It gets its name due to the presence of a pair of wings on either side of needle which is used to access the vein. A medical assistant uses the butterfly needle to draw blood or to access the vein to administer intravenous (IV) medications.

Butterfly needles are used on people when venipuncture is not possible. For example : older adults, infants, children. As the length of the needle is small, it is easier to place it on veins that are fragile or small.It is also used to collect blood in blood banks as the tubing helps in easy collection of the blood.

Butterfly needles are also used to administer IV fluids. It will help you rehydrate and restore your fluid levels. They are also used for IV therapy where medications are administered intravenously when it cannot be given via the mouth or when you need the medications to work quickly.

3. In infants, blood is often collected by neonatal prick which is also known as the dermal puncture. It is the most widely used procedure for newborns and infants up to six months of age. This procedure is often preferred because, when done correctly, it guarantees the production of blood without the uncertainty of needle sticks.

4. A CBC is used to measure the number of different kinds of cells in the human body. It is done to make sure that the bone marrow is functioning well. The results that you might expect for a patient with Melanie's characteristics is low WBC count. The body's primary defense against common cold is WBCs. As cancer patients have weakened immune systems, they may have especially low levels of neutrophils in their blood stream - a condition termed as neutropenia. Neutrophils help fight and prevent infections. Neutropenia is the most common side effect of chemotherapy. Flu-like symptoms are a group of related side effects that can be caused by chemotherapy or immunotherapy. Neutropenia can be the cause of these Flu-like symptoms in cancer patients.

5. When you have diabetes, there is a risk of cardiovascular disease too. The connection is that if the blood levels are high, a fatty material builds up on the lining of the arteries which is called as atheroma.

A healthy diet can help prevent the onset of type-2 diabetes and CVD.  Diets that are low in fat (saturated fat), and high in fibre and complex carbohydrates are effective in reducing the risk of developing diabetes and CVD. Cutting down on salt will help in maintaining the blood pressure, which if increases causes CVD.

6. The skin of the human body is a home to the normal flora of microorganisms on our body. This normal flora consists of good bacteria and bad bacteria. The good bacteria in many cases help in preventing the colonisation of bad bacteria on the surface of our skin. The continuous usage of antibacterial soap everyday can cause the loss of the normal flora on the human skin thereby making us prone to various infections. Continuous usage can also cause the creation of antibiotic-resistant bacteria which may later on be difficult to eradicate. Thereby, everyday use of antibacterial soap is not a good idea given that most of the organisms on our body are harmless.

7. As the requirement is for a throat culture specimen, the medical assistant should terminate the medical procedure immediately and use a new sterile cotton swab as the swab is contaminated with the flora of the mouth. This is done because the flora is different in different parts of the body. The flora present in the mouth are different from those that are present in the throat due to pH differences and exposure to the environment. The purpose of a throat swab culture is to detect the presence of organisms that could cause an infection in the throat.

8. Serology is a diagnostic procedure that is used for the examination of blood serum. It is done to specifically detect certain antibodies in the serum which are formed in response to an infection or against other foreign proteins. The methods in serology are agglutination, precipitation, ELISA, complement-fixation, florescent antibodies and chemiluminescence. The practical uses in medicine include :

a. Forensic studies - DNA fingerprinting and blood typing.

b. Diagnosis of Rickettsial diseases - Rocky Mountain spotted fever, Typhus fever etc.

c. Diagnosis of viral diseases - Influenza, Measles etc.

d. Detection of autoimmune diseases -  X-linked agammaglobulinemia

e. Diagnosis of rheumatic illness.

f. Determination of the prevalence of a disease in a population - Serological surveys

g. Diagnosis of bacterial diseases - syphilis, anthrax etc.