Pmlslec M003 PDF
Pmlslec M003 PDF
Pmlslec M003 PDF
: PMLS2-M003
TOPIC: Pre-Analytical Considerations CONSOLIDATED BY: Sam Jeffrey Tiongco
I. PRE-ANALYTICAL CONSIDERATIONS
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SUBJECT: Principles of Medical Laboratory Science DOCUMENT NO.: PMLS2-M003
TOPIC: Pre-Analytical Considerations CONSOLIDATED BY: Sam Jeffrey Tiongco
2. Hematoma
a. Escape of blood from the vein.
b. Cause: If the bore is partially inserted or no application of pressure during patient
care
c. May cause discomfort to the patient
d. Potential altered test results – possibility of contamination due to the presence of
blood.
3. Above and Below Infusing Fluids or from a Vascular Access Device
a. Possible contamination of specimen with IV fluids.
b. Heparin/Saline Lock
c. IV Therapy
i. Below an IV Site
1. Ideal
2. Shut off IV for 2 mins. With assistance.
3. Perform venipuncture; use discard tube.
ii. Drawing above an IV Site
1. Result: Diluted Specimen
2. Consider alternative site
3. Vascular Access Device
d. Various Type
i. Central Venous Catheters
ii. Arterial Lines
iii. Peripherally inserted central catheters
e. Risk Involved
i. Blood culture contamination
ii. IV fluid contamination
iii. High rate of hemolysis
iv. Potential to introduce air embolism into bloodstream
v. Introducing bacteria to bloodstream
vi. Risk of line of occlusion
4. Inflamed Sites
a. Including inflamed tattoos
b. Infection Complication – high number of WBC
c. Patient Discomfort
d. Potential Altered Result
5. Edematous Sites
a. Accumulation of fluid or secretion of fluid.
b. Patient Discomfort
c. Potential Altered Result
6. Extremity Affected by Store or Injury
a. Cannot hyperextend numb site.
b. Results in:
i. Nerve Injury
ii. Pain
iii. Infection
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SUBJECT: Principles of Medical Laboratory Science DOCUMENT NO.: PMLS2-M003
TOPIC: Pre-Analytical Considerations CONSOLIDATED BY: Sam Jeffrey Tiongco
1. Fainting/Syncope
a. Description/Cause
i. At the sight of the blood.
ii. Some patients may present with nausea or vomiting.
b. Management
i. Phlebotomist’s awareness of patient’s condition
ii. Terminate procedure
iii. “Head Down” position
iv. Do not drive any vehicle for at least 30 mins.
Note: The spirit of ammonia can aggravate patients with asthma.
2. Hematoma
a. Description/Cause
i. Escape of blood to surrounding tissue
ii. If patients have bleeding disorders or under medication (such as aspirin,
warfarin, cortisone – can affect clotting mechanism)
iii. Strenuous arm use following venipuncture.
iv. Syringe application is too far or partially inserted.
b. Management
i. Terminate procedure; apply pressure for 5 mins.
ii. Assure patient and give instruction.
iii. Application of cold compress to stop the bleeding. Apply hot compress to
dilate the vein.
Note: Application of ice pack can cause increase in blood flow due to vasodilation.
3. Thrombosis
a. Description/Cause
i. Formation of clots within the
blood vessel
ii. Thrombi – solid mass clots that
reside in blood vessels.
iii. Rigid/bumpy and lack elasticity
b. Management
i. Do not collect.
4. Petechiae
a. Description/Cause
i. Small, red spots appearing on patient’s
skin (indicates fragile vein)
ii. Indicates minute amount of blood escaping
into the skin epithelium
iii. May be the result of coagulation defects
(platelet abnormalities)
b. Management
i. Expect patient to bleed excessively
Page 3 of 7
SUBJECT: Principles of Medical Laboratory Science DOCUMENT NO.: PMLS2-M003
TOPIC: Pre-Analytical Considerations CONSOLIDATED BY: Sam Jeffrey Tiongco
Page 4 of 7
SUBJECT: Principles of Medical Laboratory Science DOCUMENT NO.: PMLS2-M003
TOPIC: Pre-Analytical Considerations CONSOLIDATED BY: Sam Jeffrey Tiongco
Page 5 of 7
SUBJECT: Principles of Medical Laboratory Science DOCUMENT NO.: PMLS2-M003
TOPIC: Pre-Analytical Considerations CONSOLIDATED BY: Sam Jeffrey Tiongco
15. Allergies
a. Description/Cause
i. Skin is sensitized to certain allergens.
ii. Allergies to anti-septic.
b. Management
i. Make use of hypoallergenic gloves and proper hand hygiene
ii. Make use of iodine and chlorhexidine
16. Accidental Arterial Puncture
a. Description/Cause
i. Light-red in color
ii. Faster flow of blood
iii. Rapid formation of hematoma
b. Management
i. Terminate the procedure and apply pressure at the area.
ii. Make an incident report.
17. Nerve Injury
a. Description/Cause
i. Shooting electrical or severe unusual pain.
ii. Tingling or numbness
iii. May cause paralysis
b. Management
i. Terminate the procedure immediately.
ii. Make an incident report.
TROUBLESHOOTING
1. There is no blood seen or too little blood flow into the tube.
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SUBJECT: Principles of Medical Laboratory Science DOCUMENT NO.: PMLS2-M003
TOPIC: Pre-Analytical Considerations CONSOLIDATED BY: Sam Jeffrey Tiongco
2. Underfilling of tubes.
Cause Management
Ensure that the vacuum is exhausted to fulfill
Premature removal of tubes.
the volume requirement of the tube.
Dead space in the tubing of the winged
Make use of discard tube.
collection set
Cause Management
Vein may have collapsed. Terminate and repeat.
Needle may have been repositioned outside
Reposition needle or repeat venipuncture.
the vein.
4. Occurrence of hematoma.
Cause Management
Needle may not be completely in the vein.
Needle transfix the vein.
Release the tourniquet, remove needle, and
Excessive probing.
apply pressure over the swollen area.
The tourniquet is placed too near the
insertion site.
Causes Management
Vigorous mixing of tubes. Mix tubes gently and follow proper number of inversions.
Alcohol contamination. Allow disinfected site to dry before venipuncture procedure.
Transferring from syringe to Remove needle from syringe and remove stopper top of
needle. tube before dispensing.
Anti-coagulant to blood ratio – causes rupture and
Underfilling of tubes
hemolysis due to osmosis.
Hemoconcentration can
Prolonged tourniquet Release tourniquet and apply
lead to a hemolyzed
application. proper palpation.
sample.
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