1.

Definition of Blood Sampling

In the normal blood sample collection, the technical term meaning phlebotomy

phlebotomy. In clinical laboratory practice, there are three kinds of obtaining blood,

namely: through puncture a vein (venipuncture), skin prick (skinpuncture) and

puncture arteries or veins. Venipuncture is the most common, therefore the term

phlebotomy often associated with venipuncture.

A. Capillary Blood Sampling

1. understanding

Capillary blood sampling or known as skinpuncture which means the

process of blood sampling with puncture the skin.

The place used for capillary blood sampling are:

 Fingertip (fingerstick) or child earlobe.

Capillary blood sampling is done for tests require samples with small

volumes, for example for examination of glucose, hemoglobin concentration,

hematocrit (microhematocrit) or blood gas analysis (capillary method).

3. Blood collection procedures

1) Tools and materials

2. alcohol cotton 70%

2) stage work

1. Prepare sampling equipment: a sterile lancet, cotton 70% alcohol.

2. Select the location of the cotton and disinfection with 70% alcohol, let

dry.

3. Hold the part that does not move and press a little so that the pain is

reduced.

4. Prick with a sterile lancet. Punctures should be in so that blood should

not be squeezed-wring out. Do not thrust lancet if the finger is still wet

with alcohol. This is not only because of the blood will be diluted by

alcohol, but blood is also spread over the skin so hard to fit in the

container.

5. After the blood come out, remove the first drops of blood with a dry

cotton wears, subsequent drops may be used for the examination.

6. Blood sampling endeavored not too long and not squeezed-squeezed to

prevent clot formation.

B. Venous blood sampling

1. understanding

An act of inserting needles into veins clients to obtain blood specimens.

2. Aim

For instructions for each officer who made taking blood (phlebotomy).
3. Indication

For instructions for each officer who made taking blood (phlebotomy).

4. contraindications

1. Venous blood sampling on the one hand that impaired blood circulation in

clients with mastectomy (surgical removal of the breast)

2. Regional edema

3. Hematome

4. The area where the blood is being transfused

5. Scar area or there are signs of infection, infiltration, or thrombosis at the

site of the stabbing.

6. The former area of vascular grafts (avsan) in patients with renal impairment

7. Regional intra-venous lines. Blood sampling in this area can cause the blood

to become more watery and may increase or decrease the levels of certain

substances.

8. The arm has a disorder or paralysis (paralysis of muscles and nerves)

9. Sleeve with circulatory or neurological disorders

5. Blood collection procedures (venous)

1) Tools and materials

1) 1 pair of gloves clean

2) 1 small bottle of alcohol

3) Cotton (to taste)

4) A single small pillow for support

5) 1 piece pengalas
 6) 1 piece tourniquet

7) 1 piece syringe (adjust the size of the syringe with the amount of blood

will be taken)

8) Plaster (to taste)

9) 1 piece of paper labels

10) 1 file inspection request form laboratarium

11) 1 piece of the specimen container and lid

12) 1 piece of plastic specimens

2) stage work

1) Keep your clients' privacy

2) Describe the purpose and procedure to be performed

3) Give clients Fowler position in bed or sitting in a chair position

4) Washing hands

5) Wear clean gloves

6) Replace pengalas under the hands of the client

7) Choose a location that will be taken (usually in antecubital fossa)

8) Replace tourniquet 5-10 cm above the vein selected

9) Clean the puncture site with an alcohol swab in a circular direction

from the inside to the outside (± 5 cm). allow to dry skin

10) Place the index finger of the hand non domianant under the stabbing

location (± 2.5 cm) and pull the skin gently.

11) Insert a syringe with directions 15-30 degrees slowly

13) Remove the tourniquet

14) Disconnect the syringe and cover the injection site with alcohol cotton

15) Replace the plaster on the injection site

16) Remove the syringe from syingernya

17) Enter the blood into the specimen container

18) Give it a label on the specimen container (client name, date, type of

inspection, the name of the room)

19) Insert specimens into a plastic container specimen

20) Trim tool dank client

21) Remove gloves

22) Washing hands

23) documentation of actions

24) Take the specimen container to laboratarium along laboratarium

examination request form.

C. Arterial Blood Sampling

1. understanding

Arterial blood sampling is an action to take arterial blood that the blood

vessels are derived from thick-walled chambers of the heart and stiff.

2. Aim

Arterial blood sampling performed for inspection of blood gas analysis is

used to diagnose and evaluate the respiratory diseases and conditions that affect
 how effectively the lungs deliver oxygen to the blood and eliminate carbon

dioxide from the blood.

 The partial pressure of oxygen (PO2) normal : 75-100 mmHg

 The partial pressure of carbon dioxide (PCO2) normal : 35-45 mmHg

 normal pH : 7.35 to 7.45

 Oxygen saturation (SaO2) : 94-100%

 Oxygen content (O2CT) : 15-23 volume%

 The concentration of bicarbonate (HCO3-) : 22-26 millimols

per liter (mEq / liter)

3. Indication

In patients with lung disease, premature infants with lung disease, diabetes

mellitus associated with diabetic acidosis condition.

4. contraindications

In patients with diseases such as hemophilia bleeding and low platelet

count.

5. Blood collection procedures (venous)

1) Tools and materials

1. 2 ml or 3ml syringe with a needle size 22 or 25 (for children) and the

number 20 or 21 for adults

2. heparin

3. Iodine-povidin
 4. Needle cover (cork or rubber)

5. sterile gauze

6. cotton alcohol

7. Plaster and scissors

8. Pengalas

9. Small towel

10. Disposable gloves

11. Local anesthetic if necessary

12. A container of ice

13. Paper labels for name

14. Crooked

2) stage work

1. Check the tools that will be used

2. Give greetings and call the client in accordance with its name

3. Introduce the name of the nurse

4. Explain the procedure to be performed on the client

5. Describe the purpose of the action taken

6. Keep your clients' privacy

7. Bring the tools to the client side of the bed

8. Position client comfortably

9. Wash hands and wear disposable gloves

10. Replace pengalas

12. Palpating the radial artery

13. Make allen's test

14. Hiperekstensikan clients above the wrist towel rolls

15. Raba back and palpating the radial artery pulsation loudest using the

index finger and middle finger

16. Disinfection of the area to be dipungsi use alcohol cotton

17. While palpating the artery, insert the needle at an angle of 45 ° while

stabilizing arteries with the other clients

18. Observation of pulsation (throbbing) enter syringe blood flow (when

blood can not ride himself may puncture the vein)

19. Take 1 to 2 ml of blood

20. Pull the syringe out of the artery, the former press puncture using gauze

5-10 minutes

21. Exhaust air that is in the syringe, a syringe with a cork stopper or rubber

22. Move it around the syringe so that the blood mixed with heparin

23. Place the syringe on the ice that has been broken

24. Label the specimen containing the name, temperature, oxygen

concentration used client when Kilen using oxygen therapy

25. Send immediately to the laboratory blood

26. Give plaster and gauze if the area of the puncture marks were not

bleeding (for clients receiving anticoagulant therapy, suppression takes

a long time)
 27. Clear up the tools that have been used, remove the gloves

28. Washing hands

29. End the activity and say hello

30. Documented in nursing records AGD examination time, on the side

where the blood is taken and the client response.

3) Things that must be considered

1. Measures arterial puncture should be performed by trained nurses.

2. Syringe is used to draw blood before given heparin to prevent blood

clot.

3. Assess pain threshold client, if the client is unable to tolerate the pain,

give local anesthesia.

4. When using the radial artery, perform a test to determine the patency of

the arterial allent.

5. To ascertain whether the exit venous or arterial blood, see blood coming

out, if we pull out alone without mean arterial blood

6. If the blood has been successfully retrieved, shake the syringe so that

the blood blended and not frozen

7. Do the old emphasis on the former area of insertion (arterial flow is

more rapid than the vein).

8. Remove air from the syringe if it is able to take blood and close the

needle tip with a rubber or cork.

9. Measure vital signs (especially temperature) before blood is drawn.

10. Immediately sent to the laboratory (sito).

 Tube red cap, This tube without the addition of additives, the blood will be
frozen and the serum is separated by centrifugation. Generally used for blood
chemistry, immunology, serology and blood bank (crossmatching test)
 Yellow cap tube, This tube contains a gel separator (serum separator tube /
SST) which separates serum and blood cells. After centrifugation, serum will
be at the top of the gel and the blood cells are under the gel. Generally used
for blood chemistry, immunology and serology
 Bright green cap tube, This tube contains a gel separator (plasma separator
tube / PST) with lithium heparin anticoagulant. After centrifugation, the
plasma will be at the top of the gel and the blood cells are under the gel.
Generally used for blood chemistry.
 Purple or lavender tube cap, This tube contains EDTA. Commonly used for a
complete blood count and blood bank (crossmatch)
 Tube blue cap, This tube contains sodium citrate. Commonly used for
examination of coagulation (eg, PPT, APTT)
 Green cap tube, This tube contains sodium or lithium heparin, commonly used
for examination of erythrocyte osmotic fragility, blood chemistry.
 Dark blue cap tube, This tube contains EDTA-free metal, generally used for
examination of trace elements (zinc, copper, mercury) and toxicology.
 Tube light gray cap, This tube contains sodium fluoride and potassium
oxalate, is used for glucose tests.
 Black cap tube; containing sodium citrate buffer, used for LED examination
(ESR).
 Tube cap pink; containing potassium EDTA, used for inspection
imunohematologi.
 White cap tube; potassium EDTA, used for examination of molecular / PCR
and bDNA.
 Tube yellow with black cap at the top; containing culture media used for
microbiological examination - aerobic, anaerobic and fungal