Phlebotomy procedure

Assalamu’alaikum… memandangkan dah masuk clinical year ni, everybody really interested in taking blood for investigation kan. Some of us (including me la, always forget about the right method for it). So kat sini, I just wanna share pasal phlebetomy and few tips in it.

1) What is phlebotomy?

- Obtaining blood from a vein

2) Common site

a) Median cubital vein and cephalic vein (try avoid vein branch kat bahagian medial dengan lateral site sebab painful kerana dekat dgn nerve innervation. Paling save kat tengah2 cubital fossa la)

b) Dorsum of hand

c) Foot (dalam emergency case bila vein kat hand not readily acessable

3) Elakkan/jauhi lokasi spt

- Extensive scar

- Upper limb of same side wth previous mastectomy

- Hematoma

- Same site dgn IV line. Kalau terpaksa jugak, tutup dulu IV dlm 2-3 minit bru amik. Then amik level yg lg bawah drpd posisi IV line

- Edema

4) Bahan yang diperlukan

- Kidney dish

- Syringe (depend nak buat test ape.. guan syringe 3ml, 5ml atau 10ml)

- Needle (saiz sesuai dgn saiz patient. Biasanya needle yg warna biru muda tu)

- Sample bottle

- Alcohol swab

- Cotton wool

- Salotepe

- Glove

- Torniquet (may or may not)

5) Step

- Patient ID (right PT)

- Access keadaan physical pesakit

- Check form (what type of blood investigation)

- Prepare alat2

- Pilih site of vein puncture

- Check pt allergy to antiseptic, adhesive, latex

- Positioning (sit on chair/bed, lying supine + hand hyper extend)

- Torniquet 3-4 inci atas vene puncture site

- Pakai glove

- Suruh patient gengam tangan. X perlu suh patient pumping tangan

- Sapu alcohol swab inner to outer layer. Biarkan dlm 15-20s supaya alcohol dry

- Anchor patient hand (dalam orang tua kena stretch skin sebab needle senang displace nanti)

- syringe tu, korang tarik sikit biar bagi ada space dlm 1ml.. nanti dia akan create vaccum space. Jadi dia akan draw blood easily.

- Cucuk jarum 15-30 degree sampai dengar bunyi pop atau nampak darah masuk dlm syringe.

- Bila dah nampak darah flow dalam syring.. secure syringe. Don’t move it and drain blood slowly

- Kalau korang tiba2 miss vein. Korang try position balik benda tu dlm vein.. tapi jangan tarik kuar semua jarum and cucuk balik sebab lagi sakit

- Bila dah siap drain dlm syringe, remove torniquet

- Press site vene puncture dgn cotton wool and tarik jarum keluar.. secure cotton wool dgn selotape

- Then step yg paling penting ialah mcm mana nak masukkan dalam tube kalau involve banyak jenis sample (check kat bawah)

- Make sure correct labelling of pt id dekat botol sample tu.

6) Filling blood into container (esp utk multiple Ix)

- First isi dalam container untuk blood culture

- Kedua- coagulation tube

- Tube with non-additive

- Tube additive mengikut turutan (SST, sodium heparin, PST, EDTA, ACDA/ACDB, Oxalate/fluride) ** tube yg ada additive kena mixkan blood dgn additive adequately. (Goncang bottle slowly)

TIPS

1) Do no harm to the patient (not more than 2 attempt. Kalau fail suruh doktor. Jangan ngade2 nak experimenting on patient.. ni yang saya PALING ANTI.. ape korang ingat x sakit ke?? Tak caye try la cucuk kat diri sendiri)

2) Order of filling blood sgt penting sebab additive can give false positive result

3) Kalau untuk C&S kena ingt yg ia adalah sterile procedure. Amik set khusus utk C&S sampling and pakai sterile glove. Get assistant to help you.

4) Untuk test bagi level serum potassium, kena drain blood tanpa torniquet sebab ia akan sebabkan lysis of blood. So akan jadi false hyperK+.. my suggestion amik kat dorsum vein sebab lg senang nampak.

5) Torniquet apply not more than 1 minute

6) Must look Confident

7) Be honest to patient. Cakap yg kita ni just med student bukan expert.jangan temberang patient. Kalau korang x pernah buat, terus terang je, xyah nak temberang. Kalau depa x bagi xyah la amik. Lagipun bukan keje kita pun amik darah.

8) Talk to the patient during process to calm them..

9) Kalau fail amik darah tu, bagitau elok2 kat patient and apologize.

Notes:

1) Sorry dalam bahasa rojak

2) Sorry kalau ada bahasa kasar atau x selesa kat dalam tu

3) Kalau ada salah atau nak tambah jangan segan2 bagitau…