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Basic blood circulation in heart
- DOB enters right side of heart
- DOB goes to lungs
- OB enters left side of heart
- OB enters periphery
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Artery vs vein (structure)
- Artery: endothelium (inner), smooth muscle/elastic CT (mid), fibrous CT (outer)
- more rigid
- Vein: thin muscle layer, thin CT layer, valves to prevent backflow
- bouncy
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Artery vs vein (qty)
- More veins than arteries
- redundancy in case of injury
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Artery vs vein vs tendon (feel)
- A: feel pulse, accessed w/o tourniquet
- T: hard (even w/o tourniquet), painful if stuck
- V: bouncy, expand w/ tourniquet
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What are the 3 veins most commonly used w/ location.
- 1 - Median cubital: in center of arm (well anchored)
- 2 - Cephalic: thumb side (less anchored)
- 3 - basillic: pinky side (near artery AND nerve)
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What are the major anticoagulants? What do they bind and what are they normally used for?
- EDTA (lav/pink): strongly chelates Ca2+
- lav for hematology
- pink for blood bank
- Lithium heparin (green): uses Serine protease inhibtors that act directly on clotting cascade proteins
- for chem panels
- Na Citrate (lt blue): weakly binds cations, easily reversable
- for coagulation
- Acid Citrate Dextrose (ACD) (yellow): for HLA and DNA testing
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Order of draw by color
- Blood cultures / SPS
- Lt blue
- Red
- Gold
- Green
- Purple/Pink
- Gray
- *some facilities prefer red then lt blue
- *skin puncture order is opposite (EDTA -> other -> serum)
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venipuncture procedure
- greet patient, introduce self
- describe procedure
- ID patient (name/DOB, name/med record)
- assemble equipment in easy reach
- inspect arm
- apply tourniquet
- palpate
- remove tourniquet
- clean area
- position needle bevel up
- insert needle at 15-30deg angle
- push first evac container into holder
- change tubes
- invert filled tubes
- remove tourniquet during last tube (or 1 min)
- place gauze over puncture, remove needle
- apply pressure
- activate needle safety device
- discard needle into sharps container
- ensure bleeding has ceased
- secure gauze with tape
- label tubes immediately (patient present)
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hematoma vs petichiae
- hematoma: patients should apply pressure and keep arm straightened after procedure
- punctured arm elevated above heart
- discontinue draw if hematoma is noticed during draw
- petechiae: may form during tourniquet application (even w/ correct technique)
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basic guidelines for abnormal/unique draw situations
- draw distal to hardened veins
- draw opposite to mastectomy
- draw away from fistula
- draw away from hematomas
- anchor loose veins well
- do not draw above an IV
- do not draw through burned area
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describe skin puncture procedure
- clean site to be punctured (ring or middle finger)
- make puncture w/ device (perpendicular to fingerprint lines)
- wipe away first drop
- collect in microtainers
- apply bandage
- OPPOSITE ORDER OF DRAW (EDTA -> other -> serum)
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special precautions for children
- Excessive crying increases leukocytes
- milking site can cause hemolysis
- NO pressure bandages
- lancets should be limited in depth (Tenderfoot)
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blood culture basics
- skin cleaned with iodine or chlorasepps
- alcohol (bacteriostatic)
- iodine in scrubbing motion, then circle 2-3 inches from site
- clean bottle tops with alcohol
- apply tourniquet
- fill aerobic bottle first
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3 categories of isolation
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