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blood collection, arterial blood and testing, :explode:, :explode:, …
blood collection
pediatric patients
branch of medicie dealing sith children infant to 18
drawing blood from children
dealing with the patient and the patients parent.
total blood volume
5 liters in a human adult
10 ml of blood is
0.2%total adult volume
1% of a one year old volume
3% of an infants blood volume
loss of total blood loss exceeds over 10% can result in a cardiac arrest
infants
repeated blood draws can cause latrogenic anemia
no more than 5% total volume in 24 hours
3% is the preferred maximum in 24 hours for an infant
A 7-pound 3.2 kg infant can have 9.6 ml drawn
infants should never have more than 10% blood drawn in a one month period
to determine blood volume of an infant and percentage of the volume
7/2.2= 3.2 weight
3.2 x 100 = 320
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capilarrry puncture is preferred
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always prepare equiptement ahead of time
perform somewhere other than their hospital room
use a soothing voice
explain procedure at childs level of understanding
never say it wont hurt but only a little like a soft pinch
give choices
use shortest needle
use distraction tecniques
give procedure updates
unless patient is older the pateitns parents wil be in the room with the patine`
get consent and advice from parent of caregiver
pateitns siblings can aid with distraction
follow policies for restraining or immobilizing a child if nessessary
respect patients wishes
must be wearing an ID band to draw blood
identify infants by last name and hospital ID number
blood collecton supplies
smallest needles used with very young patients
butterfly is most comon used for pediatric patients
topical anesthetic may be used
infants
bilirubin
buildup causes jaundice
bili-light of bili blanket used for slight abnormality
blood transfusion used for high levels
keeping the specimen sheilded from light
turn off bili light during collection
avoid hemmolysis
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neonatal screening
detection of inhereited inborn metabolic disorders
pku hiv cycstic fibrosis
special filter paper used
do not tough inside the cicles in the printed side of the paper
collect between 24-72 hours after birth
lying supine with heel warmer for 3-5 minutes
heel stick method
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infant venous speciemens
use dorsal hand veins
no tourniquet used
23 gauge needle and syringe pull gently on syringe once blood begins to flow
Special collections addreviations
AV
arteriovemous
reffering to artery or a vein
CVC
central venous catheter
IV
intravenous
PICC
peripherally inserted central catheter
VAD
vascular access device
PKU
phenylketonuria
STAT
immediately or short turnaround time
TLC
tender Loving Care
geriatric patients
skin changes
thinner and less elastic due to decrease collagen
bruising is more likely
longer healing periods
loose skin
use more tension when anchoring the vein
less elastic and more fragile
don now mistake pulseing artery for vein
hearing and speech changes
hearing and visual impairments common with aging
unclear speech can occur with ging but does not imply difficulty with understanding
anticoagulation therapy
apply pressure for longer period
be aware of increased risk of hematoma
frogetfulness confusion and dementia mental changes
check with nurse before loosening restraints if in place
additional considerations
frequency of drams
use gental touch when applying presssure
apply tourniquet over clothing
site considerations
check sities other than antecubital area
use samaller needle or butterfly
longer application of pressure
other collection considerations
repeat blood collection
rotate sites frequently
use smalllest needle or butterfly
consider alternate sites
vascular access device
tube inserted to
administer fluids or medications
monitor blood pressure
draw blood
common in icu and er patients
central venous catheter CVC in chest area
peripherally inserted central catheter PICC in the antecubital area
intravenous IV
draw from opposite arm
if possible have nurse turn off IV for 15 min
the tourniquet is applied and blood is drawn below the IV site from a different vein
discard first sample of blood due to use of heparin
note IV are on requisition
arterial blood and testing
arterial blood
rich in oxoygen and electrolytes
mananges oxygen , electrolytes and acid base balance ph
tests with arterial blood
ammonia levels
lactic acid level
arterial blood gases ABGs
ph
oxygen
carbon dioxide
ABGs are nessessary for critical patients
cadiac failure
respiratory failure
shock
diabetic coma
capilarry blood gas collection
warm heel to 40-42 degrees celsius
use heparinized pipet
fil tube coompletely
seal both ends
arterial puncture
arterial puncture equiptment
syringe
pre tested wwith heprin
1ml to 5ml glass of gas impermeable
needle
21-22 gauge with safety
plastic luer tip to protect against altered gas concentration
alcohol and povidone-iodine used as antiseptic
local anesthetic (lidocaine) may be used
PPE
fluid restraint gown
face protection
gloves
additional equiptment
gauze pads
pressure bandages
thermometer
transport container
crushed ice
water and ice
ice slurry or refrigerate immediately for ammonia and lactic acid specimens
ice slurry after 15-30 minutes at room temperature for arterial blood gasses
arteries
tourniquet is not used for arterial collections
arterial blood is already under pressure
select artery close to surface with collateral circulation
modified allen test determines collateral circulation
radial and brachial arteries most common
femoral and dorsalis pedis require physician or specialized training
modified allen test
radial puncture procedure requires
an artery in near the skin surface
an artery that is large enoufgh for a 23 guage needle
the site distal to collection mus have collateral circulation
https://youtu.be/gdgomN6TsuE?si=MJhvrUn-Y61uUZNc
procedure complications
arterial complications
hematoma
nerve damage
pain
lightheadedness
hemorrhage profuse bleeding
anteriospas, contriction of an artery
embolism
an obstruction
thrombosis
clot formation
arterial complications
ice slurries
used immediately for ammonia and lactic acid
after used 15-30 minutes for ABGs
use for up to an hour
not used for potassium
specimen rejection
air biubbles in specimen
inadequate specimen
used of wrong syringe
spicimen clotting
required ice slurry not used
too lomg between collection and delivery
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