What Is The First Step In Routine Blood Collection

[Sean Vaidhyanathan]

Thischapter covers all the steps recommended for safe phlebotomy and reiterates the accepted principles for blood drawing and blood collection (31). The chapter includes background information (Section 2.1), practical guidance (Section 2.2) and illustrations (Section 2.3) relevant to best practices in phlebotomy.

The information given in this section underpins that given in the remainder of Part II for specific situations. Chapter 4 also provides information relevant to the procedure for drawing blood given below in Section 2.2, but focuses on blood collection from donors.

Quality assurance is an essential part of best practice in infection prevention and control (1). In phlebotomy, it helps to minimize the chance of a mishap. Table 2.1 lists the main components of quality assurance, and explains why they are important.

Several safety-engineered devices are available on the market; such devices reduce exposure to blood and injuries. However, the use of such devices should be accompanied by other infection prevention and control practices, and training in their use. Not all safety devices are applicable to phlebotomy. Before selecting a safety-engineered device, users should thoroughly investigate available devices to determine their appropriate use, compatibility with existing phlebotomy practices, and efficacy in protecting staff and patients (12, 33). Annex B provides further information on infection prevention and control, safety equipment and best practice; Annex C provides a comprehensive guide to devices available for drawing blood, including safety-engineered equipment.

Support services should be promoted for those who undergo accidental exposure. PEP can help to avert HIV and hepatitis B infections (13, 27). Hepatitis B immunization should be provided to all health workers (including cleaners and waste handlers), either upon entry into health-care services or as part of PEP (34). Annex D has details of PEP for hepatitis B and HIV.

Tourniquets are a potential source of methicillin-resistant Staphylococcus aureus (MRSA), with up to 25% of tourniquets contaminated through lack of hand hygiene on the part of the phlebotomist or reuse of contaminated tourniquets (35). In addition, reusable finger-prick devices and related point-of-care testing devices (e.g. glucometers) contaminated with blood have been implicated in outbreaks of hepatitis B (4, 5, 36).

In hospitalized patients, do not take blood from an existing peripheral venous access site because this may give false results. Haemolysis, contamination and presence of intravenous fluid and medication can all alter the results (39). Nursing staff and physicians may access central venous lines for specimens following protocols. However, specimens from central lines carry a risk of contamination or erroneous laboratory test results.

Draw blood collection tubes in the correct order, to avoid cross-contamination of additives between tubes. As colour coding and tube additives may vary, verify recommendations with local laboratories. For illustration purposes, Table 2.3 shows the revised, simplified recommended order of draw for vacuum tubes or syringe and needle, based on United States National Committee Clinical Laboratory Standards consensus in 2003 (43).

If blood spillage has occurred (e.g. because of a laboratory sample breaking in the phlebotomy area or during transportation, or excessive bleeding during the procedure), clean it up. An example of a safe procedure is given below.

If a person was exposed to blood through nonintact skin, mucous membranes or a puncture wound, complete an incident report, as described in WHO best practices for injections and related procedures toolkit. For transportation of blood samples outside a hospital, equip the transportation vehicle with a blood spillage kit. Annex H has further information on dealing with a blood spillage.

Certain lab tests are part of routine care during pregnancy. Some of these tests are done with a blood sample. Others use a urine sample or a sample of fluid taken from your vagina, cervix, or rectum. These tests can help find conditions that may increase the risk of complications for you and your fetus. Many problems found by these tests can be treated during pregnancy.

A CBC counts the number of different types of cells that make up your blood. The number of red blood cells can show whether you have a certain type of anemia. The number of white blood cells can show how many disease-fighting cells are in your blood. The number of platelets can reveal whether you have a problem with blood clotting.

If you are Rh negative, you may be given medication during pregnancy to help prevent the development of Rh antibodies. If you are Rh negative and have already made a certain number of Rh antibodies, you might need special tests and monitoring throughout pregnancy. Your baby may also need treatment after birth.

This test also measures the amount of protein in your blood, which can be compared to levels later in pregnancy. High protein levels may signal kidney disease or preeclampsia, a serious complication that can occur later in pregnancy or after the baby is born.

It can take several days to get the results of this test. If the test shows bacteria in your urine, you should be treated with antibiotics. After you finish treatment, you may have a repeat test to see if the bacteria are gone.

Rubella (sometimes called German measles) can cause birth defects if you are infected during pregnancy. Your blood can show whether you have been infected with rubella or if you have been vaccinated against this disease. If you had this infection before or you have been vaccinated against rubella, you are immune to the disease.

Rubella is easily spread. If your blood test shows you are not immune, avoid anyone who has the disease while you are pregnant. There is a vaccine, but it contains a live virus and is not recommended during pregnancy. If you have not been vaccinated, you can get the measles-mumps-rubella (MMR) vaccine after the baby is born.

Hepatitis is a virus that infects the liver. If you are pregnant and have hepatitis B or hepatitis C, you can pass the virus to your fetus. Everyone should be tested for hepatitis B and hepatitis C infection during pregnancy.

If you are infected with hepatitis B or hepatitis C, you might need special care during pregnancy. Your baby may also need special care after birth. You can breastfeed if you have either infection. A vaccine is available to protect the baby against hepatitis B. The vaccine is given as a series of three shots, with the first dose given to the baby within a few hours of birth. Read Hepatitis B and Hepatitis C in Pregnancy to learn more.

While you are pregnant, you can take medication that can greatly reduce the risk of passing HIV to your fetus. You can also get specialized care to ensure that you stay as healthy as possible throughout your pregnancy. This is why everyone is tested for HIV early in pregnancy. Read HIV and Pregnancy to learn more.

If you have syphilis, chlamydia, or gonorrhea, you should be treated during pregnancy and tested again to see if the treatment has worked. Your sex partner or partners should also be treated to prevent you from getting infected again.

People who are at high risk of TB should be tested for it. Those at high risk include people who are infected with HIV, live in close contact with someone who has TB, or are from a country with high rates of TB.

This test measures the level of glucose, or sugar, in your blood. A high blood sugar level may be a sign of gestational diabetes, which can cause problems during pregnancy. For this test, you drink a special sugar mixture. An hour later, a blood sample is taken and sent to a lab. If your blood sugar level is high, you should have another type of glucose test to confirm the results.

This test usually is done between 24 and 28 weeks of pregnancy. This test might be done in the first trimester of pregnancy if you have risk factors for diabetes or had gestational diabetes in a past pregnancy.

In women, GBS is most often found in the vagina and rectum. This means that GBS can pass from you to your fetus during labor. This is rare. It happens to 1 or 2 babies out of 100 when the mother does not receive treatment with antibiotics during labor. The chance of a newborn getting sick is much lower when the mother receives treatment.

If the results show that GBS is present, antibiotics should be given through an intravenous (IV) line once labor has started. This is done to help protect the fetus from being infected. The best time for treatment is during labor. Read Group B Strep and Pregnancy to learn more.

When done during pregnancy, screening tests can tell you the chances that the fetus may be at risk for certain common birth defects. A screening test cannot tell whether the fetus actually has a birth defect. There is no risk to the fetus from screening tests.

Diagnostic tests can detect many, but not all, birth defects caused by defects in a gene or chromosomes. You can choose to have diagnostic tests instead of or in addition to screening tests. Some diagnostic tests carry risks, including a small risk of pregnancy loss.

No, screening and testing are a personal choice. Some people would rather not know if they are at risk of having a child with a birth defect or whether their child will have a birth defect. Others want to know in advance.

Knowing beforehand allows the option of deciding not to continue the pregnancy. If you choose to continue the pregnancy, knowing beforehand gives you time to prepare for having a child with a disorder. This means you can organize the medical care your child may need. Talk with your ob-gyn or genetic counselor about your test results.

Complications: Diseases or conditions that happen as a result of another disease or condition. An example is pneumonia that develops with the flu. An example of a pregnancy complication is preterm labor.

Group B Streptococcus (GBS): A type of bacteria that many people carry normally and can be passed to the fetus at the time of delivery. GBS can cause serious infection in some newborns. Antibiotics are given during labor to women who carry the bacteria to prevent newborn infection.

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