Coagulation and Times Inversions

7 July 2016

January 6-14 marked my date of assignment as an intern phlebotomist in the premises of our hospital. This was my most awaited section throughout the whole internship thing. I have been looking forward to be assigned in this section since the beginning of internship. Being able to extract blood from different kind of patients such as the geriatric, paediatric and obese is very rewarding because this is the hallmark of being a skilled phlebotomist. At the start of the rotation, I felt a little nervous and excited at the same time.

Good thing that I was already oriented with the dos and don’ts in phlebotomy during my afternoon and night shifts more so, made me feel a little bit confident. Before doing any blood extraction, it is essential to know first the tubes, order of draw and inversions, sites to avoid and select and of course most importantly the patient identification. The commonly used tubes in the laboratory are gold, black , light blue, red, light green and lavender. The mentioned tubes also are in their correct order of draw when evacuated tube method is used.

Coagulation and Times Inversions Essay Example

Gold top tubes contain Serum Separator Gel which are used for chemistry, immunology and serology tests and requires 5-6 inversions. Light blue tubes contain sodium citrate which are used for coagulation tests and only requires 3-4 inversions. Black top tubes on the other hand contain buffered sodium citrate which are used for erythrocyte sedimentation rate and requires 8-10 times inversions. Red plastic tubes which contain silica enhances clot formation and are used also for chemistry, immunology and serology and blood bank and also requires 5-6 times inversions.

Light green tubes contain lithium heparin which are used for troponin t and donor screening tests and requires 8-10 inversions. Lastly, the lavender tubes contain EDTA whose action forms calcium salts to remove Ca and prevent clotting and are used in CBC determination and donor screening and crossmatching and also requires 8-10 times inversions. It is also important to avoid blood extraction in sites such as edematous, calloused, burned, cold, cyanotic, and congested area because this will result to failure of collection and may also cause so much pain to patients.

There are many good and skilled phlebotomist in the lab. Some are assigned in warding in-patients (P1 and P2) and others are assigned in out-patients (OPD). I was first assigned as a P1 during my first three days in phlebotomy. The P1 are assigned to Emergency Rooms, Medical Ward Extension and 3rd floor rooms. For in-patients, the warding time is every two hours when the worklist and barcodes were already printed. I first thought that the morning shift was busier than the afternoon and evening shifts but to my surprise, only at the maximum of five patients were to be collected in every warding time.

Usually, the RMT would only let me extract blood by myself. But when I encounter a difficult vein, he was there to assist me. During my P1 days, I was able to perform unique tests such as blood culture and collect blood from difficult sites such as feet. I felt a feeling of fulfilment after doing such activities. When a STAT request is being called by the ER personnel, I was the one who usually collect the blood even if the patient has a difficult vein. Next, I was assigned as a phlebotomist in the OPD.

Usually, a patients’ request form is carried out by the receptionist then printed with barcode. The patient is then called out in order to have blood extraction. Once the patient is in, he must be identified correctly before drawing of blood. After the procedure, the specimens collected were then placed in their trays corresponding to the test. During my last three days in phlebotomy, I was finally assigned as a P2. P2 covered the ICU, OB-surg, Pedia and 4th floor wards. Life as a P2 was a little bit hard because you have to deal more with some unconscious patients, pediatric and newborns.

I’ve learned a lot of techniques from her especially when collecting from pediatric patients. She also introduced me to collect blood from newborns having tests such as bilirubin and newborn screening. After those days as a phlebotomist, I learned to control my nervousness and gained a lot of confidence. The techniques and approaches I encountered will always be treasured and forever will remain in mind. Appreciatively, now I know how to draw blood quickly and efficiently.

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