CHAPTER I

INTRODUCTION
Positioning blood sampling, mainly determined by the type of examination to
be conducted. Considerations for as little as possible of course remains an important
cause of trauma. Intake through the fingertips, called "capillary blood". While taking
in the elbow-in called "venous blood". In addition to the elbow-in, can also
elsewhere, just elbow-in is preferred because it is more profitable. Capillary blood
can be used for inspection purposes hematological (blood) routine: basic filter
anemia (hemoglobin, red blood cells, hematocrit), blood cell count, blood type. There
is a shortage, but is considered negligible for this routine hematology.
How to test blood sugar drops just wear it? This part of the concept Poct
(Point of Care Test). Measurement of blood sugar levels with venous blood is called
the wet-chemistry is that we see a portable that "dry-chemistry". What should be
used? May be used, become not handle. That is, use at home on a regular basis
please, but still must cross-check to the laboratory. Factor "blood condition" as well
as examination techniques with dry-chemistry greatly affect the outcome. Therefore,
periodically check the 1-week at home please, but keep to a routine inspection
laboratory.
While for the purposes of a more complete examination, necessary venous
blood: specific anemia screening (ie screening of iron deficiency anemia), to image
peripheral blood (blood-smear), or for the purpose of chemical examination of blood
(bilirubin levels, sugar content, fat content, protein content, blood electrolytes, etc.).
Problem ways of sampling, if viewed from the side of examination only, certainly
better venous blood. But in terms of comfort, of course if you still can with capillary
blood, it is more convenient for patients.

CHAPTER II
CONTENTS
Science is called phlebotomy blood collection (in fact broader than simply
taking a blood sample or blood sample in the PMI, is simple only). There are
standard tools and training requirements to perform duties as a phlebotomist. As is
common among professional nurses, once the officers making the blood sample is
also only based on field experience of many years. But now there standardize and
included in standard-quality laboratory parameters. Handbook No. 1 a phlebotomis
is: SURE. Determining the location of capture, location of blood vessels, patient
characteristics such as what is possible is constrained, that there is a risk freezing
slow, there is science. Once a phlebotomis not sure, then he should immediately
resign and replaced by another. Similarly, if 2 times trying to fail, will replaced by
another. Some features are more likely to be no obstacles decision: Fat child, so it is
not easy to determine the location of blood vessels Children with small blood vessels,
usually the smaller girls size, making it more difficult to take. Children with the
pattern of blood vessels of different positions. Although there are general patterns,
there is also a different pattern, so phlebotomis should seek more long. Please
understand, nor necessarily rational if we're easy to scold them. Make phlebotomis
nervous because we are angry, will only increase the risk of their failure of duty. A
more rational:
1. Make sure the officers knew exactly phlebotomis and check the identity of our
children. Do not be until there is one identity. The experience of late more and
more common name "beautiful-beautiful". Also - sorry not intend SARA - who
uses the name Chinese / Ethnic particular, need to be very sure because not all
staff understand the concept of "family-name" so that it can going wrong. We'd
better go a little difficulty ensure this, because it can occur without deliberate
mistakes pure officers, other than as it really does not know.

2. If your child ever taken blood samples, to convey the experience.

Were there any barriers, at arms which, when last taken, how the reaction after
taking them. This is very useful for phlebotomis.
3. Ask "how many will be taken, just once with a single instrument, or must be two
times?" (For a particular examination, it should be no different treatment of blood
samples, so that it can be taken separately).
4. After that ask "do you think my child will be difficult or not taken his blood
sample?"
Identity checking procedures, the range of questions before sampling history,
an explanation of how the volume of blood and techniques that will be taken, has
become standard procedure to be explained. With our ask and explain, will become
smaller risk of missing data.
Question of the patients will also give opportunity to the two parties for
mutual confidence measure. If later the officer states difficult, we just go "You are
sure to take a blood sample of my child?". With a stage like this, the officer will not
forward the emotions - which of course was not allowed for whatever reason.
Likewise, if the officer believes, give him support for the more sure. If successful
smoothly, thank you. Even then it failed, to convey "what you should not have
replaced the others to be more confident?". With steps like these, can be avoided
unnecessary stiffness relationship. Now, blood sampling devices are more advanced,
no longer use the syringe as before. There is a special tube that is "vacuum" (negative
pressure) so that the pain is lighter at the same time minimize the risk of bloodfreezing moment just taken. However, there are times also capture still using ordinary
needle, for examination purposes certain (because there are different treatment of
blood samples, unlike blood samples for blood tests in general). Blood sampling was
relatively more difficult in infants, who are getting younger. Need a high technical
and field experience long. The place often have to search for the most possible. Most
preferably remain in elbow-deep, but could also on foot. If our children are being
treated in hospital, there's more blood-making procedures that are technically more
difficult, namely to check Blood-Gas Analysis (BGA: blood gas analysis). What is
needed is "arterial blood" rather than venous blood. Usually taken from the femoral

artery (in the groin). The color of blood (bright) is different from venous blood
(darker). Having taken as soon as possible be avoided from contact with air and
examined as soon as possible. Indeed, school phlebotomis "only" able to teach
science, theory, practice on manequin and a little exercise in patients. Skills can only
be gained from the experience. There is a possibility of blood sampling on you or
your child can not be very successful. However, from experiences like that
phlebotomis will be more skilled. Arterial blood sampling via the function to check
the gases in the blood associated with the function of respiration and metabolism.
The goal:
1. Knowing the state of O2 and cell metabolism
2. Efficiency of O2 and CO2 exchange.
3. HB ability to transport O2 and CO2.
4. The level of O2 in arterial blood pressure.
Place of arterial blood sampling:
1. The radial artery is the safest first choice used for arterial function unless there
are many ex-prick or haematoem also when the Allen test is negative.
2. Dorsalis pedis artery, a second choice.
3. Brachial artery, is the third choice because more risk if there is obstruction of
blood vessels.
4. Femoral artery, is the last option if at all above the artery can not be retrieved.
When there is obstruction of blood vessels would inhibit the flow of blood
throughout the body / leg and if that can lead to long can cause tissue death.
Femoral artery adjacent to the large veins, so that mixing can occur between the
blood veins and arteries.
Steps to perform the function of arterial blood:
1. Preparation tools.
Tray (trolleys) which contains, among others:
- 1 Fruit disposible syringe 2.5 cc.
- 1 piece of disposible syringe 1 cc.
- Cork / rubber as cover needle.
- 2 pieces of sterile gauze pads.

- Bent, tape, scissors.

- Local anesthetics drugs (if) necessary.
- Cotton mix alcohol with bethadine.
- Plastic bags containing the ice when the delivery distance.
- Heparin 5000 units injection 2.5 cc syringe filled with heparin or 0.
1. cc syringe from wet wall to prevent blood clotting. Heparin should not be too
much to affect the results of the examination.
2. Inform patients about the objectives of the arterial blood sampling to be in
puncture.
3. Choosing the artery that will be on tap.
4. Preparing the patient's position:
a. Artery Radialisi:
- Patient bed semi-Fowler and hand straightened.
- Fingering artery if necessary, may be elevated or lifted up his hand.
- The artery should really be felt to ensure the localization.
b. Dorsalis pedis artery
- Patients may be flat / Fowler.
c. Brachial artery
- Position the patient semi-Fowler, hands on hyperextensikan / fouled with the
elbow.
d. Femoral artery
- Position the patient flat
5. Wash hands before and after doing perasat
6. Rabbah again artery to ensure the pulse area to be stabbed after cleaned with
cotton in a circular bethadine. After 30 seconds we repeat with cotton alcohol and
wait until dry.
7. If you need local anethesi drug use 1 cc syringes which are filled with drugs
(adrenaline 1%), then an injection of 0.2 to 0.3 cc intracutan and before the drug
first entered the aspiration to prevent the entry of drugs into blood vessels.

8. Localisation arteries that had been cleaned were fixed by the left hand by means
of skin stretched with both index finger and middle finger so that the artery that
will be stuck between these 2 fingers.
9. Syringe that has been on hold heparinisasi like holding a pencil with his right
hand needle inserted into the artery that has been in the fixation earlier.
- In the radial artery needle position 45 degrees
- In the brachial artery needle position 60 degrees
- In the femoral artery needle position 90 degrees
So that punctured an artery, arterial pressure will push the vacuum syringe so that
blood will easily fill the syringe, but sometimes the blood does not directly come
out. If forced to suck it slowly to prevent hemolysis. When the needle puncture
does not work do not immediately revoked, pull slowly until there under the skin
and then prick may be repeated again towards the throbbing.
10. After blood is obtained as much as 2 cc of us pull the needle and try to position
the syringe pump fixed to prevent terhisapnya air into the syringe and
immediately expelled from the syringe of air bubbles
11. The tip of the needle immediately closed with a cork / rubber.
12. Artery puncture puncture former press with cotton alcohol mixed with bethadine.
- In the radial and dorsalis pedis arteries for 5 minutes
- In the brachial artery for 70-10 minutes
- In the femoral artery for 10 minutes
- If the patient received anticoagulant press for 15 minutes.
13. Localisation prick cover with sterile gauze + bethadine.
14. Label labs and include the name of patient, date and clock-making room,
temperature and type of examination.
15. If delivery / inspection far, included blood-filled plastic bags of ice so that the
examination did not influence by outside air temperature.
16. Back wash hands after completion of the perasat.
Things to consider before and after blood sampling.
a. Regional blood sample should be in place alternating / alternating to prevent
terjadinyakerusakan on blood vessels

b. When using local anesthetics should be tested for drugs in advance to avoid
the occurrence of allergic reactions because of the drug.
c. If patients who require long treatment should be installed arterial line.
d. The red color of blood can be an indication of good / bad of arterial blood.
PPOM patients with low PaO2 values darker blood normally contains less
O2.
e. When may forbid the stabbing in the femoral artery.
f. If necessary, blood sampling via the radial artery to note first the existence of
collateral ulnar artery by way of experiment Allen (Allen's test).
How:
a. Instruct the patient to clench his hands tightly as possible so that blood came
out so that your palms pale.
b. Press the radial and ulnar arteries while the patient open to a closed fist
several times and closed it again. Then the hand is opened, remove the
pressure on the ulnar artery.