Time
9:00 am – 10.30 am
10.30 am – 10.45 am
Program
Phlebotomy- Venipuncture-Theory & Practice
Morning Break
Mantoux Test-Theory & Practice
10.45 am – 12.00 pm
Lunch Break
12.00 pm – 1.00 pm
Practical Test-Mantoux Test and Venipuncture
1.00 pm – 2.30 pm
Written Test
2.30 pm – 3.30 pm
Tea Break
3.30 pm – 3.45 pm
Care of patient with Diabetic Mellitus
3.45 pm – 4.45 pm
22/12/2019
4.45 pm – 5.00 pm
Discussion & Evaluation
1
Clinical Training-SRN 2018
Test Questions
Phlebotomy-Venepuncture & Mantoux Test
Part A:
• Answer 20 objectives
question.
• Total marks-20%
Grand Total part A+B=50 marks
Passing Marks-80%
Part B:
• Prepare booklet on below
topics.
• What is Diabetic
Mellitus
• Causes
• Complications.
• Health Education
•
•
•
•
Diet
Exercise
Foot Care
Self-monitoring of blood
glucose
• Pharmacological Management
• Total marks-30%.
• Timeline-2 weeks
Clinical Training
PhlebotomyVenipuncture
Mantoux Test
Injection
Care of patient with
Diabetes Mellitus
Sivagamy Kumaresan
Training ManagerClinical
SRN,OHN, B.Sc., M.Ed.
(Nursing),Trainer (HRDF),
BLS Trainer (IJN).
Phlebotomy
Definition:
• The process of making an
incision in a vein with a needle.
• The procedure is known as a
venepuncture.
Venepuncture
Definition
• The process of obtaining blood
samples from veins for
laboratory testing.
What are the items required for
venepuncture?
Venepuncture Procedure Steps:
Explain the procedure and purpose to the
patient.
Assess the patient's physical condition.
Position the patient - sitting or lying (NEVER
allow the patient to sit upright on a high
stool or standing due to the possibility of
syncope).
Check the requisition form for requested
tests, patient information, and any special
requirements.
Select a suitable site for
venepuncture.
• Prepare the equipment, the
patient and the puncture
site.
• Perform the venepuncture
tourniquet 3-4 inch above
puncture site-not more than
1 min
Clean with alcohol swabcircular
Bevel up-15 – 30 degree
angle with the skin
Improving Venous Access
• Application of a tourniquet promotes venous
distension. The tourniquet should be tight
enough to impede venous return but not
affect arterial flow.
• Lower the extremity below the level of the
heart
• Use muscle action to force blood into the
veins - e.g. open and closing of the fist
• Light tapping of the vein
Select a suitable site for
venepuncture.
• Collect the sample in the
appropriate container.
• While the syringe fills, remove
the tourniquet-needle-cotton.
• Label the collection tubes at
the drawing area.
• Immediately send the
specimens with the requisition
to the lab.
Notes:
 Additives preserve the specimen, prevent
deterioration and coagulation, or block action of
certain enzymes in blood cells.
 After filled the tube, immediately invert the
tube several times to prevent coagulation.
Tubes with anticoagulants should be gently and
completely inverted (end over end) 4 to 6 times
after collection.
This process ensures complete mixing of
anticoagulants with the blood sample and prevents
clot formation.
Some tubes contains mark line , you must fill
the tube into this mark line.
Specimens may be rejected for the
following reasons (Unacceptable
Specimens)
• There is a patient name or file number
discrepancy between specimen label and
request form.
• There is no patient name or other unique
identifier on specimen.
• Specimen is too old when received.
• There is apparently no specimen in
container.
• The tube expired.
Avoid performing a venepuncture on:
Arm on side of mastectomy
Scarred or burned
areas
Avoid performing a venepuncture on:
Oedematous
Hematoma
Care of patient
with Diabetic
Mellitus
Booklet on DM
• Prepare a booklet on DM
• Objective:• Able to give health education to the patients.
• Timeline-2 weeks-19/4/2018
• Content:
Definition
Diet
Exercise
Self monitoring of blood glucose
Medication-insulin
What is diabetes mellitus?
• Diabetes mellitus is a disease that prevents
the body from properly using the energy
from the food.
• The pancreas produces little insulin or no
insulin at all.
Management of Patient with Diabetic
Mellitus
• No cure
• Goal: Prevention of complications,
individualized treatment plans -Appropriate
goal setting
• Diet
• Exercise
• Self-monitoring of blood glucose (SMBG)
• Regular monitoring for complications
• Oral meds/insulin
Group Work
• DM complications
• Diet
• Exercise
• Self-monitoring of blood glucose (SMBG)
• Care of foot
• Oral meds/insulin
Diet
• Diabetic Meal Plan
• Small frequent meals
• CONSISTENCY!
Amount of calories
Amount of carbohydrates
Time
Snacks
Exercise and Diabetes
More Benefit of Exercise
• Increases circulation
• Improve serum lipid levels
• Improves cardiovascular status
• Assist with weight control
• Decreases stress
Rules for the exercising diabetic
•
•
•
•
•
•
•
•
•
•
Talk to Doctor first
Correlate exercise and glucose levels
Don’t exercise when hypoglycemic
Don’t exercise when hyperglycemic >250
Do not exercise when insulin is peaking
Carry a quick source of sugar
Best time = 60-90 minutes after a meal
Proper footwear
May need a pre-exercise snack
Consistency!
Self monitoring of blood glucose
(SMBG)
Foot care
• Regular monitoring for complications
Foot Care
•
•
•
•
•
•
•
•
•
•
Inspect feet daily
Wash feet with warm water and mild soap
Pat dry – do not rub
Wash daily: wash feet in warm water every day, using a
mild soap.
Dry between toes
Lubricate dry feet
Inspect
Mirror
Family
Between toes
Foot Care
• Do not soak feet.
• Dry feet well, especially between the toes.
• If the skin on feet is dry, keep it moist by applying lotion
after washing and drying.
• Apply lotion on feet (not interdigital areas)
• Check toenails once a week.
• Trim toenails with a nail clipper straight across.
• Do not round off the corners of toenails or cut down on
the sides of the nails.
• After clipping, smooth the nails with an emery board.
Foot Care
• Always wear socks or stockings with soft
elastic, and that fit feet.
• Wear socks at night if feet get cold.
• Always wear closed-toed shoes or slippers.
• Do not wear sandals and do not walk
barefoot, even around the house.
Foot Care
• Wear comfortable properly fitted shoes
• Buy shoes made of canvas or leather and
break them in slowly.
• Extra wide shoes are also available in
specialty stores that will allow for more room
for the foot for people with foot deformities.
• Break in new pair of shoes for 1 -2 hours only
until it becomes comfortable.
Pharmacological Management.
• Biguanides
• Sulfonylureas
• Meglitinide derivatives
• Alpha-glucosidase inhibitors
• Thiazolidinediones (TZDs)
• Insulins
• Amylinomimetics
• 1.) Which one of the following is true regarding tuberculin skin testing?
A. The injection is intramuscular
B. The injection is subcutaneous
C. The injection in intradermal
D. The injection is intravenous
2.) The injection material is comprised of which one of the following?
A. A live attenuated virus
B. Purified protein derivatives of the mycobacterial cell wall
C. Live attenuated strains of Bacillus-Calmette-Guerin
D. Killed strains of Mycobacterim bovis
• 3.) At which anatomic site should the test be placed?
A. Forearm
B. Deltoid region
C. Abdominal wall
D. Gluteal region
• 4.) How long after the injection should the skin test be
read?
A. One hour
B. Twelve hours
C. Twenty four hours
D. Forty-eight hours
• 5.) How should erythema (redness) at the test site be
interpreted ?
A. Indicative of active tuberculous infection
B. Indicative of latent tuberculous infection
C. Indicative of an allergy to the testing material
D. There is no significance to erythema at the test site