Venipuncture Procedure

Venous Blood Sampling

Prior to the processing always protect yourself with personal protective equipment.


1- At First ensure the patient arm is supportet then feel vein you suppose to draw


2- Apply a tourniquet proximal to the venepuncture site and let's it easy to untie with your only hand


3- Tap on or rub the skin overlying the vein you want to puncture lightly to make it standout; or if the vein is obscure, you may be able to palpate its course with you index finger.
- Sterilization with alcohol and leave to dry in air (traces of alcohol causes hemolysis)


4- Pick up the vacutainer and remove the needle guard. (If you using syringe hold it between the thumb and the middle, ring and small finger of your dominant hand and steady the needle using your index finger. " Never hold the syringe like a pencil because it limits your angle of skin entry ")

 
5- Insert the needle with the hole on the beveled edge facing up , keeping your finger position on the tube secure and steady. Insert the first vial and continued to fill the remaining vial as needed.
(If you using the syringe confirm the entry of the vein by aspiration of blood.)

 
6- When the last vial is filing release the tourniquet the remove the vial. ( Once the desired volume of blood is aspirated into the syringe, steady it with one hand and release the tourniquet with the other hand.)


7- Use a piece of dry gauze to apply gentle pressure to the entry site while the needle is withdrawn.


8- Ask the patient to continue to apply pressure while you attend to the specimen obtained .


9- Remove the needle from the tube/syringe and drop it into the special box for disposal of sharp  instruments immediately.

10- Uncap the specimen container and deposit the blood sample into it directly from the syringe. Injecting blood into the container via the needle is not advisable because:

• (a) you may prick yourself and

• (b) forcing blood through the needle may cause hemolysis that can adversely affect the analytical fitness of the specimen.

More than 100 Keyboard Shortcuts must read

More than 100 Keyboard Shortcuts must read

Keyboard Shorcuts (Microsoft Windows)
1. CTRL+C (Copy)
2. CTRL+X (Cut)
3. CTRL+V (Paste)
4. CTRL+Z (Undo)
5. DELETE (Delete)
6. SHIFT+DELETE (Delete the selected item permanently without placing the item in the Recycle Bin)
7. CTRL while dragging an item (Copy the selected item)
8. CTRL+SHIFT while dragging an item (Create a shortcut to the selected item)
9. F2 key (Rename the selected item)
10. CTRL+RIGHT ARROW (Move the insertion point to the beginning of the next word)
11. CTRL+LEFT ARROW (Move the insertion point to the beginning of the previous word)
12. CTRL+DOWN ARROW (Move the insertion point to the beginning of the next paragraph)
13. CTRL+UP ARROW (Move the insertion point to the beginning of the previous paragraph)
14. CTRL+SHIFT with any of the arrow keys (Highlight a block of text)
SHIFT with any of the arrow keys (Select more than one item in a window or on the desktop, or select text in a document)
15. CTRL+A (Select all)
16. F3 key (Search for a file or a folder)
17. ALT+ENTER (View the properties for the selected item)
18. ALT+F4 (Close the active item, or quit the active program)
19. ALT+ENTER (Display the properties of the selected object)
20. ALT+SPACEBAR (Open the shortcut menu for the active window)
21. CTRL+F4 (Close the active document in programs that enable you to have multiple documents opensimultaneou sly)
22. ALT+TAB (Switch between the open items)
23. ALT+ESC (Cycle through items in the order that they had been opened)
24. F6 key (Cycle through the screen elements in a window or on the desktop)
25. F4 key (Display the Address bar list in My Computer or Windows Explorer)
26. SHIFT+F10 (Display the shortcut menu for the selected item)
27. ALT+SPACEBAR (Display the System menu for the active window)
28. CTRL+ESC (Display the Start menu)
29. ALT+Underlined letter in a menu name (Display the corresponding menu) Underlined letter in a command name on an open menu (Perform the corresponding command)
30. F10 key (Activate the menu bar in the active program)
31. RIGHT ARROW (Open the next menu to the right, or open a submenu)
32. LEFT ARROW (Open the next menu to the left, or close a submenu)
33. F5 key (Update the active window)
34. BACKSPACE (View the folder onelevel up in My Computer or Windows Explorer)
35. ESC (Cancel the current task)
36. SHIFT when you insert a CD-ROMinto the CD-ROM drive (Prevent the CD-ROM from automatically playing)
 

Dialog Box - Keyboard Shortcuts
1. CTRL+TAB (Move forward through the tabs)
2. CTRL+SHIFT+TAB (Move backward through the tabs)
3. TAB (Move forward through the options)
4. SHIFT+TAB (Move backward through the options)
5. ALT+Underlined letter (Perform the corresponding command or select the corresponding option)
6. ENTER (Perform the command for the active option or button)
7. SPACEBAR (Select or clear the check box if the active option is a check box)
8. Arrow keys (Select a button if the active option is a group of option buttons)
9. F1 key (Display Help)
10. F4 key (Display the items in the active list)
11. BACKSPACE (Open a folder one level up if a folder is selected in the Save As or Open dialog box)

Microsoft Natural Keyboard Shortcuts
1. Windows Logo (Display or hide the Start menu)
2. Windows Logo+BREAK (Display the System Properties dialog box)
3. Windows Logo+D (Display the desktop)
4. Windows Logo+M (Minimize all of the windows)
5. Windows Logo+SHIFT+M (Restorethe minimized windows)
6. Windows Logo+E (Open My Computer)
7. Windows Logo+F (Search for a file or a folder)
8. CTRL+Windows Logo+F (Search for computers)
9. Windows Logo+F1 (Display Windows Help)
10. Windows Logo+ L (Lock the keyboard)
11. Windows Logo+R (Open the Run dialog box)
12. Windows Logo+U (Open Utility Manager)
13. Accessibility Keyboard Shortcuts
14. Right SHIFT for eight seconds (Switch FilterKeys either on or off)
15. Left ALT+left SHIFT+PRINT SCREEN (Switch High Contrast either on or off)
16. Left ALT+left SHIFT+NUM LOCK (Switch the MouseKeys either on or off)
17. SHIFT five times (Switch the StickyKeys either on or off)
18. NUM LOCK for five seconds (Switch the ToggleKeys either on or off)
19. Windows Logo +U (Open Utility Manager)
20. Windows Explorer Keyboard Shortcuts
21. END (Display the bottom of the active window)
22. HOME (Display the top of the active window)
23. NUM LOCK+Asterisk sign (*) (Display all of the subfolders that are under the selected folder)
24. NUM LOCK+Plus sign (+) (Display the contents of the selected folder)
25. NUM LOCK+Minus sign (-) (Collapse the selected folder)
26. LEFT ARROW (Collapse the current selection if it is expanded, or select the parent folder)
27. RIGHT ARROW (Display the current selection if it is collapsed, or select the first subfolder)
 

Shortcut Keys for Character Map
After you double-click a character on the grid of characters, you can move through the grid by using the keyboard shortcuts:
1. RIGHT ARROW (Move to the rightor to the beginning of the next line)
2. LEFT ARROW (Move to the left orto the end of the previous line)
3. UP ARROW (Move up one row)
4. DOWN ARROW (Move down one row)
5. PAGE UP (Move up one screen at a time)
6. PAGE DOWN (Move down one screen at a time)
7. HOME (Move to the beginning of the line)
8. END (Move to the end of the line)
9. CTRL+HOME (Move to the first character)
10. CTRL+END (Move to the last character)
11. SPACEBAR (Switch between Enlarged and Normal mode when a character is selected)
 

Microsoft Management Console (MMC)
Main Window Keyboard Shortcuts
1. CTRL+O (Open a saved console)
2. CTRL+N (Open a new console)
3. CTRL+S (Save the open console)
4. CTRL+M (Add or remove a console item)
5. CTRL+W (Open a new window)
6. F5 key (Update the content of all console windows)
7. ALT+SPACEBAR (Display the MMC window menu)
8. ALT+F4 (Close the console)
9. ALT+A (Display the Action menu)
10. ALT+V (Display the View menu)
11. ALT+F (Display the File menu)
12. ALT+O (Display the Favorites menu)

MMC Console Window Keyboard Shortcuts
1. CTRL+P (Print the current page or active pane)
2. ALT+Minus sign (-) (Display the window menu for the active console window)
3. SHIFT+F10 (Display the Action shortcut menu for the selected item)
4. F1 key (Open the Help topic, if any, for the selected item)
5. F5 key (Update the content of all console windows)
6. CTRL+F10 (Maximize the active console window)
7. CTRL+F5 (Restore the active console window)
8. ALT+ENTER (Display the Properties dialog box, if any, for theselected item)
9. F2 key (Rename the selected item)
10. CTRL+F4 (Close the active console window. When a console has only one console window, this shortcut closes the console)
 

Remote Desktop Connection Navigation
1. CTRL+ALT+END (Open the Microsoft Windows NT Security dialog box)
2. ALT+PAGE UP (Switch between programs from left to right)
3. ALT+PAGE DOWN (Switch between programs from right to left)
4. ALT+INSERT (Cycle through the programs in most recently used order)
5. ALT+HOME (Display the Start menu)
6. CTRL+ALT+BREAK (Switch the client computer between a window and a full screen)
7. ALT+DELETE (Display the Windows menu)
8. CTRL+ALT+Minus sign (-) (Place a snapshot of the active window in the client on the Terminal server clipboard and provide the same functionality as pressing PRINT SCREEN on a local computer.)
9. CTRL+ALT+Plus sign (+) (Place asnapshot of the entire client window area on the Terminal server clipboardand provide the same functionality aspressing ALT+PRINT SCREEN on a local computer.)

Microsoft Internet Explorer Keyboard Shortcuts
1. CTRL+B (Open the Organize Favorites dialog box)
2. CTRL+E (Open the Search bar)
3. CTRL+F (Start the Find utility)
4. CTRL+H (Open the History bar)
5. CTRL+I (Open the Favorites bar)
6. CTRL+L (Open the Open dialog box)
7. CTRL+N (Start another instance of the browser with the same Web address)
8. CTRL+O (Open the Open dialog box,the same as CTRL+L)
9. CTRL+P (Open the Print dialog box)
10. CTRL+R (Update the current Web )

Rh Incompatibility in Pregnancy

Rh Incompatibility in Pregnancy


The most common type of Rh incompatibility occurs when an Rh-negative pregnant mother is exposed to Rh-positive fetal red blood cells secondary to fetomaternal hemorrhage during the course of pregnancy from spontaneous or induced abortion, trauma, invasive obstetric procedures, or normal delivery .

Rh incompatibility can also occur when an Rh-negative female receives an Rh-positive blood transfusion.

An Rh-negative woman become alloimmunized to the D antigen present on fetal red blood cells (RBCs) during the first Rh-incompatible pregnancy. The first pregnancy is rarely affected because the number of Rh antibodies produced by the mother during primary immunization is low and the antibodies are usually IgM in nature . IgM can’t cross placental barrier.

When the mother is exposed to D-positive fetal RBCs during a subsequent Rh-incompatible pregnancy, the mother mounts an anamnestic, or secondary, immune response to the fetus’ RBCs. A large number of IgG-class Rh antibodies are produced. The IgG antibodies cross the placenta and make fetal red cells susceptible to destruction. The fetal RBCs are then destroyed by the fetal immune system. Anemia develops in the fetus with a concomitant increase in unconjugated bilirubin. The anemia and unconjugated bilirubin levels can lead to a number of conditions.

Treatment with Rh IgG (RhoGAM)

The current recommendation is that every Rh-negative nonimmunized woman who presents to the ED with antepartum bleeding or potential fetomaternal hemorrhage should receive 300 mcg of Rh IgG IM. For every 30 mL of fetal whole blood exposed to maternal circulation, 300 mcg of Rh IgG should be administered . A lower 50-mcg dose preparation of Rh IgG is available and recommended for Rh-negative females who have termination of pregnancy in the first trimester when fetomaternal hemorrhage is believed to be minimal.

Because of its short half-life, Rh IgG routinely is administered once at 28-32 weeks’ gestation and again within 72 hours after birth to all Rh-negative pregnant females as a part of routine prenatal care.

Other important points:

Determination of Rh blood type is required in every pregnant female.
Overall, 16% of Rh-negative women will become sensitized after their first pregnancy if not given Rhogam.
In a pregnant woman with Rh-negative blood type, the Rosette screening test often is the first test performed. The Rosette test can detect alloimmunization caused by very small amounts of fetomaternal hemorrhage.
Amniotic bilirubin scan (also known as ΔOD450) is a prenatal testing procedure . Results interpreted using a Liley or Queenan chart (Queenan chart is reported to have higher diagnostic accuracy for identifying severe anemia).

The Liley curve is divided into three zones.
 
A result in Zone I indicates mild or no disease. Fetuses in zone I are usually followed with amniocentesis every 3 weeks.
A result in zone II indicates intermediate disease. Fetuses in low Zone II are usually followed by amniocentesis every 1-2 weeks.
A result above the middle of Zone II may require transfusion or delivery.
Obtaining maternal Rh antibody titers can be helpful for future follow-up care of pregnant females who are known to be Rh negative. Maternal serum antibody Rh titer >15 IU/mL indicates high risk of severe fetal anemia.
Immediately after the birth of any infant with an Rh-negative mother examine blood from the umbilical cord of the infant for ABO blood group and Rh type, measure hematocrit and hemoglobin levels, perform a serum bilirubin analysis, obtain a blood smear, and perform a direct Coombs test.
A positive direct Coombs test result confirms the diagnosis of antibody-induced hemolytic anemia, which suggests the presence of ABO or Rh incompatibility.

Why it Itches when mosquitoes bites us and how to deal with it

Why it Itches when mosquitoes bites us?

Normally mosquito feed on nectar. They are found only female mosquitoes that suck blood. Various types of mosquitoes cause difference disease. However they cause itch on your skin. The female mosquitoes poke their proboscis through your skin so they can suck some of your blood to be later used to make eggs, they inject you with some of their saliva.

This saliva helps them to suck your blood more quickly, because it contains a cocktail of anticoagulants. It may function as blood anticoagulants so it won't clot during sucking. Once the female mosquito is full up of your blood or is disturbed, she flies away, leaving some of her saliva behind. Your body then kicks your immune system in gear as a response to the presence of this saliva.

It produces various antibodies which in turn bind to the antigens in the mosquito’s saliva. This then triggers the release of histamine.

Histamine is a nitrogen compound that, among other things, triggers an inflammatory response. It also helps white blood cells and other proteins to engage invaders in your body by making the capillaries of these cells more permeable. Bottom line, the histamine ends up making the blood vessels near the bite swell up. This produces a pink, itchy bump where the mosquito poked you.

Scratching the bump only makes this worse because it causes more irritation and inflammation of the sight, 

resulting in your immune system thinking it needs more antibodies to get rid of the foreign protein. So the more you scratch, the more it will swell; the itchier it will get; and the longer it will last.

Fit's Tips: After you realize that you've been bitten, try with all your might NOT to scratch that annoying itch - it'll only make it itch and swell more. Wash the area with soap and water, then apply calamine lotion, cortisone, or any other anti-itch cream to the infected area. An ice pack may also help.

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