Neurology Physical Examination Lecture

What is Venipuncture? While venipuncture can refer to a variety of procedures, including the insertion of IV tubes into a vein for the direct application of medicine to the blood stream, in phlebotomy venipuncture refers primarily to using a needle to create a blood evacuation point. As a phlebotomist, you must be prepared to perform venipuncture procedures on adults, children, and even infants while maintaining a supportive demeanor and procedural accuracy. Using a variety of blood extraction tools, you must be prepared to respond to numerous complications in order to minimize the risk to the patient while still drawing a clean sample. In its entirety, venipuncture includes every step in a blood draw procedure—from patient identification to puncturing the vein to labeling the sample. Patient information, needle placement, and emotional environment all play a part in the collection of a blood sample, and it's the fine details that can mean the difference between a definite result and a false positive. After placing the tourniquet and finding the vein, it's time for the phlebotomist to make the complex choice on what procedure will best suit the specific situation. Keeping this in mind, it should be noted that the following information is not an instructional guide on how to perform these phlebotomy procedures. Rather, the information below is intended to serve as an educational resource to inform you of the equipment and procedures you will use. Venipuncture Technqiues Venipuncture with an Evacuated or Vacuum Tube: This is the standard procedure for venipuncture testing. Using a needle and sheath system, this procedure allows multiple sample tubes to be filled through a single puncture. This procedure is ideal for reducing trauma to patients. After drawing the blood, the phlebotomist must make sure the test stopper is correctly coded and doesn't contact exposed blood between samples. Venipuncture with a Butterfly Needle : This is a specialized procedure that utilizes a flexible, butterfly needle adaptor. A butterfly needle has two plastic wings (one on either side of the needle) and is connected to a flexible tube, which is then attached to a reservoir for the blood. Due to the small gauge of the needle and the flexibility of the tube, this procedure is used most often in pediatric care, where the patients tend to have smaller veins and are more likely to move around during the procedure. After being inserted into a vein at a shallow angle, the butterfly needle is held in place by the wings, which allow the phlebotomist to grasp the needle very close to the skin. Phlebotomists should be careful to watch for blood clots in the flexible tubing. Venipuncture with a Syringe: This technique is typically only used when there is a supply shortage, or when a technician thinks it is the appropriate method. It uses the classic needle, tube, and plunger system, operating in a similar manner to the vacuum tube but requiring multiple punctures for multiple samples. Additionally, after the blood is drawn it must be transferred to the appropriate vacuum tube for testing purposes. If you choose to use this method, remember to check for a sterile seal, and use a safety device when transferring the sample. Fingerstick (or Fingerprick): This procedure uses a medical lance to make a small incision in the upper capillaries of a patient's finger in order to collect a tiny blood sample. It is typically used to test glucose and insulin levels. When performing a Fingerstick, the phlebotomist should remember to lance the third or fourth finger on the non-dominant arm. Never lance the tip or the center of the finger pad; instead, lance perpendicular to the fingerprint lines. Heelstick (or Heelprick): Similar to the Fingerstick procedure, this process is used on infants under six months of age. A medical lance is used to create a small incision on the side of an infant's heel in order to collect small amounts of blood for screening. As with a Fingerstick, the incision should be made perpendicular to the heel lines, and it should be made far enough to the left or right side of the heel to avoid patient agitation. Before performing a Heelstick, the infant's heel should be warmed to about 42 degrees Celsius in order to stimulate capillary blood and gas flow. Therapeutic Phlebotomy: This involves the actual letting of blood in order to relieve chemical and pressure imbalances within the blood stream. Making use of a butterfly needle, this therapy provides a slow removal of up to one pint of blood. Though the blood removed is not used for blood transfusions, the procedure and concerns are the same as with routine blood donation. As with any phlebotomy procedure, one should pay close attention to the patient in order to prevent a blood overdraw. Bleeding Time: A simple diagnostic test that is used to determine abnormalities in blood clotting and platelet production. A shallow laceration is made, followed by sterile swabbing of the wound every 30 seconds until the bleeding stops. Average bleed times range between one and nine minutes. As a phlebotomist, you should familiarize yourself with the application and cross-application of these procedures in order to recognize when a procedure is necessary, and what the risks are for each.

A very interesting video showing how white blood cells (Neutrophil) are chasing bacteria (Diplococci). It also shows how the white blood cell engulf the bacteria. This is a real video.

Breech Baby Position Exercise

Sebaceous Cyst, Hematoma and Growth Removal

In patients age ;::25, HPV DNA testing is the preferred next step in management if the initial cytology shows ASC-US. In this method, samples are collected for both cytology and reflex HPV DNA. If cytology results are positive, HPV DNA testing is performed. If cytology results are negative, the sample for HPV DNA is discarded. HPV DNA testing along with Pap smear at 3 years is recommended if initial cytology shows ASC-US but HPV DNA testing is negative

open multi puncture testicular biopsy to retrieve sperm for ICSI (IntaCytoplasmic Sperm Injection)

Curious about LASIK eye surgery? NVISION's Dr. Richard Mauer talks risks, life-changing benefits, and outcomes (plus why he loves what he does!).

Want to start your journey to better vision? Schedule your complimentary consult today! https://bit.ly/3H2i0FU

NVISION: The Eye Doctors' #1 Choice in LASIK and Laser Cataract Surgery

Lung cancer starts when cells of the lung become abnormal and begin to grow out of control. As more cancer cells develop, they can form into a tumor and spread to other areas of the body. To learn more about how cancers start and spread

Detailed examination of the joints is usually not included in the routine medical examination. However, joint related complaints are rather common, and understanding anatomy and physiology of both normal function and pathologic conditions is critically important when evaluating the symptomatic patient. By gaining an appreciation for the basic structures and functioning of the joint, you'll be able to "logic" your way thru the exam, even if you can't remember the eponym attached to each specific test!

Ophthalmoscopy - Eye Clinical Examination - OSCE - Dr Gill

Direct Ophthalmoscopy use of the eyes is a very challenging clinical skill, incorporating both the examiner's knowledge of the retina, but also understanding the use of the ophthalmoscope

In this clinical skills tutorial, we look at the use of the direct ophthalmoscope as part of an ophthalmic examination

it should be noted that in the ideal circumstances, the room lights will be dimmed during the examination, and dilating eye drops used to improve the visualisation of the fundus

Some people may notice an ASMR effect from this clinical examination

#DrGill #Ophthalmoscopy #ClinicalSkills #EyeExam

Watch that video of Tying The Sperm Canal to Avoid Ejaculation

Medical Examination of the Lower Limbs

Covers the histological structure for adipose tissue and relevant cellular physiology for adipocytes. This video is a part of our Histology Video Course (https://youtube.com/playlist?l....ist=PLnr1l7WuQdDynxT

All Histology Videos: https://youtube.com/playlist?l....ist=PLnr1l7WuQdDynxT

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Laparoscopic duodenal ulcer perforation repair 2

Intra-Uterine Device IUD Insertion Demonstration

As a pediatric surgeon at NewYork-Presbyterian/Weill Cornell Medical Center, Dr. Nitsana Spigland treats newborns, children, teens, and young adults requiring surgical interventions. She specializes in antenatal counseling and newborn congenital malformations.

Learn more about Dr. Spigland at: https://www.nyp.org/physician/nspigland.

To learn more about robotically assisted heart surgery, please visit https://cle.clinic/2Y6aHXH

Robotically assisted heart surgery is a minimally invasive option most often used for mitral valve repair. Cleveland Clinic cardiothoracic surgeons explain how it works and what to expect.

To learn more about our cardiothoracic experts, please visit
Marc Gillinov, MD - https://cle.clinic/2ZtNM7b
Daniel Burns, MD - https://cle.clinic/2W1MdxI

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