Determination of Bleeding Time by IVY method

Determination of Bleeding Time by IVY method.

Definition:

- Bleeding time is the functional test of primary hemostasis.

- This test diagnoses bleeding problems related to the abnormalities of:

        * Platelets functions. Platelets response to vascular injury.

        * Vascular response to injury.

        * Blood vessel elasticity also influences the bleeding time.

         * The ability of the blood vessels to constrict.

- Bleeding times is the best single screening test for acquired causes like uremia or congenital functional or structural disorder of platelets.

PRINCIPLE

IVY method is the traditional format for this test. In the Ivy method, a blood pressure cuff is placed on the upper arm and inflated. A lancet or scalpel blade is used to make a stab wound on the underside of the forearm. The time from when the stab wound is made until all bleeding has stopped is measured and is called the bleeding time. Every 30 seconds, filter paper or a paper towel is used to draw off the blood. The test is finished when bleeding has stopped completely.

NORMAL  RANGE

• Ivy method = 4 to 11 minutes
  • Prolonged bleeding time may be repeated to confirm it. Because if sometimes the large-caliber blood vessel is punctured, then bleeding time will be prolonged.

SPECIMEN

      -  Performed on patient; no specimen necessary.

Materials:

1. Blood pressure cuff

2. Sterile, disposable blood lancet, capable of a puncture 1 mm wide and 3 mm deep

3. Stopwatch

4. Circular filter paper

5. Alcohol pads

6. Gloves

Procedure:

1. Greet and identify the patient.

2. Explain the procedure to the patient.

3. Obtain a history about aspirin or aspirin containing compounds taken within last 7 - 10 days.

4. Select a site on the patient's forearm approximately three fingers widths below the bend in the elbow

that is free of visible subcutaneous veins.

5. Cleanse the outer surface of the patient's forearm by moving the alcohol pad in concentric circles

from the incision site outward; allow to air dry.

6. Place a blood pressure cuff on the patient's arm above the elbow. Turn the knob on the bulb of the

sphygmomanometer until it stops. Squeeze the bulb to inflate the sphygmomanometer. Inflate the cuff and maintain pressure at 40 mm Hg.

7. Holding the skin tight, and depress the “trigger” on the bleeding time device. The puncture must be

performed within 30 to 60 seconds of inflation of the blood pressure cuff. Simultaneously start the

stopwatch.

8. After 30 seconds have passed blot (do not wipe) the blood with the filter paper. The filter paper

must not touch the wound on the arm. Blot the site at regular thirty second intervals. Rotate the filter

paper after each 30 seconds.

9. When bleeding ceases, stop the watch and release the blood pressure cuff by turning the knob next to

the bulb in the opposite direction used to inflate the cuff. Remove the blood pressure cuff.

10. Record the bleeding time.

11. IMPORTANT: If bleeding continues for more than 15 minutes, the procedure should be

discontinued, and pressure applied to the wound sites. The bleeding time should be repeated on the other

arm. If bleeding has again not ceased within 15 minutes, the results are reported as greater than 15 minutes.

12. After ensuring that the bleeding has stopped, carefully bandage the site.

13. Appropriately discard all used materials and wash hands.

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