[2] phlebotomy Flashcards

Question 1

Q

blood vessels

Answer

A

the blood vessels transport blood throughout the human body

Question 2

Q

5 types of blood vessel

Answer

A

arteries
arterioles
capillaries
venules
veins

Question 3

Q

arteries

Answer

A

carry oxygenated blood away from the heart
The nearer from the heart, the bigger and more
elastic.

Question 4

Q

arterioles

Answer

A

small branches of an artery leading into
capillaries

Question 5

Q

capillaries

Answer

A

where the exchange of water and chemicals
between the blood and the tissues occurs
smallest blood vessel

Question 6

Q

venules

Answer

A

small branches of veins that lead to the
capillaries

Question 7

Q

veins

Answer

A

carry deoxygenated blood from the capillaries back towards the heart
the nearer to the heart, the bigger they are as they need to withstand the surge of blood going back to the heart

Question 8

Q

3 major layers of the blood vessel

Answer

A

tunica intima
tunica media
tunica externa

Question 9

Q

tunica intima

Answer

A

innermost and thinnest layer
composed of simple squamous epithelial cells (easy exchange of gases and diffusion of nutrients and waste) interlaced with several circularly arranged elastic bands called internal elastic lamina (unique to tunica intima)

Question 10

Q

tunica media

Answer

A

thickest layer in the arteries (so it can withstand pressure when heart pumps)
consist of circularly arranged elastic fiber, connective tissue, polysaccharide substances
separate from tunica externa by another thick elastic band called external elastic lamina

Question 11

Q

tunica externa

Answer

A

outer layer of the thickest layer in the vein
entirely made of connective tissue
contains nerves that supply the vessel as well as nutrient capillaries (vasa vasorum) in the larger blood vessels

Question 12

Q

When performing venipuncture, the needle must
pass through how many layers of blood vessel?

Answer

A

When performing venipuncture, the needle must pass through all three layers to collect the blood sample

the bevel (slanted portion) must be seen in the lumen of the vein

Question 13

Q

If your needle is only in the tunica externa or media,
the patient will suffer from what?

Question 14

Q

what sound will you hear when you insert the needle if your blood collection is successful?

Answer

A

popping sound

Question 15

Q

vessel size

Answer

A

ranges from a diameter of about 25mm for the aorta to only 8um in the capillaries

Question 16

Q

vasoconstriction

what could result from vasoconstriction?

what are vasoconstrictors and what are its effects (good/bad)?

Answer

A

is the narrowing of blood vessels by contracting the vascular smooth muscle in the vessel walls

High Blood Pressure

Conditions or stimulants that promote vasoconstriction; they may be in the form of hormones
can have good or bad effects
Vasoconstriction is good if you’re exposed to the cold.
Blood vessels constrict to prevent the escape of heat.
bad effect of vasoconstriction happens if you overdose on nasal decongestants like Decolgen or Nasatapp due to presence of ingredient that promotes vasoconstriction
○ e.g., 3 doses in 1 hour
○ It can lead to severe vasoconstriction

Question 17

Q

vasodilation

what results from vasodilation?

what are vasodilators?

Answer

A

is the widening of blood vessels due to the relaxation of the blood vessel’s muscular walls.
Enhances the flow of blood in the blood vessels.

Low Blood Pressure

Conditions or stimulants that promote vasodilation; * they may be in the form of hormones

Question 18

Q

Deoxygenated blood flow

Answer

A

Capillaries
Veins
Superior vena cava (upper), inferior (lower)
Right atrium
Tricuspid valve
Right ventricle
Pulmonic semilunar valve
Pulmonary trunk
Left pulmonary artery
Lungs (for exchange of gases, unloading of CO2 and loading of O2)

Question 19

Q

oxygenated blood flow

Answer

A

Left pulmonary veins
Left atrium
Mitral valve
Left ventricle
Aortic semilunar valve
Aorta
Arteries (unloading of O2 and loading of CO2)

*numbering is continuation from deoxygenated blood flow

Question 20

Q

Antecubital Fossa

Answer

A

Most common area for venipuncture
Known as the elbow pit
Triangular area below the antecubital crease on the anterior of the elbow
First choice for routine venipuncture
○ since it contains three major veins called the
antecubital veins

Question 21

Q

what are the 3 antecubital veins?

Answer

A

Median Cubital Vein
Cephalic Cubital Vein
Basilic Cubital Vein

Question 22

Q

what are the 2 shapes/vein arrangements of the antecubital fossa?

what differentiates the 2?

Answer

A

H-shaped antecubital vein
M-shaped antecubital vein

shape / arrangement (?)

Question 23

Q

Median Cubital Vein

Answer

A

first priority vein because it is well anchored
easiest access and least painful for the patient
it does not roll when you insert the needle
soft skin, easy access

Question 24

Q

Cephalic Cubital Vein

Answer

A

second choice for venipuncture
harder to palpate but is usually better when drawing blood from an obese patient
hard to puncture due to tender skin
aligned to the thumb

Question 25

Q

Basilic Cubital Vein

Answer

A

last choice vein, not well anchored and punctures are more painful
located near the brachial artery, so the medical technologist must be careful in collecting
hard to puncture due to tender skin
aligned to the pinky

Question 26

Q

H-shaped Antecubital Vein

what if you fail on the median cubital vein?

Answer

A

H-Shaped is the common vein arrangement that occurs in 70% of the population
Not everyone has the same vein network
formation, but the most common is H-shaped

It is recommended to use “very fit” gloves when performing venipuncture
When venipuncture fails on the median cubital vein, it is recommended to not go directly to the cephalic vein. Instead, repeat it on the median cubital vein, but on another area (e.g., below or on the other arm).

Question 27

Q

common venipunture error?

technique if ur confident in ur shot but no blood comes out?

Answer

A

A common error that happens during venipuncture which results in the failure to collect blood is when the insertion passes through the entire vein and punctures the other side. This is called “through and through.”
If you’re confident that you’ve hit a vein, but no blood comes out, the technique is to slightly pull the needle backward—anchor then pull the plunger.

When it comes to venipuncture, there isn’t really a technique that must be followed, it is up to the medical technologist to develop their own technique.

Question 28

Q

other arm and hand veins

what venipuncture method is most appropriate for these veins?

when do u collect from this site?

how would u know if there is edema? what can u get from edematous areas?

Answer

A

The most appropriate way of venipuncture for these veins is the use of the Butterfly Technique or the Winged Infusion Set
Syringes are not allowed because it is too large for the veins

Only use if the antecubital veins are not accessible (edema/for chemo)

You would know a patient has edema if pitting occurs when you press the site.
If the patient has edema, all you could get from the site is interstitial fluid.

Question 29

Q

other arm and hand veins

which areas of the hand can be used?

what should u not do when performing venipuncture on a hand vein?

Answer

A

Veins at the back of the hand that can be used are smaller and more painful; also bony area with only small muscles
Underside of the wrist must never be used as a venipuncture site because there are arteries in this area
○ (only select people in the hospital can perform
arterial blood collection on this site.)

DO NOT increase/decrease the angle of the needle during insertion.

The veins in this area are superficial and you might puncture the other side of the vein, or worse, the bone.
Thus, keep it PARALLEL to the skin/vein.

Question 30

Q

leg, ankle, and foot veins

what happens when theres a clot?

Answer

A

Must not be used in venipuncture without the permission of a physician
○ due to complications such as thrombosis
(formation of clots)
Arteries that are not used for routine blood collection
are limited to the collection of arterial blood gas.
○ Special training is needed and the procedure is
risky for the patient.

When a clot breaks off and travels through the bloodstream (embolus) –can cause stroke or pulmonary embolism
it could clog blood vessels and/or travel to different organs of the body,
which can cause even more severe complications.

Question 31

Q

where should you place the torniquet?

what happens if its too near the site of collection?

Answer

A

Place the tourniquet 3 to 4 inches above the collection site.

If it’s too near the site of collection, it poses the risk of hemolysis.

Remember, there are many areas where one can perform venipuncture, but the major area is always the antecubital fossa.

Question 32

Q

history of phlebotomy

phlebotomy (definition)

what did the Egyptians contribute to this?

Answer

A

From the Greek word “phlebos”, meaning vein, and “-tomia”, meaning cutting.
○ Also from the word “teimien”, meaning to make an incision.
Act of drawing or removing blood from the circulatory system through a cut or puncture to obtain a sample for analysis and diagnosis.
Also done as part of the patient’s treatment for certain blood disorders.

First to perform bleeding by scarification.

Question 33

Q

history of phlebotomy

Galen of Pergamon

Answer

A

A prominent Greek physician who discovered that arteries as well as veins had blood. Previously it was thought that arteries were filled with air.
He developed a complex system for the quantity of blood that should be removed and from what specific areas of the body. (bloodletting?)

Question 34

Q

history of phlebotomy

The Pilgrims

what about bloodletting?

Answer

A

Credited for bringing phlebotomy to the United States in the 18th century.
It was common at this time to use lancets that
were fired into veins at multiple locations, withdrawing up to 4 pints of blood
■ 1 pint = 473 mL

no screening for bloodletting

Over time, other instruments were developed to improve the technique. Bloodletting was a popular service for almost one hundred years, although it went out of fashion as many harmful incidents came to light.

Question 35

Q

history of phlebotomy

bleeding as a standard treatment in the 18th century

Answer

A

Fevers
○ putrid fevers (typhus and typhoid fever)
For hypertension, cases of comas, and drowsy headaches.
Recommended to reduce inflammation of the lungs according to the amount of pain, the pounding of the pulse, and the difficulty in breathing.
○ As many as 210 ounces were bled over 6 days
(210 ounces = 6, 210 mL).

Question 36

Q

history of phlebotomy

George Washington (Dec. 13, 1799)

who were his doctors? (2)

Answer

A

Was taken ill with a ‘cold’ and ‘mild hoarseness’.
A total of 2, 365 mL of blood was taken over 12 hours.
Washington’s blood eventually became viscous and flowed slowly, reflecting dehydration and hypovolemia (decreased volume of circulating blood in the body).

James Craik & Dr. Brown

James Craik - An Edinburgh-trained physician, offered no explanation for Washington’s illness.

Question 37

Q

history of phlebotomy

American Civil War (1861-1865)

Answer

A

Military doctors, unable to cope with widespread disease and infection, bled Union soldiers and civilians alike.
Early instruments included anything sharp, such as horned stones, quills, thorns, or animal teeth.
○ Thumb lancet
■ was introduced in the 15th century.
■ It was a double‐edged instrument, often with ornate handles made from turtle shells.

Question 38

Q

history of phlebotomy

Louis Pasteur (1822-1895) and Robert Koch (1843-1910)

alternative for bloodletting(?) ?

Answer

A

proved conclusively that inflammation resulted from infection and thus was not susceptible to bloodletting.
Disproved bloodletting
They offered a scientifically legitimate way of thinking about the cause and treatment of the patient’s illness

As recent as April 2008, three Kashmiri hospitals (in India) were reported to be using leeches, primarily to bleed patients as treatment for heart problems, arthritis, gout, chronic headaches, and sinusitis. The leeches are for single use to avoid transmission of disease!

Question 39

Q

history of phlebotomy

Therapeutic Phlebotomy

what should u do with blood collected from therapeutic phlebotomy?

therapeutic phlebotomy is used for what diseases? (2)

Answer

A

Phlebotomy is used every day to diagnose health problems and introduce medication intravenously. It’s also used in life-saving procedures like blood transfusions. Today, trained professionals called phlebotomists withdraw blood in clinics and hospitals all over the world.

Blood collected in therapeutic phlebotomy
must be discarded.

Polycythemia Vera (PV) - increased all blood cells in body, more than the reference range. blood becomes viscous
Patients with sickle cell disease also undergo therapeutic phlebotomy

Question 40

Q

Quality in Phlebotomy

Critical areas (and whose responsibility)

Answer

A

The role of the phlebotomist has never been more important. In the United States, it is estimated that more than 1 billion venipunctures are performed annually, and errors occurring within this process may cause serious harm to patients, either directly or indirectly.

Critical areas include:
* Appropriateness of the test request
■ it’s the physician’s responsibility to tell the patient which test to request
* Patient and sample identification
■ Medtech’s responsibility
* Criteria for acceptance and rejection of specimens
* Communication and interpretation of results
■ responsibility of (1) the attending nurse of the patient & (2) laboratorian

Question 41

Q

rationale

Specimen collection (first step–?)

what is incuded in quality assessment of phlebotomy? (3)

Answer

A

The first step in most laboratory analysis.
Test results are therefore said to be as good as sample collection and handling. (good sample = good test results)

Quality assessment in phlebotomy includes:
* preparation of a patient for any specimens to be collected,
* collection of valid samples,
* proper specimen transport. (especially when collecting from the ward) (have to be fast to maintain vitality)

Question 42

Q

Phlebotomist as a Laboratory Ambassador (3)

Answer

A

The only laboratory staff member that a patient sees.
Expected to deliver unexcelled customer satisfaction
Should understand and know the patient’s expectations, manage unrealistic expectations through patient education, and be diplomatic with customer complaints.

can be a nurse or other medical professional
○ Respiratory therapists perform Arterial Blood Gas
(ABG) Testing

Question 43

Q

what is the first step in uhhh laboratory procedures (?) ??????

different from first step of lab analysis

Answer

A

Patient Identification

Question 44

Q

patient identification

Conscious In-patients

what if patient cant speak?

Answer

A

Verbally ask their full names, verify using the identification bracelet which includes first and last name, hospital number/unit number, room/bed, and physician’s name.
○ ambulatory patients (can move, walk, talk)
○ must have a request form with patient details (name, age, date of birth, etc.)
○ ask for identification card if suspicion arises

if patient can’t speak:
* utilize hospital bracelet
* ask guardian or relative
* make the patient write

Question 45

Q

patient identification

Sleeping patients

Answer

A

They must be awakened before blood collection.
Identified same as conscious patients / ambulatory patients.

Question 46

Q

patient identification

Unconscious / Mentally challenged patients

Answer

A

Identified by asking the attending nurse or relative; ID bracelet
○ identified the same way a ambulatory patients
○ mentally challenged patients must be restrained

Question 47

Q

patient identification

Infants and Children

where should u puncture?

Answer

A

Nurse or relative may identify the patient or by ID bracelet

For blood collection, infants will be pricked on the big toe or plantar surface of the foot

Question 48

Q

patient identification

Out-patient patient

Answer

A

Verbally ask their full name, DOB and countercheck with driver’s license or ID with photo. If the patient has ID card or bracelet, same manner as with hospitalized patients

same2 ras inpatients basically

Question 49

Q

Pediatric Patients

Answer

A

Be gentle and treat them with compassion, empathy, and kindness.
Attempt to interact with the pediatric patient
Acknowledge the parent and the child. Be friendly, courteous, and responsive. Allow enough time for the procedure.

Question 50

Q

Adolescent Patients

Answer

A

When obtaining a blood specimen from an adolescent, it is important to be relaxed and perceptive about any anxiety that he or she may have.
General interaction techniques include allowing enough time for the procedure, establishing eye contact, and allowing the patient to maintain a sense of control.

Question 51

Q

Geriatric Patients

Answer

A

Treat geriatric patients with dignity and respect. Do not demean the patient. It is best to address the patient with a more formal title such as Mrs., Ms., or Mr. rather than by his or her first name.
Senior patients may enjoy a short conversation. Keep a flexible agenda so that enough time is allowed for the patient.
Speak slowly and allow enough time for questions. The elderly have the right of informed consent. Too many times this fact is lost in dealing with any patient, but it seems more prevalent in dealing with
aging patients.

Voice must still be modulated
Veins sometimes move or collapse
○ Pull skin to stabilize the vein

Question 52

Q

Additives used in blood collection (5)

Answer

A

Antiglycolytic agent
Anticoagulant agent
Clot activator
Thixotropic gel separator
Trace element-free tubes

Question 53

Q

additives used in blood collection

Antiglycolytic Agent

example?

Answer

A

Inhibits the use of glucose by blood cells.

sodium fluoride

Question 54

Q

additives used in blood collection

Anticoagulant Agent

examples and what they do?

Answer

A

prevents blood from clotting. The mechanism by which clotting is prevented varies with the anticoagulant.

EDTA, citrate, and oxalate remove calcium by chelating to calcium and forming insoluble salts,
whereas heparin prevents the conversion of prothrombin to thrombin.
– K2 EDTA - Dipotassium
– K3 EDTA - Tripotassium

Question 55

Q

additives used in blood collection

Clot Activator

what tubes are used?

examples?

Answer

A

helps initiate or enhance the clotting mechanism

Plain tubes or Serum tubes (tubes that only contain clot activator)

glass (silica) particles (additive is already in the glass) and inert clays (celite) that increase surface area for platelet activation and clotting factors such as thrombin.

Question 56

Q

additives used in blood collection

Thixotropic Gel Separator

where is it dapit sa tube / what happens when centrifuged?

tubes used? (2)

Answer

A

inert material that undergoes a temporary change in viscosity during the centrifugation process, which enables it to serve as a separation barrier between the liquid (serum and plasma) and cells.

at the bottom of the unused tube; changes viscosity when centrifuged

Serum Separator Tube (SST)
– for serum
Plasma Separator Tube (PST)
– for plasma

Question 57

Q

additives used in blood collection

Trace Element-Free Tubes

color of stoppers?

used for what? (3)

Answer

A

Made of materials that are free of trace element contamination

Have royal-blue stoppers

Used for
* trace element tests
* toxicology studies
* nutrient determination (must be trace free to prevent false increases)

Question 58

Q

Special-Use Anticoagulants (3)

Answer

A

Acid Citrate Dextrose (ACD)
Citrate Phosphate Dextrose (CPD)
Sodium Polyanethol Sulfonate (SPS)

Question 59

Q

special-use anticoagulants

Acid-Citrate Dextrose

ennumerate (2) / what color is the tube?

used for what?

Answer

A

Acid citrate
Dextrose

ACD tubes have yellows tops

Used for immunohematology tests such as
* DNA testing
* human leukocyte antigen (HLA) phenotyping

Question 60

Q

special-use anticoagulants

Acid citrate

what section is it used (2)

where is this found?

Answer

A

prevents coagulation binding calcium, with little effect on cells and platelets

section

Used in Immunohematology and Blood Banking

The anticoagulant in blood bags, ensuring RBC survival.

Question 61

Q

special-use anticoagulants

Dextrose

Answer

A

acts as an RBC nutrient and preservative by maintaining RBC viability

Question 62

Q

special-use anticoagulants

Citrate Phosphate Dextrose

ennumerate (3) + explain each

used how and in what section?

Answer

A

Citrate - prevents clotting by chelating calcium
Phosphate - stabilizes pH
Dextrose - provides cells with energy and keeps them alive

Used in collecting units of blood transfusion
Used in Blood Banking section

Question 63

Q

special-use anticoagulants

Sodium Polyanethol Sulfonate (SPS) + used for what?

what color are the stoppers + which section is this used?

explain the mechanism

Answer

A

Prevents coagulation by binding calcium
Used for blood culture collection

SPS tubes have yellow stoppers; used in Microbiology

Inactivates the complement system
– The Complement system destroys bacteria once activated
Slows down phagocytosis
– Phagocytosis happens when cell (phagocytes) try to destroy foreign particles or pathogens such as bacteria
Reduces activity of certain antibiotics

Question 64

Q

color coding for tube caps

Match cap color to specifications (9)

Answer

A

1) Red - No additive
2) Orange - Coagulant
3) Yellow - Coagulant and Separation Gel
4) Green - Sodium heparin
5) Light Green - Lithium heparin
6) Purple - EDTA
7) Light Blue - Sodium Citrate (1:9)
8) Black - Sodium Citrate (1:4)
9) Grey - Potassium Oxalate (anticoagulant), Monohydrate, and Sodium Fluoride (antiglycolytic)

Answer 64

A

The volume of blood is always greater than the volume of the Anticoagulant

Answer 65

A

Also known as Plain tube or Serum tube
Glass
– no additive
– glass surface activates clotting sequence
– Mixing of sample by inversion is not required
– SERUM: use for TDM (Therapeutic Drug
Monitoring)
Plastic
– Contains clot activators to initiate clotting sequence
– Must be inverted (5 full inversions) to mix sample with additive and initiate clotting sequence
– need to centrifuge tubes
– SERUM

60 minutes

Serum determinations in chemistry
Routine blood donor screening (crossmatching)
Diagnostic testing for infectious diseases
■ Laboratory sections: Clinical Chemistry,
Blood Banking, Immunoserology
Wait for sample to clot before centrifuge
– for 30 to 60 minutes
– upright

Answer 66

A

Contains clot activator and gel (SST - Serum Separator Tube)
Inversions: 5 Full Inversions
Tube placement: Upright
Temperature: Room Temperature
Inverted to mix and initiate clotting sequence
SERUM

30 minutes

Laboratory Use:
* Serum determination in chemistry
* Blood donor screening (crossmatching)
* Serum testing for infectious diseases

Laboratory Sections:
* Blood Banking
* Clinical Chemistry
* Immunology and Serology

Answer 67

A

Specimen: Plasma
binds Calcium (to prevent clotting)
**3-4 full gentle inversions **
– only tube that differs in inversions
– Vigorous inversions causes Hemolyzed blood and the formation of microclots (counterproductive since the goal is to detect clots)
Can centrifuge right after collection

3.2% Sodium citrate (best in preserving coag/clotting factors(, 9:1

Laboratory use:
* Clot-based studies/coagulation studies (PT and APTT)
* Mixing studies
* Ethanol gelation test

Laboratory Section:
* Used in Hematology section only
*No microtainer counterpart

Answer 68

A

Plasma (Liquid component of whole blood)
Whole blood (Entirety of sample)
Inhibits thrombin formation
Requires 8 full inversions
All anticoagulant tubes except light blue
Must be full and transported on ice if needed for pH, pO2, and ionized calcium analysis

Heparin (Li Heparin (LG), NH4 Heparin (GCT), Na Heparin (DG/RCT).

*Li - lithium, LG - light green, NH4 - ammonium, GCT - green capillary tube, Na - sodium, DG - dark green, RCT - red capillary tube

Laboratory use
* Plasma determinations in chemistry

Sample:
* Arterial Blood

Answer 69

A

Sample: can either be Plasma or Whole blood
Binds calcium through Chelation
Requires 8 full inversions
– Add 2 inversions when using the Hemoanalyzer

* Spray-coated K3EDTA (glass)
* Liquid K2EDTA (plastic)

Laboratory use
* Hematology determinations (CBC)
* Routine immunohematology testing
* Blood donor screening (crossmatching)

Answer 70

A

Prevents coagulation by precipitating calcium
Plasma and Whole blood
Maintains plasma glucose levels
Preserves glucose up to 3 days and inhibits growth of bacteria
Requires 8-10 full inversions

anticoag: Potassium Oxalate (Monohydrate)
antiglyco: Sodium Fluoride

Laboratory use
* Glucose determinations
* Lactic acid level determination (test for stress response)

Answer 71

A

Both bind calcium
Requires 8 full inversions
Sample: Plasma and Whole Blood

Acid Citrate Dextrose (ACD), Sodium Polyanethol Sulfonate (SPS)

ACD: Acid Citrate Dextrose
* Blood bank studies
* HLA phenotyping
* Paternity testing
* DNA

SPS: Sodium Polyanethol Sulfonate
* Used for special blood culture studies
* Inhibits certain antibiotics

Answer 72

A

Additives: Thrombin-based clot activator with gel for serum separation
Inversions: 5-6
Clotting time: 5 minutes

Laboratory use:
For stat serum determinations in Chemistry. Tube inversions ensure mixing of clot activator with blood.

Answer 73

A

Additive: Thrombin-based clot activator
Inversions: 8
Clotting time: 5 minutes

Laboratory use:
For stat serum determinations in Chemistry. Tube inversions ensure mixing of clot activator with blood.

Answer 74

A

Additives: Clot activator (plastic serum), K2EDTA (plastic)
Inversions: 8

For trace-element, toxicology, and nutritional-chemistry determinations. Special stopper formulation provides low levels of trace elements (see package insert). Tube inversions ensure mixing of either clot activator or anticoagulant (EDTA) with blood.

Answer 75

A

Additives: K2EDTA (plastic)
Inversions: 8

For lead determinations. This tube is certified to contain less than .01μg/mL(ppm) lead. Tube inversions prevent clotting.

Answer 76

A

Additives: K2EDTA and gel for plasma separation
Inversions: 8

For use in molecular diagnostic test methods (such as, but not limited to:
* polymerase chain reaction [PCR]
* branched DNA [bDNA] amplification techniques.)

Tube inversions ensure mixing of anticoagulant (EDTA) with blood to prevent clotting.

Answer 77

A

Additives: Spray-coated K2EDTA (plastic)
Inversions: 8

For whole blood hematology determinations. May be used for routine immunohematology testing and blood donor screening. Designed with special cross-match label for patient information required by the AABB. Tube inversions prevent clotting.

Answer 78

A

Blood Culture or Sterile tubes (yellow stopper)
Coagulation tube (light blue stopper)
Serum tube with or without clot activator or gel (red, gold, or red gray marbled)
Heparin tube (green or light green stopper
Black top tube - after Heparin tube; can be before or after EDTA tube5.
EDTA tube (lavender stopper)
Oxalate/Fluoride tube (gray stopper)

Importance of the Order of Draw
* To prevent cross-contamination of samples
* To prevent transfer of tissue thromboplastin
* To prevent additive carry-over
* To prevent contamination with microorganisms

Answer 79

A

Sterile (yellow) - Sterile Tubes / Blood Culture
Light blue - Coagulation tube
Red - Serum tube with or w/out clot activator gel
SST (Gold) - Serum tube with or w/out clot activator gel
PST (light green) - Heparin tube
Green - Heparin tube
Lavender - EDTA tube
Gray - Oxalate/Fluoride tube

Answer 80

A

Antiseptics
Gauze Pad / Cotton Balls
Sharp Disposal Containers
Pen
Watch

Answer 81

A

Used to prevent sepsis and are used to clean the site prior to blood collection

Disinfect in concentric fashion

70% ethyl alcohol
70% isopropyl alcohol (isopropanol)
– commonly used in blood collection
Benzalkonium chloride (e.g. Zephiran chloride)
Chlorhexidine gluconate
Hydrogen peroxide
Povidone-iodine
– only used during bleeding the donor and in blood culture
– used to prevent contamination of normal flora
Tincture of iodine

Answer 82

A

Clean 2-by 2-inch gauze pads folded in fourths are used to hold over the site following blood collection procedures

Gauze pad is preferred
Cotton ball can also be used but not recommended (due to its fiber material)

Answer 83

A

To contain used needles, lancet, and other sharp objects used in blood collection procedures

Answer 84

A

Carried by the phlebotomist; must be with indelible (permanent) non-smear ink to label tubes and record other patient information

Labeling of time should have AM or PM, since some tests have increased or decreased levels depending on the time of day

Answer 85

A

Vein-locating Devices
Tourniquet
Needles
Winged Infusion Set
Tube Holder
Evacuated Tubes

Answer 86

A

Also known as portable illumination devices or vein viewer
Used to easily locate veins that are difficult to see or feel
The use of high-intensity LED or infrared red light through the patient’s subcutaneous tissue to highlight the veins

Same principle as the pulse oximeter

Principle: Infrared Light Absorption

Answer 87

A

A device that is applied or tied around a patient’s arm prior to venipuncture to restrict blood flow
Must be fastened in a way that is easy to release with one hand during blood collection or in emergency situations
Most common type is the strap tourniquet
Should not be too tightly attached to restrict ONLY the venous flow but not the arterial flow

Elastic tourniquet, Buckle quick release tourniquet, Velcro tourniquet

Should be placed 3-4 inches above the site of specimen collection
– May cause hemolysis of sample if too near
Discard if tourniquet has been dropped on the floor, or if visibly contaminated with blood

Answer 88

A

Phlebotomy needles are sterile, disposable, and designed for single use only

Multisample n (ETS), Hypodermic n, Winged infusion (butterfly) n

Color coded by gauge for easy identification
* Yellow - 20 gauge
* Green - 21 gauge
* Black - 22 gauge
* Blue - 23 gauge

The higher the gauge, the smaller the needle

Criteria for choosing needle gauge:
* ze and condition of vein
* Type of blood collection procedure
* Equipment being used

Answer 89

A

15-17 (Special needle attached to collection bag) - Collection of door units, autologous blood donation and therapeutic phlebotomy
20 (Multisample hypodermic) - Sometimes used when large-volume syringes are used on patient with normal-sized veins
21 (Multisample hypodermic) - Considered the standard venipuncture needle for routine venipuncture on patients with normal veins or for syringe blood culture collection
22 (Multisample hypodermic) - Used on older children and adult patients with small veins or for syringe draw on difficult veins
23 (Butterfly) - Used on veins of infants and children and on difficult or hand veins of adults

16 - standard blood transfusion, 21 - standard venipuncture

Answer 90

A

Multisample Needles - 1- or 1.5-inch
Hypodermic Needles - 1- or 1.5-inch
Butterfly Needles - 1/2 to 3/4 inch

Answer 91

A

Plunger
Barrel
Cap with needle
Cap
Needle
Needle hub
Rubber Stopper
Scale
Flange
Thumb rest

Answer 92

A

Multisample needle
* Bevel
* Shaft
* Threaded hub
* Rubber sleeve over needle

Tube holder
Evacuated tube

Assembled system:
* Needle within stopper
* Flange

Answer 93

A

Also known as butterfly
Used for small or difficult veins such as hand veins of elderly and pediatric patients
23-gauge needle is most commonly used
25-gauge needle is used specifically to collect blood from scalp or other tiny veins of premature infants and other neonates

can use syringe or tube holder of ETS (ets is faster)

Parts of a winged infusion set (25G Butterfly Scalp Vein Set, Luer Lock)
* Wings
* Tube
* Cannula
* Plastic cap
* Female luer lock connector

Answer 94

A

A clear, plastic, disposable cylinder with a small threaded opening at one end (often called a hub) where the needle is screwed into it and a large opening at the other end where the collection tube is placed

Answer 95

A

Used with both ETS and the syringe method to obtain blood specimens
Come in various sizes and volumes ranging from 1.8 to 15 mL
Can be made of plastic or glass
Fill with blood automatically because of vacuum which is artificially created by pulling air from tube
Pre-measured vacuum will determine the volume of sample that will be collected

Instances when the vacuum will be lost if:
* Improper storage
* Opening of the tube
* Dropping the tube
* Advancing the tube too far up to the needle before venipuncture
* Needle bevel is partially out the the skin during venipuncture (indicative by hissing)

Answer 96

A

Blood Gases - Rotate between palm to mix
Slides and Smears/EDTA specimens - 10
Lithium heparin - 10
Lithium heparin with gel separator - 10
Sodium fluoride/Potassium oxalate - 10
Serum (w clot activator) - 5
Serum (w no clot activator) - None
Newborn Blood Spot Card - Recommended to be collected separately

Answer 97

A

Lancets / Incision Devices
Microcollection Containers
Microhematocrit Tubes
Clay Sealant
Warming Devices

Answer 98

A

A sterile, disposable, sharp-pointed or bladed instrument that punctures or makes an incision on the skin to obtain capillary blood specimen

Answer 99

A

Also called microtubes used to collect tiny amounts of blood obtain through capillary puncture
Often referred as “bullets” or microtainers

Answer 100

A

other name: capillary tubes
Disposable, narrow-bore plastic or glass capillary tubes that fill by capillary action and typically hold 50-70 uL of blood
Used for manual hematocrit pr packed cell volume determinations
Can be heparinized (green and red tubes) or non-anticoagulated (blue tubes)

Answer 101

A

Used to seal one end of microhematocrit tubes
Reinforced by the Paraffin Wax
purpose: avoid washing out of sample
length: 4-6mm

Answer 102

A

Increases blood flow as much as 7 times
The device provides a uniform temperature that does not exceed 42 °C to avoid being burnt

Answer 103

A

Capillary Blood Gases (CBGs)
Neonatal Bilirubin Collection
Newbown/Neonatal Screening

Answer 104

A

Capillary puncture blood is less desirable for blood gas analysis due to its composition and temporarily exposure to air during collection, causing higher risk to contamination
Rarely collected in adults
CBG specimens are collected from the same sites as routine capillary puncture specimens
Warming the site for 5-10 minutes is necessary (to increase blood flow)

Usually performed on infants and young children

Answer 105

A

Done to newborns to detect and monitor increased bilirubin levels caused by overproduction or impaired excretion of bilirubin
Bilirubin breaks down in the presence of light
Collection is done quickly by heel puncture, protected from light during transportation and handling. Sample is collected in amber-colored micro collection tubes.

If amber-colored tubes are unavailable, it can be wrapped in foil or carbon paper

Answer 106

A

Testing of newborns for the presence of certain genetic, metabolic, hormonal, and functional disorders that can cause severe mental handicaps or other serious abnormalities
Performed hours after the baby is born
Sample collected through blood spot collection
– Sample is obtained through heel puncture
– Blood drops are collected by absorption onto
circles printed on a special type of filter paper

Answer 107

A

Do not puncture the fingers of infants and children under 1 year of age.
Do not puncture fingers on the same side as mastectomy without consulting with the patient’s physician. (in case of infection)
– Mastectomy is surgery to remove all breast tissue from a breast. (i.e. breast cancer)
– Lymph nodes in the area are also removed, which weakens the immune system of the same-side arm, making it more prone to infections.
Do not puncture parallel to the grooves or lies of the fingerprint. (puncture across the ridges of the fingers / perpendicular to avoid messy collection)
Do not puncture the fifth or the pinky finger. (bone injury is most likely)
Do not puncture the index finger. (only a minimal amount of blood can be obtained; calloused area)
Do not puncture the side or very tip of the finger.
Do not puncture the thumb. (calloused area and has a pulse)

Answer 108

A

Clotted
Hemolysis
Insufficient Sample (QNS)
Wrong or Expired Collection Tube
Improper Transport and Storage
Specimen Contamination

Answer 109

A

Failure to mix or inadequate mixing of samples collected into an additive tube. The red cells clump together making the sample unsuitable for testing.

Answer 110

A

Usually caused by a procedural error:
* using too small of a needle
* pulling back too hard on the plunger of a syringe used for collecting the sample

when using a small needle size for a large amount of sample
after centrifugation, the color may seem reddish or pinkish

Answer 111

A

Caused by short draw
Certain additive tubes must be filled completely.
Incorrect blood to additive ratio will adversely affect the laboratory test results.
Additive won’t work in wrong or expired collection tube
When many tests are ordered on the same tube be sure to know the amount of sample needed for each test.
QNS - Quantity Not Sufficient

Answer 112

A

Must consult the procedure manual before collecting the specimen if unsure of the type of tube required for a test
Additive in an expired tube may not work properly

Answer 113

A

Certain tests must be collected and placed on ice, protected from light, or be kept warm after collection.

Answer 114

A

Can be a result of improper technique or carelessness such as:
* Allowing alcohol, fingerprints, glove powder, baby powder, or urine from wet diapers to contaminate NBS forms or specimens
– presence of alcohol can lead to hemolysis
– Sweat contains salt which will affect sample
* Getting glove powder on blood films (slides) or in capillary specimens
* Unwittingly dripping perspiration into capillary specimens during collection
* Using the correct antiseptic but not following the proper procedure
– apply pressure when disinfecting
* Using the wrong antiseptic to clean the site prior to specimen collection

Answer 115

A

Ecchymosis (Bruise)
Syncope (Fainting)
Hematoma
Failure to Draw Blood
Petechiae
Edema
Obesity
Hemoconcentration
Prolonged Tourniquet Application
Other Complications
Hemolysis
IV Therapy

Answer 116

A

Most commonly encountered complication in obtaining a blood specimen. (happens mostly when fishing)
It is caused by leakage of a small amount of fluid around the tissue.
Can also be caused by traumatic venipuncture

Answer 117

A

Second most common complication.
Before drawing blood, the collector should ask if he/she had prior episodes of fainting.

If the patient shows signs of collapsing/collapses, STOP!, elevate both feet, and apply cold compress on the neck.
Spirit of ammonia may be used.

Answer 118

A

When leakage of a large amount of fluid around the puncture site causes the area to swell.

Most commonly occurs when:
* The needle goes through the vein
* The bevel is partially inserted in the vein
* If the collector fails to apply enough pressure after venipuncture

Answer 119

A

Due to:
* improper needle positioning (always bevel up)
* excessive pull of the plunger
* piercing the other pole of the vein
* incorrect bevel positioning
* absence of vacuum

Answer 120

A

small red spots indicating that small amounts of blood have escaped into the skin epithelium.
* May be caused by prolonged tightness of the tourniquet; endothelial lining opens up allowing formed elements to pass through

Answer 121

A

Swelling caused by an abnormal accumulation of fluid in the intracellular spaces.

Answer 122

A

Veins may be neither readily visible nor easy to palpate can use of a blood pressure cuff in locating the vein.
– The cuff should not be inflated any higher than the patient’s diastolic pressure and should not be left on the arm for longer than 1 minute

● Best to collect on cephalic vein

Answer 123

A

An increased concentration of larger molecules and analytes (potassium) in the blood as a result of a shift in water balance.
Can be caused by leaving the tourniquet on the patient’s arm too long.

Answer 124

A

Primary effect is hemoconcentration.
The hydrostatic pressure causes some water and elements to leave the extracellular space.

Answer 125

A

Burned
damaged
scarred and occluded veins
seizure and tremors
vomiting and choking
allergies
mastectomy patients.

Answer 126

A

**Rupture of red blood cells **with the consequent escape of hemoglobin.
Can cause the plasma or serum to appear pink or red.

To prevent hemolysis:
* Mix tubes with anticoagulant additives gently
* Avoid drawing blood from a hematoma
* Avoid drawing the plunger of the syringe back too forcefully and avoid bubbles on the sample
* Make sure the venipuncture site is dry
* Avoid a probing, traumatic venipuncture

Answer 127

A

Fluid may dilute the specimen, so collect from the opposite arm if possible. Otherwise, samples may be drawn below the IV by following these procedures:
* Turn off the IV for at least 2 minutes before venipuncture
* Apply the tourniquet below the IV site. Select a vein other than the one with IV
* Perform the venipuncture. Draw 5 mL of blood and discard before drawing the specimen tubes for testing

Answer 128

A

Posture
Diurnal Rhythm
Exercise
Stress
Diet
Smoking

Answer 129

A

Changing from a supine (lying) to a sitting or standing position results in a shift of body water from inside the blood vessels to the interstitial spaces.

Answer 130

A

Levels of certain hormones such as cortisol and adrenocorticotrophic hormone decreases in the afternoon.
Other test values, such as iron and eosinophil levels increases in the afternoon.

Answer 131

A

Muscle activity elevates creatine, protein, creatine kinase, AST, and LDH.
● Exercise activates coagulation and fibrinolysis and increases platelet and white blood cells.

● Do not exercise before testing

Answer 132

A

Anxiety can cause a temporary increase in white blood cells.

Answer 133

A

If a patient has eaten recently (less than 2 hours earlier), there will be a temporary increase in glucose and lipid content in the blood.
● Serum may appear cloudy or turbid.

Answer 134

A

Patients who smoke before blood collection may have increased white blood cell counts and cortisol levels.
Long-term smoking can lead to decreased pulmonary function and result in increased hemoglobin levels.

Answer 135

A

Venous Stasis
Hemodilution
Hemolysis
Clotted Sample
Partially Filled Tubes
Using Wrong Anticoagulant
Specimen Contamination
Specimen Handling

Answer 136

A

Prolonged application of tourniquet (>1 min)
Can lead to increases in potassium concentration

Answer 137

A

Drawing above IV
Short draw (blood to anticoagulant ratio)

Answer 138

A

Traumatic stick
Too vigorous mixing
Alcohol still wet (do not dry with cotton, you can fan)
Using too small of needle
Forcing blood into syringe

Answer 139

A

Inadequate mixing
Traumatic stick

Answer 140

A

Short draw
Sodium citrate tube draw volume critical

Answer 141

A

Using insufficient or excess anticoagulant
Using expired or contaminated tubes

Answer 142

A

Using incorrect cleanser
Alcohol still wet
Powder from gloves
Drawing above IV

Answer 143

A

Exposure to light
Pre-chilled tube
Body temperature

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[2] phlebotomy Flashcards

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