[2] phlebotomy Flashcards

Question

Basilic Cubital Vein

Answer 1

* **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

Answer 2

* 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 ## Footnote * 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).

Answer 3

* 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.** ## Footnote 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.**

Answer 4

* 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) ## Footnote * 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.**

Answer 5

* **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. ## Footnote * 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.**

Answer 6

* 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. ## Footnote * 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.

Answer 7

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

Answer 8

* 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. ## Footnote First to perform bleeding by **scarification.**

Answer 9

* 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?**)

Answer 10

* 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 ## Footnote 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.**

Answer 11

* **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).

Answer 12

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

Answer 13

* 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.**

Answer 14

* 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 ## Footnote * 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!

Answer 15

* 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. ## Footnote * **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

Answer 16

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. ## Footnote 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

Answer 17

* 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) ## Footnote 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)

Answer 18

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

Answer 19

Patient Identification

Answer 20

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

Answer 21

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

Answer 22

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

Answer 23

**Nurse or relative** may identify the patient or by **ID bracelet** ## Footnote For blood collection, infants will be pricked on the **big toe or plantar surface of the foot**

Answer 24

**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*

Answer 25

* **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.

Answer 26

* 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.

Answer 27

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

Answer 28

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

Answer 29

**Inhibits the use of glucose** by blood cells. ## Footnote sodium fluoride

Answer 30

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

Answer 31

helps **initiate or enhance the clotting mechanism** | **Plain tubes or Serum tubes** (tubes that only contain clot activator) ## Footnote **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.

Answer 32

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 ## Footnote * **Serum Separator Tube (SST)** -- for serum * **Plasma Separator Tube (PST)** -- for plasma

Answer 33

Made of materials that are **free of trace element contamination** | Have **royal-blue stoppers** ## Footnote Used for * trace element tests * toxicology studies * nutrient determination (must be trace free to prevent false increases)

Answer 34

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

Answer 35

* Acid citrate * Dextrose | ACD tubes have **yellows tops** ## Footnote Used for **immunohematology tests** such as * DNA testing * human leukocyte antigen (HLA) phenotyping

Answer 36

**prevents coagulation binding calcium**, with little effect on cells and platelets section | Used in **Immunohematology** and **Blood Banking** ## Footnote The anticoagulant in **blood bags**, ensuring RBC survival.

Answer 37

acts as an RBC nutrient and preservative by maintaining RBC viability

Answer 38

* **Citrate** - prevents clotting by chelating calcium * **Phosphate** - stabilizes pH * **Dextrose** - provides cells with energy and keeps them alive ## Footnote * Used in **collecting units of blood transfusion** * Used in **Blood Banking** section

Answer 39

* **Prevents coagulation by binding calcium** * Used for **blood culture collection** | SPS tubes have **yellow stoppers**; used in **Microbiology** ## Footnote * **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**

Answer 40

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 41

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

Answer 42

* 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 ## Footnote * 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 43

* 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 ## Footnote 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 44

* 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 ## Footnote 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 45

* **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). ## Footnote *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 46

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

Answer 47

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

Answer 48

* Both bind calcium * Requires **8 full inversions** * Sample: **Plasma** and **Whole Blood** | Acid Citrate Dextrose (ACD), Sodium Polyanethol Sulfonate (SPS) ## Footnote **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 49

* Additives: **Thrombin-based clot activator** with **gel for serum separation** * Inversions: **5-6** * Clotting time: **5 minutes** ## Footnote Laboratory use: For **stat serum determinations** in **Chemistry**. Tube inversions ensure mixing of clot activator with blood.

Answer 50

* Additive: **Thrombin-based clot activator** * Inversions: **8** * Clotting time: **5 minutes** ## Footnote Laboratory use: For **stat serum determinations** in **Chemistry**. Tube inversions ensure mixing of clot activator with blood.

Answer 51

* Additives: **Clot activator** (plastic serum), **K2EDTA** (plastic) * Inversions: **8** ## Footnote 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 52

* Additives: **K2EDTA** (plastic) * Inversions: **8** ## Footnote For **lead determinations**. This tube is certified to **contain less than .01μg/mL(ppm) lead**. Tube inversions prevent clotting.

Answer 53

* Additives: **K2EDTA** and **gel** for plasma separation * Inversions: **8** ## Footnote 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 54

* Additives: **Spray-coated K2EDTA** (plastic) * Inversions: **8** ## Footnote 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 55

1. Blood Culture or Sterile tubes (**yellow** stopper) 2. Coagulation tube (**light blue** stopper) 3. Serum tube with or without clot activator or gel (**red, gold, or red gray marbled**) 4. Heparin tube (**green or light green** stopper 5. **Black** top tube - after Heparin tube; can be before or after EDTA tube5. 6. EDTA tube (**lavender** stopper) 7. Oxalate/Fluoride tube (**gray** stopper) ## Footnote 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 56

1. Sterile (yellow) - Sterile Tubes / Blood Culture 2. Light blue - Coagulation tube 3. Red - Serum tube with or w/out clot activator gel 4. SST (Gold) - Serum tube with or w/out clot activator gel 5. PST (light green) - Heparin tube 6. Green - Heparin tube 7. Lavender - EDTA tube 8. Gray - Oxalate/Fluoride tube

Answer 57

* Antiseptics * Gauze Pad / Cotton Balls * Sharp Disposal Containers * Pen * Watch

Answer 58

Used to **prevent sepsis** and are used to **clean the site prior to blood collection** | Disinfect in **concentric fashion** ## Footnote * 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 59

Clean **2-by 2-inch gauze pads folded in fourths** are used to **hold over the site** following blood collection procedures ## Footnote * **Gauze pad is preferred** * **Cotton ball** can also be used but **not recommended** (due to its fiber material)

Answer 60

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

Answer 61

Carried by the phlebotomist; must be with **indelible (permanent) non-smear ink** to label tubes and record other patient information ## Footnote Labeling of time should have **AM or PM**, since some tests have increased or decreased levels depending on the time of day

Answer 62

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

Answer 63

* 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** ## Footnote Principle: **Infrared Light Absorption**

Answer 64

* 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 ## Footnote * 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 65

Phlebotomy needles are sterile, disposable, and designed for single use only | Multisample n (ETS), Hypodermic n, Winged infusion (butterfly) n ## Footnote 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 66

* **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 67

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

Answer 68

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

Answer 69

Multisample needle * Bevel * Shaft * Threaded hub * Rubber sleeve over needle Tube holder Evacuated tube Assembled system: * Needle within stopper * Flange

Answer 70

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

Answer 71

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 72

* 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 ## Footnote 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 73

1. Blood Gases - Rotate between palm to mix 2. Slides and Smears/EDTA specimens - 10 3. Lithium heparin - 10 4. Lithium heparin with gel separator - 10 5. Sodium fluoride/Potassium oxalate - 10 6. Serum (w clot activator) - 5 7. Serum (w no clot activator) - None 8. Newborn Blood Spot Card - Recommended to be collected separately

Answer 74

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

Answer 75

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

Answer 76

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

Answer 77

* 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 78

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

Answer 79

* **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 80

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

Answer 81

* 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) ## Footnote Usually performed on **infants and young children**

Answer 82

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

Answer 83

* 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 84

1. Do not puncture the fingers of infants and children under 1 year of age. 2. 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. 3. Do not puncture parallel to the grooves or lies of the fingerprint. (puncture across the ridges of the fingers / perpendicular to avoid messy collection) 4. Do not puncture the fifth or the pinky finger. (bone injury is most likely) 5. Do not puncture the index finger. (only a minimal amount of blood can be obtained; calloused area) 6. Do not puncture the side or very tip of the finger. 7. Do not puncture the thumb. (calloused area and has a pulse)

Answer 85

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

Answer 86

**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 87

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

Answer 88

* 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 89

* 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 90

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

Answer 91

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 92

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

Answer 93

* **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 94

* Second most common complication. * Before drawing blood, the collector should ask if he/she had prior episodes of fainting. ## Footnote * 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 95

* 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 96

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 97

**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 98

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

Answer 99

* **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 ## Footnote ● Best to collect on cephalic vein

Answer 100

* 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 101

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

Answer 102

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

Answer 103

* **Rupture of red blood cells **with the consequent escape of hemoglobin. * Can cause the plasma or serum to appear **pink or red.** ## Footnote **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 104

**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 105

* Posture * Diurnal Rhythm * Exercise * Stress * Diet * Smoking

Answer 106

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 107

* 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 108

* **Muscle activity elevates** creatine, protein, creatine kinase, AST, and LDH. ● Exercise **activates coagulation and fibrinolysis** and **increases platelet and white blood cells.** ## Footnote ● Do not exercise before testing

Answer 109

Anxiety can cause a **temporary increase in white blood cells.**

Answer 110

* 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 111

* 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 112

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

Answer 113

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

Answer 114

* Drawing above IV * Short draw (blood to anticoagulant ratio)

Answer 115

* 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 116

* Inadequate mixing * Traumatic stick

Answer 117

* Short draw * Sodium citrate tube draw volume critical

Answer 118

* Using insufficient or excess anticoagulant * Using expired or contaminated tubes

Answer 119

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

Answer 120

* Exposure to light * Pre-chilled tube * Body temperature