4: OVERVIEW OF PRE-ANALYTICAL PHASE OF TESTING

Question 1

The ____________________ includes procedures such as laboratory handling and identification which takes place prior to any laboratory testing.

Answer 1

pre-analytical testing phase

Question 2

It is in this phase where proper control measures are placed to avoid subsequent issues. This starts when the doctor’s order is given and ends when the laboratory testing has officially commenced.

Answer 2

pre-analytical testing phase

Question 3

During this phase, aside from the ability to draw blood from the patient, the _____________ should also possess the skill of being able to identify factors that affect the process and address the same as needed.

Answer 3

phlebotomist

Question 4

The_______________ is used by physicians to diagnose and monitor the presence of a disease.

Answer 4

laboratory test

Question 5

In phlebotomy, the _____________ is ideal in establishing reference range since it represents the condition of the metabolism of the body early in the morning or after approximately 12 hours of fasting.

Answer 5

basal state

Question 6

PROBLEM AREAS AND TROUBLESHOOTING IN THE SITE SELECTION

Answer 6

Burns, Scars, & Tattoos
Damaged Veins
Edema

Question 7

a site which has burns, scars or tattoos is not recommended because veins in the area may be difficult to examine and blood circulation maybe impaired. Burns may be too painful to touch and tattoos may also be susceptible to infection due to the dyes used that may interfere with the process.

Answer 7

Burns, Scars, & Tattoos

Question 8

aside from encountering difficulty in puncturing the site when veins are damaged another problem is the possibility of getting inaccurate results. Veins could be Sclerosed or hardened or Thrombosed or clotted.

Answer 8

Damaged Veins

Question 9

which is also known as Oedema, is an abnormal swelling caused by accumulation of fluid in the tissues. The tissues become fragile, making the task of locating the veins harder. This condition maybe due to reactions from medications, pregnancy, infections and other medical problems. cephalic or cubital vein.

Answer 9

Edema

Question 10

a solid swelling or mass of blood in the tissues which is caused by the leakage of blood from the vessels during venipuncture. This is not only painful because it obstructs the blood flow it could also lead to the contamination of blood sample.

Answer 10

Hematoma

Question 11

a treatment for breast cancer that requires removal of the breast through surgery. Blood drawing becomes a challenge since the lymph flow is obstructed, and there maybe swelling and infection after the surgery. In addition, tourniquet cannot be applied because it can cause injury. It should also be noted that it could also change the blood composition.

Answer 11

Mastectomy

Question 12

the individual is grossly overweight. Patients that are obese have veins are deep and they are harder to locate. A solution is to use a longer tourniquet or try locating the cephalic or cubital vein.

Answer 12

Obesity

Question 13

There are cases when a patient needs a patient require the use of _____________________________ for blood sampling, infusing medication, central venous pressure readings and blood transfusion. The choice of vascular access sites is based on the needs of the patient, the purpose and length of time it needs to remain in the body. Listed are vascular access sites and devices used in phlebotomy:

Answer 13

Vascular Access Devices (VADs)

Question 14

To obtain samples for arterial blood gas and laboratory studies, critically ill patients require arterial lines where a thin catheter is inserted into an artery. This also used to monitor blood pressure continuously. Neither tourniquet nor venipuncture are allowed in the arm with an arterial line.

Answer 14

Arterial Line

Question 15

is a passageway created thru surgery which is usually in the arms with the intention of connecting the artery and a vein directly. This maybe created for hemodialysis treatment or pathological process such as erosion of arterial aneurysm.

Answer 15

Arteriovenous Shunt or Fistula

Question 16

is used to avoid the use of needle sticks, reduce infections, and reduce wastage from line draws. The device collects blood from the arterial or central venous catheter where it is connected.

Answer 16

blood sampling device

Question 17

which is commonly called a “hep-lock,” is an intravenous (IV) catheter attached to a stopcock or cap with diaphragm. The basic function is to provide access for administering medicine or drawing blood from the patient. This is threaded in the peripheral vein which is in the lower arm above the wrist for up to 48 hours. It is usually flushed with herapin or saline (to prevent clogging) and capped for future use.

Answer 17

Heparin or Saline Lock

Question 18

is a thin plastic tube or catheter inserted into a vein in the forearm to inject a volume of fluids into the bloodstream. The phlebotomist should avoid collecting blood from the arm with IV because the blood collected could be contaminated with IV fluid. If blood collection is necessary, collection site should be below the IV. Take note that collection of blood from known previously IV sites should be avoided for 24 to 48 hours.

Answer 18

Intravenous (IV) Sites

Question 19

also known as indwelling lines which is a tubing inserted to the main vein or artery used for blood collection, monitoring the patient’s pressures and administering medications and fluids.

Answer 19

Central Vascular Access Devices (CVADs)

Question 20

There are three (3) types of CVADs

Answer 20

Central Venous catheter lines
implanted port
peripherally inserted central catheter

Question 21

is also known as a central line inserted into the large vein (subclavian) and advanced into superior vena cava.

Answer 21

CENTRAL VENOUS CATHETER

Question 22

is a surgically implanted disk-shaped chamber attached into the indwelling line. This is usually placed on the upper chest just below the collarbone.

Answer 22

IMPLANTED PORT

Question 23

is a flexible tube inserted into the veins of extremities and the central veins.

Answer 23

PERIPHERALLY INSERTED CENTRAL CATHETER (PICC)

Question 24

HANDLING PATIENT COMPLICATIONS ASSOCIATED WITH BLOOD COLLECTION

Answer 24

Allergies to Equipment and Supplies
Excessive Bleeding
Fainting
Nausea and Vomiting
Pain
Petechiae
Seizures/Convulsion

Question 25

When the patient has adhesive allergy, a gauze should be placed over the site and should be removed after fifteen minutes. The alternative is to ask the patient to apply pressure for five minutes. For Antiseptic allergy, simply use a different antiseptic. And for latex allergy, look for a sign to indicate the allergy and use a non-latex alternative for gloves, tourniquet and bandages.

Answer 25

Allergies to Equipment and Supplies

Question 26

When a patient is on aspirin or anticoagulant, the bleeding may take a longer time. The pressure should be applied to the site until the bleeding stops. The attention of the authorized personnel should be called when the bleeding continues after five minutes.

Answer 26

Excessive Bleeding

Question 27

is a temporary loss of consciousness which is caused by the insufficient flow of blood to the brain. If the patient is prone to fainting during venipuncture, they are asked to lie down during the procedure.

Answer 27

Fainting

Question 28

When the patient feels nauseous and has the tendency to vomit, the phlebotomist has to discontinue the procedure until the patient feels better or until the feeling subsides. An emesis basin or wastebasket should be provided, and a cold damp washcloth should be applied in the forehead.

Answer 28

Nausea and Vomiting

Question 29

The patient should be warned before the needle insertion, and the phlebotomist should avoid redirection of the needle. If the patient complains of extreme pain or numbness, remove the needle and apply ice to the site because this could indicate nerve involvement. The phlebotomist needs to document the incident if the condition persists.

Answer 29

Pain

Question 30

This condition involves the appearance of small red or purple spots that look like rashes, which appears on the arm when tourniquet is applied.

Answer 30

Petechiae

Question 31

when this occurs, the blood draw should be discontinued immediately. Hold pressure over the site but make sure that movement is not restricted, the mouth is free from any obstruction and the patient is protected from self-injury. Call the attention of the first-aid personnel.

Answer 31

Seizures/Convulsion

Question 32

A __________________________ maybe offered to help address the swelling.

Answer 32

cold compress or ice pack

Question 33

Factors that trigger Hematoma are:

Answer 33

Excessive or blind probing
Inadvertent arterial puncture
Size of the vein - too small
The needle penetration - all through the vein
Needle is not completely inserted
Tourniquet is still on when the needle was removed
Pressure - not adequate

Question 34

This results from blood loss due to blood draw. It is important to ensure to collect only the required specimen volume because if 10% of the blood volume is removed at once from the body, the patients could face a threat.

Answer 34

Iatrogenic Anemia

Question 35

This happens when blood is filling up the tube rapidly and there is a rapid formation of hematoma on the site.

Answer 35

Inadvertent Arterial Puncture

Question 36

can be avoided by making sure that tapes or bandages are not opened ahead of time, needles are not preloaded into the tube holders, insertion site of the needle is not touched after sterilization, cap is removed just before venipuncture, and patients are advised to keep the bandage on the site for at least 15 minutes.

Answer 36

Infection

Question 37

happens when there is improper site selection, rapid needle insertion, excessive redirection of the needle and blind probing. If the initial attempt is not successful, the phlebotomist should try to redirect the needle by using a slightly forward or backward movement. The next step is to remove the needle and look for an alternative site.

Answer 37

Nerve Injury

Question 38

To avoid blood that has already been drawn to flow back into the vein from the collection tube, which may cause adverse reaction because of the presence of tube additives, make sure to keep the arm of the patient in a downward position and the tube just below the venipuncture site.

Answer 38

Reflux of Anticoagulant

Question 39

Damaging the vein could be avoided by following the proper technique and avoiding blind probing.

Answer 39

Vein Damage

Question 40

The phlebotomist should ensure that the following does not happen:

Answer 40

Needle not inserted far enough
Bevel partially out of skin
Bevel partially into vein
Bevel partially through vein
Bevel completely through vein
Bevel against vein wall
Needle beside vein
Undetermined position

Question 41

usually occur when conditions are less than ideal, which leads to the veins being blocked, resulting to insufficient blood flow. This happens when there is a strong pressure in the vacuum of the tube or plunger, the tourniquet is too close to the site or it is too tight, or when the tourniquet was removed during the draw.

Answer 41

Collapsed Vein

Question 42

To avoid failure due to loss of vacuum, the phlebotomist should make sure that the bevel is not partially out of skin and the tube itself is not damaged.

Answer 42

Tube Vacuum

Question 43

is a decrease in the fluid content or plasma volume which is usually caused by tourniquet that stagnates the normal flow of blood, leading to the increase in concentration of red blood cells and other nonfilterable large molecules.

Answer 43

Hemoconcentration

Question 44

which is also called haemolysis, refers to the rupture pes of the red blood cells. The hemoglobin is then released to the surrounding fluid.

Answer 44

Hemolysis

Question 45

or short draw, happens when the phlebotomist pulls a tube before reaching the required volume which may lead to the incorrect blood-to-additive ratio.

Answer 45

Partially Filled Tubes

Question 46

means that the specimen is compromised due to incorrect handling, which includes allowing alcohol, powder or other materials into the sample. Getting glove powder or perspiration into films and specimens, using the wrong antiseptic, or simply not following the proper antiseptic procedure could interfere with the results.

Answer 46

Specimen Contamination

Question 47

_________________________ should not be used because the manufacturer could not warrant the quality of the seal and pressure after the expiration date declared in the tube.

Answer 47

Wrong or Expired Collection Tube