Blood Collection Flashcards
1
Q
What is the first step in most laboratory analysis?
A
Specimen Collection
2
Q
Accuracy and Precision in collection can be measured by?
A
proper specimen collection and handling
3
Q
Test results are as good as?
A
sample collection and handling
4
Q
Identify the patient identification procedure
Concious inpatients
A
- verbally ask their full names,
- verify it using the identification bracelet which includes first and last name,
- hospital number/unit number,
- room/bed and physician’s name.
5
Q
Identify the patient identification procedure
Sleeping Patients
A
they must be awakened before blood collection. Identified same as conscious patients
6
Q
Identify the patient identification procedure
UNCONSCIOUS PATIENTS,
MENTALLY INCOMPETENT
PATIENTS
A
identified by asking the
attending nurse or relative; ID
bracelet
7
Q
Identify the patient identification procedure
Infants and Children
A
nurse or relative may identify
the patient or by ID bracelet
8
Q
Identify the patient identification procedure
Outpatient patient
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.
9
Q
CHARACTERISTICS OF BLOOD (6)
A
- It is in fluid form in vivo due to the naturally circulating anticoagulants, but in vitro it coagulates within 5-10 minutes.
- Red in color due to hemoglobin
- A ph average of 7.4
- Thick and viscous, 3.5 – 4.5 times thicker than water.
- For adult males, they have approx. 5-6 liters of blood
- For adult females, have 4 to 5 liters of blood
10
Q
Why is Blood fluid form in vivo?
A
due to the naturally circulating
anticoagulants
11
Q
In vitro, how long does blood coagulate?
A
5-10 mins
12
Q
Blood is/has
- Red in color due to ___________
- ph average of _____
A
- Red in color due to hemoglobin
- A ph average of 7.4
13
Q
Blood is Thick and viscous, _____ times thicker than water.
A
3.5 – 4.5 times
14
Q
How much blood is in an adult male and female?
A
5-6L for male
4-5L for female
15
Q
What is the composition of blood?
A
- LIQUID PORTION
- PLASMA
- SERUM - SOLID PORTION
- Red blood cells
- White blood cells - GASEOUS PORTION
- involves an exchange between oxygen and CO2
16
Q
Identify
This is the liquid portion of the unclotted blood with the protein fibrinogen
A
Plasma
17
Q
Identify
This is the liquid portion of the clotted blood without the fibrinogen.
A
Serum
18
Q
Identify
This is afingerstick to obtain blood for routine laboratory analysis is usually preferred for children.
A
SKIN PUNCTURE/ CAPILLARY PUNCTURE
19
Q
What is the length of a lancet and what should be the depth of incision for children and adults?
A
Length of the lancet: 1.75mm
The depth of the incision should be
<2.0mm for children and
<2.5 mm for adults
20
Q
How should the cut be oriented in skin puncture/capillary puncture?
A
The cut should be oriented across the fingerprints to generate a large drop of blood using single deliberate motion.
21
Q
What are the preferred sites of puncture?
A
- Lateral plantar heel surface
- Palmar surface of the non dominanat fingers (3rd and 4th fingers) – most common
- Plantar surface of the big toe
- Earlobes – least site
22
Q
What sites are to be avoided in skin puncture?
A
- Inflammed and pallor areas
- Cold and cyanotic areas
- Congested and edematous areas
- Scarred and heavily calloused areas
23
Q
What are the advantages of skin puncture?
A
- It is accessible to the operator
- Easy to manipulate
- Ideal for peripheral blood smears.
- It is less painful due to lesser nerve endings.
- There is more free flow of blood due to thinner skin layer.
- Less tissue juice contamination due to lesser tissues and muscle (earlobe).
24
Q
What are the disadvantages of skin puncture?
A
- Less amount of blood can be obtained
- Additional and repeated test cannot be done
- Blood obtained has tendencies to hemolyze easily.
25
What does CLSI recommend in cleaning capillary beds of the skin?
CLSI recommends using 70% isopropyl alcohol to clean capillary bed of the skin with a lancet or other sharp device
26
Why is the first drop of blood wiped away?
eliminate alcohol residue and excess tissue fluid
27
What is used to cover the site after collection?
Bandage
28
# Identify
These are sterile, disposable, sharp instruments used for capillary puncture. Their blades or points must permanently retract to prevent sharp injuries.
Lancets
29
What is the purpose of a warming device/warming process?
Warming the sites increases blood flow up to seven times and is especially important when performing heel sticks.
30
Water temperature in warming devices must not exceed ___ degrees C or it could scald the patient
42ºC
31
# Identify
➢Special small plastic tubes often
referred to as “bullets”
➢Most have color-coded stoppers that
correspond to color-coding of ETS tubes
Microcollection Tubes
32
# Identify
Narrow-bore capillary tubes primarily used for manual hematocrit determinations
MICROHEMATOCRIT TUBES
33
Microhematocrit tubes are either?
| Identify the types and purposes of each tubes
Either
- coated with heparin for collecting directly from a capillary puncture or
- plain to be used when filling with blood from an EDTA tube
34
# Identify
These are claylike substances used to seal one end of microhematocrit tubes.
Sealants
35
When is capillary puncture done?
| In what indications?
- Can be done if small amount of blood is required.
- There are no accessible veins
- Available veins are fragile or must be saved for other procedures such as chemotherapy
- Blood is to be obtained for POCT procedures such as glucose monitoring
- Capillary blood is the preferred specimen for some tests such as newborn screening
36
What are the steps in skin puncture?
1. Identify patient properly.
2. Verify patient’s condition.
3. Position the patient.
4. Choose the best location for fingerstick namely the 3rd and 4th fingers of the non-dominant hand.
5. Disinfect the site of collection in concentric fashion.
6. Allow area to dry completely. Prepare the materials needed.
7. Make a skin puncture using a sterile lancet.
8. Wipe away first drop of blood.
9. Collect drops of blood into the capillary tube.
10. Fill 2/3 of the tubes.
11. Invert capillary tubes to mix.
12. Place cotton on puncture site and instruct patient to apply pressure until bleeding stops.
13. Seal tubes with clay and paraffin wax.
14. Dispose contaminated materials to appropriate containers.
37
# Identify
A process by which blood is obtained from a patient’s vein.
Venipuncture
38
What are the sites of venipuncture?
- antecubital fossa,
- veins of the wrist,
- dorsal aspect of the hands,
- veins of the ankle
39
What methods are used in venipuncture?
Syringe and Evacuated Tube
40
# Identify
This is the best site for venipuncture because it is the largest and the best anchored vein.
Median Cubital
41
Why is the basilic vein not chosen unless no other vein is more prominent?
Basilic vein should not be chosen unless no other vein is more prominent due to its closeness to the brachial artery.
42
What SITES are TO BE AVOIDED in venipuncture?
- Intravenous lines in both arms
- Burned or scarred areas
- Areas with hematoma
- Edematous arms
- Cast on arms
- Thrombosed veins
- Arms with arteriovenous (AV) shunt or fistula
43
THINGS TO REMEMBER FOR
VENIPUNCTURE: (5)
- Verify that any **dietary restrictions** have been met (fasting. If appropriate) and check for any **sensitivity to latex.**
- Apply the **tourniquet 3 to 4 inches** above the site and instruct the patient to make a fist. **Never leave the tourniquet longer than one minute.**
- **Disinfect** the patient’s skin with alcohol pad starting at the point where you expect to insert the needle and moving outward in even widening concentric circles
- Angle for needle insertion is between **15-30 degrees**with the bevel side up
- Always **remove the tourniquet first before withdrawing the needle**. For evacuated tube method, remove the tube first and then the adaptor with the needle.
44
A properly labeled sample is essential so that the results of the test match the patient. The key elements in labeling are?
1. Patient's surname, first and middle.
2. Patient's ID number / Birthday and age
Both MUST match the same on the requisition form.
3. Date, time of collection and initials of the phlebotomist must be on the label of EACH tube.
45
What are the needle specifications used in venipuncture?
- The gauge of the needle is inversely proportional related to the size of the needle, the larger the gauge number, the smaller the needle bore and length.
- 21 gauge needle is standard for venipuncture
- 23 gauge needle is used for children, small and difficult veins.
- 16 gauge needle is used for Blood donation.
- Needle length: 1 inch or 1.5 inches – 21 to 23 gauge.
46
When is syringe system used in venipuncture?
Used for patients with small and difficult veins
47
What are the components of the syringe system?
It has components including:
1. A plastic syringe
2. Hypodermic needle
3. Transfer device
48
What are the three basic components of an evacuated system?
1. Multisample needle
2. Tube Holder/Adapter
3. Evacuated Tubes
49
# Identify
This allows collection of multiple tubes during venipuncture. Can bescrewed into a tube holder. Has a beveled point on each end
Multisample needle
50
# Identify
This is A plastic cylinder with a small opening for a needle at one end and a large opening for tubes at the other
Tube Holder/Adapter
51
# Identify
These have a premeasured vacuum that automatically draw the volume of blood indicated on the label
Evaucated Tubes
52
# Identify
This is a short needle with a plastic part resembling butterfly wings and a length of tubing with a Luer fitting for syringe use or a Luer adapter for ETS use
Butterfly system
53
What gauge is most commonly used for phlebotomy through butterfly system?
23
54
What are some COMPLICATIONS ENCOUNTERED IN BLOOD COLLECTION?
- Ecchymosis (bruise)
- Syncope (faintaing)
- Hematoma
- Failure to draw blood
- Petechiae
- Edema
- Obesity
- Hemoconcentration
- Hemolysis
- IV therapy, Burned, damaged, scarred and occluded veins, seizure and tremors, vomiting and choking, allergies and mastectomy patients.
55
Identify the complication:
one reason of this is that the vein is missed because of improper needle positioning. Other reasons are excessive pull of the plunger, piercing the other pole of the vein, incorrect bevel positioning and absence of
vacuum.
Failure to draw blood
56
# Identify the complication
small red spots indicating that small amounts of blood have escaped into the skin epithelium.
Petechiae
57
# IDentify the complication
swelling caused by an abnormal accumulation of fluid in the intracellular spaces.
Edema
58
# IDentify the complication
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.
Obesity
59
# Identify the complication
This is 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.
Hemoconcentration
60
# Identify
This is the rupture of red blood cells with the consequent escape of hemoglobin. Can cause the plasma or serum to appear pink or red.
Hemolysis
61
What are the PHYSIOLOGIC FACTORS AFFECTING
TEST RESULTS?
- Posture
- Diurnal rhythm
- Exercise
- Stress
- Diet
- Smoking
62
What physiologic factor affecting test result is meant by:
muscle activity elevates creatitine, protein, creatine kinase, AST and LDH. Exercise activates coagulation and fibrinolysis and increases platelet and white blood cells.
Exercise
63
In stress, anxiety can cause a temporary increase in what type of cell?
WBC
64
if a patient has eaten recently (less than 2 hours earlier), there will be a temporary increase in ______ and ______ content in the blood. Serum may appear _____
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.
65
What happens if a patient smokes before blood collection and smoking long term?
- increased white blood cell counts and cortisol levels.
- Long term smoking can lead to decrease pulmonary function and result in increased hemoglobin levels.
66
What additive inhibits the use of glucose by blood cells. Examples are sodium flouride and lithium iodoacetate
Antiglycolytic agent
67
# IDentify
This additive prevents blood from clotting. The mechanism by which clotting is prevented varies with the _____. EDTA, citrate and oxalate remove calcium by forming insoluble salts, whereas heparin prevents the
conversion of prothrombin to thrombin. If calcium is removed or thrombin is not formed, coagulation does not occur.
Anticoagulant agent
68
What additive is composed of an 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?
Separator gel
69
What additive helps initiate or enhance the clotting mechanism. Include glass or silica particles that provide increased surface area for platelet activation and clotting factor such as thrombin.
Clot Activator
70
What anticoagulant combines with calcium to form an insoluble salt?
Oxalate
71
What anticoagulant combines with calcium in a non ionized form?
Citrate
72
What anticoagulant combines with calcium in a process called chelation?
Ethylenediamine Tetraacetic acid (EDTA)
73
# Identify
This anticoagulant forms weakly dissociated calcium components
Fluoride
74
What anticoagulant prevents the formation of fibrin?
Heparin
75
# Identify
This refers to the order in which tubes are collected during a multiple-tube draw or are filled from a syringe
Order of Draw (ETS)
76
What is the order of draw for ETS?
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. EDTA tube (lavender stopper)
6. Oxalate/fluoride tube (gray stopper)
77
What is the ORDER OF DRAW for MICROTAINERS?
1. Blood Gases
2. Slides & Smears
3. EDTA tubes
4. Other additive microtainer
5. Serum microtainers
78
Describe the Gold or Red/Gray top tube in terms of:
Additive used:
Inversions:
Laboratory Use:
Blood Clotting Time:
Additive used: Clot Activator and gel for serum separation
Inversions: 5
Laboratory Use:
- for serum determinations in chemistry
- routine blood donor screening and diagnostic testing of serum for infectious disease
Blood Clotting time: 30 minutes
79
What is the purpose of tube inversions in gold or red/gray top tubes?
Ensure the mixing of clot activator with blood
80
Describe the Light green and Green/Gray top tube in terms of:
Additive used:
Inversions:
Laboratory Use:
Additive used: Lithium heparin and gel for plasma separation
Inversions: 8
Laboratory Use:
- plasma determinations in chemistry
81
What is the purpose of tube inversions in light green and green/gray top tubes?
To ensure mixing of anticoagulant (heparin) with blood to prevent clotting
82
Describe the red top tube (BD hemogard and conventional stoppers) in terms of:
Additive used:
Inversions:
Laboratory Use:
Blood Clotting time:
Additive used: Silicone coated (glass) and Clot activator, Silicone coated (plastic)
Inversions: 0 for glass and 5 for plastic
Laboratory Use:
- Serum determinations in chemistry
- Routine blood donor screening and diagnostic testing of serum for infectious disease
Blood Clotting time: 60 min
83
What is the purpose of tube inversions in red top tubes?
Ensure mixing of clot activator with blood
84
Describe the Orange top tube in terms of:
Additive used:
Inversions:
Laboratory Use:
Blood Clotting time:
Additive used: Thrombin-based clot activator with gel and without
Inversions: 5-6 (with gel) and 8 (without)
Laboratory Use: For stat serum determinations in chemistry
Blood Clotting time: 5 mins
85
Describe the Royal blue top tube in terms of:
Additive used:
Inversions:
Laboratory Use:
Additive used: Clot activator (plastic serum) and K2EDTA (plastic)
Inversions: both 8
Laboratory Use:
- CLOT ACTIVATOR-PLASTIC SERUM (for trace-element, toxicology, and nutritional-chemistry determinations
- K2EDTA (PLASTIC) (special stopper formulation provides low levels of trace elements
86
Describe the Green (both BD hemogard and Conventional stopper) top tube in terms of:
Additive used:
Inversions:
Laboratory Use:
Additive used: Sodium and Lithium heparin
Inversions: both 8
Laboratory Use: For plasma determinations in chemistry
87
Describe the Gray top tube in terms of:
Additive used:
Inversions:
Laboratory Use:
Additive used:
- Potassium oxalate/sodium fluoride
- Sodium fluoride/Na2 EDTA
- Sdium fluoride (serum tube)
Inversions: all 8
Laboratory Use:
- For glucose determinations
- Oxalate and EDTA anticoagulants will give plasma samples
- Sodium fluoride is antiglycolytic agent
88
Describe the Tan top tube in terms of:
Additive used:
Inversions:
Laboratory Use:
Additive used: K2EDTA (plastic)
Inversions: 8
Laboratory Use: lead determinations. certified to contain less than .01 ul/ml (ppm) lead
89
Describe the Yellow top tube in terms of:
Additive used:
Inversions:
Laboratory Use:
Additive used: Sodium polyanethol sulfonate (SPS)
Inversions: 8
Laboratory Use: SPS for blood culture specimen collections in microbiology
Additive used: Acid citrate dextrose additives (ACD):
- Solution A - 22.0 g/L trisodium citrate, 8.0 g/L citric acid, 24.5 g/L dextrose
- Solution B - 13.2 g/L trisodium citrate, 4.8 g/L citric acid, 14.7 g/L dextrose
Inversions: 8
Laboratory Use: ACD for use in blood bank studies, HLA phenotyping, and DNA and paternity testing
90
Describe the lavender top tube in terms of:
Additive used:
Inversions:
Laboratory Use:
Additive used: Liquid K3EDTA (glass) and Spray-coated K2EDTA (plastic)
Inversions: 8
Laboratory Use: K2EDTA and K3EDTA for whole blood hematology determinations. K2EDTA may be used for routine immunohematology testing, and blood donor screening
91
Describe the White top tube in terms of:
Additive used:
Inversions:
Laboratory Use:
Additive used: K2EDTA and gel for plasma separation
Inversions: 8
Laboratory Use: For use in molecular diagnostic test methods (PCR and bDNA amplification techniques)
92
Describe the Pink top tube in terms of:
Additive used:
Inversions:
Laboratory Use:
Additive used: Spray-coated K2EDTA (plastic)
Inversions: 8
Laboratory Use: 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
93
Describe the Light blue and clear (light blue) top tube in terms of:
Additive used:
Inversions:
Laboratory Use:
Additive used:
- Buffered sodium citrate (0.105 M (3.2%) glass and 0.109 M (3.2%) plastic
- Citrate, theophylline, adenosine, dipyridamole (CTAD)
Inversions: both 3-4
Laboratory Use:
- coagulation determinations
- CTAD for selected platelet function assays and routine coagulation determination
