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Clinical Microscopy > Blood collection > Flashcards

Blood collection Flashcards

1
Q

study of blood cells and coagulation. It is also the analysis of the concentration, structure and function of cells in blood

A

hematology

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2
Q

total blood volume of adults

A

5-6 liters

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3
Q

formed elements which make up 45% of blood involves the?

A

rbc, wbc, and platelets

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4
Q

The fluid portion which is made up of plasma is __% of blood

A

55%

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5
Q

T or F: the larger the gauge number, the smaller the bore

A

TRUE

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6
Q

What gauge number of needle is often used?

A

21 or 23

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7
Q

What gauge number of needle is used for blood transfusion?

A

16 or 18

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8
Q

These are designed to fill with a predetermined volume of blood by vacuum

A

evacuated collection tubes/ vacutainers

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9
Q

Essential elements in a requisition form

A 
o Patient’s surname, first name and middle initial
o Patient’s ID number
o Patient’s date of birth and sex
o Requesting physician’s complete name
o Source of specimen
o Date and time of collection
o Initials of phlebotomist
o Test requested
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10
Q

Betadine is only used for

A

blood culture

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11
Q

Where should collection tube be labeled?

A

at bedside or drawing area

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12
Q

Key elements in requisition form

A

patients complete name
Patients id number
date and time of collection
initials of phlebotomist on each tube

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13
Q

What is the need for order of draw?

A

to avoid cross-contamination between tubes

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14
Q

What is the order of draw?

A

o Blood culture tube (yellow-black stopper)
o SST (red or SST stopper)
o Coagulation tube (light blue stopper)
o Additive tubes (Dark Green, Light Green, Lavender, Pale Yellow, Light Gray)

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15
Q

The blood culture tube is drawn first to?

A

minimize chance of microbial contamination

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16
Q

To separate blood from serum on centrifugation, what is contained in SST?

A

clot activator and gel (no additives!)

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17
Q

The red top is for

A

chemistries, immunology and serology, blood bank (crossmatch)

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18
Q

Why is the coagulation tube never the first tube drawn?

A

Tissue thromboplastin from initial draw may affect test results

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19
Q

Tubes with additivies must be?

A

thoroughly mixed by inversion (not shake)

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20
Q

What is the order of draw for additive tubes?

A

Sodium heparin (dark green top)
Plasma separating tube (light green stopper)
EDTA (purple top)
ACDA or ACDB (pale yellow stopper)
Oxalate/Fluoride (light gray stopper)
*for plastic tube PST and EDTA are reversed

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21
Q

The dark green top contains sodium/lithium heparin for?

A

inactivation of thrombin and thromboplastin for use in assessment of ammonia level (both sodium and lithium heparin) and lithim level (only sodium heparin) – for suspected encephalopathy or toxicity

22
Q

Characteristics of PST?

A

o LIGHT GREEN STOPPER
o Lithium Heparin
o Anticoagulates with lithium; plasma is separated with PST gel at the bottom of the tube
o For chemistries

23
Q

Purpose of EDTA in purple top?

A

EDTA liquid forms calcium salts to remove calcium

24
Q

Use of purple top

A

for hematology (CBC, cross matching), PT (prothrombin time), PTT (partial thromboplastin time) which requires full draw and inversion of 8 times to prevent clotting and clumping

25
Q

The pale yellow stopper contains

A

acid-citrate-dextrose for complement activation used in HLA tissue typing, paternity test and DNA studies

26
Q

The light gray stopper contains what

A

sodium fluoride and potassium oxalate as an antiglycolytic agent that preserves glucose up to 5 days (full draw)

27
Q

What are the different blood collection techniques?

A

o Microsampling technique
o Venipuncture
o Arterial puncture

28
Q

The venipuncture test is used for?

A

glucose, cholesterol, uric acid, creatinine, alkaline phosphatase test

29
Q

Why isn’t evacuated tubes used on patients with small or poor veins

A

their veins may experience collapse

30
Q

What are the usual veins accessed?

A

median cephalic vein
median basilic vein
cephalic vein

31
Q

What happens if plunger of syringe is pulled back quickly?

A

hemolysis or collapsing vein

32
Q

Areas to be avoided in venipuncture

A

o Extensive scars from burns and surgery
o The upper extremity on the side of a previous mastectomy
o Hematoma
o Cannula/ fistula/ heparin lock
o Edematous extremities - tissue fluid (edema) accumulation alters test results
o Arteriovenous (AV) Fistula – connection between an artery and a vein in patients undergoing dialysis
o Intravenous (IV) therapy / blood transfusions

33
Q

Edematous extremities should be avoided in venipuncture. What to do when the ear is the only part without edema?

A

§ If the ear is the only part without edema, you should do arterial puncture

34
Q

What happens if an AV fistula is punctured?

A

it can no longer be used for dialysis.

35
Q

Procedure for doing venipuncture in patients undergoing IV therapy/blood transfusion

A

§ Turn off the IV fluid for 2 minutes before venipuncture
§ Apply the tourniquet below the IV site. You can even use the veins of the feet, the leg
§ Draw 5 mL of blood and discard before drawing the specimen tubes for testing.

36
Q

Uses of microsampling technique

A

-when smaller volumes of blood are needed (CBC, peripheral blood smears, malaria smears, blood typing)
-also useful for pediatric, obese and elderly patients where veins are small and cannot be palpated
o Useful in infants less than 6 months, in young children when small amt is needed, adults with poor veins or with several intravenous infusions and severely burned patients

37
Q

Location of phlebotomy site in microsampling technique

A

o Heel of the foot (medial and lateral portion of plantar surface), Depth of puncture (<2.6 mm)
o 3rd or 4th finger of the non-dominant hand (for infants > 1 yo; puncture perpendicular to fingerprint on palmar surface and off-centered)

38
Q

If 5th finger is punctured, why is osteomyelitis a possible risk?

A

o 5th finger tends to have less soft tissue overlying the bone so bone might be hit

39
Q

Microsampling technique can also be used in the assessment of Arterial Blood Gas because

A

There is mixing of venous and arterial blood

40
Q

T or F: use big toe, tongue and earlobe as puncture site

A

FALSE

41
Q

This method of blood collection is used to measure oxygen, carbon dioxide and pH of blood (ABG) and is critical in assessment of oxygenation problems encountered in certain illnesses and critically ill patients

A

o Arterial puncture

o Easiest way of blood collection among babies

42
Q

Gauge number of needle used in arterial puncture

A

23 or larger

43
Q

Puncture sites for arterial puncture

A

brachial artery, radial artery, femoral artery

44
Q

Why is Gauge 25 not used in arterial puncture?

A

Blood will hemolyze

45
Q

T or F: Pressure application in arterial puncture is longer compared to venipuncture

A

True (at least 2 minutes)

46
Q

Indwelling lines or catheters are potential sources of test error because?

A

most lines are flushed with a solution of heparin to reduce risk of thrombosis

47
Q

Hemoconcentration or the increased concentration of larger molecules and formed elements may be due to which factors?

A

Prolonged tourniquet application (increases total protein, aspartate aminotransferase, total lipids and cholesterol and iron), also affects packed cell volume and other cellular elements
Massaging, squeezing or probing a site (tissue fluids might come out)
Long term IV therapy
Sclerosed or occluded veins

48
Q

What to do when drawing blood from patients with uncontrolled bleeding?

A

put pressure in area of puncture or notify doctor

49
Q

Why is exercise considered as patient preparation factor?

A

creatinine kinase, aspartate aminotransferase, lactate dehydrogenase and platelet count may increase

50
Q

Stress should be considered as PPF because?

A

there is a transient elevation in WBCs and elevated adrenal hormone values (catecholamines and cortisol). Anxiety also results in hyperventilation and may cause acid-base imbalances and increased serum lactate

51
Q

What to do when you stick yourself with a contaminated needle?

A

remove gloves, dispose properly
squeeze puncture site to promote bleeding,
wash area well with soap and water
record patients name and ID number
prophylactic zidovudine to prevent seroconversion

52
Q

(see advantages and disadvantages of different blood collection techniques, patient’s bill of rights and tests affected by diurnal variation, posture and stress))

A

(see advantages and disadvantages of different blood collection techniques, patient’s bill of rights and tests affected by diurnal variation, posture and stress))

Clinical Microscopy (10 decks)

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