Blood Collection and Specimen Considerations Flashcards by JULIA FRANCESCA ALZONA

liquid portion of clotted

serum

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anticoagulated blood

plasma

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preferred for most clinical chemistry tests

serum

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serum value > plasma value

glucose
potassium
PO4
HCO3-
albumin
CK
AST
ALP

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liquid portions of clotted or anticoagulated blood prepared by centrifugation at ____ g(RCF) for ___min

1000-2000
10min

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Plasma value > serum value

TP
Calcium

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anticoagulated venous, capillary, arterial blood

whole blood

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WB value < plasma value

glucose (↓10-15%)

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CB value > VB value

glucose
potassium

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VB value > CB value

TP
calcium

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separate serum or plasma from cells within __hours of collection (except centrifuged gel tubes)

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samples should be analyzed within __hours; otherwise, refrigerate for __hours or freeze at -___degC for longer storage

4 hours
48 hours
-20degC

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select veins in the ____

antecubital fossa

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what are the veins in the antecubital fossa

median cubital vein
cephalic vein
basilic vein

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most preferred puncture site, as it is well-achored

medial cubital vein

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preferred puncture site for obese patients

cephalic vein

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least preferred puncture site because there are nerves and arteries near

basilic vein

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puncture site: veins in the dorsal part of the h___, w___, a___, f___.

hand
wrist
ankle
foot

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tourniquet application:
___inches above the puncture site;
should not be left longer than ___min

3-4 inches
1 minute

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tourniquet application: if blood pressure cuff is used, inflate to BP:___mmHg

40-60 mmHg

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routine antiseptic

70% isopropyl alcohol

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culture antiseptic

70% isopropyl alcohol
iodophor/povidone iodine
chlorhexidine

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for patients with iodine sensitivity

chlorhexidine

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ethanol assay antiseptic

benzalkonium chloride
zephiran

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angle between vein and needle

15-30 deg

Venipuncture method: not recommended by CLSI due to safety and specimen quality issues

needle and syringe

Venipuncture method: for infants and children, hand veins, and difficult-draw situations

butterfly/winged infusion set

angle for butterfly/winged infusion set

<15deg

Venipuncture method: for multi-sample collection consists of double-headed needle, adapter, color-coded evacuated tube

evacuated tube system (ETS)

__ gauge number __ lumen diameter

↑ gauge number ↓lumen diameter

gauge 20 color

yellow

gauge 21 color

green

gauge 22 color

black

gauge 23 color

blue

gauge 25 color

orange

smallest number with largest diameter for large volume syringes

gauge 20

gauge __ standard, for routine venipuncture

gauge 21

gauge __ butterfly set

gauge 23

used to collet blood from scalp or tiny veins of premature infants

gauge 25

needle length: hypodermic (needle/syringe) ETS provides better control

1-1.5 inches

needle length: butterfly set

0.5-0.75

what are the tube additives for ANTICOAGULANTS and their respective tube top colors

EDTA - lavender citrate - light blue oxalate - gray heparin - green

tubes that binds calcium and prevents coagulation

EDTA citrate oxalate

inhibits thrombin by activating anti-thrombin III

heparin

CLOT ACTIVATORS and tube top color

silica - red (plastic) thrombin - orange

THIXOTROPIC GEL SEPARATORS gel + silica ___ gel + heparin ___

SST PST

ANTIGLYCOLYTIC AGENTS

sodium fluoride /iodoacetate - gray

Order of Draw using ETS

Blood Culture Coagulation Serum Tubes Heparin EDTA Oxalate/fluoride

Stop Light Red Stay Put Green Light Go

Sterile/SPS (yellow) citrate (Light blue) Red SST (gold) PST (light green) Green Lavender Gray

Yellow, SST, PST, Green, Lavender, Gray top number of inversions

8-10x

Light Blue top number of inversions

3-4x

Red top number of inversions

For newborn screening, POCTS, DM monitoring, absence of palpable veins

Capillary Puncture

Sites of capillary puncture

lateral plantar surface (heel) 3rd/4th finger big toe ear lobe

length of lancet blade for heel sticks adults: neonates:

adults: 2.4mm neonates: 1.74-<2.0

consequences of squeezing the site

dilutions with tissue juices hemolysis

Capillary Order of Draw

Blood gas spx slides/smears EDTA Other additive tubes serum tubes

puncture for arterial blood gas analysis, absence of palpable veins; done by trained personnel/physician

arterial puncture

arterial puncture sites and its angle:

radial, brachial: 45-60deg femoral: 90 deg

T/F. Modified Allen Test should be done before using the radial artery

True

T/F. anticoagulant used in arterial puncture is heparin (lyophilized/liquid)

True

T/F. a. lyophilized heparin - powdered/dry b. liquid heparin - 0.05 ml per ml of blood

both true

use opposite arm or perform fingerstick, if possible; otherwise, have nurse turn off IV for 2 mins

indwelling catheter, blood culture, additive tubes, clot tubes

CVA (Central Venous Access) Collection

what will you do as a medtech in the presence of : cannula/fistula, mastectomy

use opposite arm

what will you do as a medtech in the presence of : burns, edema, scars, sclerosed veins, tattoos

select another site

what will you do as a medtech in the presence of : hematoma

draw blood below

bleeding from the venipuncture site and hematoma formation a. vascular b. infections

a. vascular

second most common complications a. vascular b. infections

b. infections

results from blood loss for testing; particular problem with pediatric patients a. anemia b. neurologic

a. anemia

post-phlebotomy seizure or pain a. anemia b. neurologic

b. neurologic

syncope, orthostatic hypotension, cardiac arrest a. cardiovascular b. dermatologic

a. cardiovascular

allergic reaction to iodine, adhesive or latex a. cardiovascular b. dermatologic

b. dermatologic

ambient temperature: - high temp = ___ draw volume - low temp = ___ draw volume

- high temp = DECREASE draw volume - low temp = INCREASE draw volume

High altitude (>5000 ft) = ___ draw volume

INCREASE

____ = migration of water vapor inside a tube ____ = escape of water vapor from a tube containing wet additive

high humidity low humidity

light affects:

CTAD

CTAD meaning

citric acid theophylline adenosine dipyridamole

age gender race underlying conditions a. uncontrollable factors b. controllable factors

a. uncontrollable factors

physiological (diet, stress) biological technical a. uncontrollable factors b. controllable factors

b. controllable factors

Diurnal Variation: what increases in the morning?

cortisol ACTH iron aldosterone

Diurnal Variation: what increases in the evening?

GH PTH TSH

Activity: what increases in ↑ exercise?

lactate creatinine K PO4 CK-MM AST LD4,5 aldolase

Activity: what decreases in ↑exercise?

glucose TG cholesterol