blood collection equipment, additives and order of draw Flashcards
what are the phlebotomy carts used for
morning rounds
which organization states that it is require require wearing gloves when performing phlebotomy
CDC - centers for disease control and prevention
HICPAC - healthcare infection control and practices advisory committee
OSHA - occupational safety and health administration
what type of gloves does OSHA recommend and why
nitrile gloves
as they are not thick and does not react with chemicals
special glove liners are for who
individual who develop allergies
greek word of antiseptics
anti - against
septikos - putrefactive (infected/decaying)
most commonly used antiseptics for routine blood collection
70% isopropyl alcohol (isopropanol)
this antiseptics is used for blood culture - to get rid of unwanted growth
povidone iodine
true or false:
antiseptics inhibits the growth and development of microorganism and kill them
false - but do not necessarily kill them
what disinfectants is a solution made from generics
5.25% sodium hypochlorite (household bleach)
1:100 - decontaminating nonporous surface
1:10 - large amt of blood or body fluids
- at least 10min of contact time is required
alcohol based hand cleanser is available in what form
liquid
gel
foam
it is used to pressure over the site following blood collection procedures
clean 2x2 gauze
this is not recommended to hold pressure. explain why.
cotton balls
as cotton fibers tend to stick to the site
the platelet plug sealing site can be disrupted and bleeding reinitiated
antiseptics vs disinfectants vs sterilization
antiseptics and disinfectant:
do not kill microorganism and spores
sterilization:
destroys and kills
by heat, chemical, radiation (uv light/ autoclaving)
this are used to cover a blood collection site after the bleeding has stopped
bandages
types: paper, cloth, plastic, self adhesive bandage
*change to adhesive bandages once bleeding stops
apply pressure to stop bleeding
for arterial puncture, how long should you apply pressure at blood collection site and why
10-15 minutes
to avoid hematoma (bruise but may be deeper and more painful)
these are marked with biohazard symbol and be rigid, puncture resistant, leakproff and disposable and have locking lids to seal the contents when filled to the appropriate volume
sharps containers
these are leakproof plastic bags that are commonly used to transport blood and other specimens from the collection site to the lab
biohazard bags
slides are available either ___ or with a ____ area
plain
frosted
type of watch needed to accurately determine specimen collection times and time certain tests
watch preferably with a sweep second hand
how does torniquet helps in blood collection
to compress the vermin’s and restrict blood flow
restriction of venous flow = making veins large and stretching the walls and easier to find
disadvantage:
ipit sa kamay
may cause hemolysis, numbness and our blood test will be inaccurate
may cause hemoconcentration - makes blood thicker = hard to circulate
what happens if torniquet is not available
blood pressure cuff is used under the diastolic
how many percent do torniquet are contaminated with methicillin-resistant staphylococcus aureus after just one use
25%
what is not used as a rubber tubing for blood collection
rubber tubing
the protein of rbc that carries oxygen
hemoglobin
what happens if the packaging of the needle is open or the seal is broken
it means that the needle is no longer sterile and must be disposed.
what type of gauge is for routine venipuncture
gauge 20 - 25
how is the gauge selected according to
size and condition of patient’s vein
type of procedure
volume of blood to be drawn
equipment being used
- if too large = damage veins
if too small = hemolysis
length of the needles
multisample needle and syringe:
butterfly:
multisample needle and syringe: 1-1.5 inch
butterfly: 0.5-0.75 inch
*use 1 inch to avoid intimidating patients
it is the most common, efficient and CLSI preferred system for collecting blood samples
ETS
2 types of tube holders
- traditional - without safety feature
- safety - with needles attached
it can be used with both the ETS and the syringe method of obtaining blood specimens
evacuated tubes
*volumes ranging from 1.8 to 15mL
what causes the premature loss of vacuum inn evacuated tube
improper storage
opening the tube
dropping the tube
advancing the tube too far onto the needle before venipuncture
if needle bevel becomes partially out of the skin during venipuncture
partially filled tubes that contain additives has been altered
short draw or partial draw
what are the functions of additive tubes
prevent clotting
enhance or activate clotting
preserves certain blood components
additive tubes vs nonadditive tubes
nonadditive tubes
- without additive
- used when specimen needed is serum
(glass nonadditive red-top tubes - serum chem and blood donor screening)
additive tubes
- contain some type of additive
caps, top, or closure typically made of a type of rubber that is easily penetrated with a needle but seals itself when the needle is removed
stoppers
it indicated specific purposes of tube, special property, additive content
color coding
store evacuated tubes to what temp
4 to 25 degree celcius
plastic red tops are used to collect specimens that usually contains …
no additives
this needle is used for patients with small or difficult vein
syringe system
what is the gauge and length of the needle of the syringe
21-23 gauge
1- 1.5 inches in length
*must have safety features
most common volumes used for phlebotomy in syringe system
2,5 and 10mL
difference between syringe transfer devices and ETS tube holder
syringe test tube holder has permanently attached needle wile ETS does not
but similar concept
this is used in collecting blood from small or difficult veins such as hand veins of elderly and pediatric patients
blood collection sets (infusion sets)
butterfly
etc:
hand veins of elderly (geriatric) and kids (pediatric)
how long is the winged infusion set
referred to as a butterfly
0.5 to 0.75 inches
5-12 inch length of tubing
- used in shallow angles. less than 30 degrees
*gauge 21 and 23 are most commonly used
why does gauge 25 is rarely used in infusion set
can increase the chance of hemolysis in specimen as their lumen are too small or other tiny veins of premature infants and other neonates
only trained personnel to collect blood from the scalp
has automated in-vein retraction after blood collection to eliminated exposure to the contaminated needle
non winged blood collection set
21, 23, 25 gauge
with 7-12 inch tubing
it is a complete multisampling venous blood collection system that van be manipulated by the user to perform either vacuum and or gentle aspiration blood collection based on the condition of the patient’s vein
combination systems
additives are available in what forms
liquid
spray-dried
powder forms
*powder form must be tapped lightly
anticoagulants is needed when sample needed is …
serum or plasma
EDTA is available as
dipotassium (K2EDTA)
tripotassium (K3EDTA) salt sprayed on the inside of the tue or as liquid K3EDTA
EDTA
test:
inversion:
Citrate
test:
inversion:
Heparin
test:
inversion:
Oxalates
test:
inversion:
EDTA
test:hematology section (CBC) n blood bbank
inversion: 8-10
Citrate
test: coagulation tests (PT - prothrombin time, PTT - partial thromboplastin time)
inversion: 3-4
Heparin
test: STAT tests in clinical chemistry section
*can centrifuge agad
inversion: 5-10
Oxalates
test: -
inversion: 8-10
what is the ratio of blood to anticoagulant of citrates
9:1
*centrifuge sample to separate plasma
what are the 3 heparin formulations
ammonium
lithium (least interference, commonly used)
sodium
what is being prevented when we follow the order of draw
- carryover/ cross contamination
- tissue thromboplastin contamination
- microbial contamination
silicon coating
found in both gel and non-gel plastic serum tubes
it prevents blood cells from sticking to the sides of the test tube which can interfere the results
contains special gels or mechanical separators that is activated during centrifugation
serum or plasma separator tubes
- thixotropic gel separator (changes properties during the process)
-changes viscosity when centrifuged = form physical barrier btwn blood cells and serm - nongel separator (newer technology)
-type of plasma blood collection tube called Bd barricor
those 2 allow to collect n separate blood components
briefly explain how Bd barricor works to separate blood components
blood collection:
separator sits at the top of the tube
blood flows into the tube, passing that
centrifuge:
separator stretches and moves down into the blood column - bcs of differential buoyancy
separation:
separator stretches, channels form around it
those channels allow blood cells to flow out of the plasma
final separation:
when centrifuge slows down, the elastic separator returns to its original shape
forms a seal btwn plasma (top) and blood cells (bottom)
result is stable, robust barrier between blood components
it is the trace-element-free tubes
royal blue stoppers
used for trace element tests, toxicology and nutrient determinations
*usually contain EDTA, Heparin, or no additive at all
it is the transfer of additive from one tube to another. it occurs when blood in an additive tube touches the needle during ETS blood collection or when blood is transferred from a syringe into the ETS tubes
carryover/ cross contamination
it is present un tissue fluids and activates the extrinsic coagulation pathway
tissue thromboplastin contamination
* no known significant effect to PT/PTT unless involves lot of needle manipulation
use a discard or clear tube
when must the tube for blood culture must be collected first
when sterility of site is optimal
- it is at its cleanest, best time to get the most accurate sample for checking microbes
*prevent microbial contamination of the needle from the unsterile tops of tubes
*may cause false positive blood culture results
- if bacteria from the tube tops get into blood culture sample
true or false:
it is requires that all ETS components come from the same manufacturer
false - it is recommended not required
this is where the needle is screwed into and a large opening at the other end where the collection tube is
tube holders
SESIP
sharp with engineered sharps injury protection
- needle that has a safety feature
by OSHA, occupational safety and health administration
it is any substance placed within a tube other than the tube stopper or any silicone coating
additive
syringe system and ETS consists of
syringe system:
hypodermic needle
sterile plastic syringe
luer-lock tip (parang screw siya)
ETS:
multisample needle
tube holder
evacuated tube
cylinder with graduated markings in either ___ or ___
barrel
mL or cc (cubic centimeters)
rodlike devices that fits tightly into the barrel
plunger
allows the safe transfer of blood into the tubes without using the syringe needle or removing the tube stopper
syringe transfer devices
why does the first tube collected with blood collection set will underfill
cos when blood starts flowing, the air has to be pushed out first before the tube can fill completely
what is the difference between infusion set and winged infusion set
The winged infusion set has wings for better control and is typically used for shorter or more delicate procedures, like drawing blood or for patients with difficult veins.
An infusion set refers to the general equipment used for any type of infusion but doesn’t necessarily have wings for handling.
In short, the winged infusion set is a specific type of infusion set with extra handling features (the wings).
WINGED INFUSION SET (BUTTERFLY)
- shallow angle of 30 degrees
- access small veins
why should you mix immediately after blood collection and why should you mix it gently
to avoid formation of micro clots (tiny blood clots)
shaking too hard can damage the blood cells
they are typically placed on a rotator or other mixing device to keep them from settling out before testing
hematology whole-blood specimens
*if not cells will settle at the bottom and it will be necessary to mix them to resuspend the cells before testing
this is important in coagulation because it is a cofactor of several coagulation proteins (factors 2, 7, 9, 10)
and conversion of fibrinogen, clotting is not possible without ____ inhibiting it
calcium
in Heparin, why does the plasma cuased elevated potassium levels
when centrifuging, it can cause potassium leakage from RBCs = increasing K+ level
PISO: potassium in and sodium out
- when RBC is damaged, release K+ = increase K+ level in sample
it prevents glycolysis, breakdown of glucose
antiglycotic agents
decreaase of mg/dL per hour
commonly used: sodium fluoride
preserves glucose and inhibits bacteria growth
silicon coating
found in gel and non gel plastic serum tubes
reduce red cell adherence to the test tube walls
- prevent cell from metabolizing glucose
contains special gels or mechanical separators or physical barriers that is activated during centrifugation
serum or plasma separator tubes
it is an inert substances that changes during viscosity upon centrifugation and forms a physical barrier between the cells and serum
thixotropic gel
*it floats due to the difference in density
