● Tube Size 1. Pedia: ___ uL 2. Adult: up to ___ mL

1. Pedia: 150 uL 2. Adult: up to 7 mL

CC PART 8 (PHLEBOTOMY SOURCES OF ERROR) Flashcards by Toni Mae Inductivo

● Treatment error, possibility of
transfusion fatality

Misidentification patient

How well did you know this?

Not at all

Perfectly

● Treatment errors if samples for
certain tests aren’t drawn at appropriate time.
● Ex. Therapeutic drug monitoring, analytes that exhibit diurnal variation, analytes that require fasting

Drawing at incorrect time

How well did you know this?

Not at all

Perfectly

● ____________________________ =
antiseptic used in ethanol testing
○ Non-alcohol based

Benzalkonium Cl or Zephiran

How well did you know this?

Not at all

Perfectly

● Infection at site if puncture.
Contamination of blood culture
and blood components
● Isopropyl alcohol wipes can
contaminate samples for blood
alcohol

Improper skin disinfection

How well did you know this?

Not at all

Perfectly

Cleaning of site:

Up and Down motion (CLSI)

How well did you know this?

Not at all

Perfectly

● Dilution of sample with tissue
fluid

Drawing from edematous site

How well did you know this?

Not at all

Perfectly

● Increase K+ , lactic acid, Ca2+ ,
phosphorus, decreased pH

Fist pumping during venipuncture

How well did you know this?

Not at all

Perfectly

● Increase K+ , total protein, lactic
acid

Tourniquet > 1 minute

How well did you know this?

Not at all

Perfectly

● Increase glucose, electrolytes
● For 10-15% contamination of
Dextrose 5% in Water (D5W)
the glucose ↑ by up to 500
mg/dL

IV fluid contamination

How well did you know this?

Not at all

Perfectly

● Decreased vacuum, failure to
obtain specimen

Expire collection tubes

How well did you know this?

Not at all

Perfectly

● K2 EDTA before serum or
heparin tube:
● Decreases Ca & Mg, Increase
K+
● Contamination of citrate tube
with clot activator: erroneous
results of PT and APTT

Incorrect anticoagulant or
contamination from incorrect order of draw

How well did you know this?

Not at all

Perfectly

● Sodium Heparin: Increase Na
● Lithium Heparin: Increase
Lithium
● Gel separator: Decreases

Tricyclic Antidepressants and
trace metals

Incorrect anticoagulant or
contamination from incorrect order of draw

How well did you know this?

Not at all

Perfectly

● Carryover from one tube to
another.
● Possible additive contamination

Failure to hold bottom of tube
lower than top during collection

How well did you know this?

Not at all

Perfectly

● Incorrect blood: anticoagulant
ratio affects some results like PT
and APTT

Short Draw

How well did you know this?

Not at all

Perfectly

● Micro-clots fibrin, platelet
clumping can lead to erroneous
results

Inadequate mixing of anticoagulant tube

How well did you know this?

Not at all

Perfectly

Hemolysis from alcohol contamination, “__________-” site of capillary puncture, probing with needle, vigorous shaking of
tubes, exposure of samples to extreme temperature

milking

How well did you know this?

Not at all

Perfectly

What is antiseptic used in ethanol testing?

Benzalkonium Cl or Zephiran

How well did you know this?

Not at all

Perfectly

What analyte is significantly affected by repeated and vigorous fist exercise during
venipuncture causing falsely increased levels?

A. Potassium
B. Sodium
C. Magnesium
D. Calcium

A. Potassium

How well did you know this?

Not at all

Perfectly

Which of the following is not used as antiseptic during venipuncture?

A. Benzalkonium chloride
B. Sodium Hypochlorite (Zonrox)
C. Gauze
D. 70% alcohol

B. Sodium Hypochlorite (Zonrox)

How well did you know this?

Not at all

Perfectly

Gauge for Adult patients

How well did you know this?

Not at all

Perfectly

What is the effect on draw volume if evacuated tubes are stored at high temperatures?

A. Decrease
B. None
C. Indeterminate
D. Increase

A. Decrease

How well did you know this?

Not at all

Perfectly

If blood was collected using an anticoagulant how would the volume of plasma be usually
described compared to blood collected without the anticoagulant and serum is obtained instead?

A. Same
B. Lower
C. Greater
D. Indeterminate

C. Greater

How well did you know this?

Not at all

Perfectly

Gauge for Pediatric patients = __, if not in the choices 22

How well did you know this?

Not at all

Perfectly

● Tube Size

Pedia: ___ uL
Adult: up to ___ mL

Pedia: 150 uL
Adult: up to 7 mL

How well did you know this?

Not at all

Perfectly

ORDER OF DRAW ETS

B C N H E S ● B = Blood culture ● C = Citrate ● N = Non-additive ● H = Heparin ● E = EDTA ● S = Sodium Fluoride

ORDER OF DRAW Syringe

B C H E F R

ORDER OF DRAW Capillary Puncture

E O S

ORDER OF DRAW Catheter/ Central Venous Access

B A P

Professionalism, Patient consent (implies consent), legal issues, infection control (PPE, hand hygiene, isolation)

PUBLIC RELATIONS AND CLIENT INTERACTION

The inner layer composed of a lining of epithelial cells

Tunica intima

The middle layer composed of smooth muscle and elastic tissue

Tunica media

The outer layer composed

Tunica adventitia/ externa

Heart to body cells

Arterial Blood

Larger oxygen concentration

Arterial Blood

Color: Bright Red

Arterial Blood

Heart to lungs

Venous Blood

Color: Dark Red

Venous Blood

Larger carbon dioxide concentration

Venous Blood

1. Median Cubital Vein- ___ choice 2. Cephalic vein- ___ choice 3. Basilic vein - ___ choice

1. Median Cubital Vein- 1st choice 2. Cephalic vein- 2nd choice 3. Basilic vein - 3rd choice

Tourniquet: ____ inches above the site, not more than minute

3-4

VENOUS BLOOD COLLECTION ● Needle insertion:

15-30 degree angle

Deoxygenated, Dark Red color

VENOUS BLOOD COLLECTION

○ Luer fitting for _________ ○ Luer adapter for _______

○ Luer fitting for syringe ○ Luer adapter for ETS

○ 6-9 inches long ○ 23 gauge ○ 10-15 degree angle ○ Use butterfly to: small fragile veins, pediatric, geriatric patients ○ Disadvantage: Prone to hemolysis

Winged Infusion Set (Butterfly)

The needle gauge used in pediatric venipuncture is: A. 20 B. 22 C. 21 D. 19

B. 22

How many inches above the site of venipuncture should the tourniquet be placed? A. 3-4 inches B. 1-2 inches C. 2-3 inches D. 4-5 inches

A. 3-4 inches

What is the length of the most common used needle in inches for routine venipuncture? A. 0.5-1.0 B. 1.0-1.5 C. 1.5-2.0 D. 2.0-2.5

B. 1.0-1.5

● For Arterial Blood Gas (ABG) analysis and pH measurements ● No tourniquet needed ● Oxygenated, Bright Red Color

ARTERIAL

● Common sites: Arteries—- Radial, Brachial, Femoral, Scalp ● Angle: 30, 45, 90 degree

ARTERIAL

● Before collecting blood you should do the _______ to check the blood flow ● Major Complications: Thrombosis, Hemorrhage and infection

ARTERIAL Allen’s Test

● Discard the first drop; do not milk the site ● < 1 year old: Lateral plantar heel

CAPILLARY

● Older: Palmar surfaces of 3rd and 4th fingers, Plantar surface bit toe, Earlobe ● Method of choice: NewBorn Screening

CAPILLARY

● Equipment used: Feather lancet ● Depth: <2mm for children, <3mm for adult

CAPILLARY

● DO NOT MILK THE SITE!! —-> _______________

Perpendicular

● Artery and Vein = __ layers ● Capillary = __ layer (thinner) ● Cherry red - Hgb __

● Artery and Vein = 3 layers ● Capillary = 1 layer (thinner) ● Cherry red - Hgb C

● Chocolate brown - _______ ● Mauve - _________________ ● Tomato red - Red cell suspension

● Chocolate brown- Methemoglobin ● Mauve - Sulfhemoglobin ● Tomato red - Red cell suspension

Improve the performance of a process by identifying and eliminating causes of defects and errors resulting in eliminating variation in the process

LEAN SIX SIGMA

Identify, measure, and eliminate the large gaps of inefficiency in a process

LEAN SIX SIGMA

● _____ – focus on reduction of waste ○ Customer value ○ Waste elimination ○ Speed ○ Flow ○ Resources

Lean

● __________ – Focus on reduction of error ○ Customer value ○ Defect, ○ Reduction ○ Reducing variation ○ Repeatability ○ Consistency

Six Sigma

___σ – highest value; ___σ – lowest

6σ – highest value; 3σ – lowest

In the highest level of westgard sigma control, the only error that can be committed is __________. Which means systematic error has been completely disregarded.

random error

● Refers to the overall process used to ensure that laboratory results meet the requirements for health care services to patients.

QUALITY MANAGEMENT

Focus: ■ Broader Monitoring ■ Turn-around Time ■ Patient preparation

Quality Assessment

is a major procedure for monitoring the analytical performance of laboratory testing processes.

Statistical QC

- Refers to procedures for monitoring work processes, detecting problems and making corrections prior to the delivery of products and services.

Quality Control

Refers to the broader monitoring of other dimensions or other characteristics of quality such as turnaround time, patient preparation, specimen acquisition and result reporting that are monitored through broad QA activities.

Quality Assessment

Aimed at determining the root causes or sources of the problems being identified by QC and QA.

Quality Improvement

Represent the objectives or requirements that must be achieved to satisfy the customers.

Quality Goal

Concerned with establishing and validating processes that meet customer needs.

Quality Planning

Is a confirmation that the requirements for specifically intended use or specific applications were met through OBJECTIVE EVIDENCE (see forms like rubrics for scoring).

VALIDATION

It confirms that the level of measurement is sufficient, the measurement procedures are correct and the calibration was done properly.

VALIDATION

It confirms that the measurement method/measuring system is fully functional in a specific laboratory.

VERIFICATION

Is a confirmation that the analytical characteristics data provided by the manufacturer

VERIFICATION

A laboratory or reference institution were achieved through OBJECTIVE EVIDENCE in the given laboratory with the use of a specific measuring system

VERIFICATION

Used to verify acceptability of new methods prior to reporting patient results and procurement of the machine

METHOD EVALUATION

Mnemonics for Performance Indicators (PI) ● All CC analyzers should PASSLR:

○ Precise ○ Accurate ○ Sensitive ○ Specific ○ Linearity ○ Ref. range

Validation may be accomplished by thoroughly testing reference materials or by comparison of results tests performed by alternative methods ○ PASS LR should be included

TECHNICAL VALIDATION

Should be performed before a test procedure is placed into routine use

TECHNICAL VALIDATION

● Performance indicator: ○ Sensitivity ○ Specificity

ANALYTICAL VALIDATION

Ability to accurately and reliably measure the analyte of interest in the clinical laboratory and in specimens representative of the population of interest

ANALYTICAL VALIDATION

Ability to diagnose or predict risk for a particular health condition, measured by clinical/diagnostic sensitivity and clinical/diagnostic specificity and predictive values

CLINICAL VALIDATION

○ Positive predictive value, and; ○ Negative predictive value

CLINICAL VALIDATION

Results of analytical measurement will definitely influence health, quality of life, and even the patient’s life (for patient safety)

REASONS FOR VALIDATION

● It is our professional duty to carry out measurement of sufficient QUALITY (comply with accrediting bodies) ● Accreditation (official confirmation of laboratory’s competence) requires the use of properly validated and verified measurements

REASONS FOR VALIDATION

the amount of error that can be tolerated without invalidating the medical usefulness of the result

Allowable Error

A method performed to determine is able to accurately measure an analyte

PERFORMANCE STANDARD