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MTAP - CLINICAL CHEMISTRY 1 (LEC) > CC PART 8 (PHLEBOTOMY SOURCES OF ERROR) > Flashcards

CC PART 8 (PHLEBOTOMY SOURCES OF ERROR) Flashcards

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1
Q

● Treatment error, possibility of
transfusion fatality

A

Misidentification patient

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2
Q

● 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

A

Drawing at incorrect time

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2
Q

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

A

Benzalkonium Cl or Zephiran

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3
Q

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

A

Improper skin disinfection

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4
Q

Cleaning of site:

A

Up and Down motion (CLSI)

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5
Q

● Dilution of sample with tissue
fluid

A

Drawing from edematous site

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6
Q

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

A

Fist pumping during venipuncture

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7
Q

● Increase K+ , total protein, lactic
acid

A

Tourniquet > 1 minute

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8
Q

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

A

IV fluid contamination

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9
Q

● Decreased vacuum, failure to
obtain specimen

A

Expire collection tubes

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10
Q

● 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

A

Incorrect anticoagulant or
contamination from incorrect order of draw

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11
Q

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

Tricyclic Antidepressants and
trace metals

A

Incorrect anticoagulant or
contamination from incorrect order of draw

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12
Q

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

A

Failure to hold bottom of tube
lower than top during collection

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13
Q

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

A

Short Draw

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14
Q

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

A

Inadequate mixing of anticoagulant tube

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15
Q

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

A

milking

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16
Q

What is antiseptic used in ethanol testing?

A

Benzalkonium Cl or Zephiran

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17
Q

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

A. Potassium

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17
Q

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

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

A

B. Sodium Hypochlorite (Zonrox)

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18
Q

Gauge for Adult patients

A

21

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19
Q

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

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

A

A. Decrease

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20
Q

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

A

C. Greater

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21
Q

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

A

23

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22
Q

● Tube Size

  1. Pedia: ___ uL
  2. Adult: up to ___ mL
A
  1. Pedia: 150 uL
  2. Adult: up to 7 mL
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23
Q

ORDER OF DRAW

ETS

A

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

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24
Q

ORDER OF DRAW

Syringe

A

B C H E F R

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25
Q

ORDER OF DRAW

Capillary Puncture

A

E O S

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26
Q

ORDER OF DRAW

Catheter/ Central Venous Access

A

B A P

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27
Q

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

A

PUBLIC RELATIONS AND CLIENT INTERACTION

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28
Q

The inner layer composed of a lining of epithelial cells

A

Tunica intima

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29
Q

The middle layer composed of smooth muscle and elastic tissue

A

Tunica media

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30
Q

The outer layer composed

A

Tunica adventitia/ externa

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31
Q

Heart to body cells

A

Arterial Blood

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31
Q

Larger oxygen concentration

A

Arterial Blood

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32
Q

Color: Bright Red

A

Arterial Blood

33
Q

Heart to lungs

A

Venous Blood

34
Q

Color: Dark Red

A

Venous Blood

34
Q

Larger carbon dioxide concentration

A

Venous Blood

35
Q
  1. Median Cubital Vein- ___ choice
  2. Cephalic vein- ___ choice
  3. Basilic vein - ___ choice
A
  1. Median Cubital Vein- 1st choice
  2. Cephalic vein- 2nd choice
  3. Basilic vein - 3rd choice
36
Q

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

A

3-4

36
Q

VENOUS BLOOD COLLECTION

● Needle insertion:

A

15-30 degree angle

37
Q

Deoxygenated, Dark Red color

A

VENOUS BLOOD COLLECTION

37
Q

○ Luer fitting for _________
○ Luer adapter for _______

A

○ Luer fitting for syringe
○ Luer adapter for ETS

38
Q

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

A

Winged Infusion Set (Butterfly)

39
Q

The needle gauge used in pediatric venipuncture is:

A. 20
B. 22
C. 21
D. 19

A

B. 22

40
Q

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

A. 3-4 inches

41
Q

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

A

B. 1.0-1.5

42
Q

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

A

ARTERIAL

43
Q

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

A

ARTERIAL

44
Q

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

A

ARTERIAL

Allen’s Test

45
Q

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

A

CAPILLARY

45
Q

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

A

CAPILLARY

46
Q

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

A

CAPILLARY

47
Q

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

A

Perpendicular

48
Q

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

A

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

49
Q

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

A

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

50
Q

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

A

LEAN SIX SIGMA

51
Q

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

A

LEAN SIX SIGMA

52
Q

● _____ – focus on reduction of waste

○ Customer value
○ Waste elimination
○ Speed
○ Flow
○ Resources

A

Lean

53
Q

● __________ – Focus on reduction of error

○ Customer value
○ Defect,
○ Reduction
○ Reducing variation
○ Repeatability
○ Consistency

A

Six Sigma

54
Q

___σ – highest value; ___σ – lowest

A

6σ – highest value; 3σ – lowest

55
Q

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

A

random error

56
Q

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

A

QUALITY MANAGEMENT

57
Q

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

A

Quality Assessment

57
Q

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

A

Statistical QC

57
Q
  • Refers to procedures for monitoring work processes,
    detecting problems and making corrections prior to the delivery of products and services.
A

Quality Control

57
Q

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.

A

Quality Assessment

58
Q

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

A

Quality Improvement

59
Q

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

A

Quality Goal

60
Q

Concerned with establishing and validating processes that meet customer needs.

A

Quality Planning

61
Q

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

A

VALIDATION

62
Q

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

A

VALIDATION

63
Q

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

A

VERIFICATION

63
Q

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

A

VERIFICATION

64
Q

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

A

VERIFICATION

65
Q

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

A

METHOD EVALUATION

66
Q

Mnemonics for Performance Indicators (PI)

● All CC analyzers should PASSLR:

A

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

67
Q

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

A

TECHNICAL VALIDATION

67
Q

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

A

TECHNICAL VALIDATION

68
Q

● Performance indicator:

○ Sensitivity
○ Specificity

A

ANALYTICAL VALIDATION

69
Q

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

A

ANALYTICAL VALIDATION

70
Q

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

A

CLINICAL VALIDATION

71
Q

○ Positive predictive value, and;
○ Negative predictive value

A

CLINICAL VALIDATION

72
Q

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

A

REASONS FOR VALIDATION

73
Q

● 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

A

REASONS FOR VALIDATION

74
Q

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

A

Allowable Error

75
Q

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

A

PERFORMANCE STANDARD

MTAP - CLINICAL CHEMISTRY 1 (LEC) (8 decks)

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