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HEMA 1 LEC > Chapter 3 - ROUTINE HEMATOLOGY PROCEDURES > Flashcards

Chapter 3 - ROUTINE HEMATOLOGY PROCEDURES Flashcards

1
Q

Materials for Blood Collection:

A
  1. Tourniquet
  2. Needles
  3. Evacuated Tube System
  4. Solutions for Skin Antisepsis
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2
Q

Applied to distend the veins makes veins larger and easier to find, and stretches the walls so they become thinner and easier to pierce.

A

Tourniquet

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3
Q

Application of tourniquet should not exceed ______.

A

1 min

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4
Q

Test/s that strictly does/do not require the use of tourniquet: _______

A
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5
Q

With color-coded hub indicating the gauge (Gauge is inversely related to the size/bore)

A

Needles

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6
Q

: considered standard for routine venipuncture

A

Gauge 21

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7
Q

Gauge 21-23 (? for children; ? for butterfly/winged infusion set)

A

23
21, 23 & 25

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8
Q

: for the collection of blood from scalp or other small veins of infants

A

Gauge 25

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9
Q

Needles Length: ? (G21-23); ? (butterfly needles)

A

1 or 1.5 inches
½ to ¾ inch

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10
Q

Basic components: multisample needle, tube holder, evacuated tubes (with premeasured vacuum that draws the indicated volume of blood

A

Evacuated Tube System

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11
Q

are color-coded to identify a type of additive, or absence of additive, or special tube property.

A

Tube stoppers

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12
Q

Routine collection:

A

70% isopropyl alcohol

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13
Q

Test for legal blood alcohol level:

A

non-alcohol-based antiseptic

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14
Q

30- to 60-second scrub with 70% isopropyl alcohol then 1% - 10% povidone-iodine pads, tincture of iodine, chlorhexidine compounds, or another isopropyl alcohol preparation.

A

Blood culture: Two-step procedure

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15
Q

Blood culture: One-step application

A

chlorhexidine gluconate/isopropyl alcohol or povidone-70% ethyl alcohol

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16
Q

admixture of venous, arterial and capillary blood with interstitial and intracellular fluids

A

Capillary blood

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17
Q

may be used as substitute for arterial blood gas determinations provided that the site is warmed prior to collection (blood enters capillaries under pressure and the arterial portion is highest)

A

Capillary blood

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18
Q

SOURCES OF BLOOD SPECIMENS:

A

Capillary blood
Arterial blood
Venous blood

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19
Q

Normally uniform throughout the body.

A

Arterial blood

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20
Q

For blood gas analysis and pH measurement

A

Arterial blood

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21
Q

Affected by metabolic activity of the tissue it drains and varies by collection site

A

Venous blood

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22
Q

Mostly used in chemistry analyses

A

Venous blood

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23
Q

MICROSAMPLING

A

SKIN PUNCTURE

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24
Q

MACROSAMPLING: Methods of Collection

A
  1. Evacuated tube system (ETS)
  2. Needle and syringe
  3. Winged infusion set (butterfly)
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25
Q

Method of collection for pediatric patients, obese patients, patients with thrombotic tendencies, with severe burns, geriatric patients and in routine assay requiring small amount of blood (POCT)

A

MICROSAMPLING (SKIN PUNCTURE)

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26
Q

MICROSAMPLING (SKIN PUNCTURE) Sites:
Infants:
Adults:

A

medial or lateral plantar heel surface; plantar surface of big toes
3rd or 4th finger; margins of the ear lobe

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27
Q

MICROSAMPLING (SKIN PUNCTURE)
Sites to be avoided:
(Infant) -
(Adult) -

A

Central arch area of the heal and fingers
Thumb, index, 5th finger, fingers on the site of mastectomy, edematous or a previous puncture site.

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28
Q

MICROSAMPLING (SKIN PUNCTURE)
Length of lancet:

A

1.75 mm

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29
Q

If using a lancet, the blade should not be longer than (?) to avoid injury to the heel bone)

A

2 mm

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30
Q

preferred method

A

Evacuated tube system (ETS):

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31
Q

minimizes the risk of specimen contamination and exposure to the blood

A

Evacuated tube system (ETS)

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32
Q

Discouraged by CLSI due to safety and specimen quality issues.

A

Needle and syringe

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33
Q

May be used on small, fragile, or damaged veins.

A

Needle and syringe

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34
Q

Can be used with the Evacuated tube system or a syringe.

A

Winged infusion set (butterfly)

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35
Q

Often used to draw blood from infants and children, from hand veins, and in other difficult-draw situations.

A

Winged infusion set (butterfly)

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36
Q

For arterial blood gas analysis

A

ARTERIAL PUNCTURE

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37
Q

ARTERIAL PUNCTURE

Sites:

A

radial artery, brachial artery, femoral artery, scalp artery and umbilical artery

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38
Q

Performed without a tourniquet.

A

ARTERIAL PUNCTURE

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39
Q

This is technically more difficult to perform than venous puncture and it is prone to hematoma.

A

ARTERIAL PUNCTURE

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40
Q

: Done before a radial arterial collection is performed.

A

Modified Allen Test

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41
Q

This determines whether the ulnar artery can provide collateral circulation to the hand after radial artery puncture

A

Modified Allen Test

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42
Q

Modified Allen Test Anticoagulant:

A

0.05 ml liquid Heparin/ml blood

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43
Q

Place blood in ice water/coolant (1-5OC) to minimize consumption of O2 by leukocytes

A

Modified Allen Test

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44
Q

(Substitute): earlobe is the preferred site because of vascularity, low metabolic requirements & ease with which it can be arterialized by first warming at 39 42OC.

A

Arterialized Capillary blood

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45
Q

Newborn up to 18 months:

A

Superior longitudinal sinus; External jugular vein; Temporal vein

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46
Q

18 months to 3 years:

A

Femoral vein; Long saphenous vein; Ankle vein; Popliteal vein; External Jugular vein; Temporal vein

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47
Q

3 years to adult:

A

Antecubital fossa: Median cubital, Cephalic, Median basilic
Wrist veins; Hand (dorsal aspect) veins;
Ankle veins

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48
Q

Contraindications of venipuncture at the LOWER EXTREMETIES:

A

Poorly-controlled diabetes mellitus
Hemoglobinopathies
Thrombosis

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49
Q

Use opposite arm or perform fingerstick.

A

IV or blood transfusion running

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50
Q

Ask attending the nurse to stop IV for at least 2 minutes; select vein other than the one with the IV. Draw and discard first 5 mL.

A

IV or blood transfusion running

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51
Q

Causes an increase of infused substance like glucose, chloride, potassium and sodium, with a decrease in urea and creatinine.

A

IV or blood transfusion running

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52
Q

Draw from opposite arm.

A

Fistula

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53
Q

Lab may draw below heparin lock if nothing is being infused.

A

Indwelling lines and catheters, heparin locks, cannulas

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54
Q

The first 5 mL of blood drawn should be discarded.

A

Indwelling lines and catheters, heparin locks, cannulas

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55
Q

Select another site.

A

Sclerosed veins, Scars, burns, tattoos, Edema

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56
Q

Draw below

A

Hematoma

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57
Q

Minimize venipuncture.

A

Streptokinase/TPA

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58
Q

Hold pressure until bleeding has stopped.

A

Streptokinase/Tissue plasminogen activator

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59
Q

Draw from opposite arm

A

Mastectomy

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60
Q

If you are unable to obtain a specimen on the first attempt, try again (?) the first site, on the (?), or on a (?) vein.

A

Multiple venipuncture attempt

below

other arm

hand or wrist

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61
Q

If the second attempt is unsuccessful, ask someone else to take over.

A

Multiple venipuncture attempt

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62
Q

Needle may not be placed at the center of the stopper causing blockage.

A

No Blood seen or Too little blood flow into the tube

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63
Q

Needle bevel may be flushed against the wall of the vein causing blockage.

A

No Blood seen or Too little blood flow into the tube

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64
Q

Tourniquet applied too tightly or too long, thus stopping blood flow.

A

No Blood seen or Too little blood flow into the tube

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65
Q

Tube may have been prematurely punctured.

A

No Blood seen or Too little blood flow into the tube

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66
Q

Tube may have previously been opened.

A

No Blood seen or Too little blood flow into the tube

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67
Q

Needle is not completely in the vein or has not reached the vein

A

No Blood seen or Too little blood flow into the tube

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68
Q

Transfixation

A

No Blood seen or Too little blood flow into the tube

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69
Q

Excessive probing

A

Hemolysis
Hematoma

70
Q

Underfilling of tubes

A

Hemolysis

71
Q

Alcohol contamination

A

Hemolysis

72
Q

Vigorous mixing of the sample

A

Hemolysis

73
Q

Use of too small needle during a difficult draw

A

Hemolysis

74
Q

Drawing the blood through an existing hematoma

A

Hemolysis

75
Q

Pulling back too quickly on the plunger of a syringe

A

Hemolysis

76
Q

Transferring from syringe & needle to evacuated tubes

A

Hemolysis

77
Q

Contamination of the specimen with alcohol or water at the venipuncture site or in the tubes.

A

Hemolysis

78
Q

Physiologic cause: hemolytic anemias.

A

Hemolysis

79
Q

Premature removal of the tubes

A

Underfilling of Tubes

80
Q

Long lines of tubing containing air

A

Underfilling of Tubes

81
Q

Vein may have collapsed

A

Blood stops flowing halfway during blood collection

82
Q

Needle may have been repositioned or out of the vein

A

Blood stops flowing halfway during blood collection

83
Q

Tourniquet placed too near the venipuncture site

A

Hematoma

84
Q

Failure to remove the tourniquet before removing the needle

A

Hematoma

85
Q

Failure to apply enough pressure to the site after venipuncture

A

Hematoma

86
Q

Inadvertent puncture of an artery.

A

Hematoma

87
Q

Needle may not be completely in the vein/bevel of the needle is only partially in the vein

A

Hematoma

88
Q

Transfixation resulting to leakage of large amount of blood around the puncture site causing the area to swell

A

Hematoma

89
Q

COMPLICATIONS of Phlebotomy:

A
90
Q

Ecchymosis

A

Immediate Local complication

91
Q

Localized Hemoconcentration or Venous stasis

A

Immediate Local complication

92
Q

Circulatory failure

A

Immediate Local complication

93
Q

Syncope or Fainting

A

Immediate Local complication

94
Q

Thrombosis

A

Late Local Complications

95
Q

Thrombophlebitis

A

Late Local Complications

96
Q

Allergies

A

Late Local Complications

97
Q

Patients can be allergic to antiseptics, adhesive glue in bandages, and latex. Use an alternate antiseptic if required; (?9 can be used in place of adhesive bandages

A

paper tape placed over folded gauze or self-adhesive bandage material

98
Q

transmission of blood-borne infections

A

Delayed General Complications

99
Q

Physiologic factors that may cause variations in hematology test results:

A
100
Q

: Changing from a supine to a (?) results in a shift of body water from inside the blood vessels to the interstitial spaces.

A

Posture

sitting or standing position

101
Q

: Eosinophil count is lower in the (?) and increase in the(?).

A

Diurnal Rhythm

morning; afternoon

102
Q

: can increase white blood cell count

A

Exercise

103
Q

: can cause a temporary increase in the white blood cell count.

A

Stress

104
Q

: increased lipids may cause turbidity (lipemia) in the serum or plasma, affecting some tests that require photometric measurement.

A

Diet

105
Q

smoking before blood collection may increase (?)

Long-term smoking can result in increased (?).

A

white blood cell counts and cortisol levels

hemoglobin levels

106
Q

: Used in routine and special chemistry tests

A
  1. Serum
107
Q

: Used in coagulation studies

A
  1. Plasma
108
Q

: Must be collected in an anticoagulant tube to prevent it from clotting;

A
  1. Whole blood
109
Q

Used in complete blood count (CBC)

A
  1. Whole blood
110
Q

Removes Ca++ chelation

A

EDTA

111
Q

spray-dried in plastic tubes

A

K2EDTA

112
Q

EDTA: liquid form

A

K3EDTA

113
Q

EDTA Commercial preparations:

A

Versene; Sequestrene

114
Q

1 - 2 mg/ml blood

A

EDTA
Oxalate

115
Q

Lavender

A

EDTA

116
Q

Hematology procedures (CBC; Platelet count, blood smears)

A

Pink (dry K2EDTA)

117
Q

(EDTA & Gel)

A

White

118
Q

(Plastic- K2EDTA)

A

Tan

119
Q

Blood Bank

A

Tan

120
Q

Molecular Diagnostics

A

Tan

121
Q

Lead testing

A

Tan (Plastic -K2EDTA)

EDTA

122
Q

(dry K2EDTA)

A

Pink

123
Q

Prevents platelet aggregation

A

EDTA

124
Q

does not preserve factor V

A

EDTA

125
Q

Excess causes red cells to shrink and platelets to break

A

EDTA

126
Q

After 3 hrs @ room temperature: vacuolation of cytoplasm; more homogenous nuclei; irregular or poorly defined cytoplasmic borders and irregularly-shaped nuclei.

A

EDTA

127
Q

Possible platelet satellitism

A

EDTA

128
Q

Binds with Ca++ in a nonionized form

A

Sodium Citrate

129
Q

What is the ratio of sodium citrate to blood?

A

Light Blue (1:9)
Black (1:4)

130
Q

0.1 - 0.2 mg/ml of blood

A

Heparin

131
Q

Acts as antithrombin

A

Heparin

132
Q

Li or Na heparin preparations

A

Heparin

133
Q

10 mg/mL blood

A

Na Fluoride Li iodoacetate

134
Q

Combines w/ Ca++ into insoluble calcium oxalate salt

A

Oxalate

135
Q

Erythrocyte sedimentation rate

A

Sodium citrate

Black

136
Q

Coagulation Tests

A

Light Blue

137
Q

(Na or Li)

A

Green

138
Q

(Li Heparin & Gel)

A

Light Green/Black

139
Q

(Na Heparin, Na2EDTA

A

Royal Blue

140
Q

(Glass Na Heparin)

A

Tan

141
Q

Chemistry; Lead testing

A

Tan (Glass - Na Heparin)

142
Q

Glucose test; Ethanol specimens

A

Gray

143
Q

Preserves labile coagulation factors

A

Sodium Citrate

144
Q

Helps retain functional capabilities of platelets

A

Sodium Citrate

145
Q

Best for Osmotic fragility test (OFT)

A

Heparin

146
Q

Prevents hemolysis

A

Heparin

147
Q

Causes blue background on Wright-stain blood smear

A

Heparin

148
Q

May cause clumping of WBCs and platelets

A

Heparin

149
Q

will yield serum.

A

Na Fluoride

150
Q

Distorts cell morphology

A

Oxalate

151
Q

((Paul-Hellers)

A

K oxalate

152
Q

(Wintrobe)

A

NH4 Oxalate

153
Q

Light Blue - Hematology

A

Thrombin & Soybean Trypsin Inhibitor

154
Q

Test for Fibrin Degradation Products

A

Thrombin & Soybean Trypsin Inhibitor

155
Q

None

A

Red (Glass)

156
Q

Chemistry & Serology

A

Red (Glass)

157
Q

Silica Clot Activator

A

Red (Plastic/ Hemogard)

158
Q

STAT Chemistry & Serology

A

Red (Plastic/ Hemogard)

159
Q

STAT Chemistry

A

Yellow/Gray & Orange
Red/ Gray & Gold

160
Q

Thrombin

A

Yellow/Gray & Orange

161
Q

Silica & Separation Gel

A

Red/ Gray & Gold

162
Q

Microbiology (bacterial culture)

A

Sterile, with Sodium polyanethol sulfonate (SPS)

163
Q

BB, HLA phenotyping, Paternity testing

A

ACD

164
Q

A special sequence of tube collection that reduces the risk of specimen contamination by microorganisms and additive carry-over, which may affect some chemistry tests

A

Order of Draw of Tubes

165
Q

Order of Draw from Catheter lines

A
  1. Draw 35 mL in a syringe and discard.
  2. Blood for blood culture
  3. Blood for anticoagulated tubes (lavender, green, light blue, etc.)
  4. Blood for clot tubes (red, SST, etc.)
166
Q

Order of Draw for Skin Puncture

A
  1. Tube for blood gas analysis
  2. Slides, unless made from specimen in the EDTA microcollection tube
  3. EDTA microcollection tube
  4. Other microcollection tubes with anticoagulants
  5. Serum microcollection tubes
167
Q

Read on the Order of Draw of blood and the rationale of each. (Clinical Chemistry by Bishop 6th ed., p. 47)

A
168
Q

Serum or plasma should be separated from cells within (?) from collection, unless collected in a gel separator, to prevent glycolysis, lipolysis, shift of electrolytes, hemolysis and loss of some unstable substances

A

1 hour

169
Q

Centrifugation:

A

3000 RCF for 10 mins

170
Q

Reasons for specimen rejection:
(?) do not match.
Tube is (?), or the labeling, including patient identification number, is incorrect .
Specimen is (?).
Specimen was collected at the (?).
Specimen was collected in the (?).
Specimen was (?), while the test requires whole blood or plasma.
Specimen was contaminated with (?).
Specimen is (?) (depends on the test)

A

Test order requisition and the tube identification
unlabeled
hemolyzed
wrong time
wrong tube
clotted
intravenous fluid
lipemic

HEMA 1 LEC (15 decks)

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