Chapter 43- Assisting in Blood Collection Flashcards
Phlebotomy is performed primarily to-
- aid in diagnosing disease
- monitor a patient’s condition, treatment, or medication levels
- document the existing good health of a patient
Blood borne pathogen risks are-
- Hepatitis B Virus (HBV)
- Hepatitis C Virus (HCV)
- Human Immunodeficiency Virus (HIV)
What’s the most common method to obtain a blood specimen?
Venipuncture
POL-
Physical Office Laboratory
Patient history of syncope:
- have the pt lying on an exam table or in a reclining chair
PPE-
- all facilities must stock only latex-free supplies because of the potential of allergic responders in workers and patients
- gloves
- disposable fluid- impenetrable lab coats
- protective eyewear
- face shields
Tourniquets-
- most venipuncture are done in the antecubital region
- applied 3 to 4 inches above the elbow
Antiseptics-
- the venipuncture site must be cleanses to prevent infection.
- 70 % isopropyl alcohol (rubbing alcohol)
- alcohol does not sterilize the skin but it kills many existing bacteria.
Most common collection system:
The evacuated tube system
Colored stoppers:
Indicate the tubes contents
Hemogard tops:
no splattering of blood when removed from the tube
Which tube dosen’t have any addictives?
Plain Red Topped
EDTA- Ethylenediaminetetraacetic Acid
Anticoagulant
Serum:
if blood clots and is centrifuged, the liquid portion only.
Order of the Draw:
-Blood culture bottles
– Light blue top
– Red top or gold top
– Green top
– Lavender top
– Gray top
Sterile - Blood Cultures:
Filled first because they are sterile and should not be contaminated by other tubes.
Light Blue Tube:
Sodium Citrate
Red or Gold Tube:
red serum tubes have NO anticoagulants. Gold tubes have clot activator in them and are filled next.
Green Tube:
They have plasma in their anticoagulated specimen and are used when STAT results are needed.
Lavender Tube:
they contain EDTA anticoagulant that preserves blood cell morphology. Prevents blood from clumping.
Gray Tube:
Draw last, the blood is used to test glucose or blood alcohol levels. Its additives may evaluate electrolyte levels and damage cells if passed into other tubes.
Routine Venipuncture:
Prep, Prepare, Perform, Complete
Needle Sizes:
20, 16, 23
20 Gauge:
most used in adult venipuncture.
16 Gauge:
most used by blood bank for donations
23 Gauge:
most used in infants and the elderly.
Angle:
the needle should enter the arm/vein at 15 angle.
Lumen:
Bore, or hollow space,
inside the needle; also known as
the gauge
When are syringes used?
Syringes are used when there is
concern that the strong vacuum
in a stoppered vacuum tube
might collapse the vein
Butterfly assembly used:
on small veins
What is the most common needle size?
The most common butterfly
needle size is 22 to 23 gauge with
a needle length of ½ to ¾ inch
Examples of needle safety devices:
- One-handed vacuum tube needle
– Syringe needle safety devices
– Butterfly needle safety lock
– Push-button butterfly safety device
– Needle-blunting butterfly set
What does requisitions require?
- The patient’s name, date of birth, and ID number
– The name of provider submitting the order
– The type of test required
– Test status - Patients should be asked to state and spell
their first and last name and state their birth
date - Briefly explain the venipuncture procedure
and ask them questions; answer concerns
Preparing for the Venipuncture:
- Ask the patient to extend an
arm and position his or her
other hand under the elbow to
help straighten the elbow, if
necessary - Veins in the center of the
antecubital area should be
located as a first choice - When choosing the best
available vein, palpate the
area - The tourniquet should be
placed about 3 to 4 inches
above the patient’s elbow
Performing for the Venipuncture:
-Ask the patient to extend an
arm and position his or her
other hand under the elbow to
help straighten the elbow, if
necessary
* Veins in the center of the
antecubital area should be
located as a first choice
* When choosing the best
available vein, palpate the
area
* The tourniquet should be
placed about 3 to 4 inches
above the patient’s elbow
Performing the Venipuncture:
- When you have located a vein,
remove the tourniquet - The tourniquet can remain in
place for 1 minute - Do not touch the area after
cleaning with alcohol - Anchor the vein by gently
stretching the skin downward
below the collection site with the
thumb of the non-dominant hand - The needle bevel should be facing
up - Push the evacuated tube onto
the double-pointed needle or pull
back on the syringe plunger with
the non-dominant hand
Completing the Venipuncture:
-As you remove each tube from the needle holder,
gently invert it several times before placing it in a
collection rack
* Tubes with a clot activator should be inverted 5 times
* Make sure the label contains:
– The patient’s last name, then first name
– The patient’s date of birth
– The patient’s ID number or medical insurance number
– The date and time of the draw; the phlebotomist’s initials
– The provider’s name
- If the pt was fasting
Problems Associated with Venipuncture:
Hematoma, Nerve Damage and Other Complications, Fainting,
What color tubes are drawn last?
Lavender, Green, Gray, Light Blue
Gray
Which color is the tube and stopper that is used to collect specimens for serum analysis?
Red, Green, Lavender, Blue
Red
A gray-top tube is collected for glucose testing but does not contain the required volume of blood. What effect will this have on the result?
False
Which needle lumen is used for blood bank procedures?
16 g
What effect will leaving the tourniquet on “too long” have when performing phlebotomy?
Hemoconcentration
If more than one tube must be drawn during a venipuncture, which tube is drawn first?
Blood Culture Tubes
Which location is the best site to use for capillary puncture on an infant?
Heel
Which gauge needle is used most frequently when drawing blood from the antecubital area?
21
After collecting a blood specimen for serum testing, how long must the sample sit in the rack before it is spun in the centrifuge?
30- 60 minutes
When drawing a CBC, INR, and glucose, which is the correct order of draw?
Blue, Lavender, Gray
Evacuated blood tubes, which are used to collect the patient’s blood, have color-coded tops. What does the color indicate?
Contents of the tube
What is the preferred site for a skin puncture in an infant?
Heel
To perform capillary puncture, where is the usual puncture site in adults?
Middle finger
An MA is palpating the vein of a patient during venipuncture. Which is the best finger to use for palpating a vein during venipuncture?
Index finger
Which agency establishes regulations and standards that are followed by clinical laboratories?
Occupational Safety and Health Administration
Which condition indicated a hematoma?
Presence of bruises
- A hematoma is a loss of blood into tissues.
Peeling of skin-
Sunburn can cause peel of skin which will result in damage of the epithelial layer
Vein Bulges-
When a torniquet is tied to a draw of blood
Fluid accumulation:
in the vein or tissue is edema
Which is the most preferred site for skin puncture in an 11 month old infant?
Plantar Surface of the level
While performing venipuncture, a torniquet should not be tied for longer than how many minutes at a time?
1 minute
Which is the term for the point where the needle attaches to the syringe?
Hub
Which color topped vacutainer tube contains sodium polyanethol sulfonate (SPS) as an additive?
Yellow topped tube
If hematoma forms while performing venipuncture, how long should pressure be applied?
Pressure should be applied for at least 3 minutes
Which color-stoppered evacuated tube contains heparin as an additive?
Green
(contains an anticoagulant called heparin) used to obtain plasma and whole blood
Determine the difference between capillary blood and venous blood:
Hemoglobin levels are higher in capillary blood than venous blood.
A pt experiences syncope during venipuncture. What is the minimum amount of time that the pt should avoid operating a vehicle.
30 minutes
A phlebotomist probes with a needle continuously while performing venipuncture. Identify the immediate consequence of this action of the phlebotomist.
Hematoma
In phlebotomy, which is the major cause of specimen rejection?
Hemolyzed Sample
Cannot be detected until the blood cells separate from the plasma or serum
Phleb/o:
Vein
Cubit/o:
elbow, forearm
Coagul/o:
clotting, coagulation
-itis:
inflammation
-otomy:
incision
-puncture:
to pierce the surface
-al:
pertaining to
-oma:
a swelling or tumor
Ante:
forward, before
Anti:
against
-Sepsis:
infection
Hem/o:
Blood
Inter:
between
Phlebotomy:
– is performed primarily to aid in diagnosing disease, monitor a pts condition, tx or medication levels, and to document the existing good health of a pt.
Bloodborne viruses identified as possible pathogen risks are:
Hep B, Hep C, HIV
- these viruses are not the only diseases that can be spread by contaminated blood but are considered a risk for HC worker’s public safety.
Equipment used in Routine Phlebotomy:
PPE
Alcohol wipes
Gauze
Torniquets
Double Pointed Safety Needles
Winged Infusion Sets (Butterfly)
Disposable Needle Holder
Evacuated Stoppered Tubes
Sharps Container
Biohazard Waste Container
Syncope-
fainting
Anticoagulants:
substances that prevents clotting of blood
Antiseptic:
a substance that inhibits the growth of microorganisms on living tissue (ex: alcohol and povidone- iodine solution, it is used to cleanse the skin, wounds and so on.
Blood Culture:
a microbiological procedure in which a blood sample is placed in a nutrient medium and held at body temperature. If bacteria are in the blood sample, the culture medium should encourage the growth of the infecting bacteria in the laboratory.
Clot Activators:
substances added to a venipuncture tube to enhance and speed up blood clotting.
Hemoconcentration:
a condition in which the concentration of blood cells is increased in proportion to the volume of plasma.
Nosocomial:
an infection that is acquired in a healthcare setting. Also known as healthcare acquired infections (HAI).
Thixotropic:
a chemically neutral gel added to evacuated blood tubes that creates a physical barrier between blood clots between red blood cells and plasma or serum when the tube is centrifuged
Torniquet:
a device for temporarily constricting blood flow.
Evacuated:
A tube, flask, or reaction vessel in which a vacuum has been created.
Plasma:
the liquid portion of a whole blood sample that has not clotted due to an anticoagulant. The liquid portion of the blood that contains clotting factors. The liquid portion of the blood that contains clotting factors. The liquid portion of the blood found in the body.
Serum:
The liquid portion of a clotted blood specimen that no longer contains its active clotting agents.
STAT:
latin medical term for statum, means immediately
Hematoma:
an abnormal buildup of blood in an organ or a tissue of the body, caused by a leak or cut in a blood vessel.
Aspirating:
to draw off or remove by suction.
Hemolysis:
the breakdown of red blood cells with the release of hemoglobin.
Bevel:
the angled surface formed on the tube when sharpened to make a needle point.
Hub:
Fitting at the end of a needle that can connect to a syringe or other component
Evacuated Collection Tubes:
color coded stoppers the colored stoppers indicate the tubes contents.
*They must be shatter resistant glass or plastic.
ORDER OF DRAW:
Stop Light Red, Green Light Go
Hepat/o:
Liver
True or False?
Evacuated Collection Tubes must be shatter resistant glass or plastic.
Lancet:
device used for dermal puncture
Capillary Puncture:
wipe away the first drop of blood and the collect of specimen. It can be collected in: Microtainers tubes, capillary tubes, or onto filter paper.
* We use the ring finger or middle finger.
* Heel for an infant.
Fainting:
or syncope can be a serious consequence, so the phlebotomist must always be prepared to take action quickly. Make eye contact and observe the pt before phlebotomy to evaluate their state.
1. If the patient begins to faint, quickly remove the torniquet and needle from the arm.
2. Notify staff members for assistance.
3. Lay the Pt. flat on the floor.
4. Loosen tight clothing.
5. Apply cold compress to forehand and back of neck.
6. Stay with pt until recovery is complete.
7. Document incident according to facility policies
8. When the pt remains regains consciousness, he/she must remain the facility for at least 15 mins ad does not drive for at least 30 minutes
Nerve Damage:
damage can be a consequence of
venipuncture but the risk is small.
A phlebotomist is learning about capillary blood drawn during capillary puncture. Which statement made by the phlebotomist is most appropriate?
Capillary blood contains small amounts of tissue fluid.
What happens when a green topped vacutainer tube is under filled?
False results occur because of excess heparin
Green topped tube contains?
Heparin as an additive
Yellow topped tubes contains?
Sodium Polyanethol Sulfonate
What happens when yellow topped tube is under filled?
reduces the possibility of bacterial recovery
What does red topped tubes contain?
nothing, no additives
What happens when red topped tubes are under filled?
causes the sample to be insufficient for tests
Light blue topped tubes contain?
Sodium citrate
What happens when a light blue topped tube is under filled?
Falsely prolongs the coagulation test results.
When performing venipuncture, the medical assistant inserts the needle in a steady motion. What is the reason for this action?
To prevent hematoma
A rapid jabbing motion causes the needle to go completely through the vein
results in hematoma
Rough handling of the collected blood or improper collection of blood through the evacuated tube:
causes hemolysis
Flowing of the blood through the evacuated tube back into the patient’s vein during the venipuncture is:
Venous reflux
Venous stasis:
Occurs from prolonged application of the tourniquet for more than 1 minute
Which digit is the most appropriate site for capillary puncture in adult patients?
Ring finger
Why is the index finger not used for capillary puncture?
Too much callus
Why isn’t a pinky used for capillary puncture?
small amount of tissue between the surface and the bone which can result in injury to the bone
After performing venipuncture, the MA finds a hematoma at the site of venipuncture. Which interventions does the MA perform to prevent further complication?
Applying a cold compress
Which vacutainer tube additive allows easy retrieval of plasma or serum after centrifuging the blood?
Thixotropic gel
synthetic gel that allows east retrieval of plasma in or serum after centrifuging the blood because it has a density b/w that of red cells and plasma or serum.
Thixotropic gel
Heparin-
An anticoagulant that prevents clotting of the blood
Thrombin and silica particles-
are clot activators that help in blood clotting.
Why does a phlebotomist use a tourniquet while performing venipuncture?
Prevent venous flow out of the site
Which type of testing is performed using plasma?
Coagulation studies
Stat chemistry testing:
Plasma is used
Liquid that remains after the anti coagulated whole blood is centrifuged:
Plasma
To prevent coagulation:
Whole blood has to be mixed I’m with an anticoagulant that matches with the test and does not interfere with the results
Whole blood is used for:
perform blood typing and a complete blood count (CBC)
Serum:
liquid portion that remains when clotted blood is centrifuged.
- required for most chemistry and serology testing
Which statement by the MA regarding venipuncture and blood collection using the vacuum tube system needs correction?
Venipuncture should be performed in a slow and timid motion, and invert the tubes rapidly
A MA obtained blood from the left arm of the pt, who underwent mastectomy on the left side. What reason will the MA suspect for the abnormal result?
The pt may have obstructed lymph flow
Lymphostasis:
Obstructed lymph flow
A MA is drawing blood from a geriatric pt who has fragile skin. Which action of the MA is correct?
Applying the tourniquet over a cloth
The provider has ordered hematologic tests, including a CBC test for a pt. Which tube does the MA use for the test?
Lavender
Applying cold cloths help with:
temperature and nausea
A MA observes that a 2 year old child has short tubbing attached with a 23 gauge needle at the site of venipuncture. Which type of supplies does the MA interpret to have been used in the patient?
Winged infusion set
A pt has come to the medical office for a blood draw. The provider orders a prothrombin time, CBC, blood culture, and blood chemistry test. Which is the correct order?
Yellow, light blue, red/gold, lavender
What is the most importance of wearing gloves during venipuncture?
To protect the MA from the patients blood
What is used to clean the venipuncture site to prepare for blood culture?
Povidone- iodine
What is the most common type of antiseptic used prior to venipuncture?
70% isopropyl alcohol
What can the MA do to manage the possible discomfort causes by a tourniquet?
- applying the tourniquet flat against the skin
- use a tourniquet with quick- release closures
- place the tourniquet over the patient’s clothes
How can the MA determine that arterial blood flow is not impeded after application of a torniquet?
-look for venous distension
- check for pulse below the torniquet
- observe for paleness in the extremity will become pale
What are the possible consequences of leaving a torniquet on for too long prior to drawing blood?
- altered test results
- decreased arterial blood flow
- Hemoconcentration of the blood sample
What are the steps taken to prevent needle-stick injuries?
- participate in blood borne pathogen training
- help your employer evaluate and select devices with safety features
- plan for safe handling and disposal before beginning any procedure using needles
- use safety needles that are activated with one hand immediately after use
When is it inappropriate to recap a needle?
when appropriately engineered safety devices are used.
What does OSHA recommend as the safest
Safety needles are activated with one hand immediately after use
