Chapter 7 Questions And Answers Flashcards
What is the primary duty of the phlebotomist ?
- To collect collect blood specimens for laboratory testing.
What are the methods of blood collection ?
- Arterial Puncture
- Capillary Puncture
- Venipuncture
List the general blood collection equipment and supplies ?
1) Blood Drawing Station
2) Phlebotomy Chairs
3) Equipment Carriers
4) Gloves And Glove Liners
5) Antiseptics
6) Disinfectants
7) Hand Sanitizers
8) Gauze Pads / Cotton Balls
9) Bandages
10) Needle And Sharps Disposal Containers
11) Slides
12) Pen
13) Watch
What safety organization requires the wearing of gloves when performing Phlebotomy ?
- CDC / HICPAC
- OSHA
List the different types of gloves that are acceptable for most Phlebotomy Procedures ?
- Nonsterile
- Disposable Latex
- Nitrile
- Neoprene
- Polyethylene
- Vinyl Examination
Glove powder can be a source of what ?
- Source of contamination for some tests (especially those collected by skin Puncture)
- Allergies in some users
What safety organization regulates glove quality ?
The Food and Drug Administration (FDA)
Antiseptics are substances used to prevent what ?
- Sepsis , the presence of microorganisms or their toxic products in the bloodstream.
What are the Antiseptics used in blood collection ?
1) 70% Ethyl Alcohol
2) 70% Isopropyl Alcohol (isopropanol)
3) Benzalkonium Chloride (Zephiran Chloride)
4) Chlorhexidine Gluconate
5) Hydrogen Peroxide
6) Providone-Iodine (0.1 - 1% available iodine)
7) Tincture of Iodine
(T or F) Disinfectants are EPA regulated chemical substances
True
What is the ratio of dilution recommended for decontaminating nonporous surfaces after cleaning up blood or other body fluid spills in patient care settings ?
1 : 100
What is the ratio of dilution recommended application prior to cleanup when spills involve large amounts of body or other body fluids or occur in the laboratory ?
1 : 10
When should fresh bleach solutions be made ?
- daily or as needed
Adhesive bandages should not be used on who and why ?
- Babies younger than 2 years
- Because of the danger of aspiration and suffocation
What size are the precleaned microscope slides and what are they used for ?
- 25 x 75 mm (1 x 3 -inch)
- Used to make Blood films for hematology determinations.
List the Venipuncture Equipments ?
1) Vein - Locating Devices
2) Tourniquet
3) Needles
4) Evacuated Tube System (ETS)
5) Syringe System
6) Winged Infusion Set
7) Combination Systems
What are the types of needles used in phlebotomy ?
1) Multisample Needle
2) Hypodermic Needle
3) Winged Infusion (butterfly) needles
Which needles are enclosed in sealed twist off shields or covers ?
Multisample Needles
Which needles are sealed in sterile pull apart packages ?
- Hypodermic and butterfly needles
What are the parts of a Needle ?
- Bevel
- Shaft
- Hub
- Lumen
What makes the Needle diameter and the gauge have an inverse (opposite) relationship ?
- The larger the gauge number the smaller the actual diameter of the Needle.
Since Blood typically flows more quickly through large diameter needles, Needle gauge is selected according to what ?
- Size and condition of the patients vein, the type of procedure, and the equipment being used .
Common Venipuncture Needle gauges come in what sizes ?
15-18
20-25
15-17 Needle Gauge is what type of Needle and what is it used for ?
Needle Type : Special Needle attached to collection bag
Typical Use : Collection of donor units, autologous blood donation, therapeutic phlebotomy
18 Needle Gauge is what type of Needle and what is it used for ?
Needle Type : Syringe
Typical Use : Used primarily as a transfer needle rather than for blood collection, safety issues have diminished use.
20 Needle Gauge is what type of Needle and what is it used for ?
Needle Type : Multisample Syringe
Typical Use : Sometimes Used when large volume tubes are collected or large volume syringes are used on patients with normal size veins
21 Needle Gauge is what type of Needle and what is it used for ?
Needle Type : (Green) Multisample Syringe
Typical Use : Considered the standard Venipuncture Needle for routine Venipuncture on patients with normal veins or Syringe blood culture collection
22 Needle Gauge is what type of Needle and what is it used for ?
Needle Type : Multisample Syringe
Typical Use : Used on older children and adult patients with small veins or Syringe draws on difficult veins
23 Needle Gauge is what type of Needle and what is it used for ?
Needle Type : (Black) Butterfly
Typical Use : Veins of infants and children and difficult or hand veins of adults
What is the length of a Multisample Needle ?
1 inch or 1.5 inch
What is the length of Syringe needles ?
Many lengths, 1 inch and 1.5 inch most commonly used
What are the lengths of butterfly needles ?
Typically 1/2 to 3/4 of an inch long
The FDA is responsible for clearing what for marketing ?
Medical Devices
What is the most common, efficient, and CLSI - Preferred system for collecting blood samples ?
Evacuated Tube System ( ETS )
What are the three basic components of the ETS system ?
Special blood drawing needle
Needle and tube holder
Various types of evacuated tubes
Evacuated tubes come in various sizes and volumes ranging from what ?
1.8 to 15 mL
Tube selection is based on what 3 conditions ?
Age of the patient
Amount of blood needed for the test
Size and condition of the patients vein
Premature loss of vaccum can occur from what ?
Improper storage
Opening the tube
Dropping the tube
Advancing Tube to far onto the Needle before Venipuncture
Pulling needle bevel partially out of skin during Venipuncture
If an additive prevents clotting what is the result ?
Whole blood specimen
Some whole blood specimens are used directly for testing, what are other reasons whole blood specimens are used for ?
To be centrifuges to separate the cells from the fluid portion called plasma
If the additive is a clot activator what is it’s result ?
The blood will clot and the specimen must be centrifuges to obtain the fluid portion called serum.
What is the correct way to handle tubes ?
Store between 4 and 25 degree Celsius
Light blue stopper has what additive and belongs to what department ?
Additive : Sodium Citrate
Dept. : Coagulation
Red (Glass) stopper has what additive and belongs to what department ?
Additive : None
Dept. : Chemistry, Blood Bank, Serology / Immunology
Red (Plastic) stopper has what additive and belongs to what department ?
Additive : Clot Activator
Dept. : Chemistry
Red / light grey (plastic) stopper has what additive and belongs to what department ?
Additive: Nonadditive
Dept. : NA (discard tube only)
Red / Black (tiger), Gold, Red / Gold stoppers has what additive and belongs to what department ?
Additive : Clot activator and gel separator
Dept. : Chemistry
Green / Gray, Light Green stopper has what additive and belongs to what department ?
Additive: Lithium Heparin and gel separator
Dept. : Chemistry
Green stopper has what additive and belongs to what department ?
Additive: Lithium Heparin And Sodium Heparin
Dept. : Chemistry
Lavender, Pink stopper has what additive and belongs to what department ?
Additive: EDTA
Dept. : Hematology, Blood Bank
Gray stopper has what additive and belongs to what department ?
Additive: Sodium Fluoride and Potassium Oxalate , Sodium Fluoride And EDTA, Sodium Fluoride
Dept.: Chemistry
Orange, Gray / Yellow stopper has what additive and belongs to what department ?
Additive : Thrombin
Dept. : Chemistry
Royal blue stopper has what additive and belongs to what department ?
Additive : None (red label), EDTA (lavender label), Sodium Heparin (green label)
Dept.: Chemistry
Tan (glass tube), Tan (Plastic) stopper has what additive and belongs to what department ?
Additive: Sodium Heparin, EDTA
Dept.: Chemistry
Yellow stopper has what additive and belongs to what department ?
Additive: Sodium Polyanethol Sulfonate (SPS)
Dept.: Microbiology
Canary Yellow (Blood Culture) stopper has what additive and belongs to what department ?
Additive: Acid Citrate dextrose (ACD)
Dept.: Blood Bank / Immunohematology
What are the common Syringe volumes used for phlebotomy?
2, 5, 10 mL
What are the two parts of a Syringe ?
Barrel
Plunger
What is the Winged Infusion Blood collection set or butterfly used for ?
It is a indispensable tool for collecting blood from small or difficult veins such as hand veins and veins of elderly and pediatric patients as it allows much more flexibility and precision than a needle and syringe.
How many times does an additive tube need to be inverted gently ?
3 to 8 times depending on the type, immediately after collection to adequately mix the additive with the specimen.
Anticoagulants function by which two methods ?
By chelating (binding) or precipitating Calcium so it is unavailable to the coagulation process, or by inhibiting the formation of thrombin needed to convert fibrinogen to fibrin in the coagulation process.
What are the most common anticoagulants ?
Ethylenediaminetetraacetic Acid (EDTA), Citrates, Heparin, oxalates.
What is EDTA and what is it’s purpose ?
Commonly available in a Sodium or potassium based salt and it’s purpose is to prevent coagulation by binding or chelating calcium
What is EDTA used for and what is it’s primary use ?
It is increasingly being used for Blood Bank tests.
It is Primarily used used to provide whole blood specimens for hematology tests because it preserves cell morphology and inhibits platelet aggregation or clumping
Why must EDTA specimens be mixed immediately after collection ?
To prevent platelet clumping and microclot formation which can negatively affect test results.
How many inversions are required for an EDTA Tube ?
8 inversions for proper mixing
Why does CLSI recommend spray dried EDTA instead of liquid EDTA ?
Because liquid EDTA dilutes the specimen and results in lower hemoglobin values, red and white blood cell counts, platelet counts, and packed cell volumes
What happens when EDTA tubes are underfilled ?
Excess EDTA is resulted which causes RBC’s to shrink and changes the complete blood count (CBC) results .
EDTA is contained in ?
Lavender (purple) top tubes
Microcollection containers with lavender tops
Pink plastic top tubes with a special blood. And patient ID label
Pearl top tubes with thixotropic gel separator
Royal blue top tubes with lavender color coding on the label
What is the purpose of Citrates ?
To prevent coagulation by binding or chelating Calcium
Why are coagulation test performed on plasma ?
Specimens are centrifuged to separate plasma from the cells
Why is Calcium added back to specimens during coagulation testing ?
So the clotting process can be initiated and timed
Why does coagulation specimens require immediate mixing after collection ?
To prevent activation of the coagulation process and microclot formation which invalidates test results
How many inversions are required for Citrate tubes ?
3-4 gentle inversions for proper mixing
When is Heparinized Plasma Used ?
For STAT chemistry tests and other rapid response situations when a fast turn around time (TAT) for chemistry tests is needed
What makes Faster TAT possible ?
Time is eliminated that would normally be required for a specimen to clot vector serum could be obtained
Why is Heparinized plasma preferred over serum for potassium tests ?
Because when blood clots potassium is released from cells into the serum and can falsely elevate results
Why must Heparinized specimens be mixed immediately upon collection ?
To prevent clot formation and fibrin generation
How many inversions are required for Heparin tubes ?
Eight gentle inversions are required for proper mixing and to prevent hemolysis
What are the three Heparin formulations ?
Ammonium
Lithium
Sodium Heparin
Which Heparin formulation is most commonly used for plasma and whole blood chemistry tests ?
Lithium Heparin
