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Phlebotomy > Chapter 8 > Flashcards

Chapter 8 Flashcards

1
Q

capillary puncture is also called…

A

dermal puncture

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2
Q

what is a blood culture?

A

A blood culture is a blood test that involves testing blood for the presence of bacteria. It required the use of very special equipment. Blood culture testing involves collecting samples in bottles that allow any bacteria in the blood to multiply.

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3
Q

Define peripheral blood smear

A

A peripheral blood smear requires the PBT to smear a drop of capillary blood or blood from a venous collection tube onto a microscopic slide.

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4
Q

before the specimen is drawn, the PBT must identify the patient by what?

A

by 2 unique identifiers. Most commonly, this. means asking the pt to state and spell their first and last name, and state their DOB.

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5
Q

define order of draw

A

The standard sequence in which tubes must be filled/collected from the patient

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6
Q

when drawing blood with a syringe from a tube, would you use an 18 gauge or 23 gauge needle? AKA, when drawing from a collection sample tube, not a human)

A

You would use an 18 gauge needle because this bigger needle size doesn’t allow for the RBCs to collide and cause hemolysis.

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7
Q

If you’re drawing blood from a sample, would you use 16 gauge or 25 gauge?

A

16 gauge

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8
Q

is 16 or 18 gauge bigger?

A

16

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9
Q

is 23 or 21 gauge bigger?

A

21

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10
Q

is 19 gauge or 25 gauge bigger?

A

19

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11
Q

what is one of the most important parts of drawing blood?

A

antisepsis of the draw site/area. BUT VERIFYING THE PATIENT IS MORE IMPORTANT…
This answer could also be washing hands - but just read the question carefully.

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12
Q

define antispesis

A

cleaning

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13
Q

what is a winged collection set

A

a butterfly needle

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14
Q

what are microcollection tubes?

A

Microcollection tubes are collection tubes for capillary puncture; these tubes are not evacuated tubes; they are also designed to contain a much smaller volume of blood. They generally carry 125-600 microliters of blood. So these tubes are much smaller than regular venipuncture collection tubes.

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15
Q

sometimes, capillary blood is not collected in tubes with lids, but with what?

A

sometimes, capillary blood is not collected in tubes with lids, but rather in very thin, straw-like tubes that hold a very small amount of blood, and are sealed with clay, or another substance.

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16
Q

establishing blood flow for capillary specimens requires the use of a ____

A

lancet

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17
Q

what is a lancet?

A

a lancet is a device containing a small, sharp retractable blade or needle. All lancets are disposable, single-use, and discarded in sharps container.

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18
Q

what are analytes?

A

Analytes are substances studied in diagnostic tests.

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19
Q

even as blood is being collected, ______ in the collection tubes are preparing it for testing.

A

additives

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20
Q

using a tube with the correct additive ensures what?

A

using a tube with the correct additive ensures that the analytes for each test are presented properly, and accurately reflect the blood in the patient’s bloodstream.

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21
Q

tube stopper’s colors indicate what?

A

Tube stopper colors indicate the type of additive inside

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22
Q

are tubes labeled with an expiration date?

A

yes

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23
Q

what are two different categories of tubes?

A

those WITH anticoagulants and those WITHOUT anticoagulants

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24
Q

Some tubes without anticoagulants include ____ _____ to speed up the coagulation process.

A

Some tubes without anticoagulants include clot activators to speed up the coagulation process.

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25
Q

different anticoagulants act in different ways. Some bind to calcium in the blood, what does what?

A

Some anticoagulants bind to calcium in the blood, making it unavailable. Because calcium is one of the key substances in blood clotting, this has an anticoagulant effect.

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26
Q

Other anticoagulants stop the action of thrombin, what does this do?

A

Some anticoagulants stop the action of thrombin, the enzyme that causes fibrin to form.

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27
Q

T/F: The different means of preventing coagulation make each additive suited to particular blood tests.

A

True

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28
Q

calcium is involved in…

A

coagulation … and anticoagulation

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29
Q

which tube is used to test lead levels?

A

tan-topped tubes

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30
Q

what are the two types/categories of tubes called?

A

-Serum tubes (without anticoagulants)
-Plasma tubes (with anticoagulants)

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31
Q

what are anticoagulant tubes also called? why?

A

Anticoagulant tubes are also called plasma tubes. This is because centrifuged specimens containing anticoagulants divide into plasma and cellular components.

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32
Q

what are serum tubes? what can they contain?

A

Serum tubes allow the blood to clot, yielding serum and clotted cells after centrifugation.
In addition to chemical additives that act on the blood, tubes may contain a gel that, when the specimen is centrifuged, forms a barrier between the liquid and solid components.

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33
Q

blood cultures are always drawn ____

A

first

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34
Q

what are red-topped tubes? are they serum or plasma tubes?

A

-Red-topped tubes are serum tubes.
-Red tubes collect serum and whole blood.
-Tubes with red stoppers either contain a clot activator (plastic tubes) or no additive (glass tubes)
-The inside of the tube is coated with silicone to prevent the blood cells from sticking to the tube.
-Serum tubes are used for certain chemistry, serology, and immunology tests.

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35
Q

what is serology?

A

the study of blood serum

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36
Q

what are gold/molted red and gray (tiger tops) tubes? are they serum or plasma tubes?

A

-Gold/molted red and gray tiger tops are serum tubes.
-These tubes contain both a clot activator and a separator gel.
-These tubes are called Serum Separator Tubes (SSTs).
-Like other serum tubes, SSTs are used for chemistry, serology, and immunology testing.
-They should not be used for testing therapeutic drug levels.
-Tiger tops are the molted red and gray.
-Tiger tops are SSTs.
-Gold tops are SSTs.

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37
Q

what are orange-topped tubes? are they serum or plasma tubes?

A

-Orange tubes are Stat Serum Tubes.
-They contain a fast-acting clot activator.
-These tubes are used for testing that must be conducted very quickly.
-These tubes are available with or without separator gel.

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38
Q

T/F: serum tubes may or may not contain clot activators and/or separator gel.

A

True

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39
Q

what are light blue/sky blue topped-tubes? are they serum or plasma tubes?

A

-Light/sky blue tubes are plasma tubes.
-These tubes contain an anticoagulant additive called sodium citrate.
-They are often referred to as citrate tubes.
-They are used for coagulation studies.
-Sodium citrate acts by binding to calcium, and its action is reversible, meaning technicians in the lab can also perform clotting time tests on blood collected in these tubes.
-These tubes must be filled completely for the proper balance of blood to additive.

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40
Q

what are green topped-tubes? are they serum or plasma tubes?

A

-Green tubes are plasma tubes.
-These tubes can be sometimes light, dark, or speckled green.
-They contain the anticoagulant heparin. Heparin acts by preventing thrombin from acting to form fibrin.
-Sodium heparin and lithium heparin are two different tube additives, both with the same anticoagulant action (deactivating thrombin).
-Light green usually indicates that the tube contains a separator gel, and these tubes must be referred to as Plasma Separator Tubes (PSTs). These tubes are most often used for routine chemistry tests and certain genetic testing.
-Because heparin is an anticoagulant that does NOT bind calcium, this means it is often used when calcium levels need to be tested.
-Green tubes may also be used for Stat chemistry tests.

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41
Q

If you need to test for calcium levels, which tube would you use?

A

Green tubes AKA heparin tubes

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42
Q

When the additive does NOT bind to calcium, what does this mean?

A

When the additive does NOT bind to calcium, that means calcium is freely available and can be tested. But when additives DO bind to calcium, you can’t test calcium levels.

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43
Q

what are lavender/pink/white tubes? are they serum or plasma tubes?

A

-Lavender/pink/white tubes are plasma tubes.
-These tubes contain the additive EDTA. This anticoagulant acts by inhibiting the action of calcium in a patient’s blood. So it prevents coagulation by binding to calcium.
-EDTA tubes are typically used for hematology studies (eg. complete blood count).
-Pink-topped tubes are used for blood bank specimens. (blood type and matching for transfusions, its called type and crossmatch.)

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44
Q

what are gray tubes? are they serum or plasma tubes?

A

-Gray tubes are plasma tubes.
-They are called oxalate tubes.
-Gray tubes usually contain 2 types of additives: an anticoagulant in the form of either sodium or potassium oxalate, and a substance called sodium fluoride that prevents the deterioration of glucose, or blood sugar.
-This process of deterioration, called glycolysis, affects certain test results if it is not prevented. Glucose testing is usually done using specimens in gray tubes.

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45
Q

should electrolytes be collected in gray tubes?

A

NO

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46
Q

what are yellow tubes? are they serum or plasma tubes?

A

-Yellow tubes are plasma tubes.
-These tubes contain either acid citrate dextrose (ACD) or sodium polyanethol sulfonate (SPS) as an anticoagulant additive.
-Blood cultures are drawn first, then yellow.
-These tubes are not as commonly used as the other anticoagulant tubes.
-ACD tubes are generally used to collect whole blood specimens for DNA analysis, or testing prior to organ transplant.
-SPS tubes are used for microbiology studies such as a blood culture.
-It is very important to check the label to verify the additive in a yellow tube

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47
Q

what are royal blue tubes? are they serum or plasma tubes?

A

-Royal blue tubes are plasma tubes.
-These tubes are very special tubes.
-Royal blue tubes usually contain EDTA, although they may also contain heparin or no additive.
-A colored stripe on the label shows the additive: usually lavender for EDTA, green for heparin, and red for no additive.
-These tubes are certified to be free of trace elements, or chemical elements present in tiny amounts. They are used for trace element, toxicology, and nutrition testing.
-Due to the possibility of different additives, these tubes should be checked closely before use.

48
Q

what is the order of draw? (CLSI’s order of draw)

A
  1. Blood culture (first special blood culture tubes, then yellow-topped SPS tubes).
  2. Sodium citrate tubes (light blue tops).
  3. Serum tubes, with or without separator gel or clot activator (red, molted red/gray, gold, or orange tops).
  4. Heparin tubes (green tops, all shades).
  5. EDTA tubes (lavender, pink, or pearly white topped-tubes).
  6. Oxalate tubes (gray tops).
49
Q

which of the following tubes are an anticoagulant?

A
50
Q

Sometimes, stoppers of other tubes can contain trace elements that will interfere with the results of other tubes. For example, royal blue topped-tubes are made to be free of trace elements. Because of this, order or draw may need to be changed up a bit. Royal blue tubes should be filled first, before any other tubes. After they are filled, a ______ tube must be filled (doesn’t have to be all the way), and this tube won’t be tested.

A

discard tube

51
Q

are discard tubes tested?

A

NO

52
Q

as blood is collected from a capillary puncture, does the composition change? what is the beginning vs end of the collection of blood?

A

YES, as blood is collected from a capillary puncture, the composition of the blood does change. The first blood collected more resembles arterial blood, and as the collection continues, the blood becomes more like venous blood.

53
Q

define stat

A

Immediately

54
Q

define ASAP

A

as soon as possible - usually within 30 min

55
Q

what is a glucose tolerance test?

A

A timed draw.
It is a test that is generally performed when testing for diabetes, or to test for gestational diabetes. The pt has their blood drawn before the test, then drinks a really sugary drink, and has their blood drawn at various intervals to track her body’s response to the sugar in the drink. In order to ensure the accuracy of the results, the draws should be completed as close as possible to the time on the order.

56
Q

what is gestational diabetes?

A

A type of diabetes that only occurs during pregnancy.

57
Q

what are routine tests?

A

The tests are less urgent but should not be delayed unnecessarily.

58
Q

what is bilirubin?

A

A substance associated with liver function, it is a common light-sensitive analyte. This substance needs to be protected from light.

59
Q

which tube is coated with silicone to prevent the blood cells from sticking to the tube?

A

red tubes

60
Q

tubes with red stoppers either contain a __ ____ in plastic tubes or __ ____ in glass tubes.

A

tubes with red stoppers either contain a clot activator in plastic tubes or no additive in glass tubes.

61
Q

which tube should NOT be used to collect electrolytes?

A

gray tubes; oxalate tubes

62
Q

what are sky/light blue tubes called?

A

citrate or sodium citrate tubes

63
Q

which tube is used for Stat Serum tubes?

A

Orange-topped tubes

64
Q

what do orange tubes contain?

A

fast-acting clot activator

65
Q

what are green tubes called?

A

heparin tubes

66
Q

what color are SST tubes? (serum separator tubes?)

A

gold or molted gray/red

67
Q

are orange tubes available with separator gel?

A

orange tubes are available with OR without a separator gel

68
Q

what color tubes are the serum tubes?

A

Red, Gold or molted Red/Gray, and Orange

69
Q

which tube contains both a clot activator and a separator gel?

A

SSTs; gold or molted red/gray tubes

70
Q

T/F: Different anticoagulant additives are used for specific diagnostic tests

A

TRUE

71
Q

what are lavender, pink, and white tubes called?

A

EDTA tubes

72
Q

what are gray tubes called?

A

oxalate tubes

73
Q

what are the two types of additives in green heparin tubes?

A

two types of anticoagulant additives:
sodium heparin and lithium heparin

74
Q

what do sodium and lithium heparin do in green heparin tubes?

A

they deactivate thrombin from forming fibrin

75
Q

what is a light green tube in green heparin tubes?

A

these tubes contain separator gels and are called plasma separator tubes and are used for chemistry tests and genetic testing

76
Q

what tube is used for stat chemistry testing?

A

green heparin tubes

77
Q

what tubes contain the anticoagulant additive sodium citrate?

A

light/sky blue citrate tubes

78
Q

what does sodium citrate do in light/sky blue citrate tubes?

A

it binds calcium and is reversible

79
Q

what are light/sky blue citrate tubes used for?

A

coagulation studies

80
Q

do citrate tubes need to be filled completely?

A

yes

81
Q

what two additives do gray oxalate tubes contain?

A

-Anticoagulant additives called sodium or potassium oxalate
-A substance called sodium fluoride that prevents glycolysis

82
Q

what is glycolysis?

A

the deterioration of glucose

83
Q

what tube tests for glucose levels?

A

gray oxalate tubes

84
Q

which tube contains an additive that prevents glycolysis?

A

gray oxalate tubes

85
Q

which tube contains EDTA?

A

mainly lavender, white, and pink tubes (but royal blue tubes can also contain EDTA additive)

86
Q

what does EDTA do?

A

it is an anticoagulant additive that inhibits the action of calcium by binding it

87
Q

what are EDTA tests typically used for?

A

for hematology studies like CBC

88
Q

what do pink tubes test for?

A

blood bank specimens - type and crossmatch for transfusion

89
Q

what additive(s) can yellow tubes contain?

A

yellow tubes contain either:
-Acid Citrate Dextrose (ACD) anticoagulant
-Sodium Polyanethol Sulfonate (SPS) anticoagulant

90
Q

what does ACD test for?

A

whole blood specimens for DNA analysis and prior to organ transplant

91
Q

what does SPS test for?

A

microbiology studies like blood culture

92
Q

what do royal blue tubes contain?

A

usually EDTA additive, but also can contain heparin or no additive

93
Q

in royal blue tubes, what does a red line indicate?

A

that it contains no additive

94
Q

what tubes are certified free of trace elements?

A

royal blue tubes

95
Q

what do royal blue tubes test for?

A

trace elements, toxicology, and nutrition testing

96
Q

what tubes are in the order of draw after blood culture and yellow tubes?

A

Sodium citrate tubes (light/sky blue)

97
Q

what tubes are in the order of draw after citrate tubes?

A

Serum tubes (red, tiger tops and gold, and orange)

98
Q

what tubes are in the order of draw after serum tubes?

A

Heparin tubes (green)

99
Q

what tubes are in the order of draw after heparin tubes?

A

EDTA tubes (lavender, pink, white)

100
Q

what tubes are in the order of draw after EDTA tubes?

A

Oxalate tubes (gray)

101
Q

In which of the following cases is blood not collected in a tube?
a. when the requisition is marked STAT
b. when the pt is a toddler
c. when a point-of-care test requires the use of a test strip
d. when a glucose tolerance test is being conducted

A

c. when a point-of-care test requires the use of a test strip

102
Q

which of the following tubes is most likely to be the largest?
a. a tube to collect a capillary specimen from an infant.
b. a tube to collect a venipuncture specimen from an adult.
c. a tube to collect a capillary specimen from an elderly patient
d. a tube to collect a venipuncture specimen from a small child

A

b. a tube to collect a venipuncture specimen from an adult.

103
Q

an error that occurs before a blood specimen is tested is called a _____

A

preanalytical error

104
Q

In which of the following cases should a PBT contact the provider who ordered a test?
a. the PBT doesn’t think the patient looks sick enough to need the test ordered.
b. the requisition is marked ASAP.
c. It looks like the pt’s veins might be hard to locate.
d. the writing on the requisition is not legible.

A

d. the writing on the requisition is not legible.

105
Q

a needle with a larger gauge number is:
a. narrower/thinner than one with a smaller gauge number
b. wider/thicker than one with a smaller gauge number
c. longer than one with a smaller gauge number
d. shorter than one with a smaller gauge number

A

a. narrower/thinner than one with a smaller gauge number

106
Q

what is the angled tip of a PBT needle called?

A

bevel

107
Q

Which part of an evacuated tube system is placed in a sharps container after use?
a. the needle only, unscrewed from the holder
b. the holder only, unscrewed from the needle
c. the needle, hold, and collection tube
d. the needle and holder

A

d. the needle and holder

108
Q

what is the main risk of using an evacuated tube system on a patient with fragile veins?

A

the pressure on the vein may cause it to collapse

109
Q

what antiseptic is most commonly used for routine venipuncture?

A

70% isopropyl alcohol

110
Q

what is accomplished by warming the site of a capillary puncture?

A

increased blood flow

111
Q

hematology studies are most often performed on specimens collected in _________ tubes

A

lavender tubes

112
Q

this sequence correctly follows the order of draw:
a. light blur, blood culture, gray
b. blood culture, gray, light blue
c. blood culture, light blue, gray
d. light blue, gray, blood culture

A

c. blood culture, light blue, gray

113
Q

a timed draw should be completed…
a. within 5 min of the designated time
b. exactly at the designated time
c. within 10 min of the designated time
d. less than 5 min before the designated time

A

a. within 5 min of the designated time

114
Q

According to CLSI standards for patient identification, a pt must _____ and _____ both first and last names.

A

state and spell

115
Q

in order to be used for pt identification, a wristband much be…

A

attached to the patient’s body

116
Q

if a PBT notices that the sharps receptacle is almost completely full before the first pt of the day, he should…

A

acquire a new container before calling the first patient

117
Q

amber-colored plastic of glass tubes ensure that sensitive analytes are not overexposed to….

A

light

Phlebotomy (12 decks)

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