Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phlebotomy > Chapter 9 > Flashcards

Chapter 9 Flashcards

1
Q

where is a tourniquet placed?

A

3-4 inches above the drawing site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

since venipuncture is usually performed in the inner elbow, where is the tourniquet applied?

A

on the pt’s upper arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

when do you remove the tourniquet?

A

technically twice - once after you find the vein, and another time right after you establish blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the steps you do right after you establish blood flow?

A

TTCC
Tourniquet, Tube, Control, Cover

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

the tourniquet must not be left in place for longer than …..?

A

the tourniquet must NOT be left in place for longer than 1 minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what can extended use of the tourniquet do?

A

extended use of the tourniquet can not only cause patient discomfort but also affect the result of the tests and cause hemoconcentration and hemolysis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is hemoconcentration?

A

Hemoconcentration can occur if a tourniquet is left on for too long, and it falsely elevates blood cell counts. Hemoconcentration describes a buildup of blood cells (solid components) relative to the liquid components of the blood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what does hemoconcentration describe?

A

hemoconcentration describes a buildup of blood cells (solid components) relative to the liquid components of blood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

tourniquet use above one minute can affect other analytes as well and cause _____

A

hemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is hemolysis?

A

hemolysis is the destruction of blood cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

if a tourniquet must be released due to excessive time before completing a venipuncture procedure, what should a PBT do?

A

if a tourniquet must be released due to excessive time before completing a venipuncture procedure, a PBT must wait at least 2 minutes before reapplying a tourniquet to the same arm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

where should the tourniquet be applied to if you are taking blood from hands?

A

if taking blood from the hand, the tourniquet will be applied to the area between the elbow and the wrist.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

do the same time limits apply to tourniquets when drawing from the hand?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what does AC stand for and what does it mean?

A

AC = antecubital fossa.
AC is the area inside the elbow, and is the most commonly used site for venipuncture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

out of the three veins, which is the first choice for venipuncture and why?

A

the first choice for venipuncture is the median cubital vein. This is because the median vein is usually the most anchored (aka it is the least likely to roll and move). It also poses the lowest risk of accidentally puncturing an artery or striking a nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the second choice for venipuncture?

A

the second choice for venipuncture is the cephalic vein.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the third and last choice for venipuncture in the AC?

A

the last choice for venipuncture in the AC is the basilic vein.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the two formation shapes of veins in the AC?

A

‘H’ and ‘M’ veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are four things you should look for when palpating veins?

A
  1. Vein Health
  2. Vein Depth
  3. Anchoring of the vein
  4. Diameter (width) of the vein
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is vein health?

A

a healthy vein should feel springy and uniform (not hard and bumpy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is vein depth?

A

veins are located at different depths for different patients. The age and weight of a pt can influence their vein depth. Veins of pts who are obese may not be easily visible. No matter the depth of the vein, the angle at which the needle is inserted remains the same for all pts. If, during palpating, a PBT notices the veins are relatively deep under the skin, a longer needle should be used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

if a patient’s vein is deeper than normal, would you go at a deeper angle?

A

NO, just use a longer needle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what two things can influence patients’ vein depth?

A

the age and weight of a pt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

are the veins of patients who are obese more or less visible?

A

less visible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the consideration of anchoring of the vein when palpating?

A

Veins in the median AC area tend to be well anchored. Some patients, however, have veins that tend to roll no matter where they are located. Palpation can help determine whether vein rolling is likely during venipuncture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the considerations of the diameter (width) of the vein when palpating?

A

Determining how wide the patient’s vein is will help the PBT to select the appropriate gauge of the needle and to insert the needle in the center of the vein.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are 4 techniques a PBT can try when a patient’s veins are hard to locate?

A
  1. Ask the patient to hang their arm straight down for a few minutes. This causes blood to pool in the arm and may make finding a vein easier.
  2. A warm washcloth or commercial heating pad can be applied to the area. The heat causes the veins to dilate, or expand.
  3. The patient can form a fist, which will cause the blood to temporarily surge. It is important that the patient does NOT pump the fist repeatedly. This can contribute to hemoconcentration and hemolysis.
  4. The PBT should ask the pt where venipuncture has been successful in the past. But if the pt suggests a vein that is considered unsuitable, don’t attempt venipuncture at that site.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what should a PBT never do when trying to locate a vein?

A

A PBT should NEVER slap or flick the patient’s skin to cause the veins to be more pronounced.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

the veins in the ____ are NEVER an acceptable site for venipuncture.

A

the veins in the wrist are NEVER an acceptable site for venipuncture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

if, after visual inspection and palpation of both arms, and the PBT does not locate a vein in the AC area, what is the next acceptable site?

A

the next acceptable site would be the veins in the back of the hand (also called the dorsal aspect).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what needle would be used for hand venipuncture?

A

a butterfly needle, never a straight needle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

In the rare instance that venipuncture cannot be performed in the AC or hand, what are other acceptable sites?

A

The next acceptable sites would be the lower leg, ankle, or foot ONLY IF ORDERED BY THE PHYSICIAN.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is the bevel?

A

the bevel is the angled part of the needle at the surface of the tip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

which way should a bevel be facing?

A

UPWARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

should you ever probe for a vein?

A

NO.
If blood flow is not immediately established when inserting the needle, it is very important that the PBT NOT move the needle around blindly (aka called probing for a vein).

34
Q

what can probing for a vein cause?

A

Probing for a vein is painful for the patient and carries a high risk of creating a hematoma

35
Q

what is a hematoma?

A

an area of leaked blood beneath the patients skin

36
Q

can hematomas develop even after the venipuncture procedure is complete?

A

yes, hematomas can develop even after the venipuncture procedure is complete and it can place pressure on nerves.

37
Q

what can you do instead of probing for a vein?

A

instead of probing for a vein, a PBT can gently adjust the needle SLIGHTLY forward or backward (never side to side). If this does not result in blood flow, the tourniquet should be released, the needle removed, and another site selected.

38
Q

A PBT should NEVER make more than _ attempts at venipuncture on one patient.

A

A PBT should NEVER make more than 2 attempts at venipuncture on one patient.

39
Q

what angle should you insert the needle at?

A

30 degrees or less

40
Q

when anchoring a vein, what do you do?

A

you use the thumb of your non-dominant hand to pull the vein down beneath your puncture site.

41
Q

what is a window, and should you do it?

A

NEVER make a window with your thumb and index finger when anchoring a vein. This poses a needlestick risk

42
Q

most venipuncture procedures will be performed where and with what needle and what tube?

A

most venipuncture procedures will be performed in the AC area with a straight 21-gauge multisample needle and evacuated tubes.

43
Q

what should you do if a patient has an IV?

A

you should draw blood from the other arm.

44
Q

if a patient has an IV in one arm, and the other arm is unavailable (eg. their other arm is in a cast, or if they had a mastectomy on that side of their body), what should you do?

A

you should ask the nurse to remove the IV and you should draw the blood from BELOW the IV site, meaning further away from the heart

45
Q

what are electrolytes?

A

Electrolytes are substances that affect the flow of nutrients and the removal of waste products in the blood. Electrolytes, enzymes, proteins (including antibodies), vitamins, and minerals can all be analytes.

46
Q

don’t attempt more than _ draws on a pt. what should you do after you attempt _?

A

don’t attempt more than 2 draws on a pt. after you attempt 2 draws, you’re done - go find someone else to complete the draw.

47
Q

what does a basic metabolic panel test for?

A

BMP’s test for:
-glucose (blood sugar)
-calcium
-sodium (electrolyte)
-potassium (electrolyte)
-carbon dioxide (electrolyte)
-chloride (electrolyte)
-blood urea nitrogen (BUN; waste product related to kidney function)
-creatine (waste product of muscles, related to kidney function).

48
Q

what tubes are usually used for BMP’s?

A

-Serum separator tubes (usually molted red/gray or gold)
-Heparin tube (green) may be used for STAT testing

49
Q

is fasting required for BMPs?

A

sometimes

50
Q

what does a comprehensive metabolic panel test for?

A

a CMP tests for:
-all tests involved in basic metabolic panel
-albumin (a protein produced in the liver)
-total protein
-alkaline phosphate
-alanine aminotransferase
-aspartate aminotransferase
-total bilirubin (waste product generated in the liver)

51
Q

what tubes are used for CMPs?

A

-Serum separator tube
-Heparin tube may be used for STAT testing

52
Q

is fasting required for a CMP?

A

sometimes

53
Q

what does a lipid panel test for?

A

-Total cholesterol
-High-density lipoprotein (HDL cholesterol)
-Low-density lipoprotein (LDL cholesterol)
-Triglycerides

54
Q

what tubes are used for lipid panel testing?

A

-Serum separator tube
-Heparin tube may be used for STAT testing

55
Q

is fasting required for lipid panel tests?

A

yes, usually

56
Q

what does a complete blood count test for?

A

a CBC tests for:
-White blood cell count (with or without differential)
-Red blood cell count & measurements
-Hemoglobin (Hgb, oxygen-carrying protein in blood)
-Hematocrit (Hct; ratio of RBC’s to other components)
-Platelet count

57
Q

what tube(s) is used for CBC tests?

A

EDTA tube (usually lavender)

58
Q

what is especially important when caring for CBC test tubes?

A

to avoid rough handling

59
Q

A

heparin test (???) ***

60
Q

T/F: BMPs are usually cheaper than CMPs

A

yes

61
Q

define Petechiae

A

PBTs should be aware that some patients may develop a rash-like condition known as petechiae after a tourniquet is applied.
These small, flat, red, or purple dots are created by blood leaking from capillaries. Their appearance is not a cause for discontinuing tourniquet use or stopping venipuncture. However, it is important that the PBT watch carefully after the procedure is finished to ensure that bleeding has stopped completely before dismissing the pt. These pts with petechiae may also be prone to prolonged bleeding.

62
Q

if you notice petechiae on a patient, what should you do?

A

You shouldn’t stop tourniquet use or stop venipuncture. However, after the procedure is done, make sure watch carefully to ensure that bleeding has stopped completely before you dismiss the patient. These patients are prone to prolonged bleeding.

63
Q

what is microclotting and when can it happen?

A

Microclotting can happen if you don’t collect tubes in the right order of draw, if you don’t invert the tube, etc.
It can make the testing less accurate.
It can also occur if you use expired tubes or if you remove stoppers to share specimens between tubes, even if the tubes have the same additive.

64
Q

what are two types of blood culture tubes? when are they drawn?

A

Blood cultures are ALWAYS drawn first.
The two types are:
-Aerobic: with oxygen; should be filled FIRST.
-Anaerobic: without oxygen; should be filled SECOND.

65
Q

What are the common analytes that require light protection of maintenance at a specific temperature?

Protection from light -

Keep cold (ice slurry)-

Keep at body temperature (98.6 F or 37 C)-

A

Protect from light:
-Bilirubin
-Many vitamins
-Carotene
-Folate

Keep cold (ice slurry):
-Ammonia
-Gastrin
-Lactate/lactic acid
-pH

Keep at body temperature (98.6 F or 37 C)
-Cold agglutinins
-Cryoglobulin
-Cryofibrinogen

66
Q

Do pH analytes need to be kept cold, room temp, or protected from light?

A

pH needs to be kept cold

67
Q

Do folate analytes need to be kept cold, room temp, or protected from light?

A

folate needs to be protected from light

68
Q

Do bilirubin analytes need to be kept cold, room temp, or protected from light?

A

bilirubin needs to be protected from light

69
Q

Do cryoglobulin analytes need to be kept cold, room temp, or protected from light?

A

cryoglobulin needs to be kept at room temp

70
Q

Do ammonia analytes need to be kept cold, room temp, or protected from light?

A

ammonia needs to be kept cold

71
Q

do many vitamin analytes need to be kept cold, room temp, or protected from light?

A

protected from light

72
Q

a test panel is…
a. the complete list of tests a laboratory can perform
b. a chart describing each test and the required tubes
c. the full list of tests ordered for a specific patient
d. a group of tests related to the same system or type of analyte

A

d. a group of tests related to the same system or type of analyte
(like a liver panel, thyroid panel, etc.)

73
Q

which of the following is a common complication of extended tourniquet use?
a. hemoglobin
b. hemostasis
c. hemophilia
d. hemoconcentration

A

d. hemoconcentration

74
Q

what is the scientific term for the inside of the elbow?

A

antecubital fossa

75
Q

the basilic vein is the last choice among veins in the antecubital fossa because…

A

it is located near nerves and an artery

76
Q

patients who are allergic to shellfish may have a reaction to antiseptics containing…

A

iodine

77
Q

which of these techniques is an acceptable way to make a patient’s vein easier to see and palpate?
a. lightly slap the AC area
b. ask the patient to pump his fist
c. leave the tourniquet in place for at least a minute before palpating
d. direct the patient to dangle his arm downward for a few minutes before applying the tourniquet

A

d. direct the patient to dangle his arm downward for a few minutes before applying the tourniquet

78
Q

why should a needle not be inserted into a patient’s vein at an angle greater than 30 degrees?

A

because angles greater than 30 degrees pose a greater risk of striking an artery or nerve

79
Q

which of the following needle movements is acceptable is blood flow is not established after needle insertion?
a. gentle forward and backward motion
b. gentle circling motion
c. slow side-to-side motion
d. quick needle removal and repuncturing of the skin

A

a. gentle forward and backward motion

80
Q

which patient is most likely to require the use of a syringe and transfer device?
a. a healthy-middle aged adult
b. a teenager
c. an elderly person
d. a pregnant woman

A

c. an elderly person

81
Q

a pt reports that she had a right-sided mastectomy ten years ago. She has an IV in her left arm. What will the PBT probably need to do?

A

ask the nurse to stop the IV and draw below the IV

82
Q

which scenario is most likely to cause hemolysis?
a. the PBT leaves a tourniquet on a patient’s arm for 45 seconds before drawing blood
b. a patient makes a fist while the PBT looks for a suitable vein
c. while transferring a specimen from a syringe to a tube, the PBT speeds the process by pressing the syringe plumber
d. the PBT forgets to mix an EDTA tube after collection

A

c. while transferring a specimen from a syringe to a tube, the PBT speeds the process by pressing the syringe plumber

83
Q

blood cultures are commonly performed to detect the presence of _______ infection in the patient’s blood.
a. bacterial or fungal
b. viral or bacterial
c. viral or fungal
d. bloodborne pathogen

A

a. bacterial or fungal

83
Q

a patient who had bacon and eggs right before a blood draw is likely to have a serum specimen that is:
a. lipemic
b. icteric
c. hemoconcentrated
d. hemolyzed

A

a. lipemic

84
Q
A

Phlebotomy (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions