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Chapter 5: Phlebotomy > Chapter review > Flashcards

Chapter review Flashcards

1
Q

What will you need to perform a Venipuncture?

A

Gloves, isopropyl alcohol swabs, gauze pads, adhesive bandages, tourniquets, needles, blood collection tubes, pediatric blood collection tubes, butterfly needle, vacutainer set, and lancets.

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2
Q

If you or the patient has latex allergy, what type of gloves you should use?

A

Vinyl or nitrile gloves.

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3
Q

When should you discard tourniquets?

A

When they become soiled or obviously contaminated.

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4
Q

Blood tube collection

A

Are glass or plastic tubes that have the capacity to hold 6 to 10 mL of blood. The inside of the tube is sterile but the outside is not.

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5
Q

What does the color of the stopper indicates?

A

Which additive is inside or if there is no additive.

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6
Q

What color top collection tube you should use for prothrombin time (PT) tests?

A

Blue top

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7
Q

What does prothrombin time (PT) measure?

A

The ability of the blood to clot.

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8
Q

What is inside the blue top tube?

A

Sodium citrate

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9
Q

Sodium citrate

A

Prevents blood from clotting in the tube, ensuring the PT test is accurate.

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10
Q

What are the most commonly used tubes?

A

Blue tops, lavender tops, and red tops.

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11
Q

Use the blue top tube for -

A

Coagulation tests.

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12
Q

Use the lavender top tubes for -

A

A complete blood count (CBC).

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13
Q

Use the red top tube for -

A

Tests such as serum glucose, electrolytes, and blood urea nitrogen.

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14
Q

Why should you not use an adult collection tubes for children?

A

The vacuum inside adult blood collection tubes is higher than the pressure inside the blood vessels of a child. They can collapse the children veins.

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15
Q

What does a butterfly needle, or a winged infusion set consists of?

A

Sterile needle, a short length of flexible plastic tubing, and another sterile needle at the other end of the plastic tubing.

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16
Q

What is the second needle covered with?

A

A rubber sheath.

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17
Q

Lumen

A

Technical term for the inside of a needle or tube that is used in medical procedures.

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18
Q

Vacutainer

A

The name vacutainer is a brand name, but the term is commonly used for all similar phlebotomy equipment.

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19
Q

What does the vacutainer equipment consists of?

A

A double-ended sterile needle with one end covered with a plastic protective cap and the other end it is covered with a rubber sheath.

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20
Q

When should you use a lancet?

A

To perform phlebotomy when a finger stick or heel stick is required.

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21
Q

What is a lancet?

A

A small, sterile pointed blade. Used to puncture the skin when you cannot access a vein for a Venipuncture.

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22
Q

What are the steps to correctly perform a venipuncture?

A
  1. Identify the patient.
  2. Check the order form and the patient’s chart.
  3. Have the patient sit or lie down.
  4. Assemble the equipment, wash your hands and put on disposable gloves.
  5. Locate a suitable vein.
  6. Clean the venipuncture site.
  7. Apply the tourniquet.
  8. Stabilize the vein.
  9. Uncap and inspect the needle.
  10. Insert the needle at an angle that is between 15 and 30 degrees. The beveled side, facing up.
  11. Release the tourniquet. Tourniquet should not be left on for longer than 1 minute.
  12. Attach the collection tubes.
  13. Invert the tubes after you fill them.
  14. Remove the needle.
  15. Complete the procedure.
  16. Report the test results.
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23
Q

What are the three complications are possible if you do not release the tourniquet after 1 minute?

A
  1. Specimen can undergo hemolysis and will lead to inaccurate test results.
  2. Development of petechiae; tiny hemorrhages that appear as small red or purple spots on the skin.
  3. Hemoconcentration.
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24
Q

What is hemolysis?

A

Destruction or breaking of blood cells.

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25
Q

What is Hemoconcentration?

A

Prolonged application of a tourniquet can force fluids out of the veins and into the surrounding tissue. This causes the concentration of the blood components to be artificially increased , and the blood test will be inaccurate.

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26
Q

How many liters of blood does the body have?

A

About 5 liters.

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27
Q

Why are the blood collection tubes inverted?

A

To mix the additives in the collection tubes with the blood sample.

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28
Q

An Inversion -

A

Is defined as one complete turn of the wrist.

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29
Q

What are the number of inversions for Blue top tubes?

A

3 to 4 inversions.

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30
Q

What are the number of inversion for EDTA and heparin-containing tubes (lavender top and green top)?

A

8 to 10 inversions.

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31
Q

What are the number of inversion for Serum separator tubes (SST, red tops) and serum tubes (red tops without the separating gel)?

A

5 inversions.

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32
Q

How long should you apply pressure to the venipuncture site?

A

30 seconds.

33
Q

How long should the patient to leave the bandage on after a blood draw?

A

15 minutes.

34
Q

How long should the patient apply pressure to the venipuncture site if the patient takes medication such as aspirin or warfarin and if the patient has a bleeding disorder or takes an anticoagulant medication?

A

5 minutes is the averapge recommended time, but check with your workplace protocols.

35
Q

What are the key words to remember when transmitting laboratory results?

A

Repetition and confirmation.

36
Q

Repetition and confirmation

A

Informing patient’s nurse about a test result and asking the nurse to repeat the information back to you.

37
Q

When should you use a finer stick or a heel stick?

A

When venipuncture is contraindicated or not neccessary.

38
Q

______or _______ are not venipuncture because they access capillaries, not veins.

A

Finger stick or Heel stick.

39
Q

Which finger should you use for Finger stick?

A

Side of the middle or ring finger.

40
Q

When should you never perform a Finger stick?

A

When the finger is cold, cyanotic(blue), scarred, swollen, or has a rash.

41
Q

What type of lancet is used to perform heel sticks in infants?

A

BD QuikHeel lancet

42
Q

How long should you apply the heel warmer before performing Heel stick?

A

3 to 5 minutes.

43
Q

What are the best sites for heel sticks?

A

The lateral or medial sides of the heel.

44
Q

What would be the secondary site to perform Heel stick?

A

The skin between the lateral and medial sides.

45
Q

Which part of the heel you should not puncture for heel stick and why?

A

Back of the heel because there is too little skin/tissue in that area, and a lancet puncture can hit bone.

46
Q

Phlebotomy complications can include -

A

Pain, infection, bruising, and tissue trauma.

47
Q

Phlebitis

A

Inflammation of the walls of the vein.

48
Q

When should you never perform phlebotomy unless the physician specifically orders that it is acceptable?

A

An arm that has dialysis shunt or IV line or in the arm that is on the same side on which a mastectomy was performed.

49
Q

When should you not perform a Venipuncture?

A

Through an existing hematoma or through an area that is grossly edematous.

50
Q

Edema

A

Is defined as a collection of fluid in a tissue space or a body cavity in which the fluid would not normally be found. Edema makes the skin and tissue pale, puffy, and swollen. An ankle that is sprained is often edematous.

51
Q

What does performance failure include?

A

Using an incorrect order of draw, using an incorrect tube for an ordered test, incorrect physical handling of the specimen, such as shaking the tube vigorously instead of simply inverting it to mix, using expired collection tubes, failure to make sure that the patient has been properly prepared, such as making sure she has had nothing to eat or drink for 8 to 10 hours prior to a fasting glucose test.

52
Q

What should you do when a patient begins to feel faint during blood draw procedure?

A

Withdraw the needle, have the patient lean forward, and call for help.

53
Q

What is the amount of blood that fills three specimen tubes?

A

Less than or equal to 2 tablespoons.

54
Q

Order of the draw -

A

Filling the blood collection tubes in the correct sequence.

55
Q

What is the correct order of the draw for standard phlebotomy collection?

A

Blood cultures or sterile specimens, Blue top tube, Red top tube, Green top tube, Lavender top tube, Gray

56
Q

After what color top tube should be drawn for routinely order special testing that requires additional or different additive tubes?

A

Lavender top tube

57
Q

What is the preferred order of the draw for Capillary Collection?

A

EDTA additive tube, other additive tubes, and then serum tubes.

58
Q

Plastic collection tube contain a -

A

Clot activator

59
Q

Some glass evacuated tubes contain -

A

No additive.

60
Q

Particular plastic collection tubes that have red stoppers are used for -

A

Tests that require the blood to clot before being centrifuged and for draws that require serum. Also use these tubes for chemistry and immunology tests.

61
Q

Gold (or black and red mottled) stopper tubes contain -

A

Gel and a clot activator. May be used for chemistry and immunology tests.

62
Q

What type of tubes should you use for tests that require plasma?

A

Other tubes that contain anticoagulants that prevent the blood from clotting depending on how it preserves the specimen and that it does not interfere with the test procedure.

63
Q

What are some of the widely used anticoagulants include?

A

Sodium citrate - found in the light blue stopper tubes. Mostly used for coagulation tests because it is the best at preserving the coagulation factors. Fully fill the tubes to prevent dilution and incorrect results.

EDTA - found in the lavender or pink stopper tubes, Mostly used for hematology and some blood banking tests, respectively, because they help preserve the shape of cells and reduce platelet clumping.

Heparin - found in green stopper tubes and used for most chemistry tests that require plasma or whole blood and STAT chemistry tests. Heparin and separator gel that is found in light green (or black and green mottled) stopper tubes are used for chemistry testing as well.

ACD - found in the light yellow stopper tube and used for DNA testing because the additive has little impact on platelets and cells.

SPS - found in yellow stopper tubes and are used to draw cultures for micro-organisms.

Potassium oxalate - found in the gray stopper tube and used for testing blood glucose levels because combined with sodium fluoride it helps prevent glucose deterioration.

64
Q

Blood culture

A

Is a laboratory test used to check for bacteria or other micro-organisms in a blood sample (most cultures check for bacteria).

65
Q

In the U.S., what tests are newborns required to be tested?

A

For various disorders, including cystic fibrosis, hypothyroidism, phenylketonuria (PKU), and galactosemia.

66
Q

Cystic fibrosis

A

Mucous secretions that accumulate in the lungs and other organs.

67
Q

Hypothyroidism

A

Decreased thyroid function.

68
Q

PKU

A

A buildup of phenylketones caused by decreased metabolism of phenylalanine.

69
Q

Galactosemia

A

The inability to break down galactose, a milk sugar.

70
Q

What is the depth when puncturing the heel on an infant?

A

No deeper than 2mm with a lancet.

71
Q

Filter paper

A

State-required blood tests are collected on special forms that include absorbent areas.

72
Q

What type of antiseptic should you use when collecting specimens that is used for legal cases?

A

Chlorhexidine

73
Q

What is the most commonly analyzed no blood specimen in the clinical laboratory?

A

Urine

74
Q

How many mL should the urine be when collecting specimen?

A

12 to 50 mL

75
Q

When should not a patient undergo urine tests?

A

Menstruating patient’s, until their cycle is complete.

76
Q

What are the common types of urine specimens?

A

Random specimen, Clean-catch midstream specimen, Timed specimen, 24-hour specimen, First-voided morning specimen, Catheterization, Suprapubic specimen

77
Q

Serial urine specimens

A

Are typically collected for glucose tolerance tests.

78
Q

First-voided morning specimens is commonly used for -

A

Pregnancy testing, culturing, and microseptic examination.

79
Q

Point-of-care testing

A

Is laboratory testing conducted close to the site of patient care.

Chapter 5: Phlebotomy (1 decks)

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