Chapter SEVEN Flashcards
What is the primary duty of a phlebotomist?
-to 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:
- blood-drawing stations
- phlebotomy chairs
- equipment carriers
- gloves and glove liners
- antiseptics
- disinfectants
- hand sanitizers
- gauze pads/cotton balls
- bandages
- needle and sharps disposal containers
- slides
- pen
- watch
What safety organizations require the wearing the gloves when performing phlebotomy?
- CDC/HICPAC
* OSHA
List the different types of gloves that acceptable for most phlebotomy procedures:
- non sterile
- disposable latex
- nitrile
- neoprene
- polyethylene
- vinyl examination gloves
Glove powder can be a source of what ?
- contamination for some tests (especially those collected by skin puncture)
- allergies
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?
- 70% Ethyl alcohol
- 70% isopropyl alcohol (isopropanol)
- benzalkonium chloride (e.g., Zephiran chloride)
- chlorhexidine gluconate
- hydrogen peroxide
- povidone-iodine (0.1–1% available iodine)
- tincture of iodine
(T or F)
Disinfectants are EPA regulated chemical substances
TRUE
What is the ratio of dilution recommended for decontaminating nonporous surface 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 blood or other body fluids 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
- danger of aspiration and suffocation
What size are the precleaned glass microscope slides and what are they used for?
- 25 X 75-mm
- used to make blood films for hematology determinations
List the venipuncture equipment:
- Vein-locating devices
- tourniquet
- needles
- evacuated tube system (ETS)
- syringe system
- winged infusion set
- combination system
What are the types of needles used in phlebotomy?
- multisample needles
- hypodermic needles
- 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 needles
- 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 larger-diameter needles, needle gauge is selected according to what?
- size and condition of the patients vein
- type of procedure
- equipment being used
Common venipuncture needle gauges come in what sizes?
- 15-17
- 18
- 20
- 21
- 22
- 23
(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, and 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-sized veins
21 needle gauge is what type of needle and what is it used for?
(Green)
Needle type: 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?
(Black)
Needle type: 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 ones are most commonly used
What are the lengths of butterfly needles?
Typically 1/2 to 3/4 of an inch long
FDA is responsible for clearing what for marketing?
(Safety features)
-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?
- a special blood-drawing needle
- a 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 three conditions?
- age of the patient
- amount of blood needed for the test
- the size and condition of a patients vein
Premature loss of vacuum can occur from what?
- improper storage
- opening the tube
- dropping the tube
- advancing the tube too far onto the needle before venipuncture
- pulling the needle bevel partially out of the 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 used for?
To be centrifuged to separate the cells from the fluid portion called plasma.
If the additive is clot activator, what is it’s result?
The blood will clot and the specimen must be centrifuged to obtain the fluid portion called serum.
What is the correct way to handle tubes ?
-store between 4 and 25 degrees Celsius
Light blue stopper has what additive and belongs to what department?
Additive: sodium citrate
Department: coagulation
Red (glass) stopper has what additive and belongs to what department?
- has no additive
- Department: chemistry, blood bank, Serology/Immunology
Red (plastic) stopper has what additive and belongs to what department?
- additive: clot activator
- department: chemistry
Red/light gray (plastic) stopper has what additive and belongs to what department?
Additive: non additive
Department: NA (Discard tube only)
Red/black (tiger) , gold, red/gold stopper has what additive and belongs to what department?
Additive: clot activator and gel separator
Department: chemistry
Green/gray, light green stopper has what additive and belongs to what department?
Additive: lithium heparin and gel separator
Department: chemistry
Green stopper has what additive and belongs to what department?
Additive: sodium heparin, lithium heparin
Department: chemistry
Lavender/Pink stopper has what additive and belongs to what department?
Additive: EDTA
Department: 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
Department: chemistry
Orange, gray/yellow stopper has what additive and belongs to what department?
Additive: thrombin
Department: chemistry
Royal blue stopper has what additive and belongs to what department?
Additive: none(red label) , EDTA(Lavender label) , sodium heparin (green label)
Department: chemistry
Tan(glass tube) , tan(plastic) stopper has what additive and belongs to what department?
Additive: sodium heparin , EDTA
Department: chemistry
Yellow stopper has what additive and belongs to what department?
Additive: sodium polyanethol sulfonate (SPS)
Department: microbiology
Yellow stopper has what additive and belongs to what department?
Additive: acid citrate dextrose (ACD)
Department: blood bank/Immunohematology
What the common syringe volumes used for phlebotomy?
2, 5, and 10 mL
What are the two parts of the syringes?
- barrel
- plunger
What is the winged infusion set or butterfly used for?
-is an indispensable tool used for collecting blood from small or difficult veins such as hand veins and veins of elderly and pediatric patients
How many time 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?
Ethylendiaminetetraacetic (EDTA) , citrates, heparin, and oxalates
What is EDTA and what is it’s purpose?
EDTA is commonly available in sodium or potassium-based salt. EDTA prevents coagulation by binding or chelating Calcium.
What is EDTA used for and what is it’s primary use?
- increasingly being used for blood bank tests
- primarily used to provide whole specimens for hematology tests because it preserves cell morphology and inhibits platelet aggregation.
Why must EDTA specimens be mixed immediately after collection?
-to prevent platelet clumping and micro clot formation, which can negatively affect test results.
How many inversions are required for an EDTA tube?
Eight inversions
Why does CLSI recommend spray-dried EDTA instead of Liquid EDTA?
Because Liquid EDTA dilutes the specimen and results in lower hemoglobin value, red and white blood cell counts, platelet counts, and packed cell volumes
What happens when the EDTA tubes are under filled?
Excess EDTA that results when tubes are under-filled causes RBCs to shrink and changes the CBC results
EDTA is contained in :
- lavender (purple)-top tubes
- microcollection containers with lavender tops
- pink plastic-top tubes with a special blood bank 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?
Prevent coagulation by binding or chelating Calcium
Why are coagulation tests performed on plasma?
-specimens are centrifuged to separate the plasma from the cells
Why is calcium added back to the specimens during coagulation testing?
-so the clotting process can be imitated 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 ?
Three to four gentle inversions
When is heparinized plasma used?
-used for stat chemistry tests and other rapid response situations when a fast turn around time (TAT) for chemistry test is needed
What makes faster TAT possible?
Time is eliminated that would normally be required for a specimen to clot before 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
What 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, and sodium heparin
Which heparin formulation is most commonly used for plasma and whole-blood chemistry tests?
Lithium heparin
