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Phlebotomy > Chapters 6 & 7 > Flashcards

Chapters 6 & 7 Flashcards

0
Q

Besides preventing coagulation, what is the other advantage of an anticoagulant as an additive?

A

Can contain preservatives that can extend the metabolism and life span of red blood cells after collection.

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1
Q

What is the most effective and direct method for obtaining a blood specimen?

A

Vein puncture with a vacuum (evacuated) tube.

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2
Q

Name two important points to remember when using vacuum blood collection tubes.

A
  1. These tubes have been designed for a certain amount of blood to be collected into the tube by vacuum in relation to the amount of per filled anticoagulant.
  2. If an insufficient amount of blood is collected in the anticoagulant tube, the lab test results may be wrong because of the incorrect amount of blood mixed with anticoagulant, and the sample shouldn’t be used for testing.
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3
Q

When are blood culture specimens ordered?

A

When the patient is suspected to have septicemia.

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4
Q

Why are special precautions taken when drawing blood cultures?

A

To prevent the sample from becoming contaminated with microorganisms from the skin.

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5
Q

What does the gauge number of a needle represent?

A

The diameter of the needle. The smaller the gauge number, the larger the needle diameter. Larger diameter needles are typically used for donation collection.

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6
Q

What are the pre-analytical variables that are important to the phlebotomist?

A

Patient assessment and physical disposition, test requests, specimen collection, specimen transport, and specimen receipt in the laboratory.

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7
Q

Define basal state.

A

The patient’s condition in the early morning, approximately 12 hours after food intake.

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8
Q

Why are blood tests most commonly performed in the early morning hours?

A

The results of lab tests on basal state specimens are more constant. Glucose, cholesterol, triglycerides, and protein levels are more reliable in basal state specimens.

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9
Q

Define fasting.

A

No food or drink, except water, usually for 8-12 hours.

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10
Q

Describe why many blood tests are fasting blood tests.

A

The amounts of blood analytes significantly change after meals and thus are not correct for many clinical chemistry tests.

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11
Q

How does obesity complicate venipuncture?

A

Veins tend to be difficult to visualize and/or palpate in obese patients.

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12
Q

What are sclerosed veins and why should they be avoided for venipuncture?

A

Sclerosed veins are hardened veins as a result of inflammation and disease. Blood is not easily collected from these sites.

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13
Q

Why are allergies a concern for the pre-examination phase of phlebotomy?

A

Some patients are allergic to iodine, alcohol, or other antiseptics, or to latex. Use alternative cleansing solutions. Latex-free tourniquets, gloves, and bandages must be used. Always ask the patient if they have allergies.

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14
Q

Define mastectomy.

A

Surgical removal of the breast.

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15
Q

Describe why venipuncture should not be performed on the side of a mastectomy.

A

Lymphedema in the area may make the patient more prone to infections and cause poor circulation.

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16
Q

Define lymphedema.

A

Excessive accumulation of fluid due to removal of lymph nodes.

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17
Q

Define thrombus.

A

Solid mass derived from bloos constituents in blood vessels.

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18
Q

Describe how thrombi may affect blood collection.

A

They may fully occlude an artery or vein, making venipuncture difficult.

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19
Q

Describe why burned, scarred, or tattooed areas should be avoided for venipuncture.

A

Burned areas are sensitive and susceptible to infection. Veins under scarred areas are difficult to palpate, and collecting in these areas is painful. Tattoos have dyes that can interfere with lab tests, have impaired circulation, are sensitive, and are susceptible to infection.

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20
Q

What is the most costly error a health care worker can make?

A

Improper identification can be life-threatening.

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21
Q

What may be he result of a tourniquet applied too tightly or left on the arm too long?

A

Pressure from the tourniquet can cause biological analytes to leak from tissues into blood, which can falsely elevate or decrease lab results.

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22
Q

What hazard may be caused by fist pumping?

A

Increase in plasma, potassium, lactate, and phosphate concentrations.

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23
Q

Define syncope and list the signs or symptoms.

A

Syncope is fainting. Look for signs such as sweating, paleness in the face, anxiety, hyperventilation, and nausea.

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24
Q

Define hematoma.

A

Localized leakage of blood into the tissues or an organ.

25
Q

Describe what actions can be taken to prevent he development of a hematoma.

A

Remove tourniquet and needle. Apply pressure for 2 minutes. If bleeding doesn’t stop, call nurse or supervisor. Applying a cold pack can stop the bleeding, and later at home applying a warm pack can help it to reabsorb.

26
Q

Define petichiae and what the sign may suggest.

A

Small red spots appearing on a patient’s skin, indicated minute amounts of blood have escaped into outer skin layers. This suggests a blood clotting abnormalities or illness with a fever. It could be a sign of a bad blood clot and needs to be reported immediately.

27
Q

Describe improper techniques that may lead to hemoconcentration.

A

Prolongued (greater than 1 min.) tourniquet application, massaging, squeezing, or probing the site, long-term IV therapy, sclerosed or occluded veins.

28
Q

Define hemolysis and list possible causes.

A

When RBCs are lysed, hemoglobin is released and serum or plasma is tinged pink or red. Can be caused by using too small of a needle, vigorous expulsion of blood into a tube, vigorous shaking, blood collection when alcohol on skin isn’t dry, or pulling the syringe plunger back too fast.

29
Q

Define turbid or lipemic serum.

A

Turbid serum or plasma appears milky and can be a result of bacterial contamination or high lipid levels in the blood. Lipemic serum is cloudy or milky due to temporary lipid elevation after ingestion of fatty foods.

30
Q

What are the 4 common anticoagulants?

A

Oxalates, citrates, EDTA (all chelators), and heparin (inactivates thrombin and factor X).

31
Q

What are yellow tubes for?

A

Blood cultures and ACD (blood donations and banking).

32
Q

What are light blue tubes?

A

Contain Sodium citrate for PT and APTT coagulation tests.

33
Q

What are serum separator tubes for?

A

Contain a polymer barrier that, upon centrifugation, separates the serum from the clot.

34
Q

What are red top tubes?

A

No anticoagulants or polymer barrier. Used for serum collection.

35
Q

What are green top tubes?

A

Sodium or Lithium heparin for plasma or whole blood chemical tests.

36
Q

Why can’t green-top Lithium heparin tubes be used to test Lithium levels?

A

They will cause the results to say the patient has erroneously high Lithium levels.

37
Q

What are purple tubes?

A

Contain EDTA and are used for hematology procedures such as RBC, CBC, WBC, etc.

38
Q

What are the pink tubes?

A

Contain EDTA, used for blood banking.

39
Q

What are the gray tubes?

A

Contain Sodium fluoride, a glycolytic inhibitor and antiglycolytic agent for glucose tests.

40
Q

What are royal blue tubes?

A

Used for toxicology tests for trace elements.

41
Q

What are tan tubes?

A

Contain EDTA, used to test for lead.

42
Q

What are black tubes?

A

Contain Sodium citrate. Used to analyze erythrocyte sedimentation rate.

43
Q

When are safety syringes used?

A

For patients with fragile veins.

44
Q

What volume syringe is used?

A

5-20 mL

45
Q

Why shouldn’t you push the syringe plunger?

A

The force can damage cellular components and cause hemolysis.

46
Q

When is the butterfly infusion set used?

A

Elderly persons, cancer patients, and children.

47
Q

What is the purpose of the tourniquet?

A

Slows venous flow, but not arterial, which causes blood to pool in the veins, making them easier to see and feel.

48
Q

When is skin puncture performed?

A

When small amounts of blood can be used for diagnostic tests and if venipuncture is deemed excessively hazardous to a patient.

49
Q

To avoid penetrating bone, how deep should heelsticks be?

A

Less than 2.0 mm.

50
Q

Why are clay slabs that are used to seal capillary tubes considered hazardous?

A

They become contaminated with blood and glass fragments.

51
Q

Why is abstaining from drinking water before having blood drawn for a test not recommended?

A

It can cause dehydration which can cause errors in test results.

52
Q

How long should a patient fast before timed glucose, cholesterol, and triglyceride levels are drawn?

A

8-12 hours.

53
Q

Why shouldn’t you probe/dig with a needle?

A

It’s painful for the patient, it can destroy red blood cells, and it can cause errors in the test results.

54
Q

Why should you avoid drawing from edemous sites?

A

Veins can be difficult to palpate and the fluid may contaminate the sample.

55
Q

What is the best site for blood collection on a patient with a double mastectomy?

A

Finger stick.

56
Q

How should you treat nausea?

A

Have the patient take deep breaths, put a cold compress on their head, and contact your supervisor.

57
Q

How should you deal with syncope?

A

Remove the needle, have the patient put their head between their legs and breathe deeply. Get help lying the patient down. Talk to the patient to distract them from the procedure. Gently placing a wet towel on their forehead and providing a glass of water or juice may help them feel better.

58
Q

What causes hematomas to occur?

A

When the needle punctures completely through the vein, when the bevel is only partially inserted in the vein, or when not enough pressure was applied to the puncture site.

59
Q

What should you do if you hit a patient’s nerve?

A

Remove the tourniquet, remove the needle, and apply pressure to the site. Notify your supervisor.

Phlebotomy (4 decks)

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