Chapters 8 & 5 Flashcards
What is the advantage of hand washing in the presence of the patient?
It gives the patient a visual assurance of cleanliness and reinforces a safety conscious gesture for both the patient and healthcare worker.
List the steps that are essential to every successful blood collection procedure.
- Clean hands and review lab orders.
- Approach, identify, and position the patient comfortably and safely.
- Assess the patient’s physical disposition, including diet and or whether the patient has allergies.
- Select and prepare equipment and supplies.
- Find a suitable puncture site.
- Prepare and decontaminate the puncture site.
- Choose venipuncture method.
- Collect samples in appropriate tubes and correct order.
- Discard contaminated supplies in designated containers.
- Label the samples.
- Assess the patient to ensure bleeding has stopped.
- Decontaminate hands.
- Manage and document special circumstances that occurred during the phlebotomy procedure.
Why is it important for a healthcare worker to have a neat and clean professional appearance as well as a cordial, helping temperament?
It instills a sense of professionalism and hygiene, which is gratifying to patients and promotes a safer work environment. Helps you focus on the task at hand and remove yourself from distractions.
Name some of the negative effects if the phlebotomist does not understand the test ordered on a lab request.
Pre-analytical errors, misleading test results, repeated venipuncture.
If there is a discrepancy in the identification process or the type of test to be done, what should the phlebotomist do?
Report discrepancies immediately. Never base identity on records or charts placed on patient bed or equipment.
In what circumstances may you delay a specimen collection procedure?
If a physician, clergy, or nurse is consulting with the patient.
To reduce the risk of puncturing an artery or injuring nerve, the CLSI recommends that vein selection be considered in what order?
- median cubital 2. cephalic 3. basilic (only if the other veins on both arms are not prominent.)
List some circumstances where arm veins cannot be used for venipuncture.
IV lines in both arms. Burned or scarred areas. Areas with a hematoma. Casts on arms. Thrombosed veins (lack resilience, roll easily, feel like a rope cord) Edematous arms. Mastectomy on one or both sides.
Describe two templates which will increase bloodflow to veins making them easier to visualize and palpate.
Warming the puncture site increases arterial flow to the area. Or have patient dangle his or her arm by their side downward for 1 to 2 minutes.
List important factors to understand concerning the use of a tourniquet.
Use brightly colored tourniquets so they are less likely to be forgotten. Do not leave a tourniquet on for longer than one minute. Release tourniquet after needle puncture. Place tourniquet 3 to 4 inches above site.
Define hemoconcentration as it relates to tourniquet use.
If a tourniquet is left on for longer than one minute, increased blood concentration of large molecules such as proteins, cells, and coagulation factors will occur.
List the proper techniques for site preparation.
- Always ask the patient about allergies.
- Identify the patient properly.
- Wash or sanitize hands, dry, don gloves.
- Cleanse the site with 70% isopropanol.
- Rub the site with alcohol pad, working in concentric circles inside to out. Repeat with a new pad if the skin is particularly dirty.
- If you palpate the site again, repeat cleansing, air dry or dry with sterile gauze.
What are the two most common systems used for phlebotomy and why?
Evacuated systems and winged infusion systems are widely available, equipped with safety devices, come with needles of various sizes, and comply with CLSI recommendations for systems that enable blood to flow directly into the tubes.
Identify special populations or difficult venipunctures for which the winged infusion or butterfly system may be preferred.
Patients with small veins.
Pediatric or geriatric patients.
Patients having numerous needlesticks such as cancer patients.
Patients in restrictive positions such as traction or severe arthritis.
Patients with severe burns.
Patients with fragile skin or veins.
Patients who specifically request it because it causes less pain.
Short term infusion therapy.
Describe why the syringe method is the least preferred method for blood collection.
Safety concerns, issues of accidental cross-contamination of anticoagulants if specimen is injected into multiple evacuated tubes using the same needle and syringe, excessive or forceful withdrawal, and potential clotting in the syringe.
What is the rationale for developing an order of draw for blood collection?
Many tubes contain various additives and collecting sample tubes in the correct order reduces the chances of erroneous lab results due to additive carryover.
List two important facts concerning the filling of blood collection tubes.
- To minimize transfer of additives from tube to tube, hold tube horizontally or slightly downward.
- Be attentive to the fill rate and volume for proper mix of blood with anticoagulant.
List important points to know concerning the labeling of blood samples.
Label specimens immediately at the patient’s bedside before leaving the patient. Never pre-label tubes because they may be erroneously picked up and used for the wrong patient, or if another worker must complete the draw, the initials on the label will be incorrect. If the pre-labeled tube isn’t used, this can cause wasted tubes and or labels.
All blood sample labels should consistently contain what information?
- The patient’s full name.
- Patient identification number.
- Date of collection.
- Time of collection.
- Identification of the person collecting the sample.
- Patient room number, bed assignment, or outpatient status.
List five essential items that should be on patient specimen labels.
- Patient name.
- Unique patient identifier.
- Date of birth.
- Specimen collection time and date.
- Phlebotomist identification such as signature, initials, code.
Sample integrity can be affected by what?
The method of transport, timing delays, temperature, humidity, agitation, exposure to light, and centrifugation methods.
What may affect clotting times?
It may be delayed by anticoagulant therapy or medications that the patient may be taking.
List specimens that may require chilling.
- Gastrin
- Ammonia
- Lactic acid
- Catecholamines
- Parathyroid hormone
- Pyruvate
