Day 1 - Blood Extraction Flashcards
1
Q
Liters and percent of blood in body weight
A
5-6 L and 7–8%
2
Q
Causes (3) of HYPOvolemia
A
- Loss of whole blood
- Loss of plasma
- Loss oof h2o or water
3
Q
Causes (4) of HYPERvolemia
A
- High BP
- Hemolytic anemia (may increase blood volume)
- Blood transfusion
- Intravenous injection
4
Q
Percentage of the ff iin the total blood:
A. Plasma - (water, CHONs, hormones, enzymes, lipids and salts)
B. Buffy coat - (leukocytes and platelets)
C. Erythrocytes
A
A. 55%
B. <1%
C. 45%
5
Q
Order of draw
A
- SPS (yellow)
- Citrate (light blue)
- Non additive (red)
- Serum gel separator (gold)
- Heparin (light green/ green)
- EDTA (lavender)
- Antiglycolytic agent/ flouride oxalate (gray)
6
Q
Two types of EDTA
A
- Versene - disodium salt
2. Sequestrene - tripotassium salt
7
Q
EDTA A. Purpose B. Tests C. Inversions D. Patho mentioned
A
A. Chelates calcium
B. Blood smear,hematology, cross-matching
C. 8-10
D. Platelet satellitosis
8
Q
Blood drop size for smear usig EDTA
A
2-3 mm
9
Q
SMEAR
A. Distance gap fromm frosted end
B. Termination distance
A
A. .25 inch/ 1 cm
B. .5 inch
10
Q
Prefered anticoagulant for platelet count and modified westrgen ESR
A
EDTA
11
Q
Modified westergren composition
A
2 ml EDTA + .5 ml NSS/ Citrate
12
Q
Results (4) increased EDTA
A
- Shrinkage of cells = dec. HCT , inc. MCHC , falsely low ESR , low PCV
- Degenerative changes
- Swelling of platelets = falsely increased platelet count
- Hemoglobin will not be affected
13
Q
Platelet satellitosis
A
- Platelets adhere around neutrophils forming a ring or satellite effect
- Repeat collection using Na citrate tube
14
Q
CITRATE A. Purpose B. Tests C. Inversions D. Patho mentioned
A
A. Bind calcium in soluble complex
B. Coagulation tests, platelet aggregation, std westergren
C. 3-4
D. Polycythemia vera
15
Q
Factors (2) that cannot be conserved by EDTA
A
Factor V and Factor VIII (labile and anti hemophilic factor a)
16
Q
- Increased hct >55%
A
Polycythemic px
17
Q
Ratio
A. Citrate coagulant: blood (Coagulation studies)
B. Citrate coagulant : blood (Standard westergen)
A
A. 1:9
B. 1:4
18
Q
Increased citrate remedy (2) for polycythemic px
A
- Repeat collection
2 Reduce citrate volume
100- Hct / 595 - Hct x ml Whole blood
19
Q
T or F:
Prolonged test results = Underfilled tubes
A
T
20
Q
OXALATE A. Purpose B. Tests C. Inversions D. Patho mentioned
A
A. Binds to calcium to form insoluble calcium oxalate
B. Lactate, blood glucose
C. 8 - 10
D. None
21
Q
Double balanced oxalate
A
2:3
2 Potassium oxalate (Paul-heller’s) : 3 ammonium oxalate (wintrobe’s)
22
Q
T or F:
Pot. Oxalate = Shrink cells
Amm. Oxalate = Swells cells
A
T
23
Q
HEPARIN A. Purpose B. Tests C. Inversions D. Patho mentioned
A
A. Prevent coagulation by interaction with anti-thrombin III and inhibition of thrombin
B. Osmotic fragility test, Chemistry tests, blood gases and NOT for coag/ blood film prep
C. 8
D. Hereditary spherocytosis
24
Q
FLOURIDE A. Purpose B. Tests C. Inversions D. Patho mentioned
A
A. Preservative that inhibits glycolysis
B. Glucose, lactic acid, blood alcohol
C. 8
D. Leukocytosis
25
Flouride with oxalate =
| Flouride alone =
Plasma
| Serum
26
Recommended ratio of CITRATE for blood banking (2)
1. DOH = 1:7
| 2. Harmening = 1:8
27
Types oof blood collection
1. Microsampling/ skin/ caillary puncture
2. Venipuncture
3. Arterial puncture
28
Mixture of capillary, venous, arterial blood with interstitial fluid
Microsampling puncture
29
Reason why Microsampling has probable results of :
- low hb
- low hct
- low rbc
- low platelet
- high wbc
Due to mixed tissue juces or interstitial fluids causing slight change in parameters , promotes cell injury
30
MICROSAMPLING
A. Px administered
B. Sites
C. Container
A. Infants (>6 months), young children (if small amt is needed), adults (fragile veins, burns, both hands have iv,obese)
B. Finger (Ring/ middle finger), earlobe, lateral plantar surface of the foot
C. Microcollect tube
31
Hospital-induced anemia
Osteomyelitis
- Result due to puncture more thn 2.4 mm thus hit the bone
- replace needele with tuberculin (23 gauge)
32
Reason why you need to prick perpendicular r tothe lateral plantar surface of the foot
For blood no to flow on the patterns
33
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Recommended puncture site and incsion depth
A. Premature nenates
B. Infants under 6 months
C.Child aged 6 months to 8 yrs
D. Child older than 8 yrsand aduts
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A. Heel; .85 mm
B. Heel; 2 mm
C. Finger; 1.5 mm
D. Finger; 2.4 mm
34
Sources of error in capillary puncture (5)
1. Hemolysis
2. Failure to dry the site
3. Failure to wipe 1st drop of blood
4. Milking
5. Froting or accidental capturing of bubbles
35
Blood tests for skin puncture (5)
1. Blood gases
2. Blood smear - from EDTA
3. EDTA Micrcollection
4. Other anticoagulated microcollection tubes
5. Serum microcollection tube
36
3 major sites for venipuncture
1. Antecubital fossa oor region
2. Wrist
3. Back of the hand
But can also collet from ankle or foot; last resort. Do not do this o patients that are diabeti and have circulatory problems.
37
Tourniquet
- 3 - 4 inches
- 7.5 - 10 cm above venipuncture site
- not exceed by 1 minute or 2
38
Angle for venipunctue
15 degrees - normal
45 degrees- Blood letting
= Reduce 10-20 degrees once placed in the skin
39
T or F
| The larger the gauge the mmaller the bore
T
40
Routine gauge of needles
19, 20, 21
20 most common gauge
41
Length of needle
1 to 1.5 inch
42
How to use blood pressure cuff as a torniquet
40-60 mmHg
| 60 mmHg
43
Venipuncture procedure
PAVS
Patient interaction
Assemble supplies and equipment
Venipuncture
Specimen preparationn
44
Positon of patients during venipuncture errors
Lying down - hemodilution (dec. pcv, dec. wbc)
| Up - hemoconcentration? (inc. pcv, inc. wbc)
45
Type of patient consent (6)
1. Informed
2. Expressed
3. Implied
4. HIV
5. Consent to minors
6. Refusal of consent
46
Legal issues (7)
1. Assault - fear of immediate harm
2. Battery - offensive touching
3. Invasion of privacy - right to be alone
4. Bridge of confidentiality - not publicize
5. Negligence
6. Malpractice - medical negligence
7. Standard of care - duty to protect someone
47
Fasting hours for:
A. FBS
B. Lipid profile
A. 8–10
| B. 10-12
48
Initial steps forpatient interaction (6)
1. Approach patient in a friendly manner
2. Patient identification (verify)
3. Note isolation procedures
4. Note dietary restrictions
5. Reassure patient
6. Position the patient
49
Supplies and equipments. (9)
1. Lab requisition form
2. Pen/ marker
3. Watch
4. Antiseptics
5. Disinfectants
6. Hand sanitizers
7. Gloves/ PPE
8. Gauze pads/ cotton
9. Tourniquet
50
Why do you need to note the puncture site, time and date?
- for result correlation
| - for monitoring
51
Type of antiseptics (3)
1. 70% alohool
2. Povidone iodine
3. Chlorhexidine gluconate
52
Difference of antiseptics and disinfectants
Antiseptics - used for humans
| Disinfectants - surfaces, things
53
Preferred ratio solution for sodium hypochlorite/ bleach
1:10 for 10 mins
54
Types of tourniquet (4)
1. Elastic strap
2. Buckle-type (seraket)
3. Velcro strap
4. BP Cuff
55
Methods of venipuncture (3)
1. ETS
2. Syringed method
3. Winged infusuion se/ butterfly set
56
Why is ETS needle, 2 way?
Other side prevent contamination, where evacuated tube is attached
57
When to use syringe method venipuncture
- Pediatric/ geriatric patient with fragile/movable veins.
58
Function of wings, luer cap and luer connector in butterfly set
Wings- achoring needle
Luer cap- prevent contaminaion
Luer connetor- where tube is attached
59
Function of hub in the syringe
To see backflow thus check if the vein was hit successfully
60
Single use hypodermic needle. Know the gauge
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Color:
A. Grey
B. Brown
C. Orange
D. Medium purple
E. Blue
F. Black
G. Green
H. Yellow
I. Creamish
J. Pink
K. Natural
```
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A. Grey - 27
B. Brown - 26
C. Orange - 25
D. Medium purple - 24
E. Blue -23
F. Black - 22
G. Green - 21
H. Yellow - 20
I. Creamish- 19
J. Pink -18
K. Natural - 16
```
61
Additives in ETS (4)
1. Clot activator
2. Anticoagulant
3. Antiglycolytic agent
4. Separator gel
62
Types of gloves (5)
1. Latex
2. Vinyl
3. Nitrile
4. Polyethylene
5. Neoprene
63
Specimen preparation (3)
1. Dispose contaminated materials
2. Invert and labeltubes at patient’s side
3. Transport specimen promptly and properly
64
Areas to avoid during venipuncture
- hematoma
- scars
- burns
- below iv site
- mastetomy px
- others
65
Infectious disease precautions (3)
1. Hepatitis
2. HIV/ Aids
3. Measles/ chicken pox
66
Adverse patient reaction (4)
1. Dizzines
2. Syncope or fainting
3. Nausea
4. Vomiting
67
How to prevent hematoma (5)
- Puncture uppermost wall of vein
- remove tourniquet before removing needle
- use major superficial veins
- make sure needles penetrate uppermost wall of the vein (partial penetration = allow blood to leak out innto the soft tissue surrounding the vein)
- apply pressure to venipuncture site
68
How to prevent hemolysis (5)
1. Mix tubes with anticoagulant additives gently 5-10 times
2. Avoiddrawing bloodfrom hematoma
3. Avoid drawing the plunger forcefully
4. Make sure thatt venipunctre site is dry
5. Avoid probing/fishing
69
T or F
Discard sample at least three times the volume of the line before specimen is obtained during indweling line or catheters.
T
70
Reasons for hemoconcentration
1. Prolonged tourniquet application
2. Massaging, squeezing or probing the site
3. Long-term IV therapy
4. Sclerosed or occluded veins
71
Significant increases due to prolonged tourniquet application (5)
1. Total protein
2. AST
3. Total lipids
4. Cholesterol
5. Iron
72
Patient preparation factors (5)
1. Therapeutic drug monitoring
2. Effects of exercise
3. Stress
4. Diurnal rhythms
5. Others (Age, gender, pregnancy)
73
Reasons for specimen rejection (9)
1. Hemolysis/ lipemia
2. Clots present in anticougulated specimen
3. Non fasting specimen whe test requires fastiing
4. Improper blood collection tube
5. Short draws, wrong volume
6. Improper transport conditions
7. Discrepanceds bet. Requisition and specimen label
8. Unlabeled or mislabled specimen
9. Contaminated specimen/ leaking container
74
Order of draw for CAPILLARY PUNCTURE
1. Tubes for blood gas analysis
2. Slides
3. EDTA microcollection tube
4. Other microcollecion tubes with anticoagulants
5. Serum microcollection tubes
