Definitions and Questions Flashcards
How to collect blood cultures
Strict asceptic technique.
ChloraPrep the site
Clean the collection bottles
Ordered in sets of 2
Aerobic and anaerobic in a set
Stool sample collection Process
Wear gloves
Hat shaped plastic lid or plastic wrap
collect the stool into clean dry plastic jars w/ screw lid
Get to the laboratory immediately or refrigerate
If for occult stool test smear a bit onto the card
Hematoma care and procedure
Immediately Stop
Release the tourniquet
Remove the tube
Remove the needle
Apply firm pressure and an ice pack
CLIA Definition
Clincal Laboratory Improvement Amendment of 1988
QNS Definition
Quantity not sufficient
Special Handling
Hand delivered by phlebotomist, Pneumatic tube, or courier.
Amonia, Lactic acid, ABG, Gastrin, Glucagon, Parathyroid hormone, PTT, and PT must be chilled
Cryoglobulin, Cryofibrinogen, Cold Agglutinin must be warmed.
Billirubin and mostly vitamins must be protected from light. (Vitamin B12, Urine Porphyrins, Carotene, Red Cell, Folate Serum, Folate, Vitamin B6
Lactic Acid must be drawn without stasis
Capilary/fingerstick draw process
Always wipe away the first drop of blood with gauze
3rd or 4th finger of non-dominant hand
use an automatic lancet milk the incision and put into capillary tubes
EHAS
ABG/VBG Collection Process
Grab a hepparinized needle kit.
ABG go into pulse points
For vbg swap out needle with butterfly
ABG perform allen test
ABG Angle of incidence between 45 to 90
ABG apply pressure for 2 to 5 minnutes afterwards. Do not allow patient to apply pressure.
4 Sages of Hemostasis
Vascular phase (vascular spasm)
Platelet phase (platelet plug)
Coagulation phase (coagulation cascade)
Platelets release prothrombin activator
Prothrombin activator turns prothrombin into thrombin
Thrombin cuts fibrinogen into fibrin
Fibrin bonds with plug to coagulate the vein
Fibinolysis
Tourniquet Placement
Roughly 3” to 4” above the draw site
Hemostasis Definition
The arrest of bleeding
Different forms of communication
Active listneing, non verbal communication, active response
How to care for unconscious patients
Patients who faint should regain consciousness within a minute. If not regaining conciousness follow employer protocols.
Contact Precautions
Barriers/ppe, handwashing, vaccination and inoculation, breaking the chain of infection.
Butterfly needle angle of draw/straight stick
5 degrees for butterfly /15 to 30 degrees for a straight stick
Exposure Protocol
1 Immediately wash the area
2 report the exposure to supervisor
3 refer to an MSDS
4 fill out an exposure report form
Document routes if exposure and circumstances
Identify and document source
Test the source individual’s blood
Collect your own blood and test
5 apart from exposure everything else will remain confidential
MSDS Definition
Material safety data sheet
POCT/ Waived test
Point of care testing is done in the presence of th e patient using devices onsite. Ex. Glucose meter
Waived tests are tests that can be performed by providers other than the physicians or nursing staff.
How to disinfect body fluid spills
1:10 to 1:100 EPA registered tuberculocidal left on the area for 10 minutes (sodium hypochlorite and lysol both work)
Consents
Informed consent- competent person gives voluntary permission for medical procedure
Expressed consent - permission is given verbally or in writing for a procedure
Implied consent- patient’s actions
HIV testing consent- special permission for testing
Parental consent- parent must permit procedures on a minor (18)
Question 78 is B (H pilori Test)
Question 78 is (H pilori test)
(Blood test is antigen. Breath or stool are active infection tests)
POCT Definition
Point of care testing
CDC Definition
Center for disease control
Pediatric order of draw
EHAS
EDTA
Heparin
Any other additive
Serum
Military time
24 hour time first two digits are the hour on a 24 hour scale and the last two are the minutes past the hour
SPS Definition
Sodium Polyanethole Sulfonate
LIS Definition
Laboratory Information System
Gloves Used for latex allergies
Nitrile Gloves
EDTA Definition
Ethylenediaminetetraacetic Acid -
What cannot be centrifuged
CBC
HIPAA Definition
Health Insurance Portability and Accountability Act
Infant blood draw process
Out side of the heel
No deeper than .85mm for premies & 2mm for infants
Medially from great toe to heel
And then laterally from the middle of the 4th and 5th
Always wipe away first drop with gauze
Use automatic lancet and milk incision
EHAS
TJC Definition
The Joint Commission
Guage and needle size relationship and actual size
Needle guage system. Is relative. Each decreases by roughly ~11% Smaller is larger
syncope procedures/protocol
Do not allow them to fall and get injured
Immediately Stop
Release the tourniquet
Remove the tube
Remove the needle
Safely position the patient and call for help
FUO Definition
Fever of Unknown Origin
SDS Definition
Safety Data Sheet
STAT Definition
Immediately
(Latin statim)
premature needle withdrawal
Needle comes out too early. Perhaps hearing hissing.
Layperson Terms Definition
Using words that someone who is not an expert can understand
How to Perform OGTT (and what it stands for)
Oral glucose tolerance test
Blood is drawn from patient as a baseline.
Patient must then finish glucola within 5 minutes
Blood is drawn once an hour
Is ordered for 1, 2, 3, or 5 hours
OSHA Definition
Occupational Safety and Health Administration
Failure to invert tubes
Additive will not adequately mix
8-10 times on all tubes except light blue top tube (3-4)
Cannot over invert.
PHI Definition
Protected Health Information
CLSI Definition
Clinical Laboratory Standards Institute
How to identify a patient
Ask the patient for identification, check it. Then confirm the information. In-patient clinic there will be a non-removable waterproof identification.
What information Goes on a requisition form
Patient’s Full Name
Patient’s DOB
Patient’s Sex
Patient’s Room Number
Patient’s Bed Number
Date and time of specimen collection
Technician Performing the draw
Tests requested
Specimen Identification code
Ordering Physician
Special Considerations (Fasting, Timed, STAT, Postprandial, etc.)
Original Test date
ICD 10 Code
Biohazard Safety/Waste
Whether or not you think the blood or bodily fluid is infected with bloodborne pathogens treat it as if it is.
Only needles go into the sharps container. Biohazards go into the biohazard container
Wear gloves when handling and collecting, blood, bodily fluids, or tissue spicimens. NEVER DOUBLE GLOVE
Wear a face shield for droplets
Always activate the safety mechanism
How to collect an ETOH sample
As normal but do not use alcohol to clean the site. Replace with another antisceptic
Basal State Definition
Fasting and refraining from strenuous exercise 8-12 hours before the draw
How to collect a 24 hour urine Sample
- Tell patient to discard first specimen
- Urinate into a small collection container and pour into a big container
- Refrigerate each sample after deposit
4.Keep samples refridgerated - Have patient clean the container with soap and warm water between collections
- Patient must avoid bedpans urinals and toilet paper
Venipuncture Steps
Verify the requisition form for patient information and test requested
Introduce yourself, Explain the procedure, and secure patient consent.
Wash hands and put on gloves
Gather Necessary Equipment
Assemble needle but leave it capped
Assess venipuncture site and then apply tourniquet
Palpate the vein
Cleanse the area with a back and forth movement (never blow air into the site to dry it)
Use thumb to anchor the vein (Below antecubital fossa)
Insert the needle (15 to 30 degree angle with bevel up)
Once the needle is in the tube, push the needle into the holder
Release the tourniquet once blood flow is established.
Fill tubes according to order of draw
remove last collection tube from holder
Hover gauze over venipuncture site
WIthdraw needle then immediately apply pressure
Activate needle’s safety mechanism
Tape them up
Label each specimen
Before leaving check the venipuncture site
Clean up everything and dispose of waste properly
Remove ppe
(cotton balls should not be used because they may dislodge clot. Never have the patient bend their elbow to apply pressure as this can result in continued bleeding brusing or hematoma. patient should be expected to remove bandage in about an hour)
Out of scope of practice
ABG, IV, giving out results and waived tests w/out consent
Importance of Waste tubes
Waste tubes clear the line of air and can flush out an additive from the vaccuneedle
Hemolysis Definition
The breaking of red blood cell membranes which releases free hemoglobin into the blood
PPE/Order of removal
1.Gloves
2.Goggles
3.Gown
4.Mask
Legal v Ethical Behavior
Legal issues occur when an established law has been broken vs a code of ethics which provides personal and professional performance and moral behavioral rules
Negligence, assault, battery, slander, libel, duty of care, breach of duty, malpractice are illegal. Could be criminal or civil depending on the charge and the situation.
Handwashing Technique
Make sure to use enough soap to form a lather.
Steps:
1.wash hands immediately after removal of gloves
2.Use soft antibacterial soap
3.Avoid harsh abrasive soap
4.Exposed skin should be washed thoroughly as soon as possible after removal of gloves
Wash for at least 30 seconds
End of Blood draw process
TTCC
Tourniquet
Tube
Cover/cotton
Cap
site selection
preferred site for venipuncture is upper extremities antecubital fossa
Vein selection is based on the size and condition of the vein
The vein should be palpable after the tourniquet
(Median cubital vein is often preferred
Cephalic vein is often the most straight forward vein to palpate in an obese patient
Basilic Vein is near brachial artery, risk puncturing artery or a nerve. Never redirect when entering the basilic)
