erudite Flashcards
includes procedures such as laboratory handling
and identification, which take place prior to any laboratory testing. In this phase, proper
control measures are placed to avoid subsequent issues.
pre-analytical testing phase
pre-analytical testing phase starts when and ends when??
It starts when the doctor’s order is
given and ends when the laboratory testing has officially commenced.
During this phase, the phlebotomist must not only be able to draw blood from the patient, but must also be able to identify factors that affect the process and address them as
needed.
pre-analytical testing phase
The ___ is used by physicians to diagnose and monitor the presence of a
disease.
laboratory test
The physicians compare the results to a ________ or _________ This
range shows the high and low limits of result values as compared to healthy individuals.
reference range or reference interval.
This range shows the high and low limits of result values as compared to healthy individuals.
Reference range or reference interval.
This can be influenced by age, gender, and conditions of the body.
the basal state
ideal in establishing reference range since it represents
the condition of the metabolism of the body early in the morning or after approximately 12
hours of fasting.
the basal state
Red blood cells (RBC), white blood cells (WBC), creatinine clearance
Age
Variable
Age
Altitude
Dehydration
Diet
Diurnal Variation
Drug Therapy
Exercise/IM Injection
Fever
Gender
Jaundice
Intramuscular Injection
Position
Pregnancy
Smoking
Stress
Temperature and Humidity
Red blood cells (RBC)
Altitude
Hemoconcentration, red blood cells (RBC), enzymes, iron (Fe),
calcium (Ca), sodium (NA)
Dehydration
Glucose, lipids, electrolytes
Diet
Thyroid-stimulating hormone (TSH), cortisol, iron (Fe)
Diurnal Variation
Enzymes, hormones
Drug theraphy
Potential of hydrogen (pH), carbon dioxide partial pressure (PCO2),
creatine kinase (CK), lactic acid dehydrogenase (LDH), glucose
Exercise/IM Injection
Hormones, cortisol
fever
Red blood cells (RBC), hemoglobin (HgB), hematocrit (Hct)
gender
Yellow color interfaces due to increased biliburin
Jaundice
Creatine kinase (CK) and the skeletal muscle fraction of LDH
Intramuscular Injection
Protein, potassium (K)
position
Red blood cells (RBC)
pregnancy
Cholesterol, cortisol, glucose, growth hormones (GH), triglyceride, white
blood cells (WBC)
smoking
White blood cells (WBC), iron (Fe), adrenocorticotropic hormone (ACTH),
catecholamine, cortisol
stress
when selecting the venipuncture site. They could choose an
alternative site, or perform the procedure under special conditions.
Burns, Scars, and Tattoos-
Damaged Veins
Edema
Hematoma
Masectomy
Obesity
This is the condition in which the individual is grossly
overweight.
Obesity
Hemoconcentration
Temperature and Humidity
Patients who are obese have veins that are deep and
difficult to locate.
Obesity
A solution is using a longer tourniquet or
locating the cephalic or cubital vein.
Obesity
This procedure, often done to breast cancer
patients, refers to the removal of the breast through surgery.
Mastectomy
Blood drawing from patients who had undergone this procedure
becomes a challenge since the lymph flow is obstructed, and
there may beswelling and infection after thesurgery.
Mastectomy
tourniquet cannot be applied because it can cause injury. It could
also change the blood composition.
Mastectomy
A solid swelling or mass of blood in
the tissues caused by the leakage of blood from the vessels during
venipuncture.
hematoma
The tissues
become fragile, making the task of locating the veins harder.
edema
selecting a venipuncture site with ___will be painful for the patient because it will obstruct the blood flow. It could also lead to the contamination of blood sample.
hematoma
It could also lead to the contamination of blood sample.
hematoma
This
condition may be due to reactions from medications, pregnancy,
infections, and other medical problems.
edema
also known as oedema, is an abnormal swelling
caused by the accumulation of fluid in the tissues.
edema
may also produce inaccurate results.
Damaged Veins
being difficult to perform,
Damaged Veins
Veins could be sclerosed or hardened or thrombosed or clotted.
Damaged Veins
It is not advisable to choose a site
that has ______ because veins in the area may be difficult to examine and blood circulation may be impaired.
burns, scars, or tattoos
______ may be too painful to touch and ___ may also be
susceptible to infection due to the dyes used that may interfere
with the process.
Burns, tattoos
There are cases when vascular access devices (VADs) are needed for
_________________ of a patient.
blood sampling,
infusing medication,
central venous pressure readings,
blood transfusion
Vascular Access Sites and Devices
Arterial Line
Arteriovenous Shunt or Fistula
Blood-sampling Device
Heparin or Saline Lock
Intravenous (IV) Sites
6. Central Vascular Access Devices (CVADs)
To obtain samples for arterial blood gas and laboratory
studies, critically ill patients require ______ where a
thin catheter is inserted into an artery.
arterial lines
This is also used to
monitor blood pressure continuously.
Arterial line.
Neither tourniquet nor
venipuncture is allowed in the arm with an ____.
Arterial line.
is a passageway created
through surgery, and is usually in the arms with the intention of
connecting the artery and a vein directly.
Arteriovenous Shunt or Fistula
This may be created for
hemodialysis treatment or pathological process such as erosion of
arterial aneurysm.
Arteriovenous Shunt or Fistula
Arteriovenous Shunt or Fistula
This may be created for
___ or pathological process such as ______
hemodialysis treatment; erosion of
arterial aneurysm.
A blood-sampling device is used to avoid the use of needle-sticks, prevent infections, and reduce wastage from line draws.
Blood-sampling Device
The device collects blood from the arterial or central venous
catheter where it isconnected.
Blood-sampling Device
is an intravenous (IV) catheter attached to a stopcock
or cap with diaphragm.
Heparin or Saline Lock
which is commonly called a
“hep-lock,”
Heparin or Saline Lock
Its basic function is to provide access for
administering medicine or drawing blood from the patient.
Heparin or Saline Lock
It is usually flushed with heparin
or saline (to prevent clogging) and capped for future use.
Heparin or Saline Lock
It is
threaded in the peripheral vein, which is in the lower arm above
the wrist for up to 48 hours.
Heparin or Saline Lock
also known
as indwelling lines,
Central Vascular Access Devices (CVADs)
There are
three (3) types of CVADs: __
the central venous catheter lines,
implanted port,
peripherally inserted central catheter.
are any of the tubings inserted to the main
vein or artery used for blood collection, monitoring the patient’s
pressures, and administering medications and fluids.
Central Vascular Access Devices (CVADs)
a thin plastic tube or catheter inserted into
a vein in the forearm to inject a volume of fluids into the
bloodstream.
Intravenous
IV
If blood collection is necessary,
the collection site should be _____
below the IV.
The phlebotomist should avoid collecting blood
from the arm with ___ because the blood collected could be
contaminated with ___
IV; IV fluid.
IV
Take note that
collection of blood from previously known IV sites should be
avoided for _____
24 to 48 hours.
is a surgically implanted disk-shaped
chamber attached to the indwelling line.
Implanted port
also knownas a central line
inserted into the large vein (subclavian) and advanced
into the superior vena cava.
Central venous catheteris
This is usually
placed on the upper chest just below the collarbone.
Implanted port
is a
flexible tube inserted into the veins of extremities and the
central veins.
Peripherally inserted central catheter (PICC)
Handling Patient Complications
Associated with Blood Collection
Allergies to Equipment and Supplies
Excessive Bleeding
Fainting
Nausea and Vomiting
Pain
Petechiae
Seizures or Convulsions
Seizures or Convulsions
When seizures or convulsions occur, the blood draw should be
___
discontinued quickly.
There must be pressure held over the site but it must be made certain that movement is not restricted; the mouth is free from any obstruction and the patient is protected from
self-injury. The first-aid personnel must be notified immediately.
Seizures or Convulsions
This condition involves the appearance of small red or purple
spots that look like rashes, which appear on the arm when tourniquet
is applied.
Petechiae
The patient should be warned before the needle insertion, and
the phlebotomist should avoid redirection of the needle.
Pain
Pain
If the patient
complains of extreme pain or numbness, _________ and _______ to the site because this could indicate nerve involvement.
Remove the needle and
apply ice
The phlebotomist needs to document the incident if the condition
persists.
Pain
An emesis basin or
wastebasket should be provided, and a cold damp washcloth should
be applied to the forehead.
Nausea and Vomiting
When the patient feels nauseous and has the tendency to
vomit, the phlebotomist has to _____
discontinue the procedure until the
patient feels better or until the feeling subsides.
temporary loss of consciousness which is caused by
the insufficient flow of blood to the brain.
fainting
The pressure should be applied to the site until the
bleeding stops. The attention of the authorized personnel should be
called when the bleeding continues after five minutes.
Excessive Bleeding
Patients prone to fainting
during venipuncture are asked to _____________
lie down during the procedure.
Excessive Bleeding
When a patient is on _____ or ______ the bleeding may
take a longer time.
aspirin or anticoagulant,
When the patient has adhesive allergy, a _____ should be placed
over the site and should be removed after ___
gauze; 15 min
Excessive Bleeding
The attention of the authorized personnel should be
called when the bleeding continues after ________
five minutes.
Handling Patient Complications
Associated with Blood Collection
The alternative
is to ask the patient to apply pressure for ________
5 mins
When the patient has latex allergy,
look for a sign to indicate the allergy and use a non-latex alternative for gloves, tourniquet, and bandages.
When the
patienthas antiseptic allergy, simply use _______
a different antiseptic.
Avoiding and Handling Procedural Error Risks and Failure to
Draw Blood
Hematoma Formation
latrogenic Anemia
Inadvertent Arterial Puncture
Infection
Nerve Injury
Relfux of Anticoagulant
Vein Damage
Infection can be avoided by making sure that tapes or bandages are not opened ________
ahead
of time;
needles are not _____ into the tube holders; insertion site of the needle is not ______
preloaded; touched after sterilization;
cap is removed just before venipuncture; and patients are advised to
keep the bandage on the site for at least ______.
15 minutes
This results from blood loss due to blood draw.
latrogenic Anemia
This happens when blood is filling up the tube rapidly and there is a rapid formation of
hematoma on the site.
Inadvertent Arterial Puncture
It is important to ensure that only the
required specimen volume is collected because if 10% of the blood volume is removed at
once from the body, the patient could face a threat.
latrogenic Anemia
The phlebotomist should hold pressure over the site immediately after discontinuing the
draw.
Hematoma Formation
if ___ of the blood volume is removed at ___ from the body, the patient could face a threat.
10%; once
A cold compress or ice pack may be offered to help address the swelling.
Hematoma Formation
Blood that has already been drawn flowing back into the vein from the collection tube may
cause adverse reaction because of the presence of tube additives. To avoid this, make sure that
the arm of the patient is in a downward position and the tube is just below the venipuncture
site.
Reflux of Anticoagulant
Nerve Injury
If the initial attempt is unsuccessful, the phlebotomist should try to _______. The next step is to ________
redirect the needle by using a slightly forward or backward movement
remove the needle and
look for an alternative site.
conditions that trigger hematoma:
. There is excessive or blind probing.
· There is inadvertent arterialpuncture.
. The size of the vein is too small.
. The needle penetration has gone all through the vein.
. Needle is not completelyinserted.
. Tourniquet is still on when the needle was removed.
. The pressure is notadequate.
happen when there is improper site selection, rapid needle insertion,
excessive redirection of the needle, and blind probing.
Nerve injuries
Reflux of Anticoagulant
Blood that has already been drawn flowing back into the vein from the collection tube may
cause _______ because of the ________
adverse reaction; presence of tube additives.
Reflux of Anticoagulant
To avoid this, make sure that
the arm of the patient is in a ______ and the tube is just ___
downward position ; below the venipuncture
site.
Hemoconcentration is a decrease in the fluid content or plasma volume which is
usually caused by tourniquet that stagnates the normal flow of blood leading to the
increase in concentration of red blood cells and other non-filterable large molecules.
Specimen Quality
Hemolysis, which is also called haemolysis, refers to the rupture of the red blood cells.
The hemoglobin is then released into the surrounding fluid.
Specimen Quality
Specimen contamination means that the specimen is compromised due to incorrect
handling, which involves allowing alcohol, powder or other materials into the sample.
Getting glove powder or perspiration into films and specimens; using the wrong
antiseptic; or simply not following the proper antiseptic procedure could interfere with the
results.
Specimen Quality
Partially filled tube or short draw, happens when the phlebotomist pulls a tube before
reaching the required volume. This may lead to the incorrect blood-to-additive ratio.
Specimen Quality
Wrong or expired collection tube should not be used because the manufacturer could
not warrant the quality of the seal and pressure after the expiration date indicated in the
tube.
Specimen Quality
decrease in the fluid content or plasma volume which is
usually caused by tourniquet that stagnates the normal flow of blood leading to the
increase in concentration of red blood cells and other non-filterable large molecules.
Hemoconcentration
also called haemolysis, refers to the rupture of the red blood cells.
The hemoglobin is then released into the surrounding fluid.
- Hemolysis,
happens when the phlebotomist pulls a tube before
reaching the required volume. This may lead to the incorrect blood-to-additiveratio.
Partially filled tube or short draw,
the specimen is compromised due to incorrect
handling, which involves allowing alcohol, powder or other materials into the sample.
Getting glove powder or perspiration into films and specimens; using the wrong
antiseptic; or simply not following the proper antiseptic procedure could interfere with the
results.
Specimen contamination
Troubleshooting Failed Venipuncture
Needle not inserted far enough
Bevel partially out of skin
Bevel partially into vein
Bevel partially through vein
Bevel completely through vein
Bevel against vein wall
Needle beside vein
Undetermined position
The ___ is critical to the success of the venipuncture.
needle position
should not be used because the manufacturer could
not warrant the quality of the seal and pressure after the expiration date indicated in the
tube.
Wrong or expired collection tube
usually occur when conditions are less than ideal, which leads to the
veins being blocked, resulting in insufficient blood flow.
Collapsed Veins
This happens when there is a strong
pressure in the vacuum of the tube or plunger; the tourniquet is too close to the site or it is too
tight; or when the tourniquet has been removed during the draw.
Collapsed Veins
To avoid failure due to loss of vacuum, the phlebotomist should make sure that the bevel is
not partially out of skin and the tube itself is not damaged.
Tube Vacuum
To avoid failure due to loss of vacuum, the phlebotomist should make sure that the _____
bevel is
not partially out of skin and the tube itself is not damaged.
Specimen Quality
Hemoconcentration
Hemolysis
Short Draw
Contamination
Expired
