Exam Flashcards
Explain Universal Precautions as it applies to phlebotomy
Blood and certain body fluids of all individuals are considered potentially infectious.
Explain Standard Precautions as it applies to phlebotomy
Precautions to use in caring for all patients regardless of diagnosis or presumed infection status. Standard precautions apply to all body fluids. Wear proper PPE
Explain Transmission based precautions as it applies to phlebotomy
Precautions to use for patients either suspected or known to be infected with certain pathogens transmitted by airborne, droplet, or contact routes
What are 5 steps that can be taken to reduce the risk of exposure to bloodborne pathogens?
1) Wash hands when changing gloves and between patients.
2) Wear gloves during all blood collections.
3) Wear protective covering when clothing is likely to be soiled.
4) Wear mask or eye protection.
5) Properly dispose of needles / syringes / sharps.
What are typical precautionary measures and actions that are taken in the event of an accidental needle puncture or body substance exposure?
Immediately cleanse exposed area.
Report incident to supervisor immediately.
Healthcare worker is tested for HIV, HBV and hepatitis C if consent is given.
If source patient is known, consent must be obtained and baseline HIV, HBV and hepatitis C tests are performed.
If source patient refuses testing, worker has a right to prophylaxis treatment.
Follow-up testing
Describe Protective (Reverse) Isolation. When is it utilized? What is the phlebotomist’s responsibility to a patient in protective isolation?
Protective isolation is designed to protect the patient from the healthcare worker.
Patients who are immunosuppressed or transplant patients are often in protective isolation.
PPE must be worn before entering the patient’s room. All phlebotomy supplies need to remain outside of the patients room or cleaned before be brought in.
List two instances when a syringe is more applicable than the evacuated® tube method for blood draw?
Drawing from a vein other than in the anticubital area.
Difficult-to-draw patient who have fragile, thin, or “rolling” veins.
List the anticubital veins in order of choice for routine venipuncture:
a. Median cubital vein
b. Cephalic vein
c. Basilic vein
What step should be done prior to beginning a specimen collection utilizing a syringe?
Pull back plunger to remove air lock.
State the relationship between bore size and the gauge of the needle.
The larger the gauge the smaller the bore. A larger gauge needle would be used on a narrow vein.
How does EDTA prevent coagulation?
Binds/chelates calcium
How does Potassium Oxalate prevent coagulation?
Precipitates calcium
How does Citrate prevent coagulation?
Binds/chelates calcium
How does Fluoride prevent coagulation?
Inhibits glycolysis
How does Heparin prevent coagulation?
Inhibits thrombin
What anticoagulant is in the following?
Light blue
Gray
Green
Light blue - Sodium citrate 3.2%
Gray - Lithium iodoacetate and lithium heparin
Green - Sodium heparin or Lithium heparin
What anticoagulant is in the following?
Lavender (purple)
Red
Red/black
Lavender - EDTA
Red - No anticoagulant
Red/black - gel/clot activator. Sodium heparin
What is the purpose of adding a silicon coating to a collection tube?
Fills the microscopically rough surfaces of glass so that cells don’t adhere to the sides of the tube.
Reduces the chance for hemolysis.
What is the purpose of adding silica particles to a collection tube?
Acts as a clot activator, initiates clotting process
What is the purpose of adding thixotropic gel to a collection tube?
Inert gel that undergoes change in viscosity during centrifugation.
Acts as an interface between cells, serum or plasma
In what order should blood tubes be drawn for evacuated tube?
Stop Light Red Stay Put, Green Light Go
Sterile (Blood culture), light blue, red, SST and PST(gold), green, lavender, grey
What role does the tourniquet play in specimen collection? What effects are there if the tourniquet remains on to long?
Used to access and find a good vein
Leaving it on to long can cause hemoconcentration/hematoma.
Describe different types of lancets used in capillary specimen collection based on area of collection and depth of puncture.
Neonatal to 12 months of age: heelsticks, < 2.0 mm
Shallow incision: for toddlers, children, = 1.8 mm
Normal incision: point of care tests. = 2.4 mm
Deeper incision: = 3.0 mm
Explain social, clerical, and technical skills.
Social - skills involving the patient
Clerical - skills with data entry and record keeping
Technical - skills drawing the patient
What are common causes of hemolysis in the syringe or evacuated tube techniques?
Traumatic draw.
Alcohol still on the arm during the draw.
A small needle on a syringe.
Shaking the blood in a tube instead of gently inverting 5-8 times.
Pulling or depressing plunger to hard.
What is informed consent?
A decision made by or for a patient after being informed about the proposed procedures. Implied consent is patient laying out their arm.
What is the order of draw from microcollection tubes?
Blood gases, EDTA, other additives, serum specimen.
Proper area for capillary specimen collection of finger and heel.
Finger - 3rd and 4th fingers of the non-dominant hand. Perform the stick off to side of the center of the finger.
Heel - Most medial or lateral portions of the plantar surface of the heel.
Criteria for the following specimens:
Fasting
Timed
Fasting - Patient can’t eat for 12 hours. Helps with a more accurate glucose level
Timed - Should be drawn within 15 minutes of being ordered.
Criteria for the following specimens:
Therapeutic Drug Monitoring
Stat
ASAP
Therapeutic Drug Monitoring - measurement of medication concentrations in blood
Stat - 10 minutes or less
ASAP - one hour or less
Reasons to reject a sample.
Incomplete or not clearly labeled specimen
Unlabeled or mislabeled specimen
Specimen hemolyzed
Specimen too old
Describe the modified allen test procedure and purpose.
Purpose: A modified Allen test measures arterial competency, and should be performed before taking an arterial sample.
Procedure: Apply pressure to wrist both radial and ulnar artery. Have patient open and close hand slowly, it will turn white. Release pressure from artery by pinky (ulnar).
If hand turns pink you can collect sample.
Define Arteriospasm
Spasm of the artery
Describe the cleansing process utilized in the collection of blood cultures.
Clean the tops of collection bottles with iodine.
Place a clean alcohol pad on top of each bottle until they are inoculated. Immediately before inoculation, wipe the top with the pad to prevent iodine contamination of the sample.
What anticoagulant is used in arterial blood draws?
Heparin
What is the angle of the needle when performing an arterial puncture?
45 degrees
Causes of hematoma
Push needle in to far.
What tube should be drawn for coagulation tests? (PT and APTT)
Light blue, plasma used
What tube should be drawn for a CBC?
Purple top, whole blood used
What tube should be drawn for Troponin or electrolyte tests?
Green top (without sodium), plasma or whole blood used
What tube should be drawn for a transfusion work up?
Purple top (EDTA tube), plasma and RBCs
What is a yellow/Gold top SPS tube used for?
Blood cultures
What are Dark blue top EDTA tubes used for?
trace elements testing
What are red top tubes used for?
Serum used - chemistry analytes
What are grey cap tubes used for?
blood sugars, legal or medical blood draws, lactic acid/lactate
Special circumstances for a hematoma
May need to draw elsewhere.
Hold pressure for longer periods of time
What to do when a patient faints?
Stop procedure and apply pressure. If they are sitting put their head between knees. Call for help,
How to draw from obese patients?
May need to do capillary (fingerstick) draw
Importance of a phlebotomist on a healthcare team.
- Represent the laboratory
- A properly collected sample is a very important part of the process of obtaining an accurate lab result test
- “humanistic care”
Correct patient and specimen identification protocol
Use two forms of identification
Serum vs plasma
Serum is the liquid that remains after the blood has clotted. Plasma is the liquid that remains when clotting is prevented with the addition of an anticoagulant
Drawing from a psychiatric patient
May have to have nurse draw the sample. Only bring supplies you need, they might take items.
Drawing from the saline lock
Check with nurse. Use other arm is possible. Must stick below I.V site.
Drawing from a patient with a mastectomy
Can’t draw on same side as mastectomy.
Drawing from a catheter.
Requires nurse.
Drawing from fistula/cannula patient
Requires nurse. Draws from dialysis machine.
What is the effect of a short collection in the following tubes:
Blue
Lavender
Blue: will decrease the blood to anticoagulant ratio.
Lavender: RBC shrinkage.
What can cause hemolysis that may occur during the capillary specimen collection process?
Milking the finger or heel
Order of the draw for syringe
Sterile (blood culture), light blue, lavender and PPT, green and PST, grey, red, SST
Drawing patients with edema
Should be avoided. Edema can contaminate or dilute the results.
Interfering substances.
Alcohol, betadine.
