Final Exam Flashcards
What is plasma?
portion of the blood without cells
What is serum?
liquid portion of blood after clotting has occurred, fibrinogen is not present
What is the primary function of the anticoagulant sodium fluoride?
acts as an antiglycolytic agent
What is the anticoagulant of choice for the hematology department?
EDTA
What does EDTA stand for?
ethylenediaminetetraacetic acid
What is the anticoagulant of choice for the coag department?
sodium citrate
What is the anticoagulant of choice for the chemistry department?
heparin
Why is freezing whole blood not normally recommended to preserve a specimen?
It will cause the RBCs to hemolyze
What are the two primary reasons patients are placed in isolation rooms?
to protect the healthcare staff, visitors, and other patients from the patient
What does EDTA prevent clotting?
prevents coagulation by binding or chelating calcium in the form of potassium or sodium salt
How does heparin prevent clotting?
inhibits the conversion of prothrombin to thrombin
What are the sites for capillary puncture on an adult?
finger, heel, and big toes
Where would you not want to perform capillary puncture?
ear lobes
What is the preferred area on a finger for puncture?
on the side of the middle or ring finger, cut perpendicular to finger print
What is a hematoma?
a bruise/blood bubble
What causes a hematoma?
needle puncture through a vein, or if the needle is not inserted fully
What happens if you push the tube onto the needle before entering the patient’s vein?
the vacuum in the tube will already be used and filled with air, so it will not pull the blood into the tube
What is the purpose of removing the tube from the needle prior to withdrawing from the patient’s vein?
to release the vacuum in the tube
What are clot activators?
initiates or enhances coagulation
What are some examples of clot activators?
glass or silica particles, siliceous earth, thromboplastin and thrombin
What color top is a blood culture bottle or tube?
yellow or yellow-black top
What color top is a sodium citrate tube?
light blue top
What color top is a non-additive tube?
red top
What color top is a SST tube?
red-gray or gold top
What color top is a sodium heparin tube?
green
What color top is a lithium heparin tube?
light green
What color top is a EDTA tube?
lavender
What color top is a ACDA or ACDB tube?
pale yellow
What color top is a oxalate/fluoride tube?
light gray
Why does order of the draw exist?
helps to avoid cross-contamination of additives between tubes
What does a sclerosed vein feel like when palpated?
feels hard and cord-like
Should a sclerosed vein be used?
no
What is edema?
excess fluid accumulation in tissues
What is an fistula?
direct communication between an artery and a vein
Why are fistulas important to consider when deciding on site selection for venipuncture?
do no apply tourniquet or blood pressure cuff to an arm contain an AV fistula, this may blow the connection. Venous access should not be performed in these areas due to risk of infection and/or damage to the fistula
What is a bevel?
slanted opening of a needle for venipuncture
What abnormalities should you look for on a bevel before venipuncture is performed?
look for spurs, bent tip, or any kind of damage
Why are therapeutic drug monitoring tests often timed collect testing?
different people’s bodies metabolized drugs at different rates to monitor the amount of the drug at certain times to maximize effectiveness and prevent toxicity
What is the correct anatomical term for the heel bone?
calcaneus
What does skin puncture blood most closely resemble?
arterial blood
Why is routine or strict isolation used?
prevent the spread of communicable disease
What protective equipment must be worn for routine or strict isolation?
gowns, masks, and/or gloves must be worn
What is protective or reverse isolation?
patients who are immunologically compromised that need to be protected from being infected
What patients is protective or reverse isolation recommended for?
recommended for burn victims, leukemia patients, patients on radiation therapy or immunosuppressant drugs
What type of PPE is used when entering a protective or reverse isolation room?
gown, mask, gloves, head and shoe boots
What does an abnormal retraction of a blood vessel wall during venipuncture cause?
vein collapse
What is the most important thing you should do before performing any type of specimen collection on a patient?
properly and positively identify the patient
What should you do if a patient refuses to let you collect a specimen on them?
tell the patient’s nurse or doctor and document it
Why should you allow the alcohol on the skin to dry properly before inserting the needle?
it will burn when it is pushed into the vein, may lyse red cells
Specimens should always be labeled where and when?
immediately after successful collection while you are still with the patient
Where would the bevel fall that it would not allow collection of a blood specimen?
if the bevel is not pointed up, if the needle has penetrated completely through the vein, if the needle went alongside the vein/did not hit the vein at all
What are some possible techniques for transferring blood from a syringe into the proper collection tubes?
transfer device, popping the top of the collection tube and putting the blood in
What is the proper puncture site on an infant’s heel for skin puncture?
lateral and medial side of plantar surface, not the arch or center of the heel
What type of specimen does a red stopper tube spun down yield?
serum and clotted red cells
How must a collection site be prepared for collecting blood cultures?
the site must be cleansed with Betadyne in a non overlapping circular motion and let air dry
The highest concentration of the drug during a dosing interval of therapeutic drug is called what?
peak
What is the procedure for a glucose tolerance test?
specimen drawn after patient has fasted overnight. patient drinks glucose solution. mark time. specimens drawn at one hour intervals from the end of the glucose solution ingestion for up to 5 hours
Does the order of draw change depending on the collection equipment you use?
no
Why should the site be warmed before performing a skin puncture?
to increase blood flow to the capillaries
Why is controlling the depth of your lancet important during skin puncture?
to avoid hitting the bone and to avoid excessive bleeding
What step must be taken when doing a skin puncture to eliminate tissue fluid contamination?
wipe the first drop of blood away with gauze
What is a possible consequence of mixing a tube too vigorously?
hemolysis
When drawing blood on a child, what extra steps should you take prior to venipuncture?
calm the patient, explain everything truthfully, gain trust, be patient, do not tell the patient that it won’t hurt
Why should a patient not pump their fist prior to venipuncture?
hemoconcentration
What is the most critical error a phlebotomist can make?
not identify the patient or not labeling the patient specimen
What indicator lets you know you are in the vein when doing a syringe draw?
a flash
What is the longest amount of time a tourniquet should be tied on a patient’s arm prior to venipuncture?
no longer than one minute
What type of alcohol prep pads are used for cleaning a puncture site?
70% isopropyl
What are some coagulation tests?
PT/PTT
What color tube are coagulation tests done in?
light blue
What is the anticoagulant used in a light blue tube?
sodium citrate
What should you do if your patient does not have an ID band on but is not conscious or able to identify themselves?
have the nurse put an ID band on the patient
Why is it so important to mix anticoagulant tubes thoroughly after filling them?
to ensure complete anticoagulation and to prevent micro clot formation
Small veins on a patient will collapse when what occurs?
too much suction, blood collected too quickly, pulling back too fast on a syringe
What indication might alert you to the possibility that you have entered an artery?
blood would be bright red, pulsing into the tube
What is the number one cause of hemoconcentration during venipuncture?
leaving a tourniquet on for too long
What is the appearance of normal serum?
clear straw or pale yellow
What is the appearance of normal plasma?
slightly opaque straw or pale yellow
What is the appearance of hemolyzed serum?
clear red
What is the appearance of icteric serum?
brownish-yellow tinge
What is the appearance of lipemia serum?
milky white
What color stopper does heparin have?
green
What color stopper does no additive have?
red
Why is it important to use Betadyne the way you do for a blood culture?
to prevent contamination of the culture with normal skin flora
