General Flashcards
What is Polycythemia Vera
is a rare type of blood cancer in which your body produces too many red blood cells.
Therapeutic phlebotomy is commonly used when patients have:
Polycythemia Vera
what is another word for phlebotomy?
venesection
How long should someone fast for lab work?
10-12 hours
where should the tourniquet be placed?
4-6 inches above the draw site
What should you use to clean the puncture site?
70% isopropyl alcohol
what is hemolysis
destruction of red blood cells
how long can a tourniquet be left on?
no longer than 1 minute
what causes hemoconcentration?
leaving the tourniquet on too long
_________ is when a competent person gives voluntary permission for a medical procedure after receiving adequate information about the risk of, methods, used and consequences of the procedure.
informed consent
_______ is permission given by the patient verbally or in writing for a procedure.
expressed consent
give two examples of implied consent
patient going to the emergency room or holding out an arm when told need to draw blood
_____ is when the patient’s actions permits the procedure without verbal or written consent
implied consent
______ is special permission needed to administer a test that detects HIV
HIV consent
______ is permission given by a parent or legal guardian that permits procedures administered to underage patients
Parental consent for Minors
how do you identify a patient?
asking first name, last name, DOB or wrist band
what is a syncopal episode?
fainting
what is PPE?
Personal protective equipment
what are mucous membranes?
eyes, nose, mouth
what is barrier protection?
protective clothing (PPE) that provides a physical barrier against infection
if latex gloves cause skin allergies in patients what should be used?
vinyl or nitrile
the most commonly used personal protective equipment includes (5):
masks goggles face shields respirators gloves
the amount of personal protective equipment you wear is directly correlated to the:
amount of exposure you anticipate
____ in the lab is a direct OSHA violation
eating
What does OSHA stand for?
Occupational Safety and Health Administration
What does OSHA do?
to ensure safe and healthful working conditions for working people by setting and enforcing standards and by providing training, outreach, education and assistance.
T/F It is ok to recap needles
FALSE Needles should never be recapped
Where should needles be disposed?
Labeled sharps containers only
sharps containers should be locked and disposed of when they are ____ full as indicated on the outside of the container
2/3
What should you do if the sharps container is overflowing?
report the violation to the supervisor
broken glassware must be picked up by
mechanical means
decontamination can be accomplished by using (2):
a solution of sodium hypochlorite (bleach) and water at a ratio of 1:10
or
lysol or some other EPA-registered tuberculocidal disinfectant
when cleaning up a spill of blood on chairs, lab tables, or hard flooring what do you do?
carefully pour the 10% solution of bleach over the blood and leave it for at least 10 min
why do you leave the 10% bleach solution on blood spills for at least 10 min?
to ensure that any blood-borne pathogens are killed
If you are exposed to blood or any other potentially infectious material you should (4):
- Wash the exposed area thoroughly with soap and running water.
- Report the exposure to your supervisor as soon as possible
- Refer to an MSDS
- Fill out an exposure report form.
If blood is splashed in the eye or mucous membrane, flush the affected area with running water for:
at least 15 minutes
what is a MSDS
material safety data sheet
what is HBV
hepatitis B
there are ____ OSHA compliance inspections each conducted for a different reason
four
what are the four OSHA compliance inspections
- Complaint inspection
- the fatality/accidents inspections
- the programmed inspection
- the imminent danger inspection
_____ inspection occurs after an employees files a formal complaint with OSHA. It is the most common type of inspection.
Complaint inspection
_____ occurs after OSHA receives notice from the employer of a workplace fatality or an accident resulting in the hospitalization of three or more employees. OSHA also takes notice of media reports and will frequently investigate accidents that do not result in any fatalities or hospitalizations
the fatality/accidents inspections
______ is an inspection conducted of a randomly chosen workplace determined to be engaged in particularly hazardous types of work according to their standard industry classification (SIC) codes
programmed inspection
______ inspection occurs when OSHA receives a report that a condition of imminent danger exists in a workplace. This is the least common inspection type.
imminent danger inspection
venipuncture
The puncture of a vein, usually to withdraw blood or inject a solution.
vein selection is based on
the size and condition of the vein
Name the three major vein located in the antecubital fossa in order of preference:
median cubital
cephalic
basilic
this vein is most commonly used for venipuncture procedures. It is large and it does not tend to move when the needle is inserted.
median cubital
This vein can be more difficult to locate, however, it is the easiest vein to palpate in an obese patient.
cephalic vein
this vein is the least firmly anchored and located near the brachial artery. if the needle is inserted too deep you risk puncturing the brachial artery or a nerve
basilic vein
laboratory requisition
an order form that specifies what tests are being requested
accession number
a unique tracking number different for each sample
what is the solution that is becoming more commonly used as the primary antiseptic
chloraprep
what is the purpose of a tourniquet?
slows the venous outflow of blood from the arm causing the vein to bulge thereby making hem easier to locate
hemoconcentration
increased concentration of cells and solids in the blood usually resulting from loss of fluid to the tissues
tubes with additives must be _____ the appropriate amount of times in order to ensure proper mixing of blood and additive.
inverted
the _____ of a needle refers to the diameter or thickness of the needle
gauge
the lower the number of the gauge the ____ the needle,
larger
the larger the number of the gauge the ____ the needle
smaller/thinner
___ gauge is the larger/thicker bore and ___ gauge is small/thin
16, 23
needles smaller than ____ gauge are not recommended for drawing blood because they cause hemolysis.
23 gauge
needles smaller than 23 are not recommended for drawing blood because they cause ____.
hemolysis: the rupturing (lysis) of red blood cells (erythrocytes) and the release of their contents (cytoplasm) into surrounding fluid (e.g. blood plasma)
common needle size used for venipuncture is:
21 gauge
another name for “butterfly needle”
winged infusion set
Reasons to use a butterfly needle: (3)
- venipuncture on small veins such as those in the hand
- venipuncture procedures on elderly or pediatric patients
- needle phobic
entry with the butterfly should be at:
5 degrees
another name for needle disposal container
sharps container
When is it okay to recap a needle
never recap a needle whether it has a safety or not
true or false. It is necessary to disclose your level of experience to your patients
false
It is unnecessary to disclose your level of experience to your patients
true or false, if you have gloves on you do not have to wash your hands
false, always wash your hands
The patient should not pump their fist vigorously because:
it can affect some lab values such as potassium
Where do you place your thumb to anchor the vein?
place your thumb below the antecubital area slightly pulling the skin back
True or false, use a C shape to anchor your finger above the needle
FALSE never put your finger ahead of the needle
what direction should the bevel face?
facing up
insert the needle at a ____ angle when using a vac tube
15-30 degree
what does CLSI stand for?
Clinical and Laboratory Standards Institute
_____ guidelines state that the tourniquet should be removed as soon as blood flow is established rather that waiting until the last tube is filled.
CLSI
what is the proper way to dispose of a needle?
activate the needle and put it into a biohazard sharps container right away
What four things go on the specimen label?
patient full name, number identifier such as a DOB
date
time of collection
initials
what do you do if a specimen has been collected from the wrong patient?
immediately report the incident to the supervisor
the proper steps to end a blood draw (5)
remove the tourniquet remove the tube place gauze/cotton the site remove the needle activate the safety
name 5 factors that can influence a tough draw
hard to find veins scarred and sclerosed veins unconscious patient rolling collapsing veins quantity not sufficient
how do you help a needle phobic person (4)
use smaller needle
lay them down
conceal the needle and limit extended observation
cover tube filled with blood
Where are draws done on children under 2 years of age?
median cubital vein
how many attempts does a phlebotomist have to draw blood on a patient?
2
where do you draw in relation to an IV
below the IV
What is an edema?
an accumulation of fluid in the tissues
if your patient has had a mastectomy, where should you draw from?
avoid drawing from the associated arm (left mastectomy, no draws from left arm)
in case of double mastectomy draw blood from the foot if possible or consult the patient’s nurse or physician
what is a fistula
a permanent surgical connection between an artery and a vein
True or false: It is ok to use a fistula to draw blood?
FALSE
What is a tortuous vein
winding or crooked vein and are susceptible to infection because blood flow is impaired. The sample may produce erroneous results.
what is the most common complication from phlebotomy?
hematoma: caused when the bevel of a needle is not completely in the vein and some blood releases into the tissue under the skin
what is the first thing you do if the patient faints?
remove the needle
what is vasovagal syncope
faint or experience dizziness before, during, or after venipuncture
true or false: when someone is experiencing vasovagal syncope you should put their head between their knees
FALSE. Never put their head between their knees as they can fall over and hit their head
what is a capillary?
a microscopic blood vessel
true or false: with a capillary collection always wipe away the first drop of blood with gauze
TRUE
where do you do a heel stick?
medial and lateral portions of the plantar surface of the foot
The American Academy of pediatrics recommends that heel puncture not exceed ___ mm for infants and ___mm for premies
2.0mm and 0.85mm
In a dermal puncture always ___ and never puncture deeper than ___ in an adult.
always wipe away the first drop of blood
never puncture deeper than 3.0mm in adult.
____ is a common test done on babies via heel stick
billirubin
When collecting bilirubin minimize exposure to light by:
collect in an amber tube
clear tube must be immediately protected from light by wrapping in foil or in a dark bag
what is hemostasis?
process by which blood vessels are repaired after injury
how many stages in hemostasis?
4
What are the four phases of hemostasis?
Vascular Phase
Platelet Phase
Coagulation Phase
Fibrinolysis
Which phase of hemostasis: injury to a blood vessel causes it to constrict, slowing the flow of blood.
Vascular Phase
Which phase of hemostasis: injury to the endothelial lining causes platelets to adhere to it. additional platelets stick to the site forming a temporary platelet plug in a process called “aggregation”
Platelet Phase
What are the two primary stages of hemostasis?
Platelet Phase
Vascular Phase
What test is used to evaluate the primary stages of hemostasis and when is it done?
Bleeding time test (BTT)
Performed prior to surgery
Which phase of hemostasis: this involves a cascade of interactions between coagulation factors that converts the temporary platelet plug to a stable fibrin clot.
Coagulation Phase
Which phase of hemostasis: the breakdown and removal of the clot.
Fibrinolysis
As tissue repair begins ____ (an enzyme) starts braking down the fibrin clot.
pepsin
plasmin
pepsinogen
plastin
plasmin
What are FDPs?
fibrin degradation products
what are fibrin degradation products used to monitor?
rate of fibrinolysis
Prothrombin time test (PT/INR) is used to evaluate the _____ pathway.
extrinsic
what does PT/INR stand for?
Prothrombin time/international normalized ratio
what does INR stand for?
international normalized ratio
What does PTT stand for?
Partial Thromboplastin Time
PTT is used to evaluate the _____ pathway.
intrinsic
What tube is used for the PTT or PT test? How much should it be filled?
light blue
completely filled
blood vessels, blood platelets and the coagulation factors all must be in working order for ____ to occur.
hemostasis
What is a device used in point of care testing (POCT) regarding PT/INR?
hemochron signature elite
what does POCT stand for?
Point of Care Testing
True or false the Hemochron Signature Elite is the industry standard for comprehensive point of care coagulation monitoring system
FALSE
practitioners may use an alternative
What is the basal state?
fasting, nothing by mouth and refrain from strenuous exercise for 8-12 hours prior to the blood draw.
Is water ok when basal state is required?
yes
whose responsibility is it to verify that the patient has followed the test guidelines?
the phlebotomist
what is post prandial?
after meal
What state should the patient be in and what tube is used for a lipid panel?
fasting state
SST tube
What step do you need to take if your facility allows patients to do a lipid panel unfasted?
mark on the tube that they were not fasting
the following are examples of what?
- to measure blood levels of substances exhibiting dinural variation
- to monitor changes in patients condition
- to determine levels of medication in the bloodstream, therapeutic drug monitoring
timed specimens
What tube is required for testing digoxin?
red
What is digoxin?
a drug for cardiovascular disease
Blood is drawn to coincide with the ____ (lowest chemical blood level) and/or ____ (highest chemical blood level.
trough
peak
when are trough levels collected?
15 min before the scheduled pharmaceutical dose.
In therapeutic drug monitoring, it is essential for the lab to know what?
the time of the last dose when collecting blood
Regarding warmed specimens, how long must the tube be pre-warmed?
30 min
What methods are used to pre-warm tubes for warmed specimens?
incubator or chemical hand warmer
some tests require that the specimens be kept warm until:
the serum is separated from the cells
____ _____ are antibodies produced in response to mycoplasma pneumonia infection (atypical pneumonia).
cold agglutinins
Cold agglutinins must be collected in ___ tubes, pre-warmed in the incubator at ____ degrees for ___ minutes.
red-topped
37 degrees celsius
30 minutes
What is the proper way to chill a specimen?
slurry of crushed ice water
What is a common test that needs to be chilled and is drawn in a dark green tube?
ammonia
Wrap ____ specimens in aluminum foil immediately after the specimen is drawn. If available transport these samples in an ____ ____.
light-sensitive
amber bag
with stasis means:
with a tourniquet
without stasis means:
without a tourniquet
a lactic acid blood test must be drawn _____ stasis
without
True or False: a without stasis test can use a tourniquet to find a vein.
FALSE no tourniquet can be used.
Name three specimens that require chilling
ammonia lactic acid arterial blood gas (ABG) Gastrin glucagon parathyroid hormone Partial thromboplastin time prothrombin time
The following tests require what special handeling? ammonia lactic acid arterial blood gas (AGB) Gastrin glucagon parathyroid hormone Partial thromboplastin time prothrombin time
chilling
Name three specimens that require warm collection and transportation.
cryoglobulin
cryofibrinogen
cold agglutinin
name three specimens that require protection from light
bilirubin Vitamin B12 Vitamin B6 urine porphyrins carotene red cell folate serum folate
name one specimen that requires a draw without stasis
lactic acid
True or false: some samples can be placed on dry ice
FALSE, never place samples on dry ice
__ __ is define as the skills and procedures prior to a specimen being analyzed.
pre- analytical phase
what is the most critical error a phlebotomist can make?
improperly identifying the patient prior to sample collection
what does OGTT stand for
oral glucose tolerance test
what hour windows are used for the OGTT?
1hr, 2hr, 3hr, 5hr
What is OGTT used to diagnose? (2)
diabetes mellitus and gestational diabetes
How much time dose a patient have to consume the glucola drink prior to a OGTT?
5 min
When is the first draw taken for OGTT?
before consuming the glucola
What is the first OGTT blood draw called?
basline test
a 3-hour OGTT will have how many blood draws?
4
a 5 hour OGTT will have how many blood draws?
6
for a OGTT how long should a patient fast prior to collection?
10-12 hours
__ ___ are ordered to detect the presence of microorganisms in the patient’s blood
blood cultures
what does FUO stand for?
fever of unknown origin
_____ is a systemic infection associated with the presence of pathogenic organisms introduced during venipuncture. It is a bacterial infection spread through the entire vascular system of the body.
Septicemia
blood cultures are usually ordered
STAT Warm Chilled Light protected Timed specimen
STAT or Timed specimen
what does aseptic mean?
preventing infection
Blood cultures requires strict aseptic technique. This is done using ____
Chloraprep or its generic equivalent - chlorhexidine gluconate
Improper skin preparation for blood cultures is the most common cause of _____ when drawing blood cultures.
contamination
___ ___ are usually ordered in multiple sets from multiple sites at various times.
blood cultures
1 blood culture consists of ___ ___ bottles, ___ and ___
2 bottles anaerobic, 2 bottles aerobic
what does aerobic mean?
with oxygen
what does anaerobic mean?
without oxygen
when do coritosl levels peak?
around 8am
___ ____ are the daily cyclic variations of levels within the body during a 24-hour period
dinural variations
cortisol blood tests will be ordered and drawn between ____ and ____
8 and 10am
and midnight
what is PKU
phenylketonuria
PKU testing is done on blood from where on a newborn?
Or with what other kind of test?
heel (medial or lateral plantar surface)
urine
who usually draws a arterial blood gas test?
a respiratory therapist, nurse, or physician
a ABG sample must be run with in ____ of collection
15 min
what are the 4 primary tests performed on arterial samples?
pH, carbon dioxide, oxygen and bicaronate
When drawing an ABG it is imperative that nothing else takes place between the ____ and the ____.
collection
testing
____ is the liquid portion of un-clotted blood and still contains the clotting factors
plasma
____ is the liquid portion of the blood that has been allowed to clot.
serum
are there clotting factors present in serum?
no they have been allowed to clot
name the tubes with anticoagulants
lavender, green, pink royal blue with light blue stripe, light blue, and gray
lavender, green, pink royal blue with lt. blue stripe, light blue, and gray tubes will produce ____ when separated in a centrifuge
plasma
red, tiger top, gold tubes, speckled tubes and royal blue with a red stipe tubes will produce ___ when separated in a centrifuge.
serum
name the tubes without anticoagulants (3)
red, tiger top, and royal blue with a red stipe tubes
collecting specimens in the incorrect order of draw can result in
cross contamination
who has defined the order of draw to minimize cross-contamination?
CLSI, clinical laboratory standards institute
what tubes is chemistry responsible for? (5)
red tiger top mint green dark green gray
What tests can be done with a red tube top? (3)
serum pregnancy
digoxin
cold agglutinins
What causes a hematoma in regards to phlebotomy?
when the bevel of a needle is not completely in the vein and some blood releases into the tissue under the skin
The following tests require what special handling?
ammonia lactic acid arterial blood gas (AGB) Gastrin glucagon parathyroid hormone Partial thromboplastin time prothrombin time
Chilling
Protection from light
Warm collection
Without stasis
Chilling
The following tests require what special handling?
cryoglobulin
cryofibrinogen
cold agglutinin
warm collection, 37 degrees C for 30 min
The following tests require what special handling?
bilirubin Vitamin B12 Vitamin B6 urine porphyrins carotene red cell folate serum folate
Chilling
Protection from light
Warm collection
Without stasis
Protection from light
Lactic acid specimens require what special handling?
Chilling
Protection from light
Warm collection
Without stasis
Without stasis
