Hema 1 Part 1 Flashcards by E A

Blood is ____________________ of the body weight

7.8%

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Total blood volume of adult:
Male: _____________ Female: _____________

Male: 5-7 L Female: 4-6L

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Composition of blood:
___________ = Formed elements (cells)
__________ = Fluid portion

45% = Formed elements (cells)
55% = Fluid portion

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___________ = fluid portion of unclotted or anticoagulated blood; contains __________

Plasma, Fibrinogen

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__________ = fluid portion of clotted blood

Serum

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Plasma is made up of _____________ water and _____________ solutes

90% water
10% solutes

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Skin Puncture
▪ Used for the following types of patients:
o Infants less than ______ of age

6 months

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Skin Puncture
▪ Used for the following types of patients:
when veins cannot be used because of__________

IV infusions

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Skin Puncture
▪ Used for the following types of patients:

o Infants less than 6 months of age
o Young children if only small amount of blood is needed
o Adults with poor veins
o when veins cannot be used because of IV infusions
o extreme obesity
o thrombotic tendencies
o point-of-care testing or with patients performing tests at home

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Sites of Skin puncture
o Infants less than______ of age

1 year

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Sites of Skin puncture
o Infants less than 1 year of age
•______ portion of the plantar surface of the foot

medial or lateral

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Sites of Skin puncture
o Infants less than 1 year of age
• depth of the puncture should not be more than __________

2.0 mm

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Sites of Skin puncture for Patients older than one year

Second, third or fourth finger (middle finger is the most commonly used

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Sites of Skin puncture for Patients older than one year:
Puncture should be______ to the fingerprint, on the______ of the end portion of the finger, slightly off-center

perpendicular; palmar surface

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Skin puncture site should be warmed at approximately __________

42 degrees

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______ should be filled first followed by any other anticoagulant during blood collection

EDTA

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Tournique should be approximately ________________ long and _________ wide

18-20 inch long and 1 inch wide

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Tourniquet should be placed approximately ______________________ away from the
puncture site

3-4 inches

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Tourniquet should not be left for more than _______ minute

1 min

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If greater than one minute has elapsed, tourniquet should be removed and reapplied after ___________have elapsed

2 mins

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Gauge number of the needle is ___________ proportional to the inside diameter of the needle (bore size)

Inversely

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The higher the gauge number, the ____________ the diameter of the needle is.
The lower the gauge number, the ____________ the diameter of the needle is.

The higher the gauge number, the SMALLER the diameter of the needle is.
The lower the gauge number, the BIGGER the diameter of the needle is.

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Gauge number found in needles attached to blood
bags: ___________

16 gauge

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Most commonly used gauge number for routine
venipuncture: _______

21 gauge

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Gauge number preferred for adult venipuncture: __________________

19,20,21,22 (23 not routinely used)

Length of needle used for routine venipuncture: _______________

1.0-1.5 inches

Pink needle hub

Brown/ivory needle hub

Yellow needle hub

20 G

Green needle hub

21 G

Black needle hub

22 G

Blue-green/ Blue needle hub

23 G

Red tube

Non-additive

Light blue tube

Sodium citrate

Gray tube

Sodium fluoride/Potassium oxalate

Green tube

Lithium or Sodium heparin

Yellow tube

SPS, Acid Citrate Dextrose (ACD)

Black tube

Sodium Citrate

Order of Draw for Evacuated Tubes and Syringe (Henry 22nd ed)

Blood culture tubes Citrate Serum Heparin EDTA Sodium Flouride

Order of draw for skin puncture

Blood gases Slide/ smear EDTA Other additive tubes Serum tubes

Antiseptics used to clean the venipuncture site: ______________________

70% isopropyl alcohol

Antiseptics used to clean the venipuncture site: ______________________

70% isopropyl alcohol

Angle of the needle to the skin during venipuncture: _____________

15-30 degree

Degrees of- Brachial Arterial Puncture: Femoral Arterial Puncture:

Brachial: 45-60 Femoral: 90

Patients with IV lines: IV line should be stopped for _____________ ________mL of blood should be collected and discarded

2 mins, 5 mL

Gentle inversions ______________

Atleast 8-10 times

A technologist or a student should not stick a patient more than _____times

Complications of Phlebotomy

Ecchymosis (bruise) Hematoma Syncope (fainting) Hyperventilation Edema Thrombophlebitis

1. EDTA (ethylenediaminetetraacetic acid) ▪ Most commonly used EDTA: _________________________________

Potassium

Spray-dried EDTA: _______________ Liquid EDTA: ____________________

K2, K3

EDTA (ethylenediaminetetraacetic acid) Inhibits coagulation by _______________________

Chelsting calcium ions

Concentration of EDTA: ______________________

1.5 mg/mL of blood

Proper concentration of EDTA should be maintained: Excess EDTA causes: _________________________

RBC shrinkage

Excess EDTA causes RBC shrinkage: Hct becomes falsely _______________ ESR becomes falsely ______________

Both decrease

EDTA Preserves morphology of blood if used within ___________

2 hrs

It contains Acid mucopolysaccharide (mucoitin polysulfuric acid)

Heparin

Heparin Found as a naturally occurring anticoagulant produced by the _________

Liver

Heparin Acts by inhibiting _________________Acts together with a cofactor ______________

Inhibit thrombin Cofactor anti thrombin III

Heparin Concentration: _____________________ Used for _____________

15-200 mL for EOFT

Not used for blood film preparation because it causes blue coloration of the background of blood films stained with Romanowsky stain

Heparin

Sodium Citrate ▪ Anticoagulant of choice for _______________________

Coagulation studies

Sodium Citrate Inhibits calcium by forming ______________________

Soluble complexes

In sodium citrate Potassium oxalate inhibits calcium by forming _________________________

Insoluble complex

Light blue sodium citrate concentration

3.2%

Light blue sodium citrate concentration

3.2%

Black sodium citrate concentration

3.8%

Sodium citrate Anticoagulant to Blood Ratio in light blue

1:9

Sodium citrate Anticoagulant to Blood Ratio in black

1:4

Light blue sodium citrate is for

Coagulation studies

Black sodium citrate is for

Erythrocyte Sedimentation Rate (ESR) (Original Westergren)

Tube should be completely filled, underfilled tubes leads to falsely prolonged

PT and PTT

Sodium citrate is used if patient’s hematocrit does not exceed

0.55L/L

In patients with ______sodium citrate must be reduced

polycythemia vera (PV, Hct > 0.55L/L),

In patients with PV, PT and Aptt are falsely

prolonged

ERRORS IN VENIPUNCTURE PREPARATION (BEFORE PROCEDURE)

• Improper patient identification • Failure to check patient adherence to dietary restrictions (Ex. Fasting) • Failure to calm patient prior to blood collection • Use of improper equipment and supplies • Inappropriate method of collection

ERRORS IN VENIPUNCTURE PROCEDURE (DURING PROCEDURE)

• Failure to dry the site completely after cleansing with alcohol • Inserting the needle bevel side down • Use of needle that is too small, causing hemolysis of the specimen • Venipuncture in an unacceptable area • Prolonged tourniquet application • Wrong order of tube draw • Failure to mix blood collected in additive-containing tubes immediately • Pulling back on syringe plunger too forcefully • Failure to release tourniquet prior to needle withdrawal

ERRORS AFTER VENIPUNCTURE COMPLETION (AFTER PROCEDURE)

• Failure to apply pressure immediately to venipuncture site • Vigorous shaking of anticoagulated blood specimen • Forcing blood through a syringe needle into tube • Mislabeling of tubes • Failure to label appropriate specimens with infectious disease precaution • Failure to put date, time, and initials on requisition • Slow transport of specimens to laboratory