LEC MIDTERM Flashcards
•Patients who have their blood drawn while in a
seated position
PHLEBOTOMY CHAIRS
•Most have adjustable arm rests to allow proper
positioning
PHLEBOTOMY CHAIRS
•Hold all necessary equipment for proper
sample collection.
HANDHELD CARRIERS
•In variety of styles and sizes designed to be easily
carried by the phlebotomist
HANDHELD CARRIERS
•Convenient for STAT or emergency, situations or
when relatively few patients need blood work
HANDHELD CARRIERS
•Made of stainless steel or synthetic material,
usually with swivel wheels that allows smooth
gliding
PHLEBOTOMY CARTS
•Has several shelves to carry adequate supplies
PHLEBOTOMY CARTS
Used to clean the site prior to blood collection
ANTISEPTICSh
•Prevent or inhibit the growth and development of
microorganisms but do not necessarily kill
them
ANTISEPTICS
•Considered safe to use on human skin
ANTISEPTICS
Used to remove or kill microorganisms on surfaces
and instruments.
DISINFECTANTS
•Stronger, more toxic, and typically more corrosive
than antiseptics and are not safe to use on human
skin
DISINFECTANTS
•At least _____ of contact time is required
for bleach-based
10 minutes
as a substitute for
handwashing
HAND SANITIZERS
hand sanitizer
•Should not be used when hands are visibly soiled
used to hold pressure over the site following
blood collection procedures
GAUZE PADS & COTTON
are used to cover a blood collection
site after the bleeding has stopped
•Bandages
are used to make blood films for
hematology determinations either plain or with a
frosted area at one end where the patient’s name
or other information
Precleaned 25 x 75-mm (1 x 3-in) glass
microscope slides
•can be written in pencil
•LABELING materials like pen with permanent,
non-smear ink is also needed
slides
Used needles, lancets, and other sharp objects
must be disposed of immediately in special
containers.
NEEDLE AND SHARPS DISPOSAL CONTAINERS
• Most are red for easy identification
• Must be marked with biohazard symbol
NEEDLE AND SHARPS DISPOSAL CONTAINERS
Needle and Sharps Disposal Containers Characteristics:
-Rigid
-Puncture resistant
-Leakproof
-Disposable
-Locking lids
•Leakproof plastic bags that are commonly used to
transport blood and other specimens
• Marked with a biohazard label
• Has an outside pocket where requisitions can be
placed.
BIOHAZARD BAGS
•Tend to be expensive
•Utilizes transillumination to make it easier to
locate veins that are difficult to see or feel
VEIN-LOCATING DEVICES
VEIN-LOCATING DEVICES ______ through the patient’s skin to highlight veins
shine high-intensity LED or infrared red light
the _____ in the blood within the veins
absorbs the light, causing the veins to stand out as
dark lines
hemoglobin
Applied or tied around a patient’s arm prior to
venipuncture
TOURNIQUET
tourniquet ______ veins to restrict blood flow
compresses
Restriction of venous flow _______ the
veins, making them larger and easier to find
distends or inflates
•Restriction of blood flow can change blood
components if the tourniquet is left in place for
more than 1 minute
Tourniquet Approx.
1 inch wide by 15-18 inches long
tourniquet commonly used
Flat strip type
Should be non-latex to prevent latex allergy
tourniquet
tourniquet must be applied _____ above the puncture site
3-4 inches
Pumping of hands can result to
eleveated potassium levels
•Prolonged tourniquet causes
hemoconcentration
Sterile, disposable, and designed for a single use
only
needles
type of needles
• Multisample needles (ETS)
• Hypodermic needles (Syringe System)
Winged infusion (butterfly)
-End that pierces the vein
-Allows needle to easily slip into the skin and vein
w/o coring
Bevel
Long cylindrical portion
Shaft
End that attaches to the blood collection device
Hub
Internal space of the needle
Lumen
Indicated by a number that is related to the
diameter of the lumen
GAUGE
• Inversely proportional to the needle’s
diameter
Gauge
the higher the gauge number
the smaller the diameter of the needle
selected accordingly to the size
and condition of px’s vein
Needle gauge
standard and most routine
21-gauge
most needles come in (length)
1 or 1.5 in
butterfly needles length
0.5-0.75 in | 1/2 to 3/4 inch long
-Provide immediate permanent needle
containment
-Activated using one hand
-Resheathing devices, blunting devices,
retractable needles
NEEDLE SAFETY FEATURES
shields that cover the needle after use and are devices that retract the needle after use
Resheathing Devices
-alternative for patients with small or difficult veins.
SYRINGE SYSTEM
SYRINGE SYSTEM Consist of a
(1) hypodermic needle, (2) sterile
plastic syringe with a Luer-lock tip
-Used for collecting blood from small or difficult
veins such as hand veins and veins of elderly and
pediatric patients
INFUSION SETS
-Allow much more flexibility and precision
INFUSION SETS
-Most sets have removable Luer adapters that
allow them to be used with either ETS holders or
syringes
INFUSION SETS
commonly referred as
butterfly, which contains plastic extensions that
resemble butterfly wings
-WINGED INFUSION SET
Most common, efficient, and CLSI-preferred
system for collecting blood samples
EVACUATED TUBE SYSTEM
System allows numerous tubes to be collected
with a single venipuncture
EVACUATED TUBE SYSTEM
Allows multiple tubes of blood to be collected
during a single venipuncture
MULTISAMPLE NEEDLES
Threaded in the middle and have a beveled point
on each end
MULTISAMPLE NEEDLES
•Threaded portion screws into a tube holder
• Covered by a sleeve that retracts as the needle
goes through the tube stopper
MULTISAMPLE NEEDLES
•Clear, plastic, disposable cylinder with a small
threaded opening at one end
TUBE HOLDERS
Attaches to the needle and holds the tube for ETS
Needle and tube-holder devices are available
permanently attached as a single unit or as both
devices preassembled.
TUBE HOLDERS
Collection tubes for obtaining blood.
EVACUATED TUBES
• Allows automatic filling of blood due to the
negative pressure
• Amount of vacuum is measured precisely by
manufacturer
• Able to draw exact volume of blood indicated on
the label
• Tube that has prematurely lost all or part of its
vacuum will fail to properly fill blood
VACUUM
CAUSES OF PREMATURE LOSS OF VACUUM:
• Improper storage
• Opening the tube
• Dropping the tube
• Advancing the tube too far onto the needle before
puncture
• Bevel becomes partially out of the skin during
puncture
a result of premature loss of
vacuum resulting to under-filled tube.
“SHORT DRAW”
• Any substance placed within a tube
ADDITIVE TUBES
ADDITIVE TUBES
• Have one or more specific functions:
a. Preventing clotting
b. Preserving blood components
c. Clot activator
Additive amount is
pre-calibrated
Commonly used for clearing and
discarding purposes
NON-ADDITIVE TUBES
Yield serum samples
NON-ADDITIVE TUBES
NON-ADDITIVE TUBES Examples
Vacuette® gray top, BD clear top
Tube caps, tops, or closures are made of a type
of rubber
• Some are covered by a plastic shield
STOPPERS
STOPPERS are designed to
• Prevent blood drops
• Prevent aerosols (mists)
• Prevent blood on the stopper or rim
• Prevents removal of stopper using a
“thumb-roll” or “pop-off”
• Identifies the type of additive placed in tube
• Indicates a special property of the tube
COLOR CODING
is generally universal, although
there might be a slight variation by the
manufacturer
Color coding
Guarantee reliability of additives and tube vacuum
until an
expiration date
• Liquid, spray-dried, and powder forms
BLOOD COLLECTION ADDITIVES
should be lightly tapped
prior to use
Powdered additive
Must be inverted upon addition of blood
sample
• Number of inversions are dependent on type of
additive and manufacturer
BLOOD COLLECTION ADDITIVES
Never shake or otherwise vigorously mix a
specimen as this can cause
hemolysis
Substances that prevent blood from clotting
(coagulating)
ANTICOAGULANTS
(anticoagulants) Must be mixed immediately after collection to prevent
microclot formation
3.2% Sodium Citrate
citrate
used for coagulation test (ex PT, aPTT)
Sodium Citrate
citrate has a ration of
9:1 ratio of blood to anticoagulant
used for Erythrocyte
Sodium Citrate
• Principle: prevent coagulation by binding (or
chelating) calcium
• Sample: Whole-blood
Require immediate mixing after collection to
prevent activation of coagulation process
Sedimentation Rate (ESR)
Vigorous mixing or excessive number of
inversions can
activate platelets
sodium citrate (Na citrate)
forms calcium salts to remove calcium
Coagulation tests (PT,PTT,TCT), tube must. be filled 100%
light blue top
Sodium citrate (buffered)
form calcium salts to remove calcium
westergren sedimentation rate; requires a full draw
Black top
Green-top tubes
Green-top and light green-top gel tubes
heparin
Red-banded and green-banded
microhematocrit
tubes
Plasma separating tube (Na Heparin)
Anticoagulants with lithium heparin: plasma is separated with PST gel at the bottom of the tube
-Chemestries
Light green top
sodium heparin or lithium heparin
inactivates thrombin and thromboplastin
dark green top
most widely used
Added to tubes w/ antiglycolytic
agents
Potassium oxalate
•Principle: remove calcium and prevent clotting by
binding and precipitating calcium in the form of an
insoluble salt
• Sample: Whole-blood
oxalate
Substance that prevents glycolysis (breakdown
/metabolism of glucose)
ANTIGLYCOLYTIC AGENTS
Glucose can have a decrease rate of
10mg/dL per
hour
most common antiglycolytic agent
- not an anticoagulant
Utilized to collect ethanol specimens to prevent
either a decrease in alcohol concentration due to
glycolysis, or an increase due to fermentation by
bacteria.
sodium fluoride
immunohematology, paternity tests, transplant
compatibility
Acid Citrate Dextrose (ACD)
for blood transfusion
Citrate Phosphate Dextrose (CPD)
phosphate stabilizes
pH
provides cells with energy
Dextrose
• for blood culture
• reduces the action of a protein called complement • slows down phagocytosis
• reduces the activity of certain antibiotics
Sodium Polyanethol Sulfonate (SPS)
substance that enhances coagulation in tubes
-Include substances that provide surface for
platelet activation
CLOT ACTIVATORS
CLOT ACTIVATORS
- Glass (silica)
- clot activators in SSTs (serum-separator tubes)
- Plastic red top
Thrombin
•provide a physical barrier between the serum or
plasma in the tube and the cells
Serum or Plasma Separator Tubes
•prevents the cells from continuing to metabolize
substances such as glucose in the serum or
plasma
Serum or Plasma Separator Tubes
-inert (nonreacting) synthetic substance
Thixotropic Gel Separator
-density of the gel is between that of the cells and
the serum or plasma
Thixotropic Gel Separator
made of materials that are as free of trace element
contamination as possible
Trace Element-Free Tubes
refers to the order in which tubes are collected during a multiple tube ETS draw
order of draw
intended to prevent contamination of blood specimens by carryover of additives that can interfere with some tests
order of draw
The antiseptic most commonly used for routine blood collection is
isopropyl alcohol (isopropanol)
For a higher degree of antisepsis, the traditional antiseptic has been ______ in the form of swab sticks or sponge pads for blood culture collection
For a higher degree of antisepsis, the traditional antiseptic has been povidone-iodine in the form of swab sticks or sponge pads for blood culture collection
is recommended for decontaminating nonporous surfaces after cleaning up blood or other body fluid spills in patient care settings.
1:100
When spills involve large amounts of blood or other body fluids or occur in the laboratory, a ______dilution is applied prior to cleanup.
1:10
At least ______ of contact time is required for bleach-based and some other disinfectants to be effective.
10 minutes
Fresh bleach solutions should be made
daily
should not be used on babies
younger than two years of age because of the danger of aspiration and suffocation.
adhesive bandages
Evacuated tubes are available from a number of different manufacturers and come in various sizes and volumes ranging from
1.8 to 15 mL
Tube selection is based on the
age of the patient, the amount of blood needed for the test, and the size and condition
Tube additives have one or more specific functions, such as
preventing clotting or preserving certain blood components.
If the additive prevents clotting, the result is
whole-blood specimen
nonadditive plastic tubes (Fig. 7-20) available are used for
clearing or discarding purposes
yield serum sample
nonadditive tubes
used as a clear or discard tube.
Nonadditive tubes
If a test requires whole blood or plasma, the specimen must be collected in a tube that contains an
anticoagulant
Gentle mixing is essential to prevent
hemolysis
The most common anticoagulants are
ethylenediaminetetraacetic acid, citrates, heparin, and oxalates.
are preferable due to
their high solubility (ability to dissolve)
salts
can cause a dilution of the blood.
Liquid EDTA
EDTA additive inversion
8-10
are detected in a hematology specimen, it cannot be used for testing and must be recollected
microclot
preferred for most hematology tests because liquid EDTA dilutes the specimen and results in lower hemoglobin values, red blood cell (RBC) and white blood cell (WBC) counts, platelet counts, and packed-cell volumes.
Spray-dried EDTA
which is used for coagulation tests (e.g., PT and aPTT) because it does the best job of preserving the coagulation factors
sodium citrate
Sodium citrate tubes have color
light- blue stoppers
is also the additive in special erythrocyte sedimentation rate (ESR) tubes with black stoppers.
sodium citrate
Vigorous mixing or an excessive number of inversions
activate platelets and shorten clotting times.
prevents clotting by inhibiting thrombin
heparin
an enzyme needed to convert fibrinogen into the fibrin necessary for clot formation)
thrombin
has traditionally been used for some chemistry tests (e.g., ammonia and plasma hemoglobin). It is now commonly used for STAT tests (e.g., electrolytes) and in other rapid-response situations when a fast turnaround time (TAT) for chemistry tests is needed.
heparinized plasma
is preferred over serum for potassium tests because when blood clots, potassium is released from the cells into the serum which falsely elevates test results.
heparinized plasma
Heparin is the additive in:
Green-top tubes
• Green-top and light green-top gel tubes (see Fig. 7-18)
• Mottled green and gray-top tubes
• Royal blue-top tubes with green color coding on the label
• Green-top and light green-top microtubes
• Red-banded and green-banded microhematocrit tubes
EDTA is the additive in:
Lavender (or purple)-top tubes (see Fig. 7-18).
• Microcollection containers with lavender tops.
• Pink plastic-top tubes with a special blood bank patient ID label.
• Royal blue-top tubes with lavender color coding on the label.
• Tan-top tubes used for lead analysis.
• White/pearl-top tubes with thixotropic gel separator.
There are three heparin formulations:
ammonium, lithium, and sodium heparin
causes the least interference in chemistry testing and is the most widely used anticoagulant for both
plasma and whole-blood chemistry tests.
Lithium Heparin
heparin inversion
5-10
remove calcium and prevent clotting by binding and precipitating calcium in the form of an insoluble salt
oxalate
oxalate inversion
8-10
destruction of red blood cells)
hemolysis
acts as an RBC nutrient and preservative by maintaining RBC viability
Dextrose
have yellow tops and require eight inversions immediately after collection to prevent clotting.
ACD tubes
used in collecting units of blood for transfusion. Citrate prevents clotting by chelating calcium, phosphate stabilizes pH, and dextrose provides cells with energy and helps keep them alive.
Citrate phosphate dextrose (CPD)
prevents coagulation by binding calcium. It is used for blood culture collection because in addition to being an anticoagulant, it reduces the action of a protein called complement that destroys bacteria.
Sodium polyanethol sulfonate (SPS)
ingestion of bacteria by leukocytes
phagocytosis
It also slows down phagocytosis (ingestion of bacteria by leukocytes) and reduces the activity of certain antibiotics
Sodium Polyanethol Sulfonate
have yellow stoppers and require eight inversions to prevent clotting.
sps tube
are the clot activators in serum-separator tubes (SSTs) and plastic red-top tubes
Silica particles
Blood collected in ______ such as the BD orange stopper Rapid Serum TubeTM (RST) (Fig. 7-32) normally clots within five minutes.
Blood collected in thrombin tubes such as the BD orange stopper Rapid Serum TubeTM (RST) (Fig. 7-32) normally clots within five minutes.
Minimizes chance of microbial contamination
blood culture
The first additive tube in the order because all other additive tubes affect _____ tests
Coagulation tubes
Prevents contamination by additives in other tubes
Glass nonadditive tubes
Filled after coagulation tests because silica particles activate clotting and affect coagulation tests (carryover of silica into subsequent tubes can be overridden by anticoagulant in them)
Plastic clot activator tubes
Serum-separator tubes (SSTs) colors
Red and gray rubber Gold plastic
affects coagulation tests and interferes in collection of serum specimens; it causes the least interference in tests other than coagulation tests
Heparin tubes with gel/plasma-separator tubes (PSTs)
Heparin tubes
Responsible for more carryover problems than any other additive: Elevates Na and K levels, chelates and decreases calcium and iron levels, elevates PT and PTT results
EDTA tubes
EDTA tubes with gel/plasma- preparation (PPTs)
affect sodium and potassium levels, respectively. Filled after hematology tubes because oxalate damages cell membranes and causes abnormal RBC morphology. Oxalate interferes in enzyme reactions
Oxalate/fluoride tubes
