Lesson 6: Pre-analytical Considerations in Phlebotomy Flashcards
-INCLUDES LABORATORY HANDLING AND IDENTIFICATION, WHICH TAKES PLACE PRIOR TO ANY LABORATORY TESTING
PRE-ANALYTICAL TESTING PHASE
RBC, WBC, CREATININE CLEARANCE
AGE
RBC
ALTITUDE
HEMOCONCENTRATION, RBC, ENZYMES, FE, CA, NA
DEHYDRATION
GLUCOSE, LIPIDS, ELECTROLYTES
DIET
THYROID-STIMULATING HORMONE, CORTISOL, FE
DIURNAL VARIATION
ENZYMES, HORMONES
DRUG THERAPY
pH, PCO2, CK, LDH, GLUCOSE
EXERCISE/IM INJECTION
HORMONES, CORTISOL
FEVER
RBC, HEMOGLOBIN, HEMATOCRIT
GENDER
YELLOW COLOR INTERFACES DUE TO INCREASED BILIRUBIN
JAUNDICE
CK AND THE SKELETAL MUSCLE FRACTION OF LDH
INTRAMUSCULAR INJECTION
PROTEIN, K
POSITION
RBC
PREGNANCY
CHOLESTEROL, CORTISOL, GLUCOSE, GROWTH HORMONES, TRIGLYCERIDE, WBC
SMOKING
WBC, FE, ACTH, CATECHOLAMINE, CORTISOL
STRESS
hemoconcentration
TEMPERATURE AND HUMIDITY
VEINS IN THE AREA MAY BE DIFFICULT TO EXAMINE AND BLOOD CIRCULATION MAY BE IMPAIRED
BURNS, SCARS, AND TATTOOS
DIFFICULT TO PERFORM AND MAY PRODUCE INACCURATE RESULTS
DAMAGED VEINS
ABNORMAL SWELLING CAUSED BY THE ACCUMULATION OF FLUID IN THE TISSUES
-TISSUES BECOME FRAGILE
EDEMA
SOLID SWELLING OR MASS OF BLOOD IN THE TISSUES CAUSED BY THE LEAKAGE OF BLOOD FROM THE VESSELS DURING VENIPUNCTURE.
HEMATOMA
-BLOOD DRAWING FROM PATIENTS WHO HAD UNDERGONE THIS PROCEDURE BECOMES A CHALLENGE SINCE THE LYMPH FLOW IS OBSTRUCTED, AND THERE MAY BE SWELLING AND INFECTION AFTER SURGERY.
MASTECTOMY
THEY HAVE DEEP AND DIFFICULT TO LOCATE VEINS
OBESITY
NEEDED FOR BLOOD SAMPLING, INFUSING MEDICATION, CENTRAL VENOUS PRESSURE READINGS, AND BLOOD TRANSFUSION OF A PATIENT
VASCULAR ACCESS DEVICES
-ARTERIAL BLOOD GAS AND LABORATORY STUDIES
-THIN CATHETER IS INSERTED INTO AN ARTERY
ARTERIAL LINE
PASSAGEWAY CREATED THROUGH SURGERY AND IS USUSALLY IN THE ARMS WITH THE INTENTION OF CONNECTING THE ARTERY AND A VEIN DIRECTLY
ARTERIOVENOUS SHUNT OR FISTULA
-USED TO AVOID THE USE OF NEEDLE-STICKS, PREVENT INFECTIONS, AND REDUCE WASTAGE FROM LINE DRAWS
BLOOD SAMPLING DEVICE
-HEPLOCK
-IV CATHETER ATTACHED TO A STOPCOCK OR CAP WITH DIAPHRAGM.
-PROVIDE ACCESS FOR ADMINISTERING MEDICINE OR DRAWING BLOOD FROM THE PATIENT
HEPARIN OR SALINE LOCK
THIN PLASTIC TUBE INSTERTED INTO A VEIN IN THE FOREARM TO INJECT A VOLUME OF FLUIDS INTO THE BLOODSTREAM
INTRAVENOUS SITES
-INDWELLING LINES
-TUBINGS INSERTED TO THE MAIN VEIN OR ARTERY USED FOR BLOOD COLLECTION, MONITORING THE PATIENT’S PRESSURES, AND ADMINISTERING MEDICATIONS AND FLUIDS
CENTRAL VASCULAR ACCESS DEVICES
CENTRAL LINE INSERTED INTO THE LARGE VEIN (SUBCLAVIAN) AND ADVANCESD INTO THE SUPERIOR VENA CABA
CENTRAL VENOUS CATHETER
surgically implanted disk-shaped chamber attached to the indwelling line
IMPLANTED PORT
a flexible tube inserted into the veins of extremities and the central veins
peripherally inserted central catheter (PICC)
When the patient has adhesive allergy, a gauze should be placed over the site and should be removed after fifteen minutes. The alternative is to ask the patient to apply pressure for five minutes. For Antiseptic allergy, simply use a different antiseptic. And for latex allergy, look for a sign to indicate the allergy and use a non-latex alternative for gloves, tourniquet and bandages.
allergies to equipment and supplies
When a patient is on aspirin or anticoagulant, the bleeding may take a longer time. The pressure should be applied to the site until the bleeding stops. The attention of the authorized personnel should be called when the bleeding continues after five minutes.
excessive bleeding
Temporary loss of consciousness; usually related to temporary insufficient blood flow to the brain; also known as syncope, “blacking out” or “passing out.
Fainting
When the patient feels nauseous and has the tendency to
vomit, the phlebotomist has to discontinue the procedure until the patient feels better or until the feeling subsides. An emesis basin or waste basket should be provided, and a cold damp washcloth should be applied to the forehead.
nausea and vomiting
The patient should be warned before the needle insertion, and the phlebotomist should avoid redirection of the needle. If the patient complains of extreme pain or numbness, remove the needle and apply ice to the site because this could indicate nerve involvement. The phlebotomist needs to document the incident if the condition persists.
pain
this condition involves the appearance of small red or purple spots that look like rashes, which appear on the arm when tourniquet is applied.
petechiae
the blood draw should be discontinued quickly. There must be pressure held over the site but it must be made certain that movement is not restricted; the mouth is free from any obstruction and the patient is protected from self-injury. The first-aid personnel must be notified immediately.
seizure or Convulsions
- There is excessive or blind probing.
- There is in advertent arterial puncture
- The size of the vein is too small
- The needle penetration has gone all through the vein.
- Needle is not completely inserted.
- Tourniquet is still on when the needle was removed.
- The pressure is not adequate
following are conditions that trigger hematoma
This results from blood loss due to blood draw. It is important to ensure to collect only the required specimen volume because if 10% of the blood volume is removed at once from the body, the patients could face a threat.
Iatrogenic anemia
This happens when blood is filling up the tube rapidly and there is a rapid formation of hematoma on the site.
Inadvertent arterial puncture
____ can be avoided by making sure that tapes or bandages are not opened of time; needles are not preloaded into the tube holder; insertion site of the needle is not touched after sterilization, cap is removed just before venipuncture; and patients are advised to keep the bandage on the site for at least 15 minutes.
infection
Nerve injuries happens when there is improper site selection, rapid needle insertion, excessive redirection of the needle and blind probing.
If the initial attempt is not successful, the phlebotomist should try to redirect the needle by using a slightly forward or backward movement. The next step is to remove the needle and look for an alternative site.
nerve injury
blood that has already been drawn flowing back into the vein from the collection tube may cause adverse reaction because of the presence of tube additives. To avoid this, make sure that the arm of the patient is in a downward position and the tube is just below the venipuncture site.
Reflux of Anticoagulant
Damaging the vein could be avoided by following the proper technique and avoiding blind probing.
vein damage
is a decrease in the fluid content or plasma volume which is usually caused by tourniquet that stagnates the normal flow of blood leading to the increase in concentration of red
blood cells and other non-filterable large molecules.
Hemoconcentration
refers to the rupture of the red blood cells. The hemoglobin is then released into the surrounding fluid.
hemolysis
happens when the phlebotomist pulls a tube before reaching the required volume. This may lead to
the incorrect blood-to-additive ratio.
Partially filled tube or short draw,
the specimen is compromised due to incorrect handling, which involves allowing alcohol, powder, or other materials into the sample. Getting glove powder or perspiration into films and specimens; using the wrong antiseptic; or simply not following the proper antiseptic procedure could interfere with the results.
specimen contamination
should not be used because the manufacturer could not warrant the quality of the seal and pressure after the expiration date indicated in the tube
Wrong or expired collection tube
I. Needle not inserted far enough
2. Bevel partially out of skin
3. Bevel partially into vein
4. Bevel partially through vein
5. Bevel completely through vein
6. Bevel against vein wall
7. Needle beside vein
8. Undetermined position
The phlebotomist should ensure that the following do not happen:
usually occur when conditions are less than ideal which leads to the veins being blocked, resulting in insufficient blood flow. This happens when there is a strong pressure in the vacuum of the tube or plunger; the tourniquet is too close to the site or it is too tight or when the tourniquet has been removed during the draw.
Collapsed Veins
To avoid failure due to loss of vacuum, the phlebotomist should make sure that the bevel is not partially out of skin and the tube itself is not damaged.
Tube Vacuum
