(M) Lesson 1: Performing Venipuncture Flashcards
→ aka “phlebotomy”
→ process of collecting or drawing blood from a vein
→ the most common way to collect blood specimens for laboratory testing
Venipuncture
Lack of this skill will manifests the most common error in the laboratory (i.e mislabeling of patient or specimen)
Administrative/Clerical Skills
This lists the information needed for the phlebotomist to collect blood samples; a form in which test orders are entered by the doctor
Requisition Form
T or F: Verbal test requests are not allowed during emergencies
False (they are allowed but you still need to document it afterwards)
A patient’s medical record number and room number will only be included in the requisition form if they are what type of patient?
Inpatient
The date of when the test is to be performed, billing information, and ICD-9 codes will only be included in the requisition form if the patient is of what type?
Outpatient
This form contains a number to identify all paperwork and supplies associated with each patient; commonly used for tracking the sample, entering the result, and checking and reporting patient results
Accession Order
T or F: Bar codes in accession forms can be applied to both inpatient and outpatient
False (only for inpatient)
This type of accession order contains actual labels that are placed on specimen tubes immediately after collection
Computerized
This type of accession order comes in a multipart carbon form and has three parts: request, report, and billing
Manual
T or F: Manual accession forms can be printed
False (handwritten only)
A manual accession form can be given to the phlebotomist by a nurse for what type of patient?
Inpatient
A manual accession form can be handed directly to a patient if they are of what type?
Outpatient
T or F: Manual accession forms act as backups incase computer systems fail
True
T or F: The receipt of a test request for inpatients should be printed out at a special computer terminal at the phlebotomist station in the laboratory
True
T or F: Outpatients receive laboratory requisitions or prescription slips with test orders written on them by their physicians
True
T or F: In accessioning test requests, one must do it in the order of which the requests come in simultaneously
False (chronologically)
T or F: You must arrange requisition forms according to status of priority
True
T or F: You can review requisitions in order to see what equipment is needed while in the patient’s quarters
False (review it BEFORE meeting with the patient)
T or F: Outpatients are summoned from the waiting area to the blood drawing station according to order of arrival
True
These refer to things a phlebotomist must look for before interacting with a patient (e.g precautions, allergy status, DNR, etc.)
Signs
These are messages left by other healthcare workers on how you should approach the patient
Codes
T or F: When entering a patient’s room knock regardless if the door is open or not
True
T or F: If a physician or clergy is present in the room, you may enter politely and inform them of the scheduled blood draw
False (do not interrupt, wait for your turn, draw blood from another patient if applicable and come back)
T or F: Family members can stay in the room when performing blood draws
False (ask them to step out the room)
T or F: If a patient is unavailable during the time you arrive for a blood draw, the only thing you need to do is inform the head nurse that you will come back
False (fill out a form declaring you are unable to collect blood)
T or F: Only verbal patient consent is looked out for before performing venipuncture
False (consent through actions is looked for as well)
T or F: Patient refusal for blood draw can be verified verbally
False (objections should be written or reported to personnel)
Refers to the behavior of the healthcare worker towards the patient
Bedside Manner
This is the the most important step in the collection process
Patient Identification
T or F: Do not collect samples if information contains discrepancies
True
Instead of asking yes or no questions, what should you ask the patient to say or do when identifying them?
State their full name and date of birth or you can let them spell their last name
If there are ID discrepancies, which staff should you inform first?
Nurses
If the patient suffers from a burn and cannot give consent, who should you ask consent from?
Family or their nurse
T or F: Never verify information and collect specimens from an ID band not attached to a patient
True
The identification procedure of verbally asking for a full name and confirming using ID bracelets is used for what type of patients?
Conscious or Hospitalized Patients
The identification procedure of awakening them before collection and to do the same as for the conscious patients is used for what type of patients?
Sleeping Patients
The identification procedure of awakening them before collection and to do the same as for the conscious patients is used for what type of patients?
Sleeping Patients
The identification procedure of asking relatives, nurses, physicians, and recording the name before comparing the ID bracelets is used for what type of patients?
Unconscious Patients and Infants, Children, or Mentally Incompetent Patients
The identification procedure where the receptionist will verify the ID after the patient surrenders it is used for what type of patients?
Outpatients
This type of identification procedure involves collecting the name, date of birth, patient record number, mother’s last name, and gender for what type of patients?
Babies and Neonates
Where can infant ID bands be found?
On their lower leg
T or F: Both temporary and permanent numbers can be assigned for emergency room patients
True
T or F: Permanent numbers need not be cross-referenced to the previous temporary numbers of emergency room patients
False
T or F: You must address objects in the patient’s mouth before proceeding with blood draws
True (e.g. chewing of food)
How long is the fasting period for FBS?
8-10 hours
How long is the fasting period for a lipid profile test?
10-12 hours
T or F: Arms can be bent when drawing blood
False (must be downward and comfortable)
T or F: Inpatients are seated or reclined while Outpatients are lying down on their beds during blood draws
False (inpatients are on the bed while outpatients are on chairs)
T or F: Proper hand hygiene is preferably done in the presence of the patient
True
This equipment obstructs blood flow and makes veins more prominent
Tourniquet
The tourniquet should be applied how many inches above the puncture site?
3-4 inches
A tourniquet should be applied not longer than how many minutes?
1 minute
When using blood pressure cuffs for obese patients, what is the pressure needed to obstruct blood flow?
60mmHg (between systolic and diastolic)
Why is the thumb not appropriate for palpating veins?
Because it has a pulse
T or F: Veins must be soft and bouncy
True
If the blood vessel you are palpating has a pulse, what is it?
Artery
What is the first priority vein for blood draw in the median cubital fossa?
Median cubital
What is the second priority vein for blood draw in the median cubital fossa?
Cephalic
What is the last priority vein for blood draw in the median cubital fossa?
Basilic
Why is the basilic vein the last choice for blood draw in the cubital fossa?
It lies near to the brachial artery
T or F: You cannot extract blood from a patient’s arm if they’ve recently undergone a mastectomy
True
T or F: If veins are not found, you can wrap a cold wet towel around the arm or hand
False (warm towels will promote vasodilation)
T or F: You can use a pen to mark the puncture site on a patient’s skin
False (use an alcohol pad instead)
How long until you reapply the tourniquet after the first palpation?
2 minutes
What is the motion of cleaning the site with alcohol?
Circular motion from the inside going outward
T or F: You can blow or fan on the alcohol to make it dry faster
False
T or F: No traces of alcohol should be left on the skin
True (alcohol penetrating the skin can cause hemolysis and contaminates glucose testing)
How long must you allot for the alcohol to naturally dry?
30 seconds to 1 minute
T or F: You can place the phlebotomy tray on the patient’s bed
False (it can get contaminated)
How many inches must you anchor the vein below the puncture site?
1-2 inches
In what direction must you pull the skin when anchoring a vein?
Towards the wrist (downwards)
What can happen to the blood when the fist is overly clenched or is vigorously opened and closed?
Hemoconcentration (increased concentration of cells and solids in the blood usually resulting from loss of fluid to the tissues)
T or F: Position the needle perpendicularly to the vein
False (parallel or running in the same direction as the vein)
How many degrees must the needle be inserted in?
15-30 degrees
T or F: The more superficial the vein, the higher the angle
False (lower angle)
What can be felt the moment you hit a vein?
A pop
The bevel should be facing in what direction when performing blood draws?
Upwards
T or F: You can insert the needle at the same spot you palpated
False (insert it a few inches below)
What can propagate in the syringe if you pull the plunger too fast?
Air bubbles
What is an indicator that you’ve hit a vein for the syringe method?
As soon as blood enters the hub
T or F: Remove the tourniquet after withdrawing the needle
False (remove the tourniquet first before withdrawing the needle)
This is a piece of equipment that lets you put the blood from the syringe into an evacuated tube in a clean and safe manner
Transfer device
This method is performed when no transfer device is available
Puncturing the tube stopper
What is present inside the evacuated tubes that make it easy to transfer the blood?
Vacuum
T or F: The tourniquet can be left on until after the evacuated tubes have been filled
True
On what angle is a butterfly needle inserted in the skin?
5-10 degrees
A process of recapping the needle in a safe manner
Fishing out
How many minutes should you apply pressure on the puncture site after blood extraction?
3-5 minutes (max. of 15)
T or F: The needle and tube holder/transfer device can be discarded separately
False (must be disposed of as a single unit)
T or F: The needle and syringe can be discarded both together or separately
True
T or F: You can pre-label the samples before performing blood draws
False (always label after the procedure)
Computers can generate this piece of technology which carries all the information of the patient without utilizing too much space on paper
Bar Codes
T or F: Bar codes are directly attached to the tubes using adhesives
True
Refers to increased number of formed elements in the blood
Hemoconcentration
This is the product of blood escaping from the punctured vein and traveling to the surrounding tissue
Hematoma
What is the remedy for hematomas?
Apply ice in the first 24 hours then apply warm compress after 1 day
What type of complication does hemoconcentration, failure of blood to enter syringe, hematoma, and bleeding fall under?
Immediate local
An abnormal vascular condition involving thrombus development within the blood vessel
Thrombosis
Refers to the inflammation of a vein accompanied by a clot resulting from trauma to the vessel wall
Thrombophlebitis
What type of complication does thrombosis and thrombophlebitis fall under?
Late local
Medical condition for fainting caused by:
- lack of oxygen in the brain
- inability to stay put in an upright position
- anxiety of the patient because of the procedure
Syncope
What is inhaled as part of an old method for treating fainted patients?
Ammonia
T or F: If patient feels faint, withdraw the needle and have their head lifted between their legs
False (head must be lowered in between the legs before breathing deeply)
What complication does circulatory failure and syncope fall under?
Immediate general
Refers to anemia that is hospital-induced
Iatrogenic anemia
What complication does contracting hepatitis, AIDS, anemia, and nerve injury fall under?
Late general
Refers to the breaking or rupturing of the RBC membrane
Hemolysis
Refers to yellowish or orange color of serum due to high bilirubin levels in the blood
Jaundice
Edit: hindi ba icterus ‘to?
When referring to jaundice but used for the sample and not the patient, it is called as what?
Ictericia
Refers to a white and milky color of blood due to large amounts of fats and lipids
Lipemia
How many mg/dL of hemoglobin does a pinkish color manifest?
20
How many mg/dL of hemoglobin does a reddish color manifest?
100
What two colors of the sample indicate hemolysis?
Pinkish and reddish
T or F: Small bores can cause RBCs to rupture
True
Hemolysis can occur if subjected to extreme temperatures especially when?
Cold
T or F: It is advisable to slap or flick the patient’s arm
False
Refers to the process of rotating the needle inside the skin when locating a vein
Probing
How many attempts does a phlebotomist have before they can ask for assistance from another phlebotomist or physician?
2
