(M) Lesson 2: Pre-Analytical Considerations in Phlebotomy Flashcards
This word means “before analysis”
Pre-Analytical
T or F: Pre-analysis begins during testing and ends with a test order
False (begins when a test is ordered and ends when testing begins)
Refers to the resting metabolic state of the body early morning after 12 hours of fasting (influenced by variables such as age, gender, and body conditions that CANNOT be eliminated)
Basal State
T or F: Basal state results are used to establish the reference values used for test results to know what normal and abnormal numbers are
True
T or F: RBC and WBC values are lower in newborns
False (higher)
Refers to how fast the kidney can filter creatinine
Creatinine clearance
T or F: Kidney function decreases with age
True
T or F: RBC counts are elevated at places with lower altitudes
False (higher altitude = lower oxygen levels trigger more RBC production)
This triggers higher concentration in test results due to a lack in solvent (water)
Dehydration
These increase with ingestion of fatty foods
Lipids
These are altered by drinking excessive water
Electrolytes
These chemicals increase in patients on high-protein diets
Ammonia and Urea
This is a byproduct of protein metabolism
Urea
This occurs naturally in the body and undergoes detoxification in the liver to turn into urea
Ammonia
This increases with ingestion of carbohydrates and sugary food
Glucose
T or F: Melatonin increases at night and decreases during the day
True
When are Renin and TSH at peak levels?
Predawn hours of the morning during sleep
Also known as the stress hormone
Cortisol
What are the peak hours of cortisol production?
Later in the morning (around 8am)
T or F: Chemotherapy drugs can cause an increase in blood cells (WBCs and platelets)
False (decrease)
What test is IMMEDIATELY followed after chemotherapy to measure blood components?
CBC Test
What does increased level of liver enzymes mean?
Liver failure
These increase amylase and lipase
Steroids and diuretics
T or F: During exercise, arterial pH and PCO2 levels are reduced to an acidic level
True
T or F: Glucose decreases by moderate muscular activity
False (increases)
This metallic element increases in the plasma whenever we exercise
Potassium
These 2 skeletal muscle enzymes increase during exercise
Creatinine Kinase and Lactate Dehydrogenase
T or F: Fever decreases insulin and glucagon levels
False (increases)
This chemical allows glucose to enter the cell
Insulin
This substance promotes glucose production
Glucagon
T or F: Fevers can increase cortisol
True
T or F: Blood components are higher for males than females
True
T or F: RBCs, hemoglobin, and hematocrit are all directly proportional
True
T or F: Androgen plays a key role in stimulating RBC production
True (Testosterone)
During intramuscular injections, these 2 substances increase
CK and LDH
Refers to jaundiced specimen having a deep yellow to yellow-brown color of serum or plasma
Icteric Specimen
This is responsible for the yellow pigment of the skin for jaundiced patients
Bilirubin
T or F: Bilirubin can interfere with chemistry tests based on color reactions
True
T or F: Moving positions too quickly causes blood fluids to filter into the tissues, increasing plasma volume
False (decreasing)
T or F: It is advisable to extract samples from the initial position of the patient
True
T or F: Mild anemia is normal in pregnancy
True (RBC counts are lower)
Characterized by decreased pulmonary function, increased RBC count, and hemoglobin level
Chronic Smoking
T or F: Smoking can increase the concentration of immunoglobulins
False (decrease)
T or F: WBCs increase with stress
True
T or F: Stress can increase serum iron levels
False (decrease)
T or F: Temperature plays a factor in triggering hemoconcentration
True
What is the mortal sin of medical technologists?
Patient Misidentification
T or F: Urea is photosensitive
False (Bilirubin)
This cold temperature range describes improper transport conditions of samples
2-6 degrees celsius
T or F: Glucose can decrease if RBCs come in contact with the serum due to the RBCs consuming them
True
Healed burn sites and areas with extensive scarring are still not ideal locations for blood draw due to?
Impaired circulation
T or F: Tattooed areas are acceptable places to draw blood from
False (impaired circulation, more susceptible to infection, and contains dyes that can interfere with testing)
“Sclerosed” means what?
Hardened
“Thrombosed” means what?
Clotted
T or F: You must choose veins that are proximal to damaged ones
False (distal)
T or F: Edema may yield inaccurate results due to tissue fluid contamination
True
Refers to swelling or mass of blood caused by blood leaking from a blood vessel during or following venipuncture
Hematoma
T or F: Lymph node removal causes lymphostasis
True (obstruction or stoppage of lymph flow)
T or F: Lymphostasis does not change blood composition in the arm
False (it can if blood gets contaminated with lymph fluid)
What is the most prominent vein for obese patients?
Cephalic Vein
T or F: Patients taking aspirin have a less chance of excessive bleeding
False
T or F: You can apply a pressure bandage instead of maintaining pressure
False (Never apply pressure bandages instead of maintaining pressure)
Refers to temporary loss of consciousness due to insufficiency of blood flow to the brain
Syncope
Refers to fainting due to a nervous system response to abrupt pain, stress, or trauma
Vasovagal Syncope
Refers to the sensation of spinning as a symptom of syncope
Vertigo
Refers to tiny, non-raised red (or purple) spots that appear on the patient’s skin when a tourniquet is applied due to minute drops of blood escaping the capillary wall resulting from a capillary defect or platelet abnormality
Petechiae
→ tube inserted into a vein or artery
→ ready access to the patient’s circulation
→ eliminates the need for multiple draws
→ uses include:
- administering of fluids or medication
- drawing blood
- central venous pressure reading
Vascular Access Device
T or F: You can apply a tourniquet or perform venipuncture on an arm with a VAD
False
Refers to a catheter placed in an artery (most common in a radial artery)
Arterial Line (A-Line/Art-Line)
Refers to a surgical procedure that fuses veins with arteries commonly used for hemodialysis treatment
Arteriovenous shunt/AV fistula
→ used for administering medication and drawing blood
→ uses the vein in the lower arm above the wrist
→ can be left in place for up to 48 hours
→ flushed with heparin or saline to prevent clotting
Heparin or Saline Lock
T or F: Drawing coagulation specimen is not recommended when a Hep-Lock is in place
True
→ thin plastic tube/catheter
→ inserted in a vein to administer fluids
Intravenous (IV) Sites
T or F: Blood specimen can be contaminated or diluted with IV fluid causing erroneous test results
True
T or F: Draw blood above the IV site if both arms have one
False (below the IV)
T or F: Blood can only be collected within 24 to 48 hours of the time the IV was discontinued
False (should not be collected within 24 to 48 hours of the time the IV was discontinued)
Refers to a needle-less closed device that is sometimes connected to an arterial or central venous catheter
Blood Sampling Device
→ indwelling line that consists of tubes inserted into main vessels
→ used for administering fluids and medications, monitoring pressures, and drawing blood
Central Vascular Access Device (CVAD)
Device wherein the line is inserted into large veins (subclavian advancing into the superior vena cava)
Central Venous Catheter (CVC) or Central Line
Surgically-implanted disk-shaped chamber attached to the indwelling line placed on the upper chest just below the collar bone
Implanted Port
Line is inserted into a vein (in an extremity) and threaded into a main vein leading to the heart
Peripherally Inserted Central Catheter (PICC)
This is the most common complication in venipuncture
Hematoma
What is the color of arterial blood?
Bright red
Refers to blood loss due to blood draw
Iatrogenic Anemia
Refers to an adverse condition brought by the effects of treatment/procedure
Iatrogenic
T or F: Life is threatened if more than 5% of blood volume is removed at one time
False (10%)
What artery is near the basilic vein?
Brachial Artery
Refers to back flow of additive into the patient’s vein from the tube during the venipuncture procedure
Reflux
→ decrease in fluid content or plasma volume
→ caused by stagnation of the normal venous blood flow because of tourniquet application
→ increased concentration of RBCs and other non-filterable large molecules
Hemoconcentration
Complication wherein RBCs are damaged and hemoglobin escapes into the fluid portion of the specimen
Hemolysis
Slight hemolysis is indicated by what hue of red?
Pinkish
Moderate hemolysis is indicated by what hue of red?
Dark Pink to Light Red
Gross hemolysis is indicated by what hue of red?
Dark Red
T or F: Short-draw serum tubes are generally unacceptable
False (acceptable)
T or F: Never pour two partially filled additive tubes together to fill one tube (affects the blood-to-additive ratio)
True
What forms in wrong/expired collection tubes?
Microclots
T or F: Tube vacuum can be lost if the bevel backs out the skin slightly
True
T or F: When probing, move the needle horizontally
False (retract a bit first before probing)
T or F: If vein disappears as the tube is engaged or when tourniquet is removed, that is an indicator of a collapsed vein
True
T or F: You can palpate the site of entry near the needle
False (this is painful for the patient)