Med Lab Procedures Flashcards
What is the preferred maximum percentage you can draw from pediatrics?
3%
What does RBC breakdown produce?
Bilirubin
What time frame should a PKU test be done?
Within 24-48 hours
What tests are in a pre-warmed tube?
- Cryoglobulin
- Cryofibrinogen - Abnormal serum protein
- Cold Agglutinins - Antibodies
What tests need to be protected from light?
- Bilirubin
- Beta-Carotene
- Porphyrins
- Vitamin A, Vitamin E
What are Therapeutic Drug Monitoring tests?
- Carbamazepine
- Phenobarbital
- Lithium
- Phenytoin
- Digoxin
- Vancomycin
- Gentamicin
- Tobramycin
How do you chill a tube and why do you chill it?
Cooler, Crushed Ice, Ice and Water Mix
To prevent biochemical breakdown
What are examples of time sensitive tests?
◦ Blood Gases
◦ Ammonia
◦ Special Coagulation Testing
◦ Lactate
◦ ACTH
◦ BNP
◦ Platelet Aggregation
◦ Prostatic Acid Phosphatase
◦ Semen Analysis
Why are timed sensitive tests needed to be performed rapidly?
Analytes are unstable or volatile
Within 5-10 minutes delivered to the lab
What does a blood gas test determine?
Concentration of oxygen & carbon dioxide in the blood along with pH
pO2 (Partial Pressure of Oxygen)
pCO2 (Partial Pressure of Carbon Dioxide)
What are line draws also known as?
VADS
(Vascular Access Devices)
- Tubing in patients blood vessels (artery or vein)
What is the body’s constant pH balance?
7.35 - 7.45
7 is neutral
If the body’s pH is HIGHER than 7.0 it is…
alkaline
If the body’s pH is LOWER than 7.0 it is…
Acidic
What are the 3 things on a WHMIS Workplace Label?
- Product Identifier
- Safe Handling (+pictograms)
- Reference to SDS
What are the different tubes used in Blood Cultures and how much do you collect in them?
Aerobic - 8-10mL
Anaerobic - 8-10mL
Fungi - 10mL
Pediatric - 4mL
Why would we run a Blood Culture test?
Suspicion of Sepsis or FUO (Fever of Unknown Origin)
What are the different kinds of Blood Gas Draws?
Arterial, Venous and Capillary
What tests are run on Blood Gases?
pCO2, pO2, pH, HCO3 (bicarb)
What is a DELTA CHECK?
A procedure that helps spot identification errors
Audits are…
on site verification of a process or system to ensure COMPLIANCE TO REQUIREMENTS
A Process is…
A step by step process for performing a task
What is Policy?
A written statement overall of intentions
What is included in documentation?
Training, procedures, checklists, quality control
What is an accreditation?
A check on competencies & if the lab is following them
What is an Incident Report?
An individual occurrence or report
What are competencies?
Ability to apply knowledge and skills
What are some examples of Quality Phlebotomy?
Usually includes:
Occurrence Management/Incident Reports
Variable Monitoring
Audits
Accreditation
What is Quality Phlebotomy?
To ensure the delivery of consistent high quality patient care, specimen collection, and analysis
What are some examples of Continuous Quality Control?
Usually includes:
Incident Reports, Occurrence Management Reports
Quality Assurance Indicators
Audits
Variable Monitoring
What is Quality Control?
Methods used to monitor accuracy of procedures (analytical performance)
What is Quality Assurance?
The development of standards for procedure performance
What are some examples of Quality Assurance Indicators?
Incident Reports
Equipment Malfunction Reports
Variable Tracking (Duplicate tests, TAT).
Competency Assessment
External Proficiency Testing
What are 2 types of Vascular Access Devices (VADs)
Central Venous Catheter (CVC)
Implanted VAD (IVAD/Port-A-Cath)
Peripherally Inserted Central Catheter (PICC)
Venous Arterial Blood Management System (VAMP)
Arterial Line
Heparin/Saline Locks
Hemodialysis Lines
Arteriovenous Shunt (AV SHUNT)
During respiratory disturbances if the CO2 goes up, what comes down?
pH
therefore CO2 goes down, ph goes up
Stimulation testing and Tolerance testing are examples of what?
Timed collections
What type of special group collection has a high risk of anemia and more frequent blood clots?
Geriatric patients
Neonatal screening allows for early detection of ….. (4)
- Metabolic disorders – PKU, homocystinuria, galactosemia
- Endocrine disorders - adrenal hyperplasia, hypothyroidism
- Blood and Hgb disorders – sickle cell disease
- Other conditions – cystic fibrosis, spinal muscular atrophy, immunodeficiencies
What are 3 most common tests collected on pediatric patients?
- Screening cards
- Bilirubin
- CBC
What are some good qualities of a professional?
How would you demonstrate these qualities?
1) Dependability - arrive on time, complete tasks efficiently
2) Honesty and Integrity - admit errors
3) Positive Attitude - interact positively with patient, coworkers, others
4) Professional Detachment - balances sympathy, understanding, and professional distance
5) Professional Appearance - appears clean and conservative
6) Assertiveness - expresses needs without violating coworkers, other staff, patients or patients families
7) Interpersonal Skills - demonstrates verbal/nonverbal communication and listening skills
8) Telephone skills - promptly and accurately receives, records and reports messages
Why is informed consent important? Explain.
The patient is informed and understands the risks, knows they have the right to refuse
What’s the difference between an artery, vein, and capillary?
Capillary blood - mix of venous and arterial blood
Arterial blood - rich in oxygen and electrolytes
Test variances;
Capillary - higher in hemoglobin, glucose
Venous - higher in potassium, calcium, total protein
What are the components of blood?
Plasma - fluid portion (clear pale, yellow)
Serum - Plasma without clotting factors = Formed when BLOOD CLOTS
Formed elements - Formed in bone marrow - 99% RBC
WBC - Fight infection
What do you need to be aware of when doing a capillary collection?
- Micro collection tubes should be slanted downward
- Avoid scrapping the finger or heel with the collection container
- Tap container lightly to move blood to bottom
- Be careful to always achieve the minimum volume and to not exceed the maximum.
How to deal with complications
1 - failure to draw blood?
2 - rolling veins?
3 - sclerosed(occluded) veins?
4 - collapsed veins?
5 - hematoma or a thrombosed area?
6 - burned area or scared site
- Rotate Needle - bevel stuck in wall
Slowly pull back - needle passed through vein
Slowly advance - needle not advanced far enough
vacuum pulled vein into bevel - tube too big for vein - Anchor firmer
- result of chemo, repeated venipunctures, inflammatory disease - susceptible to infection
- Pick a different site - blood flow is blocked. ??
- Do not draw blood from - blood flow into vein restricted, erroneous results
- Hard to penetrate, painful, susceptible to infection
What are the steps you take if you have an accidental needle stick?
Wash with soap and water and friction,
Notify supervisor,
Seek medical treatment
Make incident report
How can you prevent transmission of Hep A and C?
Vaccination
maintain proper hand hygiene and PPE when handling patients to prevent Hepatitis A or C
What is your best course of action to prevent getting Hep B?
Vaccination
What are the elements of communication?
Verbal
Nonverbal
Visual
Written
What is a common cause of hemoconcentration?
- Tourniquet on too long
- Massaging, squeezing, or probing a site
- Sclerosed or occluded veins
What are common causes of hemolysis?
- incorrect needle size
- improper tube mixing
- incorrect filling of tubes
- excessive suction
- prolonged tourniquet
What can cause a hematoma?
(Bruise)
- improper pressure is applied after the venipuncture
- if the patient suddenly moves, and the needle comes out of the vein
- if the needle punctures both walls of the vein
What is the maximum wait time before a specimen is delivered to the lab?
45 minutes
Blood smears should be made from an EDTA tube within what time?
within 1 hour
A red top tube with no additives completely clots in ________ (time) at room temperature
60 minutes/1 hour
Can Plasma be removed from a clot at room temperature?
no
Why are some specimens kept cool after collection and before testing?
to slow down cellular metabolism
What is the most common infection acquired in a laboratory setting?
Hepatitis B virus
What does Standard Precaution refer to?
Assuming that every body fluid is infectious that you come in contact with
What is pasteurization?
rapidly heating a liquid (to 75°C) then cooling and sealing
What is Autoclaving?
produces steam at high pressures with temperatures exceeding 120°C for around 15 minutes
What does RACE stand for and when do you use it?
For fire
Rescue
Alarm
Contain
Evacuate
What does PASS stand for and when should it be used?
Fire Extinguisher
Pull pin
Aim
Squeeze
Sweep
What is centrifuge separation based on?
Component Density
What does this symbol mean?
Flammable
Can burn or explode with exposed to heat
This symbol means?
Oxidizing
Keep separate from flammables or can cause flames and increase the intensity of a fire with supply of oxygen
This symbol represents
Corrosive
can include acids, bases or other corrosive materials
What does this symbol mean?
Reactive Material (Explosive)
May be unstable and react to compression, heat, light or jarring
May burn, explode or produce dangerous gases when mixed with other materials
This symbol means
Compressed Gases
can explode if heated or damaged
Should be kept upright
This means…
Ionizing Radiation
Can penetrate deeply into the body
This means?
Toxic
What is a fomite?
a microorganism that spreads blood borne diseases
What is a Class C fire?
Electrical
Category A Infectious Substances classes are…
What are the two different types of WHMIS labels?
Supplier Label
Workplace Label
A WHMIS label for the supplier must include what 7 things?
- Product Name
- Pictogram - Hazard Symbol
- Risk Phrases/Signal Words
- Hazard Statements
- Precautionary Measures/Statements
- Supplier Identifier
- References to SDS (Safety Data Sheet)
Name the vein on the thumb side we use as a second choice?
Cephalic vein
It is usually more difficult to locate and has a tendency to move
Often only vein palpable on obese patients
Name the vein on the pinky side used as a last choice, of the 3 main veins?
Basilic vein
Near brachial artery and nerve
Least firmly anchored
Which vein is usually the best choice for venipuncture?
Median Cubital Vein
Well anchored
It is large and does not tend to move when the needle is inserted
What angle do you enter the vein with a butterfly needle?
10-15º
There is an easy way to know if you’re in the vein with a butterfly needle, what is it?
It involves the tubing.
A flash (small amount) of blood will appear in the tubing
What does 2, 2 and 2 mean?
Hold pressure for 2 minutes (on the venipuncture site)
Leave the bandage on for 20 minutes
and, No heavy lifting for 2 hours
What are the names of these parts?
5 - as a whole what is it?
1 - Bevel
2 - Shaft
3 - Hub
4 - Retractable Sheath
5 - Multisample Needle
6 - Tube holder
7 - Evacuated Tube
8 - Assembled system
What are three types of blood specimens used for analysis?
Whole Blood
Serum
Plasma
What tests can’t be performed on blood from a capillary collection?
Test requiring larger volumes of plasma or serum,
Blood cultures
ESR (Erythrocyte sedimentation rate)
Coagulation tests
What’s the difference between venous and capillary blood?
Blood from capillaries is a combination of venous and arterial blood.
A capillary collection site should avoid ______, ______, ______ and ______
cuts, scars, bruises and rashes
How long should you leave a warm pack on for?
3-5 minutes
Where should you collect blood for a capillary collection on an adult and why?
The palmar surface of the distal segments in the middle finger or the ring finger should be used.
The thumb is too callused
Index has extra nerve endings and is more painful
Pinky has too little tissue.
What is basal state?
When the body has been fasting for 8-12 hours and absent from strenuous exercise
List some of the factors that can affect the sample quality
- Age
- Alcohol consumption
- Altitude
- Dehydration
- Diurnal variation
- Exercise
- Medications and medical treatment
- Fasting
- Patient sex
- Posture
- Pregnancy
- Obesity
Frequent causes of hemolysis?
- Using a needle smaller than 23 gauge
- Using a small needle with a large vacuum tube
- Using a small needle to transfer blood from syringe to tube
- Mishandling and improper transport of specimen
- Readjustment of the needle in the vein
What can cause a specimen to be rejected?
- Improper or inadequate identification
- Hemolysis
- Incorrect tube for the test ordered
- Tubes past their expiration date
- Inadequate ratio of blood to additive
- Insufficient volume for testing (QNS or NSQ)
- Drawing a specimen at the wrong time
- Contaminated specimen
- Improper handling
- Bringing a sample to the laboratory outside the appropriate time frame
What does the tourniquet do to the veins?
Impedes venous blood flow, resulting in dilation of the vein
What is the major duty of a phlebotomist and what is important about their responsibilities?
Obtain consent,
Select appropriate supplies
Prepare collection site
Collect sample while ensuring patient comfort and safety
Label samples correctly and transport
Proper tube labelling has 7 steps, what are they?
- Last name, First name
- PHN or MRN
- Date of Birth (DOB) (DD-MMM-YYYY)
- M/F/X
- Tests requested
- Date and Time of collection
- Your Initials
