Med. Lab Procedures - Module 1&2 Flashcards
What is phlebotomy?
The practice of drawing blood
What did the earliest phlebotomists draw blood for?
To cure disease and maintain a state of wellness in the body
Why do phlebotomists practice today?
diagnosis and monitoring treatment of disease conditions
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
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
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 colour tube can an iron deficiency test(ferritin) be done in?
(FER)
Gold or Green
What colour tube would you use for a hematology profile blood draw?
(CBC) (HP)
Lavender
What colour tube would you use for an INR test?
(INR) (PT) (PTT)
Light Blue
What colour tubes do you use for glucose chemistry testing?
Fasting = Green (Island Health)
Random - Gold (Life Labs)
Hemoglobin A1C (HGA1/A1C) - Lavender
When testing electrolytes what colour tube would you use?
Na, K+, ALB, ALP/ALK, ALT, BILI, GGT, TP, Crea, Ca, CK
Green (Island Health)
Gold (Life Labs)
If you were doing a screening panel for suspected prostate cancer what colour tube should you use?
Gold
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 is the order of draw?
1 - Blood Cultures (sterile) -
2 - Light Blue (sodium citrate) for coagulation studies don’t want to get heparin or EDTA in these tubes
3 - Red (No additive)
4 - Gold (SST)
5 - Green (Heparin)
6 - Lavender (EDTA)
7 - Grey (sodium fluoride)
What is used on non living objects to reduce the risk of infection?
Disinfectants
What is used on living skin to reduce the risk of infection?
Antiseptic
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 parts named?
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 is whole blood?
Blood collected and mixed with an anticoagulant so it’s unclotted.
What is serum?
Fluid portion of blood that remains AFTER clotting
Clotting begins 30-60 minutes after it’s been drawn
Does NOT contain fibrinogen & other clotting factors
What is plasma?
Fluid portion of the blood
INCLUDES fibrinogen & other clotting factors
obtained by ADDING an anticoagulant before centrifuging
What additives bind to calcium inhibiting coagulation of the blood?
EDTA, sodium and potassium
~ Sodium Citrate
~ Potassium Oxalate
~ Sodium Polyanethol Sulfonate (SPS) - used for blood cultures
These PREVENT clotting; anticoagulants
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
What is osteochondritis?
Inflammation of the bone or cartilage
What is osteomyelitis?
bone infection
What is the recommended puncture depth for preemies getting a capillary collection done?
.65mm - .85mm
The lancet should not penetrate deeper than _____
3mm
Why is a heel lancet depth different than a finger depth for capillary collection?
Because the heel bone is close to the surface
heel 2mm
finger 3mm
What is the order of draw for capillary collection
- Light blue
- Lavender
- Green
- Gray
- Gold
- Red
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 are common issues faced in transportation of samples?
Time
Temperature
Light
Chemistry specimen must be spun within what time frame?
2 hours
At the lab within 45 minutes to allow time to lab tech’s to spin and assess sample
Hematology specimen should be analyzed within what time if left unrefrigerated?
4 hours
If it’s refrigerated it’s 12 hours
How long do you wait for clotting before centrifuging an SST ?
30 - 60 minutes
How long do you wait for clotting before centrifuging a Red tube?
Minimum 60 minutes
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 is the purpose of a vacutainer holder?
Needle and tube holder
To prevent accidental pokes from the tube needle
What does the tourniquet do to the veins?
Impedes venous blood flow, resulting in dilation of the vein
Why do we use different needle gauges?
Type of collection, patient condition, size of vein
Different procedures - hand, vein, foot, antecubital fossa etc.
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
