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Certified Medical Assistant > Module 12: Phlebotomy > Flashcards

Module 12: Phlebotomy Flashcards

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USMLE® Step 1 flashcards
1
Q

phlebotomy

A

withdrawal of blood from a vein

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2
Q

first step of phlebotomy procedure

A

obtaining provider’s orders

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3
Q

required items on phlebotomy order

A
  • ordering provider
  • test and test code (unique to each lab)
  • diagnosis code that correlates with tests (ICD-10)
  • special specimen requirements (ex: fasting)
  • pt demographics
  • insurance or billing information
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4
Q

laboratory reference manual

A

provides all info needed for testing

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5
Q

why are timed specimens crucial

A

for therapeutic drug level monitoring to confirm pt medication dosage and compliance

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6
Q

factors to consider when performing phlebotomy

A
  • basal state
  • fasting status
  • condition of venipuncture site
  • menstrual cycle
  • edema
  • current meds
  • infections
  • vomiting
  • pregnancy
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7
Q

when should you evaluate alternative venipuncture location

A
  • veins are sclerotic
  • skin is scarred
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8
Q

effects of stress

A
  • elevation in WBC
  • decrease in iron levels
  • abnormal hormone levels
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9
Q

hemoconcentration

A

occurs if tourniquet is left on longer than 1 min

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10
Q

what info should you verify against requisition with every phlebotomy procedure to minimize errors and ensure proper collection

A
  • provider’s order
  • pt identity
  • labeling of specimens
  • identification number of specimens
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11
Q

what should you do prior to phlebotomy procedure

A
  • identify pt
  • verify pt followed any preparation instructions (ex: fasting)
  • question pt about anxiety/comfort level and previous blood draws
  • explain procedure
  • assemble equipment
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12
Q

vasovagal response

A
  • fainting due to body overreacting to certain triggers
  • sight of blood, extreme emotional distress
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13
Q

phlebotomy supplies

A
  • gloves
  • tourniquet
  • isopropyl alcohol wipes or nonalcohol prep kits/swabs (blood cultures)
  • nonsterile gauze
  • cohesive wrap or paper tape
  • double pointed needed, butterfly needle, or sterile syringe
  • blood collection tube or capillary tube
  • lab requisition and labels
  • ice or chemical cold packs
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14
Q

what should you ask a pt before getting gloves and a tourniquet

A

if they’re allergic to latex

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15
Q

what skin prep is used for blood draws

A
  • nonalcohol prep kits or swabs
  • can be povidone-iodine or chlorhexidine gluconate swabs
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16
Q

when is a butterfly needle used

A
  • for weak or fragile veins prone to collapse
  • hand draws
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17
Q

vacuum tube

A
  • blood collection tube
  • sterile glass or plastic tube with vacuum inside
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18
Q

why must tubes be drawn in a specific order

A

to avoid cross-contamination of additives

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19
Q

venipuncture site for newborns to 12 months

A
  • heel stick
  • capillary blood specimen
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20
Q

venipuncture site for 1 yr to 2 yr

A
  • finger stick
  • capillary samples
  • traditional venipuncture for extensive testing
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21
Q

what medical conditions restrict venipuncture sites

A
  • fistulas
  • ports
  • mastectomy
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22
Q

preferred venipuncture sites

A
  • veins in antecubital space
  • median cubital vein
  • cephalic vein
  • basilic vein
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23
Q

other venipuncture sites

A
  • hand
  • wrist
  • foot
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24
Q

when should blood draws from the foot be performed

A
  • only under supervision of physician
  • due to risk of DVT
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25
Q

median cubital vein

A
  • center of antecubital space
  • most common vein for phlebotomy procedures
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26
Q

cephalic vein

A
  • lateral antecubital space
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27
Q

basilic vein

A
  • medical antecubital space
  • superficial to brachial artery
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28
Q

vein changes in older pts

A
  • changing skin integrity
  • losing vein elasticity
  • venous insufficiency
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29
Q

when are veins prone to roll

A

with loss of venous sufficiency

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30
Q

effect of veins losing elasticity of venipuncture

A
  • fragile veins
  • easily damaged by venipuncture
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31
Q

position of pt with fainting history during phlebotomy procedure

A
  • semi-fowler’s
  • laying down
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32
Q

arm position during phlebotomy procedure

A
  • arm extended
  • palm facing upward
33
Q

what hand should phlebotomy needle be in

A

dominant hand

34
Q

where should supplies be set up during venipuncture

A

opposite side of dominant hand

35
Q

where should sharps container be placed during venipuncture

A
  • side of dominant hand
  • disposal without crossing needle over the body
36
Q

how to cleanse venipuncture site

A
  • 70% alcohol pads
  • circles starting from middle and moving outwards
  • let skin air dry
37
Q

evacuated tube method

A
  • most commonly used technique
  • straight double-ended needle
38
Q

syringe method

A
  • not commonly performed in ambulatory care setting
  • same needle for injections used
  • sterile syringe from 3 cc to 20 cc
  • requires blood transfer system to vacuum tubes
39
Q

butterfly method

A
  • winged infusion
  • smaller or fragile veins
  • typically smaller gauge (25 to 26)
  • long thin tubing between needle and attachment point on the sleeve
  • tubing minimizes pressure on vein from tube suction
40
Q

needle gauge for evacuated tube method

A

21 or 22

41
Q

when should you engage the needle safety

A

immediately after completing the procedure

42
Q

hemolysis

A
  • rupture of RBC
  • caused by performing phlebotomy with too small needle gauge or shaking blood tubes too hard
43
Q

where should you apply tourniquet

A

3 to 4 in above venipuncture site

44
Q

length of time tourniquet can be on

A

1 min max

45
Q

what can extended tourniquet time cause

A
  • pt discomfort
  • accumulation of platelets in restricted veins
  • nerve damage
46
Q

how long does it take for blood flow to return to normal after removing the tourniquet

A

2 mins

47
Q

where and how should you anchor the vein

A
  • 1 in below draw site
  • hold skin taught
48
Q

how to insert needle for venipuncture

A
  • bevel up
  • 15 to 30 degrees
  • smooth and deliberately
49
Q

when should you release tourniquet

A

when blood flow is established in last tube

50
Q

how to minimize bruising after phlebotomy

A
  • hold arm straight
  • apply pressure and elevate for 2 mins
51
Q

why is it important to allow tubes to fill completely

A
  • to have correct blood to additive ratio
  • accurate testing
52
Q

when should you label blood draw tube

A

after finishing blood draw

53
Q

what happens if you apply to much force on plunger during syringe method

A

vein collapse

54
Q

considerations when using butterfly method

A
  • takes longer than traditional method
  • pay attention to tourniquet time and number of tubes needed
55
Q

tube inversions

A
  • turn upside down and return to upright position
  • 3 to 10 times according to manufacturers instructions
  • mixes in additive
  • do not shake, can cause hemolysis
56
Q

when are capillary punctures used

A
  • when only small amount of blood is needed for testing
  • when immediate results are requried
57
Q

what is capillary blood

A
  • mixture of blood from arterioles, venules, capillaries, and intracellular and interstitial fluids
58
Q

capillary puncture supplies

A
  • nonsterile gloves
  • automatic retractable lancets
  • disinfectant pads, 70% isopropyl alcohol
  • gauze pads
  • bandage wraps
  • micropipette
  • blood collection device for specific test
  • biohazard sharps container
59
Q

types of capillary blood collection devices

A
  • small glass tube (capillary tube)
  • micro collection tube
  • glass microscope slide
  • reagent strip
  • screening card or paper
  • plastic testing cartridge or cassette
60
Q

preferred capillary puncture site for adults and children

A
  • middle or ring finger of nondominant hand
  • slightly off-center
61
Q

preferred capillary puncture site for infants

A
  • outer edge of underside of the heel
62
Q

prepare capillary puncture site

A
  • warm pt hands
  • 70% isopropyl alcohol pad, allow to air dry
63
Q

performing capillary puncture

A
  • hold finger firmly but gently
  • hold lancet at right angle
  • activate lancet and put in sharps
  • wipe away first drop of blood due to contamination with tissue fluids
  • apply gentle pressure to get blood to flow
  • apply gauze and pressure to site
64
Q

order of draw for microcapillary tubes

A
  • blood gases
  • EDTA tubes
  • other additive tubes
  • serum tubes
65
Q

how long should pt leave bandage on after venipuncture

A

15 mins

66
Q

what symptoms should to pt notify the clinic of after venipuncture

A
  • reoccurrence of bleeding from the site
  • radiating pain
  • dizziness
67
Q

what should you do prior to handling any specimen

A

apply PPE

68
Q

why is time management crucial in processing of specimens

A
  • after collection the specimen will start to break down
  • testing cannot be done after excessive time has passed
69
Q

centrifugation of blood specimens

A
  • blood collection tubes rotate at high speed
  • heavier elements pulled to bottom, lighter elements pulled to top
70
Q

how long should serum specimens clot prior to centrifugation

A

30 mins

71
Q

how to balance centrifuge

A
  • place tubes across from each other to balance weight
72
Q

aliquot

A
  • single specimen must be divided into multiple tubes for testing on different equipment
  • use single-use pipette
72
Q

why do most lab errors occur

A

mislabeling of specimens

73
Q

what should you add to lab requisition form after venipuncture

A
  • date and time sample was taken
  • your initials
  • any specific considerations or concerns regarding the sample
74
Q

info on specimen labels

A
  • pt name
  • unique identification number
  • date of collection
  • time of collection
  • initials of person who collected specimen
75
Q

who picks up samples for outside labs

A

courier service

76
Q

how should specimens be stored

A
  • clearly marked biohazard bag
  • some need to be stored at certain temps
  • some need to be wrapped in foil for light sensitivity
77
Q

what should you do when you receive lab results

A
  • forward to ordering provider for review
  • notify pts of their results or schedule follow-up appointments after provider review

Certified Medical Assistant (40 decks)

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