Module 12: Phlebotomy Flashcards
phlebotomy
withdrawal of blood from a vein
first step of phlebotomy procedure
obtaining provider’s orders
required items on phlebotomy order
- 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
laboratory reference manual
provides all info needed for testing
why are timed specimens crucial
for therapeutic drug level monitoring to confirm pt medication dosage and compliance
factors to consider when performing phlebotomy
- basal state
- fasting status
- condition of venipuncture site
- menstrual cycle
- edema
- current meds
- infections
- vomiting
- pregnancy
when should you evaluate alternative venipuncture location
- veins are sclerotic
- skin is scarred
effects of stress
- elevation in WBC
- decrease in iron levels
- abnormal hormone levels
hemoconcentration
occurs if tourniquet is left on longer than 1 min
what info should you verify against requisition with every phlebotomy procedure to minimize errors and ensure proper collection
- provider’s order
- pt identity
- labeling of specimens
- identification number of specimens
what should you do prior to phlebotomy procedure
- identify pt
- verify pt followed any preparation instructions (ex: fasting)
- question pt about anxiety/comfort level and previous blood draws
- explain procedure
- assemble equipment
vasovagal response
- fainting due to body overreacting to certain triggers
- sight of blood, extreme emotional distress
phlebotomy supplies
- 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
what should you ask a pt before getting gloves and a tourniquet
if they’re allergic to latex
what skin prep is used for blood draws
- nonalcohol prep kits or swabs
- can be povidone-iodine or chlorhexidine gluconate swabs
when is a butterfly needle used
- for weak or fragile veins prone to collapse
- hand draws
vacuum tube
- blood collection tube
- sterile glass or plastic tube with vacuum inside
why must tubes be drawn in a specific order
to avoid cross-contamination of additives
venipuncture site for newborns to 12 months
- heel stick
- capillary blood specimen
venipuncture site for 1 yr to 2 yr
- finger stick
- capillary samples
- traditional venipuncture for extensive testing
what medical conditions restrict venipuncture sites
- fistulas
- ports
- mastectomy
preferred venipuncture sites
- veins in antecubital space
- median cubital vein
- cephalic vein
- basilic vein
other venipuncture sites
- hand
- wrist
- foot
when should blood draws from the foot be performed
- only under supervision of physician
- due to risk of DVT
median cubital vein
- center of antecubital space
- most common vein for phlebotomy procedures
cephalic vein
- lateral antecubital space
basilic vein
- medical antecubital space
- superficial to brachial artery
vein changes in older pts
- changing skin integrity
- losing vein elasticity
- venous insufficiency
when are veins prone to roll
with loss of venous sufficiency
effect of veins losing elasticity of venipuncture
- fragile veins
- easily damaged by venipuncture
position of pt with fainting history during phlebotomy procedure
- semi-fowler’s
- laying down
arm position during phlebotomy procedure
- arm extended
- palm facing upward
what hand should phlebotomy needle be in
dominant hand
where should supplies be set up during venipuncture
opposite side of dominant hand
where should sharps container be placed during venipuncture
- side of dominant hand
- disposal without crossing needle over the body
how to cleanse venipuncture site
- 70% alcohol pads
- circles starting from middle and moving outwards
- let skin air dry
evacuated tube method
- most commonly used technique
- straight double-ended needle
syringe method
- 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
butterfly method
- 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
needle gauge for evacuated tube method
21 or 22
when should you engage the needle safety
immediately after completing the procedure
hemolysis
- rupture of RBC
- caused by performing phlebotomy with too small needle gauge or shaking blood tubes too hard
where should you apply tourniquet
3 to 4 in above venipuncture site
length of time tourniquet can be on
1 min max
what can extended tourniquet time cause
- pt discomfort
- accumulation of platelets in restricted veins
- nerve damage
how long does it take for blood flow to return to normal after removing the tourniquet
2 mins
where and how should you anchor the vein
- 1 in below draw site
- hold skin taught
how to insert needle for venipuncture
- bevel up
- 15 to 30 degrees
- smooth and deliberately
when should you release tourniquet
when blood flow is established in last tube
how to minimize bruising after phlebotomy
- hold arm straight
- apply pressure and elevate for 2 mins
why is it important to allow tubes to fill completely
- to have correct blood to additive ratio
- accurate testing
when should you label blood draw tube
after finishing blood draw
what happens if you apply to much force on plunger during syringe method
vein collapse
considerations when using butterfly method
- takes longer than traditional method
- pay attention to tourniquet time and number of tubes needed
tube inversions
- 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
when are capillary punctures used
- when only small amount of blood is needed for testing
- when immediate results are requried
what is capillary blood
- mixture of blood from arterioles, venules, capillaries, and intracellular and interstitial fluids
capillary puncture supplies
- nonsterile gloves
- automatic retractable lancets
- disinfectant pads, 70% isopropyl alcohol
- gauze pads
- bandage wraps
- micropipette
- blood collection device for specific test
- biohazard sharps container
types of capillary blood collection devices
- small glass tube (capillary tube)
- micro collection tube
- glass microscope slide
- reagent strip
- screening card or paper
- plastic testing cartridge or cassette
preferred capillary puncture site for adults and children
- middle or ring finger of nondominant hand
- slightly off-center
preferred capillary puncture site for infants
- outer edge of underside of the heel
prepare capillary puncture site
- warm pt hands
- 70% isopropyl alcohol pad, allow to air dry
performing capillary puncture
- 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
order of draw for microcapillary tubes
- blood gases
- EDTA tubes
- other additive tubes
- serum tubes
how long should pt leave bandage on after venipuncture
15 mins
what symptoms should to pt notify the clinic of after venipuncture
- reoccurrence of bleeding from the site
- radiating pain
- dizziness
what should you do prior to handling any specimen
apply PPE
why is time management crucial in processing of specimens
- after collection the specimen will start to break down
- testing cannot be done after excessive time has passed
centrifugation of blood specimens
- blood collection tubes rotate at high speed
- heavier elements pulled to bottom, lighter elements pulled to top
how long should serum specimens clot prior to centrifugation
30 mins
how to balance centrifuge
- place tubes across from each other to balance weight
aliquot
- single specimen must be divided into multiple tubes for testing on different equipment
- use single-use pipette
why do most lab errors occur
mislabeling of specimens
what should you add to lab requisition form after venipuncture
- date and time sample was taken
- your initials
- any specific considerations or concerns regarding the sample
info on specimen labels
- pt name
- unique identification number
- date of collection
- time of collection
- initials of person who collected specimen
who picks up samples for outside labs
courier service
how should specimens be stored
- clearly marked biohazard bag
- some need to be stored at certain temps
- some need to be wrapped in foil for light sensitivity
what should you do when you receive lab results
- forward to ordering provider for review
- notify pts of their results or schedule follow-up appointments after provider review
