Module 3E: Phlebotomy Flashcards

1
Q

Phlebotomy

A

The process of withdrawing blood from a vein for laboratory testing

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2
Q

When having blood work for a lipid panel, how can eating a meal prior to having blood drawn affect blood test results?

A

Patients should fast prior to having a lipid panel. If the patient ate a meal prior to having blood drawn, the test values would likely detect fats from the food and the results would indicate elevated lipid levels.

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3
Q

Fasting

A

The absence of eating food and sometimes drinking.

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4
Q

Laboratory directory

A

A catalog of information regarding laboratory tests with up-to-date test menus; testing information; specimen collection requirements; and storage, preservation, and transportation guidelines.

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5
Q

Patient positioning for blood draw

A
  1. Seat the patient in a comfortable, well-lit area.
  2. Position the patient with their arm extended out. If a phlebotomy chair with an extended arm rest is not available, have the patient make a fist with the opposite hand and place it behind the elbow of the arm being used for the procedure. This ensures the arm will stay straight and stable during the procedure.

For pediatric patients, a support person could assist in holding the patient’s arm still to avoid injury. Effective communication and accurate skills are necessary when dealing with children.

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6
Q

What is the first step to beginning any phlebotomy procedure?

A

Obtaining the provider’s order for laboratory testing. Review the provider’s order for blood work to determine what tests need to be completed. Venipuncture procedures should not be performed on patients without a provider’s order.

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7
Q

Laboratory requisition form includes….

A
  • Ordering provider’s name and contact information
  • Test and test code (unique to each lab, usually on the requisition or in the laboratory reference manual)
  • Diagnosis code that correlates with the tests being ordered (ICD-10)
  • Special specimen requirements, such as fasting
  • Patient demographics
  • Insurance or other billing information
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8
Q

Supplies and equipment needed for blood draws

A

Vary depending on what type of venipuncture procedure is being performed. In general, supplies needed include the following.

Alcohol wipes
Gauze
Adhesive bandages
Biohazard sharps container
PPE, including disposable gloves
Tourniquet
Collection tubes
Needle system

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9
Q

3 Types of Needle System

A
  1. Evacuated System
  2. Winged Infusion Set, or Butterfly System
  3. Needle Syringe System
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10
Q

Evacuated Needle System

A

This is the most commonly used system.

This system consists of a double-pointed needle, a plastic needle holder/adapter, and collection tubes.

The collection tube system creates a slight vacuum that helps transport the blood from the vein into the collection tube when penetrated.

Using this method helps to obtain multiple tubes of blood with one venipuncture stick.

Vacutainer needles are typically 20 to 22 gauge with a needle length of ¾ inch to 1 ½ inches. The length and gauge of the needle will depend on perceived depth of the vein and the size of the patient.

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11
Q

Butterfly Needle System (Winged Infusion Set)

A

The winged infusion set consists of flexible wings attached to a needle with 5 to 12 inches of flexible tubing that connects the needle to the collection device.

This method is best used for patients who have small or fragile veins. This technique tends to cause less trauma or bruising to the patient.

Butterfly needles are typically 21 to 23 gauge with a needle length of ½ to ¾ inch. The length of the needle will depend on the size of the patient.

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12
Q

Needle Syringe System

A

A needle and syringe can be used to draw blood from a vein.

This is not ideal because only a small amount of blood can be obtained with this method.

One advantage is the amount of suction can be controlled by the plunger of the syringe instead of the vacuum method.

Generally, a 16-gauge injection needle and syringe are used with this method.

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13
Q

Parts of the Needle

A
  • Lumen: hollow space inside the needle. Also referred to as the gauge. The larger the gauge number, the smaller the diameter.
  • Bevel: shaft at the end of the needle that creates a point.
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14
Q

Arranging Supplies For Blood Draw

A

All necessary phlebotomy supplies, including the sharps container for needle disposal, should be within reach.

During the procedure, hold the needle in the dominant hand and avoid switching hands once the skin has been penetrated.

This will require the remaining supplies be set up on the opposite side of the dominant hand. Arrange the supplies in the order needed to use them, including placing the tubes in the correct order of draw. Whenever possible, place the sharps container on the dominant side as well.

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15
Q

Components of blood

A

plasma, white cells, red cells, and platelets

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16
Q

Plasma

A

The liquid portion of the blood; mainly made of water; contains proteins, electrolytes, gases, some nutrients, and waste products; is required to recover from injury, distribute nutrients, and remove waste from the body.

The liquid portion of the blood obtained after centrifuging. The blood specimen must be collected in a tube containing anticoagulant. There will be three layers after the sample has been centrifuged: plasma (top layer), buffy coat (middle layer), and red blood cells (bottom layer). ​​​​​​​

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17
Q

White Blood Cells

A

Responsible for defending the body against bacteria and viruses

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18
Q

Red Blood Cells

A

Responsible for carrying oxygen to the tissues throughout the body and carbon dioxide from the body to the lungs.

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19
Q

Platelets

A

Responsible for limiting the loss of blood when a blood vessel is damaged or leaking.

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20
Q

Serum

A

​​​​​​​The liquid portion of the blood obtained after a serum sample tube has clotted and centrifuged.

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21
Q

Clotted Blood

A

This is obtained when blood is drawn in a tube that does not contain an anticoagulant.

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22
Q

Whole Blood

A

Obtained when a tube is used with an anticoagulant, which inhibits blood clotting.

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23
Q

Order of Draw for Venipuncture

A
  1. Yellow top tube or blood culture bottles
  2. Light blue
  3. Red
  4. Red/gray marbled
  5. Green
  6. Green/gray marble
  7. Lavender
  8. Gray
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24
Q

Why is draw order of vacuum tubes important?

A

The order of blood tube draw is critically important to avoid errors. During the blood draw process, the additive from one tube can carry over to another and affect test results.

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25
Q

Yellow Top Tube

A

Additive: Sodium polyanethol sulfonate; prevents blood from clotting and stabilizes bacterial growth

Laboratory Use: Blood or body fluid cultures

Number of Inversions: N/A

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26
Q

Light Blue Top Tube

A

Additive: Sodium citrate; removes calcium to prevent blood from clotting

Laboratory Use: Coagulation testing

Number of Inversions: 3 to 4

27
Q

Red Top Tube

A

Additive: None

Laboratory Use: Serum test; chemistry studies; blood bank; immunology

Number of Inversions: 5

28
Q

Red/Gray Marbled Top Tube

A

Additive: No anticoagulant but contains silica particles to enhance clot formation; use for serum separation

Laboratory Use: Serum test; chemistry studies; immunology

Number of Inversions: 5

29
Q

Green Top Tube

A

Additive: Heparin: inhibits thrombin formation to prevent clotting

Laboratory Use: Chemistry test

Number of Inversions: 8

30
Q

Green/Gray Marbled Top Tube

A

Additive: Lithium heparin and gel; for plasma separation

Laboratory Use: Plasma determinations in chemistry studies

Number of Inversions: 8

31
Q

Lavender Top Tube

A

Additive: Ethylenediaminetetraacetic acid (EDTA); removes calcium to prevent blood from clotting

Laboratory Use: Hematology test

Number of Inversions: 8

32
Q

Gray Top Tube

A

Additive: Potassium oxalate and sodium fluoride; removes calcium to prevent blood from clotting; fluoride inhibits glycolysis

Laboratory Use: Chemistry testing, especially glucose and alcohol levels

Number of Inversions: 8 to 10

33
Q

Antecubital space

A

The inner or front surface of the forearm at the elbow.

Contains the the cephalic vein (lateral), median cubital vein, and basilic veins (medial).

Preferred vein is the median cubital vein as this area tends to cause less pain and this vein is the least likely to roll during the procedure.

34
Q

Determining venipuncture site

A
  1. Have the patient extend an arm out and straighten the elbow.
  2. Always inspect both arms.
  3. Palpate the antecubital area by pushing up and down on the patient’s skin. Veins have a bouncy feel.
  4. The size, depth, and direction of the vein should be determined.
  5. Veins that are highly visible but do not have bounce to them should be avoided, as a successful draw is unlikely.
35
Q

Tourniquet Application

A

A tourniquet should be applied to the patient’s arm about 3 to 4 inches above the draw site to make the vein easier to palpate and more readily accessible for the blood draw. This is because it impairs blood flow.

36
Q

Tourniquet Side Effects/Cautions

A
  • They should be placed snuggly, but not so tightly that blood flow is completely stopped or severe pain is caused.
  • Leaving the tourniquet on longer than 1 min can cause hemoconcentration and alter test results.
  • The tourniquet should be placed while the phlebotomist is palpating and selecting a site, but then should be removed until it is time to begin the procedure.
37
Q

Hemoconcentration

A

An increase of formed elements of the blood and a decrease of fluid content.

38
Q

Tourniquet Site Restrictions

A
  • Avoid selecting site locations with scar tissue, injuries, burns, or wounds.
  • Avoid drawing blood from the same side of the body in which fistulas, ports, or mastectomy are present.
39
Q

Skin Integrity and Venous Sufficiency In Older Adults

A

Older adult patients have concerns due to physiological changes including muscular atrophy, which changes the integrity of the skin; veins that have lost their elasticity; and venous insufficiency.

With loss of venous sufficiency, veins are prone to roll, meaning the needle pushes the vein over rather than puncturing it as intended.

When veins lose elasticity, they are fragile and easily damaged by venipuncture. The need to draw blood from the hand increases with older adults.

40
Q

Preparing Site for Venipuncture

A
  1. Cleanse the site with antiseptic, wiping in an upward-and-downward motion with friction.
  2. Allow the site to air-dry
  3. Reapply the tourniquet after the site is dry
  4. Avoid touching the site again after cleansing, even with gloves on. Avoid blowing on the area or waving hands over it to dry the alcohol faster, as this can contaminate the skin.
41
Q

Preforming Venipuncture

A
  1. Anchor the vein by grasping the skin firmly about 2 to 3 inches below the puncture location, holding the skin taut. This ensures the vein is stabilized.
  2. a) When drawing from the arm, insert the needle smoothly and quickly at about a 15- to 30-degree angle depending on the depth and position of the vein.
    b)When drawing from the patient’s hand, the correct angle of insertion is lower, about 10 to 15 degrees, as the veins in the hand are smaller and thinner. The bevel of the needle should be facing upward.
  3. Once the needle is in place, with the nondominant hand, insert the evacuated stopper tube into the needle holder until blood flow is established. Watch the needle and avoid any additional movement of the needle.
  4. Once proper blood flow is established, release the tourniquet with the nondominant hand.
  5. When the tube has exhausted the vacuum and the tube is full, remove the tube, gently inverting as necessary. If more than one tube is required, fill up the remaining tubes using the correct order of draw.
  6. Once all needed tubes are full and inverted as needed, apply the gauze over the needle with the nondominant hand, not applying pressure until the needle is out of the patient’s arm.
  7. With the dominant hand, close the needle safety guard and dispose of the needle in the biohazard sharps container.
42
Q

Capillary punctures

A

The method of acquiring blood from a fingertip or heel.

This procedure is also commonly referred to as a fingerstick.

Performed when only a small amount of blood is needed for testing or when immediate results can be acquired.

43
Q

Capillary blood

A

Mixture of blood from arterioles, venules, capillaries, and intracellular and interstitial fluids.

44
Q

Capillary Puncture Supplies

A
  • Gloves
  • Automatic retractable lancet
  • Disinfectant pads, such as 70% isopropyl alcohol
  • Clean gauze pads
  • Bandage
  • Blood collection device appropriate for the test such as:
    Micropipette
    Small glass tube (capillary tube)
    Micro-collection devices
    Glucometer and testing strip
    Screening card or paper
    Plastic testing cartridge or cassette
  • Capillary tube sealer (when capillary tubes are used) ​​​​​​​
  • Biohazard sharps container
45
Q

Lancet

A

A small blade with sharp point.

46
Q

Micro-collection devices

A

Small plastic tubes designed to collect capillary blood.

47
Q

Location of Capillary Punctures for Adults

A

Middle or ring finger of the nondominant hand (preferred)

Perform the puncture slightly off-center, avoiding the central fleshy part of the fingertip, fingernail, and nail bed.

48
Q

Location of Capillary Punctures for Infants

A

Outer edge of the underside of the heel

49
Q

Where is it Never ok to Perform A Capillary Puncture on Infants?

A

Never perform capillary puncture on the finger of an infant, as risk of damage to the bone is high.

50
Q

Preparing the Site for Capillary Puncture

A

Cleanse the area with a 70% isopropyl alcohol pad and allow the site to air-dry completely.

Avoid touching the site after cleaning.

51
Q

Factors That Affect Capillary Puncture

A

For the procedure to be successful, the capillaries must have good blood flow.

If the patient’s hands are cold, the capillaries are somewhat constricted, and it can be difficult to collect enough blood.

Warm the patient’s hands prior to the procedure by having the patient rub them together or run them under warm water.

For infants, heel warmers can be used on the infant’s heel prior to performing the puncture.

52
Q

Performing Capillary Puncture

A
  1. Hold the patient’s finger between your thumb and forefinger firmly but gently.
  2. Hold the lancet device in your dominant hand and at a right angle to the desired puncture site on the patient’s finger or heel.
  3. Activate the spring or trigger system on the lancet and discard the used lancet into a sharps container immediately.
  4. Wipe away the first drop of blood unless performing a prothrombin time (PT) test. This is to obtain a clean sample without any tissue or fluid contaminants.
  5. Collect the required amount of blood. If the blood is slow to flow, a gentle pressure and rubbing can be applied to the patient’s finger.
53
Q

Order of Draw for Microcapillary Tubes

A
  1. Blood gases
  2. EDTA tubes
  3. Other additive tubes
  4. Serum tubes
54
Q

Bandaging Procedures

A

Following phlebotomy or capillary puncture, apply a gauze pad over the puncture site with pressure until the bleeding stops. The arm should be extended and elevated above the level of the heart if needed. Once bleeding has stopped, apply a clean gauze pad and bandage to the area.

Instruct patients to leave the bandaging in place for a minimum of 15 min.

54
Q

Processing Requirements Prior to Lab Transportation

A
  1. Ensure all tubes are labeled
  2. Serum must be allowed to stand upright at room temperature for 30 to 45 min before being centrifuged. This allows the blood to clot, which produces more serum from the specimen. However, blood specimens should not be allowed to stand for longer than 1 hour. This will cause leaching of substance changes and changes to the integrity of the serum.
  3. Clotted blood must stand upright at room temperature for 30 to 45 min.
54
Q

Preanalytical Errors

A

Consist of errors that can occur prior, during, or immediately after performing the venipuncture procedures.

Ex: mislabeling of specimens, errors in patient identification, mislabeling of specimen tubes, sample collection errors, insufficient quantity for testing, and incorrect handling or transporting processes.

55
Q

Postanalytical Errors

A

Consist of erroes that can occur after the specimen has been processed.

Ex: failure in reporting results, improper data entry, or misinterpretation of results.

56
Q

Glucose tolerance test (GTT)

A

Test process that evaluates glucose levels over time to assess for diabetes by measuring the body’s response to sugar.

*type of timed specimen collection

57
Q

Centrifuge

A

During centrifugation of blood specimens, the blood collection tubes rotate at a high rate of speed. This causes heavier elements within the specimen to be pulled to the bottom of the tube, separating from the lighter specimen elements at the top. ​​​​​​​

58
Q

Centrifuge Factors

A
  • Speed
  • Amount of time
  • Weight: The weight in the centrifuge must always be balanced. If multiple tubes of blood need to be spun, place tubes of the same size and containing similar amounts of blood across from one another. If there is only one specimen tube to spin or there are differences in the size and/or fill of the tubes to be spun, balance can be achieved by filling empty tubes with water and placing them across from the specimen tubes in the centrifuge. This ensures balanced weight distribution while the centrifuge is in motion.
  • Serum specimens must clot prior to centrifugation.
59
Q

Aliquot Samples

A

Occurs when a single specimen must be divided into multiple tubes for testing on different equipment.

  1. Use a single-use pipette for transfer of the serum from one tube to another.
  2. When transferring blood in the physician’s office laboratory (POL) between containers, wear face and eye protection and use a tube rack for holding the tubes upright during the transfer.
  3. Never pour blood specimens from one container to another.
  4. Always use a disposable pipette to avoid splashing and spills.
  5. Label the tubes appropriately.
60
Q

Calibration

A

Medical equipment can require calibration depending on use, working order, or manufacturer requirements.

Avoid using equipment that is overdue for calibration to prevent errors or accidents.

If a piece of equipment is overdue for calibration, notify the office manager or lab supervisor and place the unit out of service until it has been calibrated.

61
Q

Requirements for Specimen Transportation

A
  • Specimen bags should be leakproof and free from punctures or tears to ensure the safety of the transporter while handling the specimen bags.
  • Each tube must be labeled with the appropriate laboratory requisition with the patient’s name and identification information and contained within the same biohazard bag to process the specimens
  • Use a separate biohazard bag for each patient’s specimens.