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Phlebotomy > Module 4: Routine Blood Collections > Flashcards

Module 4: Routine Blood Collections Flashcards

1
Q

venipuncture

A
  • collection of blood from veins
  • usually antecubital area or dorsal part of hand
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2
Q

dermal puncture

A
  • aka: capillary collection, finger stick
  • collection of blood from capillaries on finger or heel
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3
Q

how to ensure accurate test results

A
  • use appropriate equipment
  • check expiration dates
  • inspect for manufacturer’s defects
  • ensure safety devices are intact
  • follow order of draw
  • correctly label all specimens
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4
Q

when should you assemble the equipment

A

before the tourniquet is placed

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5
Q

can you place phlebotomy equipment on the overbed tray in an inpatient setting

A
  • no
  • where pts tend to eat
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6
Q

most commonly used venipuncture method and equipment

A

evacuated tube system (ETS)

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7
Q

equipment for blood draws

A
  • gloves
  • alcohol pads
  • gauze pads
  • bandage
  • tourniquet
  • needle with safety device, 21 to 23 gauge, 1 to 1.5 in long, different for different methods
  • hub/needle holder for ETS and butterfly
  • blood collection tubes, syringe and transfer device for syringe method
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8
Q

can you use cotton balls instead of gauze

A
  • no
  • leave fibers on pt collection site
  • remove clot when removed from site
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9
Q

how much should you inflate a blood pressure cuff to act as a tourniquet

A

up to 40 mmHg

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10
Q

most common needle size for venipunture

A

21 gauge

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11
Q

ETS needle

A

double sided

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12
Q

how are adult and pediatric tubes different

A
  • adult tube size: 3 in long, 1/2 to 3/4 in wide
  • vacuum in adult tube is higher than pressure inside child blood vessels, using causing child vein to collapse
  • pediatric tubes are about half as big with less vacuum
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13
Q

purpose of colored stoppers on blood tubes

A
  • identify each tube
  • indicate which additive is contained inside
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14
Q

what info is on blood collection tube label

A
  • which additive is in the tube
  • expiration date
  • amount of blood tube will hold
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15
Q

what are anticoagulant tubes also called

A

plasma tubes

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16
Q

blood culture tube additive and use

A
  • sodium polyanethole sulfonate (SPS)
  • used for bacterial studies
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17
Q

light blue tube additive and use

A
  • sodium citrate
  • coagulation blood tests
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18
Q

green tube additive and use

A
  • sodium, lithium, or ammonia heparin
  • test chemical levels in the blood
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19
Q

purple/lavender tube additive and use

A
  • ethylenediaminetetraacetic acid (EDTA)
  • whole blood hematology determinations
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20
Q

gray tube additive and use

A
  • potassium oxalate/sodium fluoride
  • glucose determinations
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21
Q

royal blue tube additive and use

A
  • clot activator or EDTA
  • trace element testing
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22
Q

light yellow tube additive and use

A
  • acid citrate dextrose (ACD)
  • blood bank studies and DNA testing
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23
Q

red, gold, orange tube additive and use

A

-no additive if they are glass (silica in glass helps blood clot)
- plastic red and gold tubes have clot activator and are used for chemistry determinations
- orange tubes have thrombin-based clot activator and are used when the chemistry determination is for a stat blood collection

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24
Q

why are serum tubes used

A

blood tests that require the blood to clot

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25
Q

gel separator

A
  • doesn’t affect condition or quality of blood sample
  • assists in the processing of blood after centrifuged
  • called serum separator tube (SST) when in serum tube
  • called plasma separator tube (PST) when in plasma tube
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26
Q

when is the syringe method used

A
  • pts with fragile veins that collapse easily
  • manually adjust rate that blood is withdrawn
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27
Q

supplies specific to the syringe method

A
  • syringe (10-20 mL are most common)
  • 21 to 23 gauge needle, 1 to 1.5 in long, single-sided
  • transfer device
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28
Q

when is the butterfly method used

A
  • small veins, difficult to access
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29
Q

supplies specific to butterfly method

A

winged infusion set with 21-23 gauge needle that is 3/4 in long, flexible tubing, and another sterile needle on the opposite end to puncture collection tube

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30
Q

needle examination before removing from package

A

no rips or tears in package

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31
Q

needle examination before removing the cap

A
  • expiration date: refers to sterility of needle
  • label/seal
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32
Q

needle examination after removing the cap

A
  • safety device: attached firmly
  • bevel: not bent, broken, or burred
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33
Q

how many times can needles be used

A

once, even on the same pt

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34
Q

what circumstances make you avoid a site for a blood draw

A
  • mastectomy
  • tattoo
  • hematoma
  • edema
  • scars
  • sclerosed vein
  • IV
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35
Q

what must you do if you have to take blood from an arm that has an IV

A
  • may turn IV off for several minutes
  • collection below IV to prevent contamination of IV fluids with specimen
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36
Q

first choice vein

A
  • median cubital
  • firmly anchored in middle of arm
  • least painful
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37
Q

second choice vein (after median cubital)

A
  • cephalic
  • lateral
  • slightly more painful than median cubital
  • tends to be easiest to locate in obese pts
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38
Q

third choice vein (after cephalic)

A
  • accessible hand vein
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39
Q

fourth choice vein (after hand vein)

A
  • basilic
  • near radial nerve and brachial artery
  • never reposition needle
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40
Q

blood collection from infant

A
  • heel
  • not on any area with hematoma, recently accessed, cuts/scratches
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41
Q

dermal puncture site

A
  • middle and ring finger
  • nondominant hand
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42
Q

where should a tourniquet be applied

A

3 to 4 inches above the site

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43
Q

when should the tourniquet be removed and why

A
  • after 1 min
  • hemoconcentration risk
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44
Q

how to palpate for veins

A
  • start from middle of antecubital area and move to outside of arm
  • light pressure
  • use one finger, index or second finger of nondominant hand
  • use very tip of finger
  • vein: spongy and bouncy
  • tendon: hard, like bone
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45
Q

why should you palpate with your non-dominant hand

A

allows you to repalpate without switching hands if you miss

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46
Q

how to find veins

A
  • warm cloth
  • hang arm below heart level
  • small amount of rubbing
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47
Q

what to use to cleanse skin prior to venipuncture

A
  • 70% isopropyl alcohol wipe
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48
Q

how to cleanse skin prior to venipuncture

A
  • circular motions, starting at the center
  • minimum of three circles
  • do not rub up and down or side to side
  • allow alcohol to dry
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49
Q

replacements for alcohol when cleaning skin

A
  • chlorhexidine gluconate
  • povidone-iodine
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50
Q

cleansing site for blood culture collection

A
  • use alcohol and additional antiseptic (chlorhexidine gluconate or povidone-iodine)
  • clean for 30 to 60 seconds
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51
Q

cleansing skin for dermal puncture

A
  • rub area vigorously to remove microorganisms and increase blood flow
  • 70% isopropyl alcohol
  • allow to air dry
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52
Q

what can’t you use to cleanse a dermal puncture and why

A
  • povidone-iodine
  • adverse effect on results of bilirubin, uric acid, phosphorus, or potassium test
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53
Q

tube order for testing TSH and prenatal profile

A
  • SST (red)
  • EDTA (purple)
  • ACD (light yellow)
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54
Q

tube order for testing PSA, magnesium, and A1C

A
  • SST (red)
  • EDTA (purple)
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55
Q

tube order for testing glucose, FSH, and reticulocyte count

A
  • SST (red)
  • EDTA (purple)
  • Flouride (gray)
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56
Q

tube order for testing hepatic function (liver) panel, electrolytes, and CBC

A
  • SST (red)
  • Heparin (green)
  • EDTA (purple)
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57
Q

what prevents veins from rolling

A
  • proper anchoring below the site
  • quick insertion
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58
Q

how to anchor vein

A
  • thumb of nondominant hand 2 inches below site of insertion
  • hold firmly, slight distal tug
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59
Q

why is anchoring and holding the skin tightly important

A
  • reduce pain
  • keeps vessel steady
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60
Q

angle of insertion for the antecubital region

A

15 to 30 degrees

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61
Q

what happens if the angle of insertion is too high (goes in too deep)

A
  • hurting pt
  • injuring nerves and tendons
  • pierce through vessel and transfix the vein
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62
Q

what happens if the angle of insertion is too low (goes in too shallow)

A
  • forcing bevel to adhere to wall of vessel
  • stops or slows blood flow
  • miss vein entirely
  • blood leak into surrounding tissue causing hematoma
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63
Q

angle of insertion for the dorsal hand region

A

10 degrees

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64
Q

when should you stop inserting the needle

A
  • until you feel a change in resistance
  • indicates you are in the lumen (middle) of the vein
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65
Q

steps for venipuncture

A
  • introduce self
  • identify pt
  • position pt
  • wash hands and don gloves
  • assemble equipment
  • position pt arm
  • apply tourniquet
  • palpate for vein
  • choose vein
  • cleanse site
  • uncap and inspect the needle
  • anchor vein
  • alert pt of slight pinch or poke
  • insert needle
  • push tube in place with label down OR draw up with syringe
  • remove tourniquet before one minute
  • remove tubes, invert immediately
  • remove needle at same angle of insertion
  • engage safety
  • dispose of needle in sharps
  • provide pressure to site
  • check to ensure site is not still bleeding
  • apply bandage
  • label all specimens in front of the pt
  • thank the pt
  • observe pt for complications
  • collect all garbage
  • remove gloves
  • wash hands
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66
Q

what should you do before blood collection with a syringe

A
  • push plunger in and out to ensure smooth collection
  • push plunger all the way forward to ensure there’s no air in the barrel
  • calculate how much blood is needed
67
Q

who developed the order of draw and why

A
  • Clinical Laboratory Standards Institute (CLSI)
  • avoids contamination of additives
  • most accurate test results
68
Q

order of draw

A
  • blood culture bottles: yellow
  • light blue
  • serum tubes: red, gold, red and gray, red and black
  • rapid serum tubes (RST): orange
  • green
  • lavender, purple
  • pink
  • gray
  • light yellow
  • royal or dark blue
69
Q

yellow tube

A
  • blood culture
  • aerobic and anaerobic
  • contains SPS
  • used for bacterial studies
70
Q

when is the aerobic blood culture tube collected first

A

when using a butterfly needle

71
Q

light blue tube

A
  • sodium citrate
  • coagulation tests
  • must be filled 100%
72
Q

serum tubes

A
  • red, gold, red and gray, red and black
  • some contain no additive
  • some contain clot activator
  • must clot for 30 minutes before centifugation
  • chemistry blood collections
73
Q

rapid serum tubes (RST)

A
  • orange
  • when stat blood collection is required
  • clot for 5 minutes
74
Q

green tubes

A
  • sodium or lithium heparin
  • anticoagulants
75
Q

lavender or purple tubes

A
  • EDTA
  • hematology tests
76
Q

pink tubes

A
  • EDTA
  • blood bank collections
77
Q

gray tubes

A
  • sodium fluoride and potassium oxalate
  • glucose and alcohol blood collections
78
Q

light yellow tubes

A
  • acid citrate dextrose (ACD)
  • blood collections for DNA
79
Q

royal or dark blue tubes

A
  • dark blue does not indicate additive but that tube is free of element contamination
  • royal blue contains EDTA, sodium citrate, or heparin; may be serum tube; check label
80
Q

serum tube with gel separator

A

serum separator tube (SST)

81
Q

plasma tube with gel separator

A

plasma separator tube (PST)

82
Q

ratio of additive to blood in light blue tube (sodium citrate)

A
  • 9:1
  • nine part blood, 1 part additive
83
Q

what to do when using butterfly to collect in light blue tube

A
  • use tube without additive to start blood flow
  • used to clear out air so light blue tube can fill completely
84
Q

what are anticoagulant tubes used for

A

tests requiring plasma

85
Q

sodium citrate

A
  • light blue tubes
  • anticoagulant
  • used for clotting tests
  • best at preserving coagulation factors
86
Q

EDTA

A
  • lavender or pink tubes
  • anticoagulant
  • hematology tests
  • preserves shape of cells
  • reduces platelet clumping
87
Q

heparin

A
  • green tubes
  • anticoagulant
  • chemistry tests
  • prevents blood clots from causing falsely elevated results, especially in potassium and electrolyte tests
88
Q

potassium oxalate and sodium fluoride

A
  • gray tubes
  • anticoagulant
  • testing sugar
  • preserves glucose and prevents glycolysis
89
Q

tubes selected for CBC, electrolyte, and glucose test

A
  • CBC: lavender
  • electrolyte: green
  • glucose: gray
90
Q

how to ensure pt safety with someone whose mental state interferes with their ability to understand (child, cognitive deficits, dementia)

A

work closely with their guardian

91
Q

how to position pt with history of syncope

A

laying down

92
Q

things to watch for in a pt that may indicate complications (syncope)

A
  • change in breathing
  • excessive sweating
  • stops speaking abruptly
  • pale or red skin tone
  • glazed eyes
  • fixed stare
93
Q

what to do if pt asks you to stop or becomes unconscious

A
  • stop procedure
  • check for consciousness
  • administer first aid if needed
  • do not leave pt alone
94
Q

how long after pt is unconscious should you call for help

A

2 minutes

95
Q

ways to locate a vein

A
  • warm the area
  • lower the arm below the pt heart
96
Q

how many times should you attempt a blood draw

A

twice

97
Q

what to do if you don’t see a flash

A
  • pull needle back slightly and blood flow will return if you transfixed the vessel
  • repalpate the site and see if you can move the needle closer to the vein
98
Q

reasons blood flow may unexpectedly stop during collection

A
  • advanced needle to far
  • needle not advanced enough
99
Q

nerve damage complication

A
  • pt reports moderate to severe pain, sensation of numbness, feeling of pins and needles
  • stop procedure immediately
  • get medical care to evaluate extent of damage if numbness and pain continues
100
Q

hematoma complication

A
  • most common complication with phlebotomy
  • pushing needle through both walls of vessel
  • blood leaks into surrounding tissue
  • usually disappear in a few days
  • can damage surrounding nerves if it becomes too large
  • stop collection immediately
  • reduce risk by inserting needle smoothly and applying pressure after collection
101
Q

phlebitis complication

A
  • inflammation of blood vessel
  • occurs after one vein has been accessed repeatedly
102
Q

thrombosis complication

A
  • blood clot
  • partially or fully blocks vein or artery
103
Q

petechiae complication

A
  • small red dots develop below tourniquet
  • can be in routine cases or when tourniquet is tight
  • no need to stop collection
  • platelet abnormalities
  • apply adequate pressure after collection
104
Q

hemoconcentration complication

A
  • tourniquet applied for too long
  • pt excessively pumps fist
  • blood flow stagnates
  • alteration in blood tests (ammonia, calcium, coagulate, potassium, protein tests)
  • remove tourniquet before 1 min to prevent
105
Q

other physical reactions complication

A
  • diaphoresis, dizziness, nausea
  • often not serious
  • indication of complication
106
Q

collection/processing errors complication

A
  • mididentification of pt
  • improper site selection
  • using wrong tube
  • wrong order of draw
  • underfilling tubes
  • failing to invert tubes
  • failing to document
  • mislabeling tubes
107
Q

syncope complication

A
  • not preventable
  • ask pt if they’ve ever fainted prior to venipuncture
  • sudden lack of blood supply to the brain
108
Q

seizure complication

A
  • stop procedure and call 911
  • document time of onset
  • prevent pt injury
109
Q

shock complication

A
  • cold/clammy/pale skin, rapid pulse, increase in shallow breathing, blank stare
  • call for help if suspected
  • ensure pt has open airway
  • lower head below body
  • keep pt warm and safe
110
Q

nausea complication

A
  • wait until pt is no longer nauseated to perform collection
  • stop and provide basin if pt feels nauseous during procedure
  • do not leave pt
  • cold compress on head or neck
111
Q

diaphoresis complication

A
  • severe swearing
  • sign of nausea, syncope, or panic attack
  • ask how pt is feeling
  • provide towel
  • do not leave pt
112
Q

venipuncture removal

A
  • bevel up
  • same angle as insertion
  • swift and smooth motion
  • engage safety
  • dispose of needle in sharps
  • provide pressure to site
113
Q

what happens if a plasma tube is not inverted properly

A

specimen can clot

114
Q

what happens if a serum tube is not inverted properly

A

specimen may not clot completely

115
Q

hemolysis

A
  • destruction of RBC
  • shaking or roughly handling a tube
116
Q

what counts as an inversion

A

one complete turn of the wrist

117
Q

inversions for light yellow SPS tubes

A

8-10

118
Q

inversions for light blue tubes

A

3-4

119
Q

inversions for serum tubes (red)

A

5

120
Q

inversions for green tubes

A

8-10

121
Q

inversions for lavender tubes

A

8-10

122
Q

inversions for gray tubes

A

8-10

123
Q

when are dermal punctures performed

A
  • tests requiring small amount of blood
  • pt has no accessible vein
  • test requires capillary blood
  • pt at risk for iatrogenic anemia, underweight pts
  • point of care tests (glucose, cholesterol, hematocrit)
  • infants less than 1 y/o
124
Q

iatrogenic anemia

A
  • anemia caused by collecting too much blood from a pt by volume in a given amount of time
  • underweight pts
125
Q

what types of blood does a dermal puncture blood specimen contain

A
  • arterial
  • capillary
  • venous
126
Q

capillary stick site for people over 1 y/o

A
  • middle or ring finger, slightly off center
  • pinky is too thin, close to bone
  • index finger is sensitive and likely has calluses
  • thumb has a pulse
  • tip of finger is more sensitive and likely has calluses
127
Q

how to get pt hand warm for capillary stick

A
  • pt open and close hand a few times
  • rub hands together vigorously
  • place hand below heart for 30 seconds
  • wash hands in warm water
128
Q

how to puncture with an incision lancet and why

A
  • perpendicular to finger
  • helps blood form large drop that’s easy to collect
129
Q

why should you wipe away the first drop of blood in a capillary stick

A

removes contamination from alcohol or tissue fluid

130
Q

how long to take filling each capillary tube

A

no longer than 2 minutes

131
Q

who should you not use a bandage on for capillary sticks

A
  • children: can swallow it
  • infants: can irritate or tear skin
132
Q

why should you not milk the finger during capillary stick

A

can hemolyze specimen and alter test results

133
Q

lancet lengths for heel sticks on infants

A
  • no longer than 2 mm
  • 0.65 mm for infants weighing less than 1kg
  • common size is 1 mm
134
Q

how long should you apply a heel warmer for infant capillary sticks

A

3-5 minutes

135
Q

best site for heel stick

A
  • lateral or medial side of heel
  • middle of heel is secondary choice
  • do not use back of heel: little skin/tissue, can damage bone
136
Q

what to do if blood flow stops during heel stick

A
  • wipe away surface clots
  • stop squeezing
  • let capillaries refill
137
Q

what should you clean the skin with when performing capillary stick for bilirubin

A
  • alcohol
  • povidone-iodine can adversely affect test results
138
Q

reason for capillary stick order of draw

A
  • blood clots as soon as flow begins
  • order of draw ensures the sample is collected in an order with least negative effect on blood test
139
Q

CLSI order of draw for capillary collection

A
  • blood gas collections: pt may hold breath during procedure
  • purple, lavender, pink, or pearl cap tubes containing EDTA: blood clotting can alter hematology tests
  • green: contains heparin
  • any other additive specimens
  • serum tubes: no additive or clot activator, requires clotting
140
Q

when to label specimens

A
  • in front of pt
  • before pt leaves room
141
Q

what is included on a specimen label

A
  • pt full name
  • pt date of birth
  • date
  • time
  • medical number
  • initials
142
Q

where to place label on tube

A
  • every label facing same direction
  • do not cover stopper
  • place label on preprinted label
143
Q

why should you use a pressure bandage

A
  • promotes hemostasis
  • prevents bruising
144
Q

how to apply pressure bandage

A
  • gauze padding under bandage
  • pull firmly so bandage is taut
145
Q

when are self-adhering bandages recommended

A
  • older pts
  • arms with large amounts of hair
146
Q

most common additives in tubes

A

anticoagulants or clot activators

147
Q

most common additives in tubes

A

anticoagulants or clot activators

148
Q

what are SPS tubes used for

A

blood cultures

149
Q

what are ACD tubes used for

A

paternity testing

150
Q

what tube is used for a WBC test

A

EDTA

151
Q

what tube is used for coagulation test

A

sodium citrate

152
Q

what tube is used for pregnancy and random glucose tests

A

SST

153
Q

order of tubes collection for capillary collection of CBC, FSH, and electrolyte tests

A
  • lavender
  • green
  • red
154
Q

how does use of povidone-iodine as a cleanser affect potassium level results

A

increased potassium level

155
Q

tubes used for bilirubin test and a cold agglutinin titer

A

two serum tubes

156
Q

tube used for lipid profile

A

SST

157
Q

errors in specimen when drawing through a hematoma

A

hemolysis

158
Q

when are decreased electrolytes seen in a specimen

A
  • using wrong tube
  • tube with anticoagulants
159
Q

when is increased potassium seen in a specimen

A
  • hemoconcentration
  • use of iodine products
160
Q

when is increased epithelial tissue seen in a specimen

A

first drop of blood is not wiped away during capillary collection

161
Q

test results seen when leaving tourniquet on for too long and hemolysis occurs

A
  • high iron level
  • high potassium level
  • low CBC level
162
Q

should syringe collection be done on hand draws

A

no

163
Q

can tying the tourniquet too tightly cause a vein to collapse

A

yes i think

Phlebotomy (9 decks)

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