Module 8 - Phlebotomy Flashcards
Most fasting blood tests require a ___-hour fast
12
When having blood work for a lipid panel, how can eating a meal prior to having blood drawn affect blood test results?
the test values would detect fats from the food and the results would indicate elevated lipid levels.
What question is most appropriate in preparing a patient for phlebotomy?
Ask the patient how they have responded to blood draws previously.
What to do if you are unfamiliar with a laboratory test?
check the laboratory directory
Information included on the laboratory requisition form includes:
- 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
What is the typical gauge and needle length of Vacutainer needles
gauge: 20-22
length: 3/4in - 1 1/2in
The butterfly/wing infusion set is best used for what type of patients?
best used for patients who have small or fragile veins.
What is the typical gauge and needle length of butterfly needles
gauge: 21-23
length: 1/2in - 3/4in
What is the typical gauge of a needle syringe system?
16-gauge
Most commonly used system in adults
evacuated needle system
four main components of blood
plasma, RBC, WBC and platelets
Serum
The liquid portion of the blood obtained after a serum sample tube has clotted and centrifuged.
Plasma
liquid portion of the blood obtained after centrifuging
- must be collected in a tube containing anticoagulan
three layers after the sample has been centrifuged
plasma (top layer), buffy coat (middle layer), and red blood cells (bottom layer).
Clotted Blood
obtained when blood is drawn in a tube that does not contain an anticoagulant.
Whole Blood
obtained when a tube is used with an anticoagulant, which inhibits blood clotting.
Which components of blood is responsible for preventing excessive blood loss when a vessel is damaged?
platelets
Yellow tube
additive
laboratory use
A: Sodium polyanethol sulfonate; prevents clotting and stabilizes bacterial growth
L: Blood or body fluid cultures
Light blue
additive
laboratory use
Number of inversions
A: Sodium citrate; removes calcium to prevent blood from clotting
L: coagulation testing
#: 3-4
Red
additive
laboratory use
# of inversions
A: none
L: Serum test; chemistry studies; blood bank; immunology
#: 5
of inversions
Red/gray marbled
additive
laboratory use
Number of inversions
A: No anticoagulant but contains silica particles to enhance clot formation
L: Serum test; chemistry studies; immunology
#: 5
of inversions
green
additive
laboratory use
Number of inversions
A: Heparin: inhibits thrombin formation to prevent clotting
L: Chemistry Test
#: 8
Green/Gray marble
additive
laboratory use
Number of inversions
A: Lithium heparin and gel; for plasma separation
L: Plasma determinations in chemistry studies
#: 8
Lavender
additive
laboratory use
Number of inversions
: 8
A: Ethylenediaminetetraacetic acid (EDTA); removes calcium to prevent blood from clotting
L:Hematology test
Gray
additive
laboratory use
Number of inversions
: 8 to 10
A: Potassium oxalate and sodium fluoride; removes calcium to prevent blood from clotting; fluoride inhibits glycolysis
L: Chemistry testing, especially glucose and alcohol levels
Order of blood draw:
lavender, red/gray marbled, green/gray marbled, red, light blue, gray, yellow, green
- yellow
- light blue
- red
- red/gray marbled
- green
- greend/gray marbled
- lavender
- gray
Which veins have a higher risk of rolling
cephalic vein and basilic veins
Blood draws from the foot should only be performed under the supervision of a provider due to the risk of what.
deep vein thrombosis (DVT)
When only a small amount of blood is needed from a patient with limited options for draw site which type of needle is best?
needle syringe system
When drawing from the hand or small/thin veins in the antecubital space which type of needle is best?
butterfly needle
A tourniquet should be applied to the patient’s arm how many inches above the draw site
3-4
Leaving the tourniquet on longer than 1 min can cause …
hemoconcentration and alter test results.
The MA is preparing to perform phlebotomy and is assessing the patient for site selection. Based on the findings below, which of the following sites would be the best choice for vein selection?
a
The basilic vein—found to bounce when palpated
b
The right median cubital vein—the patient has had a unilateral mastectomy on the right side
c
The cephalic vein—found to be highly visible; difficult to palpate
d
The hand—the patient shared that they are extremely sensitive to the pain of blood draws
A
appropriate technique when cleansing the venipuncture site with an antiseptic wipe
Upward and downward motions with friction
When drawing from the patient’s hand, the correct angle of insertion is
10 to 15 degrees
When drawing from the patient’s antecubital space, the correct angle of insertion is
15- to 30-degree
where should the vein be anchored on the patient?
2 to 3 inches below the puncture site
When are capillary punctures done?
performed when only a small amount of blood is needed for testing or when immediate results can be acquired.
The preferred puncture site for obtaining a capillary puncture in adults and children is
the middle or ring finger of the nondominant hand
Infant capillary puncture are performed where?
on the outer edge of the underside of the heel.
order of draw for capillary blood collection
- Blood gases
- EDTA tubes
- Other additive tubes
- Serum tubes
How long should patients leave the bandage in place after phlebotomy?
15 minutes
Required info for labels for specimens
patient’s full name, date of birth, date and time of collection, and the MA’s initials
Serum must be allowed to stand upright at room temperature for how long before being centrifuged?
30 to 45 min
blood specimens should not be allowed to stand for longer than
1 hour
Clotted blood must stand upright at room temperature for
30 to 45 min
glucose tolerance test (GTT)
Test process that evaluates glucose levels over time to assess for diabetes by measuring the body’s response to sugar.
What should be worn when transferring blood into multiple test tubes?
Face and eye protection should always be worn when transferring blood into multiple test tubes
Lavender Top Tube Common Test:
- CBC (Complete Blood Count) / hematology tests
- ESR (Erythrocyte Sedimentation Rate);
- Sickle Cell Screening
- Malaria
- Reticulocyte Count: if bone marrow is making the right amount of RBC when old ones die
Light-Blue Top Tube Common Test
- Thrombin Time (TT);
- Prothrombin Time (PT)- evaluates the extrinsic; system of the coagulation cascade and monitors;
- Factor assays,
- INR
- Bleeding Time (BT)
- Coumadin therapy;
- Activated Partial Thromboplastin Time (APTT, PTT) - Evaluates the intrinsic system of the coagulation cascade and monitors Heparin therapy.
- Fibrinogen Degradation Products (FDP)
- D-Dimer; blood clotting condition
Green Top Tube Common Test
- ammonia, carboxyhemoglobin & STAT electrolytes.
- Glu, K+, Na+, CO2 etc.
- BHCG, TSH, TBil, DBil, NBil
- ALT, ALP, ASK,
- Creatinine (Crea), creatine kinase (CK)
Gray Top Tube Common Test
- Fasting blood sugar (FBS);
- Glucose tolerance test (GTT);
- Blood alcohol levels;
- Lactic acid measurement.
Red/Gray (Speckled) Top Tube Common Test
most chemistry test
Red Top Tube Common Test
Serology test; blood bank (glass only)
- serum tests
Yellow Top Tube Common Test
used to collect specimens to be cultured for the presence of microorganisms.
