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Phlebotomy Flashcards

1
Q

Whole blood - clotted or unclotted? what section of the lab uses this type of blood? what type of tests?

A

Whole blood is unclotted blood collected with an anticoagulant; hematology uses this blood; ex. CBC and ESR

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2
Q

What is plasma? Is it un-clotted or clotted blood? What section of the lab uses this specimen? Examples of tests?

A

Plasma is the clear/pale yellow portion of unclotted blood; contains fibrinogen; used in coagulation, blood bank, and chemistry. Ex. routine coagulation tests and glucose

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3
Q

What is serum? Is it un-clotted or clotted blood? What section of the lab uses this specimen? Examples of tests?

A

Serum is the clear/pale yellow portion of CLOTTED blood; contains no fibrinogen or clotting factors; used in chemistry and immunology; Ex. TSH and antibody tests

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4
Q

Lipemia specimens

A

Increase in lipids; appears milky and thick

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5
Q

LDL, lipid profile, iron, fasting glucose are all _______ tests, where you should not eat beforehand.

A

Fasting

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6
Q

T/F: patients should exercise before having blood collected.

A

False: patients should avoid strenuous exercise for 24 hours prior to having blood collected.

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7
Q

T/F: patients should avoid smoking for one hour prior to a blood draw

A

True

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8
Q

What can stress cause in a blood test?

A

Increase in WBC
Decrease in serum iron
Abnormal hormone values

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9
Q

Hemolyzed specimens

A

Increased hemoglobin released during blood draw; sample appears very pink/red

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10
Q

Icteric specimens

A

Increased bilirubin in specimen; serum or plasma takes on abnormal brown/yellow color

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11
Q

Needle gauge rule

A

The larger the gauge (diameter), the smaller the number.

The smaller the gauge (diameter), the larger the number.

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12
Q

When do we use a butterfly needle? What gauge are they typically?

A

For small veins or pediatric patients; typically 21, 23, or 25 gauge

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13
Q

standard gauge size for straight needles

A

21 or 22 gauge

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14
Q

What is the rule for sodium citrate tubes (light blue) when using a butterfly needle and it is the first/only tube being drawn?

A

A discard tube must be drawn prior to the sodium citrate tube. You do not need to completely fill the tube, but must draw some blood into the discard tube and then you can draw your sample into the sodium citrate tube.

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15
Q

What is the most commonly used antiseptic during blood drawing?

A

70% isopropyl alcohol

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16
Q

What is the antiseptic used during a blood culture collection?

A

ChloraPrep One Step (2% Chlorhexidine gluconate and 70% isopropyl alcohol)

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17
Q

When would you want to use betadine/iodine as an antiseptic?

A

During a blood alcohol test (this antiseptic contains no alcohol)

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18
Q

What is important to note when drawing blood for an inpatient?

A

MUST ensure they are wearing a wristband; if no wristband, do not draw

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19
Q

What does AIDET stand for when performing venipuncture?

A

A - acknowledge (greet patient and smile)
I - introduce yourself/tell them you will be drawing their blood today
D - duration (how long it will take)
E - explanation (explain what you are doing and answer any questions)
T - thank them

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20
Q

Where should the tourniquet be placed?

A

3-4 inches above antecubital fossa (elbow pit)

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21
Q

What is the maximum time that a tourniquet may stay in place?

A

1 minute

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22
Q

Proper technique in finding a vein (steps in order)

A
  1. apply tourniquet
  2. have patient make a fist
  3. use index finger of non-dominant hand
  4. apply varying degrees of pressure
  5. feel for spongy, bouncy, firm veins

CHECK BOTH ARMS, THEN CHECK HANDS

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23
Q

Vein selection order of preference

A
  1. Median cubital vein (check both arms for this vein before moving on to #2)
  2. Median cephalic/Cephalic vein
  3. hand veins
  4. Basilic vein
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24
Q

What is the maximum number of attempts per phlebotomist on a patient for drawing blood?

A

2

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25
What angle should a straight needle be at during venipuncture?
15-30 degrees
26
When do you remove the tourniquet?
When blood flow begins, ALWAYS before the needle is removed.
27
What angle does a butterfly needle go at?
10-15 degrees
28
What is the most important step in phlebotomy?
Patient identification
29
aerobic blood culture tube color
blue
30
anaerobic blood culture tube color
purple
31
light blue tube - department that uses it and what is the additive
coagulation, additive is sodium citrate (anticoagulant) MUST BE 1:9
32
red tube top - department that uses it and what is the additive
serology, chemistry, and blood bank. no additive
33
gold + tiger top tubes - department that uses it and what is the additive
chemistry, additive is SST (serum separator) w/ gel + clot additive
34
light green top tubes - department that uses it and what is the additive
chemistry, additive is lithium heparin (anticoagulant)
35
dark green top tubes - department that uses it and what is the additive
chemistry, additive is sodium heparin (anticoagulant)
36
yellow top tubes - department that uses it and what is the additive
blood culture, additive is SDS (anticoagulant)
37
orange top tubes - what are they called and what is the additive
RST (rapid serum tubes), additive is thrombin
38
tan top tubes - what are they used for and what is the additive
lead determination, additive is EDTA
39
lavender top tubes - department that uses it and what is the additive
hematology (ex. CBC), additive is EDTA
40
dark purple top tubes - department that uses it and what is the additive
blood bank, additive is EDTA
41
royal blue top tube - department that uses it and what is the additive and what does it test for
tests for trace metals, serology/chemistry, additive is sodium heparin or EDTA
42
gray top tube - department that uses it and what is the additive
chemistry (eg. Glucose testing), additive is sodium fluoride and potassium oxylate
43
black top tubes - department that uses it and what is the additive
hematology, additive is buffered sodium citrate
44
white top tubes - what is it used for and what is the additive
molecular diagnostics(PPT), additive is EDTA
45
pink top tubes - department that uses it and what is the additive
blood bank, additive is EDTA
46
Order of Draw
Blood culture always first -> light blue (sodium citrate) -> red/orange/gold (serum tubes) -> dark/light green (heparin tubes) -> lavender/pink/royal blue/tan (EDTA tubes) -> gray always last (glycolytic inhibitor)
47
How does EDTA work as an additive to tubes? (found in lavender tops, pink tops, royal blue tops, and tan tops)
anticoagulant that IRREVERSIBLY binds calcium
48
How does sodium citrate work as an additive in tubes? (light blue tops)
anticoagulant that REVERSIBLY binds calcium
49
what tests are light blue tops for
PT/INR and PTT
50
action of heparin as an anticoagulant
inhibits thrombin
51
action of sodium fluoride/potassium oxalate in gray top tubes
fluoride inhibits glycolysis, oxalate binds calcium to prevent clotting
52
what happens if you draw lavender tube before green tube?
falsely elevate potassium and falsely decrease calcium levels
53
what happens if you draw gray before lavender?
it will distort WBC on differential
54
what happens if you draw a gold or red/gray tube (serum tube) before light blue tube?
clot activator in serum tubes will falsely shorten coagulation tests
55
what happens if you draw EDTA tubes before heparin/light blue tubes?
can falsely increase PT and PTT
56
Sites to avoid for venipuncture (there is alot)
``` palm side of wrist lateral wrist above thumb arteries veins in legs/ankles/feet occluded and sclerosed veins IV drug use areas "track marks" Areas with edema Hematomas burns/scars/tattoos mastectomy fistulas ```
57
Rules for drawing blood on patient with IV
Use arm opposite that IV is in, or draw below IV If drawing from arm with IV: draw below it, have nurse turn off IV for 2 minutes, apply tourniquet below IV, discard first 5 mL of blood
58
Rules for blood draws post-transfusion
Must wait one hour post-transfusion to draw labs except in trauma situations
59
True/False: Never draw blood from an arm with a fistula. | What is a fistula?
True. | A fistula is an artificial shunt fusing a vein and an artery (found in dialysis patients)
60
Special considerations for bariatric patients (obese)
Veins are deep and difficult to palpate: use longer needle, use blood pressure cuff, pre-warm site or use hand/deep veins
61
Special considerations for pediatric patients
Remove 3% or less of pediatric patient blood to avoid iatrogenic anemia. Use butterfly needles or dermal puncture if small amount of blood needed
62
Special considerations for geriatric patients
many can be on anticoagulants, veins are likely to roll (decreased elasticity in skin and veins closer to the surface) so ANCHOR VEIN FIRMLY, bruising is likely
63
How to handle/identify syncope
patient will become quiet or speech becomes slowed, sweating, pale, cold Lower patient to the floor and elevate their feet, place a cold compress on them. Monitor patient for 15 minutes. DO NOT use ammonia inhalants
64
Examples of phlebotomy negligence
- nerve injury - drawing from inappropriate locations - injuries during syncope - hemorrhage - death caused by misidentification - wrong diagnosis due to collection errors
65
What is the preferred method of collection for newborns, infants, and children younger than 2 years?
Capillary collection (heel sticks, finger sticks)
66
Order of draw for microsample containers
Capillary blood gases, EDTA (lavender), other additives, then nonadditive tubes
67
Why are warming devices used for capillary punctures? What temperature should it not exceed and how long should it be applied?
Increases blood flow to the site by as much as 7 times. | Should not exceed 42 deg C and should be applied 3-5 min
68
Advisable depth for an adult finger stick
2.0-3.0 mm
69
Advisable depth and width for heel puncture stick on infants
Advisable depth is <2.0 mm. | Width should not exceed 2.5 mm
70
Correct collection technique for blood cultures
Always use a butterfly needle, draw first before anything (aerobic and then anaerobic), disinfect site with chloraprep, bottle only filled to 10 mL
71
Orders of arteries in arterial blood gas collection
first choice - radial artery second choice - brachial artery last choice - femoral artery
72
What is the Allen Test?
Used for arterial blood gas collections to note if there is presence of collateral blood flow. If test is negative (very red palms), do NOT use radial artery
73
Biggest source of error in arterial blood gas collection
Failure to deliver sample to lab IMMEDIATELY or to store on ice if delivery will be delayed. This can cause changes in analyte values.
74
What is administered prior to a glucose tolerance test? When does the time for the test begin?
Glucola (standard amount of glucose solution). The test begins right after this drink is consumed.
75
When is glucose tolerance test performed? What is it used to diagnose?
Used to diagnose diabetes mellitus; perform test after 3 days of unrestricted diet and activity. Patient must fast for 8-10 hours prior to test.
76
Rules during a glucose tolerance test
Only consume water Pt remains sedentary If pt vomits, must stop and reschedule Patient cannot smoke or chew gum during procedure
77
When are specimens drawn during a 3 hour glucose tolerance test?
Draw specimen fasting, 1 hour after drink, 2 hours after drink, and 3 hours after drink.
78
What is a chain of custody? When is it used?
COC is a legal document that maintains control of a specimen from time of collection to final disposition It is used for alcohol and drug testing for employment and forensic purposes
79
T/F: tubes should remain on their side during transport
False; tubes should always remain upright
80
Reasons for rejection of specimens
chemistry - hemolysis, not enough volume hematology - clotted coagulation - not enough volume
81
What is the most common light-sensitive analyte?
Bilirubin
82
Some examples of light-sensitive samples
bilirubin, beta-carotene, folic acid, various vitamins
83
Some examples of chilled specimens
ammonia, lactic acid, arterial blood gas, free fatty acids, carbon monoxide
84
Some examples of warmed specimens
anything with cryo in the name, cold agglutinin titers

Seminar (2 decks)

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