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Seminar > Phlebotomy > Flashcards

Phlebotomy Flashcards

1
Q

The majority of error occurs during the ___ stage of testing

A

pre analytical

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2
Q

Name some examples of phlebotomy negligence

A

nerve injury
hemorrhage
injury due to fainting
death of a patient

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3
Q

What is the type of blood of choice for most routine lab tests

A

-venous blood

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4
Q

What type of blood is used in blood gases

A

arterial blood from the artery

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5
Q

What type of blood is collected from fingers

A

capillary blood- capillaries, arterioles and venules, interstitial and intracellular fluid

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6
Q

How can you make more blood come from a finger stick

A

by warming up the area, makes arterial blood increase

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7
Q

What is the difference between serum and plasma

A

plasma- contains fibrinogen, the clear, yellow portion of anticoagulated blood
serum- yellow portion of clotted blood, serum is separated from the blood clot

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8
Q

Label the picture on Ch1 slide 31

A

A-SST not centrifuged
B- SST after centrifugation
C-centrifuged without additive or gel

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9
Q

What is lipemia

A

milky appearance, increased lipids

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10
Q

What are the main pre analytical variables that the patient can interfere with that will affect their test results

A

fasting, exercise, stress, smoking, circadian rhythm, posture, age

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11
Q

Patients should avoid strenuous ____ for ___ hours before having blood collected

A

exercise

24 hours

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12
Q

How do test results change if the patient is too stressed

A

increase in WBCs, decrease in iron, abnormal hormone values

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13
Q

How long should patients refrain from smoking prior to blood draw

A

1 hour

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14
Q

How does the diurnal rhythm affect test results

A

body fluids change throughout the day, hormone levels change, cortisol, testosterone, estradiol, progesterone, renin, TSH, serum iron, WBCs eosinophils

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15
Q

How can posture affect test results

A

enzyme, protein, lipid, iron Ca levels change with posture, should be sitting not standing nor lying down

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16
Q

What is hemolysis

A

red plasma due to RBC rupture making them release hemoglobin content

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17
Q

What are icteric specimen

A

when the serum or plasma becomes brownish yellowish

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18
Q

What are some reasons a specimen would be rejected

A

unlabeled, QNS, wrong tube, wrong order of draw, wrong time if timed sample, light protection, clotted specimen if for coag

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19
Q

How long can a tourniquet stay on a patient

A

1 minute max

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20
Q

What is the standard gauge for venipuncture with straight needles?

A

21 or 22

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21
Q

What is the standard gauge for small veins and hands

A

23 or 25

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22
Q

What is the rule when you are drawing blood from a butterfly into a light blue tube

A

you must draw a discard tube before the light blue with a non additive tube or another blue top

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23
Q

When should isopropyl alcohol NOT be used, what is used in its place

A

chlora prep- for blood culture collections

betadine-

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24
Q

What information must be on a requisition?

A

DOB, full name, test performed, name of provider, ICD 10

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25
Q

What is the difference between routine and timed tests

A

routine- scheduled often

timed- must be collected at specific time

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26
Q

Inpatients always have _______, you cannot draw from them if they dont have it!

A

wristband

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27
Q

The tourniquet should go ___ inches above the _____

A

3-4 inches, antecubital fossa- elbow pit

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28
Q

How can the patient help you find a vein, what can you do?

A

make a tight fist, no pumping
feel for vein with non dominant hand
feel more important than sight
veins do not have a pulse!

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29
Q

What sites on the hands should you NEVER draw from

A

palm side of the wrist, lateral wrist above the thumb

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30
Q

What procedures affect where you can draw blood from? What other sites should you avoid

A

mastectomy, arms with IVs, no fistulas or shunts, no hematomas or edemas, no injuries or burns

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31
Q

What sites in what order can you draw blood from

A

antecubital fossa, check both arms, check both hands

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32
Q

What veins can you draw from

A

median cubital vein

median cephalic vein

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33
Q

What vein on the arm can you NEVER draw from

A

cephalic vein- on the side of your pinky

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34
Q

What structure provides support and anchors the median cubital vein

A

bicipital aponeurosis

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35
Q

What side of the arm is the median cephalic vein on

A

the thumb side

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36
Q

Why is the basilic vein a no no

A

close to major artery and nerve, tends to roll, more painful

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37
Q

What veins should you draw from in hands

A

central veins

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38
Q

What is the site selection order of preference for blood draw

A

median cubital, cephalic, accessory cephalic, basilic, dorsal hand,

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39
Q

When should you push the tube into the adaptor

A

after inserting the needle into the vein

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40
Q

What position should the needle be in

A

bevel up

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41
Q

What angle should you use for a straight needle

A

15-30 degree angle

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42
Q

What should you do right after drawing a patients blood

A

label the tubes in their presence, reconfirm name and DOB

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43
Q

What is the last step to drawing blood

A

bandage the patient, discard trash and dismiss patient

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44
Q

What is the max amount of times a single person can try to stick a patients vein

A

2 times

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45
Q

What can you try if you can’t find a vein

A

tap the area gently, hang the arm down, warm compress, fist, tighter tourniquet

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46
Q

What must you do between patients as a phleb

A

sanitize hands and change gloves

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47
Q

How many times should you invert the tubes with additives or anticoagulants

A

5 to 8 times

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48
Q

What is the name of the substance that separates blood serum or plasma in gold top tubes

A

polymer gel

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49
Q

What additives are in gold or tiger top tubes? What department do they go to

A

silica, gel separator SST

chemistry

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50
Q

Do gold and tiger top tubes contain serum or plasma?

Do they have any extra instructions

A

serum, let clot for 30 minutes

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51
Q

What additives do red top tubes have? anticoagulants? Does it have any additional instructions?

A

no additive, clot for 60 minutes, no gel barrier

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52
Q

What tubes do not have any additives

A

red and white tops

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53
Q

What additives or anticoagulants do lavender top tubes have?

A

EDTA-irreversibly binds Ca

prevents clotting

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54
Q

What additives or anticoagulants do pink top tubes have?

A

EDTA

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55
Q

What additives or anticoagulants do light blue top tubes have? Does it have any extra instructions?

A

sodium citrate- reversibly binds Ca
must be fully filled
invert less 4-5 times, don’t overmix it

56
Q

What ratio of blood to anticoagulant do you need for a light blue top tube

A

9:1

57
Q

What additives or anticoagulants do light green/ mint top tubes have

A

lithium heparin- anticoagulant inhibits thrombin

58
Q

What additives or anticoagulants do dark green top tubes have

A

sodium heparin- inhibits thrombin

59
Q

What additives or anticoagulants do gray top tubes have

A

sodium fluoride- inhibits glycolysis

potassium oxalate- binds Ca to prevent clotting

60
Q

What kind of tests are performed on gray top tubes

A

glucose, blood alcohol, lactic acids

61
Q

What additives or anticoagulants do orange top tubes have

A

thrombin- converts fibrinogen into fibrin causes rapid clotting

61
Q

What tests are performed on orange top tubes

A

STAT serum testing like troponin, rapid serum tube is another name

62
Q

What additives or anticoagulants do royal blue tops have

A

chemically free of trace metals, might have EDTA or sodium heparin

63
Q

What tests are performed on royal blue top tubes

A

copper, zinc, cobalt, lead, aluminum

64
Q

What additives or anticoagulants are in tan top tubes

A

EDTA, lead testing

65
Q

What additives or anticoagulants do yellow top tubes have

A

ACD- acid citrate dextrose, binds Ca and preserves RBCs

SPS- binds calcium and complement

66
Q

What tests are performed on yellow top tubes

A

BB and immunology testing if ACD

blood cultures if SPS

67
Q

What additive do black top tubes have

A

buffered sodium citrate

Erythrocyte sedimentation rate

68
Q

State the order of draw

A
  • blood culture (steriles), aerobic then anaerobic
  • light blue- coag
  • red/gold/ tiger- serum tubes
  • Greens- heparin tubes
  • lavender/ pink/ royal blue/ tan- EDTA tubes
  • Grey- glycolytic inhibitor
69
Q

What could happen to a coag test if the order of draw is wrong

A

could become contaminated with anticoagulants

70
Q

What could happen if the grey top tube is collected in the wrong order of draw?

A

potassium in the grey top could interfere with chem tests

71
Q

What can happen if an EDTA tube is collected in the wrong order of draw

A

EDTA can bind to many metals and to Ca, causes problems with almost everyone

72
Q

What lab results can you expect if a lavender top is collected before a chem test

A

falsely elevated potassium

falsely decreased Ca

73
Q

What tube is responsible for more carryover problems than any other tube

A

EDTA tubes

74
Q

What can happen to lab results if Gray is drawn before lavender

A

distorted WBCs on differentials

75
Q

What lab results can be expected it a serum tube is drawn before a blue top

A

the clot activator in the serum tube will falsely shorten a coag test

76
Q

What lab results can be expected if you draw a EDTA tube before a heparin or light blue top

A

falsely increase PT and PTT

77
Q

True or false: if you accidentally draw from the wrong tube you can pour blood into the correct tube

A

False- we will find out

78
Q

What could occur if you draw from an arm that has an edema, explain what that means

A

Edema, fluid in arm, super swollen

specimen will have excess tissue fluid

79
Q

What could occur if you draw blood from a hematoma

A

you could be collecting old blood or cause hemolysis in your sample

80
Q

What if a patient has an IV? can you draw from that arm

A

IV has to be turned off for at least 2 minutes
discard 5mL of blood
record that blood was drawn from arm with IV

81
Q

What if you need to draw blood from a patient that has just had a transfusion

A

you have to wait 1 hour post transfusion

will still have elevated levels for up to 24 hrs of certain tests

82
Q

What is a VAD

A

vascular access devices

83
Q

Can you collect blood from a VAD?`

A

only a nurse can, all fluids have to be turned off, 5mL of blood has to be discarded
must discard 6 times the dead space of the line for coag tests

84
Q

What is a CVC

A

central venous catheter,

85
Q

Can you draw blood from a VAD?

A

Yes

86
Q

What is a PICC

A

peripherally inserted central catheter

87
Q

Can you draw blood from a PICC?

A

a nurse can do it, or venipuncture can be done below it,

88
Q

Can you draw blood from implanted ports?

A

only a nurse can

89
Q

Can you draw blood from a cannula?

A

insertion in arm often for blood access

only by a nurse

90
Q

What special action should be taken for bariatric patients

A

longer needles, might need to prewarm site, ask where blood draw has been successful

91
Q

What special actions should be taken for pediatric patiens

A

smaller needles, can use local anesthetics, dermal puncture only if small volume of blood needed, infants and children cannot lose more the 5% of their blood volume in 24hrs (3% max preferred). No more than 10% can be removed over 1 month. Might need help to restrain children

92
Q

What special considerations should be taken for geriatric patients

A

less collagen, skin is more elastic, easier to bruise, many could be on anticoagulants, beware of rolling veins, use butterfly on smaller veins

93
Q

If a patient is experiencing excessive bleeding it could mean

A

they are on heparin or coumadin, that have low or defective platelets

94
Q

What should you do if you accidentally puncture an artery

A

withdraw immediately, pressure for 5 or 10 minutes if on anticoagulants,

95
Q

What should you do if the patient is experiencing shooting pains, tingling or numbness

A

you might have injured a nerve, use a cold then warm compress, document the incident,

96
Q

What should you do if your patient is becoming quiet or their speech is slurred or slowed

A

They might faint (syncope), talk to them, remove tourniquet, withdraw needle, bandage, lower head and put a cold compress on their neck

97
Q

If a patient fully falls forward and is unconcious

A

lower to floor and elevate feet, cold compress, no ammonia, if they don’t regain consciousness in 1 minute call 911, document incident

98
Q

What to do after a patient has experienced syncope

A

monitor them closely for 15 minutes, make sure they look and speak normally again, do not let them stand until they are fully recovered, if fasting, give them food or drink

99
Q

What is petechiae

A

small red spots caused by defect in platelets

100
Q

What tests cannot be performed on capillary skin punctures

A

blood culture, coagulation tests, blood bank crossmatch

101
Q

What analytes are different in capillary blood

A

potassium, Ca, protein, are lower

glucose is higher

102
Q

True or False, microtainers have a different order of draw

A

True, EDTA goes first before any additives then no additives goes last

103
Q

What are the limits of using warming devices

A

temp no more than 42C apply for 3-5 minutes

104
Q

What could be the consequence of accidentally puncturing a bone

A

osteochondritis-painful inflammation of bone

osteomyelitis- could be fatal bone infection

105
Q

What is the advisable depth for an adult finger stick

what is it for heel punctures on infants

A

adult- 2-3mm

infant less tan 2 mm

106
Q

blood should be drawn ___ to _____ on finger sticks

A

perpendicular to fingerprint grooves

107
Q

What part of the heel of the foot can you draw blood from

A

medial or lateral parts of the heel, never the middle

108
Q

What is the cutoff age for heelsticks

A

12 months old or less

109
Q

What test is a light protection test

A

billirubin

110
Q

What does a red lid blood culture bottle mean

A

for mycolytic or fungal cultures

111
Q

What is the maximum blood culture sets that can be draw in a day

A

max 3 sets

112
Q

What extra step must you take before drawing a blood culture

A

mark the bottles 10mls above the fluid in bottle

disinfect bottle top

113
Q

What arteries can be used to collect arterial blood gas

A

radial artery - wrist
brachial artery- arm
femoral - leg

114
Q

What is important to note after ABG is drawn and sent to lab

A

it must be sent up on ice if it will take longer than 30 minutes to get to lab

115
Q

What is an allen test

A

test to see if blood flow is collateral, if negative you cannot draw from radial artery

116
Q

What are the common sources of error for an ABG

A

not delivering immediately to lab, not putting on ice

117
Q

True or false: If an ABG has air bubbles, it will be accepted

A

False: it would get rejected

118
Q

What rules must a patient follow prior to a glucose tolerance test

A

GTT no medications that affect glucose, fast for 8-10 hrs, 3 days of unrestricted diet and activity

119
Q

When should you call a physician for a fasting glucose result?

A

if it is higher than 140, then you need to do a GTT

120
Q

What extra steps do you have to take for a GTT test.

A 
Give patients glucola
50g prenatal
75g non pregnant
100g pregnant
they have to drink it in 5 min or less
patient has to sit still, only water, if they vomit test must be rescheduled
no smoking or chewing gum
121
Q

What time frames do you draw blood for a 3hr GTT

A

draw fating, 1hr, 2hr, and 3hr

122
Q

What is to be expected for a 2hr postprandial glucose test

A

looking to diabetes, 2 hrs after a meal, normal is less than 140

123
Q

What extra procedures must be taken for chain of custody testing

A

document identity of everyone that handles the specimen

124
Q

What is a suprapubic device and what is it for

A

for urine collection in babies

125
Q

What is the rule for occult blood specimen?

A

collected 3 days after meat free diet

126
Q

What temperature should O&P specimen be stored at

A

body temp 37C if no preservative

127
Q

What part of the mouth should be used for a throat culture

A

tonsil area

128
Q

How soon should an uncentrifuged blood sample be delivered to lab

A

within 45 minutes

129
Q

How soon should gel separated specimen be centrifuged after collection

A

2 hrs

130
Q

what tube tops can be centrifuged right after collection

A

light green tops

131
Q

how soon can samples collected in thrombin be spun

A

5 minutes

132
Q

For what reason would a chem test be rejected?

A

hemolysis, QNS

133
Q

For what reason would a heme test be rejected

A

clotted for ESR if QNS

134
Q

What types of specimen often need to stay warm 37C

A

cyro test and cold agglutinin titers

135
Q

Name 4 test that need to be on ice

A

ammonia, lactic acid, ABG

136
Q

What temp should PTT and PT/INR be kept at

A

room temp

Seminar (4 decks)

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