phlebotomy Flashcards
carry freshly oxygenated blood to the body
- branches into arterioles & capillaries
arteries
What do the coronary arteries do?
supply blood rich in oxygen and nutrients to the heart
supply blood to the lower extremities
femoral arteries
carry deoxygenated blood to the lungs
pulmonary arteries
carry deoxygenated blood from the body to the heart
veins
return deoxygenated blood from the head & neck to the heart
jugular veins
return deoxygenated blood from the lower extremities to the heart
saphenous veins
carry deoxygenated blood back to the heart from the lungs
pulmonary veins
permeable & act as exchange vessels
- oxygen & nutrients»_space; body cell from capillary»carbon dioxide & other body waste move out of body cell»capillary
capillaries
What is osmosis
A change in concentration
how can you prevent infection
- proper PPE
- hang hygiene
- safety disposal of equipment
identify patients by…
- full name
- DOB
- home address
- telephone #
- last 4 of SSN
why must you confirm consent prior
deliberately touching a patient w/o consent is battery
- criminal offense
- document refusal & notify RN
check all equipment for…
expiration dates
corruption
-missing labels
- defects
- cracks
- breaks
- rips
- tears
needles
single use item
- retract needle into the sharps container as soon as it leaves the vein
- prior to use check if burred or bent
tubes. What should check for before use?
- check for defaults & expiration dates/cracks & breaks
- do not use if label is missing
adapters
single use item
- dispose if cracked, broken, or contaminated
tourniquets
multi/single use item
- multi use»_space; dispose contaminated with hair, blood, or dirt
alcohol pads
single use item
- check for rips or tears
what and how should a specimen be labeled?
patient full name, DOB, time/date, facility ID, legibly, military time, facing same direction, does not completely or partially cover stopper, do not wrinkle or crease, double check patient ID/wristband
test that requires small amounts of blood, patient has no accessible vein, capillary blood, the patient is at risk for iatrogenic anemia, and low volume blood
dermal punctures
low hemoglobin & hematocrit count resulting from large amounts of blood smaples
iatrogenic anemia
what is the point of care for a dermal puncture?
- glucose
- cholesterol
- hematocrit
what can you use to perform a dermal puncture?
- may use capillary pipettes & micro collection tubes
- other test may require glucometer
what stick do you use on infants under 1 years old
heal stick
what kind of blood does a dermal puncture consist of?
arterial
capillary
venous
where do you perform a dermal puncture
3rd/4th finger on nondominant hand
- on the side of the finger
what do you check for before a dermal puncture?
- if finger is cold
- cyanotic
- scared
- swollen
- rash
equipment for dermal punctures
gloves, alcohol wipes, adhesive bandages/self-adherent wraps, tape, gauze, lancet, micro collection tube
what are the steps prior to venipunture?
- review requisition
- gather supplies
- double check requisition
- all supplies should be gathered prior to putting tourniquet on patient
- check expiration date
- look for defects
- arrange supplies
where should you put your phlebotomy tray?
-use a chair
- avoid putting on bedside table
how should position your patient for venipuncture?
full extension of the arm is down with palm facing upwards(supination)
- patient should never be standing, on a high stool, or edge of examination table
how do you select and palpate a vein?
- look for tattoos, scarring, hematomas
- ask if patient has a preference
- palpate the vein
- if you cannot find one, ask to palpate other arm
what order should you palpates veins in
1st- median cubital
2nd- cephalic
3rd- dorsal (hand) veins
4th- basilic
vein located in the middle of the arm on the anterior surface & least painful
median cubital vein
vein located outside lateral surface of arm, might be more painful
- easy to use for patients that obese
cephalic vein
what do you do if your patient has an IV catheter and you need to preform venipuncture?
- try to find another vein
- ask RN if infusion can be stopped temporally
- perform venipuncture distal to IV insertion site
what is the ideal vein?
well anchored, spongy, bouncy, straight, & easy-access
what do you do if your patient is having a blood transfusion and you need to collect blood?
use opposite arm or collect distally
what are specific considerations before performing venipuncture?
- mastectomy
- tattoos
- hematoma
- edema
- scars
- sclerosis
where should apply a tourniquet
7.6 to 10.1 cm (3-4 in) above the antecubital area
when should you remove a tourniquet
release prior to 1 min point or when blood flow begins
feels hard, similar to bone & you must avoid when doing venipuncture
tendons
sclerosis or scaring
hard veins
if having difficulty with palpation, what can u do?
- warm cloth or infant heal warmer
- hand below heart level
- rub area of palpated vein
antiseptic application
- wear gloves
- 70% alcohol
- clean area 6.1 to 6.1 cm (2.5 to 2.5 in)
- airdry
- if not drying, dab with sterile gauze
how should you insert a needle
should be a quick smooth movement
- stop at resistance
what happens when you puncture the wall of the vein
you are in the lumen of the vein
if you partially pernitrate the vein, blood will leak and cause a hematoma
what do you do with veins that are forked?
avoid sticking
- veins have valve and you may not get blood return
-cerebrospinal
- amniotic fluid
- material from wound
- urine specimens through catheter
non-blood specimens
low-cost, low-risk
- require time (collected every 2, 4, or 24 hrs)
urine speciemens
how do you perform a urine specimen test
- wear gloves (replace between handling)
- perform on flat surface
- collect in sterile container with lid
examines appearance, color, odor, pH, specific gravity, protein levels, glucose, & hemoglobin
urinalysis
urine specimens should never be…
left unrefrigerated
identifies microorganisms, decides which antibiotic can kill pathogens, and has to be clean-catch midstream or from catheter
culture test
most common test, no prep or time restrictions, document time & date of collection
random collection
urine before bed, collect immediately in the morning, more concentrated, refrigerate if unable to get to lab within 1 hour
first urine in the morning
how many mLs is a urine collection container
30-60 mLs
begins at specific time, must keep over ice or refrigerate
24 hour urine collection
what should you do if your patient with a 24 hour collection forgets to urinate, or if urine isn’t in ice?
notify the nurse, document
- it is out of your scope of practice as a PCT to discard a test
patient has to fast 24 hours, collect blood & urine together every 1-2 hours
glucose tolerance test
The patient urinates prior to eating, collected every 2 hours after patient eats a predetermined amount of carbs or glucose. test for patients with diabetes, monitors insulin dosage. What test is this?
postpradial test
how do you perform a clean-catch midstream urine test
- clean the urinary meatus prior to urinating
- have patient pee in toilet 1st and then continue urinating into the specimen cup
what should you do prior to collection for a culture & sensitivity test?
clean the genitals with antiseptic
what should antiseptic never be
alcohol, hydrogen peroxide, or iodine
examines for bacterial growth. provides info on pH, specific gravity, WBCs, hemoglobin, bilirubin, protein, & glucose
reagent strip method test
expected pH range
4.6 to 8.0
- should usually be 6.0
indicator of the concentration of urine
- all other test should come back negative
specific gravity
expected range for specific gravity
1.010 to 1.030
- usually 1.010 to 1.025
if SG is less than 1.010 urine is
diluted
if SG is greater than 1.010 urine is
concentrated
highly concentrated urine is an indicator of
dehydration
WBCs in reagent strip test indicates?
infection
Hemoglobin indicates
infection, cancer, kidney disease, chemical poisoning, & other pathology
ketones idicate?
product of fat metabolism
- diabetes mellitus, starvation or vomitting
bilirubin
liver disease or RBC destruction
What does protein on a reagent strip test indicate?
inflammation, infection, kidney disease, or chemical poisoning
glucose
diabetes mellitus
test for hormones, alcohol, & drug levels
saliva sample
swabs the inside of cheek to collect DNA
buccal swab
patient should take deep breaths & expectorate by coughing deeply & spit into cup
sputum speciemen
when is the best time to collect a sputum speciemen
in the morning, & several hours before eating
test for bacterial infection, parasites, occult blood, has dietary restrictions prior to collection
stool specimens
what is not allowed in a stool specimen collection
- do not allow urine or toilet paper/water into specimen cup
- do not refrigerate if being tested for parasites
what do you do if your patient has to pee during a stool collection test?
have patient urinate 1st and then defecate into hat
test that identifies blood that is not visible in the stool
fecal occult blood test
testing for strep throat
throat swab
steps in a throat swab
- wipe both tonsils & all inflamed areas
- stand to the side
test that counts sperm to access fertility
- keep warm & protect from light
- send to lab within 1 hour
- make sure patient does not use a condom
semen specimen test
test that identifies bacteria or microorganisms in blood, diagnose infections
blood culture test
disinfecting for a blood culture test
- 70% alcohol (may not be enough)
- iodine, chlorhexidine gluconate, or 70% ethyl alcohol with providone.
- cleanse site for 30-60 seconds
what should you make sure of if performing a blood culture test?
make sure patient isn’t going into septic shock
how do you collect culture & sensitivity test
- regular venipuncture
- collect aerobic specimen 1st
blood collection under the skin, due to wall of blood vessels periced, blood leaks into tissue
hematoma
inflammation of veins
phlebitis
tiny hemorrhages
- small red or purple spots on skin
petechia
a blood clot from not applying enough pressure to venipuncture site
throbus
severe sweating
diaphoresis
what do you do if your patient is having a seizure during phelbotomy
stop & get emergency assistance
what are the s/s of shock?
cold, clammy, pale, rapid pulse, increased shallow breathing , blank stare
what do you do if your patient is going into shock
- call for help
- ensure open airway
- lying down, lower head bellow their body
- keep warm
how do you handle and transport a specimen?
- test require time, heat, cold, or protection form light
- important to secure high quality test results
glucose in the blood cells can break down & interfere with test results due to…
delays
the blood specimen you are transporting must sit on ice, what is being tested?
ammonia & lactic acid
test has to be 37 C (98.6 F)
cold agglutions
test must be wrapped in foil
bilirubin & folate levels
test must be room temp.
-15 to 30 or ice slurry for 1 hour
- delivery time is important
blood gas test
test should take place within 1 hour of collection
coagulation
if test delay up to 24 hours @ room temp, then test results will not be affected
prothrombin
room temp.
22 C (72.6 F)
antibiotic peaking in the body
peak
draw at certain amount of time before giving antibiotic
trough
urine samples…
- refrigerated
- get to lab within 1 hour of collection
- room temp for no longer than 72 hours with reagent strips
room temp up to 72 hours
culture and sensitivity test
- vaginal swabs
- blood or bodily fluids from crime scene
- postmortem specimen
- toxicology testing after overdose
- must have special training
forensic specimen
- confirms maternal drug use 24 to 72 hours after childbirth of newborns urine is positive for substances
- analysis within 24 hours of childbirth
neonatal drug testing
legal BAC
0.08%
- establishes guidelines for some test tat PCT might perform in patients home and in medical facilities
- waived test»_space; decrease risk to patients
CLIVA 9 clinical laboratory improvement act)
chain of custody
maintains control and accountability for each specimen from time of collection to disposal
culture & sensitivity test should be
room temp up to 72 hours
- if not preserved, refrigerate
if you go out of order of draw, what do u do
continue draws and document mix up
what are the only times you wouldn’t continue the draw if you mix up the order?
if it is timed or for clotting
- u must do these in correct order of draw
when you draw, invert the tube a couple of times to prevent?
clotting
sitting the tube upright prevents
clotting
setting the tube sideways causes
hemolysis
Specimens that need to be put in a culture medium or lactic acid
Blood, urine, sputum, wound exudate, stool, and other body substances
Ammonia and lactic acid must be kept in…
An ice slurry immediately after collection
Cold agglutinations
Remain body temp (37 C (98.6 F))
Bilirubin and folate level
Wrap in foil to protect from light
Blood gas test
Room temp 15 to 30 min or in ice slurry for up to an hour
Coagulation test
Analysis should take place within 1 hour of collection
Prothrombin
Time is an exception
Photosensitive specimens must be
Protected from light
Peak and trough values
Collect at a specific time after administration of antibiotics
Urine specimens
Refrigerate and get to lab for testing within 1 hour of collection
Preserved urine specimens
Keep tube at room temp (22 C (72.6 F)) no longer than 72 hours before urinalysis
Culture and sensitivity
Room temp up to 72 hours
If there are any delays between time of collection and when specimen is supposed to be given to lad for testing, what do u do?
Complete laboratory requisition forms
What should be included on the laboratory requisition form?
Patients name, date, type of test, requesting providers name, ICD-10-C14 code for diagnosis, and a line for providers signature
