Phlebotomy Flashcards
a device that is applied or tied around a patient’s arm prior to venipuncture to restrict blood flow
Tourniquet
elastic strap, a heavier Velcro strap, or a blood pressure cuff
Tourniquet
Tourniquet is applied ___ to ___ inches above the venipuncture site left for no longer than _____
3 to 4 inches, no longer than 1 minute
sterile, disposable, and designed for a single use only
needles
example of needles
multisample needles, hypodermic needles and winged infusion (butterfly) needles
what is the length of needles
1- or 15- in length
most common needle size for adult venipuncture
21 gauge with a length of 1 inch
it provides better control during venipuncture
needles
Ready for use
top
Safety system engaged
Bottom
Will see “______” of blood in _____ when needle enters vein
flash, needle hub
needles used for venipuncture
22-, 21-, and 20-gauge
used for small veins and for pediatric patients
22-gauge needle
can be used in combination with a butterfly collection set
23-gauge needle
used for intermuscular injections
25-gauge
needle used for administration of a purified protein derivative (PPD) tuberculosis skin test
27-gauge
27-gauge needle used for administration of a
purified protein derivative (PPD) tuberculosis skin test
needles used for the IV infusion of fluids or blood products or removal of blood during donor process
18- and 16-gauge
Collection of donor units, autologous blood donation, and therapeutic phlebotomy.
15-17 , Special needle attached to collection bag
Used primarily as a transfer needle rather than for blood collection; safety issues have diminished use.
18, Hypodermic
Sometimes used when large-volume tubes are collected or large-volume syringes are used on patients with normal-size veins.
20, Multisample Hypodermic
Considered the standard venipuncture needle for routine venipuncture on patients with normal veins or for syringe blood culture collection.
21, Multisample Hypodermic
Used on older children and adult patients with small veins or for syringe draws on difficult veins.
22, Multisample Hypodermic
Used on the veins of infants and children and on difficult or hand veins of adults.
23, butterfly
gauge number of a needle is inversely related to the bore size:
the smaller the gauge number, the largerthe bore
most frequently used method for performing venipuncture
Evacuated System
Uses double-pointed needle
Evacuated System
angle of insertion
15 degrees
for small, difficult veins
Butterfly Collection System
Tubes are different sizes and contain different types of anticoagulant
Evacuated System Collection Tubes
Tubes can contain _____ to separate cells from serum or plasma
thixotropic gel
of separator gel tube causes gel to form interface between cells and serum or plasma
Centrifugation
prevent clotting
anticoagulant
maintain the shelf life of the donated blood products
additive solutions
substances that prevent blood from clotting (coagulating)
ANTICOAGULANTS
it is unavailable to the coagulation process or by inhibiting the formation of thrombin needed to convert fibrinogen to fibrin in the coagulation process
chelating (binding) or precipitating calcium
anticoagulant of choice for hematology cell counts and cell morphology
Ethylenediaminetetraacetic acid (EDTA)
Lavender (purple)-top tubes
Ethylenediaminetetraacetic acid (EDTA)
plastic, spray-dried EDTA
K2EDTA
glass, liquid form removes ionized calcium (Ca2+) through a process referred to as chelation
K3EDTA
glass, liquid form removes ionized calcium (Ca2+) through a process referred to as
chelation
Excess EDTA, which results when tubes are underfilled, can cause RBCs to shrink and thus change CBC results
microhematocrit
spray-dried color
pink tube top
K2EDTA TESTS
immunohematology (ABO grouping, Rh typing, and antibody screening)
EDTA and gel; molecular diagnostic testing of plasma.
White-top tubes
For coagulation testing (aPTT & PT testing)
Citrates
light blue-top tube
Citrate
containing 0.105 M or 0.129 M (3.2% or 3.8%, respectively)
Citrate
Citrate contain a ____ ratio of blood to anticoagulant
9:1
precipitating calcium into an unusable form
Citrate
can activate platelets and shorten clotting times.
Vigorous mixing or an excessive number of inversions
Black-top tubes & buffered sodium citrate, ratio of blood to anticoagulant is and its for
4:1 for Westergren sedimentation rates
used as an in vitro and in vivo anticoagulant
Heparin
green-top tubes
heparin
heparin prevents clotting by inhibiting
thrombin formation
lithium heparin (LiHep) and sodium heparin (NaHep)
heparin
used to coat capillary blood collection tubes.
heparin
an inappropriate anticoagulant for many hematology tests, including Wright-stained blood smears.
heparin
Lithium heparin- most chemistry tests except for
lithium and folate levels
heparin is an inappropriate anticoagulant for many hematology tests, including
Wright-stained blood smears
recommended for trace elements, leads, and toxicology but not for SODIUM assays
sodium heparin
Sodium heparin- recommended for trace elements, leads, and toxicology but not for
SODIUM assays
the injectable form used for anticoagulant therapy
heparin
is preferred over serum for potassium tests because when blood clots, potassium is released from cells into the serum and can falsely elevate results.
Heparinized plasma
w
Three varieties: No anticoagulant and produces a clot sample; the other two have sodium heparin or disodium EDTA as an anticoagulant.
Royal blue-stoppered tubes
Royal blue-stoppered tubes three varieties
No anticoagulant and produces a clot sample; the other two have sodium heparin or disodium EDTA as an anticoagulant.
does not contain citrate is used for collecting blood culture samples
Yellow-stoppered tube
Yellow-stoppered tube contains
additive sodium polyanethol sulfonate (SPS)
Main function of the SPS tube sodium polyanethol sulfonate (SPS)
is to allow bacteria to grow so they can be cultured
used for glucose measurements
Sodium fluoride
Gray-top tubes
Sodium fluoride
Sodium fluoride prevents glycolysis for
3 days
Sodium fluoride anticoagulant:
Potassium Oxalate
occurs faster in newborns because their metabolism is increased, and in patients with leukemia because of high metabolic activity of WBCs.
Glycolysis
substance that enhances coagulation in tubes used to collect serum specimens
CLOT ACTIVATORS
glass (silica) particles and inert clays like Celite
CLOT ACTIVATORS
are the clot activators in serum- separator tubes (SSTs) and plastic red-top tubes.
Silica particles
used for most chemistry, blood bank, and immunology assays
CLOT ACTIVATORS
an inert material that undergoes a temporary change in viscosity during the centrifugation process
THIXOTROPIC GEL SEPARATOR
this enables it to serve as a separation barrier between the liquid (serum or plasma) and cells.
THIXOTROPIC GEL SEPARATOR
Order of Draw
1.Sterile tube (blood culture)
2. Blue-top coagulation tube
3. Serum tube with or without clot activator, with or without gel
4. Heparin tube with or with or gel plasma separator
5. EDTA tube
6. Glycolytic inhibitor tube
used to puncture finger or heel
Lancets
used to collect small blood samples
Microcollection tubes
The United States and many other countries require that newborns receive/Components vary from state to state
Neonatal Screening for metabolic disorders.
to hold all equipment necessary for proper sample collection
sample collection tray or cart
Will be taken to patient’s room so phlebotomist is prepared for whatever procedure is performed
Sample Collection Trays or Carts
Blood Collection Equipment and Supplies
• Gauze pads/cotton balls
• Bandages
• Needle and sharps disposal containers • Slides
• Pen
• Watch
Routine Venipuncture Equipment
• Phlebotomy collection tray
• Evacuated tube system holders
• Syringes
• Winged blood collection sets
• Needles
• Needle disposal sharps containers
• Evacuated collection tubes
• Transfer devices
• Tourniquets
• Gloves
• 70 percent isopropyl alcohol, iodine
swabs, chlorhexidine gluconate swabs
• 2 X 2-inch gauze pads
• Bandages
• Slides
• Antimicrobial hand gel
• Marking pen
• • • • • - -
Blood-drawing station
Phlebotomy chairs
Handheld Carriers / Phlebotomy Carts
Gloves and glove liners Antiseptics
70% isopropyl alcohol
70% isopropyl alcohol + 1%-10% povidone-iodine pads, tincture of iodine, chlorhexidine
ANTISEPTICS USED IN BLOOD COLLECTION
• 70% Ethyl alcohol
• 70% Isopropyl alcohol (isopropanol)
• Benzalkonium chloride (e.g., Zephiran chloride) • Chlorhexidine gluconate
• Hydrogen peroxide
• Povidone-iodine (0.1%-1% available iodine)
• Tincture of iodine
These are used prevent or inhibit the growth and development of microorganisms in the blood and considered safe to use on human skin and are used to clean the site prior to blood collection.
Antiseptic
It only reduces the number of microorganism on the surface of the skin and not sterilize the skin.
antiseptic
These are handheld which makes blood collection portable and can be done anywhere. However, it is only ideal when catering a few patients. It contains: plaster, antiseptics such as alcohol, container for sharp disposal, tubes, and more.
Phlebotomy Tray
Only ideal when catering a big number of patient; usually used by hospitals. It could be a source of infection since it is carried throughout the hospital. Thus ideally, should not be brought inside the patient’s
room to avoid any nosocomial infection
Phlebotomy Carts
dedicated area inside a clinical laboratory that is solely used for blood collection to patients who can visit the laboratory.
blood drawing station
It should be comfortable for the patient, here should be an adjustable arm rest with a lock to secure and hold the patient while making sure they are comfortable enough.
Phlebotomy Chair
These are chemical substances or solutions used to remove or kill microorganisms on surfaces and instruments.
DISINFECTANTS
Alcohol-based hand sanitizers can be used for routine decontamination of hands as a substitute for hand washing, only when there is no visible contamination such as blood
HAND SANITIZERS
These are used to hold
pressure over the site following
blood collection procedure.
GAUZE PADS OR COTTON BALLS
These are used to cover a blood collection site after the bleeding has stopped; can also use paper, cloth, or knitted tape over folded gauze.
BANDAGES
The containers are very important wherein the sharps used during the venipuncture are disposed here.
NEEDLE AND SHARPS DISPOSAL CONTAINER
These containers should be:
• rigid
• puncture-resistance • leakproof
• disposable
These are leakproof plastic bags and used to transport blood and other specimens from the collection site to the laboratory. There are outside pockets for request forms.
BIOHAZARD BAGS
to restrict blood flow
Tourniquet
restriction of blood flow can
change blood components
types of needles
multi-sample
• hypodermic (syringe)
• winged infusion set (butterfly)
Needles used for phlebotomy include:
sterile and disposable
o designed for a single use only
butterfly needles inch long
1⁄2 to 3⁄4
end that pierces the vein
allows the needle to easily slip into the skin and vein without coring (removing a portion of the skin or vein
Bevel
the long cylindrical portion
Shaft
end that attaches to the blood collection device
Hub
internal space of the needle
Lumen
to lock and twist into the vacutainer
Threaded Hub
Is the diameter of the lumen; t
gauge
length commonly used for
venipuncture
1 or 1.5 inch
provide immediate permanent containment and be activated using one hand, which must stay behind the needle at all times
Safety Feature
shields that cover the needle after use and are devices that retract the needle after use
Resheathing Devices
are preferred by the CLSI for collecting blood samples. It is closed system which the patient’s blood flows through a needle inserted into a vein and then directly into a collection tube without being exposed to the air or outside contaminants.
EVACUATED TUBE SYSTEM
allows numerous tubes to be collected with a single venipuncture
ETS
The three basic components of ETS are:
• a special blood-drawing needle
• a tube holder
• various types of evacuated tubes
allows multiple tubes of blood to be collected during
a single venipuncture
• threaded in the middle, beveled point on each end
Multi-sample Needle
a clear, plastic, disposable cylinder with a small
threaded opening at one end, hub
Tube Holders
The tubes contain
vacuum
an alternative for patients with small or difficult veins.
syringe system
Syringe Needles
• generally gauges
21 – 23 in 1 or 1.5 inch length
It is an indispensable tool for collecting blood from small or difficult veins such as hand veins and veins of elderly and pediatric patients.
WINGED INFUSION SET
winged infusion set size
1⁄2 to 3⁄4 inch stainless steel needle is permanently connected to a 5 to 12 inch length
It is a complete system for blood collection in which the blood collection tube and collection apparatus are combined in a single unit.
COMBINATION SYSTEMS
available in liquid, spray-dried, and powder forms
additives
antiglycolytic agents
sodium fluoride
clot activators
o silica
o celite – POCT coagulation
o thrombin
substances that prevent blood from clotting
ANTICOAGULANTS
ANTICOAGULANTS
chelating (binding) or precipitating calcium o inhibiting the formation of thrombi
• powdered di-potassium (K2) or liquid tri-potassium (K3)
• preserves cell morphology
• chelates calcium
• lavender (purple) – top tubes
• micro collection containers with lavender tops
• pink plastic-top tubes with a special blood banking
patient ID label
• pearl-top tubes with thixotropic gel separator
EDTA
• prevents coagulation by binding or chelates calcium • preserves coagulation factors
• most common is sodium citrate
CITRATES
contains 9:1 ration of blood to anticoagulant o filled to the stated volume and must be filled
within 90% of that volume
light blue stopper
inhibit thrombin formation
heparin
HEPARIN is used fkr
some chemistry tests, especially STAT test
• prevent coagulation by precipitating calcium
• potassium oxalate (most used)
• gray stoppers
oxalates
SPECIAL ADDITIVES
Acid Citrate Dextrose (ACD)
Citrate Phosphate Dextrose (CPD)
Sodium Polyanethol Sulfonate (SPS)
immunohematology, paternity tests, transplant
compatibility
Acid Citrate Dextrose (ACD)
• for blood transfusion
• phosphate stabilizes Ph
Citrate Phosphate Dextrose (CPD)
for blood culture
• reduces the action of a protein called complement • slows down phagocytosis
• reduces the activity of certain antibiotics
Sodium Polyanethol Sulfonate (SPS)
Order of draw
- Sterile Tube
- Blue-top Coagulation Tube
- Serum Tube with our without clot activator, or with
or without gel - Heparin Tube with or without gel plasma separator
- EDTA tube
- Glycolytic inhibitor tube
