Phlebotomy Flashcards
What are some traits that can help a medical assistant have a positive patient experience when having a phlebotomy procedure?
Patience, compassion, attention to detail, friendly, hand-eye coordination, ability to multitask, excellent social skills
What are two key aspects of the MA’s approach to patients before a venipuncture, especially considering patient anxiety?
Introduce themselves with a pleasant, warm demeanor.
Be sensitive to the patient’s needs and provide comfort.
How should a patient’s arm be positioned for venipuncture, and what alternative can be used if a phlebotomy chair is unavailable?
Arm should be extended and stable.
Alternative: Patient makes a fist with the opposite hand and places it behind the elbow of the arm being used.
What considerations are important when performing venipuncture on pediatric patients, and what assistance might be needed?
Difficulty in obtaining blood is common.
Support person may be needed to hold the patient’s arm still.
Effective communication is necessary.
Why is it crucial to ask patients about previous blood draws and reactions, and what accommodation might be necessary based on their response?
To prepare for possible adverse reactions.
Accommodation: If a patient reports fainting, position them in semi-Fowler’s position or supine.
What two important steps should the MA take regarding communication with the patient during the venipuncture procedure?
Explain the procedure and safety precautions.
Be sensitive to verbal and nonverbal communication, and stop the procedure if the patient is in obvious distress.
Which instruction is often provided to patients that require fasting prior to blood work?
Nothing to eat or drink besides water for 12 hours prior to blood work
How would eating a meal prior to having a blood draw affect blood test results?
test values can detect fats from the food and provide inaccurate test results
How would the MA prepare a patient for phlebotomy?
Ask the patient how they responded to blood draws previously
What are the key pieces of information found in a laboratory directory manual, and why is it important to consult it?
Key information: Up-to-date list of orderable tests, specimen requirements, patient preparation, container type, and transport/processing requirements.
Importance: To ensure accurate test ordering and specimen collection.
What two patient identifiers are typically used to confirm patient identity before collecting a specimen?
Patient’s full name.
Patient’s date of birth.
List four essential pieces of information that must be included on a laboratory requisition form.
Ordering provider’s name and contact information.
Test and test code.
Diagnosis code (ICD-10).
patient demographics.
Special specimen requirements.
Insurance or other billing information.
Which of the patient’s information (besides name and DOB) should be included on lab requisition?
Insurance information
Describe the components of the evacuated tube system and explain its primary advantage.
Components: Double-pointed needle, plastic needle holder/adapter, and collection tubes. (typically 20 - 22 gauge)
Advantage: Allows for obtaining multiple tubes of blood with a single venipuncture stick.
When is a winged infusion set (butterfly system) preferred for venipuncture, and what are the typical gauge and length of butterfly needles?
Preferred when: Patients have small or fragile veins.
Typical gauge: 21 to 23 gauge.
Typical length: ½ to ¾ inch.
What is one advantage and one disadvantage of using a needle and syringe system for venipuncture?
Advantage: The amount of suction can be controlled by the plunger. (16 gauge)
Disadvantage: Only a small amount of blood can be obtained.
What are the four main components of blood?
Plasma, white blood cells, red blood cells, and platelets.
What are the primary functions of red blood cells?
Carrying oxygen to the tissues and transporting carbon dioxide to the lungs.
What is the role of white blood cells in the body?
Defending the body against bacteria and viruses.
What is the function of platelets in the blood?
Limiting blood loss when a blood vessel is damaged or leaking.
What are some of the components found within blood plasma?
Water, waste products, gases, proteins, and nutrients.
What is serum, and how is it obtained?
Serum is the liquid portion of blood obtained after a serum sample tube has clotted and been centrifuged.
What is plasma, and how is it obtained from a blood sample?
Plasma is the liquid portion of blood obtained after centrifuging a sample collected in a tube containing an anticoagulant.
After centrifuging a blood sample collected with an anticoagulant, what are the three distinct layers that form, and in what order are they found?
Top layer: Plasma
Middle layer: Buffy coat
Bottom layer: Red blood cells
How is clotted blood obtained?
It is obtained when blood is drawn in a tube that does not contain an anticoagulant
How is whole blood obtained, and what is role of the anticoagulant?
Whole blood is obtained when a tube with an anticoagulant is used. the anticoagulant inhibits blood clotting.
What is the purpose of vacuum stoppers?
Identifies any additive within the tube - also drawn in the proper order to avoid cross contamination
Why is gentle inversion of vacuum tubes with additives necessary, and what should be avoided?
Necessary for: Mixing blood and additive.
Avoid: Shaking or forceful inversion due to risk of hemolysis.
What is the significance of the order of draw in venipuncture, and what potential consequence can occur if it is not followed?
Significance: Critically important to avoid errors.
Consequence: Additive carryover, affecting test results.
List the color-top tubes in the correct order of draw, along with their additives and primary laboratory uses.
Yellow: Sodium polyanethol sulfonate (SPS); Blood/body fluid cultures.
Light Blue: Sodium citrate; Coagulation testing.
Red: None; Serum tests, chemistry, blood bank, immunology.
Red/Gray marble: Silica particles; Serum tests, chemistry, immunology.
Green: Heparin; Chemistry tests.
Green/Gray marble: Lithium heparin and gel; Plasma determinations in chemistry.
Lavender: EDTA; Hematology tests.
Gray: Potassium oxalate/sodium fluoride; Chemistry (glucose, alcohol).
What is the additive in a light blue top tube, and what type of laboratory testing is it used for?
Additive: Sodium citrate.
Laboratory use: Coagulation testing.
What is the additive in a lavender top tube, and what type of laboratory testing is it used for?
Additive: EDTA
Laboratory use: Hematology testing.
How many inversions are required for a gray top tube, and what is the function of the sodium fluoride additive?
Inversions: 8-10
Function of sodium fluoride: Inhibits glycolysis.
“Yellow Cultures Bring Light Coagulation, Red Serum Separates Green Plasma, Lavender Cells, Gray Glucose.”
Yellow: Cultures (SPS)
Blue: Light (Light Blue, Coagulation - citrate)
Red: Red (Serum)
Red/Gray: Separates (SST, serum separator)
Green: Plasma (Heparin)
Lavender: Cells (EDTA, Hematology)
Gray: Glucose (Potassium oxalate/sodium fluoride)
What is the additive in a yellow top tube, and what type of laboratory testing is it used for?
Additive: Sodium polyanethol sulfonate (SPS). Laboratory use: Blood or body fluid cultures.
What is the additive in a light blue top tube, and what type of laboratory testing is it used for?
Additive: Sodium citrate. Laboratory use: Coagulation testing.
What is the additive in a red top tube, and what type of laboratory testing is it used for?
Additive: None. Laboratory use: Serum tests, chemistry studies, blood bank, immunology.
What is the additive in a red/gray marble top tube, and what type of laboratory testing is it used for?
Additive: Silica particles. Laboratory use: Serum tests, chemistry studies, immunology.
What is the additive in a green top tube, and what type of laboratory testing is it used for?
Additive: Heparin. Laboratory use: Chemistry tests.
What is the additive in a green/gray marble top tube, and what type of laboratory testing is it used for?
Additive: Lithium heparin and gel. Laboratory use: Plasma determinations in chemistry studies.
What is the additive in a lavender top tube, and what type of laboratory testing is it used for?
Additive: EDTA. Laboratory use: Hematology tests.
What is the additive in a gray top tube, and what type of laboratory testing is it used for?
Additive: Potassium oxalate and sodium fluoride. Laboratory use: Chemistry testing, especially glucose and alcohol levels.
How many times should a light blue tube be inverted following blood draw?
3-4
How many times should a Red tube be inverted following blood draw?
5
How many times should a Red/gray marble tube be inverted following blood draw?
5
How many times should a Green tube be inverted following blood draw?
8
How many times should a Green/gray marble tube be inverted following blood draw?
8
How many times should a Lavender tube be inverted following blood draw?
8
How many times should a Gray tube be inverted following blood draw?
8 to 10
What factors influence the selection of a phlebotomy method?
Patient’s vein condition, age, skin conditions, overall health, and the medical assistant’s experience/judgment.
Which vein in the antecubital space is generally preferred for venipuncture, and why?
The median cubital vein, because it tends to cause less pain and is less likely to roll.
When are the cephalic and basilic veins considered as alternatives, and what precaution should be taken?
When the median cubital vein is inaccessible. Precaution: Extra care to anchor the vein to prevent rolling.
Under what circumstance should blood draws from the foot be performed, and why?
Only under provider supervision, due to the risk of deep vein thrombosis (DVT).
When is the butterfly method typically preferred for venipuncture?
When drawing from the hand or small/thin veins in the antecubital space.
Where should a tourniquet be applied, and for how long should it remain in place?
3 to 4 inches above the draw site, and no longer than 1 minute.
What complication can occur if a tourniquet is left on for too long?
Hemoconcentration, which can alter test results.
What site restrictions should be considered before selecting a venipuncture site?
Fistulas, ports, mastectomies, scar tissue, injuries, burns, or wounds.
What physiological changes in older adult patients can complicate venipuncture?
Muscular atrophy (changing skin integrity), loss of vein elasticity, and venous insufficiency.
What is a risk when drawing blood from the hand?
the veins are most likely to roll, and there are many nerves which can cause discomfort.
What is the appropriate technique when cleansing the venipuncture site with an antiseptic wipe?
Upward and downward motions with friction
How to anchor veins for rolling veins?
Ask patient to extend arm straight or stretch hand down to keep veins straight
How should the vein be anchored before inserting the needle, and where should the skin be grasped?
Grasp the skin firmly about 2 to 3 inches below the puncture location, holding the skin taut.
What is the recommended angle of needle insertion when drawing blood from the arm?
15 to 30 degrees.
What is the recommended angle of needle insertion when drawing blood from the hand?
10 to 15 degrees.
Which way should the bevel of the needle be facing during insertion?
Upward
When should the tourniquet be released during the venipuncture procedure?
Once proper blood flow is established.
What action should be taken immediately after removing the needle from the patient’s arm?
Apply gauze over the puncture site, after the needle is completely removed.
What is the next step after the gauze is applied?
close the needle safety guard and dispose of the needle in the biohazard sharps container.
When are capillary punctures typically performed?
When only a small amount of blood is needed, or when immediate results are required; also the preferred method for infants and young children.
What type of blood is collected during a capillary puncture, and why does this matter?
A mixture of blood from arterioles, venules, capillaries, and intracellular and interstitial fluids. This matters because not all tests can be performed on capillary blood due to its mixed composition.
List five essential supplies needed for a capillary puncture.
Gloves, automatic retractable lancet, disinfectant pads (70% isopropyl alcohol), clean gauze pads, bandage, and a blood collection device.
Name three examples of blood collection devices that might be used during a capillary puncture.
Micropipette, small glass tube (capillary tube), micro-collection devices, glucometer and testing strip, screening card or paper, plastic testing cartridge or cassette.
What additional supply is needed when using capillary tubes for blood collection?
A capillary tube sealer.
Where should used lancets be disposed of after a capillary puncture?
In a biohazard sharps container.
What are the preferred puncture sites for capillary punctures in adults and children?
The middle or ring finger of the nondominant hand.
Where on the finger should the puncture be performed, and what areas should be avoided?
Slightly off-center. Avoid the central fleshy part of the fingertip, fingernail, and nail bed.
Where is the preferred puncture site for capillary punctures in infants?
The outer edge of the underside of the heel.
Why is good capillary blood flow essential for a successful capillary puncture?
If the patient’s hands are cold, the capillaries are constricted, making it difficult to collect enough blood.
What are two methods to warm a patient’s hands before a capillary puncture?
Having the patient rub their hands together or run them under warm water.
What specific warming method is used for infants before a heel puncture?
Heel warmers.
What solution is used to cleanse the capillary puncture site, and what important step should be taken after cleansing?
70% isopropyl alcohol pad. Allow the site to air-dry completely.
What should be avoided after cleaning the capillary puncture site?
Touching the site.
How should the patient’s finger be held during a capillary puncture, and at what angle should the lancet be held?
Hold the finger firmly but gently between thumb and forefinger. Hold the lancet at a right angle to the puncture site.
What should be done immediately after activating the lancet?
Discard the used lancet into a sharps container.
Why is the first drop of blood wiped away during a capillary puncture (unless performing a PT test)?
To obtain a clean sample without tissue or fluid contaminants.
What action can be taken if blood flow is slow during a capillary puncture?
Gentle pressure and rubbing can be applied to the patient’s finger.
What steps should be taken to address excessive blood flow from a capillary puncture site?
Apply additional gauze and pressure. Elevate the arm over the level of the heart.
What is the recommended order of draw for microcapillary tubes?
Blood gases, EDTA tubes, other additive tubes, serum tubes.
How long should patients leave the bandage in place after phlebotomy?
15 minutes
Serum must be allowed to stand upright at room temperature for
30 to 45 minutes before being centrifuged
Clotted blood must stand upright at room temperature for
30 to 45 minutes
What are examples of preanalytical errors?
mislabeling of specimens, errors in patient identification, insufficient quantity for testing, and incorrect handling or transporting processes
What are examples of postanalytical errors?
Failure in reporting reuslts, improper data entry, misinterpretation of results
For court cases or for other circumstances (those established by law) what chain should it follow?
Chain of custody - requires documentation of signatures of every individual that has any contact with the specimen from time of collection to the time results are reported
What happens to blood specimens during centrifugation, and why?
Heavier elements are pulled to the bottom of the tube, separating from lighter elements at the top, due to the high rate of speed.
Why is it important to balance the weight in a centrifuge, and how can this be achieved?
To ensure balanced weight distribution during motion. Achieved by placing tubes of similar size and fill across from each other, or by using water-filled tubes to balance uneven samples.
What does the term “aliquot” mean in the context of laboratory procedures?
It means dividing a single specimen into multiple tubes for testing on different equipment.
What safety precautions should be taken when transferring serum from one tube to another?
Use a single-use pipette, wear face and eye protection, use a tube rack, and never pour blood specimens.
Why is it important to use a disposable pipette when transferring blood specimens?
To avoid splashing and spills.
What should an MA do if a piece of medical equipment is overdue for calibration?
Notify the office manager or lab supervisor and place the unit out of service until it has been calibrated.
What should be worn when transferring blood into multiple test tubes?
Face and eye protection
How should multiple patient specimens be packaged for transport?
A separate biohazard bag should be used to package each patient’s specimens prior to transport
Why should a medical assistant never provide medical information or advice to a patient based on a provider’s directions from a previous, similar situation?
Because each patient situation is unique and may have individualized considerations that the medical assistant is unaware of.
Who should review patient questions and provide medical information or advice?
The provider.
How can a medical assistant prepare for potential patient questions?
By anticipating questions based on previous experiences or the patient’s perspective, and proactively discussing them with the provider.
What is the benefit of the MA proactively asking the provider about anticipated patient questions?
It allows the medical assistant to be better prepared for the patient conversation and helps the patient receive answers more efficiently.
What steps should be taken when a critical lab value is received at the clinic?
Immediately notify the ordering provider of the critical lab value and document the notification.
How should light-sensitive samples be prepared for transport?
Wrapped in foil to shield them from light
