Phlebotomy Book- Chapter 9

Question 1

Most common technique to obtain blood specimens-

Answer 1

Venipuncture

Question 2

Basic blood collection steps- (6)

Answer 2

-Greet and properly identify the patient
-Select and assemble the appropriate equipment
-Use aseptic technique and standard precautions during venipuncture and blood specimen collection
-Provide proper post-puncture patient care
-Adhere to specimen labeling requirements
-Correctly handle and transport specimens

Question 3

Preparing the equipment steps- (2)

Answer 3

-Line up the equipment near the patient with the tubes assembled in the order of draw
-Attach needle into tube adapter.

Question 4

Positioning the patient for blood draw- (3)

Answer 4

-Patient should lie supine or sit in a phlebotomy chair
-Straight chair with arm
-Use pillow or towel if necessary

Question 5

Tourniquet application- (4)

Answer 5

-Position the tourniquet under the arm
-Cross the left end over the right end
-Grasp both ends of the tourniquet close to the patient’s arm between the thumb and forefinger of the left hand
-tuck the left end under the right end. The loose end of the tourniquet will be pointing toward the shoulder and the loop will be pointed toward the hand

Question 6

Selecting Venipuncture site- (4)

Answer 6

-Position arm at downward angle
-Ask patient to make a fist
-Examine the antecubital area first
-Palpate vein with fingertip

Question 7

1-2-3-2-1 method- (5)

Answer 7

-1—pair of gloves.
-2—tourniquet and alcohol swab.
-3—needle, holder, and tubes (in draw order).
-2—gauze/cotton swab and bandage.
-1—sharps container.

Question 8

1-2-3-2-1 method used in-

Answer 8

Locations not typically used for blood collection

Question 9

Special considerations for children- (6)

Answer 9

-Squat down to child’s height to reduce intimidation
-Never lie
-Ask the child’s caregiver to help
-Use restraining chairs or arm boards if necessary
-Have special bandages or stickers available as rewards
-Always be honest and direct

Question 10

Special considerations for geriatric patients- (3)

Answer 10

-Allow extra time for communication if sensory impairment exists
-Skin is fragile and veins tend to roll; hold skin taut
-If using a butterfly needle, a shallower angle is required during insertion

Question 11

Technique used for cleansing Venipuncture site-

Answer 11

Aseptic

Question 12

Aseptic technique- (2)

Answer 12

-70% alcohol pad
-use concentric circles

Question 13

Wet alcohol on injection site can-

Answer 13

Hemolyze the specimen & affect lab results

Question 14

Performing Venipuncture steps- (4)

Answer 14

-Reapply the tourniquet
-Visually confirm the site
-Anchor the vein
-Insert the needle

Question 15

Causes of unsuccessful Venipuncture- (5)

Answer 15

-Poor site selection (vein hard and sclerosed)
-Patient fails to remain still
-Tourniquet too tight
-Use of expired evacuated tubes
-Use of a tube that has lost vacuum

Question 16

Causes of unsuccessful Venipuncture with improper technique- (4)

Answer 16

-bevel on lower wall of vein (doesn’t allow blood flow)
-needle rotated 45 deg
-needle inserted too far
-needle partially inserted (blood leaks into tissue)

Question 17

Collecting the specimen steps- (4)

Answer 17

-Insert the first evacuated tube to start blood flow
-Hold equipment steady during tube changes
-Allow each tube to fill completely
-Mix tubes with additives immediately

Question 18

Removing the tourniquet steps- (5)

Answer 18

-Release the tourniquet
-Place gauze on puncture site
-Remove needle smoothly
-Engage needle safety mechanism
-Apply gentle pressure to patient’s arm

Question 19

Use butterfly set only when-

Answer 19

Standard draw isn’t possible

Question 20

Do not use butterfly set with evacuated tubes if-

Answer 20

Patient has fragile veins

Question 21

Transferring specimen from syringe to evacuated tube- (4)

Answer 21

-peel off backing from transfer device
-insert syringe tip into hub & rotate syringe clockwise
-Hold the syringe facing down and push the evacuated tube into the holder. Do not depress the plunger of the syringe
-after removing evacuated tube, discard tube holder and syringe in an approved sharps container

Question 22

Patient complications with allergic reactions- (2)

Answer 22

-latex
-alcohol

Question 23

Patient complications with syncope- (3)

Answer 23

-Heavy perspiration
-Pale skin
-Shallow or fast breathing

Question 24

Patient complications with syncope phlebotomist actions- (3)

Answer 24

-Remove tourniquet and needle
-Call for help
-Apply pressure to venipuncture site

Question 25

Patient Complications: Petechiae- (2)

Answer 25

-Make sure tourniquet is not too tight
-Apply tourniquet for only 1 minute at a time

Question 26

Patient Complications Bleeding- (3)

Answer 26

-Arm movement may cause bleeding to recur
-Check the arm before leaving the patient
-Apply adhesive bandage over clean piece of gauze

Question 27

Patient Complications if Hematoma occurs- (4)

Answer 27

-Release the tourniquet
-Pull the needle out
-Apply firm pressure at the site
-If patient complains of discomfort, apply ice

Question 28

Patient Complications: Iatrogenic Anemia- (2)

Answer 28

-Anemic response to removal of large amount of blood over short time period
-More than 10% blood loss may become life-threatening

Question 29

Patient complications: Exsanguination- (2)

Answer 29

-Life-threatening amount of blood loss
-Occurs easily in small patients, children, and infants

Question 30

Avoid puncture site infection- (4)

Answer 30

-Ensure sterility of all equipment used
-Do not touch puncture site after it is cleansed
-Apply pressure until all bleeding has stopped
-Never puncture through a previous puncture site

Question 31

Patient complications: injury- (2)

Answer 31

-Do not insert the needle too deeply
-NEVER probe for a vein

Question 32

Patient Complications: Additive Reflux- (3)

Answer 32

-Blood mixed with tube additive flows back into patient’s vein
-May cause adverse reactions
-To avoid, always collect blood with patient’s arm and evacuated tubes in a downward position

Question 33

Arterial puncture results in-

Answer 33

Bright red blood pulsing into tube

Question 34

What to do in case of arterial puncture- (3)

Answer 34

-End the procedure immediately
-Apply pressure for at least 5 minutes
-Apply pressure dressing

Question 35

Hemoconcentration situations that affect situation quality- (2)

Answer 35

-Water leaves the vein and enters the tissues
-Water that remains in the vein contains a falsely higher level of cells and chemicals

Question 36

Hemoconcentration-

Answer 36

Rapid increase in ratio of blood components to plasma

Question 37

Hemoconcentration can cause erroneous results in some lab tests- (3)

Answer 37

-Protein levels
-Cell counts
-Coagulation studies