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Fundamentals of MLS > Phlebotomy Ch 8 > Flashcards

Phlebotomy Ch 8 Flashcards

1
Q

T/F A patient must be registered before specimen collection can take place.

A

True

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2
Q

List the identity info required.

A

Patients ID includes: Full name, date of birth, and proof of ID.

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3
Q

T/F Patient specific identifier is typically assigned & will appear on test request and specimen labels.

A

True

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4
Q

Who requests lab tests?

A

Typically by a physician or other other qualified health care worker (e.g. nurse practioner).

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5
Q

Can certain rapid tests be purchase and performed at home by consumers?

A

Yes

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6
Q

T/F Blood specimens may be requested by law enforcement officials

A

True

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7
Q

What is important to pay attention on manual requisitions?

A

The type of tests ordered. What tubes to use and order they should be in.

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8
Q

What does LIM stand for in Shared Health’s website?

A

Lab Information Manual

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9
Q

What is done in step 1: Receive, Review & Accession Test Request?

A
  1. Receive the test request
  2. Review the requisition
    a. Check to see that all required info is present & complete
    Make certain request matches labels
    Resolve any problems or discrepancies with provider
    Verify tests to be collected & time & date of collection
    Identify diet restrictions or other special circumstances
    Determine test status & collection priority
  3. Accession the test request
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9
Q

What is done in step 1: Receive, Review & Accession Test Request?

A
  1. Receive the test request
  2. Review the requisition
    a. Check to see that all required info is present & complete
    b. Make certain request matches labels
    c. Resolve any problems or discrepancies with provider
    d. Verify tests to be collected & time & date of collection
    e. Identify diet restrictions or other special circumstances
    f. Determine test status & collection priority
  3. Accession the test request
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10
Q

In step 2: Approach, Greet, & Identify the Patient, what do you do if the patient’s physician or clergy is there?

A

Don’t interrupt physicians & clergy.
If there is a doctor or clergy in the room if its not stat or timed collection go to your next patient and let them know you will be back – its their personal health is private.

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11
Q

In step 2: How do you approach the patient?

A

Use bedside manner to gain the patient’s trust & confidence to put them at ease

Note: ALWAYS use professional tone and best bedside manner you represent our profession to this patient. They way you approach sets the tone of the whole interaction ALWAYS be polite especially if they are on edge that you are about to poke them

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12
Q

In step 2: Approach… etc what do you look for in the room?

A
  1. Look for signs containing patient info
  2. Scan the room for sharps containers, obstacles, & IVs
    Example: Signage usually on the door or above the head of the bed (Ex: additional precautions, or no blood draw/blood pressure on a certain arm)
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13
Q

In step 2: Approach… etc what do you do if family and visitors are there?

A

Ask family & visitors to step out, but use your discretion while following facility protocol if they wish to stay
Note: Also, depends on how comfortable you are if there is visitors in the room you can proceed or ask them to step out till you are done in a polite manner

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14
Q

In step 2: Approach… etc what do you do if the patient is not in their room?

A

Document if patient is unavailable

Notify nursing unit if you can’t find the patient – they will usually help you or ask you to come back

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15
Q

In step 2 Approach…. Identify, etc. how do you do the identification check?

A

Verify name & date of birth
Check ID band
Be aware of bands from other facilities or for other purposes
Use three-way ID: patient’s verbal ID statements, ID band, & visual comparison of label with ID band
Be aware of ID situations requiring extra care, for example, common names
Notify nurse of ID discrepancies
If missing ID, check ankle, avoid using bands found elsewhere in the room, follow institutional protocol

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16
Q

In step 2, what if the ID band is not on the patient but is on the bedside table?

A

The band MUST be on the patient – if its on the bedside table or in patients pocket this is inadequate, and you must notify a nurse for further ID of patient

If the patient is missing their ID band again always check with nurse to put on a new band so you can proceed

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17
Q

In step 2, what do you do if there is a discrepancy?

A

If there is any discrepancy with name spelling, PHIN number incorrect or DOB check with nurse before proceeding

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18
Q

In step 2, how do you approach a sleeping or unconscious patient to ID them before venipuncture?

A
  1. Wake sleeping patients gently to obtain identification & consent. ALWAYS wake patients up you never want to poke someone sleeping
  2. Ask relative or nurse to identify unconscious patients, be aware they may hear you & feel pain. ALWAYS talk to the patient as you normally would like letting them know you are just about to poke them etc.
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19
Q

How do you handle unidentified ER patients?

A

Unidentified ER patients is common, and they get assigned a temporary ID – most cases there will be always a nurse/HCP with the patient

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20
Q

How are babies identified?

A

Neonates – ID band is usually on their leg and information on the neonatal isolette or incubator (although that alone can not be used to ID a baby)
Sometimes you have a baby that doesn’t have a name yet so will be Infant Smith. So it is important to also check moms information but always follow your facility policy
And if they are twins or triplets it will be Infant Smith A or infant Smith B. It is very important to take special care or have someone else collect the second baby as they might not need the same treatments and could have different results.

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21
Q

In step 3: Explain the procedure and obtain consent, what is part of informed consent?

A

You must always determine that the patient understands what is about to take place and obtain permission before proceeding. This is part of informed consent, even if they have had their blood drawn before.

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22
Q

In step 3: Explain the procedure and obtain consent, what if the patient objects?

A

Patient objections – usually inpatients as they are unaware of multiple tests being ordered and the frequency.
Usually a little reminder that the physician ordered the tests and is waiting for results to provide care usually does the job
BUT never badger – ask again once you have told them and if they truly refuse (they have the right) make a note and notify physician or nurse

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23
Q

In step 3, what if the patient is being difficult?

A

Difficult patients – you never know what patients are going through, try to maintain a positive manner.
Sometimes patients aren’t having a good day so if you get that sense just remain professional and treat the patient in a caring manor

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24
Q

In step 3, explain the procedure and obtain consent, how do you deal with cognitively impaired patients?

A

Cognitively impaired – can be unpredictable and sudden movements that could be dangerous to themselves or you
May not understand why you are there – may need to obtain consent from guardian and help assisting the patient
Also make sure you have an exit route in case you need to leave
placement of equipment -out of reach for the patient

25
Q

In step 3, explain the procedure and obtain consent, how do you deal with needle phobia?

A

Needle Phobia – they could possibly have heightened sensitivity to pain or a shock type reaction – may become pail sweating nausea and fainting
Have most experienced and skilled phlebotomist
Have patient lie down
Have ice pack to site 10-15 min to numb site

26
Q

In step 3, explain the procedure and obtain consent, how do you deal with altered mental states?

A

Assistance with patients who are in an altered state consciousness is required for the safety of everyone involved and others nearby. Check facility protocols. Reasons are varied for altered mental states including drugs or changes in brain function due to their illness or procedure.

27
Q

In step 4, Collection Requirements/Sensitivities/Problems, what needs to be reviewed with the patient?

A
  1. Diet Restrictions (e.g. fasting, NPO, etc.)
  2. Sensitivities (e.g. latex)
  3. Previous problems with phlebotomy
  4. Address objects in patient’s mouth
28
Q

In Step 5: Perform HH and don gloves, what is used?

A

ABHR, allow it to evaporate.
If visibly soiled use soap and water.
Note: Always use gloves for vein selection not hands!

29
Q

In step 6: Position Patient/Apply Tourniquet, how should the arm be positioned?

A
  1. Hand well supported.
  2. Arm straight down, avoid bending at elbow for ACF venipuncture. (slight bend not to hyperextension of the elbow).

For patients in bed, it is common to use a pillow/towel to position arm.

30
Q

In step 6: Position Patient/Apply Tourniquet, why is it important the arm be placed downwards?

A

Important – a downward position necessary to ensure tubes fill bottom up to prevent reflux or backflow of the contents of the tube into the patients vein

31
Q

Is it ever acceptable to take blood for a patient standing?

A

No, never; especially for the patient’s safety. Although sitting on edge of bed can be sufficient.

32
Q

In step 6: How long should the tourniquet stay on for? What if on for longer?

A

One minute max.

If tourniquet is on longer than one (1) minute it MUST stay off for two (2) minutes prior to re-application.

33
Q

In step 6: Position Patient/Apply Tourniquet, if you have to move the bed railing or move anything else, what needs to be done when finished?

A

NOTE: YOU MUST REPLACE EVERYTHING IN THE ROOM THE WAY IT WAS. IF YOU PUT THE RAILING DOWN YOU MUST PUT IT BACK UP BEFORE YOU LEAVE – you can be held liable if patient falls

34
Q

In Step 7: Select Vein/ Release Tourniquet, where is the preferred site of venipuncture?

A

Preferred site is antecubital area of arm
First choices are median cubital & median veins

H pattern: Median cubital vein, Cephalic vein then Basilic vein
M pattern: Median, median cephalic and median basilic

35
Q

How do you palpate for a vein?

A
  1. Have patient make a fist.
  2. Palpate patient’s dominant arm with index finger
  3. Roll finger side to side while pressing against vein to judge size AND patency.
  4. While palpating the vein it is best to visualize its location, direction, depth, width.
  5. Release tourniquet & have patient open fist
36
Q

What are some things you can do if you have trouble finding the vein in the ACF?

A
  1. Wiping the site with alcohol often makes veins appear more visible (doesn’t take the place of cleansing the site)
  2. If no suitable AC vein can be located our next choice would be to check back of hand or wrist.
  3. You can always massage the arm, apply warm warp or towel for a few minutes
  4. LASTLY, if a vein cannot be found a capillary puncture should be considered
37
Q

Why would warming and massaging the arm help find a vein?

A

Warming the site will increase blood flow and makes veins more prominent

38
Q

What is a useful tip to remind yourself of site direction?

A

Use the alcohol pad to remind yourself the direction of the vein but leave the place with the corner pointing in the direction of the vein. BUT**: Ensure pad is far away enough from site so that it does not cause pain to the patient.

39
Q

In Step 8: Clean and Air Dry the Site, what is used for cleaning the site typically? What are some cautions to avoid re-contamination?

A

Use 70% isopropyl alcohol
Allow area to dry 30 seconds to 1 minute (until dry)
Don’t dry alcohol w. unsterile gauze or fan or blow on site
Don’t touch site after cleaning it

40
Q

What is done in Step 9: Prepare Collection Equipment?

A

Assemble ETS. Thread needle into tube holder.

41
Q

What is important to know in step 10: Reapply Tourniquet and Uncap and Inspect Needle

A
  1. When reapplying tourniquet careful not to contaminate site.
  2. Be knowledgeable that some tests require not to use a tourniquet (lactic acid)
  3. Visually inspect needle – rare but some could have defects
42
Q

What are the steps in Step 11: Anchor Vein and Insert Needle?

A
  1. Ask patient to make a fist again
  2. You use nondominant hand to anchor vein.
  3. Keep thumb 2-3” away from site you will poke.
  4. Anchoring skin taut, makes procedure easier and less pain for patient.
  5. Bevel/safety up.
  6. One intended motion.
  7. Warm patient just prior.
43
Q

What do you do once blood flow is established (step 12&13)?

A
  1. Remove tourniquet.

2. Fill, Remove and Mix tubes; Follow order of draw with tubes.

44
Q

What is important in Step 14, before and during removing the needle? Then what (step 15)?

A
  1. Place gauze at needle puncture site, then remove needle while simultaneously engaging its safety and apply pressure to the gauze at the puncture site.
  2. Discard needle/blood collection unit in biohazard sharps container.
45
Q

In Step 16: Label and Prepare Specimens, what information is placed on the patient’s specimens? Who is this done in front of?

A 
Patient’s First and Last Name
Patient’s identifying number (PHIN)
Date of collection
Time of collection
Phlebotomist’s initials
Plus any other important info, e.g. fasting, etc.

Done in front of patient.

46
Q

After the needle is discarded and collection is completed what are the last steps 17 to 20?

A

Step 17: Check Patient’s Arm, & Apply Bandage
Step 18: Dispose of Used Materials, & Reposition Moved Items
Step 19: Thank Patient, Remove Gloves, & Sanitize Hands
Step 20: Transport Specimen to the Lab Promptly

47
Q

When you are checking your patients arm, what should you be looking for? Why?

A
  1. Observe your patients site for 5-10 seconds for excessive or prolonged bleeding or signs of bleeding beneath the skin
  2. Some patients are on blood thinners in the hospital – may take long to stop bleeding or bleed through the gauze. Apply pressure.
48
Q

What are the limitations of doing venipuncture on young children under the age of 2?

A

Venipuncture in children under the age of 2 should be limited to superficial veins and not deep, hard to find veins.
Venipuncture on small children requires special training.

49
Q

What is recommended for pediatric patients, especially newborns up to 12 months?

A

Capillary collection – (heel poke) is recommended for pediatric patients, especially newborns up to 12 months old

50
Q

How much blood can be removed from a pediatric patient? why?

A

Removal of more than 10% of an infant’s blood volume at one time can lead to shock and cardiac arrest.
See Table 8-2 in textbook.

51
Q

How do you estimate an infant’s blood volume?

A

An average infant’s blood volume (total) is 100 ml/kg.

Divide weight in lbs by 2.2 to get kg, then kg x 100 ml/kg = ml (volume).

52
Q

What is iatrogenic anemia in infants and children?

A

Caused by cumulative blood loss from repetitive draws
Drop in Hemoglobin and hematocrit levels, accompanied by a normal mean corpuscular volume (MCV)
Usually subtle and unnoticed or perplexing

53
Q

How can parents and guardians be of help in pediatric blood draws?

A

Can provide important predictions of how the child will react.
Anxiety from parent can heavily influence child’s reaction
Earn trust of parent – warm, friendly manor
Ask about previous experience that the child has with blood draws
Gauge how the parent is cooping with the procedure- may have to ask them to leave

54
Q

How do you best approach a child who is getting their blood drawn?

A
  1. Gain their trust that you will do your best
  2. Wider zone of comfort – cannot get as close to them without them feeling uncomfortable.
  3. Approach slowly
  4. Determine degree of anxiety before handling equipment to looking at their arm
  5. Get down to their level
  6. Explain what you are about to do

DON’T LIE AND SAY IT WON’T HURT. Say it will hurt a bit and you will do your best to have it over soon. Distraction and a prize works well.

55
Q

What is a life specialist? How can they help?

A

Life specialist – used for families with a sick child to help cope with illnesses and challenges
Can facilitate blood draws to be less traumatic

56
Q

What are some pain relief options for children?

A

Topical anesthetic: EMLA – Eutectic mixture of local anesthetics contain lidocaine and prilocaine.
Neg: Takes one hour to take effect & a licensed HCP to dose based on child’s age.
Oral Sucrose:
12%-24% solutions
Infant heel poke
2 mins before, lasts 5 min, helps reduce affects of poke.

57
Q

How should a child be restrained for venipucture?

A

Newborn/infant - wrapped in a blanket.
Older infants, toddlers - physical restraint by sitting on parent’s lap. Helpful if parent’s legs are wrapped around the toddler’s legs to prevent kicking.
Older kids - can sit by themselves but a parent or another phlebotomist should steady their arm.

58
Q

What equipment is best to use for pediatric blood draws?

A

23 gauge butterfly attached to tube holder/syringe

Tubing of butterfly allows flexibility if child moves. Smallest tubes should be used to reduce risk of creating too much vacuum draw on the vein.

59
Q

What considerations need to be given for geriatric phlebotomy?

A 
Unique individuals to be treated with compassion, kindness, patients and respect
Skin changes, 
Hearing Impairment 
Visions problems and
Mobility issues
Others……
60
Q

What skin changes occur that affect geriatric phlebotomy patients?

A

Skin changes
Loss of collagen and SC fat – wrinkled, sagging and thin skin
Lack of hydration and impaired peripheral circulation caused by aging narrowing blood vessels – harder to obtain blood
Skin cells are replaced more slowly and losing its elasticity – causing injury
Also blood vessels loose elasticity becoming fragile and likely to collapse (from ETS vacuum) increase chance of bruising or failure to obtain blood.
We want to ANCHOR veins of geriatric patients very well!

Fundamentals of MLS (18 decks)

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