Phlebotomy considerations

Question 1

Bleeding from venipuncture site and hematoma formation

Answer 1

Vascular complication

Question 2

Second most common complication of phlebotomy

Answer 2

Infection complication

Question 3

Blood loss for testing; significant in pediatric patients

Answer 3

Iatrogenic anemia

Question 4

Post-phlebotomy seizures or pain

Answer 4

Neurologic complication

Question 5

Vasovagal syncope, orthostatic hypotension, cardiac arrest

Answer 5

Cardiovascular complication

Question 6

Ensure patient is lying down with feet elevated before blood draw

Answer 6

Vasovagal syncope prevention

Question 7

Allergic reactions to iodine, adhesives, or latex

Answer 7

Dermatologic complication

Question 8

IV blood draw steps

Answer 8

Opposite arm; if not, turn off IV for 2 min, discard 3–5 mL.

Question 9

CVA blood draw order

Central Venous Access

Answer 9

Discard > Culture > Additives > Clot tubes.

Question 10

Site selection: mastectomy

Answer 10

Avoid affected arm (lymphostasis).

Question 11

Hemoconcentration definition

Answer 11

Increased blood components (venous stasis).

Question 12

Site selection for burns, edema, scars, sclerosed veins, tattoos

Answer 12

Other site without the mentioned

Question 13

Diurnal variation (AM)

Answer 13

Increased: Cortisol, ACTH, Iron, Aldosterone (8 AM to 4 PM)

Question 14

Diurnal variation (PM)

Answer 14

Increased: Growth Hormone (GH), Parathyroid Hormone (PTH), Thyroid-Stimulating Hormone (TSH)

INC: GH, PTH, TSG

Question 15

Posture effect (standing)

Answer 15

Increased: Albumin, cholesterol, calcium

Increased: AlChoCa

Question 16

Posture effect (supine to upright)

Answer 16

Increased: Albumin, enzymes, protein, bound substances

Increased: AlEn ProBo

Question 17

Activity (ambulatory/recumbent)

Answer 17

Increased: Total Protein (TP), Creatine Kinase (CK)

Question 18

Exercise effect (muscle release)

Answer 18

Increased: K, PO4, creatinine, lactate, CK, AST, LD, aldolase

Inc: PoPhos, CreaLaCK, AsLDA

Question 19

Exercise effect (lipids)

Answer 19

Decreased: Triglycerides (TAG), cholesterol

Question 20

Stress response

Answer 20

Increased: Catecholamines (epinephrine, norepinephrine), prolactin, cortisol, ACTH

Question 21

Fasting required for tests

Answer 21

Triglycerides, glucose (FBS, OGTT), lipid profile

Question 22

Recent food ingestion effect

Answer 22

Increased: Glucose, insulin, gastrin, TG, Na+, uric acid, iron, LD, Ca2+. Decreased: K+, chloride, phosphate

Question 23

Smoking effect

Answer 23

Increased: CO2, NH3, Blood Urea Nitrogen (BUN)

Question 24

IV contamination

Answer 24

Falsely increased: Glucose (dextrose), Na, Cl, K

Question 25

Hemoconcentration (venous stasis)

Answer 25

Increased: K, lactate, protein-bound substances

Question 26

Hemolysis effect

Answer 26

Increased: K, Mg, PO4, Fe, LD, AST, CK. Decreased: Glucose, bilirubin, Na+

Question 27

Incorrect additive (EDTA, citrate, oxalate)

Answer 27

False increased: Na, K. False decreased: Ca, Mg, Fe

Question 28

Incorrect additive (Heparin)

Answer 28

False increased: Na, Li, NH3 (depending on component)

Question 29

Sodium fluoride effect

Answer 29

False decreased: BUN, Uric Acid (enzymatic method)

Question 30

Gel tubes (SST/PST)

Answer 30

Falsely decreased: Trace metals, drugs (TCA, anti-arrhythmics)

Question 31

Specimen requiring chilling

Answer 31

ABG, Lactate, ACTH (pre-chilled), NH3

Question 32

Specimen requiring anaerobic transport

Answer 32

Avoid bubbles: ABG, NH3, ACP, ionized Ca

Question 33

Specimen requiring light protection

Answer 33

Bilirubin, porphyrin, carotene, Vitamin A, B12

Question 34

Delayed centrifugation effect

Answer 34

Increased: K, Mg, LD, AST, ALT, creatinine, NH3, lactate.

Decreased: Glucose, ionized calcium, bicarbonate, folate