Phlebotomy Highlights <3 Flashcards
1
Q
phlebotomy
A
vein cutting
2
Q
phlebotomist
A
blood collector
3
Q
Laboratory analyses of a variety of specimens are used for three important clinical purposes:
- diagnostic testing
- therapeutic assessments
- monitoring
Define the purposes of each test
A
- diagnostic testing: to figure out what is wrong with the patient
- therapeutic assessments: to develop the appropriate therapy or treatment of the medical condition
- monitoring: to make sure the therapy or treatment is working to alleviate the disease or illness
4
Q
Technology has enabled laboratory testing to be performed closer to the point of care POC. Define POC
A
point-of-care (POC) testing: refers to tests and procedures that are performed at patient’s bedside or at the “point of care”. these tests are not sent to a lab in a remote location, rather they are rapid methods designed to produce quick results
5
Q
FDA stands for?
A
Food and Drug Administration
an agency that regulates and oversees clinical laboratories; which itself is regulated by the federal government
6
Q
CMS stands for?
A
Centers for Medicare & Medicaid Services
an agency that regulates and oversees clinical laboratories; which itself is regulated by the federal government
7
Q
FDA regulates all clinical laboratories through what?
A
Through CLIA 1988: Clinical Laboratory Improvement Amendments of 1988
8
Q
CBC stands for?
A
complete blood count
9
Q
CLIA categorizes lab tests according to level of complexity of the procedure and risk involved for the patient if errors are made in performing or interpreting the test. These three include:
- waived tests
- tests of moderate complexity
- tests of high complexity
Elaborate on each test.
A
- waived tests: easiest to perform and least susceptible to error and least risky to patients. Examples include urinalysis, urine pregnancy tests, blood glucose screening tests, blood detection from stool sample, etc. These tests are commonly done in ambulatory settings, on hospitals near the beside and in other remote locations.
- tests of moderate complexity: simple to perform but involve more risk to patient if results are inaccurate. Such include white and red blood cell counts, hemoglobin, hematocrit, blood chemistries and urine cultures.
- tests of high complexity: tests that are complex to perform and may allow reasonable risk of harm to patient if results are inaccurate. These may require sophisticated instrumentation and oversight by a pathologist or PhD level scientist. Such include molecular analyses, bone marrow evaluations, immunoassays, flow cytometry, cytogenetics analysis and electrophoresis.
10
Q
When are blood specimen tubes labeled? What information does it include?
A
At the bedside next to the patient. Information needed include: name, dob, date/time (usually in military time)
11
Q
Six Sigma
A
Six Sigma is an example of quality framework; method designed to improve process performance by reducing variation, improving quality and enhancing financial performance while improving customer satisfaction.
12
Q
List examples of inability to collect a blood specimen
A
Examples of when inability to collect a blood specimen would occur include when:
- collection attempts are unsuccessful (no more than 2 sticks)
- the patient is unavailable
- the patient refuses to have blood drawn
13
Q
Quality control
A
quality control measures are functions of everyday practice in clinical laboratories that make the testing process more accurate and precise
14
Q
What should you do before leaving a patient?
A
After the procedure but before leaving the room, always THANK the patient for their cooperation.
15
Q
STAT verbal request
A
STAT: immediate
16
Q
What is the difference between ethics and bioethics?
A
Ethics: moral standards of behavior or conduct that govern an individual’s actions
Bioethics: refers to the moral issues or problems that resulted because of modern medicine, clinical research and or technology; refers to life and death issues such as abortion, when a patient should be allowed to die and who receives organ donations
17
Q
Malpractice
A
defined as professional negligence. Improper or unskillful care of a patient by a member of the healthcare team, or any professional misconduct or unreasonable lack of skill
18
Q
Negligence
A
Failure to act or to perform duties according to the standards of the profession; violation of a duty to exercise reasonable skill and care in performing a task
19
Q
Standard of care
A
Specific standard of care to protect patients; it is a measuring stick representing the conduct of the average health care worker in the community; the community has become a national community as a result of national laboratory standards and requirements
20
Q
Informed consent
A
voluntary permission given by a patient to allow touching, examination and or treatment by health care providers
21
Q
Implied consent
A
occurs when the patient’s nonverbal behavior indicates agreement; exists when immediate action is required to save a patient’s life or to prevent permanent impairment of the patient’s health
22
Q
What does CLIA stand for and what is its purpose?
A
Clinical Laboratory Improvement Amendments ensure the quality and accuracy of laboratory testing
23
Q
Define infection
A
the condition in which the body is invaded with pathogenic (disease causing) microorganisms such as bacteria, fungi, viruses and parasites
24
Q
What does BBPs stand for and what are they? What are examples of them?
A
BBPS: blood-borne pathogens describes any infectious microorganism present in blood and other body fluids and tissues that can cause infectious diseases.
Such include: hepatitis A, B, C, D and E; HIV (AIDS), syphilis, malaria, human T-cell lymphotrotrophic virus (HTLV) types I and II
25
What is CDC the acronym for?
Centers for Disease Control and Prevention - oversees the investigation and control of various diseases, especially those that are communicable and threaten the US population
26
What are universal precautions and who were they established by?
Universal precautions established through OSHA (Occupational Safety and Health Administration), an agency of the US Department of Labor, OSHA requires employers to provide measures that will protect workers exposed to biological hazards including training to avoid BBP exposures.
Designed to prevent transmission of all infectious agents in the health care setting
27
What are the 3 components that make up the "chain of infection"?
1. source
2. mode of transmission
3. susceptible host
28
What ratio do you need to clean phlebotomy trays or specimen collection areas with?
Clean phlebotomy trays at least once a week with a 1:10 bleach solution
Clean specimen collection area with a decontaminating 1:10 bleach solution
29
What does PASS stand for?
Proper Use of Fire Extinguishers
Pull pin
Aim nozzle
Squeeze handle
Sweep side to side
30
What does RACE stand for?
```
Health care workers in response to possible fire emergencies should RACE:
Rescue
Alert
Confine
Extinguish
```
31
MSDS
Material safety data sheets
32
Because various chemicals are needed in healthcare facilities especially in the clinical lab department and because chemicals may pose health or physical hazards, OSHA amended WHAT to include health care facilities?
HCS: Hazard Communication Standard AKA HazCom
HazCom standard requires chemical manufacturers to supply MSDS for their chemicals
33
NFPA Rating System p146
Understand the blue.red.yellow and white boxes in the diamond indicate; what type of hazard? What do their numbers indicate?
```
Blue: Health Hazard
4 Deadly
3 Extreme Danger
2 Hazardous
1 Slightly hazardous
0 Normal material
```
```
Red: Fire hazard
4 Below 73F
3 Below 100F
2 Above 100F
1 Not exceeding 200F
0 Will not burn
```
```
Yellow: Reactivity/Instability
4 May detonate
3 Shock & heat
2 Violent chemical change
1 Unstable if heated
0 Stable
```
```
White: Specific hazard
ACID- acid
ALK- alkali
COR- corrosive
OXY- oxidizer
P- polymerization
Hazard sign- radioactive
W- use no water
```
34
What is the periosteum?
In general, bones consist of several layers covered by a membrane, the periosteum. The periosteum contains blood vessels that bring blood from inside the bone to the outer layer.
35
When do vessels get smaller and larger? When they head towards...?
Vessels get smaller and smaller as they move away from the heart (arteries) and then get larger again as they return toward the heart (veins)
36
What is the largest artery and veins called?
Aorta: largest artery
Veins: venae cavae
37
What are highly oxygenated vessels that carry blood away from the heart?
Arteries
Arteries appear brighter red in color because of the oxygen
38
What is blood carried toward the heart by?
Veins
All veins except the pulmonary veins contain deoxygenated blood and under the skin appear bluish in color and have thinner walls than arteries
39
What are the three types of veins used for venipuncture and what differentiates them?
The antecubital area of the forearm is most commonly used for venipuncture.
The median cubital vein (middle) is best for venipuncture because it is generally the largest and best anchored vein.
Other acceptable ones are the basilic vein (left bottom) and cephalic vein (upper outer right) p219.
40
Differentiate the 2 types of blood and how they differentiate in terms of bleeding?
Arterial blood is bright red in color (due to high O2 content) and since pressure is higher in arteries, bleeding is usually quicker.
Venous blood is dark red in color (because it lacks O2) and bleeding occurs in a steady flow.
41
What are circulating blood cells classified as?
Red blood cells/RBCs/erythrocytes as well as white blood cells/WBCs/leukocytes
42
What color tubes do RBCs go into?
purple/lavender
43
What does SST stand for?
Serum separator
44
Erythropoiesis
Production of red blood cells, millions of which normally are formed and destroyed daily
45
Erythropoietin
Hormone produced in the kidney that triggers erythropoiesis
46
What does a pink tube top test for?
Blood typing
47
What is the most common blood type?
Type O
48
What are white blood cells also known as?
WBCs or leukocytes
49
What does CBC stand for?
complete blood count
go into lavender tube tops
50
What is the liquid portion of blood and lymph called?
Plasma
51
If a blood specimen is allowed to clot, the resulting liquid portion is called what?
What kind of clot are the blood cells meshed in?
Resulting liquid portion is serum while the blood cells are meshed into a fibrin clot.
52
Hemostasis
Complex series of processes in which platelets, plasma, and coagulation factors interact to control bleeding while at the same time maintaining circulating blood in the liquid state
Injury to a vessel wall begins the basic steps in hemostasis
53
What types of medication can increase bleeding due to one of its properties being a blood thinner?
Aspirin & Coumadin (warfarin)
54
Anticoagulants
Used for patients to inhibit blood clot formation
55
What system has a close and interrelated connection with the cardiovascular system? What does this system consist of? What are the 3 main functions of the system?
The lymphatic system, which consists of lymph, lymphocytes, lymph vessels, lymph nodes, tonsils, the spleen, bone marrow and the thymus gland.
The three main functions are:
1. maintain fluid balance in the tissues by filtering blood and lymph fluid
2. provide a defense and immunity against disease through the lymphocytes
3. distribute nutrients and hormones into the bloodstream, remove waste, an absorb fats and other substances from the digestive tract
56
Edema
swellings
57
Venipuncture
blood collection from a vein
58
Skin puncture
blood collection from a finger and/or an infant's heel
59
What on tubes should be monitored continuously?
expiration dates
60
STAT means?
immediate
61
Collection Tubes: what additive is added to clotted blood/serum gray/red or clear
no additive (discard tube)
62
Collection Tubes: what additive is added to clotted blood/serum red
None or clot activator in plastic tube
63
Collection Tubes: what additive is added to clotted blood/serum red/black
Clot activator and polymer barrier
64
Collection Tubes: what additive is added to whole blood/plasma light blue
sodium citrate (3.2% or 3.8%)
65
Collection Tubes: what additive is added to whole blood/plasma lavender (purple)
EDTA
66
Collection Tubes: what additive is added to whole blood/plasma gray
sodium flouride and potassium oxalate or sodium flouride and Na2EDTA
67
Collection Tubes: what additive is added to whole blood/plasma green
lithium heparin, sodium heparin or ammonium heparin
68
Collection Tubes: what additive is added to whole blood/plasma royal blue
K2EDTA-sterile tube for toxicology and nutritional studies
69
Collection Tubes: what additive is added to whole blood yellow
Sodium polyanetholsulfonate (SPS) or acid citrate dextrose (ACD)
70
What additive is in the yellow topped tubes for blood culture specimen collections in microbiology?
Sodium polyanethol sulfonate (SPS)
71
What needle should you use to collect blood cultures with?
Butterfly needle
72
Coagulation procedures such as PT and APTT are done in what colored topped vacuum tubes?
Light blue topped vacuum tubes that contain sodium citrate
If light blue tubed top is underfilled, coagulation results will be erroneously prolonged
73
What does SST stand for?
serum separation tube
74
What do red-topped tubes indicate?
It is a tube without an anticoagulant or polymer (gel) barrier and is used for collection of serum; thus collected blood will clot in this tube.
75
Which colored tube top is used when a fast turnaround time (TAT) is needed for a STAT test?
Green-topped tube is used since whole blood can be used for testing and the time for clot formation and or centrifugation is avoided; fastest because of no clot time
76
Which colored tube tops are used for CBC? What additive is used in the tube?
Purple topped vacuum tubes (containing EDTA) are used for most hematology procedures such as CBC (complete blood count), RBCs (red blood counts), WBCs (white blood counts), platelet count, hematocrit, differentials, hemoglobin, etc.
77
What do pink-topped tubes contain? What must be done after collecting into the tube?
These tubes contain EDTA with the spray-dried K2 and are used for blood bank collections; should be COMPLETELY INVERTED 8-10 times for complete mixing of the blood with the anticoagulant
78
GTT stands for what, and what does it test?
gray topped tubes test for glucose
79
What are royal blue topped tubes used for?
Royal blue topped tubes are used to collect samples for nutritional studies, drug monitoring and toxicology. It is the trace element tube.
80
What does the tan topped tube used for?
Used for lead testing and contains EDTA
81
What does gauge number indicate?
The gauge number indicates the diameter of the needle; smaller the gauge number, the larger the needle diameter and higher the flow rate.
82
For butterflies, what needle sizes are usually used for adults? Premies?
21, 23 & 25
Adults: 21
Premies: 25
83
Butterfly needle is aka as?
winged infusion set
grip bottom & squeeze wings; BEVEL UP!
84
What is the function of a bleeding-time equipment?
Give an example of one
Bleeding time is an assay used to assess the contributions of platelet function and blood vessel integrity to primary blood clotting abilities.
Such includes the Surgicutt
85
For infants, the Clinical & Laboratory Standards Institute (CLSI) recommends a penetration depth of less than one on heel sticks?
Why?
They recommend a depth less than 2.0mm on heel sticks to avoid penetrating bone.
86
When you're using a purple topped tube, what should you do after collecting the specimen?
Keep tapping it to prevent clots.
87
Occluded veins mean veins that are?
veins that are obstructed which then prevent blood flow
88
What does it mean to have a sclerosed vein?
Veins that are hardened as a result of inflammation and disease
89
Thrombi
thrombi are solid masses derived from blood constituents that reside in the blood vessels
90
Masectomy
surgical removal of the breast
91
What can masectomies cause?
Masectomy patients often have swelling caused by lymph accumulation in the tissues (lymphedema) on the side of the surgery because of lymph node removal
92
If a patient has had a masectomy, what should never be performed on the same side?
Venipunctures
93
Number one patient safety goal for the Joint Commission is improving accuracy of patient identification by requiring how many unique identifiers?
2
Two identifiers are also required for specimen containers and tubes; can include verbal confirmation, requisition and match of identification
Bed labels, water pitchers, door charts SHOULD NOT be used as patient identifiers. even armbands are not completely reliable
94
Tourniquets should be placed where?
1 inch above the venipuncture site
95
How long can a tourniquet be applied?
No longer than 1 minute
96
Why should fist pumping before venipuncture be avoided?
Pumping of first before venipuncture should be avoided because it leads to increase in plasma potassium, lactate and phosphate concentrations
97
What is the lay term for syncope?
Syncope is the transient loss of consciousness due to lack of oxygen to the brain and results in the inability to stay in an upright position
98
Hemolysis
Hemolysis results when RBCs are lysed (cells break apart and is destroyed); hemoglobin is released and serum (straw color) becomes tinged with pink or red
99
What can happen to veins when blood is withdrawn too quickly or forcefully during venipuncture?
veins can collapse
100
Where should the specimen collection tray NOT be placed at?
Patient's bed or eating table
101
If a physician or nurse is consulting with the patient when the health care worker enters the room, the specimen procedure should be what?
Delayed until consultation is complete
102
If a patient is comatose or semiconscious, who can identify the patient? What do they need to confirm?
A nurse, relative or friend may identify the patient by providing the patient's name, address and identification number and or date of birth.
103
What situations would allow for identifications to be attached to the beds rather than the patient's arm?
Patients with severe burns or in isolation
104
During a venipuncture, the patient can assist in the process by closing his or her fist tightly for a short period; the patient should not open and close his or her fist rapidly or pump their first because of what?
It can cause localized hemoconcentration
105
What are the three most common venipuncture sites?
The most common sites include:
1. median cubital, often referred to as median vein, is preferred and most commonly used for veinpuncture because it is easiest to obtain blood from (reportedly less painful and less prone to injury if needle is not precisely placed in the vein)- healthcare worker should locate suitable median veins on both arms before considering others
2. second choice shoudl be the cephalic vein which lies on outer edge of arm
3. third choice shoudl be basilic vein which lies on edge of the antecubital fossa area
106
What does warming the puncture site help with?
Warming the puncture site helps facilitate phlebotomy by increasing arterial blood flow to the area and, by making the veins more prominent.
107
How long can you leave the tourniquet for? Why?
Should be left no longer than 1 minute because it becomes uncomfortable and causes hemoconcentration- blood infiltrates the surrounding tissues, thereby increasing venous blood concentration of large molecules such as proteins, cells and coagulation factors.
108
What makes veins more prominent and easier to puncture?
A tourniquet or blood pressure cuff makes veins more prominent and easier to puncture by slowing down the blood flow toward the heart thereby causing venous filling.
109
Once needle is in the hand for a venipuncture, what should the patient do?
Relax their hand
110
Where should the tourniquet be placed at?
Should be placed 1 inch above the site
111
How should you wipe when using alcohol pads?
Wipe in a circular motion from inside to outside
112
During a venipuncture, how should you position the needle? At what angle?
Position the needle in the same direction as the vein with bevel up and insert in a 30 degree or less slight angle.
113
What should you always do before removing the needle from the patient's vein?
Always remove the last tube of blood from the tube holder's inner needle before removing the needle from the patient's vein.
114
List the order of draw for blood collection tubes and know their associated colored tops (6)
1. blood cultures (YELLOW) or blood culture vials; always collected first to decrease possibility of bacterial contamination
2. coagulation (LIGHT BLUE)
3. serum tube (RED, speckled closure) - with or without clot activator/gel
4. Heparin tube (GREEN) w/wo gel plasma separator
5. EDTA (purple/lavender(
6. glycolytic inhibition tube (GRAY)
115
What should the ratio be for coagulation tests?
Coagulation tests require a specific plasma concentration of sodium citrate (proportion of blood to liquid sodium citrate dihydrate anticoagulant volume) of 9:1
116
What should be done immediately after collection of coagulation tubes?
Coagulation tubes should be mixed gently to prevent clotting in the tube
117
When using a butterfly, what should you do? Do you put it immediately in the light blue coagulation tube?
When using a butterfly, use a discard/red tube and then transfer it to the light blue top so correct ratio is reached in the coagulation tube.
118
What do you do if no blood cultures need to be collected?
Move on to the light blue coagulation tube but if using a butterfly, collect it in a discard tube to rid out the air as it is prone to having an air bubble when using that needle
119
Which colored topped tube is the only tube that CANNOT ALLOW for blood clots?
Purple tops cannot have any clots in them; invert the tube
120
Timed tests
Test that is ordered for a collection at a particular time
121
Therapeutic drug monitoring TDM
Timed specimens are crucial for TDMs; lab results taken from blood samples for TDM are used in establishing patient's drug dose
Used to monitor/confirm overdose, determine dosage, establish baseline measurement, check that it is not interacting with another drug
122
Fasting specimens
require blood from a patient who has abstained from eating/drinking (anything except water) for a particular time period
123
Fasting blood tests
fasting levels of glucose, cholesterol, triglycerides are used for diagnosis and monitoring
124
STAT specimens
emergency specimens that should be immediately processed for a patient who has a condition that must be treated/responded to as a medical emergency/health crisis
125
What are benefits of capillary blood samples?
Reduces: anemia, risk of accidental sharps injury, injuring adult patients (nerve damage), complications for children and infants (anemia, cardiac arrest, hemorrhage, venous thrombosis, damage to surrounding tissues/organs, infections), being perceived as less painful than a venipuncture, less costly, faster than a venipuncture specimen, easily done for diabetic patients that can do a skin puncture on themselves
126
What are tests skin punctures are not recommended for?
Coagulation studies (because of the interstitial fluid), blood cultures (because of sterility and volume requirements), erythrocyte sedimentation rate (ESR) determinations
127
What only colored tube does not have additives?
Red topped tubes
128
Why should punctures not be made on the sides?
Puncture s should not be made on the sides near the nail's edge nor on the tips of the fingers because of the risk of hitting the bone.
(ref pg 369)
129
What is the basic order of collection?
EDTA specimen for hematology tests (purple tops need to be filled between the lines and tapped immediately to avoid clots)
Other tubes with additives (other colors)
Nonadditive tubes (red)
130
Blood films should have what? At what angle do you rub the slides to obtain this?
30 degree angle to create a feathered edge
131
Hemolysis (release of blood into the surroundings) is caused by what?
Caused by not removing residual alcohol at the puncture site, excessive milking of the finger, excessive mixing of the specimen (invert, not shake), increased red blood fragility and high packed cell volume (newborns and infants)
132
TAT stands for?
Turnaround time
133
Why do inversions need to be done gently?
To avoid damage to blood cells which can result in hemolysis. If the specimen however is not mixed adequately, tiny clots may form within the specimen tube and lead to erroneous test results.
134
Which specimens are thermolabile (substance is sensitive to higher temperatures and thus need to be chilled immediately) and require chilling?
Ammonia, blood gases, lactic acid
Catecholamines, gastrin, parathyroid hormone, pyruvate
135
What specimens require transport at 37C (98.6F)?
Cold agglutinins, cryofibrinogen, cryoglobulins
136
What specimens are photosensitive and should be protected from light?
Bilirubin, beta-carotene, folate, porphyrins, vitamin A, vitamin B6
137
Aliquots
smaller portions
138
Panic value
Test result that represents a state to be defined as life threatening unless action is taken by the patient's physician
139
Pediatric phlebotomies are performed where?
Heel or finger sticks
140
Describe the steps in preparing the child and parent for the blood collection procedure
A calm, confident approach is the first step in obtaining the cooperation of the child and parent. Introduce yourself, be warm and friendly, establish eye contact with both child and parent, show you are concerned about child's health and comfort. When you interact, provide a sense of trust and confidence.
Find out about the child's past experience with blood collections; parents can provide valuable information about the approaches that worked effectively for their child.
Place yourself at the child's eye level.
141
For psychological reasons, what is the best room location for a painful procedure?
Best room location for a painful procedure is a treatment room away from the child's bed or playroom.
142
What does EMLA stand for?
Eutectic mixture of local anesthetics AKA "numbing cream"
143
What is the optimal time for when anesthesia sets in?
45-60 minutes
144
Neonatal screening includes what?
Phenylketonuria (PKU)
Untreated PKU can lead to intellectual disability, seizures, and other serious medical problems.
145
What are each state's requirements for neonatal screening? Who is in charge of knowing these facts?
The U.S. National Screening Status Report contains up to date information on each state's specific requirements. In some states, a neonate may be screened for only a few disorders whereas another state may require more than 30.
146
When is blood spot testing for screening performed before?
Blood spot testing for screening is performed before the newborn is 72 hours
147
POCT
Point of care testing = rapid results
148
What are examples of frequently used point of care tests?
Glucose, Influenza A & B, pregnancy, strep, mono (refer to pg 445)
149
Describe blood gas analysis
Blood gas analysis involves measurement of the partial pressure of oxygen (pO2), partial pressure of carbon dioxide (pCO2), and pH
150
In addition to monitoring blood gases, point of care instruments can also measure what?
blood electrolyte levels such as sodium (Na+), potassium (K+), chloride (Cl-), and calcium (Ca++)- plus glucose, calculate bicarbonate (HCO3-) and total carbon dioxide (TCO2) levels
151
Name a cardiac point of care test and what does it measure?
ROCHE TROPT which qualitatively measures troponin T to detect heart damage
152
Aside from glucose monitoring, what else is monitored? In light blue topped tubes?
Light blue topped tubes are used for collecting monitored blood coagulations - prothrombin time (PT) and International Normalized Ratio (INR)
153
What does PT and INR stand for?
What meter provides PT and INR results within 2 minutes?
The INRatio Meter provides PT and INR results within 2 minutes
154
How long does it take for a CBC to run?
CBC can be run within 1 minute; determines hematology parameters that include: platelet count, hemoglobin, hematocrit, WBC count, RBC count and platelet aggregation results
155
What is a point of care testing that can be done in 5 minutes?
Cholesterol screening with a lipid profile including total cholesterol, HDL cholesterol (good cholesterol), LDL cholesterol (bad cholesterol) and triglycerides can be done in 5 minutes.
156
What is a useful tool for testing platelet plug formation in the capillaries?
Bleeding-time test
157
What is the name for a bleeding test?
Surgicutt Bleeding Time Test
158
What is a test for maintenance of blood glucose levels?
hemoglobin A1c
159
What is used to determine fevers of unknown origin FUO?
Blood cultures and the usual method for collecting blood specimens is through a venipuncture.
2 sites
160
If blood culture collections are ordered along with other laboratory tests, which ones are collected first?
blood culture collections
161
What type of blood culture bottle must be inoculated first?
The anaerobic blood culture and then the aerobic culture because injection of air into the anaerobic bottle can cause death of some anaerobic microorganisms resulting in a false negative culture
162
When obtaining a sterile puncture site, how should you clean the site?
Circle the site and move outwards
163
What are glucose tolerance tests used for?
Good to check for pregnancy diabetes
164
ABGs stands for?
Arterial blood gases; normally drawn by nurses at a 30 degree angle
165
Which is the artery most frequently used for blood collection for ABG analysis?
Radial artery which is located on the numb side of the wrist
166
Describe TDM
Therapeutic drug monitoring TDM is used to monitor the serum concentration of certain drugs
167
Trough levels of TDM
the trough level is the lowest concentration in the patient's serum; that is, the specimen should be collected immediately prior (no more than 15 mins) to administration of the drug to ensure that the medication level stays within the therapeutic (effective dosage) range
168
Peak levels of TDM
peak level is the highest concentration of a drug in the patient's serum; time required to reach the highest varies with mode of administration (intramuscular injection vs IV infusion) and the rate at which the drug is infused
169
What colored topped tubes are used to test for trace metals?
Royal blue
These tubes are available to test for trace elements of antimony, arsenic, cadmium, lead, calcium, chromium, copper, iron, magnesium, manganese, mercury, selenium and zinc
170
What colored topped tubes are used to test for lead?
Tan
171
Therapeutic phlebotomy
Therapeutic phlebotomy is the intentional removal of blood for therapeutic reasons; used in treatment of some myeloproliferative diseases such as polycythemia and hereditary hemocromatoisis or other conditions in which there is an excessive production of blood cells
172
What is the most frequently requested laboratory procedure?
Routine urinalysis (UA) as they can provide useful indications of body health
173
If a specimen type is random, what is the reason for its collection and example of its use?
This type of specimen is most convenient to obtain and an example of uses includes a routine urinalysis UA
174
If a specimen type is clean-catch midstream, what is the reason for its collection and example of its use?
The specimen is free of contamination and an examples of uses include cultures for bacteria and/or microscopic analysis.
A type of single specimen urine test is the urine culture and sensitivity (C&S)
175
Describe the process of a 24 hour collection
Wrote down the start time of the first collection but discard it and start collecting on the second; must be refrigerated
176
Cerebrospinal fluid CSF
Cerebrospinal fluid CSF is a clear, plasma-like fluid that circulates around the outside of the brain, in cavities within the brain and in the space surrounding the spinal cord
Sent to hematology/microbiology
177
When should amniotic fluid be collected?
Amniotic fluid is the fluid that bathes the fetus within the amniotic sac. It is collected when the pregnant patient is about 16 weeks gestation so that fetal abnormalities can be detected through chromosomal analysis and chemical tests.
Make sure to protect the specimen from light
178
Pericardial fluid
fluid from the heart cavity
179
Peritoneal fluid
Fluid from the abdominal cavity
180
O&P
feces related
181
CCF
Custody and Control form used for federal drug testing
182
BAC
blood alcohol content- legal limit of BAC in the United States is 0.08%
