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MT 12 lab > PHLEBOTOMY: VENIPUNCTURE, ETS & COMPLICATIONS > Flashcards

PHLEBOTOMY: VENIPUNCTURE, ETS & COMPLICATIONS Flashcards

1
Q

what are the contents in an unclotted blood

A
  1. plasma (contains fibrinogen)
  2. White blood cells and platelets
  3. Buffy coat
  4. Red blood cells
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2
Q

What are the contents of a clotted blood?

A
  1. Serum (without fibrinogen)
  2. Clot (blood cells in fibrin clot)
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3
Q

One of three different specimens may be used:
What are the 3 different specimens?

A
  1. While blood
  2. Serum
  3. Plasma
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4
Q

This specimen, It must be analyzed within limited time

A

Whole blood specimen

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5
Q

In whole blood:

Over time, cells will lyse (rupture) in whole blood, which will change the concentration of some analytes as ___, _____, and _____.

A

Potassium
Phosphate
Lactate dehydrogenase

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6
Q

In whole blood specimen, Some _______ will continue which will alter analytes concentration like ____ and _____.

A

cellular metabolic processes
glucose and lactate

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7
Q

Serum is the same as plasma except it
doesn’t _______ (as
fibrin).

A

contain clotting factors

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8
Q

contains all clotting factors

A

plasma

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9
Q

Serum and plasma all have the same
contents of ____, ____, and _____ except clotting
factors

A

electrolytes
enzymes proteins
hormones

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10
Q

Plasma percentage

A

55%

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11
Q

White blood cells and platelets percent

A

< 1%

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12
Q

Red blood cells percentage

A

45%

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13
Q

Clotting factors + calcium =

A

Thrombin

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14
Q

Fibrinogen + thrombin

A

Fibrin strands

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15
Q

A process by which blood is obtained from a
patients vein.

A

Venipuncture

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16
Q

It is the deoxygenated blood with a
dark red color

A

Venous blood

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17
Q

Sites for venipuncture

A
  1. Antecubital Fossa
  2. Veins of the wrist
  3. Dorsal aspect of the hand
  4. Veins of the ankle
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18
Q

Methods used in venipuncture

A
  1. Syringe
  2. Evacuated tube
  3. Butterfly method
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19
Q

The major site for venipuncture

A

Antecubital Fossa

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20
Q

The major site for venipuncture

A

Antecubital Fossa

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21
Q

Most common site for venipuncture

A

Antecubital Fossa

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22
Q

The vein is the best site for venipuncture because it is the largest and the best anchored vein

A

Median cubital

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23
Q

the second choic Vein

A

Cephalic vein

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24
Q

third choice vein

A

basilic Vein

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25
Q

Basilic vein should not be chosen unless no other vein is more prominent due to its closeness to the ____

A

brachial artery

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26
Q

Sites to be avoided:
BACTEIA

A
  1. Intravenous lines in both arms
  2. Burned or scarred areas
  3. Arms with hematoma
  4. Cast on arms
  5. Thrombosis Veins
  6. Edematous Veins
  7. Arms with arteriovenous shunt or fistula
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27
Q

Rules for Intravenous line:

A
  1. Never draw above an IV line
  2. Draw from other arm
  3. Draw from the hand of the other arm
  4. Draw below the IV
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28
Q

Indwelling lines:
●Heparin locks

A
  1. Used to administer medication
  2. Only nurses can access these lines
  3. Can collect blood: called the “line draw”
  4. Must clear line of heparin contamination by discarding first 5-10cc of blood
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29
Q

Procedures in syringe method

A
  1. Approach the patient in a friendly, calm manner. Provide for their comfort as much as possible, and gain the patient’s cooperation.
  2. Identify the patient correctly.
  3. Properly fill out appropriate requisition forms, indicating the test(s) ordered.
  4. Verify the patient’s condition. Fasting, dietary restrictions, medications, timing, and medical treatment are all of concern and should be noted on the lab requisition.
  5. Check for any allergies to antiseptics, adhesives, or latex by observing for armbands and/or by asking the patient.
  6. Position the patient. The patient should either sit in a chair, lie down or sit up in bed.
    Hyperextend the patient’s arm.
  7. Apply the above the selected puncture site. Do
    tourniquet application at 3-4 inches. Do not
    place too tightly or leave on more than 1
    minute to avoid increasing risk for
    hemoconcentration). Wait 2 minutes before
    reapplying the tourniquet
  8. The patient should make a fist without pumping the hand.
  9. Select the venipuncture site.
  10. Prepare the patient’s arm using an alcohol prep. Cleanse in a circular fashion, beginning at the site and working outward. Allow to air dry.
  11. Grasp the patient’s arm firmly using your thumb to draw the skin taut and anchor the vein. The needle should form a 15 to 30 degree angle with the surface of the arm. Swiftly insert the needle through the skin and into the lumen of the vein. Avoid trauma and excessive probing.
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30
Q

Approach the patient in a ______, _______.

A

friendly, calm manner.

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31
Q

Verify the patient’s condition.
What are the concerns that needed to be noted in the lab requisition?

A
  1. Fasting
  2. Dietary restrictions
  3. Medications
  4. Timing
  5. Medical Treatments
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32
Q

In positioning the patient, the patient should be:

A

Sitting in a chair, lie down or sit up in bed

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33
Q

Do tourniquet application at ___ inches.

A

3-4 inches

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34
Q

Do not place too tightly or leave the torniquet on more than

A

1 minute

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35
Q

placing the torniquet too tightly or leaving on more than 1 minute can increase the risk for

A

hemoconcentration

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36
Q

Wait __ minutes before reapplying the tourniquet.

A

2

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37
Q

Prepare the patient’s arm using an alcohol prep.
Cleanse in a ____ fashion, beginning at the
___ and working _____. Allow to air dry.

A

circular fashion; site and working outward

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38
Q

The needle should form a ____ angle with the surface of the arm

A

15 to 30 degree

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39
Q

Verify that any _______ have been met (fasting. If appropriate) and check for any ______.

A

dietary restrictions; sensitivity to latex.

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40
Q

Apply the tourniquet ___ inches above the site and instruct the patient to make a fist.

A

3 to 4

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41
Q

Disinfect the patient’s skin with alcohol pad starting at the point where you expect to insert the needle and moving outward in even ______

A

widening concentric circles

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42
Q

Always remove the ____ first before
withdrawing the needle

A

tourniquet

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43
Q

For evacuated tube method, remove the ____ first and then the ______

A

tube; adaptor with the needle

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44
Q

The key elements in labeling
are:

A

●Patient’s surname, first and middle.
●Patient’s ID number / Birthday
●Date of collection
● time of collection
●initials of the phlebotomist
must be on the label of EACH tube

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45
Q

The gauge of the needle is inversely proportional
related to the

A

size of the needle

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46
Q

the larger the gauge number, the ___ the needle ___ and ___

A

smaller the needle bore and length

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47
Q

needle is standard for venipuncture

A

21 gauge

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48
Q

butterfly needle is used for children, small and
difficult veins

A

23 gauge

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49
Q

Needle used for Blood donation

A

16 gauge

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50
Q

Needle length for 21-23 gauge

A

1 - 1.5 inches

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51
Q

Needle length for butterfly needle

A

1/2 or 3/4

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52
Q

Parts of a syringe

A
  1. Bevel
  2. Needle shaft
  3. Hub opening
  4. Tip
  5. Barrel
  6. Plunger
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53
Q

The second pic parts of a plunger

A
  1. Luer lock
  2. Seal
  3. Barrel
  4. Barrel Flange
  5. Plunger
  6. Plunger Flange
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54
Q

tubes are designed to fill with a predetermined volume of blood by vacuum.

A

Evacuated tube system

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55
Q

The _____ are color coded according to the additive that the tube contains

A

rubber stoppers

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56
Q

Blood should NEVER be poured from one tube to another since the tubes can have different ____ and ____

A

additives and coatings

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57
Q

The gauge number indicates the bore size: the larger the gauge number, the smaller the needle bore

A

Needles

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58
Q

use with the evacuated collection system

A

Holder/Adapter

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59
Q

Wipe off with alcohol and replace frequently

A

Torniquet

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60
Q

Contains 70% isopropyl alcoho

A

Alcohol swap

61
Q

Used if blood culture is to be drawn

A

Povidone iodine

62
Q

for application on the site from which
the needle is withdrawn

A

Gauze or dry cotton balls

63
Q

needles should never be broken, bent or
recapped. Must be placed in a proper disposal unit immediately after use

A

Needle disposal unit

64
Q

can be made of latex, rubber, vinyl, etc, worn to protect the patient and phlebotomist

A

Gloves

65
Q

Parts of an ETS method

A
  1. Needle
  2. Tube advancement mark
  3. Rubber sleeve
  4. Holder
  5. Tube
66
Q

The multi sample needle has a _____ sheath

A

Retractable

67
Q

Approach the patient in a _________.
Provide for their comfort as much as possible, and gain the patient’s cooperation.

A

friendly, calm manner.

68
Q

Identify the patient ______.

A

Correctly

69
Q

Properly fill out appropriate requisition forms, indicating the _____.

A

test(s) ordered

70
Q

Verify the patient’s condition. ____, ____, ____, _____, and _______ are all of concern and should be noted on the lab requisition.

A

Fasting, dietary restrictions, medications, timing, and medical treatment

71
Q

Check for any allergies to _____, _____, or _____ by observing for armbands and/or by asking the patient.

A

antiseptics, adhesives, latex

72
Q

Remove the needle from the patient’s arm using a _____ motion.

A

swift backward

73
Q

Instruct the patient to apply pressure for ___ minutes.

A

5 minutes

74
Q

inhibits the use of glucose by blood
cells.

A

Antiglycolytic

75
Q

Examples of antiglycolytic

A

sodium fluoride and lithium iodoactetate

76
Q

prevents blood from clotting

A

Anticoagulant

77
Q

remove calcium by forming insoluble salts

A

EDTA
Citrate
Oxalate

78
Q

prevents the conversion of prothrombin to thrombin

A

heparin

79
Q

If calcium is removed or thrombin is not formed, ______ does not occur

A

coagulation

80
Q

inert material that undergoes a temporary change in viscosity during the centrifugation process

A

Separator Gel

81
Q

serve as a separation barrier between the liquid (serum and plasma) and
cells

A

Separator Gel

82
Q

helps initiate or enhance the clotting mechanism

A

Clot activator

83
Q

Clot activators include ___ or ___ particles that provide increased surface area for platelet activation and clotting factors such as thrombin.

A

glass or silica

84
Q

What are the 5 anticoagulants

A
  1. Oxalate
  2. Citrate
  3. EDTA
  4. Fluorine
  5. Heparin
85
Q

combines with calcium to form an insoluble salt

A

oxalate

86
Q

combines with calcium in a non ionized form

A

Citrate

87
Q

it combines with calcium in a process called chelation

A

Ethylenediamine Tetraacitic Acid (EDTA)

88
Q

forms weakly dissociated calcium components

A

Fluorine

89
Q

forms weakly dissociated calcium components

A

Fluorine

90
Q

prevents the formation of fibrin

A

Heparin

91
Q

– No additive
– Glass surface activates clotting sequence
– Do not mix
– SERUM: use for TDM (therapeutic drug monitoring)

A

Glass Red Top Tube

92
Q

-Contain additive to activate clotting sequence
– Contain inert gel =» SST (serum separator tube)
– Do invert to mix additive and initiate clotting sequence
– SERUM

A

Plastic Red Top Tube

93
Q

•Contain clot
activator and gel
(SST)
• Invert to mix and
initiate clotting
sequence
• SERUM

A

Gold or Mottled-red-gray top tube

94
Q

•Anticoagulant = sodium citrate
• Binds calcium
• Must be full
Blood: anticoagulant ratio critical
• Must be on ice if not analyzed within 30 minutes
• Coagulation studies

A

Blue-top tube

95
Q

•Anticoagulant = heparin
– Three formulations:
Lithium heparin
Ammonium heparin
Sodium heparin
• Inhibits thrombin formation
• Must be full and on ice if need pH, ionized Ca

A

Green Top Tube

96
Q

3 formulations of heparin

A
  1. Lithium Heparin
  2. Ammonium Heparin
  3. Sodium Heparin
97
Q

• Anticoagulant = EDTA
• Binds calcium
• Hematology studies: CBC

PLASMA
Whole blood

A

Purple-top tube

98
Q

•Anticoagulant = potassium oxalate
– Binds calcium
– PLASMA, Whole blood
• Antiglycolytic agent = sodium fluoride
– Maintains plasma glucose levels
• Limited use: glucose, lactate, ethanol testing

A

Gray Top Tube

99
Q

Anticoagulant:
• ACD = acid citrate dextrose
– Paternity testing
– DNA testing
• SPS = sodium polyanethol sulfonate
– Used for special blood culture studies
– Inhibits certain antibiotics
• Both bind calcium
• PLASMA, Whole blood

A

Yellow-top tube

100
Q

ORDER OF DRAW MICROCONTAINER

A
  1. Blood gases
  2. Slides and smears
  3. EDTA tubes
  4. Other additive microcontainer
  5. Serum microcontainer
101
Q

failure to mix or inadequate mixing of samples collected into an additive tube

A

clotted

102
Q

usually caused by a procedural error

A
  • Hemolysis
103
Q

examples of procedural error that causes hemolysis

A

using too small needle or too large needle, pulling back to hard on the plunger of a syringe used for collecting the sample

104
Q

. The red cells clump together making the sample unsuitable for testing.

A

clotted

105
Q

red cells rupture resulting in hemoglobin being released into the serum/plasma

A

hemolysis

106
Q

The serum or plasma will appear red instead of straw colored.

A

hemolysis

107
Q

certain additive tubes must be filled completely. Incorrect blood to additive ratio will adversely affect the laboratory test results

A
  • Insufficient sample (QNS)
108
Q

certain tests must be collected and placed on ice, protected from light, or be kept warm after collection.

A

improper storage

109
Q

mortal sin of medical technologists

A

improper label

110
Q

most common encountered in obtaining a blood specimen.

A
  1. Ecchymosis (bruise)
111
Q

. It is caused by leakage of a small amount of fluid around the tissue area.

A

ecchymosis

112
Q

second most common complication

A

syncope (fainting)

113
Q

Before drawing blood, the collector should ask if he/she had prior episodes of fainting.

A

syncope

114
Q

when leakage of large amount of fluid around the puncture site causes the area to swell.

A

hematoma

115
Q

Incorrect needle placement examples

A
  1. Needle is too big for the vein
  2. Needle fails to puncture the site or angle is increased
  3. Needle that goes through or beyond the vein
  4. Bevel on vein upper wall does not allow blood to flow
  5. Bevel on vein lower wall does not allow blood to flow
  6. Needle is inserted too far (through and through)
  7. Needle partially inserted and causes blood leakage into tissue
  8. Collapsed
116
Q
  • Correct insertion technique; blood flows freely into needle
A

Correct needle placement:

117
Q

one reason is that the vein is missed because of improper needle positioning

A
  1. Failure to draw blood
118
Q

small red spots indicating the small amounts of blood have escaped into the skin epithelium

A

petechiae

119
Q

swelling caused by an abnormal accumulation of fluid in the intracellular spaces

A

edema

120
Q

veins may be neither readily visible nor easy to palpate

A

obesity

121
Q

veins may be neither readily visible nor easy to palpate can use of a __________ in locating the vein.

A

blood pressure cuff

122
Q

The cuff should not be inflated ___________ pressure and should not be left on the arm longer than 1 minute.

A

any higher than the patient’s diastolic

123
Q

is an increased concentration of larger molecules and analytes (potassium) in the blood

A

hemoconcentration

124
Q

primary effect is Hemoconcentration

A

prolonged torniquet application

125
Q

The ___________ pressure causes some water and elements to leave the extracellular space.

A

hydrostatic

126
Q

Other complications include

(BDSO SVAM)

A
  • Burned
  • Damaged
  • Scarred
  • Occluded veins
  • Seizure and tremors
  • Vomiting and choking,
  • Allergies
  • Mastectomy patients
127
Q

rupture of red blood cells with the consequent escape of hemoglobin

A

hemolysis

128
Q

Can cause the plasma or serum to appear pink or red.

A

hemolysis

129
Q

ways to prevent hemolysis

A
  • Mix tubes with anticoagulant additives gently
  • Avoid drawing blood from a hematoma
  • Avoid drawing the plunger of the syringe back too forcefully and avoid bubbles on the sample
  • Make sure the venipuncture site is dry
  • Avoid a probing, traumatic puncture
130
Q

fluid may dilute the specimen, so collect from the opposite arm if possible

A

IV therapy

131
Q

Otherwise, samples may be drawn the IV by following this procedure:

A
  • Turn off the IV for at least 2 minutes before venipuncture (inform the nurse)
  • Apply the torniquet below the IV site. Select a vein other than the one with IV.
  • Perform the venipuncture. Draw 5mL of blood and discard before drawing the specimen tubes for testing.
132
Q

there will be a temporary increase in glucose and lipid content in the blood.

A

diet

133
Q

increased white blood cell counts and cortisol levels.

A

smoking

134
Q

can lead to decrease pulmonary function and result in increased hemoglobin levels.

A

smoking

135
Q

results in a shift of body water from the inside vessels to the interstitial spaces.

A

posture

136
Q
  • levels of certain hormones such as cortisol and adrenocorticotrophic hormones decrease in the afternoon.
A

diurnal rhythm

137
Q

other test values, such as iron and eosinophil levels increase in the afternoon.

A

diurnal rhythm

138
Q

muscle activity elevates creatinine, protein, creatine kinase, AST and LDH.

A

exercise

139
Q

activates coagulation and fibrinolysis and increase platelet and white blood cells.

A

exercise

140
Q

cause a temporary increase in white blood cells.

A

stress

141
Q
  • Prolonged application of torniquet ( >1 )
A

venous stasis

142
Q
  • Drawing above IV
  • Short draw (blood to anticoagulant ratio
A

hemodilution

143
Q
  • Traumatic stick
  • Too vigorous mixing
  • Alcohol is still wet
  • Using too small needle
  • Forcing blood into syringe
A

hemolysis

144
Q
  • Inadequate mixing
  • Traumatic stick
A

clotted sample

145
Q
  • Short draw
  • Sodium citrate tube draw volume critical
A

partially filled tubes

146
Q
  • Using incorrect cleanser
  • Alcohol still wet
  • Powder from gloves
  • Drawing above the IV
A

specimen contamination

147
Q
  • Exposure to light
  • Pre – chilled tube
  • Body temperature
A

specimen handling

148
Q
A

MT 12 lab (1 decks)

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