PLB Flashcards
What is the function of blood vessels in the human body?
The blood vessels transport blood throughout the human body.
What are the 5 types of blood vessels?
- Arteries
- Capillaries
- Veins
- Arterioles
- Venules
Identify
What are the major types of blood vessels and their functions?
3 MAJOR types of blood vessels:
1. arteries - carry the blood away from the heart;
- capillaries - where exchange of water and
chemicals between the blood and the tissues occurs; also where removing of wastes takes place - veins - carry deoxygenated blood from the capillaries back towards the heart
Identify
These are small branches of an artery leading into capillaries;
Arterioles
Identify
These are small branches of veins that lead to the capillaries
Venules
The blood vessels are connected. What happens if they are not?
- without connection, there is no unloading of oxygen and loading of carbon dioxide
- if no exchange of gases, then organs suffocate-patient dies
How are veins and arteries connected to the network of blood vessels?
Veins are connected through the venule
Arteries are connected through the arteriole
Why are capillaries small and thin?
For easy diffusion of gases and nutrients
What are the 3 major layers of the blood vessels?
- Tunica intima
- Tunica media
- Tunica externa
Identify
This layer of blood vessels is composed of simple squamous epithelial cells interlaced with several circularly arranged elastic bands called the internal elastic lamina
Tunica intima
Since the innermost layer of the blood vessel is Tunica intima, it is composed of simple squamous epithelial cells which make ________________________ more efficent.
exchange of nutrients and gases
What is the unique part only found in Tunica intima?
Internal elastic lamina
This layer is the thickest layer in the arteries. (What makes it thick?)
Tunica Media
Consists of circularly arranged elastic fiber, connective tissue,polysaccharide substances
Identify
Separated from tunica externa by another thick elastic band called external elastic lamina.
Tunica Media
Identify
This is the thickest layer in veins entirely made of connective tissue
Tunica externa
What is the composition of the layer: Tunica externa?
▪ Entirely made of connective tissue
▪ Contains nerves that supply the vessel as well as nutrient capillaries (vasa vasorum) in the larger blood vessels.
In venipuncture, which area should the bevel reach inside?
What happens if this area is not reached?
The bevel should reach through the 3 layers and puncture the lumen of the vein
If not reached, brusing may appear on the skin
What is the vessel size range (diameter)?
Ranges from a diameter of about 25 mm for the aorta to only 8 um in the capillaries.
Identify
This is the narrowing of blood vessels by contracting the vascular smooth muscle in the vessel walls.
Vasoconstriction
In what bodily situations is vasoconstriction good and bad for the body?
GOOD for the body
- constrict in cold temperature (body’s way to prevent heat from escaping from the body)
BAD for the body
- constrictions caused by High-blood pressure and overdose of nasal decongestants
Identify
This is the widening of blood vessels due to
relaxation of the blood vessel’s muscular walls.
Vasodilation
What happens to blood pressure when the blood vessel dilates?
decrease
When does vasodilation happen?
- Exposure to high temperatures
- Exposure to vasodilators (hormone vasopressin, neurotransmitters like epinephrine)
Explain the Blood Flow Pathway
- Deoxygenated blood enters the Superior and Inferior Vena Cava
- Deoxy Blood enters the right atirum and goes to the right ventricle when the Tricuspid valve opens
- Right ventrical pumps the blood to the pulmonary trunk
- The pulmonary arteries (right and left) brings the blood to the lungs for gas exchange.
- Oxygenated blood enters the pulmonary veins and gets inside the left ventricle through the opening of the Mitral valve
- The left ventricle pumps the blood to the aorta.
- Oxygenated blood is delivered throughout the body(organs) through the major arteries (aortas)
Identify
This is the most common area in the body where we perform venipuncture; ideal and recommended
Antecubital fossa
What triangular area is also known as the elbow pit on the anterior of the elbow, which is a site of major veins?
Antecubital fossa
Why is the Antecubital fossa the first choice for routine venipuncture?
First choice for routine venipuncture because there are several major veins called antecubital veins
This is the preferred venipuncture site in the H-shaped antecubital vein since it’s the easiest to access and least painful
for the patient
Median cubital vein
What arrangment of veins is found in 70% of the population? (or most people have this arrangement)
H-shaped cubital vein
Aside from it being the easiest to access and least painful for the patient, why is the median cubital vein the preferred venipuncture site?
It is well-anchored; will not move when punctured
Identify
This is the second choice vein in the H-shaped antecubital vein; harder to palpate but is usually better when drawing blood from an obese patient
Cephalic vein
What vein in the H-shape antecubital vein is used to draw blood from obese patients since locating the median cubital is hard?
Cephalic vein
Why is the basilic vein the last choice-vein in the H-shaped antecubital vein?
- not well anchored
- punctures are more painful
- close to the brachial artery
What is an indication that the blood vessel punctured is an artery?
Blood is bright red
Identify
These are intermediate antebrachial veins, which include the median, median cephalic, and median basilic veins.
M-shaped antecubital veins
What veins are in the M-shaped antecubital veins?
- Median vein-intermediate antebrachial vein; first choice vein; safest and less painful
- Median cephalic vein – intermediate cephalic vein; 2nd choice for venipuncture; less likely to roll
- Median basilic vein – intermediate basilic vein; last choice vein because it is more painful
What is the most appropriate method when getting a sample in the other arm and hand veins for venipunture?
Using winged infusion set or the
Butterfly method
Identify
Venipuncture through Syringe and Evacuated Tube Systems are not recommended in these parts (+Why?)
Other arm and hand veins
this is a bony part
and nipis kayo ang veins
What is the standard distance of attachment of tourniquets?
3-4 inches above the collection site
What should you do if no veins are accesible in the antecubital fossa?
Use the other arm and hand veins
When should you use the other arm and hand veins for venipuncture?
- when no veins are accessible in the antecubital fossa
- if patient has edema
- if veins in the antecubital fossa are reserved for chemotherapy
T or F
Underside of the wrist is used as a venipuncture site
F.
Underside of the wrist is never used as a venipuncture site
What veins are smaller and more painful to collect on aside from the basilic veins?
Veins at the back of the hand that can be used are smaller and thus more painful
Leg, ankle, and foot veins must not be used in venipuncture without?
the permission of a
physician due to complications such as thrombosis.
Arteries are not used for routine blood collection and are limited only to the?
to the collection of arterial blood gas
What should you do before puncturing the leg, ankle, and foot veins?
Ask the attending physician first if they allow these sites to be punctured because if there is traumatic venipuncture, it will form a clot or thrombus-muclog sa blood vessels
What is the etymology of the word Phlebotomy?
From the Greek word “phlebos”, meaning vein and “-tomia”, meaning cutting
Identify
This is the act of drawing or removing blood from the circulatory system through a cut or puncture to obtain a sample for analysis and diagnosis
Phlebotomy
Identify
This act is also done as part of the patient’s treatment for certain blood disorders
Phlebotomy
Who were the first to perform bleeding? What did they call the process? For what reason did they perform such acts?
Egyptians
first to perform bleeding by scarification
REASON: to cure patients
Who is the Greek physician that discovered that arteries as well as veins had blood?
Galen of Pergamon
What system of blood collection did Galen of Pergamon develop?
He developed a complex system for the quantity of blood which should be removed and from what specific areas of the body
Identify
They were credited for bringing phlebotomy to the United States in the 18th century.
The Pilgrims
Identify
It was common at this time to use lancets that were fired into veins at multiple locations
The time of The Pilgrims
During the time of the Pilgrims, how many pints of blood were collected through lancets?
4 pints of blood (1 pint=473mL)
What was a popular service for almost one hundred years that went out of fashion as many harmful incidents came to light?
Bloodletting
What did bleeding as a treatment aid in the 18th century?
Bleeding as a standard treatment in the 18th
century:
* For fever such as putrid fevers (typhus and typhoid fever)
* For hypertension, cases of comas, and drowsy headaches.
* Recommended to reduce inflammation of the lungs according to the amount of pain, the pounding of the pulse, and the difficulty in breathing. As much as 210 ounces were bled over a 6‐day period (210 ounces =
6, 210 mL).
What was the belief about bleeding in the 18th century regarding blood pressure?
if they get blood from patient mugamay and blood pressure
Bleeding was recommended to reduce inflammation of the lungs according to the amount of ____, the pounding of the____, and the difficulty in _____.
according to the amount of pain, the pounding of the pulse, and the difficulty in breathing.
How many ounces were bled during the 18th century to reduce inflammation in the lungs?
As much as 210 ounces were bled over a 6‐day period (210 ounces =6, 210 mL).
What happened to George Washington on December 13?
On December 13, George Washington (1799) was
- taken ill with a ‘cold’ and ‘mild hoarseness’.
- A total of 2, 365 mL of blood was taken over 12 hours.
- James Craik, an Edinburgh trained physician together with Doctor Brown, offered no explanation for this.
- Washington’s blood eventually became viscous and flowed slowly, reflecting dehydration and hypovolemia.
Who were the 2 doctors involved in the case of George Washington?
James Craik and Brown
What happened to the blood of George Washington after bleeding?
Washington’s blood eventually became viscous and flowed slowly, reflecting dehydration and hypovolemia (decreased blood volume)
Identify
During this time, military doctors, unable to cope with widespread disease and infection, bled Union soldiers and civilians alike.
American Civil War (1861–1865),
What were the instruments used during the American Civil War to bleed soldiers and civilians?
Early instruments included anything sharp, such as horned stones, quills, thorns or animal teeth.
When was the thumb lancet introduced?
15th century
Identify
This is a double‐edged instrument, often with ornate handles made from turtle shells. Introduced in the 15th century
Thumb Lancet
Who proved conclusively that inflammation resulted from infection and thus was not susceptible to bloodletting and offered a scientifically legitimate way of thinking about the cause and treatment of the patient’s illness?
Louis Pasteur (1822–1895) and Robert Koch (1843–1910)
What was the reported case of bleeding method in April 2008?
Three Kashmiri hospitals were reported to be using leeches, primarily to bleed patients
as treatment for
- heart problems
- arthritis, gout
- chronic headaches, and sinusitis.
The leeches are for single use to avoid transmission of disease
Identify
This method has been practiced recently to treat a bruised area.
Use of leeches (to remove?)
Phlebotomy is used every day in order to/for what?
- diagnose health problems and
- introduce medication intravenously
- blood transfusion
Like the egyptians, we practice bloodletting today, but what is our purpose?
Therapeutic Phlebotomy (to treat/cure)
What are some conditions that can be diagnosed through therapeutic phlebotomy?
- Polycythemia Vera
- Sickle-cell anemia
- Any condition where there is increased concentration of cells inside the body
What condition makes the blood viscous because of the increased population of cells?
Polycythemia vera
Identify
The role of the phlebotomist has never been more important. In the United States, it is estimated that more than 1 billion venipunctures are performed annually, and errors occurring within this process may cause serious harm to patients, either directly or indirectly. Critical areas include:
■ Appropriateness of the test request
■ Patient and sample identification
■ Criteria for acceptance and rejection of specimens
■ Communication and interpretation of results
What critical area in phlebotomy:
It is the Doctor’s job to order the proper tests and not tests that are unrelated which can waste money and waste resources in the lab.
Appropriateness of the test request
What critical area in phlebotomy:
You need to check for pre-analytical phase and check the quantity, quality, etc.
Criteria for acceptance and rejection of specimens
What critical area in phlebotomy:
This should be practiced and observed by the clinical lab and attending physician
Communication and interpretation of results
What is the first step in most laboratory analysis?
Specimen Collection
Test results are therefore said to be as good as?
sample collection and handling.
identify
Quality assessment in phlebotomy includes:
- preparation of a patient for any specimens to be collected,
- collection of valid samples,
- proper specimen transport.
Why are phlebotomist considered as laboratory ambassadors?
- the only staff member that a patient sees (+ receptionist)
- Expected to deliver unexcelled customer satisfaction
- understand and know the patient’s expectations, manage unrealistic expectations through patient education, and be diplomatic with customer complaints.
Identify
Patient identification procedure for Concious in-patients
- verbally ask their full names,
- verify using the identification bracelet which includes first and last name, hospital number/unit number, room/bed, and physician’s name.
Identify
PATIENT IDENTIFICATION PROCEDURE for Sleeping patients
they must be awakened before blood collection. Identified same as conscious patients.
PATIENT IDENTIFICATION PROCEDURE for Unconscious patients/Mentally challenged patients
- identified by asking the attending nurse or relative; ID bracelet
- even if unconcious, treat them like a concious person
- if mentally challenged, there must be someone else with you
PATIENT IDENTIFICATION PROCEDURE for infants and children
- nurse or relative (parent) may identify the patient or by ID bracelet
- if they can talk (5-7 yrs old) ask them personally
PATIENT IDENTIFICATION PROCEDURE for outpatient patient (ambulatory patients)
- verbally ask their full name, DOB and countercheck with driver’s license or ID with photo.
- If the patient has ID card or bracelet, same manner as with hospitalized patients.
How should pediatric patients be handled?
- Be gentle and treat them with compassion,
empathy, and kindness. - Attempt to interact with the pediatric patient
- Acknowledge the parent and the child. Be friendly, courteous, and responsive. Allow
enough time for the procedure. - Instruct the parent to restrain the child
- collect sample QUICKLY
- ensure safety and comfort of both child and parent
How should adolescent patients be handled?
- When obtaining a blood specimen from an adolescent, it is important to be relaxed and perceptive about any anxiety that he or she
may have. - General interaction techniques include
allowing enough time for the procedure, establishing eye contact, and allowing the patient to maintain a sense of control.
How should geriatric patients be handled?
- Treat geriatric patients with dignity and respect.
- Do not demean the patient.
- It is best to address the patient with a more
formal title such as Mrs., Ms., or Mr.rather than by his or her first name. - Senior patients may enjoy a short conversation.
- Keep a flexible agenda so that enough time is allowed for the patient.
- Speak slowly and allow enough time for questions.
- The elderly have the right of informed consent. Too many times this fact is lost in dealing with any patient, but it seems more prevalent in dealing with aging patients.
- Make the procedure QUICK and ensure COMFORT
Why is it challenging to collect blood samples from geriatric patients?
their skin is not firm anymore - so stretch the skin first before i insert and needle para di mumove ang vein
WHAT ARE THE CATEGORIES OF ADDITIVES USED IN BLOOD COLLECTION?
- Antiglycolytic agent
- Anticoagulant agent
- Clot activator
- Thixotropic Gel Separator
- Trace element-free tubes
Identify
This additive inhibits the use of glucose by blood cells. Example: sodium fluoride (What color?)
Antiglycolytic Agent (Grey-top tube)
What additive prevents blood from clotting? The mechanism by which clotting is prevented varies
Anticoagulant agent
List
Examples of anti-coagulants and the substance they prevent from causing clotting (What colors?)
- EDTA (purple), citrate (light blue), and oxalate (grey) remove calcium by forming insoluble salts,
- heparin (green) prevents the conversion of prothrombin to thrombin.
Without this substance, blood remains in its liquid form. What is this substance?
calcium
Additive that helps initiate or enhance the clotting mechanism. Examples: glass (silica) particles and inert clays (celite) that provide increased surface area for platelet activation and clotting factor such as thrombin.
Clot Activator
List
Examples of Clot activator and their color
- glass (silica) particles and
- inert clays(celite)
- provide increased surface area for platelet activation and clotting factor such as thrombin.
- RED-top tube sometimes called PLAIN TUBE or SERUM TUBE
Identify
Additive characterized by an inert material that undergoes a temporary change in viscosity during the centrifugation process which enables it to serve as a separation barrier between the liquid (serum and
plasma) and cells.
Thixotropic gel separator
What is the other name for Thixotropic Gel separator and what is its color?
SERUM SEPARATOR GEL (SERUM SEPARATOR TUBE)
YELLOW-top tube
What happens to the gel in the thixotropic gel separator tube
- orginally without sample?
- after centrifugation?
- originally without sample, the gel is at the bottom
- after centrifugation, the gel is between the serum of rbc
What is the purpose of the gel in the thixotropic gel separator?
- purpose of gel is to separate the serum and RBC in order to prevent the serum from being contaminated with rbc.
- the presence of rbc can interfere with the testing of serum
What additive is made of materials that are free of trace element contamination and have royal-blue stoppers?
Trace element-free tubes
What is the use of a trace element-free tube?
▪ Used for trace element tests,toxicology studies, and nutrient determination
What happens if trace element-free tubes are not sterile and free from free elements?
Contamination or presence of free elements might lead to false positives
List the SPECIAL-USE ANTICOAGULANTS and their colors
- Acid Citrate Dextrose (ACD) = Yellow
- Citrate Phosphate Dextrose (CPD) =
- Sodium Polyanethol Sulfonate (SPS) = Yellow
In ACD, what is the purpose of Acid citrate and dextrose?
- Acid citrate: prevents coagulation binding calcium, with little effect on cells and platelets
- Dextrose: acts as an RBC nutrient and preservative by maintaining RBC viability
What is the use of ACD anticoagulants?
Used for immunohematology tests such as DNA testing and human leukocyte antigen (HLA) phenotyping
In Citrate Phosphate Dextrose (CPD) what is the purpose of citrate, phosphate, and dextrose?
- Citrate: prevents clotting by chelating calcium
- Phosphate: stabilizes pH (minor changes in pH can alter viability of cells in the sample)
- Dextrose: provides cells (rbc) with energy and keep them alive
What anticoagulant is used in collecting units of blood transfusion or the blood bag?
(+ what is the concentration ratio between blood sample volume and anticoagulant?)
Citrate Phosphate Dextrose (CPD)
- 53 ml anticoagulant in 450 ml blood bag
In what section in the lab are ACD and CPD used?
IMMUNOHEMATOLOGY and BLOODBANKING
What anticoagulant prevents coagulation by binding calcium and is Used for blood culture collection?
Sodium Polyanethol Sulfonate (SPS)
What section in the laboratory is SPS used?
Microbiology section
How is SPS used for tests done in patients with sepsis?
- Used for blood culture collection for patients with sepsis in order to detect the infection in blood
ACTION/FUNCTION:
- it reduces the activity of antibiotic
- reduce the action of complement system (destroys bacteria)
- slow down phagocytosis (monocytes, wbc)
What are the specifications/additives for each cap color?
Red
Orange
Yellow
Green
Light Green
Purple
Light Blue
Black
Grey
Red = No additive
Orange = Coagulant
Yellow = Coagulant and Separation Gel
Green = Sodium heparin
Light Green = Lithium heparin
Purple = EDTA
Light Blue = Sodium Citrate (1:9)
Black = Sodium Citrate (1:4)
Grey = Potassium Oxalate Monohydrate and Sodium Fluoride
What are the 2 formulations of EDTA?
- dipotassium EDTA (appears like moisture)
- tripotassium EDTA (already coated/covered inside the tube)
The volume of the sample is always greater than the aticoagulant. What happens otherwise?
The sample will be diluted
In the additives that use grey-top tube, which is the anticoagulant and anti-glycolytic agent?
anticoagulant = Potassium oxalate Monohydrate
anti-glycolytic agent = Sodium Fluoride
Is Mixing of sample required in a tube characterized by having no additives and a glass surface activating clotting sequence?
NO (mixing by inversion is not required in RED GLASS top Tubes)
In a RED-top tube, the serum is used for?
TDM (Therapeutic Drug Monitoring) thus it is subject to CENTRIFUGATION
Identify
This contains clot activators to initiate clotting sequence. Must be inverted 5 times to mix sample with additive and initiate clotting sequence
RED PLASTIC-top Tube
How is the serum processed in a plastic red-top tube?
don’t immediately place in centrifuge to get serum - CLOT at room temp for 30 mins first before centrifugation
What is the blood clotting time for Red-top tubes?
60 mins
What is the laboratory use of Red-top tubes and in what sections is it utilized?
Laboratory use:
- Serum determinations in chemistry,
- routine blood donor screening (crossmatching), and
- diagnostic testing for infectious diseases
Used in: (CC,BB,IS)
- CLINICAL CHEMISTRY SECTION
- BLOODBANKING SECTION
- IMMUNOSEROLOGY SECTION
What tube contains a clot activator and gel (SST) and is Inverted to mix and initiate clotting sequence?
GOLD OR MOTTLED-RED-GRAY TOP TUBE
What tube contains a clot activator and gel (SST) and is Inverted to mix and initiate clotting sequence?
GOLD OR MOTTLED-RED-GRAY TOP TUBE
What is the Laboratory use of Gold or Mottled-red-gray-top tube
- serum determination in chemistry,
- blood donor screening (crossmatching), and
- serum testing for infectious diseases
What is the Laboratory use of Gold or Mottled-red-gray-top tube
- serum determination in chemistry,
- blood donor screening (crossmatching), and
- serum testing for infectious diseases
What sample is used in gold or mottled-red-gray top tube and how long is the blood clotting time?
• SERUM
• Blood clotting time: 30 minutes
What tube is this?
- Anticoagulant: 3.2 % sodium citrate
- Specimen: Plasma
- Binds calcium
LIGHT BLUE-TOP TUBE
How many inversions are done in light blue-top tubes and what is the blood to anticoagulant ratio?
- 3-4 full gentle inversion
- Blood: anticoagulant ratio (9:1)
Which tube has a Laboratory use for Clot-based studies/coagulation studies (PT and APTT), mixing studies, and ethanol gelation test
Light blue-top tube
What are the 3 formulations of heparin green -top tube?
Lithium heparin
Ammonium heparin
Sodium heparin
identify
This tube Inhibits thrombin formation and Requires 8 full inversions
green-top tube
What tube must be full and transported on ice if needed for pH, pO2, and ionized calcium analysis?
Green-top tube
What is the laboratory use of green-top tubes?
Laboratory use: plasma determinations in chemistry
What anticoagulant is found in a purple-top tube? What sample is it used for?
Anticoagulant: Spray-coated K3EDTA (glass) or liquid
K2EDTA (plastic)
Sample: Can either be plasma or whole blood
Identify
This tube has anticoagulants that bind calcium through chelation and require 8-10 full inversions
Purple-top tube
What is the laboratory use of purple-top tube?
Laboratory use: Hematology determinations (CBC), routine immunohematology testing, and blood donor screening (crossmatching)
What tube color has two possible functions (Anticoagulation and Antiglycolytic)?
Gray-top tube
Identify
This anticoagulant prevents coagulation by precipitating calcium and uses Plasma and Whole blood as samples
Potassium oxalate (gray)
Identify
This additive maintains plasma glucose levels and preserves glucose for up to 3 days and inhibits growth of bacteria
Antiglycolytic agent: Sodium fluoride (gray-top tube)
What tube requires 8-10 full inversions and has Laboratory use: glucose determinations and lactic acid level determination?
Gray-top tube
What anticoagulant is used in – Blood bank studies, HLA phenotyping, Paternity testing, and DNA?
ACD: acid citrate dextrose (yellow)
What anticoagulant is Used for special blood culture studies and inhibits certain antibiotics?
SPS : sodium polyanethol sulfonate
What tube contains anticoagulants that bind calcium, Requires 8 full inversions, and uses Sample: Plasma and Whole blood? What are these anticoagulants?
Yellow-top tube
- ACD and SPS
What tube uses
Additive: Thrombin-bassed clot activiator with gel for serum separation
Inversions: 5-6
Laboratory use: For stat serum determinations in chemistry. Tube inversions ensure mxing of clot activator with blood. blood clotting time: 5 mins
Orange
What tube uses
Additive: Thrombin-bassed clot activiator
Inversions: 8
Laboratory use: For stat serum determinations in chemistry. Tube inversions ensure mxing of clot activator with blood. blood clotting time: 5 mins
Orange
What tube uses
Additive: Clot activator (plastic serum) and K2 EDTA (plastic)
Inversions: both 8
Laboratory use:
- Clot Activator (plastic serum) = for trace-element, toxicology, and nutritional-chemistry determinations.
- K2 EDTA (plastic) = Special stopper formulation provides low levels of trace elements. tube inversions ensure mixing of either clor activator or anticoagulant (EDTA) with blood
Royal Blue
What tube uses
Additive: K2 EDTA (plastic)
Inversions: 8
Laboratory use: For lead determinations. This tube is certified to contain less than 0.01ug/mL (ppm) lead. tube inversions prevent clotting
Tan
What tube uses
Additive: K2EDTA and gel for plasma separation
Inversions: 8
Laboratory use: For use in molecular diagnostic test methods (such as, but not limited to, polymerase chain reaction and/or branched DNA aplification techniques). tube inversions ensure mixing of anticoagulant (EDTA) with blood to prevent clotting
White
What tube uses
Additive: Spray-coated K2EDTA (plastic)
Inversions: 8
Laboratory use: For whole blood hematology determinations. May be used for routine immunohematology testing and blood donor screenning. Designed with special cross-match label for patient information required by the AABB. Tube inversions prevent clotting.
Pink
What is the order of draw for evacuated tubes?
- Blood Culture or sterile tubes (yellow stopper)
- Coagulation tube (light blue stopper)
- Serum tube with or without clot activator or gel (red,
gold, or red gray marbled) - Heparin Tube (green or light green stopper)
- EDTA tube (lavender stopper)
- Oxalate/fluoride tube (gray stopper)
Stop (sterile)-Light(lt blue)-Red-Stay(SST)-Put(PST)-Green-Light(lavender)-Go(gray)
What GENERAL BLOOD COLLECTION EQUIPMENT AND SUPPLY is used to prevent sepsis and are used to clean the site prior to blood collection?
Antiseptic
What are some antiseptics used in blood collection?
- 70% ethyl alcohol
- 70% isopropyl alcohol (isopropanol)
- Benzalkonium chloride (e.g. Zephiran chloride)
- Chlorhexidine gluconate
- Hydrogen peroxide
- Povidone-iodine
- Tincture of iodine
What are used to hold over the site following blood collection procedures?
Clean 2-by 2-inch gauze pads folded in fourths or Cotton balls
Cotton balls are not recommended
What is used to contain used needles, lancet, and other harp objects used in blood collection procedures?
Sharp disposal containers
Identify
Carried by the phlebotomist; must be with indelible (permanent) nonsmear ink to label tubes and record other patient information
Pen
What is the preferred watch to be used by phlebotomists?
Preferably with a sweep second hand or timer to accurately determine specimen collection times and time certain tests
identify
This equipment is also known as portable transillumination devices used to locate easily veins that are difficult to see or feel
Vein-locating devices
What equipment is used to highlight the veins of the patient?
Venoscope II Transilluminator
Vein locating device (high-intensity LED or infrared red light through the patient’s subcutaneous tissue)
IDentify
A device that is applied or tied around a patient’s arm prior to venipuncture to restrict blood flow. Must be fastened in a way that is easy to release with one hand during blood collection or in emergency situations
Tourniquet
What are some types of tourniquet and what is the most common type?
- Elastic tourniquet
- Buckle quick release tourniquet
- Velcro tourniquet
MOST common type: STRAP TOURNIQUET
What phlebotomy equipment is sterile, disposable, and designed for single use only?
Phlebotomy needles
What are some types of phleotomy needles?
multisample needles, hypodermic needles, and winged infusion (butterfly) needles
Needles are color coded by _____ for easy identification
gauge
In using a plastic red-top tube, why is it not immediately placed in a centrifuge?
Don’t immediately place in centrifuge to get serum - CLOT at room temp for 30 mins first before centrifugation
In what sections is the red-top tube used?
- CLINICAL CHEMISTRY SECTION
- BLOODBANKING SECTION
- IMMUNOSEROLOGY SECTION
What is the difference between the Gold or Mottled-red-gray top tube (SST) and ACD?
Gold or mottled tube tas a gel for plasma
In what sections is the GOLD OR MOTTLED-RED-GRAY TOP
TUBE used?
- CLINICAL CHEMISTRY SECTION
- BLOODBANKING SECTION
- IMMUNOSEROLOGY SECTION
What is the best anticoagulant for coagulation studies and why?
3.2% sodium citrate (light blue top tube) - the best anticoagulant for coagulation studies because it has the best job for preserving the coagulation or clotting factors
Why must the inversions in a light blue-top tube be gentle?
To avoid clotting
What is the only anticoagulant with a different function and why?
Heparin (green-top tube) - only anticoagulant that different function because it does not involve chelation or binding of calcium. Its function is to PREVENT the formation of THROMBIN (part for clotting process)
What samples are used in green-top tubes?
Plasma and Whole Blood
In using the purple-top tube, what are the samples Whole blood and Plasma used for respectively?
Whole blood = for Hematology (CBC)
Plasma = for bloodbank or immunohematology
Why does a purple/lavender tube require another 2 inversions aside from the 8 initial inversions?
In order to redistribute the cells since during ward visit, the samples are delivered upright
What tubes are used for crossmatching?
Purple/lavender top tube and Gold or red-top tube
What test in the clinical chemistry section uses lavender top tube?
HbA1c
What are the 4 functions of SPS (sodium polyanethol sulfonate)?
- used for special blood culture studies
- Inhibits certain antibiotics
- reduces the action of complement system
- slows down phagocytosis
How many inversions are required for an orange top tube without a gel?
8
When is the pink top tube used?
In routine immunohematology and blood donor screening and if there are no lavender tubes available.
What is the purpose of the order of draw of evacuated tubes?
To prevent cross-contamination through:
- additive carryover
- tissue thromboplastin contamination
- microorganisms or bacteria
In what section is the blood culture or sterile tubes (yellow stopper) used?
Microbiology section
Why is the blood culture or sterile tubes (yellow stopper) first in the order of draw?
First because if it’s last then possibilities of other bacteria growing can lead to false positives
What is the method of disinfection when using blood culture or sterile tubes (yellow)?
- disinfection is 3 changes of alcohol and 3 changes of iodine
Where can you place the black tube in the order of draw?
After heparin or after EDTA tube (lavender) depending onthe request
When is povidone-iodine used?
- used in collection for blood culture
and in bleeding a donor
Why is gauze pad recommended compared to cotton balls?
- gauze pad is recommended because cotton has fibers that can initiate bleeding on the site when taken off
What specific blood flow is restricted with the use of a tournequet?
Venous blood flow
What happens if arterial blood flow is restricted with a tourniquet?
The patient’s arm displays petechiae after collection
When is a tourniquet replaced?
Ideally, every time after use. BUT it can be reused by disinfecting before and after use. REPLACED when it falls on the floor or when stained/soiled with blood
What type of needle is used for evacuated tube system? What type is used for syringes?
Multisample needles for ETS
Hypodermic needles for syringes
What is the other name of a multisample needle? Why is it called so?
also called 2-way needle because it has a needle to insert to the tube and the opposite to puncture the vein
- needle for evacuated tube is rubber so if you push the tube mumove pd ang rubber and if iremove ang tube mabalik ang rubber na cover - SAFETY FEATURE
What are the gauge numbers of yellow, green, black, and blue multisample needles?
yellow (20)
green (21)
black (22)
blue (23)
What gives you an idea on how big the diameter of the multisample needle is?
Gauge number
What is the relationship between the diameter of a needle and the gauge number?
inverse relationship between the diameter of the needle and the gauge number
- higher gauge number the smaller the diameter of the needle
What is the gauge number of Special needle attached to collection bag and what are its typical uses?
15-17
Collection of door units, autologous blood
donation and therapeutic phlebotomy
What needle is sometimes used when large-volume tubes are collected, or large-volume syringes are used on patient with normal-sized veins?
Multisample hypodermic needle (20)
why do you need to know the size of the needle gauge?
- to know what needle to use depending on the size of the vein
What needle is considered the standard venipuncture needle for routine venipuncture on patients with normal veins or for syringe blood culture collection?
Multisample hypodermic (21)
What needle is used on older children and adult patients with small veins or for syringe draw on difficult veins?
Multisample hypodermic (22)
What needle is used on the veins of infants and children and on difficult or hand veins of adults?
Butterfly (23)
What needle is used for veins located in the scalp or other tiny veins of premature infants and other neonates?
Butterfly (25)
What is the needle length of multisample, hypodermic, and butterfly needles?
Multisample = 1 or 1.5 in
Hypodermic = 1 or 1.5 in
Butterfly = 1/2 to 3/4 in
What part of the needle will tell you that you have successfully hit the vein; blood is seen?
Needle hub
What part of the needle determines the amount of sample collected?
Scale
Multisample needles don’t typically show if you have successfully hit a vein but some have _______________ which shows that you successfully hit a vein through the presence of blood.
FLASHBACKS
Identify
This needle is esed for small or difficult veins
such as hand veins of elderly and pediatric patient
Winged infusion set (butterfly)
What part of the winged infusion set is attached to a syringe or ETS?
Female luer lock connector
What is the disadvantage of using a winged-infusion set?
SECRET dapat kabalo naka
Identify
This is a clear, plastic, disposable cylinder with a small threaded opening at one end (often called a hub) where the needle is screwed into it and a large opening at the other end where the collection tube is placed
Tube holder
Identify
This is used with both ETS and the syringe method to obtain blood specimens and Come in various sizes and volumes ranging from 1.8 to 15 mL
Evacuated Tubes
Identify
This venipuncture equipment can be made of plastic or glass
* Fill with blood automatically because of vacuum which is artificially created by pulling air from the tube
Evacuated tubes
What are instances in which the pre-measured vacuum in an evacuated tube is lost?
- improper storage of tube
- opening of the tube
- dropping the tube
- advancing the tube too far onto the needle before venipuncture
- needle bevel becomes partially out of the skin (needle not anchored properly) -produce a hissing sound. SO ANCHOR NEEDLE PROPERLY!
What are the 2 methods /systems in which you can transfer a sample to an evacuated tube?
- Open system
- prone to contamination - Closed system
- like ETS (fine) but if syringe then it may cause hemolysis of sample
What is the order of draw for capillary specimens (microtainer tubes) and how many inversions for each?
- Blood Gases (Rotate between palm to mix)
- Slides & Smears/EDTA specimens (10)
- Lithium heparin (10)
- Lithium heparin with gel separator (10)
- Sodium fluoride/Potassium oxalate (10)
- Serum- with clot activator (5)
- Serum- No additive (0)
- Newborn Blood Spot Card (collected separately cause it doesn’t use a tube)
What are some tests that do not require skin puncture?
- ESR (Erythrocyte Sedimentation Test) = black top tube (3.8% sodium citrate); Black top has no microtainer
- coagulation studies
- Blood culture (no microtainer)
Identify
This is a sterile, disposable, sharp-pointed
or bladed instrument that punctures or makes an incision on the skin to obtain capillary blood specimen
Lancets/Incision Devices
Identify
These are also called microtubes used to collect tiny amounts of blood obtain through capillary puncture
* Often referred as “bullets”
microcollection containers (microtainer)
Identify
These are disposable, narrow-bore plastic or glass capillary tubes that fill by capillary action and typically hold 50-70 uL of blood
Microhematocrit tubes
What puncture equipment is used for manual hematocrit or packed cell determinations?
Microhematocrit tubes
Microhematocrit tubes can be heparinized or non-anticoagulated. Which colors are which?
Red and green - heparinized
blue - non-anticoagulated
What is the anticoagulant used in red and green microhematocrit tubes and when are these two used?
Anticoagulant = (ammonium heparin)
- used only when directly collecting the sample from the site of puncture
What is the other name for the blue microhemtocrit tube and when is it used?
Plain capillary tube - used when the sample has EDTA
How much sample should be filled into the microhematocrit tube?
- fill the capillary tube up to 2/3 or 3/4
- don’t fill up because it will be harder to read the hematocrit levels
What is used to seal one end of microhematocrit tube?
Clay sealant
Identify
This puncture equipment Increases blood flow as much as seven times and provides a uniform temperature that does not exceed 42 °C
Warming devices
When/for whom are warming devices used?
Used for patients bound to capillary blood gas collections (babies)
Identify
This puncture procedure less desirable for blood gas analysis due to its composition and temporarily exposed to air during collection. But it is used for babies and infants and rarely in adults.
Capillary blood gases (CBG)
What is the site of collection for CGB specimens?
CBG specimens are collected from the same sites as routine capillary puncture specimens
On babies = lateral side of the foot
What is a necessary step in the capillary blood gases procedure?
Warming the site for 5-10 minutes is necessary
What capillary puncture procedure is done to newborns to detect and monitor increased bilirubin levels caused by overproduction or impaired excretion of bilirubin?
Neonatal bilirubin collection
How is the neonatal bilirubin collection done?
Collection is done quickly by heel puncture, protected from light during transportation and handling. Sample is collected in amber-colored micro collection tubes.
If no amber colored tube then cover with carbon paper or foil
Identify
The purpose for this capillary pucnture procedure is the testing of newborns for the presence of certain genetic, metabolic, hormonal , and functional disorders that can cause severe mental handicaps or other serious abnormalities
Newborn/Neonatal screening
How is the sample collected in the newborn/neonatal screening?
- Sample collected through blood spot collection
▪ Sample is obtained through heel puncture
▪ Blood drops are collected by absorption onto circles printed on a special type of filter paper
When is the neonatal screening sample collected?
- Need to be collected 24 hrs after maborn ang baby
What are the 7 FINGER PUNCTURE PRECAUTIONS?
- Do not puncture fingers of infants and children under 1 year of age.
- Do not puncture fingers on the same side as mastectomy without consulting with the patient’s physician.
- Do not puncture parallel to the grooves or lies of the fingerprint.
- Do not puncture the fifth or the pinky finger.
- Do not puncture the index finger.
- Do not puncture the side or very tip of the finger.
- Do not puncture the thumb.
Why should you not puncture fingers of infants and children under 1 year of age?
The tip of the bone is close to the skin
Why should you not puncture fingers on the same side as mastectomy without consulting with the patient’s physician?
Mastectomy: remove breast - lymph nodes are included (if makuha wala nay mufight sa infection ana na site - can’t puncture on the sight for risks of infections)
puncure on opposite side
Why should you not puncture the 5th or pinky finger?
tip of bone is close to skin
Why should you not puncture the index finger?
callused finger
Why should you not puncture the thumb?
it has pulse meaning there is artery present
Which fingers should be punctured for collection?
3rd and 4th finger of non-dominant hand
Identify
This specimen quality concern is the failure to mix or inadequate mixing of samples
collected into an additive tube. This leads to red cells clumping together making the sample unsuitable for testing
Clotted
What are the causes of a clotted sample?
CLOTTED SAMPLE:
1. failure to mix
2. vigorous mixing
3. traumatic venipuncture (probing)
Hemolysis is caused by?
usually caused by a procedural error:
▪ using too small of a needle
▪ pulling back too hard on the plunger of a syringe used for collecting the sample
▪ inserting needle on site even though alcohol is not yet dry
When do you know if the sample is hemolyzed?
After centrifugation when the liquid portion is pinkish or reddish
What specimen quality concern is meant by:
certain additive tubes must be filled completely. Incorrect blood to additive ratio will adversely affect the laboratory test results. When many tests are ordered on the same tube be sure to know the amount of sample needed for each test.
Insufficient sample (qns)
Identify
To avoid this specimen quality concern, you must consult the procedure manual before collecting the specimen if unsure of the type of tube required for a test; additive in an expired tube may not work properly
Wrong or expired collection tube
What specimen quality concern is meant by:
certain tests must be collected and placed on ice, protected from light, or be kept warm after collection.
Improper transport and storage
Specimen contamination can be a result of improper technique or carelessness such as:
a. Allowing alcohol, fingerprints, glove powder, baby powder, or urine from wet diapers to contaminate NBS forms or specimens
b. Getting glove powder on blood films (slides) or in capillary specimens
c. Unwittingly dripping perspiration into capillary specimens during collection
d. Using the correct antiseptic but not following the proper procedure
e. Using the wrong antiseptic to clean the site prior to specimen collection
What is the proper procedure in wiping with an antiseptic?
Concentric fashion
What is the correct antiseptic to use to clean the site prior to specimen collection?
alcohol with concentrations above 40%
Identify
This is the most commonly encountered
complication in obtaining a blood specimen. It is caused by leakage of a small amount of fluid around the tissue due to traumatic venipuncture
Ecchymosis (Bruise)
IDentify
This is the second most common complication encountered in blood collection. Before drawing blood, the collector should ask if he/she had prior episodes of fainting
Syncope (fainting)
Identify
This cimplication in blood collection is encountered when leakage of a large amount of fluid around the puncture site causes the area to swell. Most commonly occurs when the needle goes through the vein, bevel is partially inserted in the vein, and if the collector fails to apply enough pressure after venipuncture.
Hematoma
Identify
This complication encountered in blood collection is due to improper needle positioning, excessive pull of the plunger, piercing the other pole of the vein, incorrect bevel positioning, and absence of vacuum.
Failure to draw blood
Identify
This complication encountered in blood collection is characterized by small red spots indicating that small amounts of blood have escaped into the skin epithelium.
Petechiae
What could be the cause of the appearance of petechiae on the skin after blood collection?
- reason is too tight ang application sa tourniquet
- this promotes opening of the vascular endothelium in which there are gaps/spaces between the endothelial cells and there could be escaped RBCs to the skin
Identify
This is a complication encountered in blood collection in which swelling caused by an abnormal accumulation of fluid in the intracellular spaces appears.
Edema
How should you handle the person/veins of obese patients in blood collection?
- veins may be neither readily visible nor easy to palpate can use of a blood pressure cuff in locating the vein.
- The cuff should not be inflated any higher than the patient’s diastolic pressure and should not be left on the arm for longer than 1 minute.
What is the ideal vein to be used for obese patients?
Cephalic vein
What complication in blood collection in which there is an increased concentration of
larger molecules and analytes (potassium) in the blood as a result of a shift in water balance. Can be caused by leaving the tourniquet on the patient’s arm too long
Hemoconcentration
How should you collect the sample on a patient with an IV drip?
If patient has IV drip - use the other side; if both arms then ask nurse to stop IV for 2-5 minutes
- collect the sample in arm with IV with discard tube (5ml) but actual specimen is the 2nd tube since contaminated with IV ang first. COLLECT BELOW THE IV LINE
What happens to the concentration of analytes in Hemoconcentration?
increase (esp potassium)
Identify
Primary effect of this complication in blood collection is hemoconcentration. The hydrostatic pressure causes some water and elements to leave the extracellular space.
Prolonged torniquet application
What are other complications in blood collection?
Burned, damaged, scarred and occluded veins, seizure and tremors, vomiting and choking, allergies, and mastectomy patients.
Identify
This complication in blood collection is characterized by the rupture of red blood cells with the consequent escape of hemoglobin. Can cause the plasma or serum to appear pink or red.
Hemolysis
What should you do in order to prevent hemolysis?
- 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 venipuncture
Why should you not collect in the arm with IV therapy?
fluid may dilute the specimen, so collect from the opposite arm if possible.
In patients with IV therapy, samples may be
drawn below the IV by following what procedures?
- Turn off the IV for at least 2 minutes before venipuncture
- Apply the tourniquet below the IV site. Select a vein other than the one with IV
- Perform the venipuncture. Draw 5 mL of blood and discard before drawing the specimen tubes for testing
What are the PHYSIOLOGIC FACTORS AFFECTING
TEST RESULTS?
- Posture
- Diurnal rhythm
- Exercise
- Stress
- Diet
- Smoking
How does posture affect test results?
changing from a supine (lying) to a sitting or
standing position results in a shift of body water and analytes from inside the blood vessels to the interstitial spaces
What physiologic factor affecting test results is meant by: levels of certain hormones such as cortisol and adrenocorticotrophic hormone decreases in the afternoon. Other test values, such as iron and eosinophil levels increases in the afternoon
Dirunal Rhythm
How does exercise affect test results?
- muscle activity elevates creatine, protein, creatine kinase, AST and LDH.
- Exercise activates coagulation and fibrinolysis and increases platelet and white blood cells.
How does stress affect test results?
Stress/anxiety can cause a temporary increase in white
blood cells.
What physiologic factor affecting test results is meant by: if a patient has eaten recently (less than 2 hours earlier), there will be a temporary increase in glucose and lipid content in the blood. Serum may appear cloudy or turbid.
Diet
How does smoking affect test results?
patients who smoke before blood collection
may have increased white blood cell counts and cortisol levels. Long term smoking can lead to decrease pulmonary function and result in increased hemoglobin levels.
What poor collection technique leads to venous stasis?
Prolonged application of tourniquet (>1 min)
What poor collection technique leads to Hemodilution?
- Drawing above IV
- Short draw (blood to anticoagulant ratio)
What poor collection techniques lead to hemolysis?
- Traumatic stick
- Too vigorous mixing
- Alcohol still wet
- Using too small of needle
- Forcing blood into syringe
- Pulling plunger aggressively
What poor collection technique leads to clotted sample?
- Inadequate mixing
- Traumatic stick
What poor collection technique leads to partially filled tubes?
- Short draw
- Sodium citrate tube draw volume critical
What poor collection techniques lead to specimen contamination?
- Using incorrect cleanser
- Alcohol still wet
- Powder from gloves
- Drawing above IV
What poor collection techniques lead to poor specimen handling?
- Exposure to light
- Pre-chilled tube
- Body temperature
What are the consequences of poor collection techniques?
- venous stasis
- Hemodilution
- Hemolysis
- Clotted sanoke
- Partially filled tubes
- Using wrong anticoagulant
- Specimen contamination
- Specimen handling (wrong)
