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Plebotomy Flashcards

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1
Q

Phlebotomy

A

the incision of a vein for the letting of blood, as in collecting from a donor
the letting of blood in the treatment of disease

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2
Q

Venesection

A

the incision of a vein for the letting of blood, as in collecting from a donor
the letting of blood in the treatment of disease

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3
Q

venipuncture

A

a technique in which a vein is punctured transcutaneously by a sharp rigid stylet or cannula carrying a flexible plastic catheter or by a steel needle attached to a syringe or catheter. The purpose of the procedure is to withdraw a specimen of blood, to perform a phlebotomy, to instill a medication, to start an intravenous infusion, or to inject a radio-opaque (or other) substance…

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4
Q

phlebotomy vs venesection in this course

A

The process of accessing a vein for the purpose of collecting blood

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5
Q

Venipuncture in this course

A

an all-encompassing term which includes not only accessing a vein for blood collection or blood letting, but other processes which also require accessing a vein, e.g., an injection.

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6
Q

venipuncture vs phlebotomy in this course

A

term venipuncture will be used in this course as it is most representative of the varying indications for accessing a vein by differing health disciplines. The term phlebotomy will only be used in the context of blood collection.

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7
Q

the art of dealing with anxious or apprehensive patients must be mastered to ensure a positive outcome for the venipuncture procedure includes

A

recognition of traits of apprehension and nervousness (for example, beads of sweat on the patient’s forehead or nervous laughter), good communication skills, and an empathetic attitude.

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8
Q

Give examples for why the following perform phlebotomies?
Nursing personnel
Medical laboratory personnel
Medical imaging technologists

A

Nursing personnel administer medications to patients
Medical laboratory personnel routinely perform phlebotomies for the purpose of collecting blood specimens for diagnostic testing
Medical imaging technologists administer radio-opaque and radioactive materials intravenously for imaging procedures.

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9
Q

When performing venipuncture, who may the allied health technologist deal with?

A

the patient, the patient’s family, nursing staff, physicians and other hospital or clinical staff

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10
Q

The history of phlebotomy and venipuncture dates back to

A

early Egyptian culture

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11
Q

In its earlier form, what was the practice of blood letting was thought to do?

A

Blood letting was thought to rid the body of disease and be used as a cure-all. Little was known of the body or its tissues, but blood and its method of circulation in particular were not well understood.

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12
Q

In the 12th century, blood letting became the practice of who?

A

Barbers, their red and white poles became the symbol of their trade

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13
Q 
Method of Circulation
William Harvey (1628)
A

Harvey’s illustration of the unidirectional flow of venous blood through the venous valves. Once past a valve, blood did not return to distal parts to nourish the members, as Galenic physiology had dictated.

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14
Q 
Blood Letting
Abraham Bosse (1602-1676)
A

In the seventeenth century, people were bled for any reason and often for none. Louis XIII was bled forty-seven times, and Louis XIV thirty-eight times.

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15
Q

Remedies for All Ailments

A

Essentially, blood letting was used for any reason in the treatment of various ailments, or for no reason at all.

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16
Q

Historically, what methods were used to bleed a patient?

A

Venesection
Cupping
Leeching

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17
Q

Venesection

A

a lancet was used to pierce the vein. It was thought that “bad” blood could be eliminated in this manner and remove disease from the patient. Venesection was also used in the treatment of fever.

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18
Q

Cupping

A

a heated glass cup was placed on the skin and created suction as it cooled drawing blood to capillaries under the cup. A device containing multiple blades then cut this area of skin to produce bleeding. Both venesection and cupping resulted in significant scarring.

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19
Q

Leeching

A

leeches were used to remove blood from the patient. Leeches are still used in limited applications to this day.

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20
Q

synopsis of some important aspects of anatomy pertinent to venipuncture (LO for mod 2)

A

a superficial review of blood and circulation
some important distinctions between arteries and veins
the introduction of an important concept for pharmacokinetics called compartments and compartmental exchange
blood vessels for venipuncture

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21
Q

What does a thorough knowledge of venipuncture procedures and the skill to perform them entail?

A

a review of applicable anatomy and aseptic technique
an introduction to venipuncture equipment
a description of the venipuncture process
a discussion of blood sampling
a description of complications of the venipuncture procedure.

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22
Q

Review the role of venipuncture in modern health care.

A

While witch doctors, barbers, and, later, physicians performed phlebotomies in the past, many venipuncture procedures are now performed by a variety of allied health professions. A competent standard of practice must be maintained and a professional and ethical manner must be adhered to just as in other health care disciplines.

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23
Q

Review the role of phlebotomy in the history of medicine

A

Method of Circulation
Blood Letting
Remedies for All Ailments
Methods were used to bleed a patient

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24
Q

Blood

A

Blood consists of a liquid portion - plasma - which accounts for 55 to 60% of its composition, and formed or cellular elements, which represents the other 40 to 45% of blood. In the cellular fraction of blood are red blood cells (erythrocytes), white blood cells (leukocytes), and platelets.

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25
the circulatory system is comprised of which three components
the heart, blood, and blood vessels.
26
Describe a blood sample centrifuged to separate the fluid and cellular components.
The straw-coloured fluid is plasma (the clotting factors were not removed). A faint ring of white is evident between the plasma and red cells; this so-called "buffy coat" contains the white blood cells. The red cells have been packed at the bottom of the tube by centrifugal force.
27
Plasma
When the formed elements are removed from blood, the remaining fluid is called plasma. Plasma is approximately 90% water by weight and contains a myriad of proteins, electrolytes, nutrients, waste products, hormones and blood clotting factors.
28
Serum
If the clotting factors are removed from plasma, the fluid portion remaining is called serum.
29
Formed Elements
The cellular components of blood are produced by hematopoiesis. Erthyropoiesis, the production of red blood cells, occurs in red bone marrow. Erythrocytes have a biconcave shape to maximize cell surface area and contain hemoglobin, the oxygen-carrying component of the red blood cell. The size of a red blood cell (approximately 8 um) requires that a larger needle be used in venipuncture to prevent damaging the cells on withdrawal or injection.
30
Leukocytes
the largest of blood cells, contribute to the body's inflammatory response or immune response.
31
Platelets
function to release substances essential for the clotting of blood.
32
Describe how blood vessels form a _____ circuit (e.g., the pulmonary circulation, cardiac coronary circulation) - each circuit is composed of arteries that transport oxygenated blood from the heart, arterioles that branch from from arteries, capillaries that branch from arterioles, venules that receive deoxygenated blood from the capillaries that, in turn, collect into veins that return the blood to the heart.
Blood vessels form a CLOSED circuit. Each circuit is composed of arteries that transport oxygenated blood from the heart, arterioles that branch from from arteries, capillaries that branch from arterioles, venules that receive deoxygenated blood from the capillaries that, in turn, collect into veins that return the blood to the heart.
33
Arterioles are similar to ______, and venules are similar to _______
Arterioles are similar to arteries | venules are similar to veins.
34
Describe the order of blood vessels coming from the heart and back.
heart >> arteries >> arterioles >> capillaries >> venules >> veins >> heart
35
venules
receive deoxygenated blood from the capillaries
36
Why is the artery's smooth muscle wall is thicker and stronger than the vein's?
The thicker middle layer, the tunica media, consists of elastic tissue and smooth muscle, and it is constantly contracting and relaxing
37
arteries
a thick-walled vessel to withstand the pressure of the pumping action of the heart
38
Artery and Arterioles have ____ human and ____ elastic walls
NARROW lumen and THICK elastic walls
39
In an artery, what does smooth muscle contraction and relaxation cause?
Smooth muscle contraction causes vasoconstriction decreasing the lumen diameter Smooth muscle relaxation causes vasodilation increasing the lumen diameter.
40
How is blood flow to different tissues is regulated?
by the degree of vasoconstriction or dilation, vasoconstriction decreases the lumen diameter vasodilation increases the lumen diameter
41
Layers of the artery
The inner tunica interna The thicker middle layer, the tunica media, consists of elastic tissue and smooth muscle. The outer tunica externa or adventitia is predominantly connective tissue with some smooth muscle.
42
Tunica interna (inner)
a simple layer of endothelium
43
Tunica media (mid)
this thicker middle layer consists of elastic tissue and smooth muscle
44
Tunica externa or adventitia (outter)
predominantly connective tissue with some smooth muscle
45
How do the three main layers of a blood vessel differ between veins and arteries?
In a vein, there are lesser amounts of elastic tissue and smooth muscle and more connective tissue in a vein because the pressure in a vein is significantly less than that of an artery.
46
veins and venules have ____ lumen and ____ elastic walls
WIDER lumen and THINNGER walls.
47
What part of the vein wall helps to seal a puncture site.?
the layered structure of the vein wall
48
The pressure in a vein is significantly less than that of an artery. Since it is not sufficient to return blood to the heart against gravity, how does movement of blood through veins get back to the heart?
Movement of blood through veins depends on skeletal muscle contraction to help compress the vein to move the blood and valves to prevent the back flow of blood in the vein.
49
Venous Valve
prevent the back flow of blood in the vein, permitting only one direction for blood flow. i.e venous valve
50
Artery versus Vein
Artery: thick elastic walls that pulsate with blood surges; narrow lumen no valves pulse can be felt Vein: thin walls, less elastic and wider lumen valves pulse can not be felt
51
Arteries and veins have a multi-layered structure. How is the layering of tissue is important in the artery and vein?
it helps give them strength and helps to prevent them from rupturing or splitting when punctured with a needle.
52
describe the concept of body and fluid compartments
Exchange occurs between intracellular fluids and interstitial fluid, and between interstitial fluid and plasma. Interstitial fluid and plasma are referred to as extracellular fluids. It is essential for normal body function to have exchange between compartments.
53
Artery versus Vein
Artery: thick elastic walls that pulsate with blood surges; narrow lumen no valves pulse can be felt Vein: thin walls, less elastic and wider lumen valves pulse can not be felt
54
what are the extracellular fluids?
Interstitial fluid and plasma
55
Why are compartments and compartmental exchange of substances within the body important to the venipuncturist?
Compartments and compartmental exchange of substances within the body are important to the venipuncturist because it is a blood sample which is used to measure certain body functions. Unless the concentrations of substances measured in the blood sample are representative of the compartment being studied, the information gathered is not clinically useful.
56
If a patient is receiving a therapeutic drug, it is essential that the concentration of the drug in the blood be representative of what?
the concentration of the drug in the blood should be representative of the concentration of the drug in the tissues it has its desired effect upon. This can only be the case if a suitable equilibration time is allowed to ensure that exchange between the involved compartments has occurred.
57
If a patient is receiving a therapeutic drug, it is essential that the concentration of the drug in the blood be representative of what?
the concentration of the drug in the blood should be representative of the concentration of the drug in the tissues it has its desired effect upon. This can only be the case if a suitable equilibration time is allowed to ensure that exchange between the involved compartments has occurred.
58
What is a compartmental model?
A compartmental model is a mathematical description of a compartment and the compartments it is capable of exchange with.
59
Exchange from one compartment to another may be by ______ _______ or by ________ __________.
passive diffusion or by active mechanisms
60
Exchange may be ______ (moving only from compartment A to compartment B) or ______ (moving from compartment A to compartment B and vice versa).
unidirectional (moving only from compartment A to compartment B) or bidirectional (moving from compartment A to compartment B and vice versa).
61
Common sites for venipuncture
The cephalic, median cubital, and basilic veins of the antecubital fossa are common sites for routine venipuncture.
62
For routine venipuncture, what is most often selected?
For routine venipuncture, the veins of the arm are most often selected.
63
The the hollow or depression anterior to the elbow where most venipunctures are performed is referred to as the _______ ______
antecubital fossa
64
how can the superficial veins of the antecubital fossa area be easily isolated and accessed?
With the arm extended and with muscles of the arm firmed by clenching the hand into a fist, the superficial veins of the antecubital fossa can be easily isolated and accessed.
65
What veins are used if the the veins of the antecubital fossa are difficult to access?
veins of the forearm or hand may be used
66
Veins of the forearm or hand are also used for establishing what?
Veins of the forearm or hand are also used for establishing an in-dwelling intravenous (IV) line
67
If the IV line is established in the antecubital fossa, how must the arm be positions?
the arm must be restrained in the extended position to prevent arm flexion.
68
Palpate a Vein
Compress the bicep muscle area of your right arm by squeezing it tightly with your left hand. Use your thumb to compress the medial aspect of your arm. Clench your right fist. Let your right arm hang down by your side for a moment. Bring your arm up and place it palm up on your desk top with fist still clenched. Try and identify the cephalic and median cubital veins. They should be blue and prominent. Feel the veins with the pad of the index finger of your left hand held perpendicular to the vein. They should feel rubbery and rebound to the touch.
69
Nosocomial infection
Infection developed as a result from a hospital stay
70
Autogenous infection
Infection developed from their own microbial flora
71
Microorganisms
Infectious organisms not seen by the naked eye | Bacteria, viruses, fungi, Protozoa
72
Pathogens or pathogenic organisms
Organisms capable of causing disease
73
chain of infection
describes the transmission of microorganisms
74
what does the spread of infection require?
source of pathogens portal of exit from the source means of transmission to a new host portal o entry into the susceptible host
75
aseptic technique
process that employs added precautions to prevent contamination of a person, object, or area by microorganisms
76
how can pathogens be removed or destroyed?
by cleanliness, disinfection/medical asepsis, and/or sterilization/surgical asepsis
77
what precautions need to be taken for the safe handling of blood and blood products?
body substance or blood and bodily fluid precautions
78
cleanliness
proper hand washing and cleaning may reduce transmission of organisms
79
disinfection/medical asepsis
chemical means (eg alcohol), are used to remove pathogens
80
sterilization/surgical asepsis
materials are subject too hear, gas, or chemicals to render them free of organisms
81
is venipuncture a clean or sterile technique, and what does that mean?
venipuncture is a clean technique, such that proper cleanliness and disinfection are employed. it is not a sterile technique
82
what are body substance or blood and bodily fluid precautions
infection control practices employed to ensure that neither the venipuncturist neither receives nor transmits abc infectious disease
83
universal blood and body fluid precautions
treat all patients as potentially infectious and handle their body substances accordingly, synonymous with body substance or blood and bodily fluid precautions
84
Universal Precautions (7)
1. Wear gloves when handling body substances 2. protect clothing with plastic apron if it risks being soiled 3. thoroughly wash hands often and well 4. discard uncapped needles/syringe into sharps containers and do not recap used needles 5. if a bodily substance gets on skin, wash 6. for spills or contamination of blood/blood products, use gloves to clean the area with a 1:10 dilution of bleach 7. place any material contaminated with blood blood products into biohazard garbage for disposal
85
describe precautions for handling and the disposal of biohazard waste
any body substance that is potentially infectious must be disposed of with biohazard containers that have the biohazard warning label displayed. Also, wear gloves and a plastic apron
86
how to dispose of needles and sharps
all needles and sharps must be placed in puncture-resistant, leak-proof plastic containers labeled and color coded (often red) as biohazard
87
how to dispose of non-sharp biohazardous materials
these can be stored in other types strong, leak-proof plastic containers labeled and color coded (often red) as biohazard

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