PMLS 2: UNDERSTANDING PHLEBOTOMY

Question 1

What is Phlebotomy?

Answer 1

Two Greek words:
“Phlebos” = veins
“Temnein” = to cut.

It is the act of opening a vein by using incision or puncture methods to draw blood for analysis or as part of therapeutic or diagnostic measures under the physician’s request.

Question 2

Explain the brief history/evolution of Phlebotomy.

Answer 2

The practice of phlebotomy can be traced back to the time of the Stone Age when men used crude tools to cut vessels and drain blood from the body.

The Ancient Egyptians also practiced bloodletting as early as 1400 BC.

Question 3

Phlebotomy became widely accepted during the time of?

Answer 3

Hippocrates

when health was believed to be dependent on the balance of the humors.

Question 4

What are the humors and their symbolism?

Answer 4

Earth - blood and brain

Air - phlegm and lungs

Fire - black bile and spleen

Water - yellow bile and gallbladder

Question 5

To keep the balance?

Answer 5

excess humor is removed by bloodletting

Question 6

Lab testing of blood specimens is what?

Answer 6

vital to the correct diagnosis, treatment and monitoring of a patient’s condition.

Question 7

Lab results constitutes?

Answer 7

70% of the objective information used by health-care providers to manage patient care and resolve patient health problems.

Question 8

The quality of a test result is?

Answer 8

only as good as the quality of the specimen analyzed.

Question 9

Reports from suboptimal specimen can result in treatment that can be?

Answer 9

potentially harmful to the patient by overmedicating or under-medicating the patient with death being the worse patient outcome.

Question 10

Although the primary concern or personnel collecting blood specimens is
understandably to obtain the specimen, failure to adhere to the collection procedure can?

Answer 10

compromise the integrity of a successfully collected specimen.

Question 11

Approximately 56% of
laboratory error occurs during the?

Answer 11

preanalytical phase (process that occurs before testing of the sample) of laboratory testing.

Question 12

What are the influencing factors that are responsibilities of the blood collector?

Answer 12

● Monitoring of specimen ordering
● Correct patient identification
● Patient communication and safety
● Patient preparation
● Timing of collections
● Phlebotomy equipment
● Collection techniques
● Specimen labeling
● Specimen transportation to the laboratory
● Specimen processing

Question 13

1st step in phlebotomy: comprehensive procedure

Answer 13

1. Obtain and accession the test request.

Question 14

What is under “Obtain and accession the test request.”?

Answer 14

Requisitions are the forms on which test orders are entered and sent to
the lab.
i. Hand-written requisitions
ii. Computer-printed requisitions
iii. Barcode labels

Question 15

2nd step in phlebotomy: comprehensive procedure.

Answer 15

2. Identify the patient.

Question 16

What is under “Identify the patient.” ?

Answer 16

a. The most important step in specimen collection.
b. Ask the patient to state name and date of birth.
c. Check the patient’s identification bracelet (if admitted).
i. Name
ii. Identification number
a. Medical record number
b. Visit number

Question 17

3rd step in phlebotomy: comprehensive procedure.

Answer 17

3. Verify diet restrictions

Question 18

What is under “Verify diet restrictions.”?

Answer 18

a. Fasting

Question 19

4th step in phlebotomy

Answer 19

4. Prepare the patient for testing

Question 20

What is under “Prepare the patient for testing”?

Answer 20

a. Bedside manner
b. Explain the procedure
c. Obtain consent

Question 21

5th step in phlebotomy

Answer 21

5. Assemble equipment and supplies

Question 22

6th step in phlebotomy

Answer 22

6. Wash hands and put on gloves

Question 23

7th step in phlebotomy

Answer 23

7. Reassure patient

Question 24

8th step in phlebotomy

Answer 24

8. Position patient

Question 25

What is under "Position patient."

Answer 25

a. Seated patients i. Patients arm should be supported firmly ii. Arm should not be bent at the elbow b. Supine patients i. Arm extended ii. Not bent at elbow

Question 26

9th step in phlebotomy

Answer 26

Apply tourniquet

Question 27

10th step in phlebotomy

Answer 27

10. Ask the patient to ae a fist

Question 28

What is under "Ask the patient to ae a fist."?

Answer 28

a. Veins become more prominent b. Do not allow patient to pump (open and close) fist as this causes hemoconcentration and leads to erroneous results.

Question 29

11th step in phlebotomy.

Answer 29

11. Select the venipuncture site

Question 30

What is under "Select the venipuncture site."?

Answer 30

a. Dominant arm will generally have the most prominent veins b. Veins have a bounce or resilience c. Do not select vein that feels hard and cord-like or lacks resilience i. Tendons are hard and lack resilience d. Do not draw from above an IV i. If necessary, have IV turned off for a minimum of 2 minutes prior to collecting ii. Remember to turn it back on, or inform the Nurse staff that the phlebotomy procedure is done e. Avoid burned, scarred or tattooed area f. Edematous areas should be avoided g. Avoid drawing in the area of a hematoma i. Draw from below site id no alternative h. Mastectomy patients i. Draw from the side opposite of mastectomy whenever possible ii. Application of tourniquet may cause injury on mastectomy side iii. If patient has double mastectomy, physician should be consulted – usually avoid the side of the most recent mastectomy i. Check antecubital region on both arms to find a suitable vein j. Check hand or wrist veins k. Use leg, ankle, or foot veins except as a last resort and after obtaining permission from patient’s physician i. Blood flow to the extremities may not be representative of general circulation producing erroneous results ii. Lower extremity venipuncture may cause blood clot formation

Question 31

12th step in phlebotomy

Answer 31

12. Release the tourniquet.

Question 32

13th step in phlebotomy

Answer 32

13. Clean the site

Question 33

What is under "Clean the site."?

Answer 33

a. Clean with antiseptic – 70% isopropyl alcohol b. Clean using circular, outward motion c. Do not contaminate the site by drying the alcohol with unsterile gauze d. Do not introduce airborne contaminants by fanning or blowing on t e. Do not touch the site after cleaning

Question 34

14th step in phlebotomy

Answer 34

14. Verify equipment and tube selection

Question 35

What is under "Verify equipment and tube selection."?

Answer 35

a. Remove syringe from package b. Advance the plunger to the end of the syringe c. Securely attach the needle to the system

Question 36

15th step in phlebotomy.

Answer 36

15. Reapply the tourniquet

Question 37

What is under "Reapply the tourniquet."?

Answer 37

a. Do not touch the cleansed area

Question 38

16th step in phlebotomy

Answer 38

16. Pick up and position blood collection equipment

Question 39

What is 17th step in phlebotomy

Answer 39

17. Remove the cover and inspect the needle

Question 40

What is under "Remove the cover and inspect the needle."?

Answer 40

a. Visually inspect the needle tip for obstructions, imperfections, or barbs

Question 41

18th step in phlebotomy

Answer 41

Anchor the vein

Question 42

What is under "Anchor the vein."?

Answer 42

a. Place your thumb 1-2 inches below the intended venipuncture site b. Pull the skin toward the wrist c. Use the fingers of your anchoring hand to support the back of the arm

Question 43

19th step in phlebotomy

Answer 43

19. Have the patient make a fist

Question 44

20th step in phlebotomy

Answer 44

20. Insert the needle into the vein

Question 45

What is under "Insert the needle into the vein."?

Answer 45

a. Line up the needle in the direction of the vein – bevel up b. Warn the patient c. Insert the needle into the skin at 15-30° angle d. A “flash” or small amount of blood will appear in the hub of the needle when the needle is in the vein

Question 46

What is the 21st step in phlebotomy

Answer 46

21. Fill the syringe barrel

Question 47

What is under "Fill the syringe barrel."?

Answer 47

a. Slowly pull back on the plunger of the syringe and allow the barrel of the syringe to fill with blood

Question 48

22nd step in phlebotomy

Answer 48

22. Withdraw the needle

Question 49

23rd step in phlebotomy

Answer 49

23. Engage safety device

Question 50

24th step in phlebotomy

Answer 50

24. Dispose of sharps

Question 51

25th step in phlebotomy

Answer 51

25. Transfer blood to evacuated tubes

Question 52

What is under "Transfer blood to evacuated tubes."?

Answer 52

a. Syringe transfer device i. Attach the transfer device to the syringe ii. Hold the syringe vertically, with the tip down and transfer device at the bottom iii. Following the proper order of draw for syringes, push the evacuated tube onto the needle within the transfer device iv. Keep the tube vertical so it fills from the bottom upward – let the tube fill using the vacuum draw v. If you do not want to fill the tube completely, pull back on the plunger to stop the flow before removing the tube vi. Dispose of the transfer device into a sharps container b. Transferring without a transfer device i. If a transfer device is not available, place the required tubes in the proper order of draw in a rack or a slot in the phlebotomy tray ii. Never hold the tubes in your hand iii. Penetrate the stopper of the tube with the syringe needle and allow the vacuum draw of the tube to fill the tube iv. Slant the needle to the side of the tube so the blood runs down the side of the tube to prevent hemolysis v. When the last tube is filled, withdraw the needle, activate the safety device and dispose of the needle into the sharps container

Question 53

26th step in phlebotomy

Answer 53

Label the tubes

Question 54

What is under "Label the tubes."?

Answer 54

a. Name of Patient b. Age and Gender of Patient c. Date of collection d. Time of collection e. Phlebotomist’s initials

Question 55

27th step in phlebotomy

Answer 55

27. Observe special handling instructions

Question 56

What is under "Observe special handling instructions."?

Answer 56

a. Putting on crushed ice (i.e.: ammonia, BNP, lactic acid, blood gasses) b. Keeping it warm (i.e. cold agglutinin, cryoglobulin) c. Protecting from light (i.e. bilirubin)

Question 57

28th step in phlebotomy

Answer 57

28. Check the patient’s arm and apply bandage

Question 58

29th step in phlebotomy

Answer 58

29. Dispose of contaminated materials

Question 59

30th step in phlebotomy

Answer 59

30. Thank the patient

Question 60

31st step in phlebotomy

Answer 60

31. Remove gloves and wash hands

Question 61

32nd step in phlebotomy

Answer 61

32. Check specimen collection logs (if applicable)

Question 62

33rd step in phlebotomy

Answer 62

33. Transport the specimen to the lab

Question 63

What is under "Transport the specimen to the lab."?

Answer 63

a. Transport specimens in a timely manner b. Enters specimens into the computer system or logbook to verify collection and receipt into the laboratory

Question 64

If you are unable to obtain a specimen, what should you do?

Answer 64

1. Evaluate the problem 2. Try again below the first site, on the opposite arm, or hand or write vein 3. Do not try on the 3rd time 7