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BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE > PMLS 2: UNDERSTANDING PHLEBOTOMY > Flashcards

PMLS 2: UNDERSTANDING PHLEBOTOMY Flashcards

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USMLE® Step 1 flashcards Biology 101 flashcards
1
Q

What is Phlebotomy?

A

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.

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2
Q

Explain the brief history/evolution of Phlebotomy.

A

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.

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3
Q

Phlebotomy became widely accepted during the time of?

A

Hippocrates

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

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4
Q

What are the humors and their symbolism?

A

Earth - blood and brain

Air - phlegm and lungs

Fire - black bile and spleen

Water - yellow bile and gallbladder

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5
Q

To keep the balance?

A

excess humor is removed by bloodletting

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6
Q

Lab testing of blood specimens is what?

A

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

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7
Q

Lab results constitutes?

A

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

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8
Q

The quality of a test result is?

A

only as good as the quality of the specimen analyzed.

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9
Q

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

A

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

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10
Q

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

A

compromise the integrity of a successfully collected specimen.

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11
Q

Approximately 56% of
laboratory error occurs during the?

A

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

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12
Q

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

A

● 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

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13
Q

1st step in phlebotomy: comprehensive procedure

A
  1. Obtain and accession the test request.
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14
Q

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

A

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

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15
Q

2nd step in phlebotomy: comprehensive procedure.

A
  1. Identify the patient.
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16
Q

What is under “Identify the patient.” ?

A

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

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17
Q

3rd step in phlebotomy: comprehensive procedure.

A
  1. Verify diet restrictions
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18
Q

What is under “Verify diet restrictions.”?

A

a. Fasting

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19
Q

4th step in phlebotomy

A
  1. Prepare the patient for testing
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20
Q

What is under “Prepare the patient for testing”?

A

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

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21
Q

5th step in phlebotomy

A
  1. Assemble equipment and supplies
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22
Q

6th step in phlebotomy

A
  1. Wash hands and put on gloves
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23
Q

7th step in phlebotomy

A
  1. Reassure patient
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24
Q

8th step in phlebotomy

A
  1. Position patient
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25
Q

What is under “Position patient.”

A

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

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26
Q

9th step in phlebotomy

A

Apply tourniquet

27
Q

10th step in phlebotomy

A
  1. Ask the patient to ae a fist
28
Q

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

A

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.

29
Q

11th step in phlebotomy.

A
  1. Select the venipuncture site
30
Q

What is under “Select the venipuncture site.”?

A

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

31
Q

12th step in phlebotomy

A
  1. Release the tourniquet.
32
Q

13th step in phlebotomy

A
  1. Clean the site
33
Q

What is under “Clean the site.”?

A

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

34
Q

14th step in phlebotomy

A
  1. Verify equipment and tube selection
35
Q

What is under “Verify equipment and tube selection.”?

A

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

36
Q

15th step in phlebotomy.

A
  1. Reapply the tourniquet
37
Q

What is under “Reapply the tourniquet.”?

A

a. Do not touch the cleansed area

38
Q

16th step in phlebotomy

A
  1. Pick up and position blood collection equipment
39
Q

What is 17th step in phlebotomy

A
  1. Remove the cover and inspect the needle
40
Q

What is under “Remove the cover and inspect the needle.”?

A

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

41
Q

18th step in phlebotomy

A

Anchor the vein

42
Q

What is under “Anchor the vein.”?

A

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

43
Q

19th step in phlebotomy

A
  1. Have the patient make a fist
44
Q

20th step in phlebotomy

A
  1. Insert the needle into the vein
45
Q

What is under “Insert the needle into the vein.”?

A

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

46
Q

What is the 21st step in phlebotomy

A
  1. Fill the syringe barrel
47
Q

What is under “Fill the syringe barrel.”?

A

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

48
Q

22nd step in phlebotomy

A
  1. Withdraw the needle
49
Q

23rd step in phlebotomy

A
  1. Engage safety device
50
Q

24th step in phlebotomy

A
  1. Dispose of sharps
51
Q

25th step in phlebotomy

A
  1. Transfer blood to evacuated tubes
52
Q

What is under “Transfer blood to evacuated tubes.”?

A

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

53
Q

26th step in phlebotomy

A

Label the tubes

54
Q

What is under “Label the tubes.”?

A

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

55
Q

27th step in phlebotomy

A
  1. Observe special handling instructions
56
Q

What is under “Observe special handling instructions.”?

A

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)

57
Q

28th step in phlebotomy

A
  1. Check the patient’s arm and apply bandage
58
Q

29th step in phlebotomy

A
  1. Dispose of contaminated materials
59
Q

30th step in phlebotomy

A
  1. Thank the patient
60
Q

31st step in phlebotomy

A
  1. Remove gloves and wash hands
61
Q

32nd step in phlebotomy

A
  1. Check specimen collection logs (if applicable)
62
Q

33rd step in phlebotomy

A
  1. Transport the specimen to the lab
63
Q

What is under “Transport the specimen to the lab.”?

A

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

64
Q

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

A
  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

BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE (15 decks)

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