Pre-analytical considerations in oh,ebotomy Flashcards
1
Q
ncludes procedures such as laboratory handling and identification, which take
place before any laboratory testing
A
PRE-ANALYTICAL TESTING PHASE
2
Q
Strict and proper control measures should be observed to avoid further issues
A
PRE-ANALYTICAL TESTING PHASE
3
Q
◦ It starts when the doctor’s order is given and ends when the laboratory testing has
officially commenced
A
PRE-ANALYTICAL TESTING PHASE
4
Q
RBC, WBC, Creatine Clearance
A
Age
5
Q
RBC
A
Altitude
6
Q
Hemoconcentration, RBC, Enzymes, Iron, Ca,
Na
A
Dehydration
7
Q
Glucose, Lipids, Electrolytes
A
Diet
8
Q
TSH, Cortisol, Iron
A
Diurnal Variation
9
Q
Enzymes, Hormones
A
Drug Therapy
10
Q
pH, Pco2, CK, LDH, Glucose
A
Exercise/ IM Injection
11
Q
Hormones, Cortisol
A
Fever
12
Q
RBC, Hgb, Hct
A
Gender
13
Q
Yellow color interfaces due to increased
bilirubin
A
Jaundice
14
Q
CK, LDH
A
Intramuscular injection
15
Q
Protein, K
A
Position
16
Q
RBC
A
Pregnancy
17
Q
Cholesterol, Cortisol, Glucose, GH, TAG, WBC
A
Smoking
18
Q
WBC, Iron, ACTH, Catecholamine, Cortisol
A
Stress
19
Q
Hemoconcentration
A
Temperature & Humidity
20
Q
Problem Areas to Avoid
A
Burns, scars and tattoos
Damaged veins
Edema/ Oedema-
Hematoma
Mastectomy
Obesity
21
Q
could be sclerosed, hardened,
thrombosed or clotted
A
Damaged veins
22
Q
accumulation of fluids in the tissues
A
Edema/ Oedema
23
Q
Leakage of blood from the vessels during
venipuncture
A
Hematoma
24
Q
tourniquet could not be applied in this
arm because it can cause injury.
A
Mastectomy
25
deep and difficult to locate; use a longer tourniquet,
palpate the cephalic or cubital vein
Obesity
26
are needed for blood sampling, infusing medication, central venous pressure readings, and blood transfusion of a patient.
ventricular assist device / VADs
27
VASCULAR ACCESS SITES AND DEVICE
1. Arterial Line
2. Arteriovenous shunt or Fistula
3. Blood-sampling Device
4. Heparin or Saline Lock/ “hep-lock”
5. IV Sites
6. Central Vascular Access Devices (CVADs)/ Indwelling lines
28
for medicine administration
or blood sampling
Heparin or Saline Lock/ “hep-lock”
29
phlebos should collect below IV lines
IV Sites
30
it could be a central venous catheter lines, implanted port,
peripherally inserted central catheter
Central Vascular Access Devices (CVADs)/ Indwelling lines
31
discontinue asap; check mouth for any obstruction,
and patient is protected from any self-injury. Notify first aid personnel
Seizures or convulsions-
32
Small red or purple spot that looks like rashes when tourniquet is
applied
Petechiae
33
if pt complains extreme numbness or pain, remove needle and apply ice to site because this may indicate nerve involvement.
pain
34
discontinue procedure until patient feels better
Nausea and Vomiting
35
lie down during procedure
Fainting
36
pressure should be applied until bleeding stops
Excessive Bleeding
37
apply gauze for 15 mins
Adhesive allergy
38
use a different antiseptic technique
Antiseptic allergy
39
use nonlatex gloves, tourniquet, bandages
Latex allergy
40
Allergies to Equipment and Supplies
Adhesive allergy
Antiseptic allergy
Latex allergy
41
The following are conditions that trigger hematoma:
There is excessive or blind probing
There is inadvertent arterial puncture
The size of the vein is too small
The needle penetration has gone all through the vein
Needle is not completely inserted
Tourniquet is still on when the needle was removed
The pressure is not adequate
42
Hold pressure over the site immediately after discontinuing the draw
◦ Cold compress or ice pack may be offered to help address the swelling
HEMATOMA FORMATION
43
blood loss due to blood draw. Phlebo should ensure
that only the required volume should be extracted from the patient
because a 10% loss of blood could face a threat to the patient
Iatrogenic Anemia
44
observed when the filling of the tube
happens rapidly and there is a rapid formation of hematoma on the site
Inadvertent Arterial Puncture
45
sterile conditions, veni site should be kept closed for 15 mins
Infection
46
improper site selection, rapid needle insertion, excessive
redirection of the needle, and blind probing; phlebo should swim slowly or stop veni and look for alternative sites
Nerve Injury
47
improper site selection, rapid needle insertion, excessive
redirection of the needle, and blind probing; phlebo should swim slowly or stop veni and look for alternative sites
Nerve Injury-
48
downward position should be observed and
tube should be below the veni site
Reflux of Anticoagulant
49
follow proper techniques and avoid blind probing
Vein Damage
50
decrease in fluid content or plasma volume caused
by tourniquet that stagnate the flow of blood
Hemoconcentration
51
rupture of the rbcs, the hgb is then released to the
surrounding fluid
Hemolysis
52
phlebo pulls a tube before reaching
the required volume; this leads to incorrect blood-to-additive ratio.
Partially-filled tube or short draw
53
Specimen Quality
Hemoconcentration
Hemolysis
Partially-filled tube or short draw
Specimen contamination
Wrong or Expired Collection tube
54
is critical to the success of the venipuncture
needle position
55
The phlebotomist should ensure that the following do not happen:
Needle not inserted far enough
Bevel partially out of skin
Bevel partially into vein
Bevel partially through vein
Bevel completely through vein
Bevel against vein wall
Needle beside vein
Undetermined position
56
The
phlebotomist should ensure that the following do not happen:
Needle not inserted far enough
Bevel partially out of skin
Bevel partially into vein
Bevel partially through vein
Bevel completely through vein
Bevel against vein wall
Needle beside vein
Undetermined position
57
this happens when there is a
strong pressure in the vacuum of the tube or
plunger; the tourniquet is too close to the site or
is too tight; or the tourniquet has been
removed during the draw
Collapsed Veins
58
phlebotomist should make sure
that the bevel is not partially out of skin and the
tube itself is not damaged.
Tube vacuum
59
phase of the testing process begins for the laboratory when a test is ordered and ends when testing begins
preexamination or preanalytical (before analysis)
60
is a term used for the substance (e.g., glucose)
undergoing analysis.
Analyte
61
a process used to identify the presence or absence or measure the concentration of a substance in blood or other body fluids or material.
Laboratory examination (analysis)
62
a condition in which blood components that cannot easily leave the bloodstream become concentrated in the smaller plasma volume
hemoconcentration
63
is a yellow bile pigment that is the product of the destruction of RBCs and the breakdown of the hemoglobin they contain.
Bilirubin
64
Veins may be difficult to palpate or penetrate in
burned and scarred areas
65
may have an undetected infection or be more susceptible to infection
Freshly tattooed areas
66
Some patients’ veins feel hard and cord-like and lack resiliency because they are partially or completely
occluded (obstructed)
67
hardened vein
sclerosed
68
clotted veins
thrombosed
69
is swelling caused by the abnormal accumulation of fluid in the tissues. It sometimes results when fluid from an IV infiltrates the surrounding tissues.
Edema
70
Specimens collected from _____ may yield inaccurate test results owing to contamination with tissue fluid or altered blood composition caused by the swelling.
edematous areas
71
a swelling or mass of blood (often clotted) that can be caused by blood leaking from a blood vessel during or following venipuncture.
hematoma
72
eventually spreads over the surrounding area.
large bruise
73
To ensure the collection of noncontaminated blood,
never perform venipuncture through a hematoma. If there is no alternative site, perform the venipuncture ______ hematoma to ensure the collection of free-flowing blood.
distal to (below)
74
To ensure the collection of noncontaminated blood,
never perform venipuncture through a hematoma. If there is no alternative site, perform the venipuncture ______ the hematoma to ensure the collection of free-flowing blood.
distal to (below)
75
Veins of ______ may be deep and difficult to find. Proper tourniquet selection and application is the first step to a successful venipuncture.
obese patients
76
is the loss of muscle function
Paralysis
77
When the lower part of the body and both legs are
paralyzed, it is called
paraplegia
78
If both the arms and legs are paralyzed, it is called
quadriplegia
79
are tubing and other devices that are specifically designed to allow entry to veins or arteries.
Vascular access devices (VADs)
80
They are often used for patients who require frequent venous or arterial access. They are most commonly used for administration of medications, fluids, blood products, and sometimes blood collection.
Vascular access devices (VADs)
81
means “of, pertaining to, or within a vein.
Intravenous (IV)
82
a quick way to deliver fluids, medications, blood transfusion products, and other substances to patients. It consists of a catheter inserted in a peripheral vein.
An intravenous line, referred to simply as an IV,
83
is a needleless connection device in the form of a stopcock (Fig. 9-5) or a cap that is connected to the hub of a catheter or cannula by a short length of IV tubing.
IV Catheter Lock
84
A device filled with saline is called a
saline lock.
85
One filled with heparin is called a
heparin lock (heplock)
86
One filled with heparin is called a
heparin lock (heplock)
87
present a potential source of error in testing. Never collect blood specimens from known previous IV sites within 24 to 48 hours of the time the IV was discontinued. Follow facility protocol.
Previously Active IV Sites
88
is a catheter that is placed in an artery.
arterial line (A-line or art-line)
89
arterial line (A-line or art-line) is a catheter that is placed in an artery. It is most commonly located in the
radial artery of the wrist
90
typically used to provide accurate and continuous measurement of a patient’s blood pressure. It may also be used to collect blood gas and other blood specimens and for the administration of drugs such as dopamine.
arterial line (A-line or art-line)
91
is the permanent surgical connection of an artery and vein.
arteriovenous (AV) shunt
92
means to move or force.
Shunt
93
A dialysis shunt created by direct permanent fusion of the artery and vein is called an
AV fistula
94
has become the most common type of shunt used for dialysis.
fistula
95
If the shunt was created using a piece of vein or tubing to form a loop from the artery to the vein that can be seen under the skin it is called an
AV graft
96
is a dialysis patient’s lifeline
shunt
97
is sometimes connected to an arterial or central venous catheter (CVC) (see “Vascular Access Devices”) for the specific purpose of collecting blood specimens.
needleless closed blood sampling device
98
These devices are said to reduce the chance of infection, prevent needlesticks, and minimize waste associated with line draws.
Blood Sampling Device
99
also called an indwelling line, consists of tubing inserted into a main vein or artery
central vascular access device (CVAD
100
used primarily for administering fluids and medications, monitoring pressures, and drawing blood.
central vascular access device (CVAD)
101
a line inserted into a large vein such as the subclavian and advanced into the superior vena cava, proximal to the right atrium.
CVC or central venous line
102
Occasionally phlebotomists will encounter patients who are allergic to one or more of the supplies or equipment used in blood collection.
Allergies to Equipment and Supplies
103
Occasionally, a patient is allergic to the antiseptic used in skin preparation prior to blood collection. (For example, many individuals are allergic to povidone–iodine.) Alternate antiseptics should be readily available for use in such cases.
Antiseptic Allergy
104
Some patients are allergic to the glue used in adhesive bandages. One solution is to place a clean, folded gauze square over the site and wrap it with self-adherent bandaging material
Adhesive Allergy
105
involves a reaction to certain substances in natural rubber latex. Increasing numbers of individuals are allergic to latex. Some latex allergies are seemingly minor and involve irritation or
Latex Allergy
106
a patient will stop bleeding from the venipuncture site within a few minutes. Some patients, particularly those on aspirin or anticoagulant therapy, may take longer to stop bleeding. Always maintain pressure over the site until the bleeding stops. If the bleeding continues after five minutes, notify the appropriate personnel.
Excessive Bleeding
107
The medical term for fainting is
syncope
108
described as a loss of consciousness and postural tone (ability to maintain an upright posture) resulting from insufficient blood flow to the brain. It can last for as little as a few seconds or as long as half an hour.
fainting is syncope
109
It is not unusual to have a patient experience nausea before, during, or after a blood draw. The patient may state that he or she is feeling nauseous or show signs that are similar to fainting, such as becoming pale or having beads of sweat appear on the forehead. Do not attempt a blood draw until the experience subsides. Discontinue a blood draw that is in progress.
Nausea and Vomiting
110
is normally associated with routine venipuncture and capillary puncture
Pain
111
are tiny, nonraised red, purple, or brownish colored spots that appear on the patient’s skin when a tourniquet is applied. T
Petechiae
112
have been known to occur during venipuncture, although there is no evidence that they can be caused by venipuncture. In the rare event that a patient has a seizure or goes into convulsions during blood specimen collection, discontinue the draw immediately.
Seizures/Convulsions
113
is an invasive procedure, and there are risks involved when it is performed.
Venipuncture
114
is the most common complication of venipuncture. It is caused by blood leaking into the tissues during or following venipuncture and is identified by rapid swelling at, near, or beneath the venipuncture site.
Hematoma formation
115
is an adjective used to describe an adverse condition brought on by the effects of treatment.
Iatrogenic
116
Blood loss through blood removed for testing is called
iatrogenic blood loss
117
Removing blood on a regular basis or in large quantities can lead to
iatrogenic anemia
118
Blood loss to a point at which life cannot be sustained is called
exsanguination
119
Life may be threatened if more than _____ of a patient’s blood volume is removed at one time or over a short period.
10%
120
is rare when proper venipuncture procedures are followed. It is most often associated with deep or blind probing, especially in areas near the basilic vein, which is close to the brachial artery.
Inadvertent arterial puncture
121
Although a rare occurrence, infection at the site following venipuncture does happen. The risk of infection can be minimized by using proper aseptic technique
Infection
122
is a serious phlebotomy complication that can result in permanent damage to motor or sensory nerve function of the arm or hand (Fig. 9-14) and the probability of a lawsuit.
Nerve Injury
123
There are two basic types of nerve injury that can be negative consequences of venipuncture procedures
One involves the needle directly contacting the nerve in the form of a nick or puncture, and the other results from a compression injury to the nerve rather than direct contact by the needle.
124
In rare instances, it is possible for blood to reflux (flow back) into the patient’s vein from the collection tube during the venipuncture procedure.
Reflux of Additive
125
can occur when the contents of the collection tube are in contact with the needle while the specimen is being drawn
Reflux
126
To prevent reflux, place the patient’s arm in a
downward position so that the collection tube remains below the venipuncture site and fills from the bottom up
127
occur when there is blood backflow
into a patient's vein from the
collection tube.
REFLUX ANTICOAGULANT
