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PMLS 2 > Pre-Analytical Considerations in Phlebotomy > Flashcards

Pre-Analytical Considerations in Phlebotomy Flashcards

1
Q

Includes procedures such as laboratory handling and identification which takes place prior to any
laboratory testing

A

Pre-analytical testing phase

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2
Q

Starts when the doctor’s
order is given and ends
when the laboratory test has officially commenced

A

Pre-analytical testing phase

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3
Q

The phlebotomist must be able to:

A

identify factors that affect the process and address them as needed

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4
Q

is used by physicians to diagnose and monitor
the presence of a disease

A

Laboratory test

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5
Q

This is where
physicians compare the results. This range shows the high and low limits of result values as compared to healthy individuals

A

Reference Range or Reference Interval

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6
Q

In phlebotomy, it is ideal in establishing a reference range since it represents the condition of the metabolism of the
body early in the morning or after approximately 12 hours of fasting

A

basal state

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7
Q

Age

A

RBC
WBC
Creatinine clearance

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8
Q

Altitude

A

RBC

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9
Q

Dehydration

A

Hemoconcentration
RBC
enzymes
Iron
Calcium
Sodium

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10
Q

Diet

A

Glucose
Lipids
Electrolytes

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11
Q

Diurnal Variation

A

Thyroid Stimulating Hormones (TSH)
Cortisol
Iron

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12
Q

Drug Therapy

A

Enzymes
Hormones

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13
Q

Exercise/IM Injection

A

pH
Carbon dioxide partial pressure
Creatinine Kinase (CK)
Lactic Acid Dehydrogenase (LDH)
Glucose

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14
Q

Fever

A

Hormones
Cortisol

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15
Q

Gender

A

RBC
Hgb
Hct

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16
Q

Jaundice

A

Yellow color interfaces due to increased bilirubin

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17
Q

Intramuscular Injection

A

CK
Skeletal muscle fraction of LDH

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18
Q

Position

A

Protein
Potassium

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19
Q

Pregnancy

A

RBC

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20
Q

Smoking

A

Cholesterol
Cortisol
Glucose
GH
Triglyceride
WBC

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21
Q

Stress

A

WBC
Iron
Adrenocorticotropic Hormone (ACTH)
Catecholamine
Cortisol

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22
Q

Temperature and Humidity

A

Hemoconcentration

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23
Q

is not recommended because veins in the
area may be difficult to examine and blood circulation may be impaired. Burns may be too painful to touch and tattoos may also be susceptible to infection due to the dyes used that may interfere with the process

A

Burns, Scars, & Tattoos

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24
Q

aside from encountering difficulty in puncturing the site when veins are damaged another problem is the possibility of getting inaccurate results. Veins could be Sclerosed or _______ or Thrombosed or ___________

A

Damaged Veins
hardened; clotted

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25
Q

is an abnormal swelling
caused by accumulation of fluid in the tissues. The tissues become
fragile, making the task of locating the veins harder. This condition may be due to reactions from medications, pregnancy, infections, and other medical problems

A

Edema

26
Q

a solid swelling or mass of blood in the tissues which is caused by the leakage of blood from the vessels during venipuncture. This is not
only painful because it obstructs the blood flow it could also lead to the contamination of blood samples

A

Hematoma

27
Q

a treatment for breast cancer that requires removal of the breast through surgery. Blood drawing becomes a challenge since the lymph flow is obstructed, and there maybe swelling and infection after the surgery. In addition, tourniquet cannot be applied because it
can cause injury. It should also be noted that it could also change the blood composition

A

Mastectomy

28
Q

the individual is grossly overweight. Patients that are obese have veins are deep and they are harder to locate. A solution is to use a longer tourniquet or try locating the cephalic or cubital vein.

A

Obesity

29
Q

To obtain samples for arterial blood gas and
laboratory studies, critically ill patients require arterial lines
where a thin catheter is inserted into an artery. This also used to monitor blood pressure continuously. Neither tourniquet nor venipuncture are allowed in the arm with an arterial line

A

Arterial Line

30
Q

An arteriovenous shunt or fistula is a passageway created through surgery which is usually in the arms with the intention of connecting the artery and a vein directly. This may be created for hemodialysis treatment or pathological processes such as erosion of arterial aneurysm.

A

Arteriovenous Shunt or Fistula

31
Q

A blood sampling device is used to avoid the use of needle sticks, reduce infections, and reduce wastage from line draws. The device collects blood from the arterial or central venous catheter where it is connected

A

Blood Sampling Device

32
Q

aka “hep-lock,” is an intravenous (IV) catheter attached to a stopcock or cap with diaphragm. The basic function is to provide access for administering medicine or drawing blood from the patient. This is threaded in the peripheral vein which is in the lower arm above the wrist for up to 48 hours. It is usually flushed with heparin or saline (to prevent clogging) and capped for future use

A

Heparin or Saline Lock

33
Q

is a thin plastic tube or
catheter inserted into a vein in the forearm to inject a volume of
fluids into the bloodstream. The phlebotomist should avoid collecting blood from the arm with IV because the blood collected could be contaminated with IV fluid. If blood collection is necessary, the collection site should be below the IV. Take note that collection of blood from known previously IV sites should be avoided for 24 to 48 hours.

A

Intravenous (IV) Sites

34
Q

aka indwelling lines which is a tubing inserted to the main vein or artery used for blood collection, monitoring the patient’s pressures and administering medications and fluids

A

The Central Vascular Access Devices (CVADs)

35
Q

AKA central line inserted into the large vein (subclavian) and advanced into superior vena cava.

A

CENTRAL VENOUS CATHETER

36
Q

is a surgically implanted disk-shaped chamber attached into the indwelling line. This is usually placed on the upper chest just below the collarbone

A

IMPLANTED PORT

37
Q

is a flexible tube inserted into the veins of extremities and the central veins.

A

PERIPHERALLY INSERTED
CENTRAL CATHETER (PICC)

38
Q

a gauze should be placed over the site and should be removed after 15 minutes. The alternative is to ask the patient to apply pressure for 5 minutes

A

Adhesive allergy

39
Q

simply use a different antiseptic (ex. Chlorhexidine
gluconate)

A

Antiseptic allergy

40
Q

use a non-latex alternative for gloves, tourniquet and
bandages

A

Latex Allergy

41
Q

the pressure should be applied to the site until the bleeding stops. The attention of the authorized personnel should be called when the bleeding continues after 5 minutes

A

patient on aspirin or anticoagulant under Excessive Bleeding

42
Q

is a temporary loss of consciousness caused by the insufficient
blood flow to the brain. If the patient is prone to fainting during venipuncture, they are asked to lie down during the procedure.

A

Fainting

43
Q

Phlebotomist has to discontinue the procedure until the patient feels better.
An emesis basin or wastebasket should be provided, and a cold damp washcloth should be applied in the forehead

A

Nausea and Vomiting

44
Q

The patient should be warned before the needle insertion, and the phlebotomist should avoid redirection of the needle. If the patient
complains of extreme pain or numbness, remove the needle and apply ice to the site because this could indicate nerve involvement. The phlebotomist needs to document the incident if the condition persist

A

Pain

45
Q

This condition involves the appearance of small red or purple spots
that look like rashes, which appears on the arm when tourniquet is applied

A

Petechiae

46
Q

the blood draw should be discontinued immediately. Hold pressure over the site but make sure that movement is not restricted, the mouth is free from any obstruction and the patient is protected from self-injury. Call the attention of the first-aid
personnel

A

Seizures/Convulsion

47
Q

The phlebotomist should hold pressure on the site immediately after discontinuing the draw. A cold compress or ice pack may be offered to help address the swelling

A

Hematoma Formation

48
Q

Factors that trigger Hematoma are:

A
  1. Excessive or blind probing
  2. Inadvertent arterial puncture
  3. Size of the vein - too small
  4. The needle penetration - all through the vein
  5. Needle is not completely inserted
  6. Tourniquet is still on when the needle was removed
  7. Pressure - not adequate
49
Q

This results from blood loss due to blood draw. It is important to
ensure to collect only the required specimen volume because if 10% of the blood volume is removed at once from the body, the patients could face a threat

A

Iatrogenic Anemia

50
Q

This happens when blood is filling up the tube rapidly and there is a rapid formation of hematoma on the site

A

Inadvertent Arterial Puncture

51
Q

can be avoided by making sure that tapes or bandages are not opened ahead of time, needles are not preloaded into the tube holders, insertion site of the needle is not touched after sterilization, cap is removed just before venipuncture, and patients are advised to keep the bandage on the site for at least 15 minute

A

Infection

52
Q

happen when there is improper site selection, rapid needle insertion, excessive redirection of the needle and blind probing. If the initial attempt is not successful, the phlebotomist should try to redirect the needle by using a slightly forward or backward movement. The next step is to remove the needle and look for an alternative site

A

Nerve Injury

53
Q

To avoid blood that has already been drawn to flow back into the vein from the collection tube, which may cause adverse reaction because of the presence of tube additives, make sure to keep the arm of the patient in a downward position and the tube just below the venipuncture site.

A

Reflux of Anticoagulant

54
Q

it could be avoided by following the proper technique and avoiding blind probing.

A

Vein Damage

55
Q

usually occur when conditions are less than
ideal, which leads to the veins being blocked, resulting in insufficient blood flow. 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 it is too tight, or when the tourniquet was
removed during the draw.

A

Collapsed Vein

56
Q

To avoid failure due to loss of vacuum, the phlebotomist should
make sure that the bevel is not partially out of skin and the tube
itself is not damaged

A

Tube Vacuum

57
Q

The phlebotomist should ensure that the following does not happen:

A
  1. Needle not inserted far enough
  2. Bevel partially out of skin
  3. Bevel partially into vein
  4. Bevel partially through vein
  5. Bevel completely through vein
  6. Bevel against vein wall
  7. Needle beside vein
  8. Undetermined position
58
Q

is a decrease in the fluid content or plasma
volume which is usually caused by a tourniquet that stagnates the
normal flow of blood, leading to the increase in concentration of red
blood cells and other non -filterable large molecules

A

Hemoconcentration

59
Q

refers to the rupture of
the red blood cells. The hemoglobin is then released to the surrounding fluid

A

Hemolysis

60
Q

or short draw, happens when the phlebotomist pulls a tube before reaching the required volume which may lead to the incorrect blood-to-additive ratio.

A

Partially Filled Tubes

61
Q

means that the specimen is compromised due to incorrect handling, which includes allowing alcohol, powder or other materials into the sample. Getting glove powder or perspiration into films and specimens, using the wrong antiseptic, or simply not following the proper antiseptic procedure could interfere with the results

A

Specimen Contamination

62
Q

should not be used
because the manufacturer could not warrant the quality of the seal and pressure after the expiration date declared in the tube

A

Wrong or Expired Collection Tube

PMLS 2 (19 decks)

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