Pre-Analytical Considerations in Phlebotomy Flashcards
1
Q
This means “before analysis”
A
Preanalytical
2
Q
Begins when a test is ordered and ends when testing begins
A
Preanalytical
3
Q
resting metabolic state of the body early morning after approximately 12 hours fasting
A
Basal state
4
Q
It is influenced by a number of physiologic variables such as age, gender, and conditions of the body that cannot be eliminated
A
Basal State
5
Q
What physiological Variables influence these?
* RBC and WBC values higher in newborns
* Kidney function (creatinine clearance) decrease with age
A
Age
6
Q
What physiological Variables influence these?
* Red blood cell (RBC) counts elevated at higher altitude
A
Altitude
7
Q
What physiological Variables influence these?
* Hemoconcentration
* RBCs, enzymes, iron (Fe), calcium (Ca), sodium (Na)
A
Dehydration
8
Q
What physiological Variables influence these?
* Lipid
* Electrolytes
* Ammonia, urea
* glucose
A
Diet
9
Q
In diet, _____increase with ingestion of fatty foods
A
Lipids
10
Q
In diet, _____ is altered by drinking excessive water
A
Electrolytes
11
Q
In diet, _____ increase in patients on high-protein diets
A
Ammonia, urea
12
Q
In diet, _____increase with the ingestion of carbohydrates
A
Glucose
13
Q
What is the commonality of these tests?
1. FBS
2. Glucose tolerance test
3. Triglycerides & lipid panel
4. Gastrin
5. Insulin
6. Aldosterone & renin
7. Electrolytes
A
Requires fasting
14
Q
○ Increase at night and decrease during day
A
● Melatonin levels are affected by light
15
Q
Peak levels in the predawn hours of the morning during sleep
A
Renin and thyroid-stimulating hormone (TSH)
16
Q
Peak: later in the morning, around 8:00am
A
cortisol levels
17
Q
Exhibit diurnal variation with highest levels in the _____: aldosterone, bilirubin, cortisol, hemoglobin, insulin, iron, potassium, testosterone, and RBCs
A
morning
18
Q
______ can cause a decrease in blood cells, especially WBCs and platelets
A
Chemotherapy drugs
19
Q
Many drugs are toxic to the _____
A
liver
20
Q
increase levels of ___ enzymes:
○ Aspartate aminotransaminase (AST)
○ Alkaline phosphatase (ALP)
○ Lactate dehydrogenase (LDH)
A
liver
21
Q
These increase amylase and lipase
A
Steroids and diuretics
22
Q
In ______, Arterial pH and PCO2 levels are reduced
A
exercise
23
Q
____ can be elevated by moderate muscular activity
A
Glucose
24
Q
With exercise, ______ is increased in the plasma
A
Potassium (K+)
25
Skeletal muscle enzymes ____ and ______ are increased by exercise
creatine kinase (CK) and lactate dehydrogenase (LDH)
26
○ Increases hormones
insulin and glucagon
○ increases cortisol
fever
27
In terms of gender: RBC, hemoglobin (Hgb), and hematocrit (Hct) normal values are higher for _____ than for ____
males than for females
28
increases levels of creatine kinase (CK) and the skeletal muscle fraction of LDH
intramuscular injection
29
● icteric : deep yellow to yellow-brown color of serum or plasma
● interferes with chemistry tests based on color reactions
Jaundice
30
● from supine to an upright sitting or standing position causes blood fluids to filter into the tissues, decreasing ____
plasma volume
31
In a ____ body position, it causes in increased: protein in nature or bound to protein—such as aldosterone, bilirubin, blood cells, calcium, cholesterol, iron, protein, and renin
supine
32
In supine body position, ______ levels increase
Potassium (K)
33
State that lower RBC counts
pregnancy
34
Causes increased cholesterol, cortisol, glucose, growth hormone, and triglyceride levels and WBC counts
smoking
35
This causes in decreased pulmonary function and increased RBC counts and hemoglobin levels
Chronic smoking
36
_______ can also affect the body’s immune response, lowering the conc. of immunoglobulins
Smoking
37
● Increases in WBC counts
● Decrease serum iron levels
● Increase adrenocorticotropic hormone(ACTH), catecholamine, and cortisol levels
Stress
38
Two factors that contribute to hemoconcentration
Temperature and humidity
39
3 Common Preanalytical Errors BEFORE collection
1. Incorrect test ordered
2. Inadequate patient preparation
3. Misidentification of Patient
40
4 Common Preanalytical Errors DURING collection
1. Wrong container/wrong additive
2. Short draws/ wrong anticoagulant/blood ratio
3. Prolonged tourniquet time
4. Hemolysis due to incorrect technique
41
4 Common Pre-Analytical Errors AFTER collection
1. Inadequate mixing/clots
2. Mislabeling of specimen
3. Improper transport
4. Processing errors
42
The following are example of one of the four common preanalytical errors after collection:
* Exposure to light
*Extreme temperature
* Delayed delivery
Improper Transport
43
The following are example of one of the four common preanalytical errors after collection:
* Incomplete centrifugation
* Incorrect log-in
* Improper storage
* Improper aliquoting
Processing errors
44
Problems in Venipuncture Sites: Healed burn sites & areas with extensive scarring
may have impaired circulation
45
Problems in Venipuncture Sites: newly burned areas
painful; susceptible to infection
46
Problems in Venipuncture Sites: tattooed areas (3)
* impaired circulation
* more susceptible to infection
* contain dyes that can interfere with testing
47
Problems in Venipuncture Sites: damaged veins
Hard and cord-like, occluded or obstructed
48
Problems in Venipuncture Sites: means hardened
sclerosed
49
Problems in Venipuncture Sites: means clotted
thrombosed
50
Problems in Venipuncture Sites: scarring caused by numerous venipunctures
damaged veins
51
Problems in Venipuncture Sites: these are what you do in case of ______: choose another site if possible, draw below (distal to) ___
damaged veins
52
Problems in Venipuncture Sites:
* may yield inaccurate test results (contamination with tissue fluid)
* veins are harder to locate
* tissue is often fragile and easily injured by tourniquet and antiseptic application
* healing may be prolonged
edema
53
Problems in Venipuncture Sites: swelling or mass of blood that can be caused by **blood leaking from a blood vessel** during or following venipuncture
hematoma
54
Problems in Venipuncture Sites:
● Lymph node removal causes lymphostasis
● susceptible to swelling and infection
● Applying a tourniquet to the arm can cause injury
● lymphostasis can change blood composition in that arm
mastectomy (surgical breast removal)
55
obstruction or stoppage of normal lymph flow
Lymphostasis
56
Problems in Venipuncture Sites:
● Veins may be deep and difficult to find
● Proper tourniquet selection and application
● median cubital vein
● cephalic vein
● To locate the cephalic vein, rotate the patient’s arm so that the hand is prone
obesity
57
In a vascular access device:
● Tube inserted into a __ or ___
● Ready access to the patient’s ____
● Eliminating multiple ____
* vein or artery
* circulation
* phlebotomies
58
Uses:
1.Administer fluids or medication
2. Draw blood
3. Central venous pressure reading
Vascular access device
59
Never apply torniquet or perform venipuncture
on an arm with ______
VAD (vascular access device)
60
● A-line or Art-line
● _____ that is placed in an artery
● most commonly placed in a ______
● continuous _______
● blood gas analysis
● Never apply a tourniquet or perform venipuncture on an arm with an ______
* catheter
* radial artery
* blood pressure monitoring
* arterial line
61
This is also known as A-line or Art-line
Arterial line
62
● surgical procedure that fuses vein & artery
● hemodialysis treatment
● Erosion of arterial treatment
● Never apply a blood pressure cuff or tourniquet, or perform venipuncture, on an arm with a shunt
Arteriovenous shunt/AV Fistula
63
● Administering medication
● drawing blood
● vein in the lower arm above the wrist
● can be left in place for up to 48 hours
Hep lock
64
This is ________:
● flushed with _____ or saline to keep it from clotting
● __-mL discard tube should be drawn first
● Drawing coagulation specimens is not recommended
● Only specially trained personnel
* hep lock
* heparin
* 5
65
● Thin plastic tube or catheter
● inserted in a vein to administer fluids
intravenous (IV) sites
66
Since blood specimens can be contaminated or diluted with the IV fluid, causing erroneous test result, we should _____
draw blood below the IV site
67
If the patient has an IV in one arm, where should we collect blood?
Collect blood from the other arm
68
If there are both IVs in both arms/the other arm of the patient is unavailable, how should we collect blood?
collect by capillary puncture
69
In performing venipuncture below an IV:
1. Ask the nurse to turn off the IV for __ minutes
2. Apply the tourniquet __ (location) to the IV.
3. Select a venipuncture site __ (location) to the IV.
4. Perform the venipuncture in a _______ than the one with the IV if possible.
5.Ask the nurse to ___ the IV after the specimen has been collected.
6.Document that the specimen was collected ___ an IV, indicate the ____ in the IV, and identify which __ was used.
* 2
* distal
* distal
* different vein
* restart
* below, type of fluid, arm
70
Blood should not be collected from a known previous IV site within __ to ___ hours of the time the IV was discontinued
24 to 48
71
● **Needleless closed blood sampling device is sometimes connected to an arterial or central venous catheter**
● For collecting blood specimens
● Reduce the chance of infection, prevent needlesticks, and minimize waste associated with line draws
blood sampling device
72
____, consists of tubing inserted into a main vein or artery
Indwelling line
73
● Used primarily for administering fluids and medications, monitoring pressures, and drawing blood
○ Central venous catheter
○ Implanted port
○ Peripherally inserted catheter
Indwelling line
74
Line inserted into a large vein such as subclavian and advanced into the superior vena cava
Central venous catheter (CVC) or central line
75
➢surgically implanted disk-shaped: chamber attached to the indwelling line
➢Placed on the upper chest just below the collarbone
Implanted port
76
Where is implanted port placed?
upper chest just below the collarbone
77
● Line inserted into a vein in an extremity and threaded into a main vein leading to the heart
Peripherally inserted central catheter (PICC)
78
In the case of this allergy:
● place folded gauze square over the site; remove it after 15 minutes
● instruct patient to hold pressure for 5 minutes in lieu of applying a bandage
adhesive allergy
79
In the case of this allergy:
● Alternate antiseptics should be readily available
antiseptic allergy
80
In the case of this allergy:
● wear non latex gloves
● use a nonlatex tourniquet
● use nonlatex bandages
latex allergy
81
● patients on aspirin or anticoagulant therapy
● maintain pressure over the site until the bleeding stops
● if the bleeding continues after 5 minutes, notify appropriate personnel
excessive bleeding
82
In the case of _______:
● never apply a pressure bandage instead of maintaining pressure
● do not leave or dismiss a patient until bleeding has stopped
excessive bleeding
83
○ Temporary loss of consciousness due to insufficiency of blood flow to brain
fainting/syncope
84
* Sudden faintness or loss of consciousness due to a nervous system response to abrupt pain, stress, or trauma
● relating to vagus nerve action on blood vessels
* 2nd most common complication
vasovagal syncope
85
These are signs of what?
● pallor (paleness)
● beads of sweat on the forehead
● hyperventilation
● indication from the patient that he or she is experiencing vertigo (a sensation of spinning), dizziness light-headedness, or nausea
syncope
86
Steps to follow is a patient starts to faint during venipuncture:
1. ____ the tourniquet, remove & discard needle.
2. Apply pressure to the site while having the patient ____
3. ___ to the patient.
4. ______ the patient.
5. Ask permission to ______
6. Apply cold compress or wet washcloth to the _______
7. Have someone ___ with the patient until full recovery.
8. Call first aid personnel if the patient _____.
9. _____ the incident.
* Release
* lower the head and breathe deeply.
* Talk
* Physically support
* loosen tight collar or tie or belt.
* forehead and back of the neck.
* stay
* does not respond
* Document
87
This is what you do in case when ______:
○ blood draw should not be attempted until the feeling subsides
○ blood draw that is in progress should be discontinued
patient is nauseous or show signs similar to fainting
88
When patient is nauseous or show signs similar to fainting, what do you do?
○ Ask the patient to breathe slowly and deeply
○ Apply a cold, damp washcloth or other cold compress to the patient’s forehead
89
In the case of _____, remove needle immediately
pain
90
Signs of _____:
* Marked or extreme pain, numbness of the arm, a burning or electric-shock sensation, or pain that radiates up or down the arm
nerve involvement
91
If pain persists after needle removal?
Apply of an ice pack to the site
92
○ tiny, non-raised red (or purple) spots that appear on the patient’s skin when a tourniquet is applied.
○ minute drops of blood that escape the capillaries
○ result of capillary wall defects or platelet abnormalities
Petechiae
93
If _____ happens,
● Discontinue the draw immediately
● Hold pressure over the site
● Do not attempt to put anything into the patient’s mouth
● Notify the appropriate first-aid personnel
seizures and convulsions
94
○ Most common complication
○ swelling or mass of blood that can be caused by blood leaking from a blood vessel during or following venipuncture
hematoma formation
95
What to do in case of hematoma?
first 24 hrs: apply ice (20 to 30 mins) After 24 hrs: apply warm compress
96
Causes of ______:
● Excessive or blind probing
● Inadvertent arterial puncture
● Fragile vein ( too small for the needle size)
● Needle penetrates through the vein
● Needle is partially inserted
● Needle is removed while the tourniquet is still on
● Pressure is not adequately applied after venipuncture
hematoma
97
Blood loss due to blood draw
iatrogenic anemia
98
adverse condition brought by the effects of treatment/procedure
iatrogenic
99
Life is threatened if more than ____% of a patient’s blood volume is removed at one time
10
100
* Deep or blind probing, in the area of the basilic vein (close proximity to the brachial artery)
● Can result in compression injury to a nearby nerve
Inadvertent arterial puncture
101
Signs of inadvertent arterial puncture?
○ rapidly forming hematoma
○ blood filling the tube very quickly
102
This is what you do in case of _____:
● Terminate the venipuncture immediately
● apply direct forceful pressure to the site for at least 5 minutes and until bleeding stops
inadvertent arterial puncture
103
Infections can be minimized by _______
Proper aseptic technique
104
This could result due to ○ Improper vein selection
nerve injury
105
_____ into the patient’s vein from the collection tube during the venipuncture procedure
reflux (flow back)
106
● Numerous venipunctures in the same area over an extended period of time
● Blind probing and improper technique when redirecting the needle
vein damage
107
● Decrease in fluid content or plasma volume
● Caused by stagnation of the normal venous blood flow because of tourniquet application
● Increased concentration of RBCs and other non filterable large molecules
● Increases albumin, ammonia, calcium, cholesterol, coagulation, factors, enzymes, iron, potassium, and total protein
hemoconcentration
108
● RBCs are damaged or destroyed and the hemoglobin escapes into the fluid portion of the specimen
● serum or plasma appears pink (slight hemolysis)
● “hemolyzed” specimen
hemolysis
109
○ dark pink to light red blood shows?
moderate hemolysis
110
○ dark red blood means?
gross hemolysis
111
● Short-draw _____ tubes generally acceptable
serum
112
Under-filled anticoagulant tubes: _______
blood-to-additive ratio
113
Never pour _______ together to fill one tube (affects the blood-to-additive ratio)
two partially filled additive tubes
114
2 specimen quality concerns?
* specimen contamination
* wrong or expired collection tube
115
For ______, make sure that the
● tube is properly seated
● needle in the tube holder has penetrated the tube stopper
● needle sleeve is not pushing the tube off the needle
tube position
116
Correct needle positon:
● ____is correctly positioned within the vein
● _______ must be made slowly and precisely to avoid injuring the patient
* Bevel
* Needle adjustments
117
Happens if the vein is located more deeply than normal
Needle Not Inserted Far Enough
118
How to correct Needle Not Inserted Far Enough
slowly advance the needle forward
119
What to do when the bevel is partially out of the skin?
Discard the tube, advance the needle slowly then insert a new tube
120
● bevel partly through the upper vein wall
● blood filling the tube very slowly
bevel partially into the vein
121
partial needle insertion can cause blood to leak into the tissue and form ______
hematoma
122
Vein not anchored well may roll slightly
needle beside the vein
123
● remove the tube from the holder needle
● withdraw the needle until the bevel is just under the skin
● palpate the arm above the needle entry site
○ not too close to the needle (painful)
● relocate the vein, anchor, then redirect the needle into it
undetermined needle position
124
vein walls draw together temporarily, shutting off the blood flow
collapsed vein
125
clue that a vein has collapsed?
vein disappears as soon as the tube is engaged or when the tourniquet is removed
126
● Causes:
○ Too much vacuum on small veins
○ Excessive pulling of the plunger
○ Tourniquet is tied too tightly
○ Tourniquet is removed during the draw
collapsed vein
