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Chapter 11 > Pre-analytical variables and Vena puncture complications > Flashcards

Pre-analytical variables and Vena puncture complications Flashcards

1
Q

What are the three types of variables

A

Pre-analytical analytical and post analytical

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2
Q

What are pre-analytical variables

A

Variables that occur before analysis of the specimen

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3
Q

What are analytical variables

A

Variables that occur during specimen analysis

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4
Q

Describe post analytical variables

A

They can be described as Delays in reporting results or improper entry of results in the data bank

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5
Q

Many ….

A

Pre-analytical variables arise during patient preparation and specimen collection

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6
Q

One of the most ….

A

Important pre-analytical variables is the day today and hour to hour fluctuations in the compositions of blood

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7
Q

What is the basal state

A

It can be defined as the body stay after 8 to 12 hours of fasting

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8
Q

Cholesterol and…

A

Triglyceride values increase with age

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9
Q

Both red blood cells and white blood cell…

A

Values are higher in infants than adults

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10
Q

Alcohol consumption….

A

A moderate amount is fine chronic consumption can lead to an increase values on liver function test and interfere with platelet aggregation studies

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11
Q

Altitude….

A

When you live in a higher altitude there’s less oxygen to breathe the body will compensate by producing a higher red blood cell mass

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12
Q

Dehydration…

A

The loss of the Fluid portion of blood results and hemoconcentration

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13
Q

Diurnal variation ….

A

Because of the significant changes certain specimens must be collected at certain times of the day examples include cortisol and iron

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14
Q

Exercise……

A

Short term exercise increases levels of muscle enzymes examples are creatine white blood cells and fatty acids

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15
Q

Prolonged fasting increases…

A

bilirubin and fatty acids A fasting person should be taken 8 to 12 hours after the last intake a food

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16
Q

A patient not in a fasting state…

A

May produce a lipemic sample The serum or plasma will appear turbid

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17
Q

Lipemic sample ….

A

Can cause a lot of Variances and results for phosphorus creatine and calcium

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18
Q

Males have ….

A

Higher hemoglobin hematocrit and red blood cell count than females do

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19
Q

A sample collected from an erect Pt….

A

Has higher concentrations examples include enzymes albumin minute white blood cells and ribosomes

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20
Q

The presence of a fetus and increased water retention cause a solution effect ….

A

Which gives falsely lower hemoglobin and red blood cells

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21
Q

Obesity …

A

39% of adults in the United States are rubies with a body mass index of 30kg/m2

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22
Q

Bariatric chair should we use for outpatients….

A

Because it’s more comfortable to them and allows proper positioning so they can fully extend their arm for a better view of the vein

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23
Q

Use a needle…

A

That is at least 1 inch long

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24
Q

Smoking can increase…

A

Cortisol white blood cells and hemoglobin

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25
Q

Stress …

A

Prolonged crying or hyper ventilating alters ABG and crying and increase white blood cells

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26
Q

What are the situations that make Pt ID hard

A

Emergency requisitions
Emergency room collections Orders telephoned into the laboratory Requisitions picked up at a site

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27
Q

Any discrepancies…

A

Must be resolved before collecting the specimen

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28
Q

Even if an ID band is in the room…

A

Unless an ID band is on the patient you must not draw blood

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29
Q

If you encounter a sleeping patientzz…

A

Make an attempt to gently wake them up then give them time to be oriented before you begin the draw

30
Q

If the patient cannot be awakened…

A

Consult the nurse or supervisor

31
Q

Presence of a physician…

A

If a physician is in the room come back at another time unless it is a STAT or time collection In that case respectfully interrupt and explain the reason for interruption if a physician enters while you are preparing to draw leave the room until they are finished with the patient and if the physician enters after you begin to draw blood request a few minutes to complete the procedure

32
Q

In the presence of a visitor…

A

Ask them if they would mind stepping out if the patient is a child the presence of visitors or family members during collection may be helpful

33
Q

Most patients can be easily calmed by …

A

Distracting conversations or neutral topics

34
Q

When a patient can’t understand you or give consent…

A

Get a translator

35
Q

When a patient refuses to have their blood drawn…

A

Think the patient leave the room find a nurse explained that the patient has refused the procedure Then if the patient again refuses document it

36
Q

What does occluded mean

A

Blocked

37
Q

What does scleroses mean

A

Hard

38
Q

What is edema

A

It is swelling That can be caused by some diseases medication or treatments such as fluid from an IV bag

39
Q

What is Lymphostasis

A

Lack of lymph fluid Movement

40
Q

Blood should not be drawn

A

when there is an IV device and please use another arm instead

41
Q

If blood Hass to be drawn from an IV site

A

It needs to be a site further away not close to the IV

42
Q

The best practice for drawing blood from an arm where there is an IV

A

Request of the nurse take off the IV
Wait 2-3mins
Apply tourniquet far away from the IV site Choose another vein that the nurse hasn’t chosen for Iv
When ur done discard 5ml /first tube
Then when you’re done request that the nurse restart the IV
Then document

43
Q

How do you enhance van prominent

A

Massage gently upward from the wrist to elbow
Dangle the arm downward position to increase blood
Apply heat then rotate wrist to increase prominence of the cephalic vein

44
Q

Blood pressure cuff..

A

Should be 3-4inches above Venipuncture site and inflated to 40mm hg

45
Q

Collection from the

A

From the foot or leg requires physicians written permission

46
Q

Problems associated with cleaning the side…

A

Providence -iodine or benzalkenium chloride (bulk) is used instead These antibiotics are not recommended for children under two years for patients allergic to iodine chlorhexidine gluconate is used instead

47
Q

The appearance of Petechiae may indiacte

A

that the site may bleed excessively after the procedure and require longer application

48
Q

Hand collection using a winged infusion set

A

1 Assemble your equipment
2 Position the patient hand and apply the tourniquet
-Place a towel under the wrist and asked the patient to gently curl their fingers under
the hand
3 Insert the needle
-Choose the largest and straightest vein
-Insert the needle bevel side up and lined up in the direction of the vein the angle of insertion should be 10 to 15°
-When using the syringe system never pull the syringe plunger back
-Gently thread the needle up the lumen Of the van until the bevel is not visible keeping the angle shallow
4 Collect a sample
5 Finish the collection
6 Attend to the patient
6dispose of the WIS(Winged infusion set)

49
Q

Syncope is …

A

The medical term for fainting

50
Q

Before Syncope

A

Syncope Their skin will feel cold damp beads of sweat may form on the forehead her upper lip and they said that they’re not feeling well or they will stop talking their eyes may start to roll back or their head could till forwards and backwards

51
Q

If syncope occurs …

A

Remove the tourniquet a needle immediately and apply pressure to the site fainting is more common with outpatient

52
Q

Place a patient With a history of fainting

A

With a history of fainting in a recomment or reclined position before stabbing

53
Q

If a Seziure happens

A

Remove the tourniquet a noodle immediately and apply pressure to the site if possible move them to a recumbent position or to the floor do not put anything in the patient’s mouth

54
Q

If emesis occurs (vomit)..

A

Reassure them make them feel comfortable give them an emesis basin tell them to breathe slowly and deeply

55
Q

Pain during a Venipuncture …

A

Caused by excessive propping digging and blind lateral movement of the needle

56
Q

What are the most common causes of a hematoma

A

Excessive probing to obtain blood
Failure to insert the needle far enough into the vein
Passage of the needle through both sides of the vein
Failure to remove the Tourniquetget before removing the needle

57
Q

Improper positioned needles…

A

If the bevel is stuck to the vein wall slightly rotate the needle
If the needle has passed through both sides of the vein slowly pull back on the needle
If The tube is too large for the vein causing excessive vacuum to pull Remove the tube wait a few seconds then switch to a smaller volume tube

58
Q

Collapsed vein..

A

A collapsed vein becomes evident when the tube is pushed onto the inner needle because of a collapsed vein is too much Vaccum on the small vein
When this occurs remove the tourniquet pull out the needle and select a different vein or switch to using a butterfly on a hand fan

59
Q

Veins that rolll excessively..

A

These are most commonly encountered an older patients the best strategy is to anchor the vein to minimize rolling

60
Q

A patient With a low blood oxygen lelvels

A

has arterial blood that is darker in color similar to Venous blood

61
Q

When an artery is punctured..

A

With drawl the needle and apply pressure for 5 to 10 minutes after sample collection and needle with drawl you should apply pressure for 10 minutes

62
Q

Normally The site should stop bleeding within

A

The site should stop bleeding within five minutes If not continue to apply pressure auto bleeding stops

63
Q

Failure to apply adequate pressure….

A

With patient on excessive doses of warfarin It is important with these patients to apply pressure to the site beyond five minutes

64
Q

The most frequent Causes of hematoma or improper

A

Causes of hematoma or improper insertion or removal of the needle

65
Q

what is Reflux..

A

Is the flow of blood from the collection tube back into the needle and then into the patient’s vein

66
Q

Prevention of reflux ..

A

Keep the patient’s arm angled downwards

67
Q

Removal of ..

A

3-4ml Per day may result in the development of iron deficiency anemia for some people

68
Q

Outpatients should

A

Be instructed to leave the bandage in place for at least 15 minutes

69
Q

Avoid ..

A

Using the basilic being whenever possible

70
Q

Compartment syndrome…

A

Is a condition in which pressure within the tissue prevents blood from flowing freely causes swelling and pain and carries the risk of permanent damage to nerves

Chapter 11 (1 decks)

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