Skills - Module 4

Question 1

Which site should you avoid in Peripheral Vascular disease patients when obtaining peripheral phlebotomy patients

Answer 1

Avoid the foot

Question 2

Which AC veins are preferred for venipuncture blood draw?

Answer 2

1st choice - Median cubital
2nd choice - Cephalic
3rd choice - Basilic

Question 3

How long should a tourniquet be applied during a blood draw?

Answer 3

No longer than 1 min due to increased risk of hemolysis. If accidently applied longer than 1 min, you must remove the tourniquet and wait 2min before you reapply and do the blood draw.

Question 3

How do you label peripheral venipuncture?

Answer 3

Pt name, DOB, AHC #, date & time sample taken, who took sample, site sample taken

Question 4

What is the first sample type drawn FIRST from a peripheral venous blood draw

Answer 4

cultures

Question 5

At what angle do you perform a peripheral IV cannulation?

Answer 5

15-30 degrees

Question 6

What is the first sample type drawn FIRST from a peripheral venous blood draw

Answer 6

cultures

Question 7

What is the last sample drawn from a peripheral venous blood draw

Answer 7

Paxgene tubes

Question 8

What is the most COMMON complication with peripheral IV cannulation

Answer 8

failure to extract blood

Question 9

How do you prep a vein for venipuncture?

Answer 9

Prep the vein as you would when starting an IV, use alcohol or iodine pad and cleanse the area in a circular motion, starting from the inside and working your way out.

Question 10

What are the primary influencing factors that negatively impact your reading of a peripheral venous blood draw (5)

Answer 10

1. Under/overfilled containment
2. tourniquet on for too long (greater than 1 minute)
3. improper mixing mixing of tubes
4. Hemolysis
5. specimen contamination

Question 11

Why would the venous blood sample be rejected by the lab

Answer 11

no label, inadequate volume, hemolysis, coagulated blood, delay, contaminated

Question 12

How do you measure the probe for Invasive Core Temperature Monitoring?

Answer 12

Oral insertion: Measure from corner of mouth to the earlobe to 2 cm above the xyphoid process.

Nasal Insertion: Measure from the nose to the earlobe to 2 cm above the xyphoid process.

Question 13

After the Invasive Core Temperature Monitoring probe has been inserted, what are the next steps?

Answer 13

Secure the probe, attach to temperature cable and monitor, reassess and document. Monitor patient for complications.

Question 14

what are the indications for radial artery puncture/blood draw

Answer 14

evaluation of acid/base status, respiratory distress, 02/c02 exchange, assessment of interventions

Question 15

Absolute contraindications for arterial puncture

Answer 15

Failed Allen’s test, previous surgery, shunts, grafts and fistulas

Question 16

relative contraindications for arterial punctures

Answer 16

burns, trauma, infections to the area

Question 17

Complications of arterial puncture

Answer 17

Nerve damage, bleeding, hematoma, thrombosis, and inaccurate test results.

Question 18

What gauge of catheter is used for arterial puncture?

Answer 18

23 gauge

Question 19

How many mL are you expected to draw from arterial blood sampling

Answer 19

1-2 mL

Question 20

What is the angle of insertion for arterial blood sampling

Answer 20

45 degree angle

Question 21

how much time must you put direct pressure over the puncture to avoid bleed out after an arterial puncture

Answer 21

5 minutes is the magic number

Question 22

How do you label an arterial blood sample?

Answer 22

Name, date, time, ID number and practitioner name.

Question 23

How much time must you roll syringe after arterial blood draw is obtained

Answer 23

15 seconds

Question 24

If the arterial sample will be read over 10 minutes after the draw you must do what?

Answer 24

You must place the container in an ice slurry.

Question 25

Long term storage of arterial blood sample requires what temperature and what time frame

Answer 25

0-4 degrees Celsius for a maximum time of 30 minutes

Question 26

how do you ensure an accurate read when obtaining arterial blood directly from the line

Answer 26

ensure 10 mL wastage is obtained

Question 27

What do you do after a arterial blood draw off of an arterial line?

Answer 27

Turn the stop cock off to the cap, perform a fast flush using the flushing device located on the art line transducer line. Flush until all blood is removed from the line. Re-Zero transducer.

Question 28

Arterial pressure monitoring procedure.

Answer 28

Spike 1000ml saline bag with transducer line and flush each section of the line through vented caps. Place saline bag into pressure infusion device, inflate to 300mmHg. Attach primed line to arterial catheter. Level to the phlebostatic axis and zero the pressure transducer. Repeat the leveling and zeroing each time a patient is moved.

Question 29

Where is the phlebostatic axis?

Answer 29

Land marked at the intersection of the midaxillary line with the fourth intercostal space when Pt is supine at 30° elevation.

Question 30

What is considered over damping?

Answer 30

Less than 1.5 oscillations after square wave test

Question 31

What is considered under damping?

Answer 31

More than 1.5 oscillations after square wave test

Question 32

What does the anacrotic notch indicate on arterial waveforms?

Answer 32

Represents the end of systole and the beginning of the volume displacement curve

Question 33

What does the dicrotic notch indicate on arterial pressure waveforms

Answer 33

Closing of the aortic valve and BEGINING of diastole

Question 34

Define Arterial Pressure

Answer 34

The input pressure for organ perfusion and is a function of PVR and blood flow.

Question 35

How to calculate mean arterial pressure?

Answer 35

diastolic x 2 + systolic/3

Question 36

What are the sites for arterial puncture in order of preference

Answer 36

1. radial 2. brachial 3. femoral 4. dorsalis pedis