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Phlebotomy > special phlebotomy procedures > Flashcards

special phlebotomy procedures Flashcards

1
Q

what do speical procuedure by phlebotomist include?

A

● Collection of specimens for blood cultures
● Collection of glucose tolerance specimens
● Collection of specimens for neonatal blood screening
● Preparation of blood smears
● Special identification procedures for type and cross-match specimens
● Collection of donor blood

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2
Q

what are blood culutres?

A
  • e testing of blood for the presence of septicemia (the presence of pathogenic microorganisms in the blood).
  • usually done on pt with fever of unknown origin (FUO)
  • isolate any microrganisms in blood
  • requires strict sterile technique
  • collected in tubes with culture media (enchance microrganism growth)
  • could have blood cutlures draw n in sets of 2 or 3 (30 min apart at diff sites)
  • place in incubator at 98.6
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3
Q

What tubes were designed for blood culture?

A

yellow-stoppered SPS (sodium polyanethol sulfonate) tubes. Blood culture bottles are usually larger and more cumbersome
to handle than normal venipuncture tubes. H

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4
Q

what is antibiotic removal device (ARD)?

A
  • resin that absors antibiotic
  • used for pt on antiobtioic at time of collection
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5
Q

what are the pair of bottles for blood cutlure?

A
  • one is aerobic and other is anaerboci
  • should be obtained from diff sites and/or at diff time intervals
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6
Q

what is an example of a special blodo culture bottles

A

for myobacterium (TB)

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7
Q

what is sterile proceudre for blood culture?

A
  • Cleanse the site using sterile technique and the appropriate antiseptic
  • . Cleanse the site with 70% or 90% alcohol prep, or other cleansing agents, such
    as 0.5% chlorhexidine gluconate, 2% iodine, Betadine, or benzalkonium chloride
    (Zephiran Chloride)
  • second cleanse with 0.5% chlorhexidine gluconate, 2% iodine, Betadine, or benzalkonium chloride
  • if not normal flora could be introduce ionto blood cultures
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8
Q

how much blood is drawn for blood clulture?

A
  • 8-10 mL per bottle or tube for an adults
  • amt of blood matters!!! (some bacteria like E. coli exist in small amt)
  • sometimes healthcare prvider specify blood culture x 2 which means 2 diff sites or times (prevent false neg)
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9
Q

pediatric blood culture

A

2.5-10mL for each bottle

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10
Q

blood culture for infant

A

0.5-1mL per bottle

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11
Q

how to collect blood culture

A
  • can use n evacuated system, a syringe and transfer device, or a butterfly (winged)
    collection set
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12
Q

syringe draw for blood culture?

A
  • use one that will hold enough blood for tubes and bottoles (20mL for adults)
  • anerobic first then aerobic
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13
Q

butterfuly assembly

A
  • aerobic first then anearobic to clear air in butterfyl tube
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14
Q

what is glucose testing ?

A
  • for ● diabetes mellitus (insufficient production of insulin)
    ● gestational diabetes (high blood sugar during pregnancy)
    ● hyperinsulinism (increased levels of insulin, resulting in low blood sugar
    known as hypoglycemia)
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15
Q

what is fasting blodo sugar?

A
  • idwentify risk of diabetes
  • single blood sample after no intake of food or drink for 8-12 hrs
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16
Q

2 hour post prandial blodo sugar

A
  • identify risk for dizbetes
  • take n2 hours after meal, less frequently used bc inconsistent result
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17
Q

random blood sugar

A
  • identify risk for diabetes or hypoglycemia
  • taken randomly throughout the day; a wide variety o fresults indicate problem
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18
Q

2-3 hour oral glucose tolerance test (OGTT)

A
  • diagnose gestational diabetes, diabetes mellitus, hypothalmic obesity,and reactive hypoglycemic
  • Fasting blood sugar,
    30 minutes, 1 hour, 2 hours, and 3 hours after oral glucose
    ingestion
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19
Q

glucose challege screening test

A
  • identify risk of gestation diabetes 91hr) or PCOS (2hr)
  • blood sample 1 hour or 2 hour after oral glucose ingestion
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20
Q

iv glucose tolerance test

A
  • evaluate insulin secretion in prediabetics
  • blood sampel after glucose is admnistered directly into boodstream
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21
Q

when should a GTT not be utilized

A
  • if pt have elevated glcuose (over200 or 126 mg/dL- depends on facility)
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22
Q

what tube is used for GTT test?

A
  • gray top bc sodium fluoride rpevents glyolysis
  • if immediate testing can use gold or light green top tube
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23
Q

new born screening

A

● biotinidase—deficiency of the enzyme that breaks down the vitamin biotin
● cystic fibrosis—mucous secretions accumulating in various organs
● galactosemia—the inability to break down the milk sugar galactose
● hypothyroidism—a decrease in thyroid function
● phenylketonuria (PKU)—a buildup of phenylketone due to decreased
metabolism of phenylalanine
● sickle cell disease—abnormal hemoglobin structure

  • could also do toxoplasmosis, HIV
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24
Q

what is biotinidase deficiency?

A
  • impairs activity of other enzymes that depend on biotin (biotinsynthesis of fatty acids and breakdown of amino acids)
  • could result in neurological damage,
    such as hearing and vision loss, and problems with movement and balance
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25
Q

screening for CF

A
  • dermal puncutre and collect blood on Guthrie card (if test positive chloride sweat test to conform diagnose - not done by phleb)
26
Q

what is phlenylketonuria (PKU)

A
  • build up of pheylketone in blood when body doesnt have enzyme that breakes it down
  • phenylketones can be found in blood
  • phenylalanine can cause damage to brain tissue, heart problems, microcepahgly, skin disorders such as eczema
27
Q

why would specimen not be satisfacory for state testing specimen collection

A

● all circles are not completely filled
● a circle is oversaturated
● the specimen is not allowed to dry thoroughly
● the specimen is contaminated with a foreign substance
● an expired form is used
● the form is not received within 14 days of collection

28
Q

what are peripheral blood smears

A
  • blood smear on glass slide for microscopic examination of blood
  • either venous blood or capillary
  • could prepared from blood from finger to slide
  • some of the most valuable info from peripheral blood smear
  • cbc with differnential (hematological disordes and blood parasites)
29
Q

Wjat are thin smears?

A
  • for diffentials
  • use wedge method (2 slides touching each other at angle)
  • made from fresh nocoagulated drops of blood
  • get blood from dermal puncutre or tube in EDTA
30
Q

how to obtain a good wedge smear?

A
  • angle ta 30-35 degrees
  • make sure blood drop isnt too big or too small
  • increase speed if smear too long, decrease if too short
  • smear should ocver2/3 to 3/4 of slide
31
Q

what are thick blood smears

A
  • for malarial parasite
  • direclty fro mdermal puncuter (drop of blood on cneter of clan glas and draw spiral)
  • should have a thick circular-oval smear
  • should be dense by can read newspaper through it (too thick = maky peel away)
32
Q

blood transfusion protocol- unique number on pt wristband and tube for blood bank specimen

A
  • unique number on pt wristband and tube for blood bank specimen (only used for 1 pt)
    = type and cross mathc 72 hours before draw (type and cross mathc in 1 or 2 pink top EDTA tubes)
33
Q

how to collect donor blood

A
  • if plasma, platelets, and granulocytes then can be collected apheresis (collect through speccial apparatus)
  • normal is taking 450-500 mL of blood from large vein in antecubital area
  • use 2 step cleansing with blood collection bag, tubing and 16 guage needle
  • anticoagulate citrate phosphate dextrose is in bad to preserve 450 mL of blood for 21 days
34
Q

donor qualitifications

A

● be at least 16 years old (written parental consent is required for minors)
● weigh at least 110 pounds
● be in good general health
● have eaten within 4 hours prior to donation
● not have donated blood in the past 8 weeks

35
Q

what is autologous blood collection

A
  • donate blood and stored in blood bank and is given back to pt (concern fo bloodborne pathogens)
  • if prior to surgery then writen order from healthcare provider
  • hemoglobin should be at 11 grams and surgical prcuedre more than 72 hours from autologous donation
36
Q

autologous blood transfusion during surgery

A
  • readministered blood lost during surgery from body cavities into special reservous in instruemnt called a cell saver
  • cleans blood with saline solution and infuse back into pt
  • similar is orthoPAT used for knee surgery
37
Q

what is therapeutic phlebotomy

A
  • performed for overproduction of iron or RBC or abd sotrage of iron
  • most common for polycthemia vera and hemochromatosis
  • polycthemia blood is not suitable for transfusion but hemochromatosis may be
38
Q

what is abg collection for?

A
  • determien ability of lungs to exchange o2 and co2
  • arterial puncutre is used to test ABGs
  • commonly usaed to test partial pressure of O2 and CO2 and pH level
  • mostly done by medical personal
  • respiratory therapy deperment may also do it
39
Q

what conditions measure ABGs

A

● chronic obstructive pulmonary disease (COPD)
● cardiac failure
● respiratory failure
● severe shock
● lung cancer
● coronary bypass
● open-heart surgery
● respiratory distress syndrome

40
Q

what is an allen test?

A
  • ensure blood supply to wrist is adequate
  • pt make fist while healthcare worker appliesp ressure to major artieres in hand to stop blood flow
  • pt relax fist and then fingers should be pale from lack of blood flow
  • healthcare worker releases pressure on artery not for arterial puncutre and keeps other occluded, if blood returns to palm and giners within 5-15 sec position allen test (hand can be sufficiently suppled with blood from one artery while other is drawn)
  • no tourniquet
41
Q

collection process for artieral puncutre

A
  • may use local anesthetic
  • arterial blood for ABG is collected with a short needle in a heparinized syringe and placed immediately in an ice bath
42
Q

how long pressure for arteiral punctre/-

A
  • rarely done on outpt
  • min 5 min (remain in waitig room for 30 min)
43
Q

waht are venous access device?

A
  • hoolow tube (cannula) inserted in vein and left
  • saline lock (heparin lock) is a VAD for blood specimen (1 in winged cathereer in vein for up to 96 hours)
    after blood is drawn or med is administered cannula is flushed with heparin or normal salien to prevent clotting
  • not typically done by phleb but phleb may be present for procuedre and transporation to lab
  • only specially trained personnel
  • discard first 5 mL
  • if blood culture thorugh VAD then antoehr set with venipuncutre
44
Q

wha are other types o VAD?

A
  • central venous therapy pots and shunts
  • peripherally inserted central cetherter (PICC) (introduced in to vein in arm and threaded into a central vein such as inferior or supeerior vena cava)
  • arteiral venous fistula is surgically inserted shunt connecting artery and vein in forearm for hemodialysis
  • phleb never access shunts of central venous line or collect blood from arms with venous access devcies
45
Q

what is special about VAD collection?

A
  • potential for hemoluysis
  • collect blood using special huber needle and suringe
  • transfer to tubes immediately and mix
  • pull into sringe and evacuated tube could cause hemolysis (never force blood out of syringge by psuhing hard on plunger)
46
Q

CVAD

A

central vascular access device
- indwelling line
- tibuing into main vein or artery
- for fluids med pressures and bloods
- specialy training!
- flushed with heparin or saline
- discard blood for 2x deadspace volime for noncoag and 6x (5mL) for coag

47
Q

what is initial specimen diversion

A

can reduce blood culture contamination rate down to 0.2%
- its a preassembled sterile closed system with. butterfly needle and transfer adapter
- it diverts the first 1.5-2 mL of blood with skin plugs, cells and microbes that would mess up sample

48
Q

What is media inoculation

A

adding blood to blood culture bottle

49
Q

what id direct inoculation

A

collect specimen directly into bottle with btterfuyl and special holder
- fill aerobic first

50
Q

what is syringe inoculation

A
  • do anaerobic then aerobic
  • push culture bottle tube into device until needle penetrates bottle stopper
  • don’t push plunger
51
Q

what is an intermediate blood tube

A
  • SPS reduces the action of a protein called complement that destroys bacteria and slows down the ingestion of bacteria by leukocytes and reduces the activity of certain antibiotics
    = Other anticoagulants—such as citrate, heparin, EDTA, and oxalate—may be toxic to bacteria and are not recommended. Use of an intermediate tube is discouraged, however, for the following reasons:”

Excerpt From
Phlebotomy Essentials, Enhanced Edition
McCall, Ruth;
This material may be protected by copyright.

52
Q

why are intermediate blood solutions. not recommended

A

“*When added to the blood culture bottle, SPS in the collection tube increases the final concentration of SPS.
*Transfer of blood from the intermediate tube to the blood culture bottles presents another opportunity for contamination.
*Transfer of blood to the culture bottles presents an exposure risk to laboratory staff.
”

53
Q

when would a physician order to blood culture in “fastidious antimicrobial neutralization (FAN) (bioMerieux) or antimicrobial removal device (ARD)”

A

if pt is on antimicrobial agent that can inhibit the growth of the microorganisms in the blood culture bottle
- “FAN bottles contain activated charcoal, which helps to neutralize the antibiotic. An ARD contains a resin that removes antimicrobials from the blood”

54
Q

how is blood culture different for pediatric

A

t“he same methods for skin antisepsis for adults apply to pediatric patients unless the antiseptic is tincture of iodine. It is recommended that in place of the iodine step, the site should be cleansed two additional times with separate preparation pads saturated with 70% isopropyl alcohol or ethyl alcohol.
In general, for infants and younger children, the volume of blood collected for culturing should be from 1% to 4% of the patient’s total blood volume. Pediatric blood culture bottles are designed to accommodate an inoculation of up to 4 mL of blood. See Box 11-1 for ASM’s specific recommended volumes based on patient’s weight.
”

55
Q

who can have a false positive lactose tolerance test?

A
  • pt with normally flat GTT curve
  • pt with small bowel resection
  • slow gastric emptying
  • crohns disease
  • CF
56
Q

how to test for lactose intolerance

A

drink lactose contianing olution, breath into bag

if lactose in tolerant lactose will ferment in colon = lots of hydrogen

57
Q

what tube to draw blood alc in

A

gray top sodium fluoride with or without coagulant

58
Q

what to do if drawing sample of blood for hallucinogenic?

A

light blue for hallucinogenic

lavender EDTA for inhalant or DNA analysis

59
Q

what is the test for TB

A

interferon gamma release assay (IGRA)

measures immune response to tb

60
Q

order for quantiferon test?

A
  1. gray top (nil)
  2. green top (TB1 antigen tube)
  3. yellow top (TB2 antigen tube)
  4. purple top (contain mitogen)

no definite order, just commononly uesed

61
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62
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Phlebotomy (17 decks)

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