SPECIMEN COLLECTION & HANDLING Flashcards
1
Q
Conscious Inpatients/ Hospitalized patients
A
Verbally ask their full names including middle names
Verify using ID bracelet which includes:
1. First & Last names
2. Hospital/Unit #
3. Room/ Bed #
4. Physician’s name
2
Q
Sleeping patients
A
Identified in the same manner as conscious in-patients
Must be awakened before blood collection
3
Q
Unconscious, Mentally Incompetent Patients
A
Identified by asking the attending nurse or relative
As well as thru ID bracelet
4
Q
Infants & Children
A
A nurse or relative may identify the patient
5
Q
Outpatient/ Ambulatory Patient
A
Verbally ask:
1. Full names
2. Address
3. Birth date
Countercheck with Valid ID with photo
6
Q
3-Way ID to avoid misidentification:
A
- Patient’s verbal ID statement
- Check ID band
- Visual comparison of labeled specimen with patient’s ID before leaving bedside
7
Q
Average human body contains how many liters of WB
A
5 quartz or 4.73 L
8
Q
Adult Males have approximately how many liters of WB
A
5 - 6 L
9
Q
Adult Females have approximately how many liters of WB
A
4 - 5 L
10
Q
WB is composed of ___ Plasma and ___Cells
A
60%; 40%
11
Q
Process by which blood is obtained from a pateint’s artery
A
Arterial Puncture
UseL Blood gas analysis & pH measurement
12
Q
Sites for Arterial Puncture (5)
A
- Radial Artery
- Brachial Artery
- Femoral Artery
- Scalp Artery
- Umbilical Artery
13
Q
This test is performed prior to blood collection from radial artery
A
Modified Allen Test
14
Q
Major Complication of Arterial Ouncture:
A
Thrombosis
Hemorrhage
Possible Infection
15
Q
Unacceptable Sites:
A
Irritated
Edematous
Near a Wound
Area of an AV shunt or Fistula
16
Q
Angle for Arterial Puncture:
A
45 - 60 degrees
17
Q
Blood is obtained from a patient’s vein
Deoxygenated blood with a dark red color
A
Venipuncture
18
Q
Sites for Venipuncture:
A
Antecubital fossa region
Veins on the wrist & dorsal aspect of hands
Veins on ankle
19
Q
Antecubital fossa region sites:
A
- Median Cubital vein (best site)
- Cephalic Vein
- Basilic Vein (not chosen unless no other vein is more prominent; near brachial artery)
20
Q
Order of Draw
A
- Yellow
- Light Blue
- Serum (Red)
- Green
- Lavender/ Purple
- Gray
21
Q
Anticoagulant based on Order of draw
A
- Blood Culture Tubes, Sodium Polyanetholesulfonate (SPS)
- Trisodium Citrate
- With or Without Clot Activator or Gel Separator
- Heparin (Li, Na, NH4)
- EDTA
- Sodium fluoride & Potassium Oxalate
22
Q
What tube is used for Lactate Sample collection?
A
Gray tube
Blocks Glycolysis
23
Q
Tourniquet placement and duration
A
3-4 inches above the site
Never leave tourniquet longer than one minute
24
Q
Angle of needle on Venipuncture
A
15 to 30 degree angle
Bevel side up*
25
IV Fluid contamination
Increases
Glucose
Chloride
Potassium
Sodium
26
IV Fluid Contamination
Decreases
Urea
Creatinine
27
As little as __% contamination with 5% dextrose will INCREASE glucose in blood sample by ___mg/dL or more
10% contamination;
500 mg/dL
28
No traces of alcohol should remain on skin because it may cause:
Hemolysis & contaminate Glucose testing
29
For Ethanol Testing, disinfection is:
Benzalkonium Chloride solution
Zephiran Chloride (1:750)
30
Most common form of skin cleansing before drawing blood for culture:
70% Alcohol then
Iodophor
31
Skin disinfectant for blood culture for infants 2 months and older & in patients with iodine sensitivity
Clorhexidine Gluconate
32
Color coding:
1. 20G
2. 21G
3. 22G
1. Yellow
2. Green
3. Black
33
Gauge of needle is ___related to the size of the needle
INVERSELY
34
Gauge used for venipuncture
21G
35
Gauge used for children
23G
36
Gauge for winged infusion
23G or 25G
37
Gauge most commonly used for small & difficult veins
23G
38
Gauge used for scalp or other tiny veins of premature infants
25G
39
Needle length
| Syringe
1 - 1.5 inches
40
Needle length
| Butterfly needle
1/2 to 3/4 inch
41
Red top tubes will take __ minutes to completely coagulate blood
60 minutes
42
Clot activators will cause blood to clot within ___
30 minutes
43
Tubes with thrombin particles will clot blood in ____
5 minutes
44
Sites to be avoided (Venipuncture)
1. IV lines in both arms
2. Burned or Scarred areas
3. Areas w/ Hematoma
4. Thrombosed vevins
5. Edematous arms
6. Partial/Radial Mastectomy on one or both arms
7. Arms with AV shunt or fistula
8. Casts on arms
45
Increase in number formed elements in blood
| Immediate Local Complication
Hemoconcentration
46
Failure of blood to enter the syring/ vacutainer tube
| Immediate Local Complication
1. Excessive pull of plunger
2. Piercing the other pole of the vein
3. Transfixation of the vein
4. Incorrect bevel position
5. Absence of vacuum
47
Transient loss of consciousness due to lack of O2 in brain
| Immediate Local Complication
Syncope (Fainting)
48
What to do when a patient feels faint?
Needle should be removed immediately
Patient's head should be lowered between the legs
Patient should be instructed to breath deeply
49
Abnormal vascular condition in which thrombus develops within a blood vessel
| Late Local Complication
Thrombosis
50
Inflammation of a vein often accompanied by a clot, occurs as a result of trauma to the vessel wall
| Late Local Complication
Thrombophlebitis
51
Late General Complications:
Serum Hepatitis
AIDS
52
1. Using a needle that is too small
2. Pulling a syringe plunger too fast
3. Expelling the blood strongly into a tube
4. Forcing the blood from a syringe into an evacuated tube
5. Shaking or mixing the tubes vigorously
6. Performing blood collection before the alcohol has dried at the collection site
Causes of Hemolysis or Hemolyzed specimen
53
1. Vein is fragile or too small for the needle size
2. Needle penetrates all the way through the vein
3. Needle is partly inserted into the vein
4. Needle is removed while the tourniquet is still on
5. Excessive probing
6. Pressure is not adequately applied after venipuncture
Causes of Hematoma
54
Used to obtain blood from children older than one year old
Skin Puncture
55
Length of lancet:
1.75 mm
56
Depth of incision:
< 2.0 mm in infants & children
< 2.5 mm for adults
57
Preferred sites for Skin puncture:
| 4
1. Lateral plantar heel surface
2. Palmar surfaces of the fingers (3rd or 4th)
3. Plantar surface of the big toe
4. Earlobes - least used
58
Which finger should not be used
thumb and 5th finger
59
Important step to do immediately after skin puncture:
Wipe away the first drop of blood with a sterile site
60
Order of filling microcollection tubes
1. EDTA
2. Other tubes with additives
3. Non additive tubes
61
Skin puncture is useful in adults with:
1. Extreme Obesity
2. Severe burns
3. Thrombotic tendencies
62
Sites not generally used for skin puncture
1. Central arch of an infant's heel
2. Fingers of a newborn or infant less than 1 year old
3. Thumb
4. Index finger
5. Fifth finger
6. Fingers on the side of a mastectomy
63
Used for blood gas analysis in newborn and infants for measuring pH and pCO2, but not pO2
Arterialized Capillary Blood
64
Best method for blood gas collection in newborns:
Indwelling umbilical artery catheter
65
Eliminates multiple phlebotomies and useful in critical care and surgical situations
Central Venous Access Collection
66
Order of Draw from Catheter lines:
1. Draw 3-5 mL then DISCARD
2. Blood culture
3. Anticoagulated tubes
4. Clot tubes
67
All measurements should be performed within ___ after collection
45 minutes to 1 hour
68
Centrifugation requirement:
3000 RCF for 10 minutes
69
Reasons for rapid separation of blood (after centrifugation)
1. To prevent glycolysis
2. Certain substances are very unstable (K, P, Glucose)
3. To prevent shit of electrolytes (False increase of K, and decrease of Na in serum & plasma)
4. To prevent hemolysis
70
Increased in Hemolysis:
***KLA6MPITC***
K (150x in RBC)
LDH (150x in RBC)
ACD
ALP
Aldolase
ALT
AST
Albumin
Mg
Phosphorus
Iron
Total Protein
Cholesterol
71
Other effects of Hemolysis:
1. Interferes with color reactions
2. Increases bilirubin levels
3. Inhibits Lipase enzyme
72
Most common interfering conditions:
Hemolysis
Icterus
Lipemia
73
Occurs when Serum bilirubin reaches 25.2 mg/L or 430 mmol/L
Icteric Sample
74
Occurs when serum triglyceride exceeds 25.2 mg/L or 400 mmol/L
Lipemia
75
Lipemia inhibits:
Amylase
Urate
Urea
CK
Bilirubin
Total Protein
76
Enzymes affected by low temperature storage prior to testing
***DECREASES***
LDH 4
LDH 5
***INCREASES***
Alkaline Phosphatase
77
Specimens that require chilling (4C) during transport & storage
Ammonia
Blood gases
Catecholamines
Gastrin
Lactic Acid
Renin
PTH
Pyruvate
78
Photosensitive analytes
Bilirubin
Beta-Carotene
Folate
Porphyrins
Vitamin A
Vitamin B6
79
Excessive centrifugation may cause:
| > 3000 RCF
Cell Lysis
Slight Elevation in:
K
LD
80
Insufficient centrifugation may cause:
| < 1000 RCF or < 10 minutes
Incomplete barrier formation in gel tubes
Cell contamination of the specimen
81
Most common method of collection of CSF
Lumbar puncture
between 3rd or 4th lumbar vertebrae
between 4th and 5th lumbar vertebrae
82
Required pressure before collection:
Between 90 and 180 mmHg
83
Volume that can be collected:
20 mL of CSF
84
CSF Tubes:
1. Tube 1 - Chemistry (Gluc & CHON analysis) or Immuno/Sero
2. Tube 2 - Microbiology (Culture & Gram stain)
3. Tube 3 - Hematology (Cell counts)
| Tube 3 least likely to be contaminated by bloody tap at collection
85
CSF Tubes:
1. Tube 1 - Chemistry (Gluc & CHON analysis) or Immuno/Sero
2. Tube 2 - Microbiology (Culture & Gram stain)
3. Tube 3 - Hematology (Cell counts)
| Tube 3 least likely to be contaminated by bloody tap at collection
86
Used to assess the completeness of the specimen:
24-hour Urine Creatinine
87
Preferred anticoagulant for Synovial fluid
Sodium Heparin
88
Ten Common Errors in Specimen Collection:
1. Misidentification of patient
2. Mislabeling of specimen
3. Short draws/ Wrong anticoagulant/ blood ratio
4. Mixing problems/ clots
5. Wrong tubes/ Wrong anticoagulant
6. Hemolysis/ Lipemia
7. Hemoconcentration
8. Exposure to light/ extreme temperatures
9. Improperly timed specimens/ Delayed delivery to laboratory
10. Processing errors: Incomplete centrifugation, Incorrect log-in, Improper storage
89
Combines with Calcium to form insoluble salt
Interferes with Na, K and most BUN (urease) measurement
Oxalate
90
Combines with Calcium in a non-ionized form
Citrate
91
Concentration of Citrate
3.2% or 3.8%
92
Ratio of anticoagulant to blood
1:9
93
Combines with calcium in a process called Chelation
Ethylenediamine tetraacetic acid
EDTA
94
Plastic tubes;
Spray-dried
di-potassium
K2EDTA
95
Liquid form;
Glass tubes
tri-potassium
(K3EDTA)
96
forms weakly dissociated calcium components
Fluoride
97
Inhibits glycolysis
Sodium Fluoride
98
Acts as anti-thrombin, and antithromboplastin; anti-Factor X; Ideal Universal Anticoagulant
Heparin
99
Heparin used for most chemistry tests
Lithium Heparin
100
Doing this affects:
1. RBC morphology and lipids in EDTA tubes
2. Binding of elevtrolytes and troponin to heparin in some plasma tubes
Underfilling blood collection tubes
101
Tube used for Trace elements, Toxicology and TDM
Royal blue
| Serum; No Additive
102
Used for Lead test
Tan tube
103
Used for ESR-Westergen Method
Black tube
| 4:1 blood to AC (Sodium Citrate)
104
Used for ESR-Westergen Method
Black tube
| 4:1 blood to AC (Sodium Citrate)
105
Specific Gravity of:
1. Serum
2. Gel separator
3. RBC
1. 1.03
2. 1.04
3. 1.05
| Top: Serum
Bottom: RBC (Formed elements)
