specimen collection, handling, and transport Flashcards
Never draw out the syringe without removing first the tourniquet to avoid __
hematoma
Avoid prolonged application of tourniquet to avoid __
hemoconcentration
Do not extract blood from patients while they are receiving intravenous medication because these solutions may influence the __.
chemical analysis
Blood specimens obtained must be placed in appropriate containers for each specific test. The blood specimen collected with anticoagulants must be well mixed to prevent __
coagulation
collection priorities
routine samples
asap samples
stat samples
have the highest priority and are usually ordered from the emergency department
stat tests
are usually collected early in the morning but can be collected throughout the day during scheduled “sweeps” (collection times) on the floors or from outpatients
routine samples
-means “as soon as possible.” The response time for the collection of this test sample is determined by each hospital or clinic and may vary by laboratory tests.
ASAP
sample is to be collected, analyzed, and results reported immediately.
STAT
npo (non per orem); “nothing by mouth”
fasting sample
examples of timed samples
Glucose Tolerance Tests
2-Hour Oral Glucose Tolerance Test
Lactose Tolerance Test
what are the type of samples
fasting samples
timed samples
blood culture
composition of whole blood
Liquid portion of unclotted blood
With anticoagulant
Contains albumin, globulin and fibrinogen
The first step in learning to perform a venipuncture is knowledge of the __
needed equipment
advantage of evacuated tube system
Blood is collected directly into the evacuated tube, eliminating the need for transfer of specimens and minimizing the risk of biohazard exposure
ETS includes
Double-pointed needle
Needle holder
Color-coded evacuated tubes
refers to the diameter of the needle bore
needle gauge
Sharpened end of the needle
point
The end of the shaft that forms a flat, slanted surface
bevel
the hollow core of the needle/opening
bore/lumen
the long slender stem of the needle
shaft
where the needle is attached
hub
for 2 way needle. Where the tube is punctured
rubber sleeve
Needle Size for Veni:
1-inch and 1.5-inch lengths are used
uses a shield that the phlebotomist locks over the needle tip after completion of the venipuncture
Eclipse blood collection needle (Becton, Dickinson, Franklin Lakes, NJ)
made of rigid plastic and may be designed to act as a safety shield for the used needle
needle holdrs
___directs that holders must be discarded with the used needle.
Occupational Safety and Health Administration (OSHA)
NEEDLE DISPOSAL SYSTEMS
criteria
Rigid, puncture-resistant, leak-proof disposable “sharps” containers labeled BIOHAZARD that are easily sealed and locked when full.
- also known as Vacutainers and are available in glass and plastic.
evacuated tubes
Contain a premeasured amount of vacuum for blood collection
evacuated tubes
The amount of blood collected in an evacuated tube ranges from __ mL and is determined by the size of the tube and the amount of vacuum present.
1.8 to 15
The advantage of this system is that the phlebotomist is able to control the suction pressure on the vein by slowly withdrawing the syringe plunger.
syrnge
For drawing blood from patients with small or fragile veins
syringe
Routinely used for venipuncture range from 2 to 20 mL
syringe
for performing venipuncture from very small or very fragile veins often seen in children and in the geriatric population
winged blood collection set
The primary antiseptic used for cleansing the skin in routine phlebotomy is ___
70 percent isopropyl alcohol.
For collections that require additional sterility, such as blood cultures and arterial punctures, the stronger antiseptics such as___(for patients allergic to iodine) are used to cleanse the area
iodine or chlorhexidine gluconate
. __ tape should be used for persons who are allergic to adhesive bandages.
Latex-free
patient identification procedures for conscious in-patients/hospitalized patients
verbally ask full names including middle names
verify name using the identification bracelet which includes first and last names, hospital/unit number, room/bed number, physician’s name
patients who are sleeping should be awakened before sample collection
patient identification procedures of unconscious, mentally incompetent patients
they are identified by asking the attending nurse or relative; HAVING ID BRACELET IS A MUST
patient identification procedures for infants and children
a nurse or relative may identify the patient, or by means of an identification bracelet
patient identification procedures for outpatient/ambulatory patient
verbally ask their full name, address or birthdate, and countercheck with national license cards or ID with a photo
if the patient has an ID bracelet, the manner of identification is the same with hospitalized patients
3 way ID
to avoid misidentification, a phlebotomy may require a 3 way ID system, in which the patient is identified by:
a patient’s verbal ID statement
a check of the ID band
visual comparison of the labeled specimen with the patient’s ID band before leaving the bedside
2022 hospital national patient safety goals
identify patients correctly
improve staff communication
use medicines safely
use alarms safely
prevent infection
identify patient safety risk
prevent mistakes in surgery
an average human body containes approx. ___ L of blood
4.73 Liters
adult male has approx __ L of blood
5-6 liters
adult female has approx __ L of blood
4-5 liters
whole blood is composed of approx:
plasma __ %
cells - ___ %
plasma 60%
cells 40%
a process by which blood is obtained from a person’s artery
arterial puncture
is the oxygenated blood with bright red color
arterial blood
uses of arterial puncture
blood gas analysis and pH measurement
sites of arterial puncture
radial artery
brachial artery
femoral artery
scalp artery
umbilical artery
is there a need for tourniquet in arterial puncture?
nope
before blood is collected from radial artery, ___ should be done to determine whether the ulnar artery can provide collateral circulation to the hand after the radial artery puncture
modified Allen test
____ artery is relatively large and easy to puncture, but extra care must be given to older individuals because it bleeds more than other artery sites
femoral
major complications of arterial puncture
thrombosis
hemorrhage
possible infection
unacceptable sites for arterial puncture
irritated
edematous
near a wound
in an area of an arteriovenous shunt or fistula
sites for venipuncture
antecubital fossa region
veins on the wrist and dorsal aspect of the hands
veins on the ankle
why do basilic vein is the least site to consider
due to close proximity to the brachial artery
when to consider dorsal vein
when the antecubital fossa region is not available
when to consider ankle vein
if the arm vein is not available
what does it mean if petechiae appear after venipuncture,
it indicates that minute amounts of blood have escaped into the skin epithelium
how do polymer barrier works in separating blood clot and serum
it has the specific gravity that is between the blood clot and serum
why we must avoid using tubes with separator or SST in therapeutic drug monitoring
the gel absorbs the drugs causing falsely decrease results
the gel absorbs the drugs causing falsely decrease results in TDM, in exception, what type of gel defies this statement
acrylic based gels
what type of gel absorbs drugs in SST for TDM
siliconized and polyester gels
plasma separator tubes with heparin is commonly colored ___ top
light green top
a gray top tube containing fluoride and oxalate should be used for lactate sample collection, as it blocks __
glycolysis
why do sodium fluoride is used for ethanol specimens
it prevents decrease in alcohol due to glycolysis kasi nga si fluoride kayang magblock ng glycolysis
it prevents increase by fermentation of alcohol din caused by bacteria
is a handheld medical device that helps visualize veins before phlebotomy
vein viewer
the sites adjacent to intravenous therapy should be avoided
tru or false
true
in conditions were both arms are involved in therapy and the IV cannot be discontinued for a short time, what should we do
a site below the IV line should be sought
initial 5 ml should be discarded
collection of blood below the IV line must be written on the lab requisition form to inform the staff in the chemistry laboratory or other sections
as little as 10% contamination of 5% dextrose will cause false increase to glucose of about
500 mg/dl
tourniquet application should be how many inches above the site and not longer than 1 mn
3-4 inches above the site
if blood pressure cuff is used as tourniquet, it is inflated ___ mmHg
60 mmHg
according to CLSI, if the tourniquet is used to look for a vein for selection, it should be removed and reapplied after how many minutes
2 mns
__- is applied to obstruct the return of venous blood to the heart and distend the veins, it is discarded after each phlebotomy
tourniquet
studies have shown that reusable tourniquet have the potential to transmit bacteria, what bacteria is mentioned in the book of rodriguez
staphylococcus aureus
no traces of alcohol should remain on the ksin because it may cause __
hemolysis and contaminate glucose testing
for ethanol testing, __ should be used for skin cleansing
benzalkonium chloride
is the most common form of skin cleansing before drawiing blood for culture
70% alcohol followed by an iodophor
according to CLSI, ___ is recommended skin disinfectants for blood culture for infants 2 months and older, and for patients with iodine sensitivity
chlorhexidine gluconate
color of syringe needles and their gauge
yellow - 20
green - 21
black - 22
considered as the standard needle gauge
21 needle gauge - green cap
needle gauge used for child
23 gauge
needle gauge for winged infusion set
23 or 25 gauge
needle gauge for small and difficult veins
23 gauge
is used by trtained personnel to collect blood from scalp or tiny beins of premature infants and neonates
25 gauge
using a needle smaller than 23 gauge for arm veins may cause _
hemolysis
butterfly needles comes in ___ gauges
21, 23, and 25
needle length
1 - 1.5 inch
21-23 gauge
butterfly needle length
1/2 to 3/4 inch
red top tubes without clot activators will take ____ mns to completely coagulate
60 mns
clot activators will cause the blood to clot within __mns
30 mns
tubes with thrombin III will coagulate blood in ___
5 mns
patients preferable to use winged blood collection set or syringe to minimize vessel wall injury and hemolysis
geriatric
oncology
or other hematologic patients
traumatic draw as a result of vessel wall injury can cause increase _____
CK, myoglobin, potassium
when blood is put into a vacuum tube with a narrow needle, what will happen to the rbc
destroyed
sites to be avoided in venipuncture
intravenous lines in both arms
burned or scarred areas
area with hematoma
thrombosed veins
edematous arms
partial/radical mastectomy on one or both arms
arms with arteriovenous shunt or fistula
cast on arms
refers to the increase in the number of formed elements in blood resulting either from a decrease or increase in plasma volume
hemoconcentration
caused by the excessive pull of the plunger
piercing the other pole of the vein
transfixation of vein
incorrect bevel position
absence of vacuum
failure of blood to enter the syringe/vacutainer tube
refers to the transient loss of the oxygen in the brain and results in an inability to stay in an upright position
syncope (fainting)
immediate local complications
hemoconcentration
failure of the blood to enter the syringe/vacutainer tube
syncope (fainting)
late local complications
thrombosis
thrombophlebitis
refers to abnormal vascular condition in which thrombus develops within a blood vessel of the body
thrombosis
refers to the inflammation of a vein often accompanied by a clot which occurs as a result of trauma to the vessel wall
thrombophlebitis
late general complications in venipuncture
serum hepatitis and AIDS are acquired thru contaminated needles and needle stick
causes of hemolysis
using a needle that is too small
pulling a syringe plunger back too fast
expelling the blood strongly into a tube
forcing the blood from a syringe into an evacuated tube
shaking or mixing the tubes vigorously
performing blood collection before the alcohol has dried at the collection site
causes of hematoma
vein is fragile or too small for the needle size
needle penetrates all the way through the vein
needle is partly inserted into the vein
needle is removed while the tourniquet is on
excessive probing
pressure is mot adequately applied after the venipuncture
preferred length of the lancet for skin puncture to avoid penetrating the bone
1.75 mm
to avoid contact with the bone, the depth of the incision should be
<2.0 mm for infants and children
<2.5 mm for adults
the distance from the skin surface to bone or cartilage in the middle finger is
1.5-2.5 mm
preferred sites for skin puncture
lateral plantar heel surface - newborn
palmar surfaces of the fingers - 3rd and 4th
plantar surface of the big toe
earlobes
least preferred site for skin puncture
earlobe
sites not generally recommended for skin puncture
central arch area of an infant’s heel
fingers of a newborn or infant less than 1 yr old
thumb
index
and fifth finger
fingers on the mastectomy
order of filling for microcollection tubes
EDTA
other tubes with additives
non additive tubes
advantages of skin puncture
for premature infants, because large amount of blood from repeated venipunctures may cause iatrogenic anemia
for sick infants, accessible veins must be reserved exclusively for parenteral therapy
skin puncture is often preferred in geriatric patients because the skin is thinner and less elastic
skin puncture is useful in adults with
obesity
severe burns
thrombotic tendencies
blood that is used for blood gas analysis (INFANTS AND NEWBORN) FOR MEASURING pH, pCO2, and pO2
arterialized capillary blood
is the preferred site because of vascularity, low metabolic requirements, and ease with which it can be arterialized
arterialzied capillary blood
the most commonly site for arterialized capillary blood
lateral plantar heel surface
capillary “arterialization” should not be done if arterial blood pressure is below ___ mmHg or if the area has poor blood supply
below 95mmhg
the best method for blood has collection in newborns remains the __
indwelling umbilical artery catheter
the advantage of this is it eliminate multiple phlebotomies and useful in critical care and surgical situations
central venous access collection
disadvantage of central venous access collection
not recommended for bacteriology
because the organisms that grow on the walls of the catheter can contaminate the blood specimen
