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HEMA 1 > Specimen Collection Pt. I > Flashcards

Specimen Collection Pt. I Flashcards

1
Q

general considerations in specimen collection

A
  • knowledge of necessary equipment & supplies
  • technical skills
  • strict attention to patient & specimen ID
  • awareness of & adherence to institutional safety requirements
  • proper specimen transport techniques (leak-proof containers, etc.)
  • professionalism
  • good interpersonal/communication skills
  • consideration & care for the patient
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2
Q

the most important part of specimen collection

A

Specimen & patient ID

- if patient ID is missed = mortal sin

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3
Q

T/F:

it is okay to divulge the results of patients to friends

A

FALSE

- ensure confidentiality of results & safety of the patient

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4
Q

T/F:

all body fluids are considered biohazards

A

TRUE

  • wear PPE
  • prevent injuries from needles/sharps
      • they should be used only once
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5
Q

yellow bins

A

pathologic/infectious waste

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6
Q

yellow with red bins

A

Sharps disposal

- should be puncture-proof

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7
Q

bins for genotoxic/cytotoxic waste

A

Black

- also for non-infectious non-biodegradable

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8
Q

radioactive waste

A

orange bins

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9
Q

yellow with black band/s

A

pharmaceutical, chemical waste

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10
Q

non-infectious biodegradable waste

A

green bins

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11
Q

samples used in the hematology lab

A

a. whole blood
- has all blood components
- usu. used for CBC, RBC/WBC cts.

b. plasma
- liquid portion of blood with anticoagulant
- top layer observed after centrifugation of blood

c. serum
- liquid expressed out of the clot
- for many CC & BB tests

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12
Q

blood without anticoagulant normally starts to clot in ____________

A

5-8 minutes

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13
Q

fresh blood allowed to stand for 1 hour separates into ____________ & ________

A

a. red cell-fibrin
- collects at the bottom of the tube

b. serum
- overlying liquid

*whole blood collected is allowed to clot undisturbed for (30 mins to) 1 hour at RT

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14
Q

layers of anticoagulated blood after centrifugation (top –> bottom)

A
  1. plasma
  2. buffy coat
    - WBC, platelets
  3. red cell mass
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15
Q

main coagulation difference of serum & plasma

A

Fibrinogen

- present in plasma, not in serum

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16
Q

what to do after allowing the blood to clot?

A

Rim the clot gently from tube wall

  • “rim” = “loosen”
  • use wooden stick, thin plastic, or glass rod
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17
Q

how many times is blood centrifuged to obtain serum?

A

2 times

  • after rimming clot
      • 10 mins @ 3000rpm
      • pipette supernatant serum into another tube
  • after 1st centrifuge
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18
Q

at what temperature should serum be stored if it is used immediately?

A

RT

- 20-25C

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19
Q

store at this temperature if test is delayed for 30 minutes-1 hour

A

4C

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20
Q

storage at -20C is good for..

A

3 months

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21
Q

temperature used for long term storage

A

-40C

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22
Q

what to do for frozen specimens?

A
  • thaw on the bench or in water bath (RT) before using

- invert several times to ensure homogeneity

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23
Q

T/F:

it is okay to freeze thawed specimens

A

FALSE

  • thawing destroys cells & analytes
  • DO NOT REFREEZE; discard after
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24
Q

whole blood in which fibrin is removed

A

Defibrinated whole blood

- used when serum is required urgently OR both serum & cells are required

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25
Q

instance/s when both serum & cells are required for analysis

A

investigation of hemolytic anemia

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26
Q

procedure to obtain defibrinated whole blood

A
  1. place blood in a receiver
    - contains a central glass rod with fused glass beads or capillary
  2. whisk rod by moderate rapid rotation
    * coagulation is usu. complete by 5-10 minutes –> most of fibrin is collected on the rod
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27
Q

pre-collection discrepancies

A
  • meal within 2 hours of collection
  • smoking
  • physical activity within 20 minutes
  • stress
  • age
  • gender
  • pregnancy
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28
Q

tests affected when meal is taken within 2 hours of collection

A

a. FBS
- 6 hours fasting required

b. Cholesterol
- 12 hours fasting required

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29
Q

increased in smoking

A

neutrophils

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30
Q

increased when patient is under stress

A

WBC ct.

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31
Q

increased when doing physical activity within 20 minutes of collection

A

Platelet ct.

- remedy: let patient rest for 20 minutes

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32
Q

discrepancies during collection

A
  • diurnal variance
  • posture
  • prolonged tourniquet application
  • excessive negative pressure when drawing blood into the syringe
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33
Q

diurnal variance

A

Variations at different times of the day

- some substances in the body are high/low

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34
Q

analyte/s that is low in the morning

A
  • serum iron
  • WBC ct.
      • lowest in the morning
      • peaks at midafternoon
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35
Q

analytes affected by change of posture

A

Increased:

  • enzymes
  • proteins
  • calcium
  • iron
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36
Q

results in hemoconcentration

A

Prolonged tourniquet application

  • prolonged stasis (stop) of blood flow
  • increases total protein
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37
Q

results in hemolysis

A

excessive negative pressure

  • when drawing blood into the syringe
  • RBC ct. is decreased
  • remedy: pull plunger in a moderate speed
38
Q

post collection discrepancies

A
  • insufficient/excess anticoagulant
  • inadequate mixing of blood with anticoagulant
  • patient or specimen ID error
  • delay in transit to the lab
39
Q

effect of insufficient anticoagulant

A

agglutination of RBCs

40
Q

effect of excess anticoagulant

A

diluted blood sample

41
Q

number of inversions for anticoagulant tubes

A
  • SPS, Heparin, EDTA, NaF, red tube with clot activator
      • 8-10 times
  • Citrate
      • 3-4 times
  • Plain red tube
      • none
42
Q

if blood is transported for _____________ it is to be rejected

A

more than 2 hours

43
Q

necessary for most tests that require anticoagulation, macrotechniques

A

Venous blood

  • PROS:
      • multiple & repeated exams can be performed
      • aliquots of the sample may be frozen for future reference
      • there is no variation in blood values if specimens are obtained from different veins
  • CONS:
      • lengthy procedure; requires more prep.
      • technically difficult in children, obese patients, those in shock
      • hemolyzed blood affects many tests
      • hematoma may occur in & out of the vein
      • hemoconcentration may occur
44
Q

situation:

patient’s arms are to be reserved for IV medications

A
  • do not draw blood for any lab test
  • use ankle veins CAREFULLY
      • contraindication: patients with DM (prone to clot formation)
45
Q

hemolysis interferes with what tests?

A
  • chemistry tests
      • enzymes
      • K
  • coagulation studies
46
Q

hematoma

A

clotted blood within the tissues caused by an injury to the blood vessel wall

47
Q

tests affected by hemoconcentration

A
  • ABG (arterial blood)
  • blood counts
  • blood pH (arterial blood)
  • some coagulation tests
48
Q

T/F:

anticoagulated blood should not be used for peripheral blood smears

A

TRUE

  • WBC, platelet counts, & ESR are unstable
  • changes in platelets –> may cause clumping
  • changes in WBCs –> make ID/differentiation difficult

*peripheral blood smear should be performed within 2 hours after venous blood has been obtained

49
Q

usually used in infants less than 1 year old

A

Capillary peripheral blood

  • when obtaining venous blood is not possible
  • skin puncture is carried out with a lancet
      • discard/decontaminate after use
  • CONS:
      • liable to give erroneous results
      • greater likelihood of contamination & risk of disease transmission (than venipuncture)
50
Q

capillary blood

A
  • free flowing
  • can be arteriolar in origin
  • higher Hct, RBC ct., Hgb
  • total WBC & neutrophil cts. higher by 12%
      • almost 100% in children
  • lower platelet counts
51
Q

venous blood

A
  • higher platelet counts

- - 9-32% higher than capillary blood

52
Q

why does capillary blood have lower platelet counts?

A

due to the adhesion of platelets at the site of skin puncture

53
Q

rupture of RBCs, causing the release of Hgb into the plasma

A

Hemolysis

- usu. caused by technical errors

54
Q

hemolyzed vs. non-hemolyzed blood sample

A

a. hemolyzed
- clear, print can be read (background)

b. non-hemolyzed
- opaque appearance

55
Q

hemolyzed RBCs act as ________________ in activating plasma clotting factors

A

tissue thromboplastin

56
Q

steps to prevent hemolysis

A
  • use sharp lancets
  • do not squeeze/milk puncture site (dermal puncture)
  • use sharp, smooth needles with large diameter (venipuncture)
  • tourniquet must not be too tight
  • syringe should be clean, dry, suction-gentle
  • remove needle when transferring blood to tubes (except in ETS)
  • mixed blood with anticoagulant gently by inversion
  • if serum is needed, do not rim the clot & centrifuge until clot has completely formed
57
Q

T/F:

tourniquet is removed after blood is aspirated

A

FALSE

- remove BEFORE blood is aspirated

58
Q

milking

A

drawing blood from a very small wound

59
Q

identify needle gauge:

white

A

16G

60
Q

identify needle gauge:

pink

A

18G

61
Q

identify needle gauge:

cream

A

19G

62
Q

identify needle color:

20G

A

yellow

63
Q

identify needle color:

21G

A

green

64
Q

identify needle color:

22G

A

black

65
Q

identify needle gauge:

blue

A

23G

66
Q

identify needle gauge:

orange

A

25G

67
Q

identify needle gauge:

purple

A

26G

68
Q

identify needle color:

27G

A

gray

69
Q

identify needle color:

28G

A

teal

70
Q

identify needle color:

29G

A

red

71
Q

identify needle color:

30G

A

dark yellow

72
Q

how to invert tubes?

A

figure of 8 motion

73
Q

methods of blood collection

A

a. skin/dermal puncture
b. venipuncture
c. arterial blood collection

74
Q

methods of venipuncture

A

a. butterfly infusion
b. syringe
c. evacuated tube system

75
Q

this venipuncture method is usu. used for pediatric patients

A

Butterfly infusion method

  • tube is connected to an adapter/syringe
  • uses “butterfly wings” with plastic tubings
76
Q

uses vacutainer 2-way needle (multisample needle)

A

Evacuated tube system

  • ETS
  • with a plastic holder/adapter & evacuated glass tubes with a predetermined vacuum
77
Q

method of choice for small, fragile, damaged veins

A

Syringe method

  • veins mentioned easily collapse under vacuum pressure (ETS)
  • has a barrel & plunger; needle is attached
  • phlebotomist can control the vacuum
      • gently pulling back the plunger while drawing blood
78
Q

evacuated collection tubes

A
  • designed to fill with a predetermined volume of blood by vacuum
  • various sizes available
  • has color-coded rubber stoppers
      • according to the additives present
79
Q

T/F:

never pour blood from 1 tube to another

A

TRUE

- to prevent contamination (additive carryover)

80
Q

T/F:

needle bore is directly related to the gauge number

A

FALSE

  • bigger bore size, smaller gauge number
  • needles are available for ETS, syringe, single draw, & butterfly infusion
81
Q

holder/adapter is used for ____________

A

ETS method

82
Q

other venipuncture equipment required

A
  • tourniquet
      • wipe off with alcohol & replace frequently
  • alcohol wipes
      • 70% isopropyl alcohol
83
Q

medtech should not collect any specimen without this

A

Requisition form

  • part of the medical record
  • contains patient info, test to be performed
84
Q

ways of identification

A

a. verbal
- have patient state his/her first & last names, date of birth

b. comparing info o patient’s ID band with requisition form
* it is recommended to have at least 2 patient identifiers when collecting (CLSI, CAP, JC)

85
Q

what to do after patient identification

A

Verify patient condition

  • last meal
  • allergies to latex
  • has had previous problems with venipuncture
      • if “yes”, have patient lie down
86
Q

how to position patient’s arm

A
  • downward, slightly bent
      • so that tubes till from the bottom up
  • ask patient to make a fist
87
Q

location of the tourniquet

A

3- 4 inches above the antecubital fossa (puncture site)

  • should be placed for 1 min only
  • should be worn in a manner that it can be pulled at once
88
Q

how to palpate the puncture area

A
  • vertically –> determines direction, depth

- horizontally –> determines size

89
Q

how to clean puncture site

A

Concentric circles

  • in to out
  • allow to AIR DRY
      • not air dried will cause contamination, hemolysis
90
Q

T/F:

in doing the puncture, it is important to anchor the vein

A

TRUE

  • pull the skin taut using the thumb of non-dominant hand
      • should be 1-2 inches below the puncture site

HEMA 1 (12 decks)

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