UNIT 6 Flashcards
First line to ensure quality laboratory results
PRE- EXAMINATION PHASE
Patient should be identified in two ways:
ask the patient their name and looking at the wrist band (of patient)
Wrong spelling should be asked to the nurse then a new request should be made.
TRUE
If the patient is unconscious or the cannot talk (toddler, mute, etc), Ask the relative/guardian
TRUE
Tubes are sorted by requirements and what is the priority
➢ Highest error during this phase
➢ Once you are wrong in this phase the following phases would also be wrong
PRE-ANALYTICAL PHASE
Placed in racks then delivered to which section of the laboratory the sample has to be taken
➢ Take note also of the previous result of the patient
➢ Repeated results are placed together with the previous result for comparison
➢ Huge difference calls for third repetition of testing
ANALYTICAL PHASE
➢ Gathering to release
POST-ANALYTICAL PHASE
RBC COUNT is Higher in younger patients (children)
TRUE
Small
quantity in
adult
○ Greater
oxygen
affinity
○ 50% oxygen
release
○ More higher
RBC in
children is
due to the
50% oxygen
release
present
FETAL HEMOGLOBIN
WBC COUNT- Higher in younger patients
● Children
● As the child reaches
several months, the
amount of lymphocytes
increases.
TRUE
RENAL FUNCTION TEST
- Decrease with age
- As age goes, there
would be rising kidney
functions since the
renal functions are
lowered.
- This is for patients
without initial renal
disease
- Renal function test
increases in patients
with renal disorders
TRUE
Thinner air
○ Less oxygen when you live in high places, for
instance Baguio, due to high altitude
○ Higher RBC needed
ALTITUDE
how much RBC is in the
blood
Hematocrit
Elevated in higher altitude
RBC COUNT
HEMOGLOBIN
HEMATOCRIT
C-REACTIVE PROTEINS
URIC ACID
Decreased in higher altitude
Creatinine
Suffering from diarrhea
○ Extraneous Activity
○ Plasma contains a large amount of water when
lost results in high RBC, iron, and calcium.
DEHYDRATION
Effects of Dehydration: ELEVATED
RBC COUNT
IRON
CALCIUM
High Protein- Elevated NPN ( non-protein nitrogen) compounds
UREA AND AMMONIA
Caffeine - Elevated Cortisol and ACTH and NEFA
TRUE
Carbohydrates - Elevated Glucose and insulin
As carbohydrates increase, Insulin also increases.
TRUE
Excessive water and other fluids- Decreased Hemoglobin (overhydrated)
TRUE
Fatty Foods- Elevated Lipid Profile
LDL, HDL, CHOLESTEROL, TRIGLYCERIDES
This different tests are on timed request EX:
insulin at 8pm because it is usually lower at
night
Diurnal / Circadian Variation
Increases with exercise, NO strenuous activity prior to collection, the exercise can falsely increase the
thyroxine
THYROXINE
Peaks 4-6 AM; lowest 8 PM-12 AM;
50% lower at 8 PM than at 8 AM;
increased with stress
CORTISOL
Lower at night; increased with stress
ADRENOCORTICOTROPIC
HORMONE (ACTH)
Lower at night; higher standing than
supine
PLASMA RENIN ACTIVITY
Lower at night
ALDOSTERONE, INSULIN
Higher in afternoon and evening
GROWTH HORMONE AND ACID PHOSPHATASE
Higher with stress; higher levels at 4
and 8 AM and at 8 and 10 PM
PROLACTIN
Peaks early to late morning;
decreases up to 30% during the day
IRON
4% decrease supine
CALCIUM
procedures destroy cancer cells, but can also
include normal cells, so the blood cell counts
decrease (since hematopoietic or stem cells can
also be damaged).
CHEMOTHERAPY
EFFECTS OF DRUGS - Decreased in Blood Cells (WBC, Platelets)
CHEMOTHERAPY
Elevated Liver Enzymes, Decreased clotting factors
NSAID, ANTI-TB
Elevated Liver and Pancreatic Enzymes
OPIATES
Elevated ESR (Erythrocytes Sedimentation Rate)
ORAL CONTRACEPTIVES
is one of the oldest laboratory procedures.
ESR
for DNA production; if it is slow or
discrepancy there would be a delay in nuclear ,….
○ Can lead to megaloblastic anemia
VITAMIN B12
Elevated amylase and Lipase
STEROIDS AND DIURETICS
Elevated calcium and glucose
Decreased sodium and
potassium
THIAZIDE DIURETICS
meaning induced urination;
usually given to patients
with high blood pressure
DIURETICS
It is not advisable to choose a site that has
burns, scars, or tattoos because veins in the
area may be difficult to examine and blood
circulation may be impaired.
Burns may be too painful to touch and tattoos
may also be susceptible to infection due to the
dyes used that may interfere with the process
TRUE
Aside from being difficult to perform, puncturing
damaged veins may also produce inaccurate
results.
Veins could be sclerosed, hardened,
thrombosed or clotted. SHTC
TRUE
abnormal swelling caused by the accumulation
of fluid in the tissues. The tissues become
fragile, making the task of locating the veins
harder.
○ due to reaction from medications, pregnancy,
infections, and other medical problems.
EDEMA/OEDEMA
a solid swelling or mass of blood in the tissues
caused by the leakage of blood from the
vessels during venipuncture.
HEMATOMA
Refers to the removal of the breast through
surgery. Blood drawing from patients who had
undergone this procedure becomes a challenge
since the lymph flow is obstructed, and there
may be swelling and infection after surgery.
○ In addition, a tourniquet cannot be applied
because it can cause injury. It could also
change the blood composition
MASTECTOMY
Condition in which the individual is grossly
overweight.
○ Patients who are obese have veins that are
deep and difficult to locate
○ A solution using a longer tourniquet or locating
the cephalic or cubital vein.
OBESITY
For patients with vasectomy, best site for venipuncture is the antecubital
fossa (median cubital)
TRUE
To obtain samples for arterial blood gas and laboratory studies. Also used to provide accurate and continuous
measurement of patients blood pressure
● Direct blood pressure
● Not used for blood collection/samples
● For blood pressure only
ARTERIAL LINE
A passageway created through surgery and is usually in the arms with the intention of connecting the artery and a vein directly.
● Permanent surgical connection of an artery and vein by direct fusion
● Created to be used for dialysis
● Cannot collect blood from this site
● Can be removed/reversible
● Used for dialysis patients
ARTERIOVENOUS SHUNT, FISTULA AND GRAFT
Used to avoid the use of a needle-sticks, prevent
infections, and reduce wastage from line draws
● Collects blood from the arterial or central venous catheter where it is connected
● Needleless closed blood sampling device
● Reduces the chance of infection, prevent needlesticks, and minimize waste associated with line draws
● Tubing is inserted in the vein
● Surgical procedure
● External limbs of the catheter
● Inserted in internal jugular vein
● Short-term
BLOOD SAMPLING DEVICE
An intravenous catheter attached to a stopcock or cap with diaphragm.
● Catheter or cannula connected to a stopcock or a cap with diaphragm
● Function: Provide access for administering medicine or drawing blood from the patient.
● It is threaded in the peripheral vein, which is in the lower arm above the wrist for up to 48 hours.
● Usually flushed with heparin or saline (to prevent
clogging) and capped for future use
● Access for administering medication or drawing blood
HEPARIN OR SALINE LOCK
A thin plastic tube or catheter inserted into a vein in the forearm to inject volume of fluids into the bloodstream
● Simply as an IV-catheter inserted in a vein to administer
fluids
● The phlebotomist should avoid collecting blood from the arm with IV fluid.
● If blood collection is necessary, the collection site should be below the IV.
● Collection of blood from previously known IV sites should be avoided for 24-48 hours.
● SHOULD NOT TO BE USED TO OBTAIN BLOOD
SAMPLE
INTRAVENOUS SITES
Tubings inserted to the main vein or artery used for blood
collection, monitoring the patient’s pressures, and
administering medication and fluids.
CENTRAL VASCULAR ACCESS DEVICE (CVADs) or
INDWELLING LINES
3 TYPES OF CVADs
Central Venous Catheter lines (CVCL), Implanted Port, Peripherally inserted central catheter (PICC)
surgically implanted disk-shaped
chamber attached to the indwelling
line. It is usually placed on the upper
chest just below the collarbone
IMPLANTED PORT
flexible tube inserted into the veins of
extremities and the central veins
PICC
inserted into large veins (subclavian)
and advanced into the superior vena
cava
CVCL - CENTRAL VENOUS CATHETER LINES
The following trigger hematoma:
a. Excessive or blind probing
b. Inadvertent arterial pressure
c. The size of the vein is too small
➢ Make use of smaller needle
d. Needle penetration has gone all
through the vein
➢ Transfixation or through
and through
e. Needle is not completely inserted
f. Tourniquet is still on when the needle
was removed
➢ Common when still learning
how to perform venipuncture
g. The pressure os not adequate
➢ Apply pressure after
removing needle
➢ Always check if there is
bleeding before leaving
patient
TRUE
Results from blood loss due to blood draw.
○ It is important to ensure that only the required
specimen volume is collected because if 10% of
the blood volume is removed at once from the
body, the patient could face threat
Iatrogenic anemia
This happens when blood is filling up the tube rapidly and there is a rapid formation of
hematoma on the site
Inadvertent arterial puncture
Used in determination of blood gas
➢ Not everybody is allowed to perform
➢ Needs training
➢ Radial artery
➢ Femoral artery
➢ Brachial artery
➢ Mababaw yung mga artery na yan
(superficial)
ARTERIAL PUNCTURE
Happen when there is improper site selection,
rapid needle insertion, excessive redirection of
the needle, and blind probing
○ If the initial attempt is unsuccessful, the
phlebotomist should try to redirect the needle by
using a slightly forward or backward movement.
➢ The next step is to remove the needle
and look for an alternative site
○ Can happen when probing
○ Can be manifested by numbness
NERVE INJURY
Blood that has already been drawn flowing back into the vein from the collection tube may cause adverse reaction because of the presence of tube additives
○ To avoid this, make sure that the arm of the
patient is in a downward position and the tube is
just below the venipuncture site.
○ Collecting blood using syringe, check if the
plunger is stuck in the barrel and check for
airspace which could cause reflux
Reflux of Anticoagulant
When the patient has adhesive allergy, a gauze
should be placed over the site and should be
removed after 15 mins
TRUE
When the patient has antiseptic allergy, simply
use a different antiseptic.
○ When the patient has latex allergy, look for a
sign to indicate the allergy and use a non-latex
alternative for gloves, tourniquet, and bandages
TRUE
When the patient is on aspirin or anticoagulant,
the bleeding may take a longer time
○ The pressure should be applied to the site until
the bleeding stops
TRUE
The attention of the authorized personnel
should be called when the bleeding continues
after 5 mins
TRUE
is a temporary loss of
consciousness which is caused by the
insufficient flow of blood to the brain.
FAINTING
When the patient feels nauseous and has the
tendency to vomit, the phlebotomist has to
discontinue the procedure until the patient feels
better or until the feeling subsides.
○ An emesis basin or wastebasket should be
provided, and a cold damp washcloth should be
applied to the forehead
TRUE
The patient should be warned before the needle
insertion, and the phlebotomist should avoid
redirection of the needle.
○ If the patient complains of extreme pain or
numbness, remove the needle and apply ice to
the site because this could indicate nerve
involvement.
TRUE
Involves the appearance of small red or purple
spots that look like rashes, which appear on the arm when tourniquet is applied.
○ Tiny hemorrhage
○ Prolonged application of tourniquet
○ One test to screen dengue patients
○ Common among menstruating patients
➢ Platelet count can be low
PETECHIAE
If patient is having seizures, blood draw should be discontinued quickly.
○ There must be pressure held over the site but it
must be made certain that movement is not
restricted; the mouth is free from any
obstruction and the patient is protected from
self-injury.
○ First aid personnel should be notified
immediately.
TRUE
liquid portion of clotted blood
● clearer than plasma
● blood chemistry would require this sample
● collect blood, place on evacuated tube no anticoagulant
but can have gel separator, centrifuge
● Fibrinogen is absent as opposed to plasma
● Wait for blood to clot before centrifuge
SERUM
WHAT COLOR TUBE TOP FOR PLASMA?
LIGHT BLUE (CITRATE)
WHAT COLOR TUBE TOP FOR SERUM?
RED
Liquid portion of unclotted
● Blood
● Has anticoagulant in evacuated tube
● Centrifuge to collect
● Fibrinogen is totally consumed
○ Prior to centrifuge
PLASMA
plasma and red cells
● with anticoagulant
● usually used for blood count
● Lavender tube top / EDTA
WHOLE BLOOD
a decrease in the fluid content or plasma
volume which is usually caused by tourniquet
that stagnates the normal flow of blood leading to the increase in concentration of RBCs and other non-filterable large molecules
HEMOCONCENTRATION
the rupture of RBCs. Hemoglobin is then
released into the surrounding fluid
HEMOLYSIS
happens when the phlebotomist pulls a tube before reaching the required volume. This may lead to the incorrect blood-to-additive ratio
PARTIALLY FILLED TUBE/ SHORT DRAW
the specimen is compromised due to incorrect
handling which involves allowing alcohol,
powder, or any material into the sample. Getting
glove powder or perspiration into films and
specimens; using the wrong antiseptic or simply
not following the proper antiseptic procedure
could interfere with the results.
SPECIMEN CONCENTRATION
Serum and plasma is yellow in color but if may
red it is a sign of hemolysis
○ Can be due to difficult blood collection
HEMOLYSIS
present in an anticoagulated specimen
CLOT
should be transported 37 degrees
■ sa laboratory usually nagcocollect for
easy transport
SEMINAL FLUID
