Unit 6 - Pre-analytical Considerations in Phlebotomy Flashcards
The testing process begins for the laboratory when a test is ordered and ends when testing begins.
Preanalytical phase
Numerous factors associated with this phase of the testing process, if not properly addressed, it can lead to which of the following:
A. Errors that can compromise specimen quality.
B. Jeopardize the health and safety of the patient.
C. Ultimately increase the cost of medical care.
D. A and B only
E. All of the above
E.
A phlebotomist must have the technical skills needed to perform a blood draw, the ability to recognize __________ factors and address them, if applicable, to avoid or reduce any negative impact.
Preanalytical
T/F
Most tests are performed to confirm health or to screen for, diagnose, or monitor disease.
T
T/F
To be properly evaluated, test results typically need to be compared with results expected of healthy individuals.
T
T/F
Result values for most tests are established using specimens from normal, healthy individuals.
T
T/F
Results vary somewhat from person to person
T
Used for comparison become a range of values with high and low limits.
Reference RANGE or reference INTERVAL
Most reference ranges are for _____.
Healthy fasting individuals
Although less common, some tests have reference ranges for specific situations, such as patients who are ill or those being treated for certain disorders, such as __________.
Diabetes
T/F
One way a physician evaluates a patient’s test results is by comparing them to reference ranges and, if applicable, previous results on the same patient also.
T
T/F
If a specimen has been compromised and the results are not valid, a physician could make a decision based upon incorrect information and thus jeopardize the patient’s care.
T
__________ the resting metabolic state of the body early in the morning after fasting for approximately __ hours.
Basal; 12
Ideal for establishing reference ranges on inpatients because the effects of diet, exercise, and other controllable factors on test results are minimized or eliminated.
Basal-state specimen
Basal state is influenced by a number of physiologic patient variables such as __________, __________, and __________ that cannot be eliminated.
Age, gender, and conditions of the body
__________ specimens are not basal-state specimens and may have slightly different reference ranges.
Outpatient
T/F
Values for some blood components vary considerably depending upon the age of the patient.
T
Values that are normally higher in newborns than in adults.
RBC
WBC
Some physiological functions such as _____ function decrease with age.
Kidney or renal
A measure of kidney function that is directly related to the age of the patient, which must be factored in when test results are being calculated.
Creatinine clearance
T/F
Test results for some blood analytes show significant variation at higher elevations compared with results at sea level.
T
RBC count is elevated in _____ altitude.
Higher
T/F
Decreased oxygen levels at higher altitudes cause the body to produce more RBCs to meet the body’s oxygen requirements.
T
T/F
The higher the altitude, the greater the increase.
T
T/F
RBC counts and related determinations such as _____ and _____ have higher reference ranges at higher elevations.
Hgb
Hct
Other analytes that increase at higher elevations include __________ and __________.
C-reactive protein
Uric acid
Analytes that decrease in value at increased altitude include __________ (which in turn affects creatinine clearance tests) and __________.
Urinary creatinine
Plasma renin
Creatinine is _____ in higher altitude.
Decreased
Analytes generally take ______ to adapt to high elevations; however, they adapt to a return to sea level within days.
Weeks
Decrease in total body fluid.
Dehydration
Dehydration, which occurs, for example, with persistent vomiting or diarrhea, causes __________.
Hemoconcentration
Condition in which blood components that cannot easily leave the bloodstream become concentrated in the smaller plasma volume.
Hemoconcentration
Blood components affected by dehydration include __________, __________, __________, __________, __________, and __________.
RBCs
Enzymes
Ca (Calcium)
Fe (Iron)
Na (Sodium)
Coagulation factors
T/F
Results on specimens from dehydrated patients may not accurately reflect the patient’s normal status.
T
T/F
Results on specimens from dehydrated patients may not accurately reflect the patient’s normal status.
T
It is often difficult to obtain blood specimens from __________ patients.
Dehydrated
Calcium is __________ in dehydration.
Elevated
T/F
Blood analyte composition can be altered by the ingestion of food and drink.
T
T/F
Blood specimens collected soon after a meal or snack are unsuitable for many laboratory tests.
T
Diet effects on analytes are generally TEMPORARY and vary depending upon which of the following?
A. Amount and type of food or drink.
B. Length of time between ingestion and specimen collection.
C. A only
D. B only
E. Both A and B
E
Requiring a patient to _____ or follow a special diet eliminates most dietary influences on testing.
Fast
Patients are typically asked to fast approximately __________, depending on the test.
8 to 12 hours
Fasting is normally done overnight __________ the last evening meal, with specimens collected the following morning __________ the patient has eaten.
After; before
Fasting beyond 12 hours can cause serious health problems, such as __________.
Electrolyte imbalance and heart rhythm disturbances.
T/F
Fasting specimens, especially those requiring a 12-hour fast, should be collected promptly without unreasonable delay.
T
T/F
Patients are allowed to drink water during fasting unless they are NPO (nothing by mouth) for another procedure.
T
Refraining from drinking water while fasting can result in __________, which can negatively affect test results and also make blood collection more difficult.
Dehydration
__________, __________, and __________ may be elevated in patients on high-protein diets.
Ammonia
Urea
Uric acid
__________ and __________ levels have been shown to increase with the consumption of beverages containing CAFFEINE
Adrenocorticotropic hormone (ACTH)
Cortisol
__________ increase dramatically with the ingestion of carbohydrates or sugar-laden substances but return to normal within 2 hours if the patient has normal glucose metabolism.
Glucose
Eating carbohydrates can also increase __________ levels.
Insulin
_____ levels can decrease and electrolyte balance can be altered by drinking __________ amounts of water and other fluids.
Hgb
Excessive
Increase with ingestion of foods such as butter or margarine, cheese, cream, and some enteral (tube feeding) preparations.
Lipid levels
Tube feeding
Enteral preparations
Lipid is a term meaning __________.
Fat-soluble
Abnormally increased blood lipid content.
Lipemia
T/F
Lipids do not dissolve in water and thus high levels of lipids are visible in serum or plasma.
T
Lipids appear milky or turbid, and the specimen is described as being __________.
Lipemic
Lipemia can be present for up to __ hours.
12
Accurate testing of triglycerides (a type of lipid) requires a __-hour fast.
12
T/F
Some chemistry tests cannot be performed on lipemic specimens because the cloudiness interferes with the testing procedure.
T
T/F
Lipemia in a fasting specimen is rare.
T
T/F
A test requires a fasting specimen but the serum or plasma sample submitted is lipemic, it is a clue that the patient may not have been fasting.
T
T/F
Some test methods that detect occult (hidden) blood in stool specimens also detect similar substances in meat and certain vegetables.
T
T/F
A special diet that eliminates these foods must be followed for several days before the specimen is collected.
T
Triglycerides, certain liver enzymes, and other liver function analytes are increased by chronic consumption or recent ingestion of large amounts of alcohol, which can also cause __________.
Hypoglycemia
Also affect the composition of blood analytes.
Malnutrition and starvation
Long-term starvation __________ cholesterol, triglycerides, and urea levels and __________ creatinine, ketone, and uric acid levels.
Decreases; increases
The levels of many blood components normally exhibit __________ (happening daily) or __________ (having a 24-hour cycle) variations or fluctuations.
Diurnal; circadian
Factors that play a role in diurnal variations.
Posture
Activity
Eating
Daylight
Darkness
Being awake or asleep
Melatonin levels are affected by _____.
Light
Melatonin levels __________ at night when it is dark.
Increase
Melatonin levels __________ during daylight hours.
Decrease
Maximum __________ and __________ levels normally occur in the predawn hours of the morning during sleep.
Renin
TSH
Peak __________ levels normally occur later in the morning around 8:00 AM.
Cortisol
Other blood components that exhibit diurnal variation with highest levels occurring in the morning.
Aldosterone
Bilirubin
Cortisol
Hgb
Insulin
Iron
Potassium
Testosterone
RBCs
Blood levels that are normally lowest in the morning.
Eosinophils
Creatinine
Glucose
Growth hormone
Triglycerides
Phosphate
T/F
Diurnal variations can be large.
T
For example the levels of _____, _____, and _____ can differ by 50% or more between morning and late afternoon.
Cortisol
TSH
Iron
T/F
A change of several time zones can affect diurnal rhythm and the tests associated with it.
T
T/F
Only a day may be required to restore a normal rhythm.
F
Tests influenced by diurnal variation are often ordered as _____ tests.
Timed
T/F
It is important to collect them as close to the time ordered as possible.
T
T/F
Some drugs alter physiological functions, causing changes in the concentrations of certain blood analytes.
T
T/F
In drug therapy, the effect may be desired or an unwanted side effect or sensitivity.
T
T/F
It is common for physicians to monitor levels of specific blood analytes while a patient is receiving drug therapy.
T
__________ drugs can cause a decrease in blood cells, especially _____ and _____.
Chemotherapy
WBCs
Platelets
Many drugs are toxic to the liver, as evidenced by increased levels of liver enzymes such as ___.
Aminotransaminase (AST)
Alkaline phosphatase (ALP)
Lactate dehydrogenase (LDH)
AST is also called as _____?
Serum glutamic-oxaloacetic transaminase (SGOT)
Drug therapy creases production of __________.
Clotting factors
Opiates such as morphine __________ levels of liver and pancreatic enzymes.
Increase
Oral contraceptives can ELEVATE the _____ and DECREASE levels of vitamin ___.
Erythrocyte sedimentation rate (ESR)
B12
Steroids and diuretics can cause pancreatitis and an increase in _____ and _____ values.
Amylase
Lipase
Thiazide diuretics can elevate __________ and __________ levels and decrease __________ and __________ levels.
Calcium and glucose
Sodium and potassium
T/F
Drugs can also interfere with the actual test procedure, causing false increases or decreases in test results.
T
T/F
A drug may compete with the test reagents for the substance being tested, causing a falsely low or false-negative result, or the drug may enhance the reaction, causing a falsely high or false-positive result.
T
An acronym for substances that interfere in the testing process is CRUD, which stands for?
Compounds Reacting Unfortunately as Desired
T/F
It is ultimately up to the physician to prevent or recognize and eliminate drug interferences, this can be a complicated issue that requires cooperation between the physician, pharmacy, and laboratory to make certain that test results are not affected by medications.
T
T/F
Phlebotomists can play a role in drug therapy complications by noting on the requisition when they observe medication being administered just prior to blood collection.
T
According to CAP guidelines, drugs that interfere with blood tests should be stopped or avoided __________ hours prior to obtaining the blood sample for testing.
4 to 24 hours
Drugs that interfere with urine tests should be avoided for __________ hours prior to the urine sample collection.
48 to 72
Reduced by exercise.
Arterial pH
PaCO2
Elevated by moderate muscular activity
Glucose & insulin
Total protein
Lactic acid
Creatinine
__________ is released from the cells during exercise, increasing levels in the plasma.
Potassium (K+)
T/F
Levels generally return to normal after several minutes of rest.
T
T/F
The simple exercise of pumping the hand (i.e., making and releasing a fist) during venipuncture is enough to erroneously increase potassium levels.
T
Increased by exercise.
Skeletal muscle enzymes
Increased by exercise.
Skeletal muscle enzymes
Skeletal muscle enzyme levels are increased by exercise, with levels of __________ and __________ remaining elevated for 24 hours or more.
Creatine kinase (CK)
Lactate dehydrogenase (LDH)
T/F
Athletes generally have higher resting levels of skeletal muscle enzymes, and exercise produces less of an increase.
T
Vigorous exercise shortly before blood collection can temporarily increase __________ levels by 6% or more.
Cholesterol
T/F
Levels can remain elevated for up to an hour after the exercise has stopped.
T
Vigorous or sustained exercise can also affect __________.
Hemostasis
T/F
There is an increased number of platelet clumps were seen in a study of runners evaluated immediately after running the Boston marathon.
T
Fever affects the levels of a number of _____.
Hormones
Fever-induced hypoglycemia increases _____ levels, followed by a rise in _____ levels.
Insulin
Glucagon
Fever also increases _____ and may disrupt its normal diurnal variation.
Cortisol
T/F
A patient’s gender affects the concentration of a number of blood components.
T
T/F
RBC, Hgb, and Hct normal values are higher for males than for females.
T
A recent intramuscular injection can increase levels of _____ and the skeletal muscle fraction of LDH.
Creatine kinase (CK)
T/F
It is recommended that CK and LDH levels be drawn before intramuscular injection or at least 1 hour after injection.
T
T/F
Muscular trauma from injuries or surgery can also increase CK levels.
T
Other term for jaundice.
Icterus
A condition characterized by increased bilirubin in the blood, leading to deposits of yellow bile pigment in the skin, mucous membranes, and sclerae, giving a patient a yellow appearance.
Jaundice or icterus
It is increased in the blood that leads to jaundice.
Bilirubin
This means relating to or marked by jaundice and is used to describe serum, plasma, or urine specimens that have an abnormal deep yellow to yellow-brown color due to high bilirubin levels.
Icteric
T/F
The abnormal color can interfere with chemistry tests based on color reactions, including reagent-strip analyses on urine.
T
Jaundice in a patient may indicate liver inflammation caused by _____.
Hepatitis B or C virus
T/F
Body position before and during blood collection can influence specimen composition.
T
Going from supine to an upright sitting or standing position causes blood fluids to filter into the tissues, decreasing _____ volume in an adult up to 10%.
Plasma
Only _____ fluids can pass through the capillaries.
Protein-free
What are the blood concentration of components that are protein in nature or bound to protein that increases.
Aldosterone
Bilirubin
Blood cells
Calcium
Cholesterol
Iron
Protein
Renin
T/F
In most cases the concentration of freely diffusible blood components is not affected by postural changes.
T
T/F
A significant increase in potassium (K+) levels occurs within 30 minutes of standing; this has been attributed to the release of intracellular potassium from muscle.
T
T/F
A change in position from lying to standing can cause up to a 15% variation in total and high-density lipoprotein (HDL) cholesterol results.
T
T/F
The National Cholesterol Education Program recommends that lipid profiles be collected in a consistent manner after the patient has been either lying down or sitting quietly for a minimum of 5 minutes.
T
_____ and _____ change more slowly but can double within an hour.
Plasma aldosterone
Renin
Patients are required to be _____ (lying down) for at least 30 minutes prior to aldosterone specimen collection.
Recumbent
T/F
Plasma renin-activity levels require documentation of the patient’s position during collection.
T
T/F
The RBC count on a patient who has been standing for approximately 15 minutes will be higher than a basal-state RBC count on that patient.
T
T/F
Calling outpatients into the drawing area and having them sit in the drawing chair while paperwork related to the draw is readied can help minimize effects of postural changes on some analytes.
T
T/F
Pregnancy causes physiologic changes in many body systems.
T
T/F
Results of a number of laboratory tests must be compared with reference ranges established for pregnant populations.
T
T/F
Increase in body fluid is normal during pregnancy.
T
T/F
Increase in body fluid during pregnancy have a diluting effect on the RBCs, leading to lower RBC counts.
T
T/F
A number of blood components are affected by smoking. The extent of these effects depends upon the number of cigarettes smoked.
T
Increases when the patient smoke prior to specimen collection.
Cholesterol
Cortisol
Glucose
Growth hormone
Triglycerides
WBC counts
Chronic smoking often leads to decreased pulmonary function and increased _____ and _____.
RBC counts
Hgb levels
Smoking can also affect the body’s immune response, typically lowering the concentrations of immunoglobulins ___, ___, and ___ but increasing levels of ___.
IgA, IgG, IgM
IgE
T/F
Skin-puncture specimens may be difficult to obtain from smokers because of impaired circulation in the fingertips.
T
Emotional stress such as anxiety, fear, or trauma can cause transient (short-lived) elevations in _____.
WBCs
T/F
Studies of crying infants have demonstrated marked increases in WBC counts, which returned to normal within 1 hour after the crying stopped.
T
T/F
Consequently CBC or WBC specimens on an infant are ideally obtained after the infant has been sleeping or resting quietly for at least 30 minutes.
T
T/F
If they are collected while an infant is crying, this should be noted on the report.
T
T/F
Receptors on the cell membrane of WBCs can sense stress in a person and react by increasing cell numbers.
T
Stress is also known to decrease _____ levels.
Serum iron
Stress is also known to increase _____, _____, and _____ level.
ACTH
Catecholamine
Cortisol
T/F
Other hormones that can be affected in stress include aldosterone and TSH, and GH in children.
T
Environmental factors such as _____ and _____ can affect test values by influencing the composition of body fluids.
Temperature and humidity
T/F
Acute heat exposure causes interstitial fluid to move into the blood vessels, increasing plasma volume and influencing its composition.
T
Extensive sweating without fluid replacement, on the other hand, can cause _____.
Hemoconcentration
T/F
Environmental factors associated with geographic location are accounted for when reference values are established.
T
T/F
Temperature and humidity in the laboratory are closely monitored to maintain specimen integrity and ensure proper functioning of equipment.
T
T/F
Veins are difficult to palpate or penetrate in areas that are burned, scarred, or tattooed.
T
T/F
Healed burn sites and other areas with extensive scarring may have impaired circulation and can therefore yield erroneous test results.
T
T/F
Newly burned areas are painful and also susceptible to infection.
T
T/F
Newly burned areas are painful and also susceptible to infection.
T
T/F
Tattooed areas can have impaired circulation, may be more susceptible to infection, and contain dyes that can interfere with testing.
T
T/F
If you have no choice but to draw in an area with a tattoo, try to insert the needle in a spot that does not contain dye.
T
T/F
Some patients’ veins feel hard and cord-like and lack resiliency because they are occluded or obstructed.
T
These veins may be __________ (hardened) or __________ (clotted) from the effects of inflammation, disease, or chemotherapy drugs.
Sclerosed; thrombosed
T/F
Scarring caused by numerous venipunctures can also harden veins.
T
T/F
Scarring caused by numerous venipunctures can also harden veins.
T
T/F
Damaged veins are difficult to puncture, yield erroneous (invalid) test results because of impaired blood flow, and should be avoided.
T
T/F
Choose another site if possible; otherwise draw below or distal to damaged veins.
T
Swelling caused by the abnormal accumulation of fluid in the tissues.
Edema
Results when fluid from an IV infiltrates the surrounding tissues.
Edema
T/F
Specimens collected from edematous areas may yield inaccurate test results owing to contamination with tissue fluid or altered blood composition caused by the swelling.
T
T/F
Since veins are harder to locate in an edematous area, the tissue is often fragile and easily injured by tourniquet and antiseptic application, and healing may be prolonged in these areas.
T
Phlebotomists on early-morning rounds in hospitals or nursing homes are often the first ones to notice edema from infiltrated _____ and should alert the appropriate personnel to the problem.
IVs
A swelling or mass of blood (often clotted) that can be caused by blood leaking from a blood vessel during or following venipuncture.
Hematoma
A large bruise eventually spreads over the surrounding area.
Hematoma
Venipuncture through an existing hematoma is painful and can result in collection of a specimen that is contaminated with _____ blood from outside the vein and unsuitable for testing.
Hemolyzed
T/F
Venipuncture in the area surrounding a hematoma may also be painful.
T
T/F
Obstruction of blood flow by the hematoma and the effects of the coagulation process may lead to inaccurate test results on the specimen.
T
T/F
Never perform venipuncture through a hematoma.
T
T/F
If there is no alternative site, perform the venipuncture distal to the hematoma to ensure the collection of free-flowing blood.
T
Surgical breast removal.
Mastectomy
T/F
Blood should never be drawn from an arm on the same side as a mastectomy without consulting first the patient’s physician.
T
Lymph node removal, which is typically part of the procedure, causes _____.
Lymphostasis
Obstruction or stoppage of normal lymph flow.
Lymphostasis
Impaired lymph flow makes the arm susceptible to swelling, called __________, and to infection.
Lymphedema
T/F
Effects of lymphostasis can also change blood composition in that arm and lead to erroneous test results.
T
T/F
When a mastectomy has been performed on both sides, the patient’s physician should be consulted to determine a suitable site.
T
T/F
Generally, the side of the most recent mastectomy is the one avoided.
T
T/F
Obese patients often present a challenge to the phlebotomist.
T
T/F
Veins on obese patients may be deep and difficult to find.
T
T/F
In obese patients, conventional tourniquets may be too short to fit around the arm without rolling and twisting.
T
T/F
A long length of new Penrose drain tubing or a long Velcro closure strap often works better than a latex or vinyl strap. A blood pressure cuff can also be used.
T
T/F
Obese patients often have a double crease in the antecubital area with an easily palpable median cubital vein between the two creases.
T
T/F
If no vein is easily visible or palpable on tourniquet application, ask the obese patient what sites have been successful for past blood draws.
T
T/F
Most patients who are “difficult draws” know what sites work best.
T
If the patient has never had blood drawn before or does not remember, another site to try is the _____ vein.
Cephalic
T/F
To locate the cephalic vein, rotate the patient’s arm so that the hand is prone. In this position, the weight of excess tissue often pulls downward, making the cephalic vein easier to feel and penetrate with a needle.
T
A catheter that is placed in an artery.
Arterial line
Arterial line is most commonly placed in a _____ artery.
Radial
Arterial line is typically used to provide accurate and continuous measurement of patient’s __________.
Blood pressure
Arterial line may also be used to collect __________ and for the administration of drugs such as __________.
Blood gas and other blood specimens
Dopamine
T/F
Only specially trained personnel should access arterial lines.
T
T/F
You may still apply a tourniquet or perform a venipuncture on an arm with an arterial line.
F
A permanent surgical connection of an artery and vein by direct fusion (_____), resulting in a bulging vein, or with a piece of vein or tubing (_____) that creates a loop under the skin.
Arteriovenous shunt, fistula, or graft
Arteriovenous shunt, fistula, or graft is typically created to be used for dialysis, commonly joins the _____ artery and _____ vein above the wrist on the underside of the arm, and has a distinctive buzzing sensation called a “thrill” when palpated.
Radial artery
Cephalic vein
A temporary _____ with tubing on the surface of the skin can also be created.
Shunt
T/F
Never apply a blood pressure cuff or tourniquet, or perform venipuncture, on an arm with a shunt.
T
A needleless closed blood sampling device is sometimes connected to an central venous catheter for the purpose of collecting blood specimens.
Blood sampling device
These devices are said to reduce the chance of infection, prevent needlesticks, and minimize waste associated with line draws.
Blood sampling device
Example of blood sampling device.
Venous Arterial blood Management Protection System (VAMP)
A catheter or cannula connected to a stopcock or a cap with a diaphragm (thin rubber-like cover) that provides access for administering medication or drawing blood.
Heparin or saline lock
Means “of, pertaining to, or within a vein.”
Intravenous (IV)
A catheter inserted in a vein to administer fluids.
Intravenous line
T/F
It is preferred that blood specimens not be drawn from an arm with an IV, as they can be contaminated or diluted with the IV fluid, causing erroneous test results. This is especially true if the specimen is drawn above the IV.
T
T/F
When a patient has an IV in one arm, blood specimens should be collected from the other arm.
T
If a patient has IVs in both arms or the other arm is also unavailable for some reason, it is preferred that the specimen be collected by ___________.
Capillary puncture
T/F
A specimen that cannot be collected by capillary puncture like coagulation specimens may be collected below the IV and never above.
T
Turning off the IV for __ minutes allows IV fluids to dissipate from the area.
2
T/F
Previously active IV sites present a potential source of error in testing.
T
T/F
Blood specimens should not be collected from a known previous IV site within 24 to 48 hours of the time the IV was discontinued.
T
Also called an indwelling line.
Central Vascular Access Device (CVAD)
T/F
Consists of tubing inserted into a main vein or artery.
T
Used primarily for administering fluids and medications, monitoring pressures, and drawing blood.
CVADs
It is practical for patients who need IV access for an extended time and is especially beneficial for patients who do not have easily accessible veins.
CVADs
T/F
Only specially trained personnel should access CVADs to draw blood.
T
T/F
The phlebotomist may assist by transferring the specimen to the appropriate tubes.
T
Most CVADs are routinely flushed with _____ or _____ to reduce the risk of _____.
Heparin; saline
Thrombosis
T/F
To help ensure that the specimen is not contaminated with the flush solution, a small amount of blood must be drawn from the line and discarded before a blood specimen can be collected.
T
The amount of blood discarded depends upon the _____ volume of the line.
Dead-space
2 times the dead-space volume is discarded for _____ tests and 6 times is generally recommended for _____.
Noncoagulation tests
Coagulation tests
T/F
It is not preferred that specimens for coagulation tests to be drawn from CVADs.
T
A line inserted into a large vein such as the subclavian and advanced into the superior vena cava, proximal to the right atrium.
Central Venous Catheter (CVC) or central venous line
A small chamber attached to an indwelling line.
Implanted port
Surgically implanted under the skin and most commonly located in the upper chest or arm.
Implanted port
Flexible tube inserted into the veins of extremities and the central veins.
Peripherally Inserted Central Catheter (PICC)
T/F
Some patients are allergic to the glue used in adhesive bandages.
T
One solution is to place a clean, folded gauze square over the site and wrap it with self adherent bandaging material such as _____.
Coban
Care must be taken not to wrap the coban too tightly, and the patient should be instructed to remove it in __ minutes.
15
T/F
If the patient is alert, mentally competent, and willing, another alternative is to instruct him or her to hold pressure for 5 minutes in lieu of applying a bandage.
T
T/F
Occasionally, a patient is allergic to the antiseptic used in skin preparation prior to blood collection.
T
T/F
Many individuals are allergic to povidone-iodine.
T
T/F
Alternate antiseptics should be readily available for use in such cases.
T
T/F
Increasing numbers of individuals are allergic to latex.
T
T/F
Most latex allergies are seemingly minor and involve irritation or rashes from physical contact with latex products such as gloves.
T
T/F
Other allergies are so severe that being in the same room where latex materials are used can set off a life- threatening reaction.
T
T/F
There should be a warning sign on the door to the room of any patient known to have a severe latex allergy, and it is vital that no items made of latex be brought into the room.
T
T/F
If the patient have latex allergies, the phlebotomist must wear nonlatex gloves, use a nonlatex tourniquet, and use nonlatex bandages when in the room, whether collecting blood from the patient or a roommate.
T
Patients with known allergies often wear _____ or have allergy-specific warning signs posted in their hospital rooms.
Special armbands
Normally, a patient will stop bleeding from the venipuncture site within a few minutes. Some patients, particularly those on _____ or _____, may take longer to stop bleeding.
Aspirin or anticoagulant therapy
T/F
Pressure must be maintained over the site until the bleeding stops. If the bleeding continues after 5 minutes, the appropriate personnel should be notified.
T
T/F
Never apply a pressure bandage instead of maintaining pressure, and do not leave or dismiss a patient until bleeding has stopped or the appropriate personnel have taken charge of the situation.
T
Medical term for fainting.
Syncope
loss of consciousness and postural tone resulting from insufficient blood flow to the brain. It can last for as little as a few seconds or as long as half an hour.
Fainting or syncope
T/F
Any patient has the potential to faint (Fig. 9-11) before, during, or immediately following venipuncture.
T
T/F
Some patients become faint at just the thought or sight of their blood being drawn, especially if they are ill or have been fasting for an extended period.
T
Other contributing factors in fainting.
Anemia
Dehydration
Emotional problems
Fatigue
Hypoglycemia
Hyperventilation
Medications
Nausea
Needle phobia
Poor compromised breathing.
Sudden faintness or loss of consciousness due to a nervous system response to abrupt pain, stress, or trauma.
Vasovagal syncope
A patient with a history of fainting should be asked to _____ for the procedure.
Lie down
T/F
Patients who feel faint just before or even after venipuncture should be asked to lie down until recovered.
T
Patients that are typically already lying down, rarely faint during blood draws.
Inpatients
Patients that are more likely to faint because they are usually sitting up during venipuncture.
Outpatients
T/F
Blood collection personnel should routinely ask patients how they are doing during a draw, watch for signs of fainting, and be prepared to protect them from falling.
T
Signs to watch for fainting.
Pallor (paleness)
Perspiration
Hyperventilation
Indication from the patient that he or she is experiencing vertigo
Dizziness
Lightheadedness
Nausea
T/F
Fainting can occur without any warning, so never turn your back on a patient.
T
When a patient who has fainted regains consciousness, he or she must remain in the area for at least __ minutes.
15
T/F
The patient should be instructed not to operate a vehicle for at least 30 minutes. It is important for the phlebotomist to document the incident in case of future litigation.
T
The use of _____ to revive patients can have unwanted side effects such as respiratory distress in asthmatic individuals and is not recommended.
Ammonia inhalants
T/F
It is not unusual to have a patient experience nausea before, during, or after a blood draw.
T
T/F
The patient may state that he or she is feeling nauseous or show signs similar to fainting, such as becoming pale or having beads of sweat appear on the forehead.
T
T/F
If the patient vomits during venipuncture, the procedure must be terminated immediately.
T
T/F
The patient should be reassured and made as comfortable as possible.
T
A feeling of nausea often precedes vomiting, so it is a good idea to give the patient a/an _____ to hold as a precaution.
Emesis basin or wastebasket
T/F
Ask the patient to breathe slowly and deeply. Apply a cold, damp washcloth or other cold compress to the patient’s forehead.
T
T/F
If the patient vomits, provide tissues or a washcloth to wipe the face and water to rinse the mouth.
T
T/F
If the patient is NPO for surgery, other procedures, or otherwise not allowed to have water, advise him or her to spit the water out after rinsing and not swallow any.
T
Warning the patient prior to needle insertion helps avoid a _____.
Startle reflex
T/F
A stinging sensation can be avoided by allowing the alcohol to dry completely prior to needle insertion.
T
Excessive, deep, blind, or lateral redirection of the needle.
Probing
It can be very painful to the patient; risks injury to arteries, nerves, and other tissues; and should never be attempted.
Probing
Marked or extreme pain, numbness of the arm, a burning or electric-shock sensation, or pain that radiates up or down the arm during a venipuncture attempt indicates _____ involvement and required immediate removal of the needle.
Nerve
T/F
Application of an ice pack to the site after needle removal can help prevent or reduce inflammation associated with nerve involvement.
T
T/F
If marked or extreme pain occurs, or the patient asks you to remove the needle for any reason, the venipuncture should be terminated immediately, even if there are no other signs of nerve injury.
T
Tiny, nonraised red spots that appear on the patient’s skin when a tourniquet is applied.
Petechiae
The spots are minute drops of blood that escape the capillaries and come to the surface of the skin below the tourniquet, most commonly as a result of __________ or __________.
Capillary wall defects or platelet abnormalities.
T/F
Petechiae are not an indication that the phlebotomist has used incorrect procedure. However, they are indication that the venipuncture site may bleed excessively.
T
T/F
Seizures have been known to occur during venipuncture, although there is no evidence that they can be caused by venipuncture.
T
T/F
In the rare event that a patient has a seizure or goes into convulsions during blood specimen collection, it is important to discontinue the draw immediately.
T
T/F
If seizure or convulsion occurs, hold pressure over the site without overly restricting the patient’s movement. Do not attempt to put anything into the patient’s mouth. Try to protect the patient from self-injury without completely restricting movement of the extremities.
T
Most common complication of venipuncture.
Hematoma
Caused by blood leaking into the tissues during or following venipuncture and is identified by rapid swelling at or near the venipuncture site.
Hematoma
T/F
Excessive or blind probing is used to locate the vein can trigger hematoma formation.
T
T/F
Inadvertent arterial puncture can trigger hematoma formation.
T
T/F
The vein is fragile or too small for the needle size can trigger hematoma formation.
T
T/F
The needle that penetrates all the way through the vein can trigger hematoma formation.
T
T/F
The needle is only partly inserted into the vein can trigger hematoma formation.
T
T/F
The needle is removed while the tourniquet is still on can trigger hematoma formation.
T
T/F
Pressure is not adequately applied following venipuncture can also trigger hematoma formation.
T
A rapidly forming hematoma may indicate that an _____ has been inadvertently hit.
Artery
T/F
A hematoma is painful to the patient and often results in unsightly bruising and it can also cause compression injuries to nerves and lead to lawsuits.
T
T/F
Continuing to draw blood while a hematoma is forming risks injury to the patient and collection of a specimen contaminated with hematoma blood that has mixed with tissue fluids from outside the vein.
T
If a hematoma forms during blood collection, the phlebotomist should discontinue the draw immediately and hold pressure over the site for a minimum of __ minutes.
2
T/F
A small amount of blood under the skin is relatively harmless and generally resolves on its own.
T
If the hematoma is large and causes swelling and discomfort, the patient should be offered a __________ to relieve pain and reduce swelling.
Cold compress or ice pack
It can help to relieve discomfort from a hematoma.
Acetaminophen or ibuprofen
T/F
Ice applied in the first 24 hours of hematoma helps manage the swelling and discomfort.
T
T/F
After 24 hours, application of heat or warm, moist compresses can encourage the resorption of accumulated blood.
T
Adjective used to describe an adverse condition brought on by the effects of treatment.
Iatrogenic
Blood loss as a result of blood removed for testing.
Iatrogenic blood loss
A condition when removing blood on a regular basis or in large quantities in some patients, especially infants.
Iatrogenic anemia
A primary reason for blood transfusion in neonatal ICU patients.
To replace iatrogenic blood loss
Blood loss to a point where life cannot be sustained.
Exsanguination
Life is threatened if more than _____% of a patient’s blood volume is removed at one time or over a short period of time.
10%
T/F
Coordination with physicians to minimize the number of draws per patient, following qual- ity assurance procedures to minimize redraws, collecting minimum required specimen volumes, especially from infants, and keeping a log of draws can help reduce iatrogenic blood loss.
T
A rapidly forming hematoma and blood filling the tube very quickly.
Inadvertent arterial puncture
T/F
Arterial blood can be recognized by the fact that it spurts or pulses into the tube or by its bright red color if the patient’s pulmonary function is normal.
T
T/F
If arterial puncture is suspected, terminate the venipuncture immediately and apply direct forceful pressure to the site for at least 5 minutes and until bleeding stops.
T
T/F
If you think a specimen might be arterial blood, check with laboratory personnel to determine if a suspected arterial specimen is acceptable for testing, as opposed to redrawing more blood from the patient. If testing is permitted, identify the specimen as possible arterial blood, since some test values are different for arterial specimens.
T
T/F
infection at the site following venipuncture does happen.
T
T/F
Do not open adhesive tape or bandages ahead of time or temporarily tape them to your lab coat cuffs or other contaminated objects.
T
T/F
Do not preload needles onto tube holders to have a supply for many draws ready ahead of time. The sterility of the needle is breached once the seal is broken.
T
T/F
Before or during needle insertion, do not touch the site with your finger, gauze, or any other non sterile object after it has been cleaned.
T
T/F
Try to minimize the time between removing the needle cap and performing the venipuncture.
T
Remind the patient to keep the bandage on for at least _____ minutes after specimen collection.
15
Poor site or improper vein selection, inserting the needle too deeply or quickly, movement by the patient as the needle is inserted, excessive or lateral redirection of the needle, or blind probing while attempting venipuncture.
Nerve injury (median cutaneous nerve)
Signs of nerve involvement
Extreme pain
Burning or electric-shock sensation
Numbness of the arm
Pain that radiates up or down the arm
T/F
Application of an ice pack to the site after needle removal can help prevent or reduce inflammation associated with nerve involvement.
T
T/F
It is possible for blood to reflux (flow back) into the patient’s vein from the collection tube during the venipuncture procedure.
T
Some patients have had adverse reactions to tube additives, particularly _____, that were attributes to reflux.
EDTA
T/F
Reflux can occur when the contents of the collection tube are in contact with the needle while the specimen is being drawn.
T
T/F
To prevent reflux, the patient’s arm must be kept in a downward position so that the collection tube remains below the venipuncture site and fills from the bottom up.
T
T/F
An example of reflux is when venipuncture is performed using a butterfly, blood initially flows into the tubing, but then some of it starts to disappear back into the vein before the tube is engaged.
T
Numerous venipunctures in the same area over an extended period of time, however, will eventually cause a buildup of __________ and increase the difficulty of performing subsequent venipunctures.
Scar tissue
T/F
Blind probing and improper technique when redirecting the needle can also damage veins and impair patency.
T
Tourniquet application causes localized _____.
Venous stasis
Stagnation of normal venous blood flow or the trapping of blood in an extremity by compression of veins.
Venous stasis (venostasis)
In response, some of the plasma and filterable components of the blood pass through the capillary walls into the tissues. This results in _____.
Hemoconcentration
A decrease in the fluid content of the blood with a subsequent increase in non filterable large molecules or protein-based blood components such as RBCs.
Hemoconcentration
Abnormally increased analytes in hemoconcentration.
Albumin
Ammonia
Calcium
Cholesterol
Coagulation factors
Enzymes
Iron
Potassium
Total protein
T/F
Cholesterol levels can increase up to 5% after 2 minutes of tourniquet application and up to 15% after 5 minutes.
T
T/F
Ask the patient to release the fist upon blood flow to prevent hemoconcentration upon blood flow.
T
T/F
Choose an appropriate patent vein to prevent hemoconcentration during venipuncture.
T
T/F
Do not allow the patient to pump the fist during venipuncture to prevent hemoconcentration.
T
T/F
Do not excessively massage the area in locating a vein to prevent hemoconcentration during venipuncture.
T
T/F
During venipuncture, do not probe or redirect the needle multiple times in search of a vein to prevent hemoconcentration during venipuncture.
T
T/F
Release the tourniquet within 1 minute to prevent hemoconcentration during venipuncture.
T
T/F
Hand or fist pumping can increase blood potassium levels up to 20%. It is reported to be responsible for a third of all elevated potassiums and may also increase lactate and phosphate levels.
T
Results when RBCs are damaged or destroyed and the hemoglobin they contain escapes into the fluid portion of the specimen.
Hemolysis
The red color of the hemoglobin makes the serum or plasma appear _____.
Pink
T/F
Drawing blood through a hematoma or from a vein with a hematoma can cause specimen hemolysis.
T
T/F
Failure to wipe away the first drop of capillary blood, which can contain alcohol residue can cause specimen hemolysis.
T
T/F
Forceful aspiration of blood during syringe draw can cause specimen hemolysis.
T
T/F
Frothing of blood from caused by improper fit of the needle on a syringe can cause specimen hemolysis.
T
T/F
Horizontal transport of tubes, which lets the blood slosh back and forth can cause specimen hemolysis.
T
T/F
Mixing additive tubes vigorously, shaking them, or inverting them too quickly or forcefully can cause specimen hemolysis.
T
T/F
Partially filling a normal-draw sodium fluoride tube can cause specimen hemolysis.
T
T/F
Pulling back the plunger too quickly during a syringe draw can cause specimen hemolysis.
T
T/F
Rough handling during transport can cause specimen hemolysis.
T
T/F
Squeezing the site during capillary puncture can cause specimen hemolysis.
T
T/F
Syringe transfer delay in which partially clotted blood is forced into a tube can cause specimen hemolysis.
T
T/F
Using a large-volume tube with a small-diameter butterfly needle can cause specimen hemolysis.
T
T/F
Using a needle with a diameter that is too small for venipuncture can cause specimen hemolysis.
T
Patient conditions of a hemolyzed specimens.
Hemolytic anemia
Liver disease
Transfusion reaction
T/F
ETS tubes should be filled until the normal amount of vacuum is exhausted.
T
This results in a partially filled tube.
Short draw
Acceptable tubes for short draw as long it is not hemolyzed.
Red top tubes
SST tube
T/F
Never pour two partially filled additive tubes together to fill one tube, as this will also affect the blood-to-additive ratio.
T
T/F
Excess EDTA in underfilled lavender-top tubes can shrink RBCs, causing erroneously low blood cell counts and hematocrits and negatively affecting the morphological examination of the RBCs on a blood smear. It can also alter the staining characteristics of the cells on a blood smear.
T
T/F
Excess heparin in plasma from underfilled green-top tubes may interfere with the testing of some chemistry analytes.
T
T/F
Excess sodium fluoride in underfilled gray-top tubes can result in hemolysis of the specimen.
T
T/F
Underfilled coagulation tubes do not have the correct blood-to-additive ratio and will produce erroneous results.
T
T/F
Inadvertent (unintentional) short draws are usually the result of difficult draw situations in which blood flow stops or vacuum is lost during needle manipulation.
T
T/F
Inadvertent (unintentional) short draws are usually the result of difficult draw situations in which blood flow stops or vacuum is lost during needle manipulation.
T
T/F
Partial-vacuum tubes are available that are the same size as some standard-fill tubes but designed to contain a smaller volume of blood.
T
Sometimes referred to as “short-draw” tubes.
Partial-vacuum tubes
T/F
Allowing, alcohol, fingerprints, glove powder, baby powder, or urine from wet diapers to contaminate newborn screening forms or specimens, leading to specimen rejection.
T
T/F
Example of specimen contamination is allowing, alcohol, fingerprints, glove powder, baby powder, or urine from wet diapers to contaminate newborn screening forms or specimens, leading to specimen rejection.
T
T/F
Example of specimen contamination is getting a glove powder on blood films (slides) or in capillary specimens, resulting in misinterpretation of results. Calcium-containing powders can affect calcium results.
T
T/F
Unwittingly dripping perspiration into capillary specimens during collection or any specimen during processing or testing is contaminated. The salt in sweat, for example, can affect sodium and chloride levels.
T
T/F
Expired anticoagulant may allow the formation of microclots.
T
