W2 phlebotomy equipment Flashcards
contents of tray and what to restock
gloves- extra pairs (since you must take soiled gloves off immediately) tourniquits alcohol swabs cotton balls. gauze. tape and/or Band-aids. pen. Needles in various gauges. Butterfly needles. lancets.-to poke Tube holders. Syringes. Capillaries. lab reference manual
why are gloves necessary when taking blood
because there is no excuse for not wearing gloves like duh you are touching “dirty” people.
- they protect from blood spills.
- *reduce the volume of blood entering body from a needle-stick injury by 86%.
what happens if the tourniquet is left on for too long?
If it’s on longer than 1 minute, the plasma starts to seep into the connective tissue outside of the vein. This means that the plasma concentration has decreased, the fluid part at least. This leads to incorrect results because the concentration of the analyze level in the blood will increase.
Long story short, it will create a false concentration of analyses. This whole process is known as hemoconcentration
how do you know when tourniquet too tight
patient complaint
white skin
reddish purpling of hand
petechiae
What do you clean injection site with?
70% isopropyl alcohol. Used for routine venipunctures. Use friction scrub 5-7 cm in diameter and let air-dry because you are not retarded and you are not about to blow on a sterilized injection site. BUT wait for it to be dry because patients will feel a burning sensation.
you can repalpate IF you clean your palpating finger but its not routine practice
if patient on anticoagulant how long should bandaid be left on
12-24 hours usually its just 15 minutes
parts of a needle
bevel- point which punctures skin, it should enter vein facing upwards. It will always enter vein facing upwards if you are using the safety device in the correct location (which is over the thumb)
shaft- is the long part of the needle, the inside is known as the lumen
Hub- connects the shaft of the needle to the tube holder.
** your fingers should never touch the bevel, shaft, or hub and it should always be behind the safety device on the tube holder.
gauge number on needles
larger the gauge number the smaller the needle
22,21 gauge needles, green and black are usually used for adult venipuncture
23 gauge needles, blue used in paediatrics,
18 gauge is pink and used in blood donations
** to avoid hemolysis avoid using needles with a small lumen and a tube that has a large vacuum
how to enter needle into skin
the angle of insertion must be less than 30 degrees and greater than 15 degrees.
your fingers should be resting on the arm of the patient and your own arm should be relaxed.
** forward and backward movements are okay and they don’t cause damage but when you move the needle side to side that can cause damage.
evacuated system equipment
one end punctures patients skin, the other needle end punctures into the tube vacuum the end that enters the tube has a rubber sleeve around it that slides back when stopper is pushed on. the tubes we use that collected the blood are called evacuated tubes because they act like a vacuum and suck the correct amount of blood into the tube.
what does the colour of the tube identify?
it identifies the tube additive if one is present and determines which tubes should be used to collect the correct specimen; serum, plasma or whole blood.
the order of draw relates to the colour of the tube and therefore the additive.
what are non-additive tubes
don’t contain chemicals but are coated with silicon to keep the blood from sticking
what are additive tubes?, and what are they used for?4
they are chemicals added to tubes other than silicon that prevent the blood from anticoagulant- prevent clot clot activator-enhance clot formation cell preservatives gel-physically separate blood pst sst
sst
serum separator tubes so they WOULD contain a clot activator, and they separate that from the serum so they would have gel as well
pst
plasma separator tubes would contain an anticoagulant to keep the plasma intact as well as the gel.
what are the chemicals used as anticoagulants? anticoagulants always mean plasma sample
EDTA- which- dipotassium or dry powder, it binds to protein used in clotting *** edta is important for complete blood count because it maintains cellular integrity and does not interfere with staining procedures (lav tube)
Heparins- 3 types ammonium lithium and sodium they stop thrombin formation(mint)
sodium citrate- chelates with calcium(blue)
potassium or ammonium oxalate-bind to calcium and usually used with antiglycolytic agents (grey)
antiglycolytic agent
preserves cell
inhibits metabolism of glucose by cells
sodium flouride used and it inactivates the enzyme systems used
clot activators -test serum
increase sa
enhance clotting process such as thromboplastin and thrombin
these would be the red or gold tubes
thixotropic gel separators
physical barrier after centrifuge and they are inert
pst- plasma separators
set-serum separators
both have gel.
order of draw
sterile-blood cultures blue-citrate tube red,gold- SERUM mint, green- plasma, pst with or without separator lav-EDTA gray-flouride
what is acronym to remember order of draw?
stop buying roses girls love gold
so sterile, blue, red and gold, green but mint green first, lavender, grey
yellow sps tube
used for blood culture.
sterile media bottles
they contain sodium polyanethol sultanate which prevents coagulation by binding to calcium
this one is first because has minimal microbial contamination
light blue tubes
anticoagulant
sodium citrate prevent coagulation by binding to calcium
this is first tube in order because all other additive tubes affect coagulation tests
red tubes
glass- contain nothing
plastic- contain silica particles and helps to activate the clot
so technically it doesn’t contain any additives
this is after coagulation light blue test because the silica particles activate clotting. and this can inhibit the anticoagulant
gold tubes
SST
contains the silica particles
contains thixotropic gel
the gold tubes go after red tubes so the gel doesn’t get in the red tubes. they are also behind light blue tubes because the silica activates clotting factors and can override the anticoagulant
mint tubes
PST
contain lithium heparin which prevents clotting by inhibiting thrombin and it also has thixotropic gel.
heparin effects coagulation tests and interfere with serum which is why it is behind the serum tests (gold and red)
green tubes
lithium or sodium
heparin binds to thrombin and prevents clot must be behind mint `
lavender tubes
EDTA ehtylenediaminetetraccetic acid
prevents clot or coagulation by removing calcium from blood via chelating and it forms a salt.
it is second last- responsible for most carry over problems it elevates na k levels for pst and sst when looking at analyses in fluid portion of blood. and elevates pt and ptt
grey tubes
has anticoagulant and antiglycolytic agent
this is to look at glucose
potassium oxalate anticoagulant-chelates blood
sodium fluoride antiglycolytic prevents the cells metabolism of glucose
sodium fluoride and potassium oxalate effect na and k levels and oxalate damages cell membranes and causes abnormal rbc shape in EDTAS chelates ca would effect ca in other tests
blood additive ratio
ratio altered if not enough blood collected, this is very important, especially in light blue tubes where the ratio is 9:1 of 4.5 ml of blood to 0.5 ml to additive `
important points to remember for tubes
follow order do your best to fill document insufficiency and recollect mix 8-10 times label all tubes
