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Comps > Blood Withdrawal Policy > Flashcards

Blood Withdrawal Policy Flashcards

1
Q

Name the nursing personnel who are permitted to perform blood withrdawal?

A

RN and Certified LVN; LVN must be certified in Blood Draw (not only certified in IV tx)

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2
Q

Gold Gel; Additive; purpose; Min Volume required

A

Serum Seperation Gel for chemistry, toxicology, endocrinology, and immunology tests; 4.5 mL

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3
Q

Lavender Top; Additive; purpose; Min Volume required

A

EDTA K3E; FULL Tube

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4
Q

Light Blue; Additive; purpose; Min Volume required

A

Buffered Sodium Citrate; Coagulation tube; “to min fill line” FULL Tube

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5
Q

Pink Top; Additive; purpose; Min Volume required

A

EDTA K2 for Blood Bank for type and cross for blood and blood products; FULL Tube

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6
Q

2 acceptable forms of ID

A

ID band @ BUE and BLE & ID tag @ ED; ID plate @ Amb Care)

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7
Q

3 standards that should be observed in order to ensure accurate and safe blood withdrawal.

A

Proper ID of pt; Right tube; Standard precaution; Complete paper form at bedside

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8
Q

Gel Tubes should be used when collecting blood samples for which 4 types of tests?

A

chemistry, toxicology, endocrinology, immunology

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9
Q

Pink Tubes are used for

A

EDTA K2 for Blood Bank for type and cross for blood and blood products.

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10
Q

What action will the laboratory take if they receive a specimen tube that is unlabled or mislabled?

A

Test will be cancelled; specimen discarded

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11
Q

T/F It is recommended that all health care professionals who come in contact with blood be vaccinated with the Hepatitis B vaccine.

A

True. For all Health Care Workers who come in contact with blood.

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12
Q

Which device/needle is best used for drawing blood in the antecubital fossa?

A

Vacutainer

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13
Q

Which of the following procedures should be followed when withdrawing blood by venipuncture?

A

Observe standard precaution

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14
Q

3 Safety factors to be observed when withdrawing blood by skin puncture.

A

use lancets to puncture site; alternate puncture site; use lateral aspect of either finger or heel

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15
Q

How many mL of NS should be flushed into a CVC catheter after blood withdrawal?

A

10 mL

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16
Q

Following an infusion of TPN, how many mL of NS should be flushed into a CVC catheter internal valve (without external clamp) prior to blood withdrwal?

A

20 mL

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17
Q

It is BEST to obtain blood culture in when?

A

Prior to initiation of abx tx

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18
Q

How many minutes apart must the 2 peripheral sticks for blood culture be drawn?

A

20 min

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19
Q

4 complecations associated with blood withdrwal.

A

hematoma, syncope, continued bleeding, thrombosis

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20
Q

Blood specimens for typing and crossmatiching must be labeled at the (where)

A

bedside after checking the pt’s ID band

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21
Q

Consult what for correct tube, laboratory form, amount of blood required?

A

Laboratory handbook on Labs and Pathology via intranet; Specimen Collection Container Guide on Labs and Pathology via intranet; MD who ordered test; blood tube label from comp order mgmt sys; Medical Center Laboratory

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22
Q

In what container to submit to laboratory

A

Original container. (Do NOT decant from one vacutainer to another).

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23
Q

Blood withdrawal standard precaution

A

hand hygiene, gloves, specimen in bag for transport, do NOT recap, discard contaminated supplies appropriately, change soiled linen

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24
Q

What is a vacutainer?

A

vacuum specimen tube with needle.

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25
Q

Where to use vacutainer?

A

antecubital vein, on arm with NO IV liine.

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26
Q

Don’t use vacutainer on what?

A

small veins. Too much negative pressure from tube will collapse the vein or be sucked against the needle bevel (e.g. small vein on hand)

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27
Q

Winged Tip Needle Set is also known as

A

Butterfly or Scalp Needle

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28
Q

Can you use a Vacutainer or syringe with a winged tip needle set?

A

Yes.

29
Q

What type of veins are used with wing tip needle set?

A

veins on wrist or forearm when the antecubital veins are not available (d/t bruise, sore, swollen hard, or IV line present)

30
Q

IV Cannula is also known as

A

over the needle catheter

31
Q

When do you use an IV cannula?

A

when both a blood specimen and IV line are required. It’s used to spare pt from additional venipunctures.

32
Q

What makes using an IV cannula more difficult for blood withdrawal?

A

Hypovolemia, dehydration, and vasoconstriction

33
Q

Observe what steps for Blood Withdrawal via Venipuncture?

A

Verify MD order; Standard Precaution; Use distal vein of forearm to ensure availability of more proximal veins for use in future; Use veins in upper extremeties only; Do NOT use central veins (e.g. jugular, subclavian, femoral); Wipe with alcohol, let dry; Clean cholorhexidine or povodine-iodine antiseptic if withdrawing blood for Blood Culture; apply tourniquet; Use 21G (Vacutainer or Winged tip Needle Set) for Adults and 23 G for Peds; Bevel Up; do NOT stick pt > 3x; Withdraw only exact amount of blood required for each test (do NOT draw extra as spare); remove tourniquet prior to removing needle;

34
Q

When do you need a Discard Tube FIRST and for what kind of needle set?

A

Winged tip needle set; if only the anticoagulant tube is to be drawn

35
Q

How long to mix all tubes containing an anticoagulant or additive? Why?

A

5 - 10 sec by gentle inversion in order for the anticoagulant or other addtive to be effective.

36
Q

What do you apply over the puncture site once blood has been collected? Never what?

A

dry, sterile 2x2 gauze; never alcohol pad over needle exit

37
Q

Fingerstick is commonly used for what kind of test?

A

blood glucose testing

38
Q

Why use alternate puncture sites?

A

to prevent hematoma

39
Q

Can LVN craw blood or manipulate CVCs?

A

No. LVNs can only change the dressing.

40
Q

What is recommended for blood withdrawal from CVC like PICC?

A

syringe

41
Q

Always do what before drawing blood for testing from CVC?

A

Withdraw blood discard before drawing blood for testing from CVC

42
Q

What is a blood discard from CVC?

A

4-6 mL (Adults) IV fluid/flush solution and blood that is cleared from the CVC

43
Q

Rationale for blood discard from CVC

A

ensures non contaminated blood sample.

44
Q

How much flush after withdrawing blood from CVC?

A

10 mL NS to avoid damage to catheter.

45
Q

How do you transfer the blood specimen from the syringe to the tube?

A

A blood transfer device.

46
Q

Do not do what to transfer blood specimen from syringe to tube for CVC?

A

Do NOT remove the top of the tube and do not use a needle to transfer the blood to the tube.

47
Q

Which ports can you use to withdraw blood from CVC?

A

Use free CVC port. Do NOT interrupt infusion for blood withdrawal.

48
Q

What do you consider if any CVC ports are being used?

A

Consider what solution is infusing before drawing blood sample. For example, Do NOT draw potassium if IV containing potassium is infusing into any CVC port

49
Q

When are you discouraged from drawing blood from free CVC port? So, where can you collect blood in this case?

A

during ongoing infusions of TPN or IV fluids with electrolytes in other ports. Collect by venipuncture. If no vein available, STOP TPN or IV infusion (with additives) for 5 min and aspirate blood discard if possible

50
Q

How mucht to flush CVC with internal valve (without external clamp) before blood draw following an infusion of a thick fluid like blood or TPN?

A

20 mL NS

51
Q

For CVC with internal valve (without external clamps), how much to you wait and how much blood discard do you withdraw?

A

Wait for a few minutes after 20 mL NS flush before drawing blood discard of 4-6 mL. Then draw blood specimen.

52
Q

Obtain a blood culture before starting what?

A

antibiotic therapy

53
Q

Steps to collecting blood culture specimen?

A

Scrub top of culture bottle or Isolator with alcohol pad. Leave pad on bottle until blood is ready to inject. Do NOT obtain blood culture from CVC unless MD order or r/o CVC infection. Withdraw blood from 2 separate peripheral venous sites 20 min apart. Clean site for 30 sec with alcohold pad. Use chlorohexidine or povidone-iodine.

54
Q

What do you draw first? Blood culture or blood for other tests?

A

Draw blood culture first.

55
Q

What kind of containers do you use for blood culture specimens for adults?

A

aerobic bottle is blue; anaerobic bottle is yellow. If pt on abx, use gray top bottle instead of blue.

56
Q

Inoculate with bottle for blood culture collection for adults?

A

Inoculate aerobic bottle FIRST.

57
Q

What and how many bottles are required for peds < 14 yo?

A

1 bottle. PINK bottle.

58
Q

Where do you find information about Blood Culture Specimens?

A

Laboratory Handbook, Intranet on Nursing Procedures (Blood Culture Withdrawal).

59
Q

How do you get a hematoma from Blood withdrawal? What’s your intervention?

A

incomplete insertion of needle into lumen of vein. Release tourniquet and withdraw needle at first sign of swelling (d/t blood diffusing to adjacent tissue). Apply pressure for 2-3 min or until bleeding has stopped. You can ask the pt to apply pressure while discarding needles and syringe. Do NOT reapply tourniquet to same extremity immediately after venipuncture.

60
Q

How do you get syncope from blood withdrawal? What is your intervention?

A

from fear of needles. Provide reassurance. Instruc pt to look away or focus on an object in the room while venipuncture is being performed.

61
Q

How do you get continued bleeding from blood withdrawal?

A

Inadequate pressure on puncture site or coagulation problems. Apply pressure for 5 min. Notify MD if excessive bleeding is noted and document on Nursing Progress Notes.

62
Q

How do you get thrombosis from blood withdrawal?

A

blood clot formation at insertion site. Always rotate venipuncture sites.

63
Q

How do you label Blood Specimen?

A

at bedside. Label the tube and compare the label with the pt ID prior to drawing. Whoever draws it labels it. Label is placed along side of the tube to allow visualization of the volume within the tube.

64
Q

How NOT to label Blood Specimens?

A

DO NOT put unlabled tubes in pocket, have someone else label the tube, label tube away from bedside, label other nurse’s tube, label plastic bag containing specimen.

65
Q

Specimen label MUST be

A

legible

66
Q

When do you deliver blood specimen to lab?

A

Promptly for separation of anylytes from serum or plasma. Analytes like Creatinine Kinase is unstable at room temp.

67
Q

If blood specimen order is expedited testing, STAT or urgent service, do what?

A

bring blood specimen directly to lab AND tell lab personnel it needs STAT handling.

68
Q

How to deliver specimen to Blood Bank? What is it for?

A

Directly deliver to Blood Bank for type and crossmatching.

69
Q

To whom do you report critical lab values?

A

to pt’s MD, then backup notification to resident on call, then on call provider identified by each service. In Peds, ED, OR, or ICU report critical values to primary RN.

Comps (9 decks)

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