Chapter 3 - ROUTINE HEMATOLOGY PROCEDURES Flashcards
1
Q
Materials for Blood Collection:
A
- Tourniquet
- Needles
- Evacuated Tube System
- Solutions for Skin Antisepsis
2
Q
Applied to distend the veins makes veins larger and easier to find, and stretches the walls so they become thinner and easier to pierce.
A
Tourniquet
3
Q
Application of tourniquet should not exceed ______.
A
1 min
4
Q
Test/s that strictly does/do not require the use of tourniquet: _______
A
5
Q
With color-coded hub indicating the gauge (Gauge is inversely related to the size/bore)
A
Needles
6
Q
: considered standard for routine venipuncture
A
Gauge 21
7
Q
Gauge 21-23 (? for children; ? for butterfly/winged infusion set)
A
23
21, 23 & 25
8
Q
: for the collection of blood from scalp or other small veins of infants
A
Gauge 25
9
Q
Needles Length: ? (G21-23); ? (butterfly needles)
A
1 or 1.5 inches
½ to ¾ inch
10
Q
Basic components: multisample needle, tube holder, evacuated tubes (with premeasured vacuum that draws the indicated volume of blood
A
Evacuated Tube System
11
Q
are color-coded to identify a type of additive, or absence of additive, or special tube property.
A
Tube stoppers
12
Q
Routine collection:
A
70% isopropyl alcohol
13
Q
Test for legal blood alcohol level:
A
non-alcohol-based antiseptic
14
Q
30- to 60-second scrub with 70% isopropyl alcohol then 1% - 10% povidone-iodine pads, tincture of iodine, chlorhexidine compounds, or another isopropyl alcohol preparation.
A
Blood culture: Two-step procedure
15
Q
Blood culture: One-step application
A
chlorhexidine gluconate/isopropyl alcohol or povidone-70% ethyl alcohol
16
Q
admixture of venous, arterial and capillary blood with interstitial and intracellular fluids
A
Capillary blood
17
Q
may be used as substitute for arterial blood gas determinations provided that the site is warmed prior to collection (blood enters capillaries under pressure and the arterial portion is highest)
A
Capillary blood
18
Q
SOURCES OF BLOOD SPECIMENS:
A
Capillary blood
Arterial blood
Venous blood
19
Q
Normally uniform throughout the body.
A
Arterial blood
20
Q
For blood gas analysis and pH measurement
A
Arterial blood
21
Q
Affected by metabolic activity of the tissue it drains and varies by collection site
A
Venous blood
22
Q
Mostly used in chemistry analyses
A
Venous blood
23
Q
MICROSAMPLING
A
SKIN PUNCTURE
24
Q
MACROSAMPLING: Methods of Collection
A
- Evacuated tube system (ETS)
- Needle and syringe
- Winged infusion set (butterfly)
25
Method of collection for pediatric patients, obese patients, patients with thrombotic tendencies, with severe burns, geriatric patients and in routine assay requiring small amount of blood (POCT)
MICROSAMPLING (SKIN PUNCTURE)
26
MICROSAMPLING (SKIN PUNCTURE) Sites:
Infants:
Adults:
medial or lateral plantar heel surface; plantar surface of big toes
3rd or 4th finger; margins of the ear lobe
27
MICROSAMPLING (SKIN PUNCTURE)
Sites to be avoided:
(Infant) -
(Adult) -
Central arch area of the heal and fingers
Thumb, index, 5th finger, fingers on the site of mastectomy, edematous or a previous puncture site.
28
MICROSAMPLING (SKIN PUNCTURE)
Length of lancet:
1.75 mm
29
If using a lancet, the blade should not be longer than (?) to avoid injury to the heel bone)
2 mm
30
preferred method
Evacuated tube system (ETS):
31
minimizes the risk of specimen contamination and exposure to the blood
Evacuated tube system (ETS)
32
Discouraged by CLSI due to safety and specimen quality issues.
Needle and syringe
33
May be used on small, fragile, or damaged veins.
Needle and syringe
34
Can be used with the Evacuated tube system or a syringe.
Winged infusion set (butterfly)
35
Often used to draw blood from infants and children, from hand veins, and in other difficult-draw situations.
Winged infusion set (butterfly)
36
For arterial blood gas analysis
ARTERIAL PUNCTURE
37
ARTERIAL PUNCTURE
Sites:
radial artery, brachial artery, femoral artery, scalp artery and umbilical artery
38
Performed without a tourniquet.
ARTERIAL PUNCTURE
39
This is technically more difficult to perform than venous puncture and it is prone to hematoma.
ARTERIAL PUNCTURE
40
: Done before a radial arterial collection is performed.
Modified Allen Test
41
This determines whether the ulnar artery can provide collateral circulation to the hand after radial artery puncture
Modified Allen Test
42
Modified Allen Test Anticoagulant:
0.05 ml liquid Heparin/ml blood
43
Place blood in ice water/coolant (1-5OC) to minimize consumption of O2 by leukocytes
Modified Allen Test
44
(Substitute): earlobe is the preferred site because of vascularity, low metabolic requirements & ease with which it can be arterialized by first warming at 39 42OC.
Arterialized Capillary blood
45
Newborn up to 18 months:
Superior longitudinal sinus; External jugular vein; Temporal vein
46
18 months to 3 years:
Femoral vein; Long saphenous vein; Ankle vein; Popliteal vein; External Jugular vein; Temporal vein
47
3 years to adult:
Antecubital fossa: Median cubital, Cephalic, Median basilic
Wrist veins; Hand (dorsal aspect) veins;
Ankle veins
48
Contraindications of venipuncture at the LOWER EXTREMETIES:
Poorly-controlled diabetes mellitus
Hemoglobinopathies
Thrombosis
49
Use opposite arm or perform fingerstick.
IV or blood transfusion running
50
Ask attending the nurse to stop IV for at least 2 minutes; select vein other than the one with the IV. Draw and discard first 5 mL.
IV or blood transfusion running
51
Causes an increase of infused substance like glucose, chloride, potassium and sodium, with a decrease in urea and creatinine.
IV or blood transfusion running
52
Draw from opposite arm.
Fistula
53
Lab may draw below heparin lock if nothing is being infused.
Indwelling lines and catheters, heparin locks, cannulas
54
The first 5 mL of blood drawn should be discarded.
Indwelling lines and catheters, heparin locks, cannulas
55
Select another site.
Sclerosed veins, Scars, burns, tattoos, Edema
56
Draw below
Hematoma
57
Minimize venipuncture.
Streptokinase/TPA
58
Hold pressure until bleeding has stopped.
Streptokinase/Tissue plasminogen activator
59
Draw from opposite arm
Mastectomy
60
If you are unable to obtain a specimen on the first attempt, try again (?) the first site, on the (?), or on a (?) vein.
Multiple venipuncture attempt
below
other arm
hand or wrist
61
If the second attempt is unsuccessful, ask someone else to take over.
Multiple venipuncture attempt
62
Needle may not be placed at the center of the stopper causing blockage.
No Blood seen or Too little blood flow into the tube
63
Needle bevel may be flushed against the wall of the vein causing blockage.
No Blood seen or Too little blood flow into the tube
64
Tourniquet applied too tightly or too long, thus stopping blood flow.
No Blood seen or Too little blood flow into the tube
65
Tube may have been prematurely punctured.
No Blood seen or Too little blood flow into the tube
66
Tube may have previously been opened.
No Blood seen or Too little blood flow into the tube
67
Needle is not completely in the vein or has not reached the vein
No Blood seen or Too little blood flow into the tube
68
Transfixation
No Blood seen or Too little blood flow into the tube
69
Excessive probing
Hemolysis
Hematoma
70
Underfilling of tubes
Hemolysis
71
Alcohol contamination
Hemolysis
72
Vigorous mixing of the sample
Hemolysis
73
Use of too small needle during a difficult draw
Hemolysis
74
Drawing the blood through an existing hematoma
Hemolysis
75
Pulling back too quickly on the plunger of a syringe
Hemolysis
76
Transferring from syringe & needle to evacuated tubes
Hemolysis
77
Contamination of the specimen with alcohol or water at the venipuncture site or in the tubes.
Hemolysis
78
Physiologic cause: hemolytic anemias.
Hemolysis
79
Premature removal of the tubes
Underfilling of Tubes
80
Long lines of tubing containing air
Underfilling of Tubes
81
Vein may have collapsed
Blood stops flowing halfway during blood collection
82
Needle may have been repositioned or out of the vein
Blood stops flowing halfway during blood collection
83
Tourniquet placed too near the venipuncture site
Hematoma
84
Failure to remove the tourniquet before removing the needle
Hematoma
85
Failure to apply enough pressure to the site after venipuncture
Hematoma
86
Inadvertent puncture of an artery.
Hematoma
87
Needle may not be completely in the vein/bevel of the needle is only partially in the vein
Hematoma
88
Transfixation resulting to leakage of large amount of blood around the puncture site causing the area to swell
Hematoma
89
COMPLICATIONS of Phlebotomy:
90
Ecchymosis
Immediate Local complication
91
Localized Hemoconcentration or Venous stasis
Immediate Local complication
92
Circulatory failure
Immediate Local complication
93
Syncope or Fainting
Immediate Local complication
94
Thrombosis
Late Local Complications
95
Thrombophlebitis
Late Local Complications
96
Allergies
Late Local Complications
97
Patients can be allergic to antiseptics, adhesive glue in bandages, and latex. Use an alternate antiseptic if required; (?9 can be used in place of adhesive bandages
paper tape placed over folded gauze or self-adhesive bandage material
98
transmission of blood-borne infections
Delayed General Complications
99
Physiologic factors that may cause variations in hematology test results:
100
: Changing from a supine to a (?) results in a shift of body water from inside the blood vessels to the interstitial spaces.
Posture
sitting or standing position
101
: Eosinophil count is lower in the (?) and increase in the(?).
Diurnal Rhythm
morning; afternoon
102
: can increase white blood cell count
Exercise
103
: can cause a temporary increase in the white blood cell count.
Stress
104
: increased lipids may cause turbidity (lipemia) in the serum or plasma, affecting some tests that require photometric measurement.
Diet
105
smoking before blood collection may increase (?)
Long-term smoking can result in increased (?).
white blood cell counts and cortisol levels
hemoglobin levels
106
: Used in routine and special chemistry tests
1. Serum
107
: Used in coagulation studies
2. Plasma
108
: Must be collected in an anticoagulant tube to prevent it from clotting;
3. Whole blood
109
Used in complete blood count (CBC)
3. Whole blood
110
Removes Ca++ chelation
EDTA
111
spray-dried in plastic tubes
K2EDTA
112
EDTA: liquid form
K3EDTA
113
EDTA Commercial preparations:
Versene; Sequestrene
114
1 - 2 mg/ml blood
EDTA
Oxalate
115
Lavender
EDTA
116
Hematology procedures (CBC; Platelet count, blood smears)
Pink (dry K2EDTA)
117
(EDTA & Gel)
White
118
(Plastic- K2EDTA)
Tan
119
Blood Bank
Tan
120
Molecular Diagnostics
Tan
121
Lead testing
Tan (Plastic -K2EDTA)
EDTA
122
(dry K2EDTA)
Pink
123
Prevents platelet aggregation
EDTA
124
does not preserve factor V
EDTA
125
Excess causes red cells to shrink and platelets to break
EDTA
126
After 3 hrs @ room temperature: vacuolation of cytoplasm; more homogenous nuclei; irregular or poorly defined cytoplasmic borders and irregularly-shaped nuclei.
EDTA
127
Possible platelet satellitism
EDTA
128
Binds with Ca++ in a nonionized form
Sodium Citrate
129
What is the ratio of sodium citrate to blood?
Light Blue (1:9)
Black (1:4)
130
0.1 - 0.2 mg/ml of blood
Heparin
131
Acts as antithrombin
Heparin
132
Li or Na heparin preparations
Heparin
133
10 mg/mL blood
Na Fluoride Li iodoacetate
134
Combines w/ Ca++ into insoluble calcium oxalate salt
Oxalate
135
Erythrocyte sedimentation rate
Sodium citrate
Black
136
Coagulation Tests
Light Blue
137
(Na or Li)
Green
138
(Li Heparin & Gel)
Light Green/Black
139
(Na Heparin, Na2EDTA
Royal Blue
140
(Glass Na Heparin)
Tan
141
Chemistry; Lead testing
Tan (Glass - Na Heparin)
142
Glucose test; Ethanol specimens
Gray
143
Preserves labile coagulation factors
Sodium Citrate
144
Helps retain functional capabilities of platelets
Sodium Citrate
145
Best for Osmotic fragility test (OFT)
Heparin
146
Prevents hemolysis
Heparin
147
Causes blue background on Wright-stain blood smear
Heparin
148
May cause clumping of WBCs and platelets
Heparin
149
will yield serum.
Na Fluoride
150
Distorts cell morphology
Oxalate
151
((Paul-Hellers)
K oxalate
152
(Wintrobe)
NH4 Oxalate
153
Light Blue - Hematology
Thrombin & Soybean Trypsin Inhibitor
154
Test for Fibrin Degradation Products
Thrombin & Soybean Trypsin Inhibitor
155
None
Red (Glass)
156
Chemistry & Serology
Red (Glass)
157
Silica Clot Activator
Red (Plastic/ Hemogard)
158
STAT Chemistry & Serology
Red (Plastic/ Hemogard)
159
STAT Chemistry
Yellow/Gray & Orange
Red/ Gray & Gold
160
Thrombin
Yellow/Gray & Orange
161
Silica & Separation Gel
Red/ Gray & Gold
162
Microbiology (bacterial culture)
Sterile, with Sodium polyanethol sulfonate (SPS)
163
BB, HLA phenotyping, Paternity testing
ACD
164
A special sequence of tube collection that reduces the risk of specimen contamination by microorganisms and additive carry-over, which may affect some chemistry tests
Order of Draw of Tubes
165
Order of Draw from Catheter lines
1. Draw 35 mL in a syringe and discard.
2. Blood for blood culture
3. Blood for anticoagulated tubes (lavender, green, light blue, etc.)
4. Blood for clot tubes (red, SST, etc.)
166
Order of Draw for Skin Puncture
1. Tube for blood gas analysis
2. Slides, unless made from specimen in the EDTA microcollection tube
3. EDTA microcollection tube
4. Other microcollection tubes with anticoagulants
5. Serum microcollection tubes
167
Read on the Order of Draw of blood and the rationale of each. (Clinical Chemistry by Bishop 6th ed., p. 47)
168
Serum or plasma should be separated from cells within (?) from collection, unless collected in a gel separator, to prevent glycolysis, lipolysis, shift of electrolytes, hemolysis and loss of some unstable substances
1 hour
169
Centrifugation:
3000 RCF for 10 mins
170
Reasons for specimen rejection:
(?) do not match.
Tube is (?), or the labeling, including patient identification number, is incorrect .
Specimen is (?).
Specimen was collected at the (?).
Specimen was collected in the (?).
Specimen was (?), while the test requires whole blood or plasma.
Specimen was contaminated with (?).
Specimen is (?) (depends on the test)
Test order requisition and the tube identification
unlabeled
hemolyzed
wrong time
wrong tube
clotted
intravenous fluid
lipemic
