CPT-1 Flashcards
1
Q
where did the word phlebotomy originate from?
A
phlebo-vein
tomy-to make an incision
2
Q
what is therapeutic phlebotomy commonly used for?
A
patients who have Polycythemia
Polycythemia-condition characterized by high RBC count
3
Q
who performs phlebotomy? what is phlebotomy also called?
A
- nurse or phlebotomist
- phlebotomy also called a venisection
4
Q
where is a tourniquet tied? how long can it be left on?
A
- 4-6 inches above draw site
- max. 1 minute
5
Q
what is hemolysis?
A
destruction of red blood cells
6
Q
how does hemoconcentration occur?
A
results from the tourniquet being left on the arm for too long
7
Q
what is a right under the patient’s bill of rights?
A
- patients always have the option to decline medical treatment
- know what tests are being performed on them
8
Q
can a phlebotomist give results to a patient?
A
no, because they are not medically qualified
9
Q
patient consent
A
various forms of consent that are needed from the patient in order to do a procedure
10
Q
informed consent
A
- a competent person gives voluntary permission for a medical procedure
- after receiving adequate info about the risk of, methods, and consequences
11
Q
expressed consent
A
permission given by a patient verbally or in writing for a procedure
12
Q
implied consent
A
-patients actions gives permission for the procedure without verbal or written consent
EX: going to the ER, or holding out arm for blood draw
13
Q
HIV consent
A
-special permission need to administer a test which detects HIV
14
Q
parental consent for minors
A
- a parent or legal guardian must give permission for procedures administered to underage patients
- range from 18-21 depending on state law
15
Q
tort
A
- an injury/wrong committed with or without force to the person/property of another
- for which civil liability may be imposed
16
Q
what is donning? what is doffing?
A
donning: putting on the tourniquet
doffing: taking off the tourniquet
17
Q
What characterizes tests waived by CLIA?
A
employ methodologies
18
Q
what is barrier protection?
A
-PPE that provides physical barrier against infection
19
Q
5 types of barrier protection
A
- masks
- goggles
- face shields
- respirators
- gloves (must be worn at all times)
20
Q
what are mucous membranes?
A
eyes, nose, mouth
21
Q
3 reasons why gloves are worn:
A
- provide protective barrier, prevent cross contamination
- reduce likelihood that microorganisms present on hands will be transmitted to patients
- reduce likelihood that hands contaminated with micro organisms from one patient will transmit to another patient
22
Q
needles should never be _______
A
recapped
23
Q
when should sharps containers be emptied/disposed of?
A
contains should be locked and disposed of when they are 2/3 full
24
Q
what are 2 liquids used for decontamination?
A
- solution if sodium hypochlorite (bleach)
2. lysol
25
what is the needle stick safety and prevention act?
sharps injury log must contain:
1. type and brand of device involved in incident
2. department/work area where exposure incident occurred
3. explanation of how the incident occurred
26
what are 4 things you must do if exposed to blood or any potentially infectious material?
1. wash exposed area w/ soap and running water
2. report exposure to supervisor
3. refer to the MSDS
4. full out an exposure report form
27
what is vein selection based on?
size and condition of the vein
28
you should always draw blood ________ Abd IV site
below
29
median cubical vein
- vein most commonly used for venipuncture procedure
| - large and usually anchored well
30
cephalic vein
- can be more difficult to locate
| - easiest vein to palate in an obese patient
31
basilica vein
- least firmly anchored
- located near brachial artery
- if needle inserted too deep, risk puncturing brachial artery or an nerve
32
9 pieces of supplies for venipuncture
1. laboratory requisition
2. antiseptic
3. tourniquet
4. gloves
5. vacutainer tubes
6. vacutainer needles
7. needle adapters
8. winged infusion set
9. needle disposal container
33
what do labels include?
- accession number
| - unique tracking number different for each sample
34
what is a tourniquet?
- slows venous outflow of blood from arm
| - causes veins to bulge
35
when must gloves be worn?
always
36
the lower the gauge __________
the larger the needle
37
why are needles smaller than 23 gauge not recommended?
-they can cause hemolysis
38
what is a winged infusion set also called?
butterfly needle
39
what is the most commonly used butterfly needle size?
23 gauge
40
when can you recap a needle?
never
41
what are the 5 proper steps to end a blood draw?
1. remove tourniquet
2. remove the tube
3. place cotton over site
4. remove the needle
5. activate safety
42
what is edema?
accumulation of fluid in the tissues /excessive swelling
43
what are 8 venipuncture problems?
1. failure to obtain blood
2. inappropriate puncture site
3. scarred and sclerosed veins
4. rolling veins
5. collapsing veins
6. hematoma
7. premature needle withdrawal
8. fainting
44
what is a hematoma?
this is the most common complication from phlebotomy
45
what is vasovagal syncope?
fainting
46
what is the first thing you do if your patient faints?
get the needle out of the arm
47
what is a capillary?
a microscopic blood vessel
48
what can cause hemolysis?
- milking a finger too much
| - using too small of a needle
49
what is a finger stick?
-capillary puncture done on finger when patient is over the age of 2
50
which finger do you choose for a fingerstick?
either 3rd or 4th finger of the non dominant hand
51
what is important to remember about finger sticks in terms of collecting blood?
always wipe away the first drop of blood with gauze (never alcohol)
52
What is a heel stick primarily used for? (What type of test)
bilirubin
53
What is bilirubin associated with?
- overproduction occurs when liver doesn't break down/excreting RBC
- jaundice
54
How far should you puncture for a heel stick?
-do not exceed 2.0mm
55
What age do you perform heelsticks?
-infants less than 1-2 years of age
56
What is the recommended location for a heel stick?
- medial + lateral portions of the plantar surface of foot
| - between big toe + 3/4 toe
57
What should be placed on the heel prior to a heel stick?
-heel-warmer to dilate the capillaries
58
What kind of tubes are used to collect bilirubin samples?
- amber colored containers
| - minimize exposure to light
59
What is hemostasis?
the healing process
60
What are the 4 phases of hemostasis?
1. vascular phase
2. platelet phase
3. coagulation phase
4. fibrinolysis
61
What is the vascular phase of hemostasis?
- injury to blood vessel causes it to constrinct
| - slowing flow of blood
62
What is the platelet phase of hemostasis?
- injury to endothelial lining causes platelets to stick to it
- form temproary platelet plug (aggregation)
63
What is a BTT?
- bleeding time test
| - used to evaluate primary stages of hemostasis
64
What is the coagulation phase of hemostasis?
- interactions between coagulation factors
- convert temporary platelet plug to a stable fribin clot
- intrinsic + extrinsic pathway
65
What is a PT/INR?
- Prothrombin Time test (light blue)
- evaluate extrinsic pathway
- monitors anticoagulant therapy
66
What is a PTT?
- Partial Thromboplastin Time
| - evaluate intrinsic pathway
67
What is fibrinolysis?
-breakdown and removal of the clot
68
What are the 3 things needed for hemostasis to occur?
1. blood vessels
2. blood platelets
3. coagulation factors
69
What is the basal state?
- fasting and refrain from strenuous exercise for 8012 hrs prior to draw
- water is okay
70
What is post-prandial?
-after a meal
71
What type of panel should be drawn when a patient is fasting?
lipid panal
72
what are 3 uses for timed specimens?
1. measure blood levels of substances exhibiting diurnal variation (EX: monitor cortisol)
2. monitor changes in a patient's condition
3. determine levels of medication in blood strema
73
what is diurnal variation?
-different during the day and night
74
What is therapeutic drug monitoring?
-monitor blood levels of certain medications to ensure patient safety + maintain a plasma level
75
What is a trough? What is a peak?
- trough: lowest chemical blood level
| - peak: highest chemical blood level
76
When are trough levels collected?
-30 min before the scheduled pharma dose
77
How are warmed specimens collected?
- blood is collected in tubes pre-warmed in incubator
| - cold agglutinins are antibodies produced in response to mycoplasma
78
What is a common test that requires chilled specimens?
-ammonia
79
How are light-sensitive specimens proteted?
-aluminum foil or amber tubes
80
What is a test drawn without stasis?
-without a tourniquet
81
What does with stasis mean?
-with a tourniquet
82
What type of test must be drawn without stasis?
-lactate test
83
What is the most critical pre-analytical error that a phlebotomist can make?
-improperly identifying the patient prior to sample collection
84
What is a glucose tolerance test?
- used to diagnose diabetes mellitus + gestational diabetes
| - fasting
85
How many draws are there in a glucose tolerance test?
-baseline then 1 for every hour after the baseline
86
What are blood cultures ordered for?
- detect the presence of microorganisms in the patient's blood
- patient will usually have chills/fever of unknown origin
87
What is septicemia?
-presence of pathogenic/infectious microoganisms in the blood
88
How many approved methods are there to clean the skin for a blood culture?
2
89
What are the 2 methods used for cleaning the skin for a blood culture?
1. with alcohol then iodine
| 2. with chlorhexadine
90
What is the most common cause of contamination when drawing blood cultures?
improper site preparation
91
what is PKU?
- test ordered for infants to detect phenylketonuria
| - genetic disease that causes mental retardation + brain damage
92
What kind of draw is used for a PKU?
- dermal puncture
| - heel or urine
93
Who draws an arterial blood gas?
-respiratory therapist, nurse, or physician
94
Where is an ABG sample taken from?
- radial arter
| - thumb side of wrist
95
What is arterial blood used for?
-determine blood gas levels and blood pH/acidity
96
What are the 4 primary tests performed on arterial samples?
1. pH
2. carbon dioxide
3. oxgyen
4. bicarbonate
97
What is the angle for an ABG draw?
90 degrees
98
What is plasma?
- liquid portion of unclotted blood
| - still contains clotting factors
99
what is serum?
- liquid portion of blood that has been allowed to clot
| - does not contain clotting factors
100
which tubes have anticoagulants?
-lavender
-green
-royal blue (lavender stripe)
-light blue
-gray
(plasma)
101
which tubes are without anticoagulants?
-red
-tiger top/gold
-royal blue with red
(serum)
102
what is the hematology section?
- formed elements of blood are studied via RBCs, WBCs, platelets
- disorders/infections are detected
- coagulation section
103
What is the chemistry section?
-largest and most automated
104
what is the chemistry section divided into?
1. electrophoresis
2. toxicology
3. immunochemistry
105
What is the blood bank section?
-blood is collected, stored, prepared for transfusion
106
What is the serology/immunology section?
-performs tests to evaluate a patient's immune response through the production of antibodies
107
What is the microbiology section?
-detection of pathogenic microorganisms in patient samples
108
What does pathogenic mean?
microoganisms that cause disease
109
What is a C&S (culture and sensitivity) test used for?
detect + identify microorganisms
110
What is the urinalysis section?
-detect infection of kidney, urinary tract, metabolic disorders, drug abuse
111
What type of sample should be collected if a physician suspects a drug abuse?
- urine sample
| - clean catch mid stream (used for chemistry evaluation of the urine)
112
What are cytology studies?
-presense of abnormal cells from urinary tract
113
What is a clean catch specimen?
- involves cleaning of the genital area
| - collecting urine into sterile container
114
What are the 3 components of urinalysis?
1. physical examination
2. chemical examination
3. microscopic examination
