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Phlebotomy > Exam > Flashcards

Exam Flashcards

1
Q

Explain Universal Precautions as it applies to phlebotomy

A

Blood and certain body fluids of all individuals are considered potentially infectious.

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2
Q

Explain Standard Precautions as it applies to phlebotomy

A

Precautions to use in caring for all patients regardless of diagnosis or presumed infection status. Standard precautions apply to all body fluids. Wear proper PPE

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3
Q

Explain Transmission based precautions as it applies to phlebotomy

A

Precautions to use for patients either suspected or known to be infected with certain pathogens transmitted by airborne, droplet, or contact routes

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4
Q

What are 5 steps that can be taken to reduce the risk of exposure to bloodborne pathogens?

A

1) Wash hands when changing gloves and between patients.
2) Wear gloves during all blood collections.
3) Wear protective covering when clothing is likely to be soiled.
4) Wear mask or eye protection.
5) Properly dispose of needles / syringes / sharps.

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5
Q

What are typical precautionary measures and actions that are taken in the event of an accidental needle puncture or body substance exposure?

A

Immediately cleanse exposed area.

Report incident to supervisor immediately.

Healthcare worker is tested for HIV, HBV and hepatitis C if consent is given.

If source patient is known, consent must be obtained and baseline HIV, HBV and hepatitis C tests are performed.

If source patient refuses testing, worker has a right to prophylaxis treatment.

Follow-up testing

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6
Q

Describe Protective (Reverse) Isolation. When is it utilized? What is the phlebotomist’s responsibility to a patient in protective isolation?

A

Protective isolation is designed to protect the patient from the healthcare worker.

Patients who are immunosuppressed or transplant patients are often in protective isolation.

PPE must be worn before entering the patient’s room. All phlebotomy supplies need to remain outside of the patients room or cleaned before be brought in.

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7
Q

List two instances when a syringe is more applicable than the evacuated® tube method for blood draw?

A

Drawing from a vein other than in the anticubital area.

Difficult-to-draw patient who have fragile, thin, or “rolling” veins.

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8
Q

List the anticubital veins in order of choice for routine venipuncture:

A

a. Median cubital vein
b. Cephalic vein
c. Basilic vein

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9
Q

What step should be done prior to beginning a specimen collection utilizing a syringe?

A

Pull back plunger to remove air lock.

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10
Q

State the relationship between bore size and the gauge of the needle.

A

The larger the gauge the smaller the bore. A larger gauge needle would be used on a narrow vein.

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11
Q

How does EDTA prevent coagulation?

A

Binds/chelates calcium

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12
Q

How does Potassium Oxalate prevent coagulation?

A

Precipitates calcium

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13
Q

How does Citrate prevent coagulation?

A

Binds/chelates calcium

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14
Q

How does Fluoride prevent coagulation?

A

Inhibits glycolysis

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15
Q

How does Heparin prevent coagulation?

A

Inhibits thrombin

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16
Q

What anticoagulant is in the following?
Light blue
Gray
Green

A

Light blue - Sodium citrate 3.2%
Gray - Lithium iodoacetate and lithium heparin
Green - Sodium heparin or Lithium heparin

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17
Q

What anticoagulant is in the following?
Lavender (purple)
Red
Red/black

A

Lavender - EDTA
Red - No anticoagulant
Red/black - gel/clot activator. Sodium heparin

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18
Q

What is the purpose of adding a silicon coating to a collection tube?

A

Fills the microscopically rough surfaces of glass so that cells don’t adhere to the sides of the tube.
Reduces the chance for hemolysis.

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19
Q

What is the purpose of adding silica particles to a collection tube?

A

Acts as a clot activator, initiates clotting process

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20
Q

What is the purpose of adding thixotropic gel to a collection tube?

A

Inert gel that undergoes change in viscosity during centrifugation.
Acts as an interface between cells, serum or plasma

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21
Q

In what order should blood tubes be drawn for evacuated tube?

A

Stop Light Red Stay Put, Green Light Go

Sterile (Blood culture), light blue, red, SST and PST(gold), green, lavender, grey

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22
Q

What role does the tourniquet play in specimen collection? What effects are there if the tourniquet remains on to long?

A

Used to access and find a good vein

Leaving it on to long can cause hemoconcentration/hematoma.

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23
Q

Describe different types of lancets used in capillary specimen collection based on area of collection and depth of puncture.

A

Neonatal to 12 months of age: heelsticks, < 2.0 mm
Shallow incision: for toddlers, children, = 1.8 mm
Normal incision: point of care tests. = 2.4 mm
Deeper incision: = 3.0 mm

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24
Q

Explain social, clerical, and technical skills.

A

Social - skills involving the patient
Clerical - skills with data entry and record keeping
Technical - skills drawing the patient

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25
Q

What are common causes of hemolysis in the syringe or evacuated tube techniques?

A

Traumatic draw.
Alcohol still on the arm during the draw.
A small needle on a syringe.
Shaking the blood in a tube instead of gently inverting 5-8 times.
Pulling or depressing plunger to hard.

26
Q

What is informed consent?

A

A decision made by or for a patient after being informed about the proposed procedures. Implied consent is patient laying out their arm.

27
Q

What is the order of draw from microcollection tubes?

A

Blood gases, EDTA, other additives, serum specimen.

28
Q

Proper area for capillary specimen collection of finger and heel.

A

Finger - 3rd and 4th fingers of the non-dominant hand. Perform the stick off to side of the center of the finger.

Heel - Most medial or lateral portions of the plantar surface of the heel.

29
Q

Criteria for the following specimens:
Fasting
Timed

A

Fasting - Patient can’t eat for 12 hours. Helps with a more accurate glucose level
Timed - Should be drawn within 15 minutes of being ordered.

30
Q

Criteria for the following specimens:
Therapeutic Drug Monitoring
Stat
ASAP

A

Therapeutic Drug Monitoring - measurement of medication concentrations in blood

Stat - 10 minutes or less

ASAP - one hour or less

31
Q

Reasons to reject a sample.

A

Incomplete or not clearly labeled specimen
Unlabeled or mislabeled specimen
Specimen hemolyzed
Specimen too old

32
Q

Describe the modified allen test procedure and purpose.

A

Purpose: A modified Allen test measures arterial competency, and should be performed before taking an arterial sample.

Procedure: Apply pressure to wrist both radial and ulnar artery. Have patient open and close hand slowly, it will turn white. Release pressure from artery by pinky (ulnar).
If hand turns pink you can collect sample.

33
Q

Define Arteriospasm

A

Spasm of the artery

34
Q

Describe the cleansing process utilized in the collection of blood cultures.

A

Clean the tops of collection bottles with iodine.
Place a clean alcohol pad on top of each bottle until they are inoculated. Immediately before inoculation, wipe the top with the pad to prevent iodine contamination of the sample.

35
Q

What anticoagulant is used in arterial blood draws?

A

Heparin

36
Q

What is the angle of the needle when performing an arterial puncture?

A

45 degrees

37
Q

Causes of hematoma

A

Push needle in to far.

38
Q

What tube should be drawn for coagulation tests? (PT and APTT)

A

Light blue, plasma used

39
Q

What tube should be drawn for a CBC?

A

Purple top, whole blood used

40
Q

What tube should be drawn for Troponin or electrolyte tests?

A

Green top (without sodium), plasma or whole blood used

41
Q

What tube should be drawn for a transfusion work up?

A

Purple top (EDTA tube), plasma and RBCs

42
Q

What is a yellow/Gold top SPS tube used for?

A

Blood cultures

43
Q

What are Dark blue top EDTA tubes used for?

A

trace elements testing

44
Q

What are red top tubes used for?

A

Serum used - chemistry analytes

45
Q

What are grey cap tubes used for?

A

blood sugars, legal or medical blood draws, lactic acid/lactate

46
Q

Special circumstances for a hematoma

A

May need to draw elsewhere.

Hold pressure for longer periods of time

47
Q

What to do when a patient faints?

A

Stop procedure and apply pressure. If they are sitting put their head between knees. Call for help,

48
Q

How to draw from obese patients?

A

May need to do capillary (fingerstick) draw

49
Q

Importance of a phlebotomist on a healthcare team.

A
  1. Represent the laboratory
  2. A properly collected sample is a very important part of the process of obtaining an accurate lab result test
  3. “humanistic care”
50
Q

Correct patient and specimen identification protocol

A

Use two forms of identification

51
Q

Serum vs plasma

A

Serum is the liquid that remains after the blood has clotted. Plasma is the liquid that remains when clotting is prevented with the addition of an anticoagulant

52
Q

Drawing from a psychiatric patient

A

May have to have nurse draw the sample. Only bring supplies you need, they might take items.

53
Q

Drawing from the saline lock

A

Check with nurse. Use other arm is possible. Must stick below I.V site.

54
Q

Drawing from a patient with a mastectomy

A

Can’t draw on same side as mastectomy.

55
Q

Drawing from a catheter.

A

Requires nurse.

56
Q

Drawing from fistula/cannula patient

A

Requires nurse. Draws from dialysis machine.

57
Q

What is the effect of a short collection in the following tubes:
Blue
Lavender

A

Blue: will decrease the blood to anticoagulant ratio.

Lavender: RBC shrinkage.

58
Q

What can cause hemolysis that may occur during the capillary specimen collection process?

A

Milking the finger or heel

59
Q

Order of the draw for syringe

A

Sterile (blood culture), light blue, lavender and PPT, green and PST, grey, red, SST

60
Q

Drawing patients with edema

A

Should be avoided. Edema can contaminate or dilute the results.

61
Q

Interfering substances.

A

Alcohol, betadine.

Phlebotomy (1 decks)

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