LESSON 6 Flashcards by Abigail Aquinde

The ___ includes procedures such, laboratory handling and identification, which take place prior to laboratory testing. in this phase, proper control measures are place, avoid subsequent issues. It starts when the doctor’s order is given a ends when the laboratory testing has officially commenced.

pre-analytical testing phase

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During this phase, the phlebotomist must not only be able to draw blood from the patient, but must also be able to identify factors that after the process and address them as needed.

pre-analytical testing phase

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The ___ is used by plysicians to diagnose and monitorie presence of a disease.

laboratory test

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The physicians compare the results to a _____.

reference range or reference interval.

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This range shows the high and low limit of result values as compared to healthy individuals.

reference range or reference interval.

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In phlebotomy, the ____ is ideal in establishing reference range since it represents the condition of the metabolism of the body early in the morning or after approximately 12 hours of fasting. This can be influenced by age, gender, and conditions of the body.

basal state

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It is not advisable to choose a site that has _____ because veins in the area may be difficult to examine and blood circulation may be impaired.

burns, scars, or tattoos

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A venipuncture site may be too painful to touch because of?

Burns

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A venipuncture site may be susceptible to infection due to the dyes used that may interfere with the process because of

Tattoos

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Aside from being difficult to perform, puncturing____ may also produce inaccurate results.

damaged veins

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What can happen if you puncture damaged veins?

Veins could be sclerosed or hardened or thrombosed or clotted.

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This is an abnormal swelling caused by the accumulation of fluid in the tissues. The tissues become fragile, making the task of locating the veins harder. This condition may be due to reactions from medications, pregnancy, infections, and other medical problems.

Edema

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Edema is also known as

Oedema

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This is a solid swelling or mass of blood in the tissues caused by the leakage of blood from the vessels during venipuncture.

Hematoma

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Selecting a venipuncture site with hematoma will be painful for the patient because it will ____. It could also lead to the ____ of blood sample. (2)

obstruct the blood flow

contamination

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This procedure, often done to breast cancer patients, refers to the removal of the breast through surgery.

Mastectomy

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Why is blood drawing from patients who had undergone this procedure becomes a challenge?

lymph flow is obstructed and there may be swelling and infection after the surgery

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When the patient has undergone mastectomy, this cannot be applied because it can cause injury. It could also change the blood composition.

tourniquet

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This is the condition in which the individual is grossly overweight.

Obesity

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Patients who are obese have veins that are:

Deep and difficult to locate

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A solution to puncturing obese patients is to

Use a longer tourniquet or locating the cephalic or cubital vein

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There are cases when _____ are needed do blood sampling, infusing medication, central venous pressure reading. and blood transfusion of a patient.

vascular access devices (VADs)

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Choosing ____ is based On the needs of the patient, the purpose, and the length of time the device is to remain in the body.

vascular access sites

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What are the VADS used in phlebotomy?

Arterial Line
Arteriovenous Shunt or Fistula
Blood-sampling Device
Heparin or Saline Lock
Intravenous (IV) Sites
Central Vascular Access Devices (CVADs)

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To obtain samples for arterial blood gas and laboratory studies, critically ill patients require ___ where a thin catheter is inserted into an artery.

Arterial lines

This is also used to monitor blood pressure continuously.

Arterial Line

Is a tourniquet or venipuncture allowed in the arm with an arterial line?

No, neither tourniquet nor venipuncture is allowed in the arm with an arterial line.

This is a passageway created through surgery, and is usually in the arms with the intention of connecting the artery and a vein directly.

Arteriovenous shunt or fistula

This may be created for hemodialysis treatment or pathological process such as erosion of arterial aneurysm.

Arteriovenous shunt or fistula

This is used to avoid the use of needle-sticks, prevent infections, and reduce wastage from line draws.

Blood-sampling device

The device collects blood from the arterial or central venous catheter where it is connected.

Blood-sampling device

It is an intravenous (IV) catheter attached to a stopcock or cap with diaphragm. Its basic function is to provide access for administering medicine or drawing blood from the patient.

Heparin or Saline Lock

Heparin or Saline Lock is commonly known as

Hep-lock

Hep-lock is threaded in the peripheral vein, which is in the lower arm above the wrist for up to ___.

48 hours

It is usually flushed with heparin or saline (to prevent clogging) and capped for future use.

Heparin or Saline Lock

It is a thin plastic tube or catheter inserted into a vein in the forearm to inject a volume of fluids into the bloodstream.

Intravenous or IV line

The phlebotomist should avoid collecting blood from the arm with IV because the blood collected could be contaminated with ___.

IV fluid

If blood collection is necessary, the collection site should be ____ the IV. Above or Below?

Below

Take note that collection of blood from previously known IV sites should be avoided for:

24 to 48 hours.

These are any of the tubings inserted to the main vein or artery used for blood collection, monitoring the patient's pressures, and administering medications and fluids.

central vascular access devices (CVADs)

CVADS are also known as?

indwelling lines

There are three (3) types of CVADs:

(1) central venous catheter (2) implanted port (3) peripherally inserted central catheter (PICC)

This is also known as a central line inserted into the large vein (subclavian) and advanced into the superior vena cava.

Central venous catheter

It is a surgically implanted disk-shaped chamber attached to the indwelling line.

Implanted port

This is usually placed on the upper chest just below the collarbone.

Implanted port

It is a flexible tube inserted into the veins of extremities and the central veins.

Peripherally inserted central catheter (PICC)

When the patient has adhesive allergy, a ___ should be placed over the site.

gauze

When the patient has adhesive allergy, a gauze should be placed over the site and should be removed after how many minutes/hours?

15 minutes

When the patient has adhesive allergy, a gauze should be placed over the site and should be removed after 15 minutes. The alternative is to ask the patient to apply pressure for how many minutes/hours?

five minutes

When the patient has antiseptic allergy, simply use a ____.

different antiseptic

When the patient has latex allergy, look for a sign to indicate the allergy and use a ____.

non-latex alternative for gloves, tourniquet, and bandages

When a patient is on ___, the bleeding may take a longer time. The pressure should be applied to the site until the bleeding stops.

aspirin or anticoagulant

The attention of the authorized personnel should be called when the bleeding continues after ___.

five minutes

This is a temporary loss of consciousness which is caused by the insufficient flow of blood to the brain.

Fainting

Patients prone to fainting during venipuncture are asked to ___ during the procedure.

lie down

When the patient feels nauseous and has the tendency to vomit, the phlebotomist has to ___ the procedure until the patient feels better or until the feeling subsides.

discontinue

In nausea and vomiting, a/an _____ should be provided, and a cold damp washcloth should be applied to the forehead.

emesis basin or wastebasket

The patient should be ___ before the needle insertion, and the phlebotomist should avoid ___ of the needle. (2)

(1) warned (2) redirection

If the patient complains of extreme pain or numbness, remove the needle and apply ice to the site because this could indicate ___.

nerve involvement

(Pain) When there is nerve involvement, the phlebotomist needs to ___ if the condition persists.

document the incident

This condition involves the appearance of small red or purple spots that look like rashes, which appear on the arm when tourniquet is applied.

Petechiae

When these occur, the blood draw should be discontinued quickly. There must be pressure held over the site but it must be made certain that movement is not restricted, the mouth is free from any obstruction and the patient is protected from self-injury. The first-aid personnel must be notified immediately.

Seizures or Convulsions

the phlebotomist should hold pressure over the site immediately after discontinuing the draw. A cold compress or ice pack may be offered to help address the swelling. Which part of Avoiding and Handling Procedural Error Risks and Failure to Draw Blood is this?

Hematoma Formation

The following are conditions that triggers hematoma: (7)

• There is excessive or blind probing. • There is inadvertent arterial puncture. •The size of the vein is too small. • The needle penetration has gone all through the vein • Needle is not completely inserted. • Tourniquet is still on when the needle was removed. • The pressure is not adequate.

This results from blood loss due to blood

latrogenic Anemia

In Iatrogenic Anemia, It is important to ensure that only the required specimen volume is collected because if ___ of the blood volume is removed at once from the body, the patient could face a threat.

10%

This happens when blood is filling up the tube rapidly and there is a rapid formation of hematoma on the site.

Inadvertent Arterial Puncture

This can be avoided by making sure that tapes or bandages are not opened ahead of time; needles are not preloaded into the tube holders; insertion site of the needle is not touched after sterilization; cap is removed just before venipuncture; and patients are advised to keep the bandage on the site for at least 15 minutes.

Infection

How many minutes/hours are the patients advised to keep the bandage on the site?

At least 15 minutes.

This happen when there is improper site selection, rapid needle insertion, excessive redirection of the needle, and blind probing.

Nerve injuries

If the initial attempt is unsuccessful, the phlebotomist should try to redirect the needle by using a ___.

slightly forward or backward movement

What is The next step after redirecting the needle?

remove the needle and look for an alternative site.

Blood that has already been drawn flowing back into the vein from the collection tube may cause adverse reaction because of the presence of tube additives.

Reflux of Anticoagulant

How do you avoid reflux of anticoagulant? (2)

(1) arm of the patient is in a downward position (2) the tube is just below the venipuncture site.

Damaging the vein could be avoided by:

Following the proper technique and avoiding blind probing

This is a decrease in the fluid content or plasma volume which is usually caused by tourniquet that stagnates the normal flow of blood leading to the increase in concentration of red blood cells and other non-filterable large molecules.

Hemoconcentration

This refers to the rupture of the red blood cells. The hemoglobin is then released into the surrounding fluid.

Hemolysis

Hemolysis is also called?

haemolysis

This happens when the phlebotomist pulls a tube before reaching the required volume.

Partially filled tube or short draw

Short draw may lead to

incorrect blood-to-additive ratio

This means that the specimen is compromised due to incorrect handling, which involves allowing alcohol, powder or other materials into the sample.

Specimen contamination

Examples of specimen contamination (2)

Getting glove powder or perspiration into films and specimens using the wrong antiseptics or simply not following the proper antiseptic procedure

These should not be used because the manufacturer could not warrant the quality of the seal and pressure after the expiration date indicated in the tube.

Wrong or expired collection tube

Venipuncture attempts could fail due to (2)

(1) improper seating of the tube (2) failure of the needle to go through the stopper

The ___ is critical to the success of the venipuncture.

needle position

The phlebotomist should ensure that the following do not happen: (8)

1. Needle not inserted far enough 2. Bevel partially out of skin 3. Bevel partially into vein 4. Bevel partially through vein 5. Bevel completely through vein 6. Bevel against vein wall 7. Needle beside vein 8. Undetermined position

The ___ usually occur when conditions are less than ideal which leads to the veins being blocked, resulting in insufficient blood flow.

collapsed veins

This happens when there is a strong pressure in the vacuum of the tube or plunger; the tourniquet is too close to the site or it is too tight, or when the tourniquet has been removed during the draw.

Collapsed veins

To avoid failure due to loss of vacuum, the phlebotomist should make sure that the ___. (2)

bevel is not partially out of skin and the tube itself is not damaged