Module 12: Phlebotomy Flashcards
1
Q
phlebotomy
A
withdrawal of blood from a vein
2
Q
first step of phlebotomy procedure
A
obtaining provider’s orders
3
Q
required items on phlebotomy order
A
- ordering provider
- test and test code (unique to each lab)
- diagnosis code that correlates with tests (ICD-10)
- special specimen requirements (ex: fasting)
- pt demographics
- insurance or billing information
4
Q
laboratory reference manual
A
provides all info needed for testing
5
Q
why are timed specimens crucial
A
for therapeutic drug level monitoring to confirm pt medication dosage and compliance
6
Q
factors to consider when performing phlebotomy
A
- basal state
- fasting status
- condition of venipuncture site
- menstrual cycle
- edema
- current meds
- infections
- vomiting
- pregnancy
7
Q
when should you evaluate alternative venipuncture location
A
- veins are sclerotic
- skin is scarred
8
Q
effects of stress
A
- elevation in WBC
- decrease in iron levels
- abnormal hormone levels
9
Q
hemoconcentration
A
occurs if tourniquet is left on longer than 1 min
10
Q
what info should you verify against requisition with every phlebotomy procedure to minimize errors and ensure proper collection
A
- provider’s order
- pt identity
- labeling of specimens
- identification number of specimens
11
Q
what should you do prior to phlebotomy procedure
A
- identify pt
- verify pt followed any preparation instructions (ex: fasting)
- question pt about anxiety/comfort level and previous blood draws
- explain procedure
- assemble equipment
12
Q
vasovagal response
A
- fainting due to body overreacting to certain triggers
- sight of blood, extreme emotional distress
13
Q
phlebotomy supplies
A
- gloves
- tourniquet
- isopropyl alcohol wipes or nonalcohol prep kits/swabs (blood cultures)
- nonsterile gauze
- cohesive wrap or paper tape
- double pointed needed, butterfly needle, or sterile syringe
- blood collection tube or capillary tube
- lab requisition and labels
- ice or chemical cold packs
14
Q
what should you ask a pt before getting gloves and a tourniquet
A
if they’re allergic to latex
15
Q
what skin prep is used for blood draws
A
- nonalcohol prep kits or swabs
- can be povidone-iodine or chlorhexidine gluconate swabs
16
Q
when is a butterfly needle used
A
- for weak or fragile veins prone to collapse
- hand draws
17
Q
vacuum tube
A
- blood collection tube
- sterile glass or plastic tube with vacuum inside
18
Q
why must tubes be drawn in a specific order
A
to avoid cross-contamination of additives
19
Q
venipuncture site for newborns to 12 months
A
- heel stick
- capillary blood specimen
20
Q
venipuncture site for 1 yr to 2 yr
A
- finger stick
- capillary samples
- traditional venipuncture for extensive testing
21
Q
what medical conditions restrict venipuncture sites
A
- fistulas
- ports
- mastectomy
22
Q
preferred venipuncture sites
A
- veins in antecubital space
- median cubital vein
- cephalic vein
- basilic vein
23
Q
other venipuncture sites
A
- hand
- wrist
- foot
24
Q
when should blood draws from the foot be performed
A
- only under supervision of physician
- due to risk of DVT
25
median cubital vein
- center of antecubital space
- most common vein for phlebotomy procedures
26
cephalic vein
- lateral antecubital space
27
basilic vein
- medical antecubital space
- superficial to brachial artery
28
vein changes in older pts
- changing skin integrity
- losing vein elasticity
- venous insufficiency
29
when are veins prone to roll
with loss of venous sufficiency
30
effect of veins losing elasticity of venipuncture
- fragile veins
- easily damaged by venipuncture
31
position of pt with fainting history during phlebotomy procedure
- semi-fowler's
- laying down
32
arm position during phlebotomy procedure
- arm extended
- palm facing upward
33
what hand should phlebotomy needle be in
dominant hand
34
where should supplies be set up during venipuncture
opposite side of dominant hand
35
where should sharps container be placed during venipuncture
- side of dominant hand
- disposal without crossing needle over the body
36
how to cleanse venipuncture site
- 70% alcohol pads
- circles starting from middle and moving outwards
- let skin air dry
37
evacuated tube method
- most commonly used technique
- straight double-ended needle
38
syringe method
- not commonly performed in ambulatory care setting
- same needle for injections used
- sterile syringe from 3 cc to 20 cc
- requires blood transfer system to vacuum tubes
39
butterfly method
- winged infusion
- smaller or fragile veins
- typically smaller gauge (25 to 26)
- long thin tubing between needle and attachment point on the sleeve
- tubing minimizes pressure on vein from tube suction
40
needle gauge for evacuated tube method
21 or 22
41
when should you engage the needle safety
immediately after completing the procedure
42
hemolysis
- rupture of RBC
- caused by performing phlebotomy with too small needle gauge or shaking blood tubes too hard
43
where should you apply tourniquet
3 to 4 in above venipuncture site
44
length of time tourniquet can be on
1 min max
45
what can extended tourniquet time cause
- pt discomfort
- accumulation of platelets in restricted veins
- nerve damage
46
how long does it take for blood flow to return to normal after removing the tourniquet
2 mins
47
where and how should you anchor the vein
- 1 in below draw site
- hold skin taught
48
how to insert needle for venipuncture
- bevel up
- 15 to 30 degrees
- smooth and deliberately
49
when should you release tourniquet
when blood flow is established in last tube
50
how to minimize bruising after phlebotomy
- hold arm straight
- apply pressure and elevate for 2 mins
51
why is it important to allow tubes to fill completely
- to have correct blood to additive ratio
- accurate testing
52
when should you label blood draw tube
after finishing blood draw
53
what happens if you apply to much force on plunger during syringe method
vein collapse
54
considerations when using butterfly method
- takes longer than traditional method
- pay attention to tourniquet time and number of tubes needed
55
tube inversions
- turn upside down and return to upright position
- 3 to 10 times according to manufacturers instructions
- mixes in additive
- do not shake, can cause hemolysis
56
when are capillary punctures used
- when only small amount of blood is needed for testing
- when immediate results are requried
57
what is capillary blood
- mixture of blood from arterioles, venules, capillaries, and intracellular and interstitial fluids
58
capillary puncture supplies
- nonsterile gloves
- automatic retractable lancets
- disinfectant pads, 70% isopropyl alcohol
- gauze pads
- bandage wraps
- micropipette
- blood collection device for specific test
- biohazard sharps container
59
types of capillary blood collection devices
- small glass tube (capillary tube)
- micro collection tube
- glass microscope slide
- reagent strip
- screening card or paper
- plastic testing cartridge or cassette
60
preferred capillary puncture site for adults and children
- middle or ring finger of nondominant hand
- slightly off-center
61
preferred capillary puncture site for infants
- outer edge of underside of the heel
62
prepare capillary puncture site
- warm pt hands
- 70% isopropyl alcohol pad, allow to air dry
63
performing capillary puncture
- hold finger firmly but gently
- hold lancet at right angle
- activate lancet and put in sharps
- wipe away first drop of blood due to contamination with tissue fluids
- apply gentle pressure to get blood to flow
- apply gauze and pressure to site
64
order of draw for microcapillary tubes
- blood gases
- EDTA tubes
- other additive tubes
- serum tubes
65
how long should pt leave bandage on after venipuncture
15 mins
66
what symptoms should to pt notify the clinic of after venipuncture
- reoccurrence of bleeding from the site
- radiating pain
- dizziness
67
what should you do prior to handling any specimen
apply PPE
68
why is time management crucial in processing of specimens
- after collection the specimen will start to break down
- testing cannot be done after excessive time has passed
69
centrifugation of blood specimens
- blood collection tubes rotate at high speed
- heavier elements pulled to bottom, lighter elements pulled to top
70
how long should serum specimens clot prior to centrifugation
30 mins
71
how to balance centrifuge
- place tubes across from each other to balance weight
72
aliquot
- single specimen must be divided into multiple tubes for testing on different equipment
- use single-use pipette
72
why do most lab errors occur
mislabeling of specimens
73
what should you add to lab requisition form after venipuncture
- date and time sample was taken
- your initials
- any specific considerations or concerns regarding the sample
74
info on specimen labels
- pt name
- unique identification number
- date of collection
- time of collection
- initials of person who collected specimen
75
who picks up samples for outside labs
courier service
76
how should specimens be stored
- clearly marked biohazard bag
- some need to be stored at certain temps
- some need to be wrapped in foil for light sensitivity
77
what should you do when you receive lab results
- forward to ordering provider for review
- notify pts of their results or schedule follow-up appointments after provider review
