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Phlebotomy > Module 4: Routine Blood Collections > Flashcards

Module 4: Routine Blood Collections Flashcards

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1
Q

venipuncture

A
  • collection of blood from veins
  • usually antecubital area or dorsal part of hand
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2
Q

dermal puncture

A
  • aka: capillary collection, finger stick
  • collection of blood from capillaries on finger or heel
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3
Q

how to ensure accurate test results

A
  • use appropriate equipment
  • check expiration dates
  • inspect for manufacturer’s defects
  • ensure safety devices are intact
  • follow order of draw
  • correctly label all specimens
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4
Q

when should you assemble the equipment

A

before the tourniquet is placed

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5
Q

can you place phlebotomy equipment on the overbed tray in an inpatient setting

A
  • no
  • where pts tend to eat
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6
Q

most commonly used venipuncture method and equipment

A

evacuated tube system (ETS)

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7
Q

equipment for blood draws

A
  • gloves
  • alcohol pads
  • gauze pads
  • bandage
  • tourniquet
  • needle with safety device, 21 to 23 gauge, 1 to 1.5 in long, different for different methods
  • hub/needle holder for ETS and butterfly
  • blood collection tubes, syringe and transfer device for syringe method
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8
Q

can you use cotton balls instead of gauze

A
  • no
  • leave fibers on pt collection site
  • remove clot when removed from site
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9
Q

how much should you inflate a blood pressure cuff to act as a tourniquet

A

up to 40 mmHg

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10
Q

most common needle size for venipunture

A

21 gauge

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11
Q

ETS needle

A

double sided

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12
Q

how are adult and pediatric tubes different

A
  • adult tube size: 3 in long, 1/2 to 3/4 in wide
  • vacuum in adult tube is higher than pressure inside child blood vessels, using causing child vein to collapse
  • pediatric tubes are about half as big with less vacuum
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13
Q

purpose of colored stoppers on blood tubes

A
  • identify each tube
  • indicate which additive is contained inside
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14
Q

what info is on blood collection tube label

A
  • which additive is in the tube
  • expiration date
  • amount of blood tube will hold
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15
Q

what are anticoagulant tubes also called

A

plasma tubes

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16
Q

blood culture tube additive and use

A
  • sodium polyanethole sulfonate (SPS)
  • used for bacterial studies
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17
Q

light blue tube additive and use

A
  • sodium citrate
  • coagulation blood tests
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18
Q

green tube additive and use

A
  • sodium, lithium, or ammonia heparin
  • test chemical levels in the blood
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19
Q

purple/lavender tube additive and use

A
  • ethylenediaminetetraacetic acid (EDTA)
  • whole blood hematology determinations
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20
Q

gray tube additive and use

A
  • potassium oxalate/sodium fluoride
  • glucose determinations
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21
Q

royal blue tube additive and use

A
  • clot activator or EDTA
  • trace element testing
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22
Q

light yellow tube additive and use

A
  • acid citrate dextrose (ACD)
  • blood bank studies and DNA testing
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23
Q

red, gold, orange tube additive and use

A

-no additive if they are glass (silica in glass helps blood clot)
- plastic red and gold tubes have clot activator and are used for chemistry determinations
- orange tubes have thrombin-based clot activator and are used when the chemistry determination is for a stat blood collection

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24
Q

why are serum tubes used

A

blood tests that require the blood to clot

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25
gel separator
- doesn't affect condition or quality of blood sample - assists in the processing of blood after centrifuged - called serum separator tube (SST) when in serum tube - called plasma separator tube (PST) when in plasma tube
26
when is the syringe method used
- pts with fragile veins that collapse easily - manually adjust rate that blood is withdrawn
27
supplies specific to the syringe method
- syringe (10-20 mL are most common) - 21 to 23 gauge needle, 1 to 1.5 in long, single-sided - transfer device
28
when is the butterfly method used
- small veins, difficult to access
29
supplies specific to butterfly method
winged infusion set with 21-23 gauge needle that is 3/4 in long, flexible tubing, and another sterile needle on the opposite end to puncture collection tube
30
needle examination before removing from package
no rips or tears in package
31
needle examination before removing the cap
- expiration date: refers to sterility of needle - label/seal
32
needle examination after removing the cap
- safety device: attached firmly - bevel: not bent, broken, or burred
33
how many times can needles be used
once, even on the same pt
34
what circumstances make you avoid a site for a blood draw
- mastectomy - tattoo - hematoma - edema - scars - sclerosed vein - IV
35
what must you do if you have to take blood from an arm that has an IV
- may turn IV off for several minutes - collection below IV to prevent contamination of IV fluids with specimen
36
first choice vein
- median cubital - firmly anchored in middle of arm - least painful
37
second choice vein (after median cubital)
- cephalic - lateral - slightly more painful than median cubital - tends to be easiest to locate in obese pts
38
third choice vein (after cephalic)
- accessible hand vein
39
fourth choice vein (after hand vein)
- basilic - near radial nerve and brachial artery - never reposition needle
40
blood collection from infant
- heel - not on any area with hematoma, recently accessed, cuts/scratches
41
dermal puncture site
- middle and ring finger - nondominant hand
42
where should a tourniquet be applied
3 to 4 inches above the site
43
when should the tourniquet be removed and why
- after 1 min - hemoconcentration risk
44
how to palpate for veins
- start from middle of antecubital area and move to outside of arm - light pressure - use one finger, index or second finger of nondominant hand - use very tip of finger - vein: spongy and bouncy - tendon: hard, like bone
45
why should you palpate with your non-dominant hand
allows you to repalpate without switching hands if you miss
46
how to find veins
- warm cloth - hang arm below heart level - small amount of rubbing
47
what to use to cleanse skin prior to venipuncture
- 70% isopropyl alcohol wipe
48
how to cleanse skin prior to venipuncture
- circular motions, starting at the center - minimum of three circles - do not rub up and down or side to side - allow alcohol to dry
49
replacements for alcohol when cleaning skin
- chlorhexidine gluconate - povidone-iodine
50
cleansing site for blood culture collection
- use alcohol and additional antiseptic (chlorhexidine gluconate or povidone-iodine) - clean for 30 to 60 seconds
51
cleansing skin for dermal puncture
- rub area vigorously to remove microorganisms and increase blood flow - 70% isopropyl alcohol - allow to air dry
52
what can't you use to cleanse a dermal puncture and why
- povidone-iodine - adverse effect on results of bilirubin, uric acid, phosphorus, or potassium test
53
tube order for testing TSH and prenatal profile
- SST (red) - EDTA (purple) - ACD (light yellow)
54
tube order for testing PSA, magnesium, and A1C
- SST (red) - EDTA (purple)
55
tube order for testing glucose, FSH, and reticulocyte count
- SST (red) - EDTA (purple) - Flouride (gray)
56
tube order for testing hepatic function (liver) panel, electrolytes, and CBC
- SST (red) - Heparin (green) - EDTA (purple)
57
what prevents veins from rolling
- proper anchoring below the site - quick insertion
58
how to anchor vein
- thumb of nondominant hand 2 inches below site of insertion - hold firmly, slight distal tug
59
why is anchoring and holding the skin tightly important
- reduce pain - keeps vessel steady
60
angle of insertion for the antecubital region
15 to 30 degrees
61
what happens if the angle of insertion is too high (goes in too deep)
- hurting pt - injuring nerves and tendons - pierce through vessel and transfix the vein
62
what happens if the angle of insertion is too low (goes in too shallow)
- forcing bevel to adhere to wall of vessel - stops or slows blood flow - miss vein entirely - blood leak into surrounding tissue causing hematoma
63
angle of insertion for the dorsal hand region
10 degrees
64
when should you stop inserting the needle
- until you feel a change in resistance - indicates you are in the lumen (middle) of the vein
65
steps for venipuncture
- introduce self - identify pt - position pt - wash hands and don gloves - assemble equipment - position pt arm - apply tourniquet - palpate for vein - choose vein - cleanse site - uncap and inspect the needle - anchor vein - alert pt of slight pinch or poke - insert needle - push tube in place with label down OR draw up with syringe - remove tourniquet before one minute - remove tubes, invert immediately - remove needle at same angle of insertion - engage safety - dispose of needle in sharps - provide pressure to site - check to ensure site is not still bleeding - apply bandage - label all specimens in front of the pt - thank the pt - observe pt for complications - collect all garbage - remove gloves - wash hands
66
what should you do before blood collection with a syringe
- push plunger in and out to ensure smooth collection - push plunger all the way forward to ensure there's no air in the barrel - calculate how much blood is needed
67
who developed the order of draw and why
- Clinical Laboratory Standards Institute (CLSI) - avoids contamination of additives - most accurate test results
68
order of draw
- blood culture bottles: yellow - light blue - serum tubes: red, gold, red and gray, red and black - rapid serum tubes (RST): orange - green - lavender, purple - pink - gray - light yellow - royal or dark blue
69
yellow tube
- blood culture - aerobic and anaerobic - contains SPS - used for bacterial studies
70
when is the aerobic blood culture tube collected first
when using a butterfly needle
71
light blue tube
- sodium citrate - coagulation tests - must be filled 100%
72
serum tubes
- red, gold, red and gray, red and black - some contain no additive - some contain clot activator - must clot for 30 minutes before centifugation - chemistry blood collections
73
rapid serum tubes (RST)
- orange - when stat blood collection is required - clot for 5 minutes
74
green tubes
- sodium or lithium heparin - anticoagulants
75
lavender or purple tubes
- EDTA - hematology tests
76
pink tubes
- EDTA - blood bank collections
77
gray tubes
- sodium fluoride and potassium oxalate - glucose and alcohol blood collections
78
light yellow tubes
- acid citrate dextrose (ACD) - blood collections for DNA
79
royal or dark blue tubes
- dark blue does not indicate additive but that tube is free of element contamination - royal blue contains EDTA, sodium citrate, or heparin; may be serum tube; check label
80
serum tube with gel separator
serum separator tube (SST)
81
plasma tube with gel separator
plasma separator tube (PST)
82
ratio of additive to blood in light blue tube (sodium citrate)
- 9:1 - nine part blood, 1 part additive
83
what to do when using butterfly to collect in light blue tube
- use tube without additive to start blood flow - used to clear out air so light blue tube can fill completely
84
what are anticoagulant tubes used for
tests requiring plasma
85
sodium citrate
- light blue tubes - anticoagulant - used for clotting tests - best at preserving coagulation factors
86
EDTA
- lavender or pink tubes - anticoagulant - hematology tests - preserves shape of cells - reduces platelet clumping
87
heparin
- green tubes - anticoagulant - chemistry tests - prevents blood clots from causing falsely elevated results, especially in potassium and electrolyte tests
88
potassium oxalate and sodium fluoride
- gray tubes - anticoagulant - testing sugar - preserves glucose and prevents glycolysis
89
tubes selected for CBC, electrolyte, and glucose test
- CBC: lavender - electrolyte: green - glucose: gray
90
how to ensure pt safety with someone whose mental state interferes with their ability to understand (child, cognitive deficits, dementia)
work closely with their guardian
91
how to position pt with history of syncope
laying down
92
things to watch for in a pt that may indicate complications (syncope)
- change in breathing - excessive sweating - stops speaking abruptly - pale or red skin tone - glazed eyes - fixed stare
93
what to do if pt asks you to stop or becomes unconscious
- stop procedure - check for consciousness - administer first aid if needed - do not leave pt alone
94
how long after pt is unconscious should you call for help
2 minutes
95
ways to locate a vein
- warm the area - lower the arm below the pt heart
96
how many times should you attempt a blood draw
twice
97
what to do if you don't see a flash
- pull needle back slightly and blood flow will return if you transfixed the vessel - repalpate the site and see if you can move the needle closer to the vein
98
reasons blood flow may unexpectedly stop during collection
- advanced needle to far - needle not advanced enough
99
nerve damage complication
- pt reports moderate to severe pain, sensation of numbness, feeling of pins and needles - stop procedure immediately - get medical care to evaluate extent of damage if numbness and pain continues
100
hematoma complication
- most common complication with phlebotomy - pushing needle through both walls of vessel - blood leaks into surrounding tissue - usually disappear in a few days - can damage surrounding nerves if it becomes too large - stop collection immediately - reduce risk by inserting needle smoothly and applying pressure after collection
101
phlebitis complication
- inflammation of blood vessel - occurs after one vein has been accessed repeatedly
102
thrombosis complication
- blood clot - partially or fully blocks vein or artery
103
petechiae complication
- small red dots develop below tourniquet - can be in routine cases or when tourniquet is tight - no need to stop collection - platelet abnormalities - apply adequate pressure after collection
104
hemoconcentration complication
- tourniquet applied for too long - pt excessively pumps fist - blood flow stagnates - alteration in blood tests (ammonia, calcium, coagulate, potassium, protein tests) - remove tourniquet before 1 min to prevent
105
other physical reactions complication
- diaphoresis, dizziness, nausea - often not serious - indication of complication
106
collection/processing errors complication
- mididentification of pt - improper site selection - using wrong tube - wrong order of draw - underfilling tubes - failing to invert tubes - failing to document - mislabeling tubes
107
syncope complication
- not preventable - ask pt if they've ever fainted prior to venipuncture - sudden lack of blood supply to the brain
108
seizure complication
- stop procedure and call 911 - document time of onset - prevent pt injury
109
shock complication
- cold/clammy/pale skin, rapid pulse, increase in shallow breathing, blank stare - call for help if suspected - ensure pt has open airway - lower head below body - keep pt warm and safe
110
nausea complication
- wait until pt is no longer nauseated to perform collection - stop and provide basin if pt feels nauseous during procedure - do not leave pt - cold compress on head or neck
111
diaphoresis complication
- severe swearing - sign of nausea, syncope, or panic attack - ask how pt is feeling - provide towel - do not leave pt
112
venipuncture removal
- bevel up - same angle as insertion - swift and smooth motion - engage safety - dispose of needle in sharps - provide pressure to site
113
what happens if a plasma tube is not inverted properly
specimen can clot
114
what happens if a serum tube is not inverted properly
specimen may not clot completely
115
hemolysis
- destruction of RBC - shaking or roughly handling a tube
116
what counts as an inversion
one complete turn of the wrist
117
inversions for light yellow SPS tubes
8-10
118
inversions for light blue tubes
3-4
119
inversions for serum tubes (red)
5
120
inversions for green tubes
8-10
121
inversions for lavender tubes
8-10
122
inversions for gray tubes
8-10
123
when are dermal punctures performed
- tests requiring small amount of blood - pt has no accessible vein - test requires capillary blood - pt at risk for iatrogenic anemia, underweight pts - point of care tests (glucose, cholesterol, hematocrit) - infants less than 1 y/o
124
iatrogenic anemia
- anemia caused by collecting too much blood from a pt by volume in a given amount of time - underweight pts
125
what types of blood does a dermal puncture blood specimen contain
- arterial - capillary - venous
126
capillary stick site for people over 1 y/o
- middle or ring finger, slightly off center - pinky is too thin, close to bone - index finger is sensitive and likely has calluses - thumb has a pulse - tip of finger is more sensitive and likely has calluses
127
how to get pt hand warm for capillary stick
- pt open and close hand a few times - rub hands together vigorously - place hand below heart for 30 seconds - wash hands in warm water
128
how to puncture with an incision lancet and why
- perpendicular to finger - helps blood form large drop that's easy to collect
129
why should you wipe away the first drop of blood in a capillary stick
removes contamination from alcohol or tissue fluid
130
how long to take filling each capillary tube
no longer than 2 minutes
131
who should you not use a bandage on for capillary sticks
- children: can swallow it - infants: can irritate or tear skin
132
why should you not milk the finger during capillary stick
can hemolyze specimen and alter test results
133
lancet lengths for heel sticks on infants
- no longer than 2 mm - 0.65 mm for infants weighing less than 1kg - common size is 1 mm
134
how long should you apply a heel warmer for infant capillary sticks
3-5 minutes
135
best site for heel stick
- lateral or medial side of heel - middle of heel is secondary choice - do not use back of heel: little skin/tissue, can damage bone
136
what to do if blood flow stops during heel stick
- wipe away surface clots - stop squeezing - let capillaries refill
137
what should you clean the skin with when performing capillary stick for bilirubin
- alcohol - povidone-iodine can adversely affect test results
138
reason for capillary stick order of draw
- blood clots as soon as flow begins - order of draw ensures the sample is collected in an order with least negative effect on blood test
139
CLSI order of draw for capillary collection
- blood gas collections: pt may hold breath during procedure - purple, lavender, pink, or pearl cap tubes containing EDTA: blood clotting can alter hematology tests - green: contains heparin - any other additive specimens - serum tubes: no additive or clot activator, requires clotting
140
when to label specimens
- in front of pt - before pt leaves room
141
what is included on a specimen label
- pt full name - pt date of birth - date - time - medical number - initials
142
where to place label on tube
- every label facing same direction - do not cover stopper - place label on preprinted label
143
why should you use a pressure bandage
- promotes hemostasis - prevents bruising
144
how to apply pressure bandage
- gauze padding under bandage - pull firmly so bandage is taut
145
when are self-adhering bandages recommended
- older pts - arms with large amounts of hair
146
most common additives in tubes
anticoagulants or clot activators
147
most common additives in tubes
anticoagulants or clot activators
148
what are SPS tubes used for
blood cultures
149
what are ACD tubes used for
paternity testing
150
what tube is used for a WBC test
EDTA
151
what tube is used for coagulation test
sodium citrate
152
what tube is used for pregnancy and random glucose tests
SST
153
order of tubes collection for capillary collection of CBC, FSH, and electrolyte tests
- lavender - green - red
154
how does use of povidone-iodine as a cleanser affect potassium level results
increased potassium level
155
tubes used for bilirubin test and a cold agglutinin titer
two serum tubes
156
tube used for lipid profile
SST
157
errors in specimen when drawing through a hematoma
hemolysis
158
when are decreased electrolytes seen in a specimen
- using wrong tube - tube with anticoagulants
159
when is increased potassium seen in a specimen
- hemoconcentration - use of iodine products
160
when is increased epithelial tissue seen in a specimen
first drop of blood is not wiped away during capillary collection
161
test results seen when leaving tourniquet on for too long and hemolysis occurs
- high iron level - high potassium level - low CBC level
162
should syringe collection be done on hand draws
no
163
can tying the tourniquet too tightly cause a vein to collapse
yes i think

Phlebotomy (9 decks)

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