Phlebotomy Flashcards
1
Q
Transport blood throughout the body
A
Blood Vessels
2
Q
Five types of blood vessels
A
- Arteries
- Aterioles
- Capillaries
- Venules
- Veins
3
Q
Carry oxygenated blood away from the heart
A
Arteries
4
Q
Small branches of any artery leading into capillaries
A
Arterioles
5
Q
Where exchange of water and chemicals (gases and waste) between the blood and tissues occurs
A
Capillaries
6
Q
Small branches of veins that lead to the capillaries
A
Venules
7
Q
Carry deoxygenated blood from capillaries back towards the heart
A
Veins
8
Q
Major blood vessels
A
- Arteries
- Veins
9
Q
They have to be thick to withstand pressure
A
Major blood vessels
10
Q
Have to be very thick with bigger diameter to withstand great pressure from the pumping of the heart
A
Arteries
11
Q
Three major layers of the blood vessels (Veins and Arteries)
A
- Tunica intima
- Tunica media
- Tunica externa
12
Q
- Innermost and thinnest layer
A
Tunica Intima
13
Q
- Composed of simple squamos epithelial cells interlaced with several circularly arranged elastic bands called internal elastic lamina
A
Tunica Intima
14
Q
Type of cells that is for easy gas exchange and diffusion for nutrient
A
Squamos Epithelial Cells
15
Q
Unique only for Tunica Intima
A
Internal Elastic Lamina
16
Q
- Thickest layer in the arteries
A
Tunica Media
17
Q
- Consist of circulary arranged elastic fiber, connective tissue, polysaccharide substances
A
Tunica Media
18
Q
Separated from tunica externa by another thick elastic band called external elastic lamina
A
Tunica Media
19
Q
- Outer layer and thickest layer in veins
A
Tunica Externa
20
Q
- Entirely made of connective tissue
A
Tunica Externa
21
Q
- Contains nerves that supply the vessel as well as nutrient capillaries (vasa vasorum) in the larger blood vessels
A
Tunica Externa
22
Q
Three main blood vessels
A
- Veins
- Capillaries
- Arteries
23
Q
Middlemost layer where blood is stored and transported
A
Lumen
24
Q
The slanted tip of a needles
A
Bevel
25
Indication that the needle has penetrated the blood vessel.
**Popping sound**
## Footnote
The needle should reach the lumen of the vein.
26
You inserted a needle, hit a vein, and there is still no backflow. Possibly indicate that the needle has not yer reached the lume. What should you consider?
* **Angle of Insertion**
* **Depths of penetration**
27
What would happened you hit layers other than the lumen, tunica externa or media
**Hematoma**
28
Vessel whose size ranges from a **diameter of about 25 mm**
**Aorta**
29
Vessel whose size ranges from a **diameter of about 8 um**
**Capillaries**
30
The **narrowing of the blood vessels by contracting** the vascular smooth muscle in the vessel walls
**Vasoconstriction**
## Footnote
* **GOOD FOR THE BODY**
- Constrict in cold temperature to keep the body warm. Prevents heat from escaping the body
- Injured vascular epithelium (constrict to avoid blood going out of the skin)
* **BAD FOR THE BODY**: taken escessively
- e.g. high blood and overdose of nasal decongested or medicine
- Increases blood pressure
- Passageway diameter becomes smaller.
31
The **widening of blood vessels due to relaxation** of the blood vessels muscular walls.
**Vasodilation**
## Footnote
* Happens when:
1. **high temperature**
2. **Exposure to vasodilators** (hormone vasopressin, neurotransmitters like epinephrine)
* Enchances blood flow. Decreases blood pressure. Increase passageway diameter of blood.
32
What **happens when blood vessels have a build up of lipid**
**Passageway narrows**; Blood pressure increases
33
**Part of the heart that receives deoxygenated blood**
**Vena Cava**
34
Where **deoxynated blood from the upper extremities flows into the heart**
**Superior Vena Cava**
35
Where **deoxynated blood from the abdomen and lower extremities flows into the heart**
**Inferior Vena Cava**
36
Loading of O2, unloading of C02
**Lungs**
37
**Gas exchange** that happens in the lungs
Loading of 02, unloading of C02
38
Loading of C02, unloading for 02
Body Tissue
39
Gas exchange that happends in the body tissue
Loading of C02, unloading of 02
40
Known as the **elbow pit**
**Antecubital fossa**
41
What is the other name that the **Antecubital Fossa** is known for
**Elbow Pit**
42
**Triangular area** on the anterior of the elbow (**antecubital crease**), which in a site of major veins
**Antecubital fossa**
43
**First choice for routine venipuncture** because there are several major veins called antecubital vein
**Antecubital fossa**
44
Ideal and recommended site; Most veins are prominent and more anchored in this area
**Antecubital fossa**
45
Most common area for venipuncture
**Antecubital Fossa**
46
**Three major veins** (Antecubital fossa)
1. Median cubital vein
2. Cephalic vein
3. Basilic vein
47
Which vein should be always prioritized
**Median cubital vein**
| Only cephalic and basilic when you fail to take from the median cubital
48
Best site for puncture
| H-Shaped Antecubital Vein
**Median Cubital Vein**
## Footnote
1. More prominent
2. Well-anchored
3. Stable/steady - Does not roll when you insert the needle
49
**the second choice for venipuncture**; harder than palpate but is **usually better when drawing blood from an obese patient**
| H-Shaped Antecubital Vein
**Cephalic vein**
50
The preferred venipuncture site; easiest to access and least painful for the patient
| H-Shaped Antecubital Vein
**Median cubital vein**
## Footnote
1. More prominent
2. Well-anchored
3. Stable/Steady - Does not roll when you insert needle (other veins are movable
* If failed, you can still draw blood from Median cubital vein but draw from another side. Ask for consent. If not confident, proceed to cephalic
51
**The last choice-vein**; not well anchored and punctures are more painful
| H-Shaped Antecubital Vein
**Basilic vein**
52
Vein arrangement that occurs **70% of the population**
**H-shaped Antecubital Vein**
53
Why is the basilic vein the last choice?
**located near a brachial artery**
54
how to differentiate the basilic and cephalic
**Basilic aligns with the pinky finger (P - B)**
55
What are included in the **intermediate antebrachial veins**
Inlcudes the following:
1. Median
2. Median Cephalic
3. Median Basilic veins
56
how to differentiate the basilic and cephalic
**Cephalic aligns with the thumb (P - C)**
57
Intermediate antebrachial vein; first choice vein; safest and less painful
**Median vein**
58
Intermediate cephalic vein; second choice for venipuncture; less likely to roll
**Median cephalic vein**
59
Intermediate basilic vein; last choice vein because it is painful
**Median basilic vein**
60
Not ideal for venipuncture
**Cephalic and Basilic**
| Even if you palpate it, it can still roll, resulting to fishing
61
Used only if the antecubital veins are not accessible
Other arm and hand veins
## Footnote
* Veins at the back of the hand (dorsal aspect) that can be used are smaller and thus more painful
* Underside of the wrist is never used as a venipuncture site
62
Never used as a venipuncture site
underside of the wrist
63
Most suggest for **Butterfly Needle (Winged Infusion Set)**
Back of the hand (dorsal aspect)
## Footnote
it is thinner and appropirate for bony hands
64
Not recommended on the underside of the wrist
Syringe and ETS
## Footnote
as it is thinner and appropirate for bony hands
65
Where do we attach the torniquette on the wrist
3-4 inches above the collection site
66
Where do we puncture the patient if they have edema on their antecubital fossa
Patient has edema
67
Accumulation of fluid in the antecubital fossa
Edematous
## Footnote
Not ideal as you cant properly hit the vein. You can get interstitial fluid instead
68
What are the veins in the antecubital fossa reserved for
**Chemotherapy**
69
What could result from slow puncturing of the skin
Spraying of the blood
| Careful not to puncture near or on top of the bones (painful)
70
what type of blood collection is utilized on the underside of the wrist
Arterial Blood Collection
71
Must not be used in venipuncture without permission of physician due to complications such thrombosis
Leg, ankle, and foot veins
72
Why must you ask permission to venipuncture from the legs, ankle, foot veins
Because a clot may form that part of the body (thrombosis) from traumatic venipuncture
73
What could result from a traumatic venipuncture
Thrombosis
74
What can thrombosis from a traumatic venipuncture lead to?
Stroke and pulmonary embolism
75
What happens when a clot breaks off and travels through the bloodstream
It could clog blood vessels and travel to different organs, causing complications
76
Location of veins used for puncturing when the forearm and hand is not accessible
Leg
## Footnote
Treat the veins here the same way you treat the hands because it is boney. Syringe is not recommended.
77
Can be done in the area between the wrist and antecubital fossa, but it is more painful because of the skin is thicker
Arms
78
Where do we always place the torniquette
3-4 inches above
79
**Not used in blood collection** and are limited ton collection of arterial blood gas. Special training needed, and the procedure is risky for the patient
**Arteries**
80
What happens if the torniquette is near the collection site
**prone to Hemolysis**
81
From the Greek word **"phlebos"**
**vein**
82
From the Greek word "**tomia**"
**cutting**
83
It means to "**to make incision to draw blood for laboratory purposes**"
**Phlebotomy**
84
Act of **drawing or removing blood form the circulatory system** through a cut or puncture to obtain a sample for analysis and diagnosis
**Phlebotomy**
85
Also **done as part of the patient's treatment for certian blood disorders**
**Phlebotomy**
86
First to perform bleeding by **scarification**
**Egyptians**
87
They don’t collect blood for lab analysis, but to alleviate the condition of the patient (e.g. if. patient experiences headache)
**Egyptians**
88
Their practices are not acceptable because they remove too much blood from the patient (4-6 Liters)
**Egyptians**
89
How much blood do Egyptian usually remove from patients by scarification
**4-6 liters**
90
Belief that removing blood cures bodily illnesses
**Scarification**
91
A **prominent Greek physician**, that **discovered that arteries as well as veins had blood**.
**Galen of Pergamon**
92
What was previously thought about what filled arteries.
Previously it was thought that **arteries were filled with air.**
93
Who **developed a complex system for the quantity of blood** which should be removed and from what specific areas of the body
**Galen Perganon**
| (more of a trial-and-error situation)
94
Credited for bringing phlebotomy to the United States in the 18th century.
**The Pilgrims**
95
A popular service for almost one hundred years, although it went out of fashion as many harmful incidents came to light
**Bloodletting**
96
What was common at the **18th Century**
To use lancets that were fired into veins at multiple locations, **withdrawing up to four pints of blood**
## Footnote
(1 pint = 473 mL) - Almost 2 Liters of Blood
97
What was the standard treatment in the 18th century
**Bleeding**
98
What was the initial belief about decreasing blood pressure
If they get bloof from the patient, blood pressure decreases
99
What happened in December 13 (1799)
George Washington was taken ill with a "cold hoarness"
100
Bleeding was believed to cure diseases
| True or False
False
101
Inhibits the use of glucose by blood cells
| Example: Sodium Flouride
**Antiglycolytic Agent**
102
Added to sample to preserve glucose.
| For some people, they would want to know the level of their glucose
**Antiglycolytic Agent**
103
Prevents RBCs to consume the analyte or glucose
**Antiglycolytic Agent**
104
Source of energy for RBC
**Glucose**
105
Found in the grey top tube
**Sodium Flouride**
106
Prevents blood from clotting
**Anticoagulant Agent**
107
Does the mechanism by which clotting is prevented varies with the anticoagulant?
| Yes or No
**Yes**
108
Anticoagulants that remove calcium by forming insoluble salts
* EDTA
* Citrate
* Oxalate
109
Found in the lavender/purple top tube
**EDTA**
110
Percentage of Citrate in a light blue top tube
3.2% Citrate
111
Percentage of Citrate in a black top tube
3.8% Citrate
112
What is found in a grey top tube
**Potassium Oxalate Monohydrate**
113
What are the function of EDTA, Citrate, and Oxalate
Their function as coagulants is to inhibit calcium through **Chelation**
114
Process wherein anticoagulants binds to calcium
**Chelation**
115
Why do anticoagulants need to bind to calcium
it needs to bind because **calcium facilitates clotting**
116
What prevents the conversion of prothrombin to thrombin
**Heparin**
117
Important in the clotting or coagulation process
**Thrombin**
118
Where is Heparin found
Green or Light green stopper
119
Helps initiate or enhance the clotting mechanism
**Clot Activator**
120
Examples that provide increased surface area for platelet activation and clotting factor such as thrombin
Glass (silica) particle and inert clays (celite) for plastic
121
Another additives found in blood collection tube; opposite of anticoagulant as it promotes coagulation and immediate clotting
**Clot Activator**
122
Found in red top tube/yellow tube
**Clot Activator**
123
Although no additives; this has clotting factors
Red Top Tube
124
Also called Plain/Serum Tube
Red Top Tube
125
Liquid portion of coagulated samples
Serum
126
Liquid portion of anticoagulated liquid
Plasma
127
**Inert material that undergoes a temporary change in viscosity during the centrifugation** process which enables it to serve as a separation barrier between the liquid (serum and plasma) and cells
**Thixothropic Gel Separator**
128
Also known as **Serum Separator Tube**
**Thixothropic Gel Separator**
129
What is found in the bottom of a unused tube
Gel
130
What happens when you centrifuge the sample containing gel
The gel becomes **viscous and transfers between the liquid (serum) and solid (formed elements) portion**.
131
Why is gel separator necessary
For some test requiring serum, even minute amount of RBCs in sample causes interference in testing: Serum has to be free from RBCs
132
What does the Gel Matrix act as
Acts as a barrier
133
What colored tube stopper is Thixotrpic Gel Separator found
Yellow Top Tube Stopper
134
Made of materials that are **free of trace elements contamination**
**Trace Element-Free Tubes**
135
What colored tube stopper do trace element-free tubes have
**Royal-blue Stoppers**
136
Used to/for (1) trace elements tests, (2) toxicology studies and (3) nutrient determination
Trace Element-Free Tubes
137
What would result from **NOT** making sure the material used has **NO traces of elements**
Result to **false positives or false increase** in the results.
138
Not all sections of the laboratory utilizes this anticoagulant, only specific ones. There are only a few
Special-Use Anticoagulants
139
Prevents coagulation binding calcium, with little effect on cells and platelets
Acid Citrate
| Anticoagulant
140
Acts as an RBC nutrient and preservatives by maitaining RBC viability
Dextrose
| Source of energy for RBCs
141
Used for immunohematology tests such as DNA testing anf human leukocyte antigen (HLA) phenotyping
Acid Citrate Dextrose
142
Patients bound for organ transplant paternity testing
Human Leukocyte Antigen (HLA)
143
What colored top tubes do ACD have
Yellow Top Tubes
144
Laboratory sections ACD is utilized
Blood Banking and Immunohematology
145
Primary goal of ACD
Preserve viability of RBCs
146
What is done in order to make sure viability of RBCs in insured
Add Dextrose
147
Difference of ACD and SST
SST has gel, ACD has none
148
Prevents clotting chelating calcium
Citrate
149
stabilizez pH; important in the survival of RBC
Phosphate
150
Provide cells with energy and keep them alive
Dextrose
151
Used in collecting units of blood transfusion
Citrate Phosphate Dextrose (CPD)
152
Laboratory sections where citrate phosphate dextrose is utilized
Immunohematology and Blood banking
153
In donating blood, the blood bags have fluid inside. What is the fluid?
| Specific volume of anticoagulant in the blood bag
The anticoagulant CPD
| 53 mL; equivalent anticoagulationfor 450 mL of donor's blood
154
Prevents coagulation by binding calcium
Sodium Polynethol Sulfonate (SPS)
155
Used for blood culture collection (anticoagulant incorporated in blood culture tubes)
Sodium Polynethol Sulfonate (SPS)
156
What colored top stopper does SPS have
Yellow stopper (aka Sterile Tubes)
157
Purpose of Sodium Polynethol Sulfonate
Detecting/suspecting bacteria, such as sepsis, or the presence of bacteria in the circulation.
158
Among the three special-use anticoagulants, this is the only one not used in the Blood Banking
Sodium Polynethol Sulfonate
159
Laboratory section where sodium polynethol sulfonate
Microbiology section
160
Source of food for bacterias in SPS
Broth
161
Functions of SPS
1. Prevents coagulation
2. Reduces the action of the complement system in the immune system to prevent killing of bacteria
3. It prevents phagocytosis (Cell-eating); WBC (phagocytes)
4. Inactivates activity of certain antibiotics; not all but sometimes, for bacteria
162
Cap color that has **no additives**
**Red**
163
Cap color that has **ONLY coagulant**
**Orange**
164
Cap color that has both **coagulant** and **separation gel**
**Yellow**
165
Cap color that has **sodium heparin**
**Green**
166
Cap color that has **lithium heparin**
**Light Green**
167
Cap color that has **ONLY EDTA**
**Purple**
168
2 Formulations of EDTA
1. Dipotassium EDTA
2. Tripotassium EDTA
169
Cap color that has **3.2% Citrate** (1:9)
**Light blue**
170
Cap color that has **3.8% Citrate** (1:4)
**Black**
171
Cap color that has both **Potassium Oxalate Monohydrate (Anticoagulant)** and **Sodium Fluoride (Antiglycolytic Agent)**
**Grey**
172
what is the composition of the 1:9 ratio
1 part additives to 9 parts of blood
| You dont have to measaure when collecting blood
## Footnote
"9 parts of blood" depends on the tube, but the pre-measured vacuum volume of the tubes usually already indicates the ratio.
173
Are tubes sensitive to anticoagulant ratio?
| Yes or No
## Footnote
Why
Yes
## Footnote
If you dont follow the ratio, the sample would be most likely dilute or clot.
174
What is to remember for tubes sensitve to blood and anticoagulant ratio.
**The volume of blood should ALWAYS be greater than the anticoagulant**. Otherwise, it will result in dilution or clotting
175
Can be made of glass or plastics
Red-Top Tube
176
Are the number of inversion depend on the material of the test tube
| Yes or No
Yes
177
Other known as the **Plain/Serum Tube**
**Red-Top Tube**
178
Glass tubes has **ADDITIVES PRESENT**
| True or False
**False**
| No Additives
179
Glass surface **DO NOT ACTIVATE clotting sequence**
| True or False
False
| activates clotting sequence
180
Mixing samples in a glass tube by inversion is **REQUIRED**
| True or False
**False**
| Not Required
181
Use for TDM (Therapeutic Drug Monitoring)
Serum
182
What does **TDM** stand for
Therapeutic Drug Monitoring
183
How many inversion does the red-top tube need?
**0 inversions**
184
Glass itslef cannot act as the clot activator
| True or False
**False**
| Glass itself could already act as the clot activators
185
Must be inverted to mix samples with additive and initiate clotting sequence
| How many inversions
Plastic
| 5 full inversions
186
Contains clot activators to initiate clotting sequence
Plastic
187
Its material cant activate clot
Plastic
188
Sample recommended for plastic tubes
Serum
189
how to get Serum
centrifuge
190
Blood clotting time
60 minutes
## Footnote
After getting the serum, let the sample stand by at room temperature for 30 - 60 minutes before centrifuge (upright position)
191
What will happen if the sample (serum) is not has not stood by at room temperature for 30 - 60 minutes before centrifuge (upright position)
Smaller volume of serum obtained
192
Laboratory use for serum
Serum determination in chemistry, routine blood donor screening (cross matching), and diagnostic testing for infectious diseases
193
194
What happened to George Washingtons blood after his treatment
His blood became viscous and flowed slowly
## Footnote
Due to not drinking water when he was being bleeded
195
What reflects from blood being viscous and slow in flow
Dehygration and Hypovolemia
196
An Edinburgh trained physician
Dr. James Craik
197
Who were the doctors of George Washington
Dr. Craik and Brown
198
How much blood was taken from George Washington over 12 hours
A total of 2,365 mL
199
A condition where there is a decreased amount of fluid in the blood.
Hypovolemia
200
This is a result of blood being more viscous and has difficulty in flowing.
Hypovolemia
201
202
203
What happened during the American Civil War (1861 - 1865)
Military doctors bled union soldiers and civilians alike to cope with the widespread disease and infection
204
When was the thumb lancet introduced
15th Century
205
It was a double-edge instrument, often with irnate handles made from turtle shells.
Thumb lancets
206
What were early intruments
Anything sharp, such as horned stones, quills, thorns or animal teeth.
207
208
209
210
Who proved conclusively that inflammation resulted from infection thus was not susceptible to bloodletting
Louis Pasteur (1822-1895)
Robert Koch (1843-1910)
211
Disapproved theory that in order for person to be cured by an illness, he/she needs to be bled
Louis Pasteur (1822-1895)
Robert Koch (1843-1910)
212
They said the reason why a person gets infected or killed is due to microorganism
Louis Pasteur (1822-1895)
Robert Koch (1843-1910)
213
Said that in order to be cured, they have to take medications
Louis Pasteur (1822-1895)
Robert Koch (1843-1910)
214
They offered a scientifically legitimate way of thinking about the cause and treatment of the patient's illness
Louis Pasteur (1822-1895)
Robert Koch (1843-1910)
215
As rescently as April 2008, three Kashmiri hospitals were reported using these to bleed patients as treatment for heart problems, arthritis, gout, chronic headaches, and sinusitis
Leeches
216
What were leeches primarily used for
Treatment for heart problems, gout, arthritis, chronic headaches, sinusitis
217
Leeches are for multiple use
| True or False
False
| Leeches are for single use
218
Why are leeches for single use
to avoid transmission of disease
219
Is using leeches accepted and still being practice till today for conditions like too much bruises (severe bruising) in the area.
| Yes or No
Yes
220
How is Phlebotomy used everyday
To introduce health problems and introduce intravenously.
221
What produre is Phlebotomy used for
Blood tranfusion
| Live-saving procedure
222
What do phlebotomist do
Withdraw blood in clinics and hospitals all over the world.
223
Increased blood cells. In this case, all blood cells increase turning the blood more viscous
Polycythemia vera
224
Crescent or Sickle, The patients feels pain because of the morpholoyg of the blood cells
Sickle Cell Anemia
225
Blood collected through therapeutic phlebotomy is not to be discarded.
| True or False
False
| Blood collected through therapeutic phlebotomy is to be discarded.
226
Good thing about therapeutic phlebotomy
It limits to 450 mL of blood collection within a week.
227
What is the estimated number of venipunctures performed annually in the United States.
1 billion
228
Critical areas in Phlebotomy
* Appropriateness of the test request
* Patient and samplen identidication
* Criteria for acceptance and rejection of specimens
* Communication and interpretation of results
229
Should the quality of result be always be dependent on the quality of the sample
| Yes or No
Yes
230
What is the first step in most laboratory analysis
Specimen Collection
231
Are results therefore said to be as good as sample collection and handling
| Yes or No
Yes
232
The only laboratory staff member (receptionist) that a patient sees.
Phlebotomist
233
234
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237
