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Fundamentals of MLS > Phlebotomy Ch 6 & 7 > Flashcards

Phlebotomy Ch 6 & 7 Flashcards

(63 cards)

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1
Q

What is hemostasis?

A

Arrest or stoppage of bleeding after injury by the body.
Detailed coordinated interaction of endothelial cells lining blood vessels, platelets, other blood cells, plasma proteins and clotting factors.

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2
Q

True or False. Hemostasis is an ongoing occurrence in our body inconjunction with vessel repair.

A

True

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3
Q

What are the four process steps of Hemostasis?

A
  1. Vasoconstriction
  2. Formation of a primary platelet plug
  3. Progression to a stable blood clot
  4. Fibrinolysis (dissolving of clot)
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4
Q

What is serum?

A

Fluid portion of blood remaining after clotting.
Can be separated from clot by centrifugation.
Does not contain fibrinogen (used up by clotting).

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5
Q

What is plasma?

A

Fluid portion of blood separated from RBCs, WBCs, and platelets by centrifugation.
Contains fibrinogen.
Specimen must be collected in an anticoagulant tube.

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6
Q

When is plasma used for testing?

A

Used when serum cannot be used.

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7
Q

What colour is serum?

A

Pale clear yellow colour fluid.

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8
Q

What are some general equipment (furniture) and their features for phlebotomy?

A 
Blood-Drawing Station
- Table for supplies
- Special chair
- Bed or reclining chair
Phlebotomy Chairs
- Comfortable
- Adjustable armrests
- Protect patient from falling injury in case they faint (syncope)
Phlebotomy Carts and Trays
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9
Q

What are the concerns regarding phlebotomy carts? Are they brought into patients rooms? Main purpose.

A

They are large, cumbersome and have a potential to harbor nosocomial infections – for that reason would never be brought into patients rooms
Used for morning routine “sweeps” on wards

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10
Q

Name as many phlebotomy supplies as you can.

A 
Gloves
Antiseptic
Hand Sanitizer
Gauze pads
Bandages
Pen
Patient ID equipment
Sharps container
Biohazard Bag
Tourniquet
Needle – various sizes
Tube Holder
ETS Tubes
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11
Q

What are syringe tubes used for?

A

Alternative for patients with small or difficult veins

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12
Q

What are some features of syringe needles (length, sheathing, types)?

A 
Syringe needles
1- to 1.5-in long
Must have re-sheathing feature (safety cover) if used to draw blood
Syringes
- Barrel
 - Plunger
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13
Q

How do you draw blood into a tube with a syringe? What is the advantage of this?

A

When drawing venous blood by syringe, the phlebotomist slowly pulls back the plunger, creating a vacuum which causes the barrel to fill with blood
This technique takes a bit more manual dexterity.

For fragile veins, this allows you to control the vacuum and be more gentle on small frail veins.

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14
Q

How do you transfer blood into tubes after using a syringe? Is this time sensitive?

A

Syringe transfer device allows safe transfer of blood into tubes without using syringe needle or removing tube stopper
Since the syringes used for collection do not contain additives blood must immediately transferred into ETS tubes before it starts to clot.

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15
Q

What the main steps when using a syringe needle for blood draw after withdrawal of needle from patient?

A

STEPS:

  1. Complete the syringe draw and immediately activate the needle safety device
  2. Remove the needle
  3. Discard into sharps container
  4. Attach a transfer device to the hub of the syringe
  5. Follow order of draw
  6. Place ETS tube inside transfer device (we will use a tube rack shown in the video)
  7. Advance tube onto the needle until blood is drawn into the tube
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16
Q

What are winged infusion set used for?

A

Winged Infusion Set
Commonly referred to as a butterfly
Effective for small or difficult veins (hands; elderly & pediatric)

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17
Q

What ranges of needle lengths are used on winged infusion sets and why?

A

Winged infusion sets have a 0.5 to 0.75inch stainless steel needle connected to 5-12 inch tubing
The short needle is important for a smaller angle of insertion needed for difficult or small veins
Comes in various gauges
Some have a 25 gauge needle – remember that small gauge needles will increase chance of hemolysis
Trained professionals may want to use a 25 gauge needle for scalp veins of an infant or tiny veins of premature infants or neonates

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18
Q

What is a nonwinged blood collection set?

A

Nonwinged Blood Collection Set
VANISHPOINT: Automated in-vein retraction after blood collection to eliminate exposure to the contaminated needle. Depress retraction trigger to retract needle from vein into device.

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19
Q

What are the different safety devices on winged infusion sets?

A

Textbook:
- Locking shields that slide over the needle,
- Blunting devices
- Needle retracting devices.
Powerpoint:
1. The wings and a plastic sleeve moves over
2. Two plastic pieces separate to move the wings over the needle.

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20
Q

What is a combination system and some of their options?

A
  1. Complete system for blood collection; Blood collection tube & collection apparatus are combined in single unit
  2. Specimen can be collected by evacuated tube or syringe
  3. Available with regular or butterfly-style needles
  4. Safety devices are available
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21
Q

What is a limitation of the combination system?

A

Would only be used if only need one specific tube – no substitution or combining of tubes with different additives is allowed with this system

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22
Q

What are anticoagulants?

A

Substances that prevent blood from clotting.
Two methods of preventing clotting:
1. Precipitating calcium
2. Inhibiting formation of thrombin
They either bind calcium or precipitating calcium so it is unavailable to the coagulation process OR by inhibiting the formation of thrombin needed to convert fibrinogen to fibrin

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23
Q

What are different types of anticoagulants?

A 
Types:
Ethylenediaminetetraacetic acid (EDTA)
Citrates
Heparin
Oxalates
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24
Q

What must be done after collecting a blood tube with anticoagulant for specimen integrity?

A

Must be mixed ASAP to prevent microclot formation – gentle mixing essential to prevent hemolysis.
Typically for Hematology whole blood specimens are on a constant mixing device to keep the samples continuously mixed or the cells will settle to the bottom of the tube.

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25
How does EDTA prevent clots?
REMOVES calcium by binding it making it unavailable for the clotting process and forms an insoluble salt
26
What happens if an EDTA tube is under filled with blood?
Excess EDTA (i.e. underfilled) can cause RBC shrinkage which negatively affects complete blood counts (CBCs).
27
What EDTA tubes are used for trace elements? For what purpose?
Trace elements: Tubes made of materials free of trace element contamination Used for trace element tests, toxicology studies, & nutrient determinations Feature royal-blue stoppers
28
What kind of additives are in the EDTA tubes?
Dipotassium (salt spray) or Tripotassium (liquid) | Salt is preferred due to high solubility, liquid can dilute samples
29
How many inversions does an EDTA tube typically require?
8-10 inversions
30
How do citrate tubes prevent coagulation? Typical common tests performed? Ratio of blood to anticoagulant?
Prevent coagulation by chelating calcium Most common Na Citrate for coagulation test Light blue top Immediate mixing Ratio of 9:1 ratio of blood to anticoagulant must be filled.
31
What are citrate tubes often used for?
Used for coagulation tests because it does best job of preserving coagulation factors
32
How many inversions does a citrate tube typically require?
3-4 inversions immediately after collection to prevent activation of the coagulation process and microclot formation (SPECIMEN INTERETY)
33
What is a black top sodium citrate tube used for?
Black top tube will contain Sodium Citrate for hematology test ESR (erythrocyte sedimentation rate)
34
How do heparin tubes prevent coagulation? Types of formulations? Number of times inverted?
Inhibiting thrombin and factor X Common for Chemistry tests Can be centrifuged right away saving time Three formulations - Ammonium - Lithium (most common - least interference in chemistry testing) - Sodium Must be mixed immediately five to 10 times to prevent clotting or fibrin generation
35
What are heparin tubes often used for and why?
Common for STAT testing in chemistry – electrolytes When fast TAT (turn around time) is needed. Specimens for tests that are performed on heparinized plasma can be centrifuged right away. No need to wait for blood to clot to get serum
36
How many inversions does a heparin tube typically require?
5-10 inversions immediately after collection to prevent clot formation and fibrin generation Gentle mixing required to prevent hemolysis. Hemolyzed specimens are unsuitable for some chemistry tests
37
How do oxalate tubes prevent coagulation? Number of inversions? Common test used for?
Most common Potassium oxalate Removes Calcium - Binding and precipitating calcium to form an insoluble salt. 8 – 10 inversions to prevent clot formation Some Chemistry tests (Lactate)
38
What do you need to watch out for when filling an oxalate tube?
1. Important to fill to volume stated, excess oxalate causes hemolysis and releases hemoglobin 2. Mixed immediately to prevent clot formation and fibrin generation
39
What must one do with anticoagulant tubes immediately after blood draw?
Must be mixed immediately Gentle mixing prevents hemolysis Recommended number of inversions required Numbers vary by manufacturer; consult manufacturer instructions
40
What are the special non-routine tubes?
Special tubes, not part of our general collections; usually require special ordering and special collections Special-Use Anticoagulants - Acid citrate dextrose (ACD) – two formulas solution A and solution B - Citrate phosphate dextrose (CPD) - Sodium polyanethol sulfonate (SPS) Antiglycolytic Agents - Substances that prevent glycolysis (breakdown of glucose by blood cells) - Sodium fluoride (most common)
41
What is an ACD tube used for?
ACD – Used in immunohematology tests like DNA testing and HLA or human leukocyte antigen phenotyping for paternity evaluation or transplant compatibility Acid citrate binding calcium, Dextrose is RBC nutrient and preservative Yellow top 8-10 inversions immediately after collection to prevent clotting
42
What is CPD tubes (or CPD in bags) used for?
CPD – Citrate chelating calcium, Phosphate to maintain pH, Dextrose provides energy for cells to keep them alive Citrate Phosphate Dextrose – in collection bags for transfusion
43
What are SPS tubes used for?
SPS – binding calcium common in blood culture bottles also reduces complement that destroys bacteria. Slows down phagocytosis and reduces antibiotic activity
44
What are sodium fluoride used for in blood collection tubes?
Sodium Fluoride: - Preserves glucose for up to 3 days & inhibits bacterial growth. Used w. potassium oxalate (anticoagulant) for rapid response - Used in combination with anticoagulant potassium oxalate or EDTA, as alone it does not prevent clotting Gray top tube 5 -10 inversions - Also used for ethanol specimens to prevent decrease in alcohol concentration or an increase due to fermentation by bacteria
45
What are clot activators?
Clot Activators: | Substances that enhance coagulation in serum-separator tubes (SSTs)
46
What are the types of clot activators?
Types: 1. Substances that provide more surface for platelet activation: a. Glass (silica) particles b. Inert clays (Celite) 2. Clotting factors (thrombin)
47
How well do silica particles assist blood to clot and how fast?
Silica particles cause blood to clot more completely not faster generally will clot in 15 – 30 minutes
48
How fast will blood clot using a rapid serum tube (RST)?
RST is a rapid serum tube – blood will clot in 5 minutes (never used or seen these but one manufacture does produce them)
49
What happens if a tube is not mixed with a SST (silica particles) tube?
Blood in an SST tube will eventually clot without mixing; however, when it is not mixed, glass particles may become suspended in the serum and could interfere in the testing process, as glass particles have been known to plug the small-diameter tubing in some analyzers.
50
How many inversions are required for clot activator tubes?
5-10 inversions for complete and rapid clotting to occur
51
What do serum or plasma separator tubes do? (e.g. a thixotropic gel separator)? How?
Thixotropic Gel Separator Has density between that of cells & serum or plasma When centrifuged, gel moves between cells & serum or plasma Prevents cells from continuing to metabolize substances
52
Describe the gel used in a separator tube?
Inert synthetic substance near the bottom of certain tubes. When a specimen in a gel tube is centrifuged, the gel changes viscosity and moves between the cells and serum or plasma forming a physical barrier between them
53
What is the order of draw?
1. Blood culture tube or bottles 2. Sodium citrate tube (light blue) 3. Serum tube with or without gel (red or gold) 4. Heparin tube with or without gel (light or dark green) 5. EDTA tube with or without gel separator (lavender) 6. Sodium fluoride or potassium oxalate. (gray)
54
What is to be a sterile collection
Blood culture (details not discussed in class).
55
What do you do if you realize you have drawn a tube out of order?
If you realize that a tube has been drawn in the wrong order, draw a second one of that tube and discard the first one. Draw a few mL of blood into a discard tube and resume the order of draw for any subsequent tubes (This needs further clarification, see notes).
56
What is carryover / cross-contamination? When can it occur?
Carryover/Cross-Contamination Transfer of additive from one tube to the next. Cross over can affect test results. Can occur when: - Blood in additive tube touches needle during ETS collection - Blood is transferred from a syringe into ETS tubes - Blood remaining on or within the needle can be transferred to the next tube drawn or filled
57
Why is there an order of draw?
Order of draw presents sequence of collection that minimizes risk for interference should carryover occur Filling specimen tubes from bottom up minimizes carryover
58
What blood tube causes the most carryover problems? | What tube causes the least?
EDTA - the most | Heparin - the least
59
What is meant by tubes filling bottom up?
Tubes filling from bottom up and the contents of the tube do not touch the back end of the needle or when transferring blood into tubes with syringe minimizes carryover.
60
What is Tissue Thromboplastin Contamination?
Tissue Thromboplastin Contamination: Tissue thromboplastin, present in tissue fluid: Activates extrinsic coagulation pathway Can interfere with coagulation tests For coagulation tests (other than PT or PTT), draw a few millimeters of blood into another (non-additive or light blue - discard tube) tube before collecting coagulation specimen. Note: Tissue Thromboplastin is picked up by needle during venipuncture and flushed into the first tube filled during ETS collection, especially if there is a difficult draw and a lot of needle manipulation
61
What is microbial contamination?
Microbial Contamination Microorganisms found on skin can contaminate blood specimens Blood cultures are collected first in order of draw, when sterility of site is optimal & to prevent contamination of needle
62
What must be considered if you are using a butterfly system and need a 9:1 ratio in the tube?
If you are using a butterfly system to collect a lt. blue tube - as the tubbing contains air that will go into your first tube – this will affect the 9:1 ratio, therefore a discard tube must be collected first
63
Why should phlebotomy should be avoided on the arm on the same side as a mastectomy?
Because axillary lymph nodes are often removed as part of breast cancer surgery. This results in problems with combating bacterial infections and removal of foreign matter in the arm on that side. That is why an arm on the same side as a mastectomy is not suitable for venipuncture.

Fundamentals of MLS (18 decks)

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