PMLS-2 Lesson 8 Flashcards by Gio Ebarola

Routine process during which data are collected that creates patient record

A. Patient Registration
B. Request for Testing
C. Test Requisition
D. None of the above

A. Patient Registration

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Physician ordered
Exception: rapid test or home purchased tests
Legalized direct accessed Testing (DAT)

A. Patient Registration
B. Request for Testing
C. Test Requisition
D. None of the above

B. Request for Testing

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Also known as Test Req./Lab order
Physicians order to request testing for patient

A. Patient Registration
B. Request for Testing
C. Test Requisition
D. None of the above

C. Test Requisition

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3 types of Requisition

Manual Requisition
Computer-generated Requisition
Barcode Requisition

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Test request written by prescription pad or physicians

A. Simple Form
B. Special Form
C. One dimensional
D. Two-dimensional

A. Simple Form

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Issued by reference Laboratory

A. Simple Form
B. Special Form
C. One dimensional
D. Two-dimensional

B. Special Form

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Electronicallt Submitted
Constains: actual labels and type of tube needed for specimen

A. Manual Requisition
B. Computer-generated Requisition
C. Barcode Requisition

B. Computer-Generated Requisition

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Black stripes & white spaces if varying widths, corresponds to letteres of no. that represents patients’ info

One-DimensionalRe

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Rectangle, dots, and geometric patterns in 2D to represent patients’ info

Two-Dimensional

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What is ETS

Evacuated Tube System

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Closed System
Recommended

A. Evacuated Tube
B. Syringe Method

Evacuated tube

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“Needle & Syringe”
Advantage: allows collection from patient with small fragile or weak veins
Disadvantage: Higher risk of needle stick injury

A. Evacuated Tube System
B. Syringe Method

Syringe Method

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Advantage of Syringe Method:

A. Allows collection from patient with strong veins
B. Allows collection from patient with big tough veins
C. None of the above

C. None of the Above

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Equipment of Venipuncture

Personal Protective Equipment(PPE)
Syringe
Test Tubes
Tourniquets
Sharp Containers
Transfer Device
Pen (non-smear)

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Step by Step of Venipuncture Procedure [ETS]

Receive, Review, and Accession the test request
Approach, greet and identify patient
explain procedure and obtain conssent
Very collection requirements and identify sensitivities and potential problems
Sanitize hands and put on gloves
position the patient, apply tourniquet, and ask the patient to make a fist
Select vein, release tourniquet and ask the patient to open the fist
Clean and airdry the site
Prepare Equipment

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Step by step of tourniquet application

Apply tourniquet around th arm 3-4 inch above the intended venipuncture site
Grasp one die of the tourniquet in each hand a few inches from the end
Apply a small amount of tension, and maintain througout the process
Bring 2 sides together and grasp both between the thumb and forefinger of the right hand
Reacg over the right hand, and grasp the right side of the tourniquet between the thumb and forefinger of the left hand and release it from the grip of the right hand
Cross the left end over the right end near the left index finger grapsing both sides together between the thumb and forefinger of the left hand, close to the patients’ arm.
Use either the left middle finger or the right index finger to tuck a
portion of the left side under the right side and pull it into a loop
A properly tied tourniquet has the ends pointing toward the shoulder.

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Complete
▪ Date and time of collection
▪ Priority
▪ Identify diet restrictions
▪ Status designation [ASAP/ STAT or Routine]
▪ Test request [electrolytes, CBC]

A. Step 1
B. Step 2
C. Step 3
D. Step4
E. Step 5
F. Step 6
G. Step 7
H. Step 8
I. Step 9
J. Step 10
K. Step 11
L. Step 12
M. Step 13
N. Step 14
O. Step 15
P. Step 16
Q. Step 17
R. Step 18
S. Step 19
T. Step 20

A. Step 1

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Place arm straight downward
→ Apply tourniquet: 3 to 4 inches above
→ If patients’ skin is sensitive:
▪ tourniquet over clothing or the sleeve
▪ clean washcloth or unfolded 4x4 gauzed

F. Step 6

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→ Preventing the spread of infection or diseases
→ are hands visibly soiled or not?

E. Step 5

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→ Fasting previous problems during collection
→ must know the Allergies
→ Fainting: recliner or recumbent position

D. Step 4

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→ They must be knowing the procedure and has consent

C. Step 3

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→ Collection area should be clean and well-stocked supplies to
have a positive patient encounter
▪ Proper bedside manner
o behavior towards the patient
▪ Ask the patients to state & spell name and DOB

B. Step 2

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→ not more than 1 min
→ 2 mins rest to restore circulation
→ Veins at median — lateral — medial
→ Legs or foot: written permission from MD

G. Step 7

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→ Friction scrub with back-and-forth movement (not circular motion)
→ Re-palpate: gloved finger must be cleaned with alcohol
→ Use: 70% isopropyl alcohol

H. Step 8

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→ Selecting right equipment o collecting system o needle size o tube volume according to age o size and loc of vein o amount of blood o Proper tubes (lab requirement) A. Step 1 B. Step 2 C. Step 3 D. Step4 E. Step 5 F. Step 6 G. Step 7 H. Step 8 I. Step 9 J. Step 10 K. Step 11 L. Step 12 M. Step 13 N. Step 14 O. Step 15 P. Step 16 Q. Step 17 R. Step 18 S. Step 19 T. Step 20

I. Step 9

→ Inspect needle → Pick up the equipment’s using non-dominant hand → When removing needle cover, careful not to touch the needle with gloves A. Step 1 B. Step 2 C. Step 3 D. Step4 E. Step 5 F. Step 6 G. Step 7 H. Step 8 I. Step 9 J. Step 10 K. Step 11 L. Step 12 M. Step 13 N. Step 14 O. Step 15 P. Step 16 Q. Step 17 R. Step 18 S. Step 19 T. Step 20

J. Step 10

→ stretch the skin or “L” hold technique → “Pop” – description for slight “give” or decrease resistance ▪ When lessening the resistance means the needle is in the Vein → Bevel up → < 30 angle needle insertion and depending on the depth → Warn the patient before inserting [Do not lie; na di masakit] → Do not continue if the patient faint or has discomfort → Wait for a flash of blood to enter the needle hub (backflow) → Butterfly Needle or non-winged: 10* degree or less (at a shallow angle) K. Step 11 L. Step 12 M. Step 13 N. Step 14 O. Step 15 P. Step 16 Q. Step 17 R. Step 18 S. Step 19 T. Step 20

K. Step 11

→ Pierce the first tube → Holder flange: middle and index finger → Bottom of the tube: thumb → Release tourniquet: after blood flow is established & not left > 1min K. Step 11 L. Step 12 M. Step 13 N. Step 14 O. Step 15 P. Step 16 Q. Step 17 R. Step 18 S. Step 19 T. Step 20

L. Step 12

→ Release tourniquet before removing the needle → Remove needle before placing gauze → Apply pressure for 3-5 minutes → Formation of HEMATOMA if pressure is not applied K. Step 11 L. Step 12 M. Step 13 N. Step 14 O. Step 15 P. Step 16 Q. Step 17 R. Step 18 S. Step 19 T. Step 20

N. Step 14

→ Place tubes by the Order of Draw → Maintain needle position while filling the tubes or needle o Try not to Pull, press down or move since its painful o Keep arm in downward position → Do not remove stopper to fill the tubes from syringe → Mix immediately after removing from hub → Additive containing tube: 3 to 8 inversions (depends on the tube) → Inversions should be 180 degrees gently K. Step 11 L. Step 12 M. Step 13 N. Step 14 O. Step 15 P. Step 16 Q. Step 17 R. Step 18 S. Step 19 T. Step 20

M. Step 13

→ Discard the needle and the tube holder K. Step 11 L. Step 12 M. Step 13 N. Step 14 O. Step 15 P. Step 16 Q. Step 17 R. Step 18 S. Step 19 T. Step 20

O. Step 15

→ Labeled by: o Full name (with middle name) o Patient-specific identifier (MR number) o Date and Time of collection o Phlebotomist’s initial o Pertinent additional info (FASTING) → Verify Info from the patient → Tubes placed in an upright position in biohazard specimen bag during transport → 37-degree Celsius heat block or warming devices K. Step 11 L. Step 12 M. Step 13 N. Step 14 O. Step 15 P. Step 16 Q. Step 17 R. Step 18 S. Step 19 T. Step 20

P. Step 16

→ Observe site for 5 to10 seconds to check for signs of bleeding → Apply bandage to the puncture site → Limited exertion and pressure → Bleeding > 5 mins.: notify MD → Instruct to leave the bandage on for 15 mins - 30 mins to avoid irritation K. Step 11 L. Step 12 M. Step 13 N. Step 14 O. Step 15 P. Step 16 Q. Step 17 R. Step 18 S. Step 19 T. Step 20

Q. Step 17

→ Dispose used materials to the proper biohazard containers → Items that have been moved must be returned to their original position K. Step 11 L. Step 12 M. Step 13 N. Step 14 O. Step 15 P. Step 16 Q. Step 17 R. Step 18 S. Step 19 T. Step 20

R. Step 18

→ Preferred because its direct, efficient and safe → Allow multiple tubes to be easily collected A. Routine ETS Venipuncture B. Blood Collection Set Procedure C. Syringe Venipuncture Procedure

A. Routine ETS Venipuncture

→ Can be winged or non-winged infusion → Infants and small children that has difficult veins → 23-Gauge (common in this collection) A. Routine ETS Venipuncture B. Blood Collection Set Procedure C. Syringe Venipuncture Procedure

B. Blood Collection Set Procedure

→ Preferred: venipuncture specimen in ETS method A. Routine ETS Venipuncture B. Blood Collection Set Procedure C. Syringe Venipuncture Procedure

C. Syringe Venipuncture Procedure

Steps 1-12 of Venipuncture Procedure [Syringe]

Same as routine ETS Venipuncture

→ Slowly pull back the plunger A. Step 13 B. Step 14 C. Step 15 D. Step 16 E. Step 17 F. Step 18 G. Step 19 H. Step 20

A. Step 13

→ Remove needle before placing gauze → Apply pressure for 3-5 minutes → Extend or raise arm A. Step 13 B. Step 14 C. Step 15 D. Step 16 E. Step 17 F. Step 18 G. Step 19 H. Step 20

B. Step 14

Remove syringe needle, and discard it in sharp's container A. Step 13 B. Step 14 C. Step 15 D. Step 16 E. Step 17 F. Step 18 G. Step 19 H. Step 20

C. Step 15

Attach the syringe hub to the transfer device hub, rotating it to ensure secure attachment A. Step 13 B. Step 14 C. Step 15 D. Step 16 E. Step 17 F. Step 18 G. Step 19 H. Step 20

D. Step 16

Hold the syringe vertically with tip down, and transfer device at the bottom A. Step 13 B. Step 14 C. Step 15 D. Step 16 E. Step 17 F. Step 18 G. Step 19 H. Step 20

E. Step 17

Place ETS tube in transfer device and push it all the way to the end A. Step 13 B. Step 14 C. Step 15 D. Step 16 E. Step 17 F. Step 18 G. Step 19 H. Step 20

F. Step 18

Let the tubes fill using the vacuum draw of the tube -> Do not push the syringe plunger A. Step 13 B. Step 14 C. Step 15 D. Step 16 E. Step 17 F. Step 18 G. Step 19 H. Step 20

G. Step 19

When finished, discard the syringe and transfer device unit in a sharp;s container A. Step 13 B. Step 14 C. Step 15 D. Step 16 E. Step 17 F. Step 18 G. Step 19 H. Step 20

H. Step 20

Same as routine venipuncture

Steps 1-12 and Steps 21-25

→Two unsuccessful tries: ask another phlebotomist →Whatever the reason of the inability to obtain specimen: NOTIFY THE MD or RN Arterial is not an alternative A. Stop, assess and correct B. Pediatric Collection C. Techniques to enhance vein and recover a failed venipuncture

A. Stop, assess and correct

→ Check the tests and the volume required → Not more than 10% of the total blood volume (hospitals do have their own policy) Risks for iatrogenic anemia Ask parents or guardians about history of blood collection → Behavior & approach that will work A. Stop, assess and correct B. Pediatric Collection C. Techniques to enhance vein and recover a failed venipuncture

B. Pediatric Collection

→ Option should be given: stay or wait outside the room → Lower yourself to the patient's level → NEVER TELL A CHILD THAT IT WILL NOT HURT! → Approaches for distraction: Videos, games, songs, counting → EMLA / 12-24% sucrose solution → Methods of restraining A. Stop, assess and correct B. Pediatric Collection C. Techniques to enhance vein and recover a failed venipuncture

B. Pediatric Collection

1. Retie the tourniquet. 2. Use a blood pressure cuff in place of the tourniquet. 3. Massage the arm. Do not slap the arm. 4. Lower the patient's arm. 5. Warm the venipuncture location. 6. Reseat the tube in the holder. 7. Use a different tube. 8. Place your finger below the venipuncture site and stretch the vein slightly. 9. Rotate the needle. 10. Pull back or advance the needle slightly. A. Stop, assess and correct B. Pediatric Collection C. Techniques to enhance vein and recover a failed venipuncture

C. Techniques to enhanace vein and recover a failed venipuncture

What are the challenges of geriatric collection

Skin discoloration, hearing and vision problems, mobility issues, diabetics, mental and emotional problems

Skin loses ___ and lack of hydration

Elasticity

→Hearing problems may have a hard time in answering questions →Guide/escort those who are visually impaired →Speak clearly and slowly and expect to repeat statements or questions A. Stop, assess and correct B. Pediatric Collection C. Techniques to enhance vein and recover a failed venipuncture D. None of the Above

D. None of the Above

→Hearing problems may have a hard time in answering questions →Guide/escort those who are visually impaired →Speak clearly and slowly and expect to repeat statements or questions A. Geriatric Collection B. Pediatric Collection C. Dialysis Patient

A. Geriatric Collection

AV shunt or fistula should not be used to take BP or venipuncture

Dialysis Patient

Terminally ill patiend should be approached with care, kindness, and respect A. Dialysis Patient B. Hospice Patient C. Long Term Care Patients D. none of the above

B. Hospice Patient

Elderly/Disabled patients who can't take care of themselves A. Dialysis Patient B. Hospice Patient C. Home Care Patients D. none of the above

D. None of the Above

→ Bedridden patients who are staying at home → Mobile blood collection o Phlebotomist should have exceptional skills o All necessary equipment should be brought o Protect samples during transport A. Dialysis Patient B. Hospice Patient C. Home Care Patients D. none of the above

C. Home Care Patients

→ Elderly/ Disabled patients who can't take care of themselves A. Dialysis Patient B. Hospice Patient C. Long Term Care Patients D. none of the above

C. Long Term Care Patietns

careful when moving them o Perform collection in patients while being seated in wheelchair. Use pillow or padded boards.

Wheelchairs

→Diabetes may cause ____ of skin punctures: warm the site

scarring

True or False Tell a child that it will hurt

False. NEVER TELL A CHILD THAT IT WILL NOT HURT!

True or False If you tried twice, you should ask another phlebotomist.

True.

True or False Whatever the reason of the inability to obtain specimen: NOTIFY THE MD or RN Arterial is not an alternative

True.

Step 13. _____ pull back the plunger

Slowly

Step 14 of VENIPUNCTURE PROCEDURE [SYRINGE]. ___ needle before placing gauze

Remove needles

Step 14 of VENIPUNCTURE PROCEDURE [SYRINGE] Apply Pressure for ____ min

3-5

PMLS-2 Lesson 8 Flashcards

(68 cards)