PMLS finals Flashcards
(185 cards)
1
Q
What is an evacuated tube system?
A
A system used for collecting blood samples in a controlled environment
It includes components such as multi-sample needles, tube holders, and evacuated tubes.
2
Q
What are the basic components of an evacuated tube system?
A
- Multi sample / 2 way needle
- Tube holder / adapter
- Evacuated tubes
3
Q
Why is the order of draw significant?
A
- Carryover or cross-contamination
- Tissue thromboplastin contamination
- Microbial contamination
- Interference with assay
- Removal of constituents
- Effect on enzyme action
- Alteration of cellular constituents
4
Q
What color-coded tube is used for sterile samples?
A
Sterile tube
5
Q
What are serum separator tubes indicated by?
A
- Gold BD hemograd closure
- Red gray (tiger speckled)
6
Q
What color is the heparin tube?
A
Green
7
Q
What color-coded tube is used for EDTA?
A
Lavender (purple) top
8
Q
Fill in the blank: The light green or green gray tubes are used for _______.
A
[plasma separator tubes]
9
Q
What are the parts of the butterfly set?
A
- Needle
- Plastic wings
- Plastic tubing
- Syringe
- Adapter of evacuated tube system
10
Q
What are the types of butterfly sets?
A
- For syringe system method
- For evacuated tube system method
11
Q
What are alternative uses for the butterfly set?
A
- IV hydration
- Medication
12
Q
What is a principle of capillary puncture?
A
To obtain blood samples from capillaries, typically in infants and young children.
13
Q
What equipment is used for capillary puncture?
A
- Lancets or incision devices
- Microcollection containers
- Microhematocrit tubes and sealants
14
Q
What are the indications for capillary puncture?
A
- For adults and older children
- For infants and very young children
15
Q
What is a common complication of arterial puncture?
A
- Asteriospasm
- Artery damage
- Discomfort
- Infection
- Hematoma
- Numbness
- Thrombus formation
- Vasovagal response
16
Q
What are common ABG analytes?
A
- pH
- PaO2
- HCO3
- O2 saturation
- Base excess (or deficit)
17
Q
True or False: A collapsed vein can occur despite correct needle position.
A
True
18
Q
What causes a tube to lose its vacuum during a venipuncture?
A
If the needle bevel is not completely under the skin or during shipment and storage.
19
Q
What is the one-hand scoop technique used for?
A
To safely re-sheath a used needle.
20
Q
List the procedures for safe waste and sharps disposal.
A
- Set up and enforce a policy for infectious waste
- Place biomedical waste in marked bags
- Use puncture-resistant containers for sharp instruments
- Do not recap, bend, or break needles by hand
- Dispose of biomedical waste according to recommended procedures
21
Q
What must be done immediately after using a blood-sampling device?
A
Dispose of it in a sharp, leak-proof, closable, puncture-proof container.
22
Q
What are some causes of sampling errors in arterial puncture?
A
- Air bubbles
- Delay in analysis
- Improper mixing
- Improper syringe
- Obtaining venous blood by mistake
- Use of improper anticoagulant
- Use of too much or too little heparin
23
Q
What is the definition of quality assurance in phlebotomy?
A
A systematic process to ensure the quality of care provided in phlebotomy.
24
Q
What are some quality assurance indicators?
A
- Process and outcomes
- Quality control
- Patient preparation procedures
- Specimen collection procedures
25
What is the purpose of the Modified Allen Test?
To assess collateral circulation before radial ABG collection.
26
Fill in the blank: The _______ method is a quality assurance system that aims to improve processes.
[LEAN system]
27
What is the purpose of disposing of blood-sampling devices?
To ensure safety by preventing needle-stick injuries and contamination
## Footnote
Blood-sampling devices should be placed in a sharp, leak-proof, closable, puncture-proof container.
28
What are some challenges in the safe removal of sharps?
* Needle recapping
* Decanting of used sharps containers
* Recycling of containers
* Overfilling of sharps containers
## Footnote
These challenges can lead to increased needle-stick injuries.
29
What should be done immediately after blood spillage?
Clean it up promptly
## Footnote
This includes wearing gloves and using paper towels to absorb the liquid.
30
What is the preferred concentration of sodium hypochlorite for large blood spills?
Approximately 5000 parts per million (ppm)
## Footnote
This is a 1:10 dilution of 5.25% chlorine bleach to water.
31
What is the first step in handling a blood spillage?
Put on gloves and a gown or apron
## Footnote
This is important if contamination of clothing is likely.
32
What should be done with broken glass during a blood spillage incident?
Use tongs or a pan and brush to sweep up the glass
## Footnote
Do not pick up pieces with your hands.
33
What is a common cause of slow blood flow during venipuncture?
Needle is beside the vein
## Footnote
This often occurs when the vein is not properly anchored.
34
When should a new venipuncture site be selected?
If correction of needle position fails
## Footnote
This ensures safety and proper technique.
35
What is the importance of proper specimen identification?
To ensure correct results are reported for the correct patient
## Footnote
Identification must be maintained throughout the testing process.
36
Fill in the blank: All specimens should be treated as if they are potentially _______.
infectious
## Footnote
This is a principle known as universal precautions.
37
What should be done to preserve blood specimens before analysis?
Use anticoagulated tubes and invert them properly
## Footnote
This helps maintain accurate results.
38
What is the effect of chilling a specimen with solid ice?
Can freeze parts of the specimen
## Footnote
This may lead to hemolysis and analyte breakdown.
39
What is the maximum time allowed to transport specimens to the lab?
Within 45 minutes of collection
## Footnote
If separating serum or plasma, centrifuge within 1 hour.
40
What can cause hemolysis during specimen transport?
Excessive movements and improper positioning
## Footnote
Samples should be kept upright and secured.
41
What is glycolysis in the context of blood specimens?
A metabolic process that lowers glucose levels
## Footnote
It can be minimized by prompt delivery and separation.
42
What should be done if a specimen is unsuitable for testing?
Reject the specimen and obtain a new one
## Footnote
Unsuitable specimens may be caused by hemolysis or insufficient volume.
43
True or False: Hemolysis can be identified only after testing is complete.
True
## Footnote
This makes it crucial to check specimens before processing.
44
What is the role of an aliquot in specimen testing?
A part of a specimen used for testing
## Footnote
It allows one specimen to be used for multiple tests.
45
What is one major disadvantage of using pneumatic tube systems for specimen transport?
Can cause hemolysis
## Footnote
This increases concentration of certain enzymes.
46
What are required for accurate lab results?
Specimens must be suitable
## Footnote
Unsuitable specimens must be rejected for testing and new specimens obtained.
47
What causes rejection of chemistry specimens?
Hemolysis, insufficient amount of specimen
## Footnote
Hemolysis may not be noticed until processing has started or completed.
48
What causes rejection of hematology specimens?
Clotting
49
Give an example of inadequate specimen identification.
Urine specimen not labeled
50
What is an example of inadequate volume of blood in additive tubes?
Partially filled coagulation tube
51
What is hemolysis?
Destruction of red blood cells leading to release of hemoglobin
52
What is a wrong tube error in specimen collection?
CNC specimen collected in a red top tube
53
What happens if a specimen is collected in an outdated tube?
CBC specimen collected in a tube that expired
54
What is improper handling in specimen collection?
EDTA tube with CBC specimen that has clots due to improper mixing
55
What does QNS stand for?
Quantity Not Sufficient
56
What is the stability duration for an EDTA specimen for CBC?
Analyzed within 6 hours
57
True or False: Blood smears made from EDTA specimens must be prepared within 3 hours of collection.
True
58
What is the main reason for arterial puncture?
To obtain blood for arterial blood gas (ABG) tests
59
What does ABG evaluation assess?
Respiratory function, electrolyte balance, acid-base balance
60
What is the normal range for pH in ABG?
7.35 to 7.45
61
What does a decrease in PaO2 levels indicate?
Increased respiration rate
62
What is the normal range for PaCO2?
35 to 45 mmHg
63
What does HCO3 measure in the blood?
Amount of bicarbonate
64
What is the normal range for O2 saturation?
97 to 100%
65
Who performs arterial puncture?
Medical personnel with extensive training
66
What is the purpose of the Modified Allen Test?
To determine collateral circulation before arterial puncture
67
What complication can arise from arterial puncture due to patient anxiety?
Arteriospasm
68
What is a hematoma?
A localized collection of blood outside of blood vessels
69
What should be done to prevent air bubbles in ABG samples?
Must be immediately and completely expelled
70
What can delay in analysis affect in ABG results?
pH, blood gas, glucose values
71
What is the correct anticoagulant for ABG collection?
Heparin
72
Fill in the blank: A specimen collected and placed in an evacuated tube with a gel barrier may prevent _______ for up to 24 hours.
glycolysis
73
What is the normal range for base excess in ABG?
(-2) to (+2) mEg/L
74
What is the main hazard associated with arterial puncture?
Infection
75
What is the main disadvantage of using the femoral artery for puncture?
Requires specially trained personnel
76
What is the preferred artery for collecting large volumes of blood?
Brachial artery
## Footnote
It is large, easy to palpate and puncture, but deeper than the radial artery.
77
Where is the femoral artery located?
Superficially in the groin, lateral to the pubic bone
## Footnote
It is the largest artery and used in emergency situations.
78
What is a key risk associated with using the femoral artery for blood collection?
More chance of infection
## Footnote
This is due to difficulty in achieving aseptic technique.
79
What does QA stand for in the context of healthcare?
Quality Assurance
## Footnote
QA guarantees quality patient care by tracking outcomes.
80
What are quality indicators?
Guides to monitor all aspects of patient care
## Footnote
They must be measurable, well-defined, objective, and specific.
81
List three components of Quality System Essentials (QSEs).
* The laboratory
* Personnel
* Equipment
82
What is the purpose of documentation in a QA program?
To standardize procedures and record problems for evaluation
## Footnote
Documentation can also serve legal purposes.
83
What is the Lean System focused on?
Elimination of waste
## Footnote
It allows a facility to do more with less while increasing satisfaction.
84
What does Six Sigma aim to achieve?
Reduce variables and decrease errors to 3.4 defects per 1 million opportunities
## Footnote
It is a statistical modification of the PDCA method.
85
What is the first step in risk management?
Identification of the risk
## Footnote
This is part of an internal process focused on minimizing risks.
86
What type of consent is required for high-risk procedures?
Expressed consent
## Footnote
This can be given verbally or in writing.
87
What must be provided to a patient for informed consent?
Adequate information regarding the method, risks, and consequences of a procedure
## Footnote
Information should be given in nontechnical terms.
88
What is implied consent?
The patient’s actions imply consent without verbal or written expression
## Footnote
This often applies in emergency situations.
89
What does a delta check involve?
It compares current results of a lab test with previous results for the same patient
## Footnote
Major differences may indicate an error.
90
What is a threshold value in quality assurance?
A level of acceptable practice beyond which quality patient care cannot be assured
## Footnote
It helps in evaluating and monitoring outcomes.
91
What is required by the Joint Commission for quality assurance?
* A detailed procedure manual
* Identification of variables associated with procedures
* Competency assessments
92
What is the main purpose of patient records?
Chronologic documentation of the medical care given to the patient
## Footnote
It serves as a legal document and aids communication.
93
What is one of the basic reasons for maintaining accurate medical records?
To provide an aid to the practice of medicine
## Footnote
It allows for documentation of treatment and care plans.
94
What should be done if a puncture device's seal is broken?
It should be put in a sharps container and a new one obtained
## Footnote
This ensures patient safety.
95
What is required for labeling specimens?
Labeling must be exact
## Footnote
Inaccuracies can result in specimens being discarded.
96
What does the safety manual contain?
Procedures related to chemical, electrical, fire, and radiation safety
## Footnote
It also includes disaster plans and hazardous material handling.
97
What is the role of risk management in healthcare?
To identify and minimize situations that pose risk to patients and employees
## Footnote
It involves controlling risks and addressing occurrences.
98
What is required for the administration of medical treatment to a minor?
Parental or guardian consent is required
## Footnote
Healthcare personnel who violate this rule are liable for assault and battery.
99
What constitutional right does an individual have regarding medical procedures?
An individual has a constitutional right to refuse a medical procedure
## Footnote
The refusal may be based on religious or personal beliefs and preferences.
100
What is the purpose of the evacuated tube system?
It enables blood to be directly collected into a tube, minimizing the risk of specimen contamination
## Footnote
It allows multiple tubes to be collected.
101
What are the basic components of the evacuated tube system?
* Multi sample / 2 way needle
* Tube holder / adapter
* Evacuated tubes
102
What is the significance of the order of draw in blood collection?
* Carryover or cross-contamination
* Tissue thromboplastin contamination
* Microbial contamination
* Interference with assay
* Removal of constituents
* Effect on enzyme action
* Alteration of cellular constituents
103
What does carryover or cross-contamination refer to?
The transfer of additive from one tube to the next
## Footnote
Occurs when blood in an additive tube touches the needle during ETS blood collection.
104
Which additive is known to cause more carryover problems than any other?
EDTA
105
Which additive has the least interference in tests?
Heparin
106
What is tissue thromboplastin contamination?
A substance present in tissue fluid that activates the extrinsic coagulation pathway and can interfere with coagulation tests.
107
What is the purpose of a discard tube in blood collection?
Necessary for coagulation tests other than prothrombin time
## Footnote
Since tissue thromboplastin has no significant effect for these tests.
108
Why are blood culture tubes collected first in the order of draw?
To ensure that they are collected when sterility of the site is optimal
## Footnote
Prevents contamination of the needle from unsterile tops of tubes used to collect other tests.
109
What is the effect of sodium fluoride on enzyme action?
Destroys many enzymes
110
What is a common use for lavender (purple) top EDTA tubes?
Routine hematology tests such as CBC and sedimentation rate
111
What type of blood collection tube is used for molecular diagnostics?
Pearl/white top
112
What is the purpose of glycolytic inhibitor tubes?
Used for lactic acid and glucose tolerance tests
## Footnote
Contains sodium fluoride or Iodoacetate.
113
What is the recommended blood-to-anticoagulant ratio for sodium citrate tubes?
9:1 blood-to-anticoagulant ratio must be maintained
114
What is the primary function of heparin tubes?
Used for determination of pH, blood gases, and electrolytes
115
Which type of blood collection tube is designed to minimize lead contamination?
Tan tube
116
What type of needle is used in the winged infusion system?
Butterfly needle
117
What is a significant advantage of butterfly needles?
Allow more precise placement, especially in hard-to-access veins
118
What is the relationship between needle gauge and bore size?
The higher the needle gauge, the smaller the bore of the needle
119
What is the typical length of a butterfly needle?
1/2 to 3/4 inch
120
What type of adapter is needed for the evacuated tube system with butterfly needles?
A special adapter is necessary to attach the tubing to the holder
121
What is the purpose of the plastic wings on a butterfly needle?
For gripping
122
What is the standard length of plastic tubing attached to a butterfly needle?
Approximately 5 to 12 inches long
123
What is the standard length of the butterfly-winged infusion set?
12 inches long
124
What is the purpose of shorter tubes in blood collection?
Used for blood draws
125
What are longer tubes in blood collection intended for?
IV applications
126
Is an adapter necessary for using the butterfly-winged infusion set with the syringe method?
No adapter is necessary
127
How is the syringe attached to the butterfly infusion set?
Directly attached to the screw-type end of the tubing
128
What is required to attach the tubing to the holder of the vacuum collection system?
A special adapter
129
Why are pediatric sized tubes preferred for small veins?
Less likely to cause small veins to collapse due to reduced vacuum pressure
130
What is the primary use of butterfly needles?
Best used with syringes
131
What should be done before using the syringe for blood collection?
Remove air from the syringe
132
What is the recommended method to transfer blood from the syringe to the tubes?
Dispense slowly on the side of the appropriate tube(s)
133
What may excessive pulling back on the plunger cause?
Vein collapse or hemolysis of the blood sample
134
When is a discard tube used in the ETS method?
If an anticoagulated test is required
135
Why should the butterfly method rarely be used?
If the vein is large enough, a regular vacuum collection holder/needle assembly is preferred
136
Where can venipuncture be performed if veins in both arms are unsuitable?
Top of the hand, top of the wrist, ankle, or top of the foot
137
What is a common challenge when accessing hand veins?
They are generally smaller and not well anchored
138
What is one of the uses of the butterfly needle in IV therapy?
To access a vein for IV fluids
139
What is an advantage of the butterfly-infusion set syringe method?
Pressure is controlled by the phlebotomist
140
What is a major disadvantage of the butterfly-infusion set?
The needle is short, which allows for possible retraction from the vein
141
What needle gauge should be used for pediatric patients?
Gauge of 23 or 25
142
What is the purpose of using the butterfly set?
To extract blood samples from small, fragile veins
143
Why might the first tube collected underfill using the ETS method?
Due to air in the tubing
144
What should be done to prevent underfilling in the first tube collected?
Draw a few milliliters of blood into a non-additive tube as a discard
145
Where should butterfly sets be disposed of?
In a sharp’s container with a biohazard label
146
What is a capillary puncture?
Collection of drops of blood by puncturing the capillary bed
147
What type of fluid is typically found in capillary specimens?
A mixture of arterial, venous, and capillary blood, along with interstitial fluid
148
What is the impact of warming the skin before capillary puncture?
Increases arterial flow into the area
149
What are indications for capillary puncture in adults?
["Fragile veins", "Multiple unsuccessful venipunctures", "Thrombotic tendencies", "Needle apprehension", "No accessible veins", "POCT procedures"]
150
What is the maximum depth for a capillary puncture?
2.0 mm
151
What should be avoided during capillary puncture?
["Puncturing deeper than 2.0 mm", "Puncturing in areas with previous punctures", "Puncturing swollen areas"]
152
What is the order of draw for capillary punctures?
Hematology specimens first, serum specimens last
153
What is a special consideration for capillary blood gases?
Less desirable for blood gas analysis due to exposure to air
154
What should be done when collecting a bilirubin specimen?
Turn off UV light before collection
155
How should bilirubin specimens be collected to avoid light exposure?
In amber-colored micro collection containers
156
What complication can occur from removing too much blood from an infant?
Anemia or cardiac arrest
157
What is the purpose of neonatal screening?
To detect and monitor increased bilirubin levels
158
What is the primary purpose of collecting specimens quickly?
To minimize exposure to light and protect them during transportation and handling.
## Footnote
Light exposure can affect the integrity of the specimen.
159
What type of containers are typically used to reduce light exposure when collecting specimens?
Amber-colored micro collection containers.
## Footnote
These containers help protect the specimens from light.
160
What is neonatal screening typically performed on?
A few drops of blood obtained by heel puncture.
161
What are blood spots in the context of neonatal screening?
Blood-filled circles collected by absorption onto special filter paper.
162
How many different disorders can be detected in the blood spots during neonatal screening?
As many as 30 different disorders.
163
Define phenylketonuria (PKU).
A genetic disorder characterized by a defect in the enzyme that breaks down the amino acid phenylalanine.
164
What is hypothyroidism?
Insufficient thyroid hormones that can affect brain development.
165
What is galactosemia?
An inherited disorder caused by a lack of the enzyme needed to convert galactose into glucose.
166
What is the first step in the procedure for neonatal screening?
Aseptic technique is always a must before making an incision or puncture.
167
What should be done with the first blood drop collected during heel puncture?
It should be wiped away in the normal manner.
168
What must be avoided to ensure proper blood collection on filter paper?
The paper must not touch the surface of the heel.
169
Why must the original position of the filter paper be maintained during blood collection?
To ensure complete filling of the circles on both sides of the paper.
170
What can result from unfilled or incompletely filled circles on the filter paper?
Inability to perform all required tests.
171
What is a blood film or smear?
A drop of blood spread thin on a microscope slide for examination.
172
What is the purpose of a manual differential test?
To determine the number, type, and characteristics of blood cells.
173
How many blood smears are normally prepared and submitted for testing?
Two blood smears.
174
What type of blood smears may require evaluation of a fresh drop of blood?
Special tests like leukocyte alkaline phosphatase (LAP) stain.
175
How soon should blood smears prepared from EDTA specimens be made?
Within 1 hour of collection.
176
What does capillary puncture blood contain?
A. Arterial blood
B. Interstitial fluids
C. Venous blood
D. All of the above
177
Which substance has a higher concentration in capillary blood than in venous blood?
C. Glucose
178
When is capillary puncture typically performed on adults?
A. No accessible veins can be located
B. Patients have thrombotic tendencies
C. Veins are saved for chemotherapy
D. All of the above
179
Which test specimen is collected first during capillary puncture?
C. Glucose
180
Which conditions disqualify a site for capillary puncture?
A. Cyanotic
B. Edematous
C. Swollen
D. All of the above
181
What is the least hazardous area of an infant’s foot for capillary puncture?
B. Lateral plantar heel surface
182
According to CLSI, a heel puncture lancet should puncture no deeper than:
B. 2.0 mm
183
What is a proper capillary puncture procedure?
A. Clean the site thoroughly with povidone–iodine.
B. Wipe away the very first drop of blood.
184
At what angle is the 'pusher slide' used when making a routine blood smear?
C. 30
185
For which test is the blood specimen placed in circles on special filter paper?
C. PKU
