Pre-Analytical Consideration Part B

Question 1

avoid these areas since it’s difficult to palpate or penetrate in burned
and scarred areas.
o painful
o susceptible to infection
→ healed sites with extensive scarring may have impaired circulation that
could lead to erroneous (invalid or false) test results

Answer 1

Burns, Scars and Tattoos

Question 2

may feel hard and cordlike and lack of resiliency since they are partially or completely occluded (obstructed)

Answer 2

Damaged Veins

Question 3

Veins may be:

Answer 3

• Sclerosed (hardened)
• Thrombosed (clotted)

Question 4

Effects of inflammation, disease, or chemotherapy drugs

Answer 4

Thrombosed (clotted)

Question 5

Swelling caused by abdominal accumulation of fluid in tissue

Answer 5

Edema

Question 6

What is the common problem after mastectomy

Answer 6

Edema

Question 7

yield inaccurate test results owing to contamination by swelling
▪ harder to locate
▪ fragile
▪ easily injured by tourniquet & antiseptic
▪ healing may be prolonged

Answer 7

Edema

Question 8

Swelling or mass of blood (often clotted)

Answer 8

Hematoma

Question 9

o can be caused by blood leaking from a blood vessel
o large bruise spread around the area
o Hemolyzed blood will occur when puncturing to hematoma
site
▪ painful
▪ can coagulation and lead to inaccurate test

Answer 9

Hematoma

Question 10

Surgical Breast Removal

Answer 10

Mastectomy

Question 11

• never drawn blood from an arm on the same side
  o Lymph node removal
  ▪ part of the procedure

Answer 11

Mastectomy

Question 12

May case Lymphocytosis

Answer 12

Mastectomy

Question 13

o Obstruction or stoppage of normal lymph flow
o could change blood composition
o lead to inaccurate test results

Answer 13

Lymphocytosis

Question 14

it’s an impaired lymph flow makes the arm susceptible to
swelling

Answer 14

Lymphedema

Question 15

• Extremely Overweight

Answer 15

Obesity

Question 16

18 inch long

Answer 16

Strap Tourniquet

Question 17

Designed for obese

Answer 17

Bariatric Tourniquets

Question 18

used and just below the patient’s diastolic pressure

Answer 18

Bariatric or XL size blood pressure cuff

Question 19

What are the steps to locate obese vain

Answer 19

–> 1st check antecubital area
→ next palpable is median cubital vein
→ then ask the patient where or what sites have been successful for past blood draws
→ next option: cephalic vein
o to locate: rotate the patient’s arm medially

Question 20

• Loss of muscle function
• Can be temporary or permanent
• Can be localized in one area or widespread

Answer 20

Paralysis

Question 21

What is the meaning of ALS

Answer 21

Amyotrophic lateral sclerosis

Question 22

What is the meaning of VADS

Answer 22

Vascular Access Devices and Sites

Question 23

→ tubing devices that are designed to allow entry to veins or arteries
→ for patients who require frequent venous or arterial access
→ commonly used for administration of meds, fluids, blood products & sometimes blood collection
→ General Rule: do not performed in extremity with VAD

Answer 23

Vascular Access Devices and Sites (VADS)

Question 24

What is the meaning of IV?

Answer 24

Intravenous Line

Question 25

→ “Pertaining to or within the vein” → quick way to deliver fluids, meds, blood transfusion products and other substances

Answer 25

Intravenous Line (IV)

Question 26

o catheter inserted in peripheral vein ▪ its typically connected to a line that is used to administer fluid o line is attached to a bag containing the substance being administered

Answer 26

Intravenous Line (IV)

Question 27

Line is usually having a special drip chamber that prevents air from entering the tubing allows the flow rate to be estimated and controlled

Answer 27

IV Drip

Question 28

If the patient has an IV in both arms, draw ____ the IV

Answer 28

distal (below)

Question 29

If both are not free ____ must be taken

Answer 29

Capillary puncture

Question 30

needle connection device in the form of a stopcock or a cap that is connected to a hub of catheter or cannula by short length of IV tubing o cap or stopcock has a diaphragm ▪ thin, rubberlike cover ▪ for administering meds or drawing blood o lock, often places in vein in the lower arm above the back of the wrist and can be left in place for 48 hours

Answer 30

IV Catheter Lock

Question 31

Device filled with saline known as SAline Lock

Answer 31

Lock

Question 32

One filled with Heparin known as ___ or Heplock

Answer 32

Heparin Lock

Question 33

- A-line or Art-line - Catheter placed in an artery - located in radial artery of the wrist

Answer 33

Arterial Line

Question 34

Permanent surgical connection of an artery and vein

Answer 34

Arteriovenous AV shunt

Question 35

bypasses the capillaries and forces arterial blood directly into a vein

Answer 35

AV shunt

Question 36

to move or force

Answer 36

shunt

Question 37

dialysis shunt created by direct permanent fusion of the artery and vein

Answer 37

AV fistula

Question 38

Most common type of shunt for dialysis

Answer 38

AV Fistula

Question 39

piece of vein or tubing form a loop from the artery to vein that can be seen under the skin

Answer 39

AV Graft

Question 40

Distinctive buzzing sensation of shunt

Answer 40

Thrill

Question 41

Needle closed blood sampling sometime connected to an arterial or central venous catheter

Answer 41

Blood Sampling Device

Question 42

Also known as indwelling line

Answer 42

Central Vascular Access Devices (CVAD)

Question 43

o consists of tubing inserted into main vein or artery o primarily used for administering fluids and meds o monitoring pressures and drawing blood

Answer 43

Central vascular Acess devices

Question 43

Mostly; povidone-iodine

Answer 43

Antiseptic Allergy

Question 43

→ place a clean, folded gauze square over the site & wrap it with self-adherent elastic bandage → instruct to remove after 15 mins → hold press the site for 5 mins

Answer 43

Adhesive Allergy

Question 44

- Involves irritation or rashes - can be; life-threatening reaction

Answer 44

Latex Allergy

Question 45

→ aspirin or anticoagulant therapy (may take longer to stop bleeding) → if continuous in 5mins, notify personnel’s

Answer 45

Excessive Bleeding

Question 46

→ loss of consciousness and postural tone → contributing factors: anemia, dehydration, emotional problems, fatigue, hypoglycemia, hyperventilation, medications, nausea, needle phobia and poor or compromised breathing

Answer 46

Fainting [Syncope]

Question 47

→ not usual to experience → do not attempt until it subsides → give an emesis basin or wastebasket to hold as precaution → ask to breath slowly & deeply → apply cold, damp washcloth or cold compress to forehead

Answer 47

Nausea and Vomiting

Question 48

→ usually in routine venipuncture & capillary puncture

Answer 48

Pain

Question 49

→ Tiny, non-raised red, purple or brownish spots when tourniquet is applied → spots are mins drops of blood that escape capillaries and come to surface → Thrombocytopenia – low platelet count

Answer 49

Petechiae

Question 50

→ discontinue the draw → call for help to ease patient

Answer 50

Seizures / Convulsions

Question 51

→ common complication → if hematoma forms while blood drawing; discontinue → hold for 3 to 5 mins → the arm should be elevated and put cold compress

Answer 51

Hematoma Formation and Bruising

Question 52

adjective used to describe an adverse condition brought the effect of treatment

Answer 52

Iatrogenic

Question 53

Blood loss though blood removed for testing

Answer 53

Iatrogenic blood loss

Question 54

o blood loss to a point at which life cannot be sustained o life may be threatened if more than 10% (infant) 14% (adult) volume is removed

Answer 54

Exsanguination

Question 55

→ rare when proper venipuncture is followed → most often associated with deep or blind probing o especially in basilic vein close to brachial artery

Answer 55

Inadvertent Arterial Puncture

Question 56

--> rare occurrence but does happen o don’t open adhesive tape or bandages ahead of time or temporarily tape them to lab-coat cuffs or other contaminated objects o don’t pre-load (attach) needles onto tube holders to have a supply for many draws ahead of time. sterility of needle is breached once seal is broken o allow alcohol to dry prior to needle insertion o before/during don’t touch the site with finger, glove, gauze or any nonsterile after it has been cleaned o try to minimize the time between removing the needle cap o remind patient to keep bandage atleast 15 mins

Answer 56

Infection

Question 57

→ flow back → to avoid reflux; place patient’s arm downward position → will cause buildup of scar tissue and increase difficulty to performing subsequent venipunctures → Blind probing and improper technique can damage veins and impair vein patency

Answer 57

Reflux of Additive

Question 58

→ localized venous stasis or stagnation of normal venous blood flow

Answer 58

Hemoconcentration

Question 59

Ways to prevent Hemoconcentration

Answer 59

o ask to release fist upon blood flow o choose appropriate patent vein o don’t allow to pump the fist o don’t excessively massage the area in locating vein o don’t probe or redirect the needle multiple times in search of a vein o release tourniquet within 1 min

Question 60

→ results when RBC are damaged or destroyed

Answer 60

Hemolysis

Question 61

Slightly hemolysis

Answer 61

Pink

Question 62

Moderate hemolysis

Answer 62

Dark Pink to light Red

Question 63

Gross hemolysis

Answer 63

Dark red

Question 64

→ Hemolyzed specimen can result in conditions such as

Answer 64

o hemolytic anemia o liver disease o transfusion reaction

Question 65

→ Must fill ETS tubes until normal amount of vacuum is exhausted

Answer 65

Partially Filled Tubes

Question 66

→ Short Draws o failure to partially filled tubes o acceptable only in: Red tops & SSTs

Answer 66

Partially Filled Tubes

Question 67

→ improper technique or carelessness

Answer 67

Specimen Contamination

Question 68

→ Affect test results and jeopardized patient safety

Answer 68

Wrong or Expired Collection Tube

Question 69

→ not inserted far enough → bevel partially out of the skin → bevel partially into the skin → bevel partially through the vein → bevel completely through the vein → bevel against vein wall → bevel in valve → needle beside the vein → undetermined needle position

Answer 69

Needle Positions

Question 70

What are some needle positions

Answer 70

→ not inserted far enough → bevel partially out of the skin → bevel partially into the skin → bevel partially through the vein → bevel completely through the vein → bevel against vein wall → bevel in valve → needle beside the vein → undetermined needle position