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MELS301 > Week 1 > Flashcards

Week 1 Flashcards

1
Q

4 qualities in a good venepuncture vein

A
  1. Well anchored to the skin
  2. Shows elasticity
  3. Large enough for good blood flow
  4. Easily visible
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2
Q

Pre analytical factors

A

Test ordering system, patient ID matching sample, patient preparation, specimen transport

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3
Q

Analytical factors

A

Calibration, reagents, QC, equipment maintenance

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4
Q

Post analytical factors

A

Result reporting, turn around time

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5
Q

Non analytical factors

A

Staff training, lab policies, health and safety

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6
Q

Best vein for venepuncture and why

A

Median cubital vein as it is large and well anchored, less painful and likely to bruise

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7
Q

Second best venepuncture vein and why

A

Cephalic vein
May be more painful, not as well anchored but large

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8
Q

3rd best venepuncture vein

A

Easy to palpate but more painful and near brachial artery/nerve which could cause pain and you don’t want artery blood

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9
Q

Secondary venepuncture sites

A

Hands and feet is the last resort

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10
Q

What are some inappropriate venepuncture sites

A

Edematous/lympodema sites
Bruised and scarred areas
Arms with grafts/fistula
Inner wrist
Diabetic feet/ anyone with peripheral vascular disease
Arm with IV in, use the other arm or hand
Thrombosed veins

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11
Q

Types of needles

A

Flashback- to see if you’re in a vein
Butterfly - good for training, less pain

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12
Q

Hand washing precaution

A

Assume all substances from the body are dangerous
Wash hands before and after touching patients/doing a procedure and after touching surroundings near a patient

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13
Q

Procedure before sticking the needle in

A

Wash hands
Greet patient and check ID
Position patient
Consider the vein using a torniquet
Alcohol wipe

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14
Q

Order of draw saying

A

Stop light red, green light go

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15
Q

Order of draw colour order

A

Light blue
Red
Gold
Green
Light green
Lavender
Grey

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16
Q

Light blue tube

A

First in order of draw as it uses a weak anticoagulant reversible
Na citrate
Looking at coagulation and platelets

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17
Q

Red tube

A

Second in draw order
Plain tube
No anticoagulants as you want the blood to clot

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18
Q

Gold tube

A

SST
3rd in order
Serum, no anticoagulants

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19
Q

Light green

A

5th
PST plasma
Non coagulating

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20
Q

Green tube

A

4TH
LiHep
Non coagulating plasma

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21
Q

Lavender tube

A

6th
EDTA
Whole blood used for blood films and HbAc1, full blood counts

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22
Q

Grey tube

A

Last in order of draw
NaF or F oxalate
Plasma
For glucose

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23
Q

Pink tube

A

Just before grey
EDTA for blood banks only

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24
Q

Tourniquet uses

A

Make veins easier to feel and locate
10cm above vein
Stays on for 1 min at a time

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25
What happens if tourniquet for longer than a min
Haemo concentration so increase in proteins/albumin/Ca Water balance changes Haemolysis
26
What do you clean the venepuncture surface/ features
70% alcohol Circular motion, wait 30sec to dry
27
Underfilling tube leads to
Excessive additive Not enough blood for testing Need to recollect
28
Overfilling tubes results in /common with what type
Not enough additive in tube Common with syringe draws
29
When do you remove the needle in regards to tourniquet
After the tourniquet is released
30
What do you do after removing the needle
Dispose it first Apply pressure second
31
Should you bend arm after venepuncture
No Do not wipe either
32
What to do with tubes after needle is disposed of
Gently invert Label patient info Then give plaster
33
How many times do you invert a citrate tube
3-4x
34
How many times do you invert every tube but citrate
8-10x
35
What is phlebotomy syncope
1% of procedures Vasovagal response - BV dilate, heart rate slows down, BP drops so less blood reaches brain Fainting after procedure
36
What to do if patient feels faint
Stop procedure Call for assistance Remove needle and tourniquet Apply pressure to wound Head between knees if seated Elevate legs if on back 111 if not breathing Cold compress to back of neck Stay with patient for 15-30 mins No vehicle operation 30 mins after fainting
37
What are influencing factors
Cause a true change in analyse quantity Patient related not method
38
What are interfering factors
Cause a false change in analyse quantity Dependent on method more so
39
What are some modifiable influencing factors
Fasting state Exercise before coming in Vein or artery blood Posture Tourniquet Treatments
40
What are some unmodifiable influencing factors
Sex, race, gender Medications Disease state Pregnancy Period Mode of baby delivery Altitude
41
What are some endogenous interfering factors
Tourniquet left on too long = haemoconcentration Lipaemia Icterus Paraproteins Pathologies
42
List exogenous interfering factors
Shaking tube Wrong tube additive Didn’t invert In vitro haemolysis from tube temp Drugs Tracer dye Canula additives Tube additives Clot in tube
43
How to reduce influencing and interfering factors
Standardise methods
44
Beer lambert law
For spectrophotometry
45
Small particle scattering
Not all light is absorbed Symmetrical scattering Less than 5% of wavelength
46
Large particle scattering
Due to constructive and destructive interferences Forward scattering increases Backwards scattering decreases so asymmetrical
47
What is turbidimetry measuring and what type of particles is it better for
Decrease in transmitted light is measured Better for larger particles and higher concentrations
48
Detector placement in turbidity vs nephelometry
In turbidity the detector is in line with the source In neph the detector is at a 90 angle to the source
49
What is nephelometry measuring
Scattered light Better for smaller particles at lower concentrations More scattered =less absorbed
50
What is haemolysis
Disruption in blood cell membrane causing lysis of RBC
51
What is the most common preanalytical error in chem path tests
Haemolysis
52
In vivid haemolysis occurs how/ what proteins does this effect
Due to pathology Less serum haptoglobin Increased urine Hb Sample reflects patient so it’s fine
53
In vitro haemolysis cause
Cells damaged via Vein trauma Needle size Syringe collection too fast IV lines Shaking tubing Temp May need to redraw
54
How does haemolysis cause spectrophotometric interference
Causes peaks at 415, 540, 570nm False analyte conc
55
Haemolysis causes interference by increasing what analyte conc
LDH Pi AST K+ In plasma
56
What does haemolysis do to sample dilution
Effects analytes with greater extracellular conc like albumin, Ana and bilirubin
57
How does haemolysis affect assays with an example
It competes for binding sites, inhibit reactions Free Hb may start binding
58
When is lipaemia found the most
Lipid disorders Acute pancreatitis Drugs some Post prandial samples Had a fatty meal
59
What type of fats contribute to lipaemia
Lipoproteins chylomicrons VLDL
60
How to reduce lipaemia in blood samples
Fasting before the sample is taken Lipid clearing agents High speed centrifugation so lipids go to the top
61
How does lipaemia cause spectrophotometric interference
Absorption decreases between 300-700n Light scattering interferes with turbidity and nephelometry
62
What is the volume depletion in lipaemia
Lipid droplets take up volume in aspirated sample Falsely decrease concentration of analyte of interest
63
Random problems with lipaemia
Abnormal peaks in electrophoresis Masking of binding sites Partitioning of sample hard for automatic analyser
64
What is icterus
High bilirubin levels in plasma/serum
65
When is icterus samples seen
Liver disease Cancer Neonates
66
How does icterus interfere
Spec interference at 400-540nm Chemical interference with hydrogen peroxide for cholesterol/glucose/triglyceride
67
What does automated serum indices measure
Haemolysis Lipaemia Icterus
68
How does automated serum indices work
Sample blanked at absorbance maxima of Hb/lipids/bilirubin and interference is graded and unsuitable samples are flagged
69
What is bichromatic analysis
Measures two wavelengths Measures absorbance at points where no change in absorbance occurs and is used as a reference point
70
Example of bichromatic analysis with equations
Want to measure chromogen but bilirubin will interfere Primary absorbance - bilirubin absorbance = absorbance from chromogen Abs at 2nd - 1st = abs from interference

MELS301 (6 decks)

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