MEDCA PHLEBOTOMY EXAM

Work duties of a phlebotomist technician can be categorized into 4 categories

Equipment

Procedure

Patient Care

Patient Information

Equipment

- phlebotomists must ensure that all equipment and areas used are sterile

- equipment includes needles, bandages, gauzes, tubes, other

collection devices, as well as labels for tubes

- tracking supplies to ensure that proper amounts are always present - disposal of needles and other used supplies

Procedure

- correct puncture or incision of patient's skin

- collecting the correct amount of blood or other fluids - correct labeling of collection tubes/devices

- completing and submitting documents needed to lab

Patient Care

- reassuring patients, as some may have fear of needles

- being able to answer questions that patients may have

- verifying patient information to ensure accuracy of tests or procedure - monitoring patient during procedure to prevent movement or fainting

Patient Information

- patients' rights must be respected

- keeping patients' medical records confidential

- accurate documentation of collection, ordered tests, and test results - providing accurate documentation to the laboratory to ensure

performance of tests ordered by physician

Quality Improvement Methods

Include the use of data-based methods in order to reach improvement

Include flow charts and pareto charts

Flowchart

- used to break out components into diagrams in order to understand a process

Pareto Chart

- bar charts are made that show the frequency of problems

What does quality improvement for specimen collection involve?

Technique of Phlebotomist

Frequency of hematoma

Recollection Rates

What is included in quality control records

Expiration Date

Stability Information

Storage Information

Proper Use

Precision of testing supplies/reagents

Accuracy of testing supplies/reagents

Where can phlebotomists work?

Hospital

Clinic

Doctor's office

Laboratories

Blood Banks

Research Firms

Pharmaceutical Firms

Hospital

institution which provides medical and surgical treatment

Clinic

institution or hospital department focusing on diagnosis and care of outpatients

Doctor's Office

suite/office where doctors receive and treat patients

Laboratory

building or room where tests are performed to evaluate specimens in order to diagnose medical conditions

Blood Bank

institution where blood is collected from donors, and then stored and prepared for transfusion

Research Firm

institution equipped for scientific/medical research that may specialize in basic research or on specific areas

Pharmaceutical Firm

institution that develops and markets drugs for use as medications

How must all needles be discarded?

intact

What does it mean if an infection is classified as nosocomical

A patient developed the infection while they were in the hospital that was not present before entering the hospital

What is included in the chain of infection

source

susceptible host

poor isolation technique

Hygiene

wash hands with soap and water if they are visibly dirty

good hand-hygiene techniques reduce number of outbreaks of infections

hand washing is the single most important way to prevent spread of infection

Equipment used to control infections

gloves, masks, goggles, gowns, or coats

autoclaves (instruments for sterilizing under pressure)

Emergency Needle Stick Information

if exposed to blood due to a needle stick or other sharp object, wash needle stick and cut with soap and water

flush mouth, eyes, and skin with water

report the incident to a supervisor

seek medical treatment

Blood Pressure

pressure exerted by circulating blood upon the walls of blood vessels

Usually refers to the arterial pressure of systemic circulation

When does blood pressure decrease

decreases as the circulating blood moves away from the heart through the arteries

Where does blood pressure drop most rapidly

along the small arteries and arterioles

Decreases continuously as it moves through capillaries and back through veins to the heart

What other factors can influence blood pressure in the body

valves in veins

Gravity

Pumping from contraction of skeletal muscles

How is blood pressure measured

Systolic (maximum) over diastolic (diastolic)

Systolic

Blood pressure at the time of contraction

Specifically during contraction of the left ventricle

Systolic contraction is contraction of the ventricles

Heard during the normal first and second heart sound

Diastolic

Blood pressure when the heart is in relaxation and expansion

Minimum arterial pressure when the ventricles are filling with blood

Heard during diastole, when the heart relaxes

Pulse/ Heart Rate

rhythmical expansion of arteries due to contractions of the heart

Recorded as beats per minute

Where can a persons pulse be felt?

any place that will allow an artery to be compressed against a bone

Radial Artery

Carotid Artery

Brachial Artery

Popliteal Artery

Posterior Tibial Artery

Which finger can not be used to measure pulse?

Thumb: it has a pulse of its own

Is a lower or higher pulse rate better?

Lower

Although, 60 may be dangerous

Newborn Pulse

120 - 160 beats per minute

1 month-12 months Pulse

80-140

1-2 years pulse

80-130

2-6 years pulse

75-120

6-12 years pulse

75-110

13+ pulse

60-100

adult athletes pulse

40-60

What are blood cells called

hemaocytes

Serum

fluid portion of blood

What cells does blood circulate through

arteries

arterioles

veins

venules

capillaries

Where is blood made

bone marrow: soft center of bones

95% of blood cells are produced here

How does formation of blood cells begin

Begins in bone marrow as stem cells

These cells will grow and mature into blood cells

3 Types of Blood cells

Erythrocytes (red blood cells)

Leukocytes (white blood cells)

Thrombocytes (platelets)

What percentage do cells make up of blood

45%

What percentage does plasma make up of blood

55%

Blood makes up how much of our body weight

8%

( 5 Liters)

What is the blood pH level

7.35-7.45

Function of blood

To carry materials to bodily tissues

(hormones, oxygen, vitamines, antibodies, heat, electrolytes, nourishment)

To carry materials away from bodily tissues

( carbon dioxide, waste)

Red Blood Cells

most numerous blood cell in the body

Have a shape similiar to biconcave lenses and have no nucleus

These cells are our way of delivering oxygen to the body

Have a life span of 100-120 days

Hemoglobin

Iron containing pigment which gives red blood cells their color

Helps bind to oxygen

Anemic

Lower levels of red blood cells or hemoglobin

3 Stages of Red Blood Cell Life Cycle

Development (Erythropoiesis)

Functional (functional development )

Senescent (Senescence)

Erythopoiesis Stage

- process of development in which new red blood cells are produced

- cells mature in about 7 days

- about 2 million red blood cells per second are continuously produced in

the bone marrow

- developing cells are also known as reticulocytes, and make up around

1% of the red blood cells in the circulatory system

Functional Lifetime

- red blood cells live between 100 days to 120 days

- during this stage, red blood cells move continuously

- blood flow pushes erythrocytes in arteries, pulls erythrocytes in veins,

and squeezes erythrocytes through capillaries and other small vessels

Senescence

- as erythrocytes, they go through changes in their plasma membrane

- these changes make the cells more recognizable for removal of old and

defective cells, a process called eryptosis

- eryptosis takes place at the same rate as production of cells, therefore

keeping a balance in the amount of red blood cells

Leukocytes

cells of the immune system and help the body defend against diseases and foreign materials

Have a nucleus

What cell to leukocytes develop from in bone marrow

hematopoietic stem cell

Two types of leukocytes

Granulocytes

Lymphoid

Granulocytes

Have granules in cytoplasm

Neutrophil

Eosinophil

Basophil

Lymphoid Cells

Lymphocytes and monocytes

Order of most abundant to least abundant white blood cells

NEVER LET MONKEYS EAT BASIL

neutrophil 50 - 70 %

lymphocyte 20 - 40 %

monocyte 3 - 8 %

eosinophil 2 - 4 %

basophil 0.5 - 1 %

Neutrophile

- defend against fungal or bacterial infection

- unable to renew the lysosomes used in the defense against infection, these cells

die and, in large numbers, form pus

Lymphocyte

- although present in blood, lymphocytes are common in the lymphatic system - produce antibodies that bind to pathogens

- grouped into B cells, T cells, and NK cells

Monocyte

- forerunners of macrophages

- larger cells that enter the circulatory system for about 24 - 36 hours before

becoming macrophages

Eosinophils

- main function is the defense against parasites

Basophils

- responsible for antigen and allergic response by releasing histamine

Platelet Function

to sop blood loss due to wounds to maintain homeostasis

They release factors that promote blood coagulation

Have a lifespan of about 5-9 days

How long does it take for normal blood to clot

30-60 min

What cells to platelets develop from in bone marrow

megakaryocyte

Each cell can produce 5,000-10,000 platelets

How is platelet development regulated

regulated by a hormone called thrombopoietin

hormone is produced in liver and kidneys

Destruction of platelets

Takes place by phagocytosis in the spleen and Kupffer cells in the liver

Reserve platelets are kept in the spleen

How to platelets clump together

fibrinogen

vWF (von Willebrand factor)

Once activated, platelets will attach to exposed collagen and clumping and attachment will form a clot

Clumped platelets secrete chemicals to urge fibroblasts into the wound to heal

3 Major Types of Blood Vessels

Arteries

Veins

Capillaries

Arteries

Carry blood away from the heart

Oxygen Rich

Main arteries of body

Ascending aorta

Arch of aorta

External Carotid

Internal Carotid

Subclavian

Axillary

Brachial

thoracic

Abdominal

Gonadal

Lumbar

Inferior Mesenteric

Median Sacral

Common Iliac

External Iliac

Veins

Carry blood towards the heart

Oxygen deprived

Less muscular and closer to the skin than arteries

Contain valves

Can be obstructed due to blood clots

Two layers of veins

Tunica adventitia (connective tissue)

Tunica Media (smooth muscle)

Inside of veins is tunica intimate

Pulmonary Veins

right superior

left superior

right inferior

left inferior

Systemic Cardia Veins

Great cardiac

Oblique Vein of left atrium

Left marginal

Small cardiac

middle cardiac

Posterior vein of left ventricle

Capillaries

Exchange of chemical and water between blood and tissue

Systemic Head Neck Veins

- frontal vein

- supraorbital vein

- angular vein

- anterior facial vein

- posterior facial vein

- occipital vein

- superficial temporal vein - posterior auricular vein

- internal maxillary vein

Systemic Neck Veins

- anterior jugular vein

- posterior external jugular vein - internal jugular vein

- external jugular vein

- vertebral vein

Systemic Diploic Veins

- anterior temporal vein - posterior temporal vein - frontal vein

- occipital vein

Systemic Veins of brain

- superior cerebral vein - inferior cerebral vein - middle cerebral vein - basal vein

- terminal vein

- choroid vein

- great cerebral vein

- superior cerebral vein - inferior cerebral vein

Systemic Veins of Eye and SKull

- superior ophthalmic vein - inferior ophthalmic vein - two transverse sinuses

- occipital sinus

- straight sinus

- superior sagittal sinus - inferior sagittal sinus

Upper Extremity systemic Veins

- dorsal digital vein

- volar digital vein

- dorsal metacarpal vein

- intercapitular vein

- cephalic vein

- accessory cephalic vein - basilic vein

- median antibrachial vein - axillary vein

- subclavian vein

Systemic Veins of Thoracic

right innominate vein

- left innominate vein

- internal mammary vein

- superior phrenic vein

- inferior thyroid vein

- highest intercostal vein

- superior vena cava

- hemiazygos vein

- accessory hemiazygos vein

- bronchial vein

- external vertebral venous plexus

- internal vertebral venous plexus

- postvertebral vein

- invertebral vein

- vein of the medulla spinalis

Portal System Systemic Veins

- portal vein

- lineal vein

- short gastric vein

- left gastroepiploic vein

- right gastroepiploic vein - pancreatic vein

- inferior mesenteric vein - hemorrhoidal vein

- sigmoid vein

- left colic vein

- superior mesenteric vein - pancreatic duodenal vein - coronary vein

- pyloric vein

- cystic vein

- parumbilical vein

How many layers do arteries have

3

How many layers do veins have

2

Arterial Vessels

carry blood away from the heart

Venous Vessels

Carry blood towards the heart

Exceptions to arterial and Venous Vessels

Pulmonary Vein: carries oxygen rich blood

Pulmonary Artery: carries oxygen deprived blood

Where does arterial system develop?

aortic arches (and dorsal aorta) at 4 weeks of human development

Where do venous system develop

3 bilateral veins between 4 and 8 weeks of human development

(umbilical, cardinal, vitelline )