Phlebotomy Exam Review

What is the definition of phlebotomy?

The incision of a vein for collecting a blood sample for laboratory testing or other therapeutic purposes

What is a venous specimen?

Direct puncture of a vein by venipuncture, vascular access device

What is venous specimens typically used for?

Routine laboratory tests

What is an arterial specimen?

Direct puncture of an artery; vascular access device

What are arterial specimens used for?

Arterial blood gases

What is a capillary specimen?

Dermal puncture of fingertip or heel

What is a capillary specimen used for?

• Infants, young children

• Elderly patients with fragile veins

• Severely burned patients

• Point-of-care testing

What are the ethical standards of phlebotomy?

• Do not harm anyone intentionally

• Perform duties according to sound technical ability and good judgment

• Respect patient’s rights

What is required on a specimen label?

• Patient name

• Date of Birth

• Hospital Number

• Date

• Time of collection

• Initials of collector

What are laws?

societal rules or regulations

• Protect the welfare and safety of society

• Resolve conflicts in an orderly and nonviolent manner

What are ethics?

the moral standards of behavior or conduct that govern an individual’s action

What is bioethics?

refers to the moral issues or problems that have resulted because of modern medicine, clinical research and/ or technology

Usually it refers to “life-and-death“ issues such as in-vitro fertilization, cloning, and who receives organ donations

What is negligence?

The failure to act or to perform duties according to standards of the profession

What are some examples of negligence?

• Confusion of patient samples leading to a patient’s death

• A phlebotomist collected blood from a patient, the needle went through the vein into the median nerve and the patient subsequently lost the use of three fingers of his hand due to nerve damage

• Using a long, large needle to collect blood from an older patient with frail veins will lead to vein damage and accumulation of blood in the skin around the venipuncture

What is malpractice?

Improper or unskilled care of a patient by a member of the healthcare team, or any professional misconduct or unreasonable lack of skill

What is HIPAA?

Law created legal requirements for the protection, security, and appropriate sharing of a patient’s personal health information

What is invasion of privacy?

The unauthorized release of information about a patient

What is informed consent?

The voluntary permission given by a patient to allow touching, examination, and/or treatment by healthcare providers

What is assault?

Threat to touch another person without consent and with the intent to cause fear

What is battery?

• Intentional touching of another person without consent

• The unlawful beating of another or carrying out of threatened physical harm

• ALWAYS includes assault

What is a litigation process?

the process of legal action to determine a decision in court

What is vicarious liability?

supervisors & directors may be held liable for the negligent actions of their employees

What is an infection?

the condition in which the body is invaded with pathogenic (disease-causing) microorganisms

What is a communicable disease?

category of diseases resulting from the transmission of infectious microorganisms to individuals by direct or indirect contact or as an airborne infection

What is a blood-borne pathogen?

any infectious microorganism present in blood and other body fluids and tissues can cause infectious disease

What are examples of infectious body fluids?

• Blood

• Visibly bloody body fluids

• Semen

• Vaginal secretions

• Cerebrospinal fluid

• Synovial fluid

• Pleural Fluid

• Peritoneal Fluid

• Pericardial fluid

• Amniotic Fluid

What are examples of NON-infectious body fluids?

• Feces

• Nasal secretion

• Saliva

• Sputum

• Sweat

• Tears

• Urine

• Vomit

What are nosocomial infections?

Infections acquired by a patient after admission to a healthcare facility

What is another name for nosocomial infection?

Healthcare-Associated Infection (HAIs)

What is the chain of infection (IN ORDER)

1. Pathogen/Infectious Agent

2. Reservoir

3. Portal of exit

4. Mode of transmission

5. Portal of entry

6. Susceptible Host

What is a pathogen/infectious agent?

• The microorganisms that cause infectious disease

• Include: bacteria, fungi, viruses, worms, protozoa

What are examples of a reservoir?

• Human hands

• Lab coats

• Scrubs

• Neck ties

• Tourniquets

What is portal of exit?

Pathogen can exit from an infected person ( the reservoir) by body fluids that are excreted or by respiratory droplets that are released into the air by sneezing or coughing

What is mode of transmission?

Transmission from the reservoir to the next host

What are the five modes of transmission?

1. Direct contact

2. Air

3. Medical instruments

4. Other objects — inanimate objects (fomites)

5. Vectors — insects and rodents

What is portal of entry?

An entrance pathway into the “susceptible host”

What is an example of a portal of entry?

Mouth or nasal passage

How can we break the chain of infection in the infectious agent stage?

Diagnosis/treatment

How can we break the chain of infection during the source (reservoir) stage?

• Education/policy

• Environmental sanitation

• Disinfection

How can we break the chain of infection during the exit (portal of exit) stage?

• Handwashing

• Control of aerosols and splatter

How can we break the chain of infection during the mode of transmission stage?

• Isolation

• Disinfection

• Handwashing

How can we break the chain of infection during the portal of entry stage?

• First aid

• Personal hygiene

• Handwashing

How can we break the chain of infection during the susceptible host phase?

• Immunization

• Treatment of underlying diseases

What is Universal precaution?

apply only to transmission of blood-borne pathogens

What are standard precautions?

Decrease the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals

• Applies to all body fluids & all body fluids, non-intact skin & mucous membranes

What are airborne precautions?

reduce spread of airborne droplet transmission

What are droplet precautions?

reduce diseases transmitted through contact of mucous membranes (eye, mouth, nose)

What are contact precautions?

reduce risk of diseases transmitted through direct or indirect contact

What is strict isolation?

Used to prevent the transmission of all highly communicable diseases that are spread by contact or airborne routes of transmission

What are some examples of diseases that would require strict isolation?

Rabies, chickenpox, measles, diphtheria

What is respiratory isolation?

Used to prevent transmission of organisms by means of droplets that are sneezed or breathed into the environemnt

What are some examples of diseases that would require respiratory isolation?

influenza, tuberculosis, whooping cough, meningococcal meningitis

What is protective isolation?

Used to prevent contact between potentially pathogenic microorganisms and uninfected persons with impaired resistance

What are some examples of patients that would require protective isolation?

patient on leukemia

What is enteric isolation?

Used to control disease that can be transmitted through direct or indirect contact with infected feces(?) or contaminated articles

What are some examples of diseases that would require enteric isolation

dysentery, intestinal parasites; ingestion of enteric pathogens — Salmonella sp., Shigella sp., Yersinia sp.

What is wound & skin isolation?

Used to prevent spread of microorganisms found in wounds and heavily contaminated articles

What are some examples of conditions that would require skin and wound isolation?

infected burns, infected wounds, infections with lots of pus

What are some examples of diseases that would require wound and skin isolation?

herpes, impetigo, ringworm

What is blood isolation/precautions?

Used to prevent acquisition of infections by patients & personnel from contact with blood or items contaminated with blood

What are some examples of diseases that would require blood isolation/precautions?

Hepatitis B Virus & HIV

What are the most common errors in phlebotomy?

• Misidentification

• Improper vein selection

• Improper cleansing

• Improper specimen collection

• Procedural errors

What is #1 National Patient Safety Goal (NPSG)?

Improving the accuracy of patient identification through at least two unique idenifiers

How long do we keep the tourniquet on a patient?

no longer than 1 minute at a time

How do you correct the needle not going in far enough?

slowly advance the needle forward until blood flow is established

How do you correct inserting the needle all the way through the vein?

slowly withdraw the needle until blood flow is established

How do you correct inserting the needle partially through the vein?

pull the needle back slightly until blood flow is established

• If not corrected quickly, blood can leak into the tissue and form a hematoma

• If this happens, discontinue the draw & hold pressure over the site

How do you correct holding the needle bevel against the vein wall?

remove the tube from the needle to release vacuum pull on the vein; pull the needle back slightly; advance tube back onto the needle; if blood flow is established, problem most likely bevel and the vein wall

How do you correct rolling veins?

Securely anchor the vein prior to blood collection

How do you correct bevel partially into the vein?

gently push the needle forward into the vein

• If not corrected quickly, blood can leak into the tissue & form a hematoma

• If this happens, discontinue the draw & hold pressure over the site

How do you correct losing the vacuum in the tube?

hold equipment firmly

How do you correct insertion of needle of a collapsed vein?

use an evacuated tube with a smaller volume and/or smaller needle size during the collection process on patients with smaller veins and/or geriatric patients

What is a hematoma?

A swelling or mass of blood (often clotted) that can be caused by blood leaking from a blood vessel during or following a venipuncture.

What is a hemoconcentration?

A decrease in plasma volume with an increased concentration of cells and larger molecules

What is edema?

Swelling caused by the abnormal accumulation of fluid in tissues

What is some of the equipment required for routine venipuncture?

• Antiseptics

• Antimicrobial hand gel or foam

• Tourniquet

• Disposable gloves

• Gauze pads

• Bandages

• Safety syringes

• Safety butterfly sets

• Sharps container

• Safety-needle collection device

• Syringe blood transfer device

• Needles

• Vacuum (evacuated) tubes

What is the purpose of antiseptics?

Prevent or inhibit the growth & development of microorganisms, but don’t necessarily kill them

What is the purpose of tourniquets?

• Makes veins more visible and easier to feel & find

• Should not restrict arterial blood flowing to the arm

What are gauze pads used for?

Gauze pads folded in fourths are used to hold pressure over the site following blood collection

Why are cotton balls not recommended?

• Stick to the site

• Reinitiate bleeding when removed

What are safety syringes used for?

Used with patients who have fragile veins

What does needle gauge indicate?

the diameter of the needle

What is safety holders used for?

to prevent accidental needlesticks

What is the method of action of oxalates, citrates, and EDTA?

Prevents coagulation by removing calcium and forming insoluble calcium salts

What is the method of action of heparin?

prevents blood clotting by inactivating the blood-clotting chemicals thrombin and Factor X

All tubes containing an anticoagulant must be ______ to mix the contents and avoid microclot formation

immediately inverted

What is the order of draw (IN ORDER)

1. Sterile/ yellow top

2. Light Blue Top

3. Red Top Tube

4. Serum Separator Tube (SST)

5. Plasma separator Tube (PST)/ light green

6. Dark Green tubes

7. Lavendar/Purple

8. Pink

9. Royal Blue

10. Grey

What is the anticoagulant in yellow top tube (sterile)?

sodium polyanethol sulfonate (SPS)

How many times do you invert yellow top (sterile) tubes?

8-10 times

What is the anticoagulant in light blue tubes?

sodium citrate

What is the ratio of blood to anticoagulant in light blue tubes?

9:1

If the light blue tube is underfilled, it leads to _____.

prolonged results

When using a winged/butterfly collection set for venipuncture and a coagulation tube is first specimen to be drawn, a _________ should be drawn first to fill the “dead space“ in the tubing

discard tube

Using a discard tube will ensure ________

proper blood to anticoagulant ratio

The discard tube should be a tube with ___a____, such as a red top without clotting activators or a __b___ identical to the one to be filled for testing.

a. no additives

b. coagulation tube

How many times do you invert a light blue top?

3-4 times end to end

Overmixing of light blue top tubes can ______ and cause erroneous coagulation results.

activate platelets

What is the anticoagulant of red top tubes?

(some) clot activator

(most) nothing added

The clotting process begins _____

immediately after hitting tube

It takes ______ for fibrin clot to form.

at least 30 minutes