MLAB 147 UNIT 3: Blood Collection: Special Populations
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149 Terms
Q: What are special populations in phlebotomy?
A: Patients requiring modified collection techniques due to age, physical condition, or medical status.
Q: What are the main special populations in blood collection?
A: Pediatric, geriatric, chronic illness, and ICU/ER patients.
Q: Why do pediatric patients require special blood collection considerations?
A: They have lower blood volumes and higher risk of iatrogenic anemia.
Q: Why are children at higher risk of iatrogenic anemia?
A: They have smaller total blood volumes.
Q: What is iatrogenic anemia?
A: Anemia caused by excessive blood collection or medical procedures.
Q: What is the maximum pediatric blood collection limit?
A: 3% to 5% of total blood volume.
Q: What is the preferred maximum blood volume collection in pediatrics?
A: 3% of total blood volume.
Q: What is the absolute maximum pediatric blood collection limit?
A: 5% of total blood volume.
Q: What is the risk of exceeding pediatric blood volume limits?
A: Iatrogenic anemia.
Q: What is the 24
hour pediatric blood collection limit?
Q: What is the 30
day pediatric blood collection limit?
Q: Why must pediatric blood volumes be monitored carefully?
A: Children have lower circulating blood volume compared with adults.
Q: What is the pediatric blood volume memory rule?
A: Volume is everything; small patients cannot lose much blood.
Q: How are pediatric patients classified by age?
A: Neonates, infants, children, and teens.
Q: What age range defines a neonate?
A: Less than 28 days old.
Q: What age range defines an infant?
A: 0–1 year.
Q: What age range defines a child?
A: 1–12 years.
Q: What age range defines a teen?
A: 13–19 years.
Q: What is the preferred dermal puncture site for infants under 1 year?
A: Heel.
Q: What is the preferred dermal puncture site for children over 1 year?
A: Finger.
Q: Why is the heel used for infants?
A: Fingers are too small and the heel provides safer blood collection.
Q: What is the preferred heel area for infant capillary collection?
A: The medial or lateral plantar surface of the heel.
Q: What should be done before an infant heel stick?
A: Warm the heel.
Q: Why warm the heel before infant collection?
A: To increase blood flow and improve specimen collection.
Q: How long should the heel be warmed?
A: Approximately 3–5 minutes.
Q: What is the main pediatric dermal puncture rule?
A: Warm the site and use proper limits.
Q: What is NOT collected by dermal puncture?
A: Blood cultures and coagulation tests.
Q: Why are blood cultures not collected by dermal puncture?
A: They require larger, sterile venous samples.
Q: Why are coagulation tests not collected by dermal puncture?
A: They require specific blood
Q: What is a concern with newborn blood composition?
A: Newborns have higher RBC counts and less plasma.
Q: Why may newborns require more blood for certain tests?
A: They have less plasma available compared with adults.
Q: What is neonatal PKU screening?
A: A newborn screening test for phenylketonuria.
Q: When is PKU screening usually performed?
A: 24–48 hours after birth.
Q: Why is PKU screening not performed immediately after birth?
A: The newborn needs time to feed and produce detectable metabolites.
Q: What is the first step before collecting PKU blood spots?
A: Wipe away the first drop of blood.
Q: Why is the first drop wiped away during PKU screening?
A: It may contain tissue fluid contamination.
Q: What should never touch the circles on a PKU card?
A: The blood collection device or fingers.
Q: Why should PKU circles not be touched?
A: It can contaminate the specimen.
Q: How should PKU cards be dried?
A: Air dried horizontally.
Q: Why are PKU cards dried horizontally?
A: To allow proper drying and prevent uneven spreading.
Q: Why are bilirubin specimens protected from light?
A: Bilirubin is light
Q: What happens to bilirubin when exposed to light?
A: It decreases, causing inaccurate results.
Q: What should be done with UV lights during a bilirubin draw?
A: Turn off UV lights.
Q: How should bilirubin specimens be transported?
A: Shielded from light.
Q: What can be used to protect bilirubin specimens from light?
A: Aluminum foil/tinfoil or light
Q: What appearance should be expected from a high bilirubin specimen?
A: Icteric (dark yellow/amber).
Q: What does an icteric specimen indicate?
A: Increased bilirubin levels.
Q: What is the bilirubin memory rule?
A: Bilirubin hates light → protect it.
Q: What is the inpatient pediatric identification rule?
A: Always check the patient wristband.
Q: Are wristband checks optional for pediatric inpatients?
A: No, they are required.
Q: How is an outpatient child identified?
A: Parent or guardian confirms identification.
Q: How are neonates identified?
A: Using last name and Baby Boy/Girl identification.
Q: How are twins identified in neonatal settings?
A: Using additional identifiers such as A and B.
Q: Why are proper pediatric identifiers important?
A: To prevent patient identification errors.
Q: What are pediatric restraint techniques used for?
A: To safely stabilize the child during collection.
Q: What is the vertical restraint technique?
A: Parent hugs the child while holding the unused arm.
Q: When is vertical restraint commonly used?
A: For older children who can sit upright.
Q: What is the horizontal restraint technique?
A: Child lies down while parent leans over and stabilizes them.
Q: When is horizontal restraint commonly used?
A: When more stabilization is needed.
Q: What is swaddling used for?
A: Neonates and young infants.
Q: Why is swaddling helpful during neonatal collection?
A: It provides comfort and limits movement.
Q: What is an important pediatric anxiety reduction strategy?
A: Prepare supplies out of the child's sight.
Q: Why should supplies be prepared out of sight for children?
A: Seeing equipment increases anxiety and fear.
Q: What is the main goal when collecting from children?
A: Minimize stress while obtaining a quality specimen.
Q: What needle size is commonly used for pediatric venipuncture?
A: 23G or 25G winged infusion set (butterfly).
Q: Why are butterfly needles commonly used in pediatric patients?
A: They allow better control and work well with small veins.
Q: What is the common neonatal venipuncture site?
A: Dorsal hand veins.
Q: Why are dorsal hand veins commonly used in neonates?
A: They are accessible and suitable for small volumes.
Q: Is a tourniquet usually used for neonatal venipuncture?
A: No.
Q: What replaces a tourniquet during neonatal collection?
A: Hand positioning/MLA grip.
Q: Why is a tourniquet avoided in neonates?
A: Their veins are small and fragile.
Q: What is the aftercare rule for infant venipuncture?
A: Do not use band
Q: Why are band
aids avoided in infants?
Q: What should be used instead of a band
aid for infants?
Q: What is EMLA cream?
A: A topical anesthetic used to reduce pain during procedures.
Q: What two medications make up EMLA?
A: Lidocaine and prilocaine.
Q: What is the purpose of EMLA cream?
A: To numb the skin before venipuncture.
Q: How long before collection should EMLA be applied?
A: Approximately 60 minutes before the draw.
Q: Can EMLA be used for PKU screening?
A: No.
Q: Why is EMLA not used for PKU screening?
A: It may interfere with the screening process.
Q: What is the major pediatric collection concern?
A: Preventing excessive blood loss.
Q: What is the pediatric volume memory rule?
A: Small body = small blood volume.
Q: What is the most important pediatric specimen concern?
A: Avoiding iatrogenic anemia.
Q: What is the main technique difference between pediatric and adult collection?
A: Smaller volumes, smaller equipment, and increased comfort measures.
Q: What is the best approach when collecting from anxious children?
A: Be prepared, explain simply, and minimize waiting time.
Q: Why should pediatric supplies be ready before approaching the patient?
A: To reduce anxiety and improve cooperation.
Q:* Why do geriatric patients require special blood collection considerations?
A: Aging causes changes in skin, veins, and overall health that affect collection.
Q: What is a major skin change in geriatric patients?
A: Reduced collagen causing thin, fragile skin.
Q: Why is geriatric skin more likely to tear?
A: Loss of collagen makes skin thinner and less elastic.
Q: What type of tape is preferred for elderly patients?
A: Paper tape.
Q: Why is paper tape preferred for geriatric patients?
A: It is gentler and reduces skin tearing.
Q: Why should regular adhesive bandages be avoided in fragile skin?
A: They can damage or tear the skin.
Q: What is a common vein change in elderly patients?
A: Veins become fragile and roll easily.
Q: Why do geriatric veins roll?
A: Loss of subcutaneous fat reduces vein support.
Q: What is the main technique for rolling veins?
A: Firm anchoring.
Q: Why is firm anchoring important in geriatric patients?
A: It prevents veins from moving during needle insertion.
Q: What should be avoided when collecting from elderly veins?
A: Fishing or excessive probing.
Q: Why should probing be avoided in geriatric patients?
A: It increases bruising and tissue injury.
Q: What happens to vein depth in elderly patients?
A: Veins may become more superficial.
Q: How should needle angle change for elderly patients?
A: Use a reduced angle of entry.