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Venipuncture
most frequently performed phlebotomy procedure
Dermal Puncture
Method of choice for collecting blood from infants and children younger than 2 years
Clinical and Laboratory Standards Institute (CLSI)
the organization that stated incision depth must not exceed 2.0mm
Occupational Safety and Health Administration (OSHA)
recommends the lock and retract safety device to prevent reuse and needlestick injury
0.35 - 1.6mm
Needle depth for newborn
2.5mm
Ideal width for needle
3.0mm
incision depth for adults
capillary tubes
referred to as microhematocrit tubes
50 - 75 ul of blood
volume of blood in microhematocrit tubes
Red
color of band for heparizined tube
Blue
color of band for plain tube
requisition form
cannot proceed to extraction if the patient does not have this
lying down on back with heel downward
position for patient (newborn)
lying down or seated with fingers downward
position for adults
third and fourth finger of non-dominant hand
ideal site for collection in adults
lateral and medial of the plantar heel
ideal site for collection in infants
42 degrees
ideal temperature for warming the site
3-5 mins
ideal minutes for warming the site
bilirubin
light-sensitive chemical and destroyed when exposed to light
UV light
treatment for infants with jaundice
hemolyzed sample
can falsely lower bilirubin results
24 - 72 hours
blood is collected between ____ and ____ hours after birth
newborn screening test
performed when blood is collected between 24 and 72 hours after birth
phenylketonuria
caused by the lack of enzyme needed to metabolize the amino acid phenylalanine
congenital hypothyroidism
thyroid hormone deficiency present at birth
galactosemia
genetic metabolic disorder caused by the lack of liver enzyme needed to convert galactose into glucose
Plasmodium species
parasite that causes malaria
malaria
exhibits periodic episodes of fever and chills
2 hours
smears are allowed to dry for at least ____
bleeding time
performed to measure the time required for platelets to form a plug strong enough to stop bleeding
volar surface of forearm
place where bleeding time is performed
40 mmHg
mm Hg of blood cuff when doing BT
Joint commission
recommends that phlebotomist must be proficient with all age groups
Geriatric population
goal is to perform atraumatic venipuncture without bruising or excessive bleeding
FALSE
TRUE OR FALSE: Patients in comma no longer need to be talked about the procedure
winged blood collection set with 23 gauge needle
Ideal equipment to use when handling geriatric patients
forearm or hand
site to perform venipuncture in oldies
dealing with children
introduce him to the parents and explain the procedure
Toddlers
talk to the child calmly and maintain eye contact
older children
interactive conversation (ie touching the tourniquet)
teenagers
use adult language
Vertical restraint
method of restraint that involves an upright position on the lap
Horizontal restraint
method of restraint that involves lying down and parent leaning over holding the near arm
3%
maximum of child’s blood volume collected at one time
10%
maximum of child’s blood volume collected at one month
Phototherapy
solution for hyperbilirubinemia
Quantity insufficient for testing
Filter paper is removed before blood has completely filled circle
Appears scratched
blood applied with capillary pipette
Not dry before mailing
Sample mailed before drying a minimum of 3 hours
Appears supersaturated
excess blood applied to filter paper using an alternate device. Blood applied to both sides of filter paper
Appears diluted, discolored, contaminated
Filter paper contaminated with powder, alcohol, formula, water, lotion. Blood spots exposed to direct heat
Exhibits serum rings
alcohol not dry before puncture. Milking the puncture site
appears clotted or layered
several drops used. blood applied to both sides
TRUE
True or False: performing deep arterial puncture in newborns and young children is usually not recommended
Blood smear
needed for microscopic examination of blood cells that is performed for differential blood cell count
Blood smear
made within 1 hour of collection to avoid cell distortion caused by EDTA anticoagulant
syncope
other term for fainting
fainting
Spontaneous loss of consciousness
Apprehensive patients
requires nursing assistance to help calm the patient
Cold compress
applied to the forehead and back of the neck will help to revive the patient
15 - 30 minutes
amount of time needed for a prolonged fasting patient to remain in the area
seizure
restraining the patient to prevent further injury
petechiae
small, non-raised red hemorrhagic spots
petechiae
indication of coagulation disorder
allergies
occasionally allergic to alcohol, iodine, latex, or glue in adhesive bandages
Vomiting
forceful ejection of the contents of the stomach and upper digestive system through the mouth
hemoconcentration
application of tourniquet for more than 1 minute causes ____
damaged veins
veins that contain thrombi
hematoma
indicates that blood has been accumulated in the tissue surrounding a vein during venipuncture
edema
areas containing excess tissue fluid
Burns, scars, and tattoo
have decreased circulation and yields inaccurate results
fistula
patients receiving renal dialysis have a permanent surgical fusion of an artery and vein called what
cannula
temporary external connection between the artery and a vein that contains a special T-tube connector with a diaphragm for drawing blood
needle too deep
technical complication that involves the angle being too steep (greater than 30 degrees)
Needle too shallow
technical complication that involves the angle being too steep (less than 15 degrees)
faulty evacuated tube
technical complication if there is no quality check
Nerve injury
may lead to loss of movement and improper venipuncture technique
Iatrogenic anemia
healthcare induced anemia; condition of blood loss caused by treatment
hemolysis
presence of pink or red plasma/serum
Point-of-care testing
referred to as bedside testing
CLIA 88
encompasses all laboratory testing and requires every testing site to be regulated
Food and Drug Administration (FDA)
has the responsibility for categorizing tests and classifying testing device and systems
Waived complexity
simple procedures that are cleared by the FDA
Certificate of Waiver
this is obtained from CMS to perform waived testing
waived complexity test
pregnancy test, glucose monitoring
Moderate complexity
more difficult to perform and require documentation of training in testing principle, instrument calibration, and QC.
Moderate complexity
chemistry and hematology are assigned in this category of complexity
High complexity
require sophisticated instrumentation and a high degree of interpretation by the testing personnel
High complexity
must have formal education with a degree in laboratory science
High complexity
microbiology, immunology, immunohematology, and cytology belong in this category
provider-performed microscopy procedure
includes clinical microscopy procedures only
provider-performed microscopy procedure
contains certain procedure that can be performed in conjunction with any waived test and includes clinical microscopy procedures
2 years
laboratories performing moderate or high complexity test must be inspected every how many years
FALSE
TRUE OF FALSE: waived laboratories are subjected to routine inspection
30 - 40 degrees
angle when making blood smear
bleeding time
test performed to evaluate platelet performance
blood smear, CBC, bilirubin
order of draw between cbc, bilirubin, blood smear
Cholesterol level; 2. 2-5%; 3. 10-15%
_____ increases ______ to ______ percent when tourniquet is left for 2 minutes and ____ after 5 minutes
edema
this causes the sample to be contaminated with tissue fluid and yield inaccurate results