PMLS 2 Lecture P2

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

1. 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