MDLT 1203: Unit Three

Modules 11-13: Special Phlebotomy Procedures, Quality Essentials, Practicing Professional Behavior

The appropriate functions that the thyroid is responsible for

Metabolism, Growth, Brain Development

To check for diabetes mellitus, you test carbohydrate metabolism through the levels of ___ in the blood

Glucose

As a result of sickle cell disease, RBCs become what shape?

Crescent

Aerobic is

With air

Anaerobic is

Without air

Arterial punctures are used to assess

Blood Gases & pH

The most common angle used to make a blood smear is

30 Degrees

Drawing too little blood for blood cultures will cause what type of result?

False Negative

A blood culture bottle with a specimen collected without oxygen/air is called ___

Anaerobic

Galactosemia results from the body’s inability to metabolize ___

Milk Sugar

Which types of specimen containers are required for blood culture testing?

SPS Tubes & Blood Culture Bottles
(SPS = Sodium Polyanethol Sulfonate)

A diet low in ___ may help minimize the effects of galactosemia

Lactose

Which of the following may result from too little biotin?

Hearing Loss, Vision Loss, & Balance Issues

Phenylalanine can cause damage to ___ tissue if left untreated

Brain

A blood smear is a thin film of blood spread onto a glass slide and is used for ___

Microscopic examination of blood

Which of the following is the reason blood cultures are frequently ordered for patients?

Fever

Which of the following are used for patient identification prior to blood bank collection and transfusion?

Tube Labeling System, Special Identification Wristband, & Hospital Administration Wristband

When reviewing a patient’s lab result the CBC indicated the patient’s RBCs is abnormally high. What condition is the provider considering?

Polycythemia Vera

Babies must be tested after they reach of a minimum age of ___ hour(s) for neonatal screening?

Twenty-Four (24)

Galactosemia

Failure to break down milk sugars

Biotinidase Deficiency 

Deficiency that causes hearing and vision loss

Cystic Fibrosis

Symptoms that include respiratory problems

Hypothyroidism

Cannot make iodine-containing hormones

Phenylketonuria

Failure to break down amino acid, spills into the urine

Sickle Cell Disease

Abnormal structure of hemoglobin molecule

The most important step in blood culture collection is ___

Cleaning the venipuncture site

A differential is performed to count types of white blood cells and note any abnormalities in cell ___

Size, Shape, & Color

Neonatal screening for cystic fibrosis involves collecting blood on a special card called a(n) ___card

Guthrie

What products may be collected form donor blood?

Platelets, Red Blood Cells (RBCs), & Plasma

Thick blood smears are used to look for ___

Malaria parasites

The presence of pathogenic microorganisms in the blood

Septicemia

FUO

Fever of Unknown Origin

ARD

Antibiotic Removal Device

Why would an ARD be needed in a blood culture bottle if the patient is septic? Wouldn’t you want the patient to be on an antibiotic if they had a bacterial infection in their blood?

The ARD is needed to be present in the bottle so that we can see what organism is causing the infection, and the provider can prescribe the correct antibiotic to attack that specific organism.

What color corresponds with each Blood Culture Bottle?

Blue, Purple, Yellow, Red

Blue: Aerobic

Purple: Anaerobic

Yellow: Pediatric

Red: Mycobacterium Bottle

Cleansing process for blood culture collection:

1. Cleanse with 70% isopropyl alcohol

2. Cleanse again with any of the following:
   - 0.5% Chlorhexidine Gluconate
   - 2% Iodine
   - Betadine
   - Benzalkonium Chloride

Why is it important to follow the two-step cleaning process when collecting blood cultures from a patient?

Because we have a normal bacterial (commensal flora) that live on our skin, and if a strict sterile technique is not followed then our natural flora with get into the bottle and cause a false negative (patient is septic). This causes the patient to receive medication for the sepsis that is unneeded and will harm their organs and immune system

What are the two blood collection methods?

Syringe & Butterfly

Which bottle must be collected first in a syringe procedure? Which bottle second?

Anaerobic, Aerobic

Why is an anaerobic bottle collected first in a syringe procedure?

Collecting the anaerobic bottle first will prevent air from entering the specimen

Which bottle must be collected first in a butterfly procedure? Which bottle second?

Aerobic, Anaerobic

Why must you collect the aerobic bottle first in a butterfly procedure?

Collecting the aerobic bottle first will clear the air from the butterfly tubing so air does not enter the anaerobic bottle

How should you label a blood culture set?

• Patient’s Name

• DOB

• MRN

• Date

• Military Time

• Phlebotomist’s Initials/Employee ID

• Set #1 Draw Site

  • 
    

___ is a procedure used to ensure equipment provides accurate results

Calibration

What is the highest level of quality oversight that is managed at the organizational and institutional level?

Total Quality Management

___ is achieving complete correctness or acceptable measures as close as possible to the true value

Accuracy

Random Errors

Errors that occur with no predictable pattern and may have several causes

Levey-Jennings Chart

Graph showing acceptable limits for quality control results

Systematic Errors

Errors that occur due to aging reagents or temperature changes

Shift

Sudden jump in results that continues at a higher or lower level

A control material is ___

Used when doing equipment system checks

What are soft skills?

Personal attributes/behaviors that enhance an individual's interactions, job performance, & career aspects

What are hard skills?

Technical skills that require specific training as well as operating proficiencies within a professional scope of practice

In the butterfly procedure, why do you collect the aerobic bottle before the anaerobic bottle?

So the air found in the butterfly tubing does not interfere with the procedure and test results

What is a random glucose level?

Is a measurement of the patient’s glucose level when they have not been fasting

What is a two-hour postprandial glucose test?

A test taken two hours after a patient has consumed a meal to test their glucose levels

What is an unsafe level to perfume an oral glucose tolerance test (OGTT)?

If the patient’s fasting glucose levels are 126mg/dL or over; if the glucose level exceeds 200mg/dL, then the test must be discontinued.

OGTT

Oral Glucose Tolerance Test

What are the common neonatal screening tests?

• Biotinidase Deficiency

• Cystic Fibrosis

• Galactosemia

• Hypothyroidism

• Phenylketonuria (PKU)

• Sickle Cell Disease

Define Septicemia

A severe, life-threatening infection that results from a rapid increase of bacteria and their toxins in the blood stream

Give the reason for why we use an ARD in blood culture bottles

An ARD will neutralize any antibiotics present in the patient’s blood, which in turn will prevent the bacteria from getting harmed making the sample useless. With an ARD, it makes identifying the bad bacteria easier and allows the provider to administer the correct medication(s)

How many specimens are collected during an oral glucose tolerance test and when are they collected?

This glucose test requires the collection of three blood specimens: Fasting, 1-hour, 2-hour

What is the preferred way to make a thin blood smear?

The Wedge Method

At what angle is used for a thin blood smear?

30 to 35 degrees

What is the purpose of making a thin smear?

To analyze the morphology of individual blood cells.
- Size, Shape, Color

What is the purpose of making a thick blood smear?

To screen the blood for parasites
- Plasmodium, Malaria

Biotinidase Deficiency

Description: Inherited disorder where the body cannot properly use biotin (Vitamin B7), which leads to mental and physical disabilities

• Vision, Mobility, Hearing

Treatment: Daily Vitamin B7 supplements

Cystic Fibrosis

Description: Genetic disorder that causes a overproduction of mucus build up that will clog the organs

• Lungs, Pancreas, Digestive Tract

Treatment: Pancreatic Enzymes, Chest Physiotherapy, Bronchodilators, CFTR Modular Medications

Galactosemia

Description: Metabolic condition where the body cannot break down galactose

Treatment: Diet that consists of neither lactose nor galactose

Hypothyroidism

Description: Congenital underachieve thyroid gland that does not produce enough of the thyroid hormone causing delayed development

• Growth,

Treatment: Daily oral thyroid hormone replacement therapy (Levothyroxine)

Phenylketonuria (PKU)

Description: Metabolic disorder that causes the inability to break down phenylalanine, which can cause a build up of toxic levels in the brain

Treatment: Low phenylalanine diet and specialized medical formula

• Avoid high-protein foods

Sickle Cells Disease

Description: Inherited RBC disorder that causes and abnormal hemoglobin cells shape that will block blood flow

• Crescent/Sickle Shaped

Treatment: Prophylactic penicillin/antibiotics, hydroxyurea, routing vaccinations, pain management

What are the five (5) requirements to become a blood donor?

1. Must be at least 16 years of age

2. Must weigh at least 110 lbs

3. Must be in good health

4. Have eaten in the last four (4) hours

5. Must meet the minimum hemoglobin/hematocrit levels

Define autologous blood donation

This type of blood donation is taken from the patient who will then use their blood for transfusions into themselves

Polycythemia vera and hemochromatosis are conditions that use what type of phlebotomy for treatment?

Therapeutic Phlebotomy

• Thinning of RBC mass or reduction of excess iron

Name the specimen (type and additive) and special transport considerations that are needed for an arterial blood gas to be accepted by the laboratory

Type: WAB

Additive: Heparin (Li liquid/dry)

Special Transport: Immediately deliver to the lab in an airtight, bubble free syringe. If transportation/analysis is delayed, put the sample in an ice-water slurry

WAB

Whole Arterial Blood

Define Cannula

A flexible, hollow tube that is inserted into. body cavity, duct, or blood vessel

Describe the difference between quality assurance (QA) and quality control (QC)

QA: Proactive system that monitors the testing process from start to finish.

• Pre-Analytical, Analytical, Post-Analytical

QC: Reactive process that focuses on the analytical phase

• Testing control materials with patient samples to detect errors or instrument malfunctions

Name the difference between a trend vs. a shift

T: Gradual, progressive deviation of control values in one direction over consecutive days.

• Reagent expiration

S: Abrupt, sudden change in control values where data points will suddenly cluster on one side of the mean.

• New reagent lot, instrument malfunction, recalibration

Name the difference between competency testing and proficiency testing

C: Internal assessments performed by the lab to evaluates the employee’s individual skills, knowledge, ability to perform their job duties

P: External assessment where the lab will receive unknown samples that they will test to verify the labs overall testing accuracy.

Name the difference between validation and a delta check

V: Process performed prior to patient testing to prove and document that instrument, kit, or test system is performing reliably and meets clinical specifications

DC: Compares a patient’s current results to previous results

Credential

Definition: An umbrella term for any certificate, degree, badge, or license that verifies an individual's qualifications, competence, or authority in a specific field

Description: It acts as documented evidence of achievement or expertise. Credentials can be issued by educational institutions, professional organizations, or government bodies (e.g., a Bachelor's degree, a specialized IT certification, or a medical license)

Registration

Definition: The process of listing one's name and qualifications on an official roster or registry maintained by a government agency or professional board

Description: ___ is often a formal administrative requirement to keep track of practitioners. In some fields, it is voluntary to show professional standing, while in others, it is a mandatory step alongside licensure to legally practice

Licensure

Definition: The mandatory process by which a government agency grants time-limited permission to an individual to engage in a regulated profession after verifying they have met specific competency criteria

Description: This is the most restrictive form of professional regulation. It is legally required to practice the profession (e.g., a licensed registered nurse or a licensed attorney) and is designed strictly to protect public health, safety, and welfare by prohibiting unlicensed individuals from practicing