MA CH.4 ROUTINE BLOOD COLLECTIONS

What does Potassium oxalate/ Sodium fluoride do?

It helps preserve the glucose and prevent glycolysis.

What does heparin do?

Prevents blood clots from causing falsely elevated results, especially in potassium and electrolyte tests.

dermal puncture

A procedure that involves puncturing the finger or heel with a lancet device to obtain a small quantity of blood for testing. Also referred to as skin puncture or a capillary collection.

Antecubital

In front of the elbow (from ante meaning before,and cubitum meaning elbow)

Bevel

sharpened and slanted cut edge of a needle designed to ease in the process of puncturing tissue

Plasma

liquid portion of blood in which blood cells are suspended

ethylenediaminetetraacetic acid

an additive in collection tubes used as an anticoagulant to keep blood specimens from clotting

EDTA

ethylenediaminetetraacetic acid

Serum

straw-colored liquid portion of the blood visible after the specimen has been allowed to clot and after centrifugation

median cubital vein

Vein located near the middle of the antecubital area. First choice for a venipuncture collection.

Cephalic vein

Vein that runs along the lateral side of the antecubital region. The second choice for venipuncture and can result in slight pain for the patient due to the location.

Basilic vein

Vein that runs medially and is located in the upper arm and forearm. Last choice for venipuncture because of proximity to nerves and arteries.

Hemoconcentration

excessive accumulation of blood into an area of the body, usually caused by a tourniquet left on too long or a patient pumping their fist

Lumen

Hollow core of the vein; best place for needle position during venipuncture

Transfix

To puncture through both sides of the vein, resulting in a failed blood collection.

Hemolysis

destruction of red blood cells

iatrogenic anemia

anemia caused by collecting too much blood from a patient by volume in a given amount of time

Hematocrit

Portion of blood that is expressed as a percentage by volume and consists of packaged red blood cells

Hemostasis

stopping of blood flow

venipuncture

refer to blood collection

Dermal puncture

collects blood from capillaries, usually finger or heel using a lancet

What is something that is more important than test accuracy?

The safety of the patient

What additive is in a yellow tube

SPS (Sodium polyanethol sulfonate)

What are blood culture bottles and yellow tubes used for?

Bacterial studies

How long does a specimen in a Rapid serum tube need to clot?

5 minutes

What are two types of blood culture bottles?

Aerobic and anaerobic

When are aerobic tubes used first?

When the blood collection is performed with a butterfly needle

What additive is in a light blue tube?

sodium citrate

What are light blue tubes used for?

coagulation tests

How full must a light blue tube be for a collection?

100%

What additive is in a serum tube?

Some contain no additive and some contain a clot activator

What colors can the stoppers of serum tubes be?

Red, Gold, speckled red and grey, or red and black

When is a Rapid serum tube to be used?

When a STAT blood collection is required

What tests are serum tubes used for?

Chemistry blood collections

What color is the stopper of a Rapid serum tube?

Orange

When a STAT blood collection is required a specimen in a serum tube needs to clot...

30 minutes prior to centrifugation

What additive is in a green tube?

Sodium heparin or lithium heparin

What tests are pink tubes used for?

Blood bank collections

What additive is in a light yellow tube?

Acid Citrate Dextrose

What do Sodium heparin and lithium heparin do?

They are anticoagulants that prevent clotting

What additive is in a lavender or purple tube?

Both contain EDTA

What additive is in a pink tube?

EDTA

What additive is in a grey tube?

sodium fluoride and potassium oxalate

What tests are lavender or purple tubes used for?

Hematology testing

What tests are grey tubes used for?

Glucose and alcohol blood collections

What tests are light yellow tubes used for?

Blood collections for thing such as DNA testing

What additive is in a Royal blue tube?

EDTA, sodium citrate, heparin, or they can be serum tubes

What color tube has sodium citrate?

Light blue

What additive is in a Dark blue tube?

Tube color does not indicate the additive but the tube is as free of element contamination as possible

What tests are conducted with sodium citrate?

Clotting tests

What color tube has EDTA

Lavender or pink

What was sodium citrate the best at?

It is the best at preserving coagulation factors

What tests are conducted with EDTA

Hematology tests

What does EDTA do?

It helps preserve the shape of cells and reduces platelet clumping.

What color tube has heparin

Green

What tests are conducted with heparin?

Chemistry tests

What color tube has Potassium oxalate/ Sodium fluoride

Grey

What tests are conducted with Potassium oxalate/ Sodium fluoride

Sugar testing

What feeling does the patient have when the phlebotomist has all of the supplies collected and ready to go at the beginning of the collection?

They get a feeling of confidence.

Where should you place the equipment when doing a venipuncture?

Within easy reach

Why should you keep all items within easy reach during a venipuncture?

To help you and the patient stay safe

Where is one place you should not set the phlebotomy tray?

The patients overbed table

Why should you not set the phlebotomy tray on the patients overbed table?

Because the patient eats from that space and it may be dirty.

ETS

Evacuated tube system

What are 8 pieces of equipment you will need while performing a venipuncture

Gloves, Isopropyl alcohol swabs or pads, gauze pads, tape or selfadhearing bandages, tourniquet, Needles, hub/adaptor/needle holder, and blood collection tubes

When a tourniquet is not available what can be used?

A blood pressure cuff pumped up to 40 mmhg

Why are cotton balls unacceptable to use?

They leave fibers on the patients collection site and can remove a clot when removed

How long should a venipuncture needle be?

1 to 1.5 inches long

What gauge needle should be used for a routine venipuncture?

21- to 23- gauge

What is the most common needle gauge?

21 gauge

Vacuum tubes have what kind of pressure?

Negative pressure

SST

serum separator tube

PST

plasma separator tube

Who is the syringe method used on?

Patients who have fragile veins that are easily collapsible

Why are ETS systems more likely to cause veins to collapse?

They have a vacuum that collects blood at a rapid, uncontrollable and hard to determine rate

Why is the syringe method better to use for easily collapsible veins?

The plunger on the barrel makes of the syringe allows for the phlebotomist to control the rate blood is withdrawn from the patient manually

What is another term for a winged infusion set?

Butterfly catheter

Why are winged infusion sets sometimes called butterfly catheters?

Because the holders on either side of the device look like wings

When should you check equipment?

Before each procedure

What are some things you should be looking for when you are checking equiptment?

Missing labels. defects, cracks, and breaks

What should you do if you find something wrong with the needle package

discard the needle into the sharps bin

Needle expiration dates

The needle itself can not expire, the date refers to the sterility of the needle

Safety devices

Should be attached firmly to the needle or adapter and cover the needle completely

What could a broken or bent bevel cause?

skin tearing instead of puncturing causing pain for the patient.

When should you inspect the needle?

inspect needle before every blood collection

What are some defects that a bevel may have?

bends, breaks, or burrs

How many times can a needle be used?

Once

What should you do if you withdraw from the vein

Do not reinsert the needle, a new one must be used

What can happen if a tube expires?

The additives in the tube may not work correctly which can alter test results.

What happens to the tubes that are defective?

They must be discarded

What are some observable factors that can affect the blood collection

Tattoos, scarring, hematomas

What should you do if you can't find a vein on one arm

Ask patient for permission to palpate the other arm

Why should you not draw from a limb that has edema

There is possibility that the collection may be altered because of the extra fluid in that area

Where should you collect in the patient has an IV

the other arm or below the IV

Why would you not collect above the IV

could mean that the blood being tested could have iv fluid in it and yield inaccurate results

first choice in vein for venipuncture is

median cubital vein

Where is the median cubital vein found?

surface of the inside of the elbow

Second choice vein

cephalic vein

Where is the cephalic vein located

toward the outside surface of the arm

last choice vein

basilic vein