PHLEBOTOMY NATIONAL EXAM (NHA)

Characteristics imperative to a phlebotomist

Dependability, honesty, integrity, empathy and compassion, professional appearance, interpersonal skills

Circulatory system function

deliver oxygen, nutrients, hormones, & enzymes to cells and transport cellular waste (CO2) to organs where they can be expelled

The two circulations

Pulmonary & Systemic

Pulmonary circulation

carries deoxygenated blood from the right ventricle to the lungs and returns oxygenated blood from lungs to left atrium

Where does oxygenation take place in the lungs?

alveoli

Systemic circulation

carries oxygenated blood from left ventricle throughout the body

Upper chambers of the heart

right and left atria

lower chambers of the heart

right and left ventricle

tricuspid valve

atrioventricular valve, situated between right atrium and right ventricle
**to remember this valve is on the right side of the heart-- people TRY to be RIGHT

pulmonic valve

semi-lunar valve situated between the right ventricle and the pulmonary artery

Mitral valve (or bicuspid)

atrioventricular valve located between the left atrium and left ventricle

aortic valve

semi lunar valve situated between the left ventricle and aorta

Flow of blood through the heart

Superior and Inferior Vena Cavae< Right atrium< tricuspid valve< right ventricle< pulmonic valve< pulmonary artery< lungs< pulmonary vein< left atrium< mitral (bicuspid) valve< left ventricle< aorta< rest of body

Three layers of the heart

Endocardium, myocardium, epicardium

Blood vessels

arteries, arterioles, capillaries, venules, veins, superior & inferior vena cavae

aorta, arteries, and arterioles carry_____ blood _______ the heart

oxygenated & away from

venules, veins, and superior and inferior vena cave carry _____ blood ________ the heart

deoxygenated & back to

The average adult has ______ liters of blood

5-6

Plasma comprises how much of circulating blood?

55%

Plasma contains....

proteins, amino acids, gases, electrolytes, sugars, hormones, minerals, vitamins, and water

What percent of plasma is water?

92%

Formed elements comprise what percent of circulating blood?

45%

another name for red blood cells...

Erythrocytes

What makes up the formed elements?

Red blood cells, White blood cells, and platelets

Another name for white blood cells...

leukocytes

another name for platelets...

thrombocytes

What comprises 99% of the formed elements?

red blood cells (erythrocytes)

Where do blood cells originate?

stem cells in bone marrow

How many RBCs are in a microliter of blood?

4.2 to 6.2 million

Normal life span of an RBS is...

120 days

Function of a leukocyte

provide the body protection against infection

Amount of WBCs per microliter of blood

5,000-10,000

leukocytosis

increase in WBCs

leukocytosis is seen when?

cases of infection and leukemia

leukopenia

decrease in WBCs

leukopenia is seen when?

viral infections or chemotherapy

Five types of WBCs

neutrophils, lymphocytes, monocytes, eosinophils, basophils

Average number of platelets per microliter of blood

140,000-440,000

Hemostasis

process by which blood vessels are repaired after injury

Stage 1 of Hemostasis

Vascular phase

Vascular phase

blood vessel constricts slowing blood flow

Stage 2 of Hemostasis

platelet phase

Platelet phase

platelets adhere to inner lining of vessel to form a platelet plug

Stage 3 of Hemostasis

Coagulation phase

Coagulation phase

converts platelet plug to a stable fibrin clot

Stage 4 of Hemostasis

Fibrinolysis

Fibrinolysis

breakdown and removal of the clot

Preferred site for venipuncture

antecubital fossa

Three major veins located in antecubital fossa

Median cubital vein, cephalic vein, basilic vein

The vein of choice because it is large and doesn't tend to move

Median cubital vein

What vein would you use in an obese patient when the median cubital vein cannot be found?

cephalic vein

What side of the arm is the cephalic vein located?

thumb side

What side of the arm is the basilic vein located?

inner side

unsuitable veins for venipuncture...

sclerosed, thrombotic, and tortuous veins

sclerosed veins

hard and cordlike

tortuous veins

winding/crooked. susceptible to infection

Do you draw above or below an IV?

below

How long should the IV be shut off before you can perform a venipuncture?

2 minutes

Is a phlebotomist allowed to shut off/turn on and IV?

NOOOO

Complications associated with phlebotomy

Hematoma, hemoconcentration, phlebitis, petechiae, thrombus, thrombophlebitis, septicemia, trauma

Most common complication of phlebotomy procedure

hematoma

What is a hematoma?

blood accumulated in the tissue surrounding a vein

two most common causes of a hematoma...

1. needle going through the vein
2. failure to apply enough pressure on site after need removal

What is hemoconcentration?

INCREASE in proportion of formed elements to plasma

What is the cause of hemoconcentration?

tourniquet being left on too long

What is petechiae?

tine NON-RAISED red spots that appear on skin due to ruptured capillaries

What is the cause of petechiae?

prolonged use of tourniquet

What is a thrombus?

blood clot

What is thrombophlebitis?

inflammation of a vein with formation of a clot

septicemia is...

systemic infection associated with the presence of pathogenic organisms

Trauma in reference to venipuncture is...

an injury to an underlying tissue cause by probing of the needle

Factors to consider prior to performing venipuncture

fasting, edema, and a fistula

Quality assurance is...

a program that guarantees quality patient care by tracking the outcomes through scheduled audits in which areas of the hospital look at the appropriateness, applicability, and timeliness of patient care

Where should the tourniquet be applied?

3-4 inches above site

What motion do you use when cleansing the site?

circular

Which way does the bevel face?

UPWARD

What angle should the needle be inserted at?

15-30 degrees

How long are you allowed to leave the tourniquet on?

one minute

What might happen if you leave the tourniquet on for more than one minute?

hemoconcentration, petechiae, and a thrombus

What should be written on the collected specimen labels?

patients name and ID number, the time and date, and YOUR initials

Should you label the tubes before or after you dismiss the patient?

BEFORE!

Basal state

fasted and refrained from strenuous exercise for 12 hours prior to draw

Two-Hour Postprandial Test

used to evaluate diabetes mellitus. Fasting glucose level is compared with the levels 2 hours after eating a full meal

Oral Glucose Tolerance Test (OGTT)

used to diagnose diabetes mellitus and evaluate patients with frequent low blood sugar

hyperglycemia is...

abnormally high blood sugar level

hypoglycemia is...

abnormally low blood sugar level

Therapeutic Drug Monitoring

used to monitor blood levels of certain medication to ensure patient safety & maintain a plasma level

Blood Cultures (BC)

ordered to detect presence of microorganisms in blood

FUO means...

fever of unknown origin

PKU

ordered for infants to detect phenylketonuria

Cold Agglutinins are...

antibodies produced in response to infection

Cold Agglutinins should be kept warm or cold?

warm

What color tube is blood for cold agglutinins collected in?

red-topped

Tests that require chilled specimens...

arterial blood gases, ammonia, lactic acid, pyruvate, ACTH, gastrin, and parathyroid hormone

exposure to light could alter the test results for...

bilirubin, beta-carotene, Vitamins A & B6, and porphyrins

Where would you perform a dermal puncture on an infant?

heel

What area of the foot are recommended for dermal puncture?

medial and lateral areas of the plantar surface of the foot

How deep are you allowed to puncture an infants heel?

2.0 mm

order of draw for CAPILLARY specimens

Lavender, tubes with other additives, tubes without additives

ORDER OF DRAW

blood culture tubes, light blue, tiger top/red, green, lavender, gray