phlebotomy chapter 8 & 9

Prioritized patients for blood draw are?

Stat, timed, and fasting

Timed specimens include what?

2 hr post-prandial (2 hours after meal)

Cardiac enzymes (4-8 hours after admission)

Trough and peak (therapeutic drug levels should be drawn at the correct times

What are the reasons for specimen rejection?

Unlabeled, discrepancies between the requisition and tubes, hemolyzed specimens, clotted specimens, and not enough

Name the correct tubes for the order of draw:

Blood cultures

Red(glass)

Light blue

Red(plastic)

STT (red/gray, gold)

Green

Light green

Lavender, pink

Gray

What blood draw is collected first?

Blood cultures

What should you do whenever a coag test is ordered and is the only test?

Use a discard tube first.

What veins are more susceptible to infection and the formation of thrombi (clots) in patients with diabetes, cardiac, and coag disorders?

Leg veins

Never stick a diabetic where?

In the foot

Specimen labels should include what?

Patients first and last name, patients identification number (inpatient, date of birth (outpatient), date and time of collections, and phlebotomist’s initials

Failure to remove the tourniquet prior to removing the needle can cause what?

Hematoma

Never stick a vein that cannot be?

Felt

Why should the tourniquet not be left on for more than a minute?

Be uncomfortable, cause hemoconcentration, and petechiae

Unacceptable or acceptable?

A vein in the left hand; there is an IV in the left antecubital area

Acceptable

Unacceptable or acceptable?

A vein under scar tissue

Unacceptable

Unacceptable or acceptable?

A vein that you cannot feel

Unacceptable

Unacceptable or acceptable?

A vein in the left antecubital area; the patient’s armband does not match your requisition

Unacceptable

Unacceptable or acceptable?

A vein in the right antecubital area; an IV is in the right hand

Unacceptable

Unacceptable or acceptable?

A vein in the right arm of a woman who has had a right mastectomy

Unacceptable

Unacceptable or acceptable?

A vein on the back of the hand

Acceptable

Unacceptable or acceptable?

A foot vein of a diabetic

Unacceptable

Unacceptable or acceptable?

A vein that feels hard or cord like?

Unacceptable

Unacceptable or acceptable?

A vein you cannot see

Acceptable

Blood cultures should be collected in tubes containing the anticoagulant:

A. EDTA

B. Sodium citrate

C. ACD

D. SPS

SPS

How does heparin prevent blood from clotting?

A. Binds calcium

B. Inactivates thrombin

C. Binds sodium

D. Inactivates sodium

Inactivates thrombin

What is the anticoagulant found in the green top tubes?

A. Heparin

B. EDTA

C. Sodium citrate

D. Thrombin

Heparin

Black top tubes are used to preform what?

A. SED rates

B. Glucose analysis

C. CBC’s

D. Lipid profiles

SED rates

Centrifugation of blue top tubes will yield what two things?

Plasma and cells

A CBC is drawn in a tube containing the anticoagulant?

A. Sodium citrate

B. EDTA

C. Heparin

D. Oxalates

EDTA

Purple top tubes contain?

A. Heparin

B. Sodium citrate

C. Oxalates

D. EDTA

EDTA

What anticoagulant is found in gray top tubes?

A. Oxalates

B. EDTA

C. Heparin

D. Sodium citrate

Oxalates

The ratio of blood to anticoagulant in a black top tubes should be _ to one

A. 4

B. 6

C. 8

D. 9

4

Which of the following tests is routinely preformed on royal blue top tubes?

Trace metals

A blood collection tray is a way to?

Organize and transport equipment to a patients room

A mobile phlebotomy workstation consists of?

Trays, computers, band scanners, printers, waste containers, sharps containers, and storage drawers and shelves

Your duties in regards to maintenance on the drawing stations are?

Cleaning, disinfecting, and restocking the stations

What method is used most frequently for venipuncture?

ETS

ETS consists of what?

Double-pointed needles with one point to pierce the vein and the other to pierce the collection tube stopper

What equipment is needed when collected blood?

Evacuated blood collection tubes, tube holders, multisample needles, syringes with safety hypodermic needles, winged collection set, blood transfer devices, tourniquets, alcohol pads, gauze, bandages, gloves, microcollection equipment, and sharps container

Venipuncture needles include what 3 needles?

Multisample, hypodermic, and butterflies

for routine venipuncture, what gauge and length for the needles are used most commonly?

22-23 gauge and 1-1.5in length needles

How do you determine the type and gauge of needle to use?

Size and condition of the vein, amount of blood required, and blood collection system being used

Needle size varies by what two things?

Length and gauge

For multisample and hypodermic needles, what lengths are used?

1-1.5in

For butterflies, what needle length is used?

0.5-0.75in

What inch needle gives better control?

1

Needle gauge refers to what?

The diameter of the needle lumen

Needle diameters go from what?

16 gauge to 25 gauge

True or false:

Small the gauge number, the bigger the diameter of the needle

True

What gauge needle is used for most antecubital venipunctures?

21

What are the two most common errors when using the ETS?

Pulling the needle out and pushing the needle through the vein

16-18 gauge needles are used for what?

Collecting units of blood

21-25 gauge needles are used for what?

Children, elderly, and patients with small veins

All needles consist of what four things?

Bevel, shaft, lumen, hub

What color are 22 gauge needles?

Black

What color are 21 gauge needles?

Green

The bevel should always be?

Up

What is the advantage to using ETS?

Collects blood directly into tube, eliminates the need to transfer and minimize risks of biohazard exposure

What does ETS stand for?

Evacuated tube system

What needle used with ETS are threaded in the middle and have a bevel at each end?

Multisample

Where should you dispose of needles?

In approved sharps containers

What is the advantage of using the syringe system?

Allows control of suction on vein

Syringes consist of what two things?

Barrel and plunger

Points to remember about syringes are?

Don’t accidentally withdraw the needle while pulling back on the plunger and do not pull so hard that you cause hemolysis or collapse the vein

Blood will appear where when a vein is successfully entered?

The hub

What needle system can attach to holders, syringes, or an IV

Butterflies

What is the advantage to using butterflies?

Can use wings to guide the needle into the vein and lower insertion angle.

What needle is used on fragile veins? (Children and elderly)

Butterflies

When using a syringe, what should you not do when pulling back on the plunger?

Withdraw the needle

When using a syringe, do not pull so hard that you cause what?

Hemolysis or collapsed vein

Choose a syringe over the vacutainer system for what three things?

Babies, elderly, and veins that collapse easily

Hemolysis can be caused by

Forcing the blood into the tube

When selecting the appropriate size tube, you should consider what?

Amount of blood needed, age of patient, and size and condition of patient’s vein

The adapter is a special plastic what?

Holder

The amount of blood collected is determined by what two things?

Size of tube and amount of vacuum present

Tubes are labeled with what three things?

Type of anticoagulant/additive, the draw volume, and the expiration date

Tubes can be what two things?

Glass or plastic

What material is used most for tubes?

Plastic

What does the silicon-coat in tubes prevent?

Cells from adhering to the tube

Tests may be ran on what three things?

Plasma, serum, whole blood

Tests may require the presence of what four things?

Preservatives, inhibitors, clot activators, or barrier gels

Tests requiring what two specimens are collected in tubes containing an anticoagulant to prevent clotting of the specimen?

Whole blood or plasma

What are the three most common anticoagulants that work by binding calcium?

EDTA, citrates, Oxalates

What anticoagulant prevents clotting by inhibiting thrombin, which is necessary to convert fibrinogen to fibrin in the coagulation process?

Heparin

What two substances can anticoagulants be?

Powder or liquid

What should happen to the powder at the bottom of the tube before drawing blood?

Tapped

SSTs have what gel in the bottom of the tube that will act as a barrier between rbc’s and the serum after centrifugation?

Thixotropic

SSTs are used most often in?

Chemistry

SSTs cannot be used in what because of the gel?

Blood banks or therapeutic drug levels

Preservatives extend what

Metabolism and lifespan of the rbc’s

EDTA is in what colored tubes?

Lavender, pink, and white

What anticoagulant is used in hematology for blood cell counts?

EDTA

EDTA maintains, inhibits, and doesn’t interfere with what?

Maintains cellular integrity, inhibits platelet clumping, and doesn’t interfere with routine staining procedures

List the anticoagulant/additive, sample types, and laboratory use, and how many times to invert of the lavender topper.

EDTA, whole blood/plasma, hematology, 8

List the anticoagulant/additive, sample types, and laboratory use, and how many times to invert of the pink topper.

EDTA, whole blood/plasma, blood bank, 8

List the anticoagulant/additive, sample types, and laboratory use, and how many times to invert of the white topper also called PPTs.

EDTA and gel, plasma, molecular diagnostic, 8

Sodium citrate is in what colored tubes?

Light blue or blue

What anticoagulant is used in coagulation testing (pt/ptt)?

Sodium citrate

Sodium citrate preserves the what?

Liable biologically or chemically unstable coag factors

The ratio of blood to liquid sodium citrate in light blue tubes is what?

9 to 1

When drawing coag tests of patients with polycythemia or hematocrit readings over 55%, what should happen to the anticoagulant?

Should be decreased, in order to prevent diluting the plasma