ucla phleb session 3

What are the advantages of using the evacuated tube method or straight method? (3 reasons)

Double sided, can collect more than one tube, and faster

What does a double sided needle mean?

One side punctures the vein, the other side punctures the tube

What is the common gauge of the evacuated tube method or straight method?

21G

How many times must tubes be inverted and at what degree?

8-10 times at 180 degrees

• ensures additives are properly mixed and to prevent clotting

How can you tell that you are in the vein when using the winged infusion set or butterfly method?

Flash

• small amount of blood appears in tubing

What is a disadvantage of using the winged infusion set or butterfly method? (3 reasons)

Needlestick injuries, more expensive, slower

What population commonly requires the winged infusion set or butterfly method?

Pediatric and geriatric patients

What is the common gauge for the winged infusion set or butterfly method?

23G

What type of needle does the syringe method use?

Hypodermic needle

What is an advantage of the syringe method? (1 reason)

Controlled vacuum

What population commonly requires the syringe method?

Geriatric or patients who have fragile and weak veins that tend to collapse

What is the common gauge for the syringe method?

21G

What is the process of blood collection and transfer for the syringe method? (3 steps)

Blood enters the graduated barrel → Blood vacuumed by plunger → Blood transfer device transfer blood into tube from syringe

What antiseptic is used to clean the site before a routine venipuncture?

70% isopropyl alcohol

How are antiseptics applied to clean the site?

Scrub up and down and allow to air dry for 30 sec

What is the difference between a hub and a blood transfer device?

Blood transfer device already has a permanent needle and rubber sleeve

What area should be tried before the basilic vein and at what degree should the needle be inserted?

Dorsal hand at 10 degrees

What is the purpose of preservatives?

Slows down metabolic activity of cells and makes sample last longer

What is plasma?

Cell-free liquid part of blood that has been treated with anticoagulant

What makes up the buffy coat?

WBCs and platelets, makes up <1%

Name the portions of this plasma tube from top to bottom.

Plasma → Buffy coat → RBCs

What is serum?

Liquid part of blood after coagulation

Name the portions of this serum tube from top to bottom.

Serum → Clot

Name the portions of this serum tube from top to bottom.

Serum → Gel → Clot

What does supernatant mean?

Liquid

The supernate of a lavender top tube is what?

Plasma

The order of draw is determined by which organization?

CLSI

What is the order of draw?

Blood cultures (aerobic first) → Light blue → Serum (red, gold, tiger) → Light green → Dark green → Lavender → Gray

What department do blood cultures bottles go to?

Microbiology

Besides 2 bottles, what is another option for blood culture bottles?

SPS; sodium polyanethol sulfanate yellow tubes

What method should be used for blood culture bottles?

Butterfly method

What antiseptic is used for a blood culture sample?

Chlorhexidene (Chloraprep)

How many mL is required for each blood culture bottle?

10mL each

What anticoagulant is in the light blue tube?

Sodium citrate

What department does the light blue tube go to?

Coagulation

What tests are commonly requested for light blue tubes?

PT (prothrombin time), aPTT (activated partial thromboplastin time)

The blood to additive ratio of 9:1 is required for specimen collected in what tube?

Light blue

How many times must the light blue tube be inverted?

3-4 times

Which tube is the discard tube?

Red top

Is a discard tube needed?

No

Is a discard tube needed?

Yes

Is a discard tube needed?

No

Which tubes are SST (serum separator tube)?

Gold and Tiger

Which tubes are PST (plasma separator tube)?

Light and Dark Green

Which department do the green tubes go to?

Chemistry

What anticoagulant is in the light green tube and what does it test for?

Lithium heparin. Tests for sodium level/electrolytes

What anticoagulant is in the dark green tube and what does it test for?

Sodium heparin. Tests for lithium level/Vitamin B1

What anticoagulant is in the lavender tube?

EDTA

Which tube preserves blood cell morphology and platelet aggregation/clotting?

Lavender

What department does the lavender tube go to?

Hematology

What 3 commonly requested tests are ordered for lavender tube?

CBC (complete blood count), WSR (Westergren Sedimentation Rate), ESR (Erythrocyte Sedimentation Rate)

Which tube should NOT be centrifuged?

Lavender

What anticoagulant is in the gray tube and what is its mode of action?

Potassium oxalate; binds to Calcium

What preservative is in the gray tube and what is its mode of action?

Sodium fluoride; inhibits glycolytic activity

What antiseptic is used to clean site for gray tube sample collection?

Povidone iodine

Which tests are performed for the gray tube and what department do they go to?

Glucose testing goes to Chemistry, EtOH goes to Toxicology

Why do we need to draw blood? (2 reasons)

Information about bodily functions, Blood analysis of information received

What should a blood draw always begin with?

Requisition

What does LIS stand for?

Laboratory Information System

What is the most important task does the phlebotomist perform?

Identification of patient

According to the Joint Commission, the patient must be identified using at least __ identifiers?

2

If the patient is unconscious how should you verify ID?

Verify ID with nurse/relative/physician

What form of identification do patients in the emergency department have?

Temporary ID bands

What should be done if the patient is out of the room?

Document and inform the nurse