Phlebs Ch. 6

Phlebotomy Equipment

Metric System Unit Prefixes

Mega ( M ) = x1,000,000

Kilo (k) = x1,000

Hecto (h) = x100

Deca ( da ) = x10

• Can also be Deka ( dk ) - Both spellings are correct

[Basic Unit]

Deci ( d ) = 1/10

Centi ( c ) = 1/100

Milli ( m ) = 1/1,000

1kg is equal to...

2.205 lb is equal to...

1lb is equal to...

0.454kg is equal to...

The normal range of human body temperature in °C is…

35.8°C - 37.6°C is the normal range of…

98.6°F (normal human body temp.) is equal to…

37°C is equal to…

What do you see in the needle hub when the needle enters a vein?

A “flash” of blood is seen in the needle hub when…

The volume of syringes ranges from...

1-60mL is the volume range of...

The technique of pulling back the plunger and then pushing it closed again before using the syringe to make it smoother when drawing from the patient is called...

Breathing the syringe refers to...

These gauges of needles are used for venipuncture of adult patients...

20, 21, and 22-gauge needles are used for venipuncture of what patients?

This gauge of needle is used for small veins and pediatric patients...

22-gauge needles are used for...

Butterfly collection sets use this gauge of needle...

23-gauge needles are used in with...

• 22 may also be used

25-gauge needles are used for...

This gauge of needle is used for intramuscular injections...

27-gauge needles are used for...

This gauge of needle is used for administration of a purified protein derivative (PPD) tuberculosis skin test...

• This type of injection is subcutaneous (dermal? according to April)

18 and 16-gauge needles are used for...

This gauge of needle is used for the IV infusion of fluids or blood products/transfusions/donations

The metric basic unit of weight is...

The Kilogram is the…

The insertion angle range for evacuated system (double pointed) needles is...

A 15 to 30 degree angle to the skin is the range for...

The bevel of the needle is...

The angled tip of the needle is called...

The bevel of the needle should always be facing this way when inserting a needle...

This should always be facing upwards when inserting a needle...

Removing the tube before pulling the needle from the patient will reduce the chance of...

The chance for blood spatter from the tip of the needle upon removal from a patient can be reduced by...

To reduce the likelihood of blood splattering, the correct order for removing an evacuated tube system needle from a patient is...

1. Tourniquet

2. Tube

3. Needle

What is the purpose of following this order of steps?

Hemolyzed blood can be caused by...

Leaving a tourniquet on the patient for too long (over 1 minute,) and other negligent actions can cause this to happen to the sample...

What should you do if the tourniquet has been on a patient for a minute, but you still need to collect more samples?

The tourniquet should be removed immediately, blood will continue to flow and you can still collect samples

A patient can be infected by a contaminated tube because...

Blood can backflow from a contaminated tube into a patient causing...

If a droplet of blood appears around a needle after it is inserted into the patient, this is a sign that...

A sign that the needle has been inserted improperly and may cause squirting of blood is...

The primary material used for tubes in healthcare today is...

Plastic is the primary material used for...

Additives inside a tube are not not anticoagulants or preservatives, but instead...

Substances inside of a tube that are used to improve sample quality or accelerate sample processing are called...

Why do most tubes have a silicon coating inside?

This material coating the inside of tubes fills the microscopically rough surface (cracks and crevices) inside the tube to prevent cells from adhering to the surface of the tube and reduces the likelihood of hemolysis. It can also make it easier to draw blood due to reduced friction.

Thixotropic separator gel separates...

This gel separates cells from serum or plasma during centrifugation by temporarily changing in viscosity and having a density between the liquid and formed portions of the blood...

Viscosity means...

The degree of thickness or resistance to flow of a substance (during centrifugation) is called...

The Butterfly Collection System is also known as...

The Winged Infusion Set is also known as...

The Butterfly Collection system is for...

This collection system is used for patients with very small or difficult to puncture veins because it provides more control over the needle and extracts the blood more slowly, with less strong of a vacuum

Hemostasis is the coagulation process causing formation of the blood clot when injury occurs, when the injury is repaired, this final process happens to the clot...

When the injury is repaired, lysing of the blood clot occurs to dissolve the clot back into the surrounding tissue, this is the final part of...

Vasoconstriction means...

The tightening of blood vessels to limit bleeding is called...

Bleeding time tests were inaccurate due to being highly technique-dependent and thus replaced by...

Platelet Function Test replaced this test due to its innacuracy...

The platelet plug (Platelet Adhesion) formed by platelets clumping together (Platelet Aggregation) in this stage is all that is needed for small injuries...

Primary Hemostasis forms this, which is all that is needed to stop small injuries from bleeding...

The process of breaking down fibrin into small fragments occuring when an injury is repaired, at the end of the clotting process...

Fibrinolysis is the process of breaking down fibrin into small fragments to allow the fibrin clot to disintegrate, and takes place when...

Anticoagulants are used to keep blood from clotting in order to obtain...

To obtain whole blood or plasma for testing, these are included in t...

Anticoagulants work by...

These work by removing/binding the calcium or stopping the reaction converting prothrombin to thrombin

• Or Fibrinogen to Fibrin (per web search)

Tourniquets should be applied flat around the arm and not be left tied on a patient for longer than...

One minute is the maximum duration that...

Tourniquets must be this many inches long...

15-18” is the length which these should be...

The tourniquet should be applied this far above the venipuncture site...

3-4” above the venipuncture site is where...

In order to facilitate quick removal, the tourniquet must...

The tourniquet must be died with a loop on the bottom, and a strip on the top that serves this purpose...

Palpating should be done with...

A sensitive finger on the non-dominant hand should be used for...

The index finger is recommended for palpating; The thumb should not be used because...

The thumb has a pulse and is less sensitive, therefore it should not be used for...

Hemoconcentration can occur if...

This can occur if the tourniquet is left on for longer than 60s

Hemoconcentration increases the concentration of blood within the tissues and causes inaccurate results due to increased levels of...

Potassium will be increased and affect results if this occurs...

Causes of Hemolysis

• Forcing blood out

• Using a needle with too small of a bore

  • Results in a large vacuum force on the blood, causing stress on RBCs

• Shaking the tubes (inversion must be gentle 180 deg. flips)

• Over-Centrifugation or miscalibrated, misconfigured, unbalanced centrifuge

• Incorrect ratio of blood and additives (Underfilled or Overfilled Tubes)

• Not allowing sterilizing wipes to dry on the patient’s skin before venipuncture

  • Allow at least 30s for the alcohol to dry

• Prolonged tourniquet time

  • Interstitial fluid leaks into the tissues (Hemoconcentration) and causes Hemolysis

• Excessive probing of the vein

• Incorrect order of draw

Microcollection Order of Draw (Expanded in Ch. 7)

1. Blood Gases

2. Lavender Microcollection Tube

3. Light Green (Li Hep) Microcollection Tube

4. All other tubes with additives

5. Red Microcollection Tube

Consequences of Hemolysis

• When RBCs rupture, they spill their contents (mostly Hgb) into the serum or plasma, causing it to turn red.

• RBCs contain 23x as much K⁺ as the liquid portion of blood; Hemolyzed specimens will have a large spike in K⁺

• K⁺, Bilirubin, Zinc, Magnesium, Albumin, Acid Phosphate, ALT, AST, Total Proteins, Calcium, Lactate Dehydrogenase and Coagulation Tests may all be elevated

• Haptoglobin, Bilirubin, and Troponin may all be decreased

Blood Culture Notes

• STRICT aseptic cleansing procedure required

  • Chlorhexidine Gluconate used to sterilize the site

  • 70% IPA used to sterilize the top of the bottle

• Per NHA, Aerobic is always drawn first

  • In field: Butterfly sets draw Aerobic first

  • In field: Syringe draws Anaerobic first???

  • Per Tina: Must draw from different sites?

Coagulation Tube Notes (Light Blue Tubes)

• PT/INR and PTT must be full draw or the sample will be rejected

• PT/INR tubes are stable for 24h post-draw

• aPTT and PTT are stable for 4h post-draw

• Heparin monitoring specimens are stable for 1h post-draw

• D-Dimer - measures a protein fragment released when a blood clot dissolves

  • Used to rule out active blood clotting disorders such as

    • Deep Vein Thrombosis (DVT)

    • Pulmonary Embolism (PE) - DVT that traveled to the lung

Microcollections

• Lancet used to puncture capillaries in the finger or heel

  • Fingers are used for adults

  • Heel used for infants

• Microcollection tubes used for collecting the sample

• Glucose monitors are not adequate for microcollection

• First drop of blood contaminated by lymph fluid and must be wiped away

• Must allow gravity to drip the blood into the container

  • Forcing the blood out will cause hemolysis

This tube is known as the coagulation tube

Light blue tubes are known as...

This test is used for testing primary hemostasis...

Platelet Function Test (PFT)

What is formed around the platelet plug during Secondary Hemostasis?

During this stage, an insoluble fibrin mesh is formed around the platelet plug

How many coagulation factors (protein enzymes) are involved in the coagulation cascade?

17 protein enzymes are known as and involved in what?

The six steps of the coagulation cascade are...

1. Platelet Aggregation

2. Factor Activation

3. Calcium Utilized

4. Prothrombin converted to Thrombin

5. Fibrinogen converted to Fibrin

6. Clot formed

Purified Protein Derivative (PPD) Tests are used for...

This subcutaneous test is performed to test for tuberculosis

1in is equal to...

2.54cm is equal to...

1ft is equal to...

30.48cm is equal to...

1yd is equal to...

Roughly 0.9m or 91.44cm is equal to...

1cm is equal to...

.39” is equal to...

1oz is equal to...

29.57mL is equal to...

1pt is equal to...

.47L is equal to...

1qt is equal to...

.95L is equal to...

1gal is equal to...

3.78L is equal to...

100°C is equal to...

212°F is equal to...

The formula to convert °F to °C is...

(_x°F-32) * (5/9)

• Can also do (_x°F-32) / 1.8

The formula to convert °C to °F is...

(_x°C*(9/5)) + 32

• 9/5 = 1.8

1L is equal to...

1.06qt is equal to...

5mL is equal to...

1tsp is equal to...

1mL is equal to...

.03oz is equal to...

The recommended length of needle for a syringe blood draw in order to not go too deep when inserted at the correct angle is...

1” - 1.5” is the recommended length for this...

The most common needle gauge for venipuncture because too small of a needle may cause hemolysis or damage to RBCs is...

21 is the most common needle gauge for venipuncture because...

A phlebotomist is limited to this many attempts for venipuncture...

Two attempts is the limit for...

This contains aerosols when the cap is removed from a tube and prevents leaking during transportation...

The purpose of Hemogard stoppers is...

The correct insertion angle for the butterfly collection system is approximately...

Approximately 5 degrees is the correct insertion angle for...

The butterfly system has a longer draw time, but veins will not collapse as easily because...

There is less of a vacuum when drawing with...

The intrinsic factor pathway which takes place in the blood is activated by...

Collagen and platelets activate this slower coagulation pathway...

The extrinsic pathway, initiated by external trauma, is activated by...

Tissues and vessels activate this faster coagulation pathway...

The aPTT (Activated Partial Thromboplastin Time) test measures...

The intrinsic pathway’s factors (specifically XII) are measured by this test...

The PT (Prothrombin Time) and INR (International Normalized Ratio) tests measure...

The extrinsic pathway’s factors (specifically VII) are measured by these tests...

In addition to the formation of a Platelet Plug & Platelet Adhesion, this also occurs during Primary Hemostasis...

Damaged blood vessels constrict (Vasoconstriction) to limit blood flow to an injury during...

Potassium Oxalate and Sodium Fluoride are in which tube?

Grey tubes contain these anticoagulants...

Light Blue tubes contain this anticoagulant...

Sodium Citrate is the additive in this tube...

Ethylenediaminetetraacetic Acid (EDTA) may be in which 5 tubes?

Lavender, White, Pink¹, Royal Blue², and Tan³ tubes may contain this anticoagulant...

1. Potassium EDTA

2. Disodium EDTA

3. Dipotassium EDTA

Green tubes may contain one of which two anticoagulants?

These tubes may contain Lithium Heparin or Sodium Heparin...

The main function of SPS tubes is to allow...

Tubes with this additive allow bacteria to grow for culture...

A mixture of citric acid, trisodium citrate, and dextrose is included in which tube...

(Dark) Yellow tubes, labeled Solution A or B, have a mixture of these three additives...

Yellow tubes that do not contain this are used for blood culture samples...

Yellow tubes that do not contain citrate are used for...

In addition to EDTA, white tubes contain...

Gel to separate plasma from cells, along with EDTA is contained in this tube...

This tube comes in three varieties:

• No anticoagulant for clot samples

• Sodium Heparin -or- Disodium EDTA

Royal Blue tubes come in three varieties containing these anticoagulants...

Tourniquets should be made of this material, and function by...

Must be made of non-latex material, constricts blood flow in the arm to make veins more prominent

The Neonatal Screening is required by the US and many other countries, components tested vary by state, but the main purpose is to screen for...

The main purpose of this screening performed with drops of blood on filter paper is to screen for metabolic disorders...

The phlebotomist can be prepared for whatever procedure needs to be performed by...

Taking a sample collection tray or cart to the patient’s room allows the phlebotomist to...

• Carts are usually preferred over trays

The metric prefix for x1,000,000 is...

Mega (M) is the metric prefix for...

• Capital M

The metric prefix for x100 is...

Hecto (h) is the metric prefix for...

The metric prefix for 1/1,000,000 is...

Micro (μ) is the metric prefix for...

The metric prefix for x10 is...

Deca (da or dk) is the metric prefix for...