phlebotomy final exam

order of the draw

yellow, light blue, red, green, lavender, and grey

additives found in yellow top tubes

SPS (sodium polyanethol sulfonate), or acid citrate dextrose

additives found in light blue top tubes

SODIUM CITRATE

additives found in red top tubes

NONE

additive found in green top tubes

SODIUM HEPARIN, LITHIUM HEPARIN, AND AMMONIUM HEPARIN

additive found in lavender top tubes

EDTA

additive found in grey top tubes

SODIUM FLUORIDE / POTASSIUM OXALATE / HEPARIN

additive found in royal blue top tubes

NONE / SODIUM HEPARIN / EDTA

deliver lavender top tubes to this department

HEMATOLOGY

deliver grey top tubes to this department

CHEMISTRY

deliver gold top tubes to this department

CHEMISTRY

deliver yellow top tubes to this department

MICROBIOLOGY

deliver CBG test to this department

CHEMISTRY

filling tubes in the wrong order can result in

CONTAMINATION OF A SPECIMEN DUE TO ADDITIVE CARRYOVER

standard needle gauge for venipuncture

21g

coagulation dept runs these tests

PT / APTT / PTT

time needed for blood clotting in a tube containing no additive

30 - 60 mins

veins are anchored in order to

prevent the vein from rolling

royal blue top tubes are used to collect

toxicology and traced metal specimens

21g - 22g needles are used for

routine venipuncture

the proper order of vein selection

MEDIAN CUBITAL / CEPHALIC / BASILIC

reasons to allow alcohol to dry completely before needle insertion

puncture will sting less, hemolysis is less likely to occur, evaporation process helps destroy microbes

improper cleaning of venipuncture site can cause

INFECTION

second choice vein, more visible on obesse patients

CEPHALIC VEIN

tourniquets should never

tied over open sores (causes infection) / tied too tightly (cuases petechiae) / left on longer than one minute (causes hemoconcentration)

to properl anchor a vein

pull the skin taut with your thumb, below the tube holder

butterfly and syringe needles may be used

on small frail veins such as those in children and geriatric patients

types of needles used for phlebotomy

hypodermic needle / multisample needle / winged infusion (butterfly)

yellow top tubes are used to collect

Blood culture specimens

during venipuncture the needle is inserted at

a 15 - 30 degree angle with the bevel up

lavender top tubes are used to collect

CBC specimens

when identifying a patient in the hospital seeting always

check the patients ID band / ask the nurse the patients name / ask the patient to state his or her name

after venipuncture pressure should be applied

for at least 5 mins prior to bandaging

phlebotomist should avoid the basilic vein because

it lies near a major nerve and near the brachial artery and is more painful when punctured

glucose tesst are collected in

grey top tubes

types of anticoagulants include

sodium citrate, EDTA, sodium heparin, lithium heparin and ammonium heparin

thixotropic gel found in light green tubes is a

coagulant

the easiest veins to anchor

median cubital veins

tubes containing anticoagulants

prevent clotting

palpataing a vein is useful because it aids in determining

the depth of a vein / the direction of a vein / the size of the vein

slanted tip of the needle is known as the

bevel

open space inside the needle described by gauge

lumen

located where the needl attaches to the syringe

hub

when determining needle size remember that

the higher the gauge of the needle, the smaller the lumen

the tourniquet should be applied

3 - 4 inches above the injection site

tubes should always be labeled with the following informatiom

patients name (ID #) / date / time of draw / phlebotomist initials / test type and urgency

clot activators are designed to

accelerate coagulation

the correct order for finishing a phlebotomy procedure

remove the tourniquet / remove the tube / place the gauze / remove the needle / apply pressure / discard needle in a sharps container

after the torniquet is applied blood should be drawn

within 1 minute

what anticoagulant is found in green top tubes

sodium heparin / lithium heparin / ammonium heparin

items needed for routine venipuncture include

alcohol / mutisample needle / gloves / tourniquet / gauze and tape / tubes and tube holder / bandaids

after preforming venipuncture you should

apply pressure and instruct the patient not to bend his or her arm

if pressure is applied to the gauze during needle removal

it is painful to the patient / prolongs needle removal / and the needl may cut through the patients skin

correct order of the draw

yellow / light blue / red / green / lavender / grey

a stat specimen should be collected

IMMEDIATELY

when preforming venipuncture the following area should be avoided

areas that are scarred, burned, or sclerotic, and areas that appear edematous

hemolysyis is likely to occur if

tubes are mixed vigorously / blood is pulled into the syringe to quickly / you use a needle with to small a lumen

hematomas can result from

inadequate pressure applied after procedure / needle penetrating through the back of the vein / needl bevel is only partially inserted into the vein

if a pateint experiences syncope during venipuncture you should

remove the tourniquet and the needle

factors to consider during site selection for venipuncture

scars or burns / edema / masectomy

reasons specimens may be rejected

tube not initialed / blood is hemolyzed / improperly transported / contaminated specimen

drawing blood from an edematous extremity may cause

test results to be erroneous or altered

scarred or burned areas should be avoided as collection sites because

may be more painful for patient / may have compromised circulation / veins that are difficult to palpatate

an abnormal collection of fluid in the tissues that causes swelling is called an

EDEMA

the most common complication from a venipuncture is a

HEMATOMA

if blood is drawn to quickly from a frail vein it will likely

collapse

veins may collapse due to

too large a tube being used for vein / veins that are fragile / plunger of syringe being pulled back to quickly

if an inpatient is asleep when you arrive to draw blood you should

shake the bed gently and call out the patients name softly

if a patients door is closed when you arrive you should

knock softly and open the door slowly, checking to see its alright to enter

when collecting blood from a child you should

use the patient identification process / explain the procedure / during the draw keep the child informed as to how much longer the procedure will take / never tell a child this wont hurt

success of blood colllection from pediatric patients depends most on

patient immobilization

a butterfly needle and 23- gauge needles are helpful in patients under 2 years of age because

the flexibility of the tubing allows for the childs movement

you must draw a PT or protime specimen from a patinet with IVS in both arms what shoould you do

draw the specimen below the IV line

jaundice means

yellowing of the skin

which lab test assesses jaundice

bilirubin test

when warming an infants heel for dermal pucnture the heel should be warmed for

3 - 5 minutes

samples for PKU testing is normally collected

on special filter paper

failure to completely fill the filter paper circle for a new born screening could result in

a false negative result

if you are unable to verbally communicate with a patient you should

try to communicate with your hands and body language

crying in children causes an increase in

white blood cell count

only speciallly trained personnel acting on a doctors orders are allowed to collect specimens from

vascular access devices (VADs)

two phlebotomist are discussing a patients condition in the elevator and are overheard this is what type of violation

invasion of privacy (HIPPA VIOLATION)

proof of participation in workshops to upgrade skills required by some agencies to renew certification is called

continuing education units CEUs

effective communication skills include

verbal skills / non-verbal skills / listening skills

informed consent means

the patient is aware of intended treatments and their risk before they are performed

when a patient refuses to have blood drawn the phlebotomist should

try to persuade the patient to have the procedure if the patient still refuses notify the physician immediately

when using the telephone you should always

identify yourself and department whenever answering or making a call

capillary blood has a higer value of this, compared to venous blood

HEMOGLOBIN

the depth of a heel puncture should not exceed

2.0 mm

the two most common fingers used for capillary collection are

the middle and ring fingers

a dermal puncture should be

perpendicular to the whorls of the fingerprint

location for heel sticks is the

medial or lateral borders borders of the plantar surface

a normal bleeding time result

is 2 to 10 minutes

canidates for dermal puncture include patients who

require frequent blood draws / have burns on the arms / are at risk for venous thrombosis

never use rough squeezing of massaging during dermal puncture cause

it can lead to accumulation of tissue fluid which can throw off test results

lavender microcollection container are used to collect

CBC specimens

it is necessary to control the depth oh lancet insertion during dermal punctures to avoid

BONE INJURY

evacuated tubes are never used for

dermal puncture colllection or collection from hand veins or other small frail veins

the flow of capilllary blood can be increased by

warming the site for 3 - 5 mins

vigorous massaging during dermal puncture can result in

specimen cotamination by tissue fluid