Unit 2 - Phlebotomy Book Questions

Can you tell the difference visually between plasma and serum?

No, they look the same - both are lighter, yellow-tinted fluids

the liquid portion of blood with clotting factors

plasma

the liquid portion of blood that has no clotting factors bc it has been allowed to coagulate

serum

Tubes that have anticoagulants _ plasma tubes:

Light Blue

Green (light and dark)

Lavender

Pink

Royal Blue with Lavender Stripe

Grey

Tubes without anticoagulants - serum tubes

Clear

Red top glass

Red plastic will have clot activator

SST - Red Speckled Grey, Tiger, Gold Top, Marble Top

Royal Blue with a Red Stripe

Both plasma and serum are produced when what the tubes are?

centrifuged

If there is a mislabeled tube that has specimen, the phlebotomist should transfer the specimen to another tube.

True or false

FALSE. Do not transfer bc the measure of the original additive could be altered.

Tell your supervisor so you can correct mistakes together

when is the order of draw recommended by National Certifying Entities and lab associations?

when more than one specimen is requested

Collecting specimens in the incorrect order of draw can result in?

cross contamination and erroneous results

who defined the order of draw and made it industry standard?

CLSI (Clinical and Lab. Standards Institute)

What is the approved order of draw?

Blood CX x 2

Discard Tube ( Clear or Red)

Light Blue Top
Red Top

Royal Blue with Red Stripe

SST (Gold, Tiger, Marble, Speckled)

Light Green

Dark Green

Lavender/Pink Top

Royal Blue with Lav Stripe

Grey Top

Yellow Top

What percentage of the blood is plasma?

55%

What does plasma have in it?

clear yellow pale fluid has:

nutrients

lipids

hormones

vitamins

glucose

sodium

magnesium

potassium

O2 and Co2

Nitrogen

Antibodies

Cells make up how much of whole blood?

45% of whole blood is made up of cells or formed elements

What formed elements or cells are found in whole blood?

Thrombocytes

Erythrocytes

Leukocytes

What is another name for thrombocytes?

platelets

Name the supplies you need to draw blood

1. Lab req

2. antiseptic

3. tourniquet

4. gloves

5. vacutainer tubes

6. vacutainer needles

7. Needle adapters or hub

8. Winged infusion set

   1. Needle Disposal container or Sharps

an order form that specifies what test are requested and has accompanying labels with an accession number

Lab requistion

this is a unique tracking number that is different for each sample

accession number

prepackaged 70% isopropyl alcohol, chloraprep, chlorhexadine are examples of?

antiseptics used for blood draws

this slows the venous outflow of blood from the arm causing the veins to bulge and make them easier to find

tourniquet

how many inches above the puncture side should the tourniquet be applied

3-4 inches

it’s okay if the tourniquet rolls or turns on the arm

True or falsefor 1

false - it must lie flat for proper restriction

how long can a tourniquet be left in place?

1 minute

what happens to the blood samples if you leave a tourniquet on too long when drawing?

hemoconcentration and blood infiltration into the tissues

when a tourniquet isn’t available what else can be used in it’s place?

bp cuff or sphygmomanometer

What happens to the temperature of the blood when it gets sucked inside a vacutainer tube?

the temperature drops bc of the vacuum

needle size differ in _____ and _______

width and gauge

the lower the gauge of the needle…..

the larger the needle

the higher the gauge of the needle…

the smaller or thinner the needle

What is the smallest acceptable needle gauge size?

23 gauge, anything smaller can cause hemolysis

what is the most common size needle gauge for venipuncture?

21 gauge, 1.25” long

What size needle is used for blood donations?

18 gauge

What is another name for the winged infusion set?

butterfly needle

what is the butterfly best used for?

small veins in the hand, or for elderly or pediatric patientsw

What is the most commonly used gauge for butterfly?

23 guage

The angle of entry for a butterfly needle should be?

5 degrees

This is a small pricking blade used to pierce the skin to obtain capillary samples

lancet

small tubes or microcontainers that are color coded, have a wide mouth and scooping edge for easy collection, and no vacuum

capillary collection tubes

small glass or plastic tubes used to collect blood from a fingerstick and can be spun in a centrifuge for a hematocrit

capillary tubes

Patients can order their own lab tests - true or false

false, must come from their physician or provider

the lab form will need to have :

the ______ and the ______ the sample was drawn and ______ drew it.

the date, the time and who drew it.

before performing venipuncture the tech should check for what code?

specimen identification code

What errors or missing information should a tech check for before drawing?

duplicate test orders, discrepancies, and missing information

if there are multiple orders for a patient or similar blood tests, what should you do?

Notify the ordering doc or the lab manager

What should a req form have on it?

Pt Name

Pt DOB

Patient Sex

Pt Room #

PT Bed #

Date and Time of collection

technician name doing the draw

Tests

Specimen ID Code

Ordering Provider

Special considerations (Stat, timed, post prandial, etc)

Original Test Date

Diagnosis /Disease Code (ICD-10)

if the lab req and labels are barcoded, does that increase or decrease the risk of mislabeled or misplaced specimens

decreases the risk, and the labeling of tubes is easier, more accurate and less risk of ink smearing

What should be verified when a patient comes in for a draw?

1. Positive Patient ID - (State ID with DOB or if inpatient - Pt ID band)

2. Allergies, Medic Alert Bracelet or Other ID - that id’s any special conditions (mastectomy, allergies, seizures)

3. Medication Schedule - last dose (peak med dose), if schedule accurate

can a phlebotomist go ahead and draw from a patient in inpatient without checking with the attending nurse?

No, must always check with the nurse first, and verify last dose of meds and if schedule is accurate

Blood Draw Methods

1. Evacuated Tube Method - straight needle with hub and butterflies

2. Syringe method

3. Lancet

when should a syringe blood draw be done?

when an exact amount of blood needs to be drawn

OR

if the patient’s vascularity can’t handle the vacuum from the evacuated tube method

How is blood transfered from the syringe to a vacutainer tube?

using a syringe transfer device after the needle from the syringe has been sheathed using the safety device

when drawing blood from the hand, what veins will you likely be drawing from?

lower basilic vein

lower cephalic vein

dorsal veins

when drawing blood from the forearm or elbow area, which veins will you most likely be drawing from?

Cephalic Vein

Basilic Vein

Median Cubital Vein

Which vein in the elbow area is more lateral?

cephalic vein

which vein in the elbow area is more medial?

basilic vein

What is the angle of entry for the needle when drawing from the elbow area?

between 15-30 degrees

what is the preferred site for venipuncture in the Upper Extremity?

the antecubital fossa, the “ditch” or “impression” opposite the elbow

How do you select a vein?

size (big enough for shaft of needle) and condition

What is the most commonly used vein in the elbow area, that is large and doesn’t roll?

median cubital vein

this is the easiest vein to palpate in an overweight person

cephalic

least firmly anchored vein near the bracial artery and nerve

Basilic Vein, puncture this vein too far and you risk hitting a nerve or artery

patients who exhibit swelling or continue to bleed after the venipuncture should

place more pressure on the area for a longer time

when using a lancet, if not enough blood comes out after the first poke, what can the phlebotomist do?

squeeze the fingertip slightly to get more blood to the skin surface

According to CLSI, proper patient ID includes?

1. Full name and DOB

2. Spell first and last name

3. Compare to req form

4. patient ID band must match

do you label the tubes before or after the venipuncture?

after the draw

how do you anchor a vein?

using your thumb below the site, NEVER a “C” bc of risk of needle stick

which way should the needle bevel be facing when getting blood drawn?

bevel up

applying _____ immediately after the needle is withdrawn to stop bleeding is crucial to avoid _______________ and __________

pressure to avoid a hematoma or bruising

cottonballs should not be used to apply pressure bc?

the cotton fibers can get stuck to the clot and dislodge it

should the patient bend their arm/elbow to hold the gausze in place?

No, can result in continued bleeding, bruising or hematoma

What should a sample tube be labeled with?

a patient’s full name

numeric ID - like DOB

Date and Time of Collection

Phleb tech’s initials

If the patient is still bleeding after applying pressure…what should you do?

apply pressure for another 2 minutes,

if bleeding persists after 8 minutes - the pt doc or nurse should be notified

when bleeding has subsided, the patient can remove the bandage in an hour

after a blood draw how should you remove your gloves?

one at a time, turning them inside out

Can you dismiss a patient before labeling their tubes?

no

can a patient leave before you have checked to see if the bleeding has stopped?

No

After you are done drawing and have disposed of the needle, labeled and bagged your tubes, patient has been bandaged, and waste has been discarded, then what should happen?

1. Gloves first - inside out

2. remove rest of ppe

3. wash hands

4. say GB

5. and inform them provider will give them results

before applying a bandage, what should you ask a patient

if they have any allergies to adhesive, if they do use self adhesive wrap like koban

What are some adhesive issues

paper-thin onion skin

hairy arms

oily skin

lotion skin

sweaty skin

if a patient says the blood draw hurts, itches, or is painful - what should you do?

stop the draw immediately

if the patient says their arm is falling asleep or sharp pain running up or down their arm, what has happened?

aggrevation of a nerve

the longer the needle is in contact with the nerve, the more _____ of the nerve

irritation

What is the single most common injury that leads to litigation in venipuncture?

nerve damage

What are some tests that can’t be done by dermal puncture?

ESR

PT / PTT

Blood cultures

or tests that require a large amount of blood

the name of a microscopic blood vessel

capillary

capillary puncture can be done in what patients?

adult and pediatric patients

excessively milk a finger during a skin puncture can cause

hemolysis and contamination of the sample with tissue fluids

what is a way to improve blood flow to your dermal puncture site before you begin the puncture?

warm the site

can you do a dermal puncture with a surgical blade or hypodermic needle?

no - too big and too much damage, and possibly too deep (can cause osteomyelitis/bone and bone marrow infection)

How deep does the lancet puncture in infants

0.85 mm

How deep does the lancet puncture in adults

3.0 mm

what should you do with the first drop of blood from a lancet puncture?

wipe it away with gauze bc it is contaminated with thromboplastin, skin particles and tissue fluids which can alter the results

why should not use alcohol to wipe away the first drop of blood after a lancet puncture?

can hemolyze the sample, and keep a round droplet from forming

Do you use a tourniquet for a capillary puncture?

NO

why can’t you use the earlobe as a draw site?

too much movement and it’s uncomfortable

at what age can you do a fingerstick?

over two years old

When would you use a fingerstick?

• can’t find a vein

• burns, scars, non-intact skin

• severely obese and can’t find vein

• if only a small amount of blood is needed

• if they need to save vein integrity for other procedures

What is the best fingerstick site(s)?

fleshy, side of center of the 3rd or 4th fingers of non-dominant hand perpendicular to finger print lines

warmed before stick*

When do you do a heel stick

on infants and toddlers up to 2 years of agew

what areas of the foot are recm’d for heel sticks

medial and lateral portions of the plantar surface

• draw a line from middle part of big toe to heel - medial side

  • draw a line from middle of the 4th and 5th toes to heel - lateral side