Learn: NHA PCT Exam: Phlebotomy

arteries

blood vessels that carry oxygenated blood away from the heart to other parts of the body

Diaphoretic

Characterized by profuse sweating.

pallid

pale

veins

Blood vessels that carry de-oxygenated blood back to the heart

Arterioles

small vessels that receive blood from the arteries

Capillaries

Microscopic vessel through which exchanges take place between the blood and cells of the body

are permeable and function as exchange vessels

coronary arteries

supply blood rich in oxygen and nutrients to the heart

femoral arteries

supply blood to the lower extremities

jugular veins

return deoxygenated blood from the head and neck to the heart

saphenous veins

return deoxygenated blood from the lower extremities to the heart

pulmonary veins

carry re oxygenated blood back to the heart from the lungs

standard precautions during venipuncture

-use PPE when handling body fluids, non intact skin or mucous membranes

-practice hand hygiene before and after contact

-safely dispose of all used equipment

how to properly confirm a pts indenity?

-Full name

-DOB

-SS

-Last 4 of phone #

-Physical ID

what is the first step you take before performing veinipuncture?

confirming consent

before uncapping needle what do you observe?

-expiration date

-label and seal intact

-safety device and bevel is intact

normal needle

bent needle

are adapters single or multi use?

single

are tourniquets single or multi use

both

antispetic

germ-killing substance

How to label a specimen?

-using a pen write pts full name

-DOB

-date/time

-ID number

-write legibly

when to perform dermal punctures?

-for tests that require a small amount of blood

-when a patient does not have an accessible vein but blood collection is essential

-when a lab test requires capillary blood

-for a patient at risk of latrogenic anemia

iatrogenic anemia

anemia caused by excessive blood draws that leads to a deficiency of red blood cells or of hemoglobin in the blood -> pallor & fatigue

blood tests that call for dermal punctures

-glucose testing

-cholesterol testing

-hematocrit determinations

capillary pipettes

Small glass pipettes with one calibration mark used for very small blood samples

microcollection tubes

small tube used to collect dermal puncture samples; also called a "bullet"

what type of blood test is preferable for pts younger than age 1?

dermal puncture, requires less blood

3 types of blood dermal puncture blood specimens contain

-arterial

-capillary

-venous

preferred fingers for fingerstick

third/fourth finger, using fleshy off center sides of fingers

equipment for fingerstick

isopropyl alcohol wipes, gauze, lancet, micro container

fingerstick procedure

1) Have pt sit or lie down

2) Check warmth pf pts hand. If needed have pt open and close hand a few times or rub hands vigorously.

3) Identify site

4) Rub area with 70% isopropyl alcohol, allow to dry

5)Puncture site with lancet, puncturing perpendicular to fingerprint lines.

6) Dispose in biohazard sharps container

7) Wipe away first drop of blood

8) Allow blood to drip into collection tube, cap when full. If blood flow stops or slows have pt drop hand below the level of heart and apply pressure to first joint of finger with a press-and-release technique. Take max 2 mins to fill each tube. Cap and gently invert.

9) Use gauze and apply pressure to puncture site for several mins. When bleeding stops put adhesive bandage, tape and gauze, or folded gauze pad and self-adhesive wrap over puncture site.

why shouldn't you use povidone-iodine on fingerstick cleanse?

will have adverse affect on results of bilirubin, uric acid, phosphorus or potassium tests

heel stick

Pediatric phlebotomy procedure that requires puncturing one of specified areas of an infant's heel, or when veins cannot or should not be used for adults and dermal is not a option

best site for heel stick

medial/lateral side of plantar surface of heel

hematoma

a solid swelling of clotted blood within the tissues.

equipment for heelsitcks

-gloves

-heel warming device

-isopropyl alcohol swab

-sterile lancet

-micro collection tubes

-gauze pad

Heel stick procedure

1) Choose right lancet, no deeper than 2mm (preferably the smallest one available)

2) Position pt (ideally supine), ask nurse about any positioning restrictions

3) Apply heel warming device for 3 to 5 mins

4) Select and cleanse site

5) Place lancet on skin and puncture. Use your thumb and fingers to apply gentle pressure to heel, do not squeeze or use excessive pressure

6) Wipe away first drop of blood

7) Touch open tip of tube to puncture site, do not scoop and let blood flow into tube

8) If flow stops wipe any surface clots with a guze

9) When tube is filled apply gauze and pressure to stop bleeding

10) Bandage if necessary, avoiding adhesive bandages

Before blood collection, review the _______

requisition

optimal veinipuncture postition

full arm extension with palm facing upwards

antecubital area

anterior surface of elbow

first choice for venipuncture

median cubital vein

second choice for venipuncture

cephalic vein

when performing veinipuncture on an IV site

-perform puncture distal to the IV catheter's insertion site

can you collect blood from a site where blood transfusion is taking place?

no

mastectomy considerations of veinipuncture

avoid using the arm on the affected side of a pt who

tattoo considerations of veinipuncture

avoid performing puncture in any skin that has a tattoo if possible

hematoma considerations of veinipuncture

do not collect blood through a hematoma because it could affect test results and cause more pain for the pt

edema considerations of veinipuncture

avoid area altogether, excess fluid could be included accidentally in blood collection

scars considerations of veinipuncture

do not collect blood from an area of scaring, can be difficult to find vein and painful for pt

sclerosis considerations of veinipuncture

do not collect blood from sclerotic vein, blood flow is likely to be inadequate and painful for pt

sclerotic veins

becoming rigid and unresponsive; losing the ability to adapt

edematous

swollen

Phlebitic veins

Tender and warm with a red area around them

Tortuous veins

these are winding or crooked veins. These are very susceptible to infection and since blood flow is impaired, the collection may produce erroneous test results.

how to stop epistaxis

lean forward and hold bridge of nose (10-15 minutes)

Tourniquet Application

-position 3 to 4 in. above antecubital area for collections in that region, or above the wrist bone for dorsal hand collections

-apply gently yet firm

-remove within 1 min, after this hemoconcentration begins and can yield inaccurate results

-remove gently while needle still in vein and blood flow is established, or 1 minute has passed

-if no tourniquet is available inflate a bp cuff to 40 mmHg and release at 1 minute mark of when blood flow is established

what degree should be used for a Venipuncture

15-30 degree

10 degree for dorsal sticks

lumen

space within a tubular part or organ, such as the space within a blood vessel

Transfixing of the vein

When the needle enters the top of the vein and then punctures the bottom of the vein too.

needle gauge for routine veinipuncture

20-23 gauge hollow needles, 1 to 1.5 in beveled edge (21 most common)

Light Blue Tube

Contains Sodium Citrate. Used in Coagulation dept. Tests for PT, PTT, Fibrinogen, clotting factors (coagulation)

Green tube

Stat Chemistry

Sodium/Lithium/Ammonium Heparin (chemistry)

Lavender Tube

Contains EDTA. Used in Hematology & tests CBC, WBC, RBC, Platelet counts, any blood counts (hematology), dermal samples

Gray tube

potassium oxalate and sodium fluoride, EDTA

Glucose Tolerance Test, Fasting Blood Sugar, Lactic Acid, Blood alcohol (chemistry)

Royal blue tube

no additive, EDTA or heparin

Used got toxicology, trace metals, and nutritional analysis (chemistry)

light yellow tube

Contain acid citrate dextrose (ACD) and are used for blood bank studies and DNA testing (blood bank)

Red tube top

No additive; used for blood chemistries or any test requiring serum (chemistry)

Gold Tube Top

Gel Separator Tube

Additive: none

Mode of Action: serum separator tube, gel at the bottom to separate blood from serum when centrifuged

Uses: immunology, serology, chemistry

evacuated tube system procedure

- position patient's arm in a slightly bent, downward position

- apply tourniquet. palpate and choose most accessible vein

- cleanse with a friction scrub back-and-forth

- uncap needle, and inspect it

- stabilize the vein

- alert patient to feel poke or pinch

- insert at 15-30 degree angle

- gently push evacuated tube in place, label down, using the proper order of draw

- make sure blood is flowing into tube

- remove tourniquet before 1 min

- remove each tube and invert immediately

- remove needle swiftly and at same angle

- provide pressure at the site of insertion

- apply an adhesive bandage

Evacuated Tube System (ETS)

A closed system in which the patient's blood flows directly into a collection tube through a needle inserted into a vein.

patients arm during butterfly needle venipuncture?

arm extended, slightly bent, palms facing down

syringe method procedure

-have pt lie or sit down

-assemble equipment, test plunger and push out to release air

-calculate how much blood is necessary to fill tubes for test required by determining how much blood you will collect in syringe and rounding up

-position pt arm slightly bent, palm facing down

-apply tourniquet

-uncap needle and inspect

-stabilize vein

-insert needle at 15 to 30 degree angle (10 for hand collection)

-pull back slowly on the plunger

-collect blood

-remove needle

-apply pressure

-use transfer device to move blood from syringe to tubes

venipuncture steps summarized

-equipment selection

-select and prep site

-observation and palpation

-antiseptic application

-venipuncture insertion and removal

-post procedural care

cerebrospinal fluid (CSF)

plasma-like clear fluid circulating in and around the brain and spinal cord

amniotic fluid

fluid within the amniotic sac that surrounds and protects the fetus

pH

hydrogen ion concentration

Specific gravity of urine

compares the density of urine to the density of water

how much urine needed for testing?

30-60mL

Timed Urine Specimen Collection

Time required may be 2, 12. or 24 hour collections. The timed period begins after the client urinates and ends with a final voiding at the end of the time period.

begins at specific time first urinating into toilet then beginning collection every hour

must keep container on ice or in fridge

must not place any water or toilet paper in container

glucose tolerance test (GTT)

test for initial diagnosis of diabetes mellitus; patient is given dose of glucose; patient fasts then blood samples are taken at regular intervals to determine patient's ability to use glucose properly

postprandial test

blood test performed after eating to determine the blood glucose level

urinate, eat meal then collect urine speciment 2 hrs after pt has ate

clean-catch midstream urine specimen

a type of urine specimen that requires special cleansing of the external genitalia to avoid contamination by organisms residing near the external opening of the urethra an is used to identify the number and types of pathogens present in urine

first pee into toiler then pee in container

expected range for specific gravity

1.010-1.030

SG less then 1.010 indicates

diluted urine

SG more than 1.010 indicates

concentrated urine, higher levels show dehydration

WBC in urine indicate

infection

blood in urine indicate

-infection

-cancer

-kidney disease

-chemical poisoning

ketones in urine indicate

-diabetes

-lipolysis

-starvation

-vomitting

Bilirubin in urine indicates

liver disease or red blood cell destruction

Lipolysis

breakdown of fat

protein in urine indicates

-inflammation or infection

-kidney disease

-chemical poisoning

glucose in urine indicates

diabetes mellitus

expectorate

cough or spit out phlegm from the throat or lungs

what time of day should you collect a sputum specimen from a pt?

first thing in the morning

occult blood

blood present in such minute quantities that it cannot be detected with the unassisted eye

fecal occult blood test (FOBT)

test of feces to discover blood not visibly apparent

How to perform a throat swab

-wipe both tonsils, throat and all areas that look inflamed or infected with the swab

buccal swab

A swab of the inner portion of the cheek; cheek cells are usually collected to determine the DNA profile of an individual

Blood Culture Collection

-Sterile blood specimen for blood cultures for a patient suspected of having septicemia.

-Site to be cleaned with Iodine, not alcohol.

-BCCs are always done FIRST, before any other tubes.

what antiseptic should you use for patients with shellfish allergy?

Chlorhexidine gluconate or benzalkonium chloride