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thixotropic gel found in light green tubes is a
coagulant
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
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
failure to completely fill the filter paper circle for a new born screening could result in
a false negative result
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
lavender top tubes are used to collect
CBC specimens
glucose tesst are collected in
grey top tubes
the easiest veins to anchor
median cubital veins
the tourniquet should be applied
3 - 4 inches above the injection site
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
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
if you are unable to verbally communicate with a patient you should
try to communicate with your hands and body language
when using the telephone you should always
identify yourself and department whenever answering or making a call
failure to puncture the skin across the fingerprint will cause
blood to run down the finger
when a puncture is made through a previous site
the chance for infection is greater
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
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
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
types of anticoagulants include
sodium citrate, EDTA, sodium heparin, lithium heparin and ammonium heparin
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
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
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
if an inpatient is asleep when you arrive to draw blood you should
shake the bed gently and call out the patients name softly
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
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
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
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