Comprehensive NHCO Phlebotomy Exam Study Guide with Key Terminology and Definitions

informed consent

A competent person gives voluntary permission for a medical procedure after receiving adequate information about the risk of the procedures methods and consequences

expressed consent

permission for care that a person gives verbally or in writing for a procedure

Implied consent

The patients actions permit the procedure without verbal or written consent

Ex: patient extends arm out when told they need blood drawn

HIV Testing consent

special permission is needed to administer a test that detects HIV

Parental Consent for Minors

A parent or a legal guardian must permit procedures administered to underage patients depending on the state law may range from 18 to 21 years old.

Refusal of Care

Patients have a right to refuse care and stop care at any point during the procedure. Failure to stop care at any point may result in criminal charges such as assault or battery

Who cannot refuse care?

Patients under the custody of parents or law enforcement cannot refuse care as that falls to custodian

What should the technician do if patient refuses care

Stop immediately and have patient sign refusal form

How do you identify patient?

ask the patient to state his or her full name and DOB

Ask patient to spell their first and last names

Compare requisition form

The patient's ID band must match

Order of draw

Discard Tube

Light Blue Top

Red Top

Gold/ Tiger Top

Light Green Top

Pink Top

Lavender/ Dark Purple Top

Gray Top

(Dark blue red stripe before red top; dark blue lavender stripe after lavender top)

What should you do as soon as you walk into patients room

Identify your patient

Is a serum or plasma clotted?

Serum-clotted

Plasma- unclotted

What do you do when a name is not the same as your patient?

Contact supervisor

Labeling tubes

Do not label tubes before the venipuncture; label with patients full name after drawing

Before venipuncture what should you check the requisition form for

For a specimen identification code, duplicate test orders, discrepancies, and missing information; clarify with the ordering physician or lab manager

What should be noted on the requisition form?

The date the sample was drawn, what time it was drawn, and who did the draw

What does every blood collection procedure begin with ?

A requisition form; patients cannot order their own test and must be by physician who results will be sent to

What form of identification is needed for outpatient facility

Sate issued ID

What form of identification is used for inpatient facility

Patient ID band

Medication Schedule

Verify with attending nurse before drawing patients blood

Blood Draw methods

evacuated tube method and syringe method

What do you do if your patient is allergic to latex

Use nitrile gloves

What is essential personal protective equipment (PPE)

Masks

Goggles/ safety glasses

Face shields

Respirators

Gloves

Gowns

Order of removal for PPE

1. Gloves

2. Goggles or safety glasses

3. Gown

4. Mask

Isolation Procedures

Used with patients who are immune compromised or burn patients. Keeps the entire room sterile. Providers will have to sanitize themselves and wear special clothing covers and booted over their shoes and sometimes breathing apparatus

How many times should you wash your hands?

Before and after patient

What PPE is required for droplet precautions?

What PPE is required for tuberculosis

N 95 mask

What should you do if you accidentally stick yourself

Go wash the area first then ; tell supervisor and report for medical evaluation, report for hiv evaluation (in any order )

Universal Precautions

steps taken to prevent the spread of disease through blood and other body fluids when providing first aid or health care ; treat blood and potentially infectious materials as if they were infected with bloodbourne pathogens

If you get blood in your eye, how long do you stay under eyewash?

15 minutes

What PPE is required for airborne precautions?

*N95 mask, gloves, gown

Can the phlebotomist give patients their results?

No, results will be sent to physician who patient can speak with; phlebotomist can tell patient what they are being tested for

HIPPA

Health Insurance Portability and Accountability Act of 1996

OSHA

Occupational Safety and Health Administration, a government agency in the Department of Labor to maintain a safe and healthy work environment

TJC (The Joint Commission)

establishes standards of care for hospitals and long term care facilities

CLIA

Clinical Laboratory Improvement Amendments

CLSI

Clinical Laboratory Standards Institute; an organization that sets standards for laboratories

How full can sharps container be?

2/3 full

What should you do if needle gets exposed/ touches something

Throw it away

How do you clean blood spill ?

Pour 10% bleach solution over blood and leave it 10 minutes ; sodium hypochlorite solution (household bleach) diluted between 1:10 and 1:100 with water; the more bleach you have compared to water the stronger it will be

Can a phlebotomist start IV

No

Last 4 steps of venipuncture:

Tourniquet

Tube

Gauze

Needle -safety

Basal State

When the patient has fasted and not excersiced in 12 hours

When do you use pressure wrap

How do you collect blood on child under 2?

If arm does not look good or you cannot find vein what should you do?

Choose another site

What other sites can you collect blood from newborn

What 2 test are most common for newborns

Bilirubin, PKU

Bilirubin

PKU

How should 24 hour urine test be handled

Where do you draw for patient with IV

Where do you stick drug addicts

Where can you draw babies over 2

Fingerstick

What can excessively milking the finger during skin puncture cause

Hemolysis and contamination of specimen with tissue fluids

Where do you place tourniquet on geriatric patient

Lactic acid test

What do you do when drawing ABG

Why would a sample be rejected

What should you do if you hear hiss sound during venipuncture

Infection control practices

The easiest and most effective way to break the chain of transmission is by washing your hands. Hand washing is one of the essential practices used to prevent the transmission of bloodbourne pathogens. Make sure to use enough soap to form a lather on hands

direct contact transmission

person to person transmission (skin to skin contact with infectious person)

indirect contact transmission

spreads to a host by a nonliving object called a fomite ( contact with contaminated object like clothing, lice, scabies, lesions, rsv, diarrhea, impetigo)

droplet transmission

Respiratory or salivary secretions are expelled from infected individual (sneezing, coughing)

airborne transmission

Occurs when infectious particles are so small and lightweight that they can float in the air and be spread through air currents ( tuberculosis is contracted by infectious particles that remain in the air)

vehicle transmission

The agent is contained in bodily fluid that susceptible host contacts (doorknob, faucet, telephone, pen in mouth)

vector-borne transmission

occurs when a pathogen transmits through an invertebrate, such as an insect (malaria, Lyme disease, dengue virus

Parental Transmission

A disease is transmitted other than mouth nose or eyes ( needle stick, open wound, hang nail

noscomial infection

any infection contracted in a health care setting

What is the most common nosocomial infection for employees

Hepatitis B ( HBV)

The CDC

Centers for Disease Control and Prevention; recommends universal precautions

Standard Precautions

Wear gloves when collecting and handling blood, bodily fluids, or tissue specimens. NEVER double glove

Wear face shields when there is danger of splashing onto mucous membranes

Dispose of all needles and sharp objects in puncture resistant containers without recapping.

ALWAYS activate the safety mechanism

Be aware that disinfectants are used to clean fluid spills, killing pathogenic organisms

Cough and sneezing etiquette

Cough and sneeze into elbow bend; wash hand and elbow after

antecubital fossa

interior depression (ditch or impression ) opposite of the elbow; blood pressure site

What should you do if sharps container is overflowing

Report violation to supervisor

How do you pick up glassware

Mechanical means ( forceps, tweezers, broom and dust pan)

Thrombocytes

platelets, blood-clotting cell fragments; aid in process of hemostasis and are critical to repairing blood vessels after injury

Erythrocytes

red blood cells( rbc); contain hemoglobin the oxygen carrying protein

Leukocytes

white blood cells, fight infection

Where should tourniquet be applied?

3 to 4 inches above the venipuncture site

How long can a tourniquet be left on?

60 seconds/ 1 minute

Venipuncture Equipment/supplies

Laboratory requisition

Antiseptic

Tourniquet

Gloves

Vacutainer tubes

Vacuainer needles

Needle adapters

Sharps container

median cubital vein

The vein of choice because is it large and does not tend to move the the needle is inserted.

cephalic vein

Large vein on the outermost side of the upper arm

basilic vein

The third choice for venipunctures. It is the least firmly anchored and located near the brachial artery. If the needle is inserted too deep, this artery may be punctured.

Which vein should you use for obese patient?

Cephalic vein

What should you do if the patient complains the blood draw hurts, itches, or is painful

Stop the blood draw immediately

Labeling each collected specimen

Patients full name

A numeric identifier such as DOB

Date and time of collection

Phlebotomist initials

When choosing fingerstick site

Select either 3rd or 4th finger of the non dominant hand

Heel stick

Method of obtaining blood samples on infants and toddlers up to 2 years old; stick on the outside lateral plantar portion of foot. Draw imaginary lines medially extending from the middle of the great toe to the heel, and then laterally from the middle of the fourth and fifth toes to the heel.

Collecting bilirubin

Within 24-48 hours; must be done quick to minimize exposure to light, blood should be collected in amber colored container

arterial blood gases (ABGs)

a test performed on arterial blood to determine levels of oxygen, carbon dioxide, and other gases present blood ph; obtained from radial artery (thumb side of wrist) sample must be run 15 min of collection, needle is inserted 90 degrees from the artery creating small hole

Collected in heparin tubes

PKU

Ordered within 72 hours using heel stick

mastectomy patients

Draw on opposite side or hand

IV patient

Draw below IV site

What is the most common complication of phlebotomy?

Hematoma- a localized collection of blood within tissues due to leakage from the wall of a blood vessel produces a bluish discoloration (ecchymosis) and pain.

Stop venipuncture

If vein is missed

Adhere to 2 stick rule

To prevent missing vein

Apply tourniquet right

Palpate vein

Warm site

If no blood comes out

Always have back up tube

Reposition needle