CLS 301 - Phlebotomy Exam (slides I-III) (copy)

Prepare: Wash hands and review test requisition(s)

Step 1 of blood collection process (basic venipuncture)

Approach, identify, and assess the patient

Step 2 of blood collection process (basic venipuncture)

Put on gloves, position the patient and locate suitable puncture site

Step 3 of blood collection process (basic venipuncture)

Select and prepare venipuncture equipment and supplies

Step 4 of blood collection process (basic venipuncture)

Decontaminate the puncture site, then apply the tourniquet

Step 5 of blood collection process (basic venipuncture)

Collect the blood sample in the proper tubes and in correct order

Step 6 of blood collection process (basic venipuncture)

Withdraw needle, invert tubes, and control bleeding

Step 7 of blood collection process (basic venipuncture)

Safely discard needle and waste

Step 8 of blood collection process (basic venipuncture)

Properly label specimens and prepare for transport

Step 9 of blood collection process (basic venipuncture)

Assess the patient and remove gloves and wash hands

Step 10 of blood collection process (basic venipuncture)

• Address patient complaints or concerns

• Ask if patient prefers particular arm or vein

• Convey self-confidence and professionalism

How to act in front of patient (both inpatient and outpatient)

• identification band (adult on wrist & infant on ankle)

• unique identifiers (name,MRN,DOB)

• If id band is missing ask if they have checked-in or verify with charge nurse before proceeding.

inpatient identification (3)

if no id band

• give MRN and name John/Jane Doe

• random DOB

• MRN should stay the same after identified

how to identify sleeping or unconscious patient (emergency room)

• wake up patient and let them orient themselves

• if unconscious do the same if they were awake (2 identifies, introduce yourself, explain the procedure)

how to identify sleeping or unconscious patient (inpatient)

• no id band but come with test orders/requistion

• same rules apply and check of ID

outpatient identification (ambulatory patients)

• use mothers name

• baby girl Jane Smith or baby boy Jane Smith

• if two or more “baby girl1 Jane Smith” “baby boy2 Jane Smith”

how to identify infants/pediatric patients (when they don’t have a name)

• room number

• name of card on bed or door

• id band NOT attached to patient

• wristband that looks tampered with

what NOT to use to ID patient (4)

• have the right to refuse

• record patients id and refusal

• tell charge nurse of supervisor

if patient refuses procedure… (3)

tubes must be labeled with 2 forms of identification & date/time of collection

Association for the Advancement of Blood & Biotherapies (AABB) requirements

two healthier care professionals must document patients ID

AABB requirements for transfusion medicine

• label each tube at bedside or site of draw

• always us pen/permanent marker

• must include patients name, MRN, Date/time of collection, phlebotomist initials

• NEVER label before collection

how to label tubes (4)

• gauge number indicates diameter

• smaller gauge number = larger needle diameter

• large gauge number = smaller needle diameter

needle gauge number indicates (——); small gauge number = (——) needle while large number = (——) needle

Hemolysis

(winged infusion set) smaller needles are more likely to cause…

where routine vacutainers will suffice

winged infusion set should be avoided…

• seated in comfortable chair

• lying down if prone to fainting

• never allow patient to stand

position of outpatient (3)

supine with ventral surface of arm facing up

position of inpatient

• address patients complaints or concerns

• ask if patient prefers particular arm or vein

• convey self confidence and professionalism

how to address patient (3)

• extend patients arm, palm facing up

• examine antecubital area (median cubital, cephalic, basic veins)

• palpate veins to determine size, direction and depth

venipuncture site selection procedure (3)

pumping can cause hemoconcentration and blood cannot be used

During venipuncture site selection, patient may make a fist, but not pump because…

there is an increased risk of hemoconcentration with prolonged tourniquet use

Tourniquet cannot be tied more than one minute during basic venipunture procedure because…

Yourn

• patient may make a fist but not pump

  • can cause hemoconcentration (blood becomes concentrated and can’t be used)

• tourniquet should only be tied on the patient no longer than 1 minute

  • risk of hemoconcentration

• you can use the tourniquet to palpate and select vein

  • remove and really once ready to draw

site selection

inappropriate venipuncture sites

• arm on same side as mastectomy

• edematous areas

• hematomas

• arm w/ running transfusion

• arm above an IV

• arms with cannulas (small tube), fistulas, or vascular grafts

site preparation - cleanse the area

• clean with alcohol

• rub pad in concentric circles

• repeat until “rubs clean”

• allow to air dry

  • use chlorohexidine or povidone-iodine if drawing blood

how to attach tourniquet

• tie 3-5 inches above venipuncture site

• use half loaf for easy one handed release

how to begin the draw

• stabilize the vein

  • hold vein steady with the thumb 1-2 inches below the insertion site

• pull skin taut with thumb

• insert needle bevel side up

  • 15 to 30 degree angle relative to the skin

venipuncture procedure

• stabilize the apparatus so the needle does not move

• engage the first vacutainer tube, remove when full and repeat for addition tubes

• as soon as blood starts flowing into the first tube as the patient to relax their fist

what to do if blood doesn’t immediately enter the tube

• slowly draw the needle until the bevel is close to exiting the skin

• redirect the needle slight and push the needle in the new direction

• if redirection is unsuccessful or patient feels pain stop the blood draw and attempt in another location

• if two attempts are unsuccessful or patient says to stop ask for help

post puncture care

• release tourniquet while the last tube is filling

• when let tube is full withdraw the needle

• apply pressure to the site

• immediately engage safety feature and dispose needle

• check puncture site and apple pressure bandage

• asses the patient

• wash hands

Angio-

Root word for “vessel”

Cardio-

Root word for “heart”

Phleb-

Root word for “vein”

Hem-

Root word for “blood”

Cubitum-

Root word for “Elbow, forearm”

Thromb-

Root word for “clot”

Arter-

Root word for “artery”

Pulm-

Root word for “lung”

Peri-

Prefix for “around, surrounding”

Ante-

Prefix for “Before, forward”

Endo-

Prefix for “within, into'“

Hyper-

Prefix for “Above, excessive, increased”

Sub-

Prefix for “below, less, under”

Trans-

Prefix for “across, through”

Mal-

Prefix for “Bad, poor”

Ortho

Prefix for “correct, normal, straight”

Poly-

Prefix for “Many”

-cystic

Suffix for “pertaining to a cell”

-ectomy

Suffix for “cutting out, excision, surgical removal”

-iasis

Suffix for “abnormal condition, pathological state”

-itis

Suffix for “inflammation”

-lysis

Suffix for “breakdown, destruction”

-ology

Suffix for “science or study of”

-stasis

Suffix for “control, stopping”

-dema

Suffix for “swelling with fluid”

-poiesis

Suffix for “formation”

Anterior (ventral)

Front of the body

Posterior (dorsal)

Back of the body

Medial

Toward the midline

Lateral

Toward the outer part of the body

Distal

Away from the center or point of attachment

Proximal

Near the center or point of attachment

External

Near the surface

Internal

Away from the surface

Normal

Erect, standing, arms at rest body positioning

Supine

Lying or reclining, face-up body positioning

Prone

Lying on stomach, face-down body position

Lateral recumbent

Lying on right or left side body position

Sagittal

Body plane that divides right from left

Transverse

Body plane that divides top from bottom

Coronal

Body plane that divides front from back

Abduction

Movement away from the central plane

Adduction

Movement towards central plane

• Cranial cavity (brain)

• Spinal cavity

• Diaphragm (divides thoracic and abdominal)

• Thoracic (heart and lungs)

• Abdominal (internal organs)

• Pelvic (bladder and reproductive organs)

Body cavities (6)

Bone and cartilage

Skeletal system involves the…

• Support

• Protection

• Movement

• Hematopoiesis

• Mineral storage

Functions of the skeletal system (5)

Osteoblasts

Form bones from mineral intake

Osteoclasts

Break down bones to release minerals for use by the body

• Provide locomotion

• Maintain posture

Muscular system functions (2)

Striated, involuntary

Cardiac muscle characteristics (2)

Striated, voluntary, attached to bones

Skeletal muscle characteristics (3)

Involuntary; veins, arteries, intestines

Smooth muscle characteristics and location (3)

• Allow for exchange of gases between atmosphere and blood

• pH maintenance (respiratory alkalosis/acidosis)

Respiratory system function (2)

Pulmonary veins

Only veins to carry blood with high oxygen

Arteries

Vessels that typically have high oxygen content

Nervous system

Body’s communication system

Brain and spinal chord

Nervous system involves the… (2)

Meninges

Membrane that covers the brain and spinal cord

Vertebrae

Spinal column consists of…

Skin and hair

Integumentary system involves the… (2)

• Protection

• Temperature regulation

• Sensory receptor

Functions of the integumentary system (3)