Phlebotomy & Vascular Access Review

Flashcards covering key phlebotomy concepts including anatomy, circulatory loops, blood composition, tube additives, order of draw, infection control, vein selection, procedural mechanics, pre-analytical errors, patient identification, and medical terminology based on lecture notes.

What is the etymological origin of the word phlebotomy?

It is derived from the Greek words $phlebos$, meaning vein, and $tome$, meaning to cut open.

What is the difference between venipuncture and dermal puncture?

Venipuncture involves penetrating a vein to obtain large-volume systemic blood specimens, whereas dermal puncture involves puncturing the skin (finger or heel) to collect capillary blood.

What clinical conditions are managed using therapeutic phlebotomy?

Therapeutic phlebotomy is used to treat Polycythemia by thinning blood volume and to collect blood from donors for transfusions.

According to the anatomic planes table, which plane divides the body into front (anterior/ventral) and back (posterior/dorsal) sections?

The Coronal (Frontal) plane.

How many times does a normal heart beat per day, and how much blood does it pump per minute?

The heart beats approximately $100,000$ times per day and pumps $5\text{ to }6\text{ liters}$ of blood every minute.

What microvascular structures connect arterioles to venules in the circulatory system, as illustrated in the provided diagram?

Capillaries.

What are the three structural tissue layers that make up the heart wall?

The Epicardium (outer layer), Myocardium (thick middle muscle layer), and Endocardium (innermost layer lining the heart chambers).

What sequence of structures describes the systemic circulatory loop?

Left Ventricle $\rightarrow$ Aortic Valve $\rightarrow$ Aorta $\rightarrow$ Systemic Arteries and Capillaries $\rightarrow$ Venae Cavae $\rightarrow$ Right Atrium.

What are the three blood vessel tunicas?

Tunica Adventitia (Externa, outer connective tissue layer), Tunica Media (middle smooth muscle and elastic fiber layer), and Tunica Intima (Interna, inner endothelial layer).

What are the two major components of whole blood and their respective percentages?

Formed elements ($45\%$ of total blood volume) and Plasma ($55\%$ of total blood volume).

What are the physical structure and lifespan of human erythrocytes (red blood cells)?

They are anuclear, biconcave disks produced via erythropoiesis in bone marrow with a lifespan of $120\,days$.

What are the five types of leukocytes and their normal percentage ranges in blood?

Neutrophils ($54\text{ to }62\%$), Lymphocytes ($25\text{ to }38\%$), Monocytes ($3\text{ to }7\%$), Eosinophils ($1\text{ to }3\%$), and Basophils ($<1\%$).

What sequence of physiological events occurs following vascular injury to achieve hemostasis?

1. Vasoconstriction, 2. Platelet Aggregation (primary plug formation), 3. Fibrin Clot Formation, 4. Fibrinolysis (dissolving the clot).

What core components make up a Vacutainer tube, as shown in the labeled diagram?

A protect cap with an international color code, butyl rubber stopper, glass or PET tube, customizable label, and internal additive.

What storage temperature range is required for Vacutainer blood collection tubes?

Tubes must be stored between $4^\circ\text{C}$ and $25^\circ\text{C}$.

Why is K2EDTA preferred over K3EDTA as an anticoagulant additive?

Because K2EDTA is spray-dried on tube walls and more soluble, whereas K3EDTA is a liquid that can cause slight sample dilution.

What is the primary action of sodium fluoride in gray-top blood tubes?

It inhibits the enzyme enolase to stop glycolysis (the breakdown of glucose by blood cells).

At what rate does glucose degrade in unpreserved blood samples?

Glucose degrades at a rate of $10\,mg/dL$ per hour.

What strict blood-to-anticoagulant ratio must be maintained in light blue top tubes containing 3.2% sodium citrate?

A strict $9:1$ blood-to-anticoagulant ratio, requiring the tube to be filled within $90\%$ of its stated volume.

How does serum preparation protocol differ from plasma preparation protocol?

Serum requires unclotted blood to stand upright for $30\text{ to }60\,minutes$ to clot before centrifuging at $1,000\text{ to }2,000 \times g$ for $10\,minutes$; plasma is collected with an anticoagulant and centrifuged immediately.

What six interconnected components comprise the Chain of Infection?

1. Infectious Agent, 2. Reservoir, 3. Exit Pathway, 4. Mode of Transmission, 5. Entry Pathway, 6. Susceptible Host.

In what clinical situations is hand washing with soap and water mandatory over alcohol-based rubs?

When hands are visibly dirty or soiled with blood/body fluids, after suspected exposure to spore-forming organisms (Clostridium difficile or Bacillus anthracis), before eating, and after using the restroom.

What is the required order for donning personal protective equipment (PPE)?

1. Gown, 2. Mask/Respirator, 3. Goggles/Face Shield, 4. Gloves (pulled over gown cuffs).

What is the required order for doffing personal protective equipment (PPE)?

1. Gloves, 2. Goggles/Face Shield, 3. Gown, 4. Mask/Respirator.

What immediate steps must be taken following an occupational sharps injury?

Remove embedded shards, wash the site with soap and water for at least $30\,seconds$ (without squeezing, rubbing, or bleaching), report the incident immediately to a supervisor, and seek medical evaluation.

What is the standard vaccination administration schedule for Hepatitis B Virus (HBV)?

A 3-dose series: Dose 1 at start, Dose 2 at $1\,month$, Dose 3 at $5\,months$ after Dose 2, followed by an anti-HBs serologic titer test $1\text{ to }2\,months$ later.

What is the vein selection hierarchy in the H-shaped antecubital fossa pattern?

1. Median Cubital Vein (first choice), 2. Cephalic Vein (second choice), 3. Basilic Vein (third choice / last resort).

Why is the basilic vein categorized as a last-resort site in the antecubital fossa?

Because it runs in extreme proximity to the brachial artery and primary branches of the median nerve, raising the risk of nerve or arterial injury.

Why is venipuncture strictly forbidden on the palmar and lateral wrist?

The wrist contains an intricate network of vulnerable nerves, tendons, and arteries, making punctures unsafe and in violation of CLSI standards.

How do veins and arteries differ in pulsation and tactile texture?

Veins have no pulse and feel soft, compressible, and springy; arteries have a palpable pulse driven by cardiac pressure and feel firm with thick elastic vessel walls.

Why must 70% isopropyl alcohol be allowed to air-dry for at least 30 seconds to 1 minute prior to venipuncture?

To allow proper biocide disinfection, prevent liquid alcohol from entering the sample and causing hemolysis, avoid patient burning, and prevent needle tip contamination.

Why does red blood cell destruction (hemolysis) falsely elevate serum potassium levels?

Because red blood cells contain $23$ times more potassium than plasma, so hemolyzed cells release potassium directly into the liquid serum or plasma.

What is the maximum time a tourniquet can remain applied to a patient's arm during venipuncture?

A tourniquet must not remain applied for longer than $1\,minute$ ($60\,seconds$) to avoid hemoconcentration.

Based on the needle gauge reference chart, what gauge needle is designated as the standard for routine adult venipuncture?

21-Gauge (Green / Standard hub).

What is the relationship between needle gauge number and lumen diameter?

They have an inverse relationship: a higher gauge number indicates a smaller internal lumen diameter.

Why is a discard tube required when using a winged infusion set (butterfly) to draw a Light Blue sodium citrate tube?

To purge air from the tubing dead space so that the Light Blue tube fills completely and maintains the required $9:1$ blood-to-anticoagulant ratio.

What is the CLSI Venous Order of Draw for blood collection tubes?

1. Blood culture bottles, 2. Sodium citrate (Light Blue), 3. Serum tubes (Red/Gold), 4. Heparin (Green), 5. EDTA (Lavender/Pink), 6. Sodium fluoride/potassium oxalate (Gray).

How does EDTA additive carryover into a serum chemistry tube alter analyte results?

It causes false hyperkalemia (falsely high potassium) because EDTA contains potassium, and falsely decreases calcium by chelating calcium ions.

What are the approved primary identifiers for verifying patient identity?

Full legal name, date of birth (DOB), hospital unit number/MRN, health card number, hospital account number, or government-issued photo ID.

What identifier is strictly prohibited for patient verification?

Patient room number or bed tag location.

What action must a phlebotomist take if an inpatient does not have an identification armband attached?

Do not proceed with the blood draw; inform the floor nurse immediately so a verified armband can be attached prior to specimen collection.

According to the consent tier reference chart, which consent tier is indicated for emergency life-threatening situations and non-invasive routine care?

Implied Consent.

What emergency steps should be taken if a patient experiences syncope (fainting) during venipuncture?

1. Stop the procedure immediately and withdraw the needle; 2. Release the tourniquet and discard the needle; 3. Support the patient's head; 4. Place the patient in a supine position with legs elevated.

According to the clinical guidance for post-draw bandaging, what type of dressing is recommended for patients on anticoagulants or with bleeding disorders?

Compressive Dressing (Gauze + Coban Wrap).

What mandatory information must be recorded on a specimen tube label at the bedside?

Patient's full legal name, date of birth, unique patient identifier (MRN/Health Card #), exact date and time of collection, and phlebotomist's initials or collector ID.

Why must the first drop of blood be wiped away during a dermal (capillary) puncture?

Because the first drop contains interstitial tissue fluid and residual alcohol that dilute the specimen and cause hemolysis.

What is the correct Order of Draw for capillary blood collection?

1. Blood Gas Specimens (CBGs), 2. EDTA Specimens (Lavender), 3. Other Additive Specimens (Green/Gray), 4. Serum Specimens (Red/Gold).

What is the standard insertion angle for an ETS needle during routine venipuncture?

An angle of $15^\circ\text{ to }30^\circ$ relative to the skin surface.

What special handling measures are required for light-sensitive blood analytes like Bilirubin or Vitamin B12?

Tubes must be protected from light by wrapping them in aluminum foil or using amber-colored containers.

Which blood specimens require chilling in an ice slurry during transport?

Ammonia, Lactic Acid, and Arterial Blood Gases (ABGs).

What is the buffy coat layer and what percentage of whole blood does it comprise?

A thin whitish middle layer composed of white blood cells and platelets that forms between plasma and RBCs after centrifugation, representing less than $1\%$ of total blood volume.

Why are trailing zeros (such as 1.0 mg) prohibited on Joint Commission 'Do Not Use' lists?

Because the decimal point can be overlooked, leading to a $10\text{-fold}$ medication dose error.