Phlebotomy Study Guide

Venipuncture Study Guide #2

Main Veins for Venipuncture

  • The three main veins used for venipuncture are:
    • Median cubital
    • Cephalic
    • Basilic

First Choice Vein

  • The median cubital vein is the first choice for venipuncture.

Layers of Blood Vessels

  • The three layers of blood vessels are:
    • Tunica media
    • Tunica intima
    • Tunica adventitia

Single Layer Blood Vessel

  • Capillaries are the blood vessels with only one layer.

Hemolysis

  • Hemolysis is the rupture of red blood cells.
  • Causes of hemolysis include:
    • Using a needle too large for the vein
    • Leaving the tourniquet on for too long
    • Excessive force during blood draw

Role of Erythrocytes

  • The role of erythrocytes is to carry oxygen to tissues and remove carbon dioxide.

Anticoagulant in Lavender Top Tube

  • EDTA is the anticoagulant found in the lavender top tube.

Purpose of Anticoagulants

  • The purpose of an anticoagulant in tubes is to prevent blood from clotting.

Tubes Making Serum

  • Tubes that make serum include:
    • Red top
    • Tiger top
    • Royal blue with the red stripe

Tubes Making Plasma

  • Tubes that make plasma include:
    • Light blue
    • Light green
    • Dark green
    • Pink
    • Lavender
    • Gray
    • Royal blue with lavender stripe

Needle Insertion Angle

  • The angle at which the needle should be inserted:
    • Hand draw: 5 degrees
    • Arm draw: 15-30 degrees

Maximum Attempts

  • The maximum number of attempts a phlebotomist should make before seeking help is two.

Patient Identification Steps

  • Steps to identify a patient before drawing blood:
    • Ask for the patient's full name and DOB (date of birth).
    • Check the band or ID.
    • Compare the information to the requisition form.

Tourniquet Placement

  • A tourniquet should be tied 3-4 inches above the draw site.

Tourniquet Time Limit

  • A tourniquet should not be left on for more than a minute to prevent hemolysis/hemoconcentration.

Preventing Hemoconcentration

  • The best way to prevent hemoconcentration is to remove the tourniquet before 1 minute.

Tube Inversion

  • It is important to invert tubes after collection to mix the additive properly and prevent clotting.

Palpation

  • The technical term used when “feeling” for a vein is palpation.

Blood Smear Method

  • The correct method for performing a blood smear is to place a drop of blood on a slide from a lavender top tube and spread it with another slide at a 30-45 degree angle.

Heel Stick Area

  • When performing a heel stick, the preferred area is the sides of the heel of the foot.

Cleansing Agent to Avoid

  • The test drawn that you should not use alcohol to cleanse the patient’s skin before the blood draw? Alcohol/Ethanol

ABG Sample Transport

  • An ABG (arterial blood gas) sample should be transported to the lab on ice and immediately after collection.

Specimen Transport Methods

  • Different ways to transport specimens to the lab:
    • Hand delivery
    • Tube system
    • Courier service

24-Hour Urine Sample Collection

  • The proper procedure for collecting a 24-hour urine sample:
    • Discard the first urine in the morning.
    • Collect the rest of the urine in the container for 24 hours.
    • Keep refrigerated.

Bilirubin Sample Protection

  • Bilirubin samples should be protected during transport to the lab by keeping them in a light-protected container (amber tube) or wrapping them in a paper towel/aluminum foil.

OSHA

  • OSHA stands for Occupational Safety and Health Administration.

Standard Precautions

  • The purpose of standard precautions is to reduce the risk of transmission of infections.

Universal Precautions

  • Universal Precautions mean in phlebotomy:
    • Treat all blood and bodily fluids as potentially infectious.

Contaminated Needle Disposal

  • A contaminated needle should be disposed of in a sharps container without recapping.

Infection Prevention

  • The most effective way to prevent the spread of infection is hand washing.

Hematoma

  • Signs of a hematoma:
    • Swelling
    • Bruising
    • Pain
  • Prevention:
    • Avoid fishing
    • Apply pressure immediately afterwards

PPE

  • Different types of PPE (personal protective equipment):
    • Gloves
    • Gown
    • Mask
    • Respirator
    • Goggles

Needlestick Injury Protocol

  • The protocol for an accidental needlestick injury:
    • Wash the area with soap and water.
    • Report to supervisor.
    • Fill out an exposure/injury form.

HIPAA

  • HIPAA stands for Health Insurance Portability and Accountability Act. It protects patient confidentiality.

Unethical and Illegal Behaviors

  • Examples of unethical and illegal behaviors:
    • Assault
    • Battery
    • Slander
    • Breach of duty
    • Malpractice
    • Negligence

Blood Culture Collection Volume

  • Blood collected in blood culture bottles:
    • Adults: 8-10 mL
    • Child: 3-5 mL

Largest Lab Department

  • The largest department in the lab is chemistry.

Types of Gloves

  • The two types of gloves used when drawing blood: Vinyl and nitrile.

CLSI

  • CLSI stands for Clinical Laboratory Standards Institute; it sets lab testing standards.

Types of Consent

  • Different types of consent:
    • Informed
    • Implied
    • Expressed
    • HIV consent
    • Parental consent for minors

IV Procedures

  • You cannot start or stop an IV.

Basal State

  • Basal state refers to the fasting state after 8-12 hours without food or exercise.

Infant Venipuncture Sites

  • When the heel stick is not available for an infant, you can stick them in the median cubital or the back of the hand.

Disclosing Tests to Patients

  • Yes, you can tell a patient what test(s) are being drawn.

PKU Test Timing

  • A PKU test is performed on an infant within the first 72 hours of life.

POCT Machines

  • Examples of POCT (point of care testing) machines:
    • Glucometer
    • PT testing
    • Lipids

Mastectomy Considerations

  • Venipuncture on patients with mastectomy:
    • Single mastectomy: draw on the opposite side.
    • Double mastectomy: ask the provider.

Medical Facility Inspections

  • OSHA is the agency that does inspections for medical facilities.

Requisition Information Mismatch

  • No, you cannot continue a blood draw if the information on the requisition does not match the patient provides to you.

Venipuncture Procedure Steps

  • The four steps to ending the venipuncture procedure:
    • Remove tourniquet
    • Remove tubes
    • Remove needle and apply gauze
    • Activate safety