First test of new six weeks
What information goes in the lab requisition? - Patient registration information, billing information, specimen information, barcoded specimen labels and a provider order for confirmation of testing
Know the size of needles for butterfly, syringe, ETS method. - 21 to 23 gauge with a needle length of ½ to ¾ inch, 16 gauge needle, 20 to 22 with a needle length of ¾ inch to 1½ inches
Why is the ETS method used the most? - Helps to obtain multiple tubes of blood with one venipuncture stick
On what type of veins would it be most beneficial to use the winged infusion method? - For patients who have small or fragile veins
Why do we use the syringe method? - When a patient has easy to collapse veins
What are critical/panic values and how are they handled? - Call the providers office, be sure to confirm they understand the information by asking them to repeat it back and address any questions they have, get the name and title of the person you reported a panic/ critical result to, NEVER give results to a patient without the provider first reviewing the results!
Know the steps in performing a venipuncture, including applying a bandage after collection and what to do when a patient is not feeling well during a venipuncture.
What are possible complications with venipunctures? -Nerve damage, hematoma, phlebitis, thrombosis, petechiae, hemoconcentration, diaphoresis, syncope, seizure, shock, nausea
What questions are asked before performing a venipuncture? - Name and DOB, are you scared of needles? Are you allergic to anything? (Ask specifically about latex, povidone iodine, tape.) Have you ever fainted when your blood was drawn? Have you eaten or drunk anything in the past two hours?
What is the % of alcohol in sanitizer? -70%
Know when a chain of custody form is required. -Drug test, forensic specimen, rape testing (court cases)
How is bilirubin handled when collected? - Should immediately be protected from light to avoid changes to the specimen that could impact results therefore it should be put in amber colored containers or wrap container with foil paper
How often is quality control/checking your equipment done? - Daily, and before use
Know your order of draw including inversions- Yellow top N/A, light blue 3 to 4, red 5, red/gray marbled(tiger top) 5, green 8, green/gray marbled 8, lavender 8, gray 8 to 10, royal blue 8 to 10
additives and which tubes are serum/plasma - Yellow SPS, light blue Sodium citrate, Red none, red/gray marbled (tigertop) Silica serum, Green heparin, green/gray marbled lithium heparin plasma, lavender EDTA, gray Potassium Oxalate/sodium Fluoride, Royal blue can be EDTA - Heparin - none
How long do we allow serum tubes to clot? And no longer than how much time? - 30-45 min NO longer than 1 hour
Name the veins in the antecubital fossa and which vein is 1st, 2nd, 3rd? - Median cubital, Cephalic, Basilic
What instructions are given to a patient having a lipid panel? Why? - Not eating, drinking certain beverages and taking medications for 12 hours
How do you care for a patient with a history of syncope during a venipuncture? - Have the patient in semi-fowlers position or supine during the procedure
What supplies are needed to do a venipuncture using ETS, butterfly, syringe method? Sharps container for needle disposal should be within reach, arrange supplies in order needed to use them including placing tubes in the correct order
-Why do we invert tubes? - To mix mix blood with the additives within the tube, and to maintain accuracy of results, avoid shaking or it’ll cause hemolysis (rupturing of RBCs)
Describe a light blue tube. - Sodium citrate; removes calcium to prevent blood clotting, and it is coagulation testing
Why would you do a hand draw? What are its disadvantages?-
The risk of deep vein thrombosis (DVT)
Describe how to place a tourniquet and what would happen if left too long. - Hemoconcentration and alter test results
Where would you avoid performing a venipuncture? - Burns, scars and sclerosed areas
How do you cleanse a site before inserting the needle? -Wiping in an upward and downward motion with friction do NOT blot , allow the site to air dry, avoid touching the skin
Know the steps for a venipuncture. -Anchor the vein by grasping firmly about 2 to 3 inches below the puncture location, holding the skin taunt, insert needle smoothly and quickly at about 15 to 30 degrees angle, however when drawing from a hand angle is lower about 10 to 15 degrees, as the vein in the hand is smaller and thinner, ensure that the bevel faces upward
Why do we remove the first drop of blood during a capillary puncture? - To obtain a clean sample without any tissue or fluid contaminants
Which test is the only one where we do not remove the first drop of blood with capillary puncture? - obtaining prothrombin test (PT)
What happens in:
● Preanalytical - Before the collection of specimen
● Analytical - The actual testing phase
● Postanalytical - Testing is done; specimen is discarded, reports are logged in; provider interprets results/signs’ patient is notified
Define:
● Laboratory Directory/Laboratory Reference Manual - Includes an up-to-date list of orderable test and provide information on specimen requirements, patient preparation requirements needed, container type needed, and transport/ or processing requirements
● Lumen - The hollow bore of the needle shaft where liquid flows through
● Bevel -The point or tip of the needle
● Hemostasis- Body's normal reaction to an injury that causes bleeding. This reaction stops bleeding and allows your body to start repairs on the injury.
Capillary order of draw - 1- Blood Gas (varies in color) 2- EDTA (pink/pearl/lavender/purple) 3- Heparin (green) 4- Any other additive 5- Clot Activator (gold)/No Additive (red) if PT test is being performed light blue
After a venipuncture leave pressure on the bandage for 15 minutes however - Do NOT put band-aid
on the heel of an infant because they can choke on it
After reporting a critical value to a provider - Document who you spoke to