Phlebotomy Flashcards

What are lab analyses of specimens used for?

Diagnostic TestingTherapeutic AssessmentsMonitoring

What 1991 act did OSHA pass?

1991 Safety Standards for Biological Hazards-Published because of a significant health risk associated with exposure. Primary concerns are HIV, hepatitis B and hepatitis C.

Safety Standards Update, Needlestick Safety and Prevention Act-Passed to revise the bloodborne pathogens standards to establish in greater detail requirements that employers identify and make use of safer medical devices.

What is the chain of infection?

-Pathogen-Source of disease -Mode of transmission -Susceptible host

What are the modes of transmission?

AirborneDropletContact Vector

What are fomites?

Inanimate objects that can harbor infectious agents and transmit infections.

What are the types of infections?

Healthcare-associated infections: health care-associated infections, sometimes known as healthcare acquired infections and previously known as nosocomial infections, are infections that occur while a patient is hospitalized or is receiving treatment in any type of healthcare facility. According to the CDC, about 1 in 20 hospital patients will develop an HAI. -Medicare: if patient gets HAI, the entire stay is free-Foley catheters are number one source of infection. Community acquired infection: type of infection from within the community that may require admission to a health care facility.

What is the proper order for entering an airborne risk patient's room/

Gown, mask, eyewear, glovesRemoval is gloves, gown, mask last.

What are standard needle lengths and gauges?

Length: 1-1.5 inchesGauge: 16-25-The gauge number indicates the diameter of the needle; the smaller the gauge number, the larger the needle diameter and flow rate.

How long should a tourniquet be on a patient's arm?

No longer than one minute. If it takes longer than one minute to find a vein, release the tourniquet for two minutes.

What patient identifiers must phlebotomists use?

Patient NamePatient Date of Birth Medical Record Number (less common)

What must the manual labeling of specimen tubes include?

1. Patient's name2. Patient's date of birth/medical record number3. Date of collection4. Time of collection (in military time) 5. Collector's initials

How do you palpate veins?

Check for a potential site by palpating the vein using the index finger of the nondominant hand.

At what angle should a needle be inserted?

30 degree angle

What are green topped tubes for?

The anticoagulants sodium heparin, ammonium heparin and lithium heparin are found in these tubes. These are used in various chemistry assays requiring plasma or whole blood.

What are purple topped tubes for?

The anticoagulant is EDTA. These are used for most hematology procedures, and also used for molecular diagnostic testing.

What are light blue topped tubes for?

These are used for coagulation procedures, such as PT and APTT, and the tube contains sodium citrate at a concentration of 3.2 or 3.8 percent. -Has to be filled to top.

What are red topped tubes/gold SST?

This indicates a tube without anticoagulant for the collection of serum, thus the collected blood will clot in this tube.

What are royal blue topped tubes for?

These are used to collect sample for nutritional studies, therapeutic drug monitoring, and toxicology.

What are gray topped tubes for?

This tube contains potassium oxalate/sodium fluoride and are used for blood alcohol and glucose.

What are tan topped tubes for?

This tube is used for lead testing and contains EDTA.

What are pink topped tubes for?

These are commonly used for blood bank samples and contains EDTA.

What is the proper order of draw for blood?

What are the different types of white blood cells?

Neutrophils: immune defense phagocytes that fight against pathogens in the body. Will be increased with infections. Eosinophils: defense against parasites and will be increased in parasitic infections and allergic reactions. Basophils: inflammatory response cell. Will be increased with inflammation in the body. Monocytes: immune defense phagocyte. Will be increased in viral infections. Lymphocytes: cellular immune response, antibody production. Will be elevated in viral diseases such as infectious mononucleosis.

What are normal blood cell counts?

White blood cells: 5,00-10,000 cells per microliterRed blood cells: 4-6 million cells per microliterHemoglobin: 12-17 grams per deciliterHematocrit: -Women: 36-44%-Men: 41-50%Platelets: 140,00-450,000 cells per microliter

What are normal percentages of white blood cells?

Neutrophils: 62% (target bacteria and fungi)Lymphocyte: 30% (B and T cells)Monocytes: 5.3% (macrophages)Eosinophil: 2.3% (parasites and allergic reactions)Basophil: 0.4% (inflammatory response)

What is a differential?

The morphologic characteristics of white blood cells and red blood cells are observed using special lab staining techniques. A differential be performed manually with a microscope, or by using special automated instrumentation.

What is the difference between serum and plasma?

Serum: liquid portion of a blood specimen if the specimen is allowed to clot. Plasma: liquid portion of a blood specimen if a specimen contains an anticoagulant that prevents clotting.

What is a panel/profile?

A test group that includes multiple defined analytes requested. Usually relating to a specific disease or a specific organ. May be ordered alone or with other tests. May be ordered together as tests. May vary from one facility to another depending on lab protocol.

What should be used if a patient has an allergic reaction to betadine/iodine or alcohol?

Alternative cleanser is chlorohexidine or benzalkonium chloride antiseptic towelette.

What is syncope?

The transient and occasional sudden loss of consciousness, due to the lack of oxygen to the brain, and results in the ability to stay in an upright position. Patients normally recover quickly, but injuries may result from falling to the ground.

What is the major cause of hematoma?

The major cause of hematoma is due to inadequate pressure and improper bandaging of the site.

What is the most common cause of hemolysis?

The most common cause of hemolysis is due to improper positioning of the needle in the vein.

What are PT and PTT tests?

The partial thromboplastin time (PTT) is used in conjunction with another measure of how quickly blood clotting takes place called the prothrombin time (PT). The prothrombin time measures how quickly blood clots via the extrinsic pathway. PT: coumadin, "blood thinner," DVT/A-FIB, fish oil, ASA per day. Arthritis medications. PTT: heparin therapy, DVT, CVA/stroke, TPA. Diseases: hemophiliac and factor deficiencies.

What are blood cultures used for?

FUO: fever of undetermined origin. Bacteremia: bacterial infection in one location of the body. Septicemia: bacteria in the blood stream, sometimes called blood poisoning. Major cause of death in the United States.

What is proper preparation for blood culture collection?

Sterile technique:-Alcohol/betadine: 1 min/1 min-Chloroprep: 30 sec-1 min friction scrub-Air dry: collect with winged infusion set-Decontaminate vial tops with alcohol Proper preparation to reduce contamination of sample. Contamination usually occurs because of poor collection technique and skills. Contaminated collection is a major cost factor for inpatient facilities.

What are the two blood culture bottles?

2 bottles: aerobic and anaerobic If using butterfly, do aerobic first.

What is the method of collection for blood cultures?

Time: fever spikes over time, recommended collection times 3, q 1 hour. Volume: large amount of blood at one time better chance of obtaining bacteria. Same time different sites.

What are fingersticks?

Skin punctures in adults and children 1-4 years. Preferred site is the fleshy, central palmar surface of the distal fingertip of the middle or ring finger of the nondominant hand. The puncture should be made slightly off-center of the thickest, fleshy part of the finger due to the calloused center.

What is infant capillary collection?

A heel stick is the most desirable site for skin puncture of infant or neonate under 1 year old. The most medial or lateral section of the plantar surface of the heel should be used. To obtain an adequate sample from a single heel stick, pre-warming of the heel may be indicated to increase blood flow. Osteomyelitis: inflammation of the bone due to bacterial infection.

What are capillary microtainers?

Order of draw for capillary micro-tainer collection: lavender first due to clottin.

From whence is the word "phlebotomy" dervied?

Phlebo: veinTomy: to cut intoPhlebotomy is the science of cutting into the veins for the purpose of collecting blood.

When leaving an isolation room, what is the proper protocol for equipment removal?

Remove gloves, then gown, then mask.

What does the color coding for needles indicate?

Gauge

What should you do if a patient faints?

Immediately remove needle and activate safety device, remove tourniquet, and apply pressure. Lower patient's head between knees. Have patients take slow, deep breaths. Summon help. Move to supine position if possible, protect head and neck. Elevate feet approximately 12 inches.

What is basal state?

12 hours fasting

What is post prandial?

Glucose test 1-2 hours after ingestion of meal. -Usually done for gestational diabetes.

What are the 5 D's?

Death, disease, disability, discomfort, dissatisfaction.

What are the parts of a hospital-based laboratory?

Clinical pathology area: blood and other types of body fluids and tissues are analyzed. Anatomical pathology area: autopsies are performed, histology (tissue) and cytologic (fluid) procedures are utilized for tissue and fluid specimens. Forensic specimens: are those specimens involved in criminal or civil legal cases. -Rape kits, DUIs, assault

How should blood specimens be transported and handle?

Specimens should arrive in laboratory within two hours of collection. -Leak-proof plastic bag with biohazard label. Shipping: inner primary package with absorbent material, placed into a secondary container, then into an outer package. Primary package must be able to withstand 25 pounds per square inch.

What specimens require special transportation?

Protect from light: bilirubin and folate. Warm specimen: cold agglutinins disease.-Heat packsWet/iced: arterial blood gases, gastrin, and lactic acid. -Ice and water.

What is turn around time?

Time it takes for a specimen to be ordered, collected, transported, processed, analyzed, and results are reported back to the chart.

What are timed specimens?

These specimen are collected for the time ordered. Example of timed specimens are: trough (just prior to next dose), peak (draw after the therapeutic medication is given). Most peak levels are drawn one hour after administration. Results should be generated within one hour.

What are routine specimens?

These specimens are collected throughout the day on a regular basis throughout all of the facilities. Results are generated in a routine manner with the normal workflow.

What are the most urgent specimens?

1) STAT: emergency or stat collections are commonly in the emergency room, and in complicated surgical or medical floors. This collection requires extra speed and accuracy without jeopardizing the adequate collection. Results should be generated immediately. 2) ASAP/Urgent: These specimens are to be collected as soon as possible. The specimens are collected throughout all of the facility. Results should be generated within one hour. 3) Priority for collection: the process of determining priority for collection includes many factors; order status, location of patient, staff available.

What is quality assurance?

Guarantees quality patient services. Tracks outcomes through audits. Look for appropriateness, accountability, and timeliness.

What is the correct order of draw for phlebotomy?

1. Blood culture2. Clear3. Light blue4. Red5. Tiger top6. Gold7. Green8. Lavender9. Grey

What tests is the light blue tube used for?

Anticoagulants: sodium citratePreservative: noneComponent: plasmaDepartment: coagulation Tests: prothrombin tine, activated partial prothrombin time (APTT)

What tests is the red tube used for?

Anticoagulants: nonePreservative: noneComponent: serum Department: GeneralTests: Therapeutic medication testing-Digoxin-Dilantin-Gentamycin-Lithium-Phenobarbital-Theophyline-Tegratol-Valproic acid-Tobramycin

What tests is the gold tube used for?

Anticoagulants: nonePreservative: noneComponent: serumDepartment: ImmunologyTests: Monospot, lyme, etc. -ANA-Beta Hcg screen-HAV, IgG-HAV, IgM-HBsAB (antibody)-Hepatitis C antibody-HIV-H. pylori IgG antibody-Lyme antibody-Monospot-Rheumatoid factor-RPR-Rubella

What tests is the green tube used for?

Anticoagulants: lithium or sodium heparinPreservative: noneComponent: plasmaDepartment: ChemistryTests: Profiles, lipid, cardiac risk, liver, basic, comprehensive, and all routine chemistry analytes-Albumin-Ammonia-Acid phosphatase-Alk phosphatase-Amylase-Beta HCG quantitative-Bilirubin, direct-Bilirubin, total-Calcium-Cholesterol-CPK-Creatinine-CGT-Glycated Hb-HDL-Iron-LDH-LDL direct-Lipase-Magnesium-Phosphorus-Potassium-AST-ALT-Transferrin-Triglycerides-Uric Acid -Vitamin B12-CEA-Ferritin-Folate-Free T3-Free T4-Free PSA-PSA-T3 total-T4 total-TSH

What tests are lavender tubes used for?

Anticoagulants: EDTAPreservative: noneComponent: plasmaDepartment: HematologyTests: CBC, WBC, RBC, hemoglobin, hematocrit, platelets-CBC with diff-CBC without diff-Hemoglobin-Platelet count-Retic count-Sedimentation rate-White blood count (WBC)

What tests are grey tubes used for?

Anticoagulants: potassium oxalatePreservative: sodium fluorideComponent: plasmaDepartment: ChemistryTests: glucose, legal alcohol

What is basal state?

Usually first thing in the morning12 hours of not eating, exercisingHelps establish reference rangesQuestions:-What time did you wake up?-When was the last time you ate or drank?-Did you exercise today?

What are some rules to follow for a capillary puncture?

Remember to wipe away first drop of bloodDon't take longer than 2 minutes to fill a tubeFor infants, don't use a lancet that penetrates deeper than 2 mm

What is the appropriate number of inversions for each of the tube types?

Light yellow SPS: 8-10 inversionsLight blue: 3-4 inversionsSerum separator tubes: 5 inversionsGreen, lavender, grey: 8-10 inversions

What are common complications of draws?

Hematoma: if one starts to appear, stop the drawPhlebitis: happens when a vein is accessed repeatedlyThrombus: happens when you apply insufficient pressure to the site

What is notable about peripheral blood smears?

Can use venous or capillary bloodCan apply blood directly from finger to slidePrepare smear within 1 hour of collection in EDTA tubeTo prepare: -Apply drop of blood onto slide, 0.5 inch from end-Hold spreader slide at 30 to 35 degree angle

What is notable about blood culture collections?

Make sure to cleanse top of bottlesCleanse site for 60 seconds with alcohol or chlorhexidine gluconateClean area again using outward spiral with povidine-iodine

What is notable about blood samples for inborn errors of metabolism?

Hospitals screen newborns for cystic fibrosis, hypothyroidism, phenylketonuria, galactosemia, etc. Test is after baby is 24 hours old. State-required forms:-Touch filter paper to drop of blood, allow drop to soak completely to saturate circles. -Air dry blood spots completely for 3 hours at room temperature. -Keep paper away from direct sunlight and heat.

What is therapeutic phlebotomy?

Blood removal to lower red blood cell or iron levels. Polycythemia vera: high red blood cell levelHemochromatosis: high iron level

What is autologous blood donation?

Self-donation of bloodPatient must have written order, be in good healthHemoglobin must be at least 11 g/dLSurgery must be at least 72 hours after donation

What is part of the screening process for blood bank donations?

Screeners give donor mini-physical -Temperature, pulse, blood pressure-Health history

What are the maximum blood draw volumes for adult and pediatric patients?

Draw no more than 10% of infant's blood volumeDraw no more than 100 mL for adultsCalculate infant blood volume:1) Multiply kg by 100 to get volume in mL2) Convert mL to L by dividing by 1000

What specimens have temperature and light requirements?

Ammonia and lactic acid tests require ice slurry immediately after drawCold agglutinins require body temperature (37 degrees C) Protect bilirubin, serum folate by wrapping tube in foil

How is stool properly collected?

Clean outside of collection container. Transport to laboratory, maintaining specimen at body temperature. For fecal occult blood testing, patient collects feces on test cards. Fecal fat analysis - specimen needs 72 hours of refrigeration.

How is urine properly collected?

Most common nonblood specimen. Should be between 12-50 mL Label container with patient name, date, time of collection. Record patient's medications on patient requisition form, chart. Menstruating women should not undergo urine test. Refrigerate or test immediately. Refrigerate urine, process within 1 hour of collection.

What are the types of urine specimen?

Random urine specimen: most common, can be collected at any time. Clean-catch midstream urine specimen: container must be sterile, patient must clean genital area. Used to diagnose UTI and kidney infections, evaluate drug effectiveness. Culture and sensitivity test: requires minimal contamination, patient must cleanse and rinse soap residue. Some urine must be voided into toilet as discard. Patient should submit closed container to laboratory. Timed urine specimen: patient discards first specimen. Urine should not come in contact with stool, toilet paper. Patient should refrigerate specimen until delivered to laboratory. 24-hour urine specimen: Used to test substances released sporadically into urine. Evaluate urine output. Avoid bedpans, urinals, toilet paper. Discard first specimen. Urinates into small collection container, then pour into larger container. Clean small container with soap, water between collections. Refrigerate urine. First-voided morning urine specimen: Collected immediately upon waking. Substances collect overnight, found in greater concentrations in morning urine. Used for pregnancy testing, culturing, microscopic evaluation. Catheterization urine specimen: allows for sterile urine specimen when patient cannot void naturally. Measures residual urine in bladder after normal voiding. Ordered on female patients to prevent vaginal contamination. Ordered on infants for culture and sensitivity tests. Suprapubic urine specimen: suprapubic tap - sterile syringe with needle inserted into bladder. Microbial analysis, cytology studies.

How is semen properly collected?

Requires clean container free of spermicides, detergents. Patient collects, brings to laboratory immediately. Patient must not expose specimen to light, extreme temperature - keep at body temperature. Wear gloves when transporting semen samples. Samples must reach laboratory in less than 2 hours.

How is sputum properly collected?

Collect in sterile container for microbiology specimens. Tuberculosis test containers contain poisonous preservative - use caution.

How are patient-collected, nonblood specimens stored?

Preserved specimens: can keep at room temperature for 72 hours for chemical reagent strip testing. Culture and sensitivity tests: can be kept at room temperature for 72 hours.