phlebo-
veins
-tomy
cutting
Venipuncture
incision of the vein for blood letting
What is the purpose of phlebotomy?
to obtain blood for diagnostic testing and to remove blood for transfusion
Where do you place the tourniquet?
3-4 inches above the puncture site
If tourniquet is on to long what may occur?
hemoconcentration,
hemolysis,
petechiae
Hemoconcentration
too many blood elements in plasma
Hemolysis
destruction of red blood cells
Petechiae
a small red or purple spot caused by a tourniquet being to tight
List 1st, 2nd, & 3rd choice of veins in antecubital fossa (inside of elbow)
median cubital vein
cephalic vein
basilic vein
Reflux
backflow
Hematoma
a solid swelling of clotted blood within the tissues
How long do you apply pressure on the site after a draw
?
for up to two minutes
What goes on the blood collection tube after a draw?
patient's name, id number, date, and time of draw
ALP
alkaline phosphatase
ALT
alanine aminotransferase
APTT
activated partial thromboplastin time
AST
aspartate aminotransferase
BT
bleeding time
BUN
blood urea nitrogen
BURPP
bilirubin, uric acid, phosphorus, potassium
CBC
complete blood count
Diff
differential
EDTA
ethylenediaminetetraacetic acid
EIA
enzyme immunoassay
ESR
erythrocyte sedimentation rate
FBS
fasting blood sugar
GTT
glucose tolerance test
HCT
hematocrit
HDL
high-density lipoprotein
Hgb
hemoglobin
INR
international normalized ratio
LDH
lactate dehydrogenase
LDL
low-density lipoprotein
MCH
mean corpuscular hemoglobin
MCHC
mean corpuscular hemoglobin concentration
MCV
mean corpuscular volume
MPV
mean platelet volume
PT
prothrombin time
PTT
partial thromboplastin time
RBC
red blood cell or red blood count
RDW
red blood cell distribution width
SPS
sodium polyanethol sulfonate
SST
serum separator tube
WBC
white blood cell or white blood count
Pulmonary circulation
carries deoxygenated blood back to the heart and lungs for as exchange
Systemic circulation
carries blood between the heart and the rest of the body's tissue
Heart
contains four chambers and is located slightly left of the midline in the thoracic (chest) cavity
Blood vessels
carry highly oxygenated blood from the heart to the capillary beds
Veins
carry deoxygenated blood back to the heart
veins are normally dark red and have thinner walls than arteries
they have one-way valves to prevent blood from flowing back and pooling
capillary blood enters venules (larger than capillaries but smaller than ve
Capillaries
capillaries enable the interchange of water, oxygen, carbon dioxide, and many other nutrients and waste substances between blood and surrounding tissue
Blood
provides nutrients, oxygen, chemical substances and waste removal for each of the individual cells in the body
A average adult has 5 to 6 liters f blood
What is blood composed of?
erythrocytes (RBC)
leukocytes (WBC)
thrombocytes
platelets
plasma (main component)
serum (plasma, w/o clotting factors)
Erythrocytes (RBC's)
Carry hemoglobin (Hgb), which gives blood its red color and transport oxygen
Life span of 120 days, before being removed by the liver, bone marrow, or spleen
Transfer O2 to CO2
flexible shape
about 7 micrometer in diameter and 2 micrometers thick
Leukocytes (WBC's)
differ in size and shape
part of the body's defense mechanism
formed in the bone marrow and lymphatic tissues
there are 5,000-10,000 WBC's in a microliter of blood
Neutrophils
most abundant WBC; digest bacteria (phagocytosis)
Eosinophils
combat infection; control allergies and asthma
Basophils
release histamine(s) to defend the body
Lymphocytes
B- and T-cells; play a role in immunity
Monocytes
largest of the WBC's; stimulate other WBC's to defend the body
Thrombocytes and Platelets
created in the bone marrow
smallest of the blood cells
aid in the clotting process
life span 9-12 days
Antigen
a substance that prompts the generation of antibodies and can cause an immune response
Common Blood Test
CBC
WBC
Differential
Platelet count
Mean platelet volume(MPV)
RBC
Hematocrit(HCT)
Plasma
the colorless fluid part of blood, lymph, or milk in which corpuscles or fat globule are suspended
Serum
an amber-colored, protein-rich liquid that separates out when blood coagulates. (iquid portion of bld)
What are the three types of blood specimens that are used for analysis?
whole blood
serum
plasma
When does clotting begin?
30-60 minutes after blood has been drawn
Hemoglobin
measures the level of hemoglobin in the blood, which determined the oxygen carrying ability
Mean corpuscular Hgb
determines the average amount of hemoglobin in the average RBC
Thrombophlebitis
blood clots
Chem 7 (test type)
to asses basic organ function; genral metabolic screen/basic panel
Glucose Panel (test type)
to check for diabetes, which is indicated by elevated levels of glucose
Electrolyte Panel (test type)
to evaluate levels ion in the blood, which indicate various conditions
Liver Function Panel (test type)
to asses liver health/function
Renal function panel (test type)
to asses kidney health/function
Coronary Risk Panel (test type)
to asses risk of heart disease
Myocardial infarction screen (test type)
to asses occurrence and timing of heart attack that has already happened
Lipid Panel (test type)
to asses risk of cardiac event or stroke
Gauge size
20 to 21 gauge needles are used when collecting routine blood samples from adult patients
Anticoagulants
prevent clotting
What is EDTA's function?
preserves blood cell integrity, prevents platelet clumping, but interferes with coagulation studies
What is sodium citrate's function?
used for coagulation studies
What is SPS function?
used for blood culture because it inhibits certain immune system components that could destroy blood-borne bacteria
What is Heparin's function?
preferred for plasma chemistry and blood gas determination
What is potassium oxalate's function?
used for glucose determination; may be combined with sodium fluoride
What is the most important step before draw?
pt. identification
What do you check for on an inpatient?
first, last, dob, and check for there bracelet
What is a certification?
passing an exam
What is an accreditation?
meeting standards
What are the main antiseptic we use?
Isopropyl alcohol 70% a.k.a rubbing alcohol
iodine
chlorhexidine gluconate
soap and water (if allergic to all 3)
What steps do you take on an accidental self stick?
first push the bld out, second flush the site for at least 15 min. minimum, last wash with soap and water or antiseptic. if face and body contaminated wash for 15 min.
When should a sharps container be emptied?
when 3/4 of it is full
What is a fomite?
contaminated object
What do you do if bld. is spilled?
1:10 of bleach for 20-30 minutes
Chain of infection
contact #1, droplet, and airborne
How is Hep a,b,c,d transferable?
hep A- contaminated by food
hep B,C,D- thru bld.
PPE
personal protective equipment
What is an infection?
invasion or growth of a microorganism
Susceptible host
someone who easily gets sick
Isolation
separation of infectious source from susceptible host. also read chart to find out what type of isolation the pt. is on
Reservoir
someone who sick but don't show symptoms and can get everyone else sick
Nosocomial infection
infection acquired in the hospital
What is the most common nosocomial infection?
UTI (urinary tract infection)
What are the three main bld. vessels?
arteries, veins, and capillaries
Capillaries
are the smallest because they're one layer thin which is called tonica intima and it performs gas exchange
Arteries and Veins
they have three layers: tonica adventitia (outer)
tonica media (middle)
tonica intima (inner)
arteries have a pulse and pushes bld. away from the heart. veins have valves to prevent back flow and veins sends bld. to the heart
Arterioles and Venules
arterioles are the smallest artery in the body. venules are the smallest veins in the body.
Arterial and Venous bld.
arterial bld.-o2 and bright red
venous bld.-co2 and dark red
3 main veins
median cubital
cephalic (outer part of arm)
basilic (inner part of arm)- last choice because its a sensitive area and over brachial artery
Accidental artery puncture
apply pressure for 5 min.
Antecubital fossa
brachial crease area
What are the formed elements?
RBC- erythrocytes (live for 120 days or 4 months)
WBC- leukocytes
Platelets- thrombocytes
Hemoglobin
is a protein in the RBC that transport o2
What are the types of WBC?
neutrophils- increase during bacteria infection
basophils- allergic reaction
monocytes- largest WBC
lymphocytes- increase during viral infection
eosinophils- react to allergic reaction
Where do bld. cells come from?
bone marrow
Plasma
liquid portion of bld.
Centrifuge
machine that separates the liquid from the cells and will become damaged if unbalanced
Hemostasis
process of bld. coagulation or process of bld. vessels repairing after injury
What are the four phases of hemostasis?
vascular- cut, bleeding
platelet plug- bleeding stops
coagulation- clotting
fibrinolysis- skin heals, back to normal
Autoimmunity
body attacks itself
Autologous
donating bld. to yourself
What is the angle for a butterfly?
10 degrees to 15 degrees
What is the angle for a routine venipuncture?
15 degrees to 30 degrees
What is the angle for a bld. smear?
25 degrees to 30 degrees
What is another name for a bld. smear?
feathered edge
Phlebotomy gauge range?
21g-23g (21g is the most common)
What gauge is used when donating bld. and why?
16g to 18g the gauge is bigger so more bld. can be withdraw at a faster pace
What test is performed before surgery?
bleeding time test (wick bld. away every 30 sec. the test is to see how long pt. take to clot. the normal bleeding time is 2-10 min.
Why do we wipe the first drop of bld.?
to prevent contamination of tissue fluid
Dermal puncture and band aids
stops at age two or when child starts walking, pre warm site to increase bld. flow or heel warmer on pt. skin for 3-5 min. band aids before two are not giving to prevent choking
What is the evacuated tube system?
needle
tube
tube adapter
Primary 6 rubber stopper colors
yellow
light blue
red/sst/gold
green
lavender/pink
gray
Which color would you use as a discard tube?
red/glass
Dermal puncture on adult
3.0mm
Dermal puncture on infant
depth 2.0mm
Dermal puncture on premature infant
0.65-0.85mm width of lancet should not exceed 2.4
Basal state
8-12 hrs. fasting w/ water only
Lipid panel
cholesterol level (fats)
Glucose tolerance test
fasting 10-12 hrs.
2 hr. post prandial
2 hrs. after a meal, testing for diabetes
Test required chilled
lactic acid (gray)
ammonia (green)
ABG's
Light sensitive test
ammonia levels
ABG
bilirubin
Pre-warmed test
cold agglutinins
cryofibrinogen
cryoglobulin
Polycythemia
increase in RBC
OSHA
deal with bld. borne pathogens
Tort
visible injury
Assault
attempt or threat
Battery
forcing venipuncture on pt.
Lymphocytes
viral infections
Aerosol formation
microscopic mist of bld.
Blood time test
test for platelets, pump bld. to 40 for bp
What are the test for myocardial infraction?
ck-mb
myoglobin
troponin T
Hemolysis
destruction of RBC
Hemoconcentration
increase in the ratio of formed elements to plasma, usually caused by leaving tourniquet to long
Periphery
venipuncture site should be cleaned in a circular motion from the center to the periphery
Another term for fishing?
probing
What is the order of draw?
yellow, light blue, red, sst/tiger top, green, lavender or pink, gray, tan, royal blue
What is the additive for the yellow tube?
sodium polyanethol sulfonate and acid citrate dextrose
What is the additive for the light blue tube?
sodium citrate
What is the additive for the red tube?
plastic which is a clot activator and glass-none
What is the additive for the SST tube and the tiger top?
thixotropic gel and polymer gel
What is the additive for the green tube?
heparin
What is the additive for the lavender or pink tube?
EDTA- ethylenediaminetetraacetic acid
What is the additive for the gray tube?
sodium fluoride and potassium oxalate
What is the additive for the tan tube?
heparin
What is the additive for the royal blue tube?
heparin, edta or none
Why is the tourniquet used?
to stop the blood flow and get a good visual on the vein
What is the #1 way to prevent the transmission of disease?
hand washing
Define OSHA and it's responsibilities
federal agency charged with enforcement safety in the workplace
What is universal precautions?
treat all specimens as if they are hazardous
What are the smallest veins?
venules
Why is it necessary to wipe the first drop of blood from a capillary puncture?
contamination of interstitial tissue
Should blood be drawn below or above an IV site?
below
What do evacuated tubes contain?
additives and anticoagulants
What angle is a blood smear performed?
25 degrees to 30 degrees
What is a CBC and what color tube is it collected in?
complete blood count and lavender or pink
Calcium is bound by what tube additive?
EDTA
What is the standard needle size used in venipuncture?
21-23 gauge
What is the function of the urinary system?
filters blood and eliminates waste and also helps maintain blood ph
What is it called when a puncture site begins to sell and what should you do?
hematoma and remove needle and apply pressure
What is the function of the respiratory system?
provides oxygen and removes carbon dioxide
What artery is used in the ABG?
radial
When doing a coagulation study what color tube and how full should the tube be?
light blue and 9:1 ratio
What causes the formation of fibrin strands in a blood sample?
hemostasis
Ethanol specimens should be collected in what color tube?
gray
How do you use a bleach solution to clean a work station?
1:10 ration
How can aerosol contamination be prevented?
close centrifuge
What type of needle can be used to draw blood from a burn victim?
butterfly or dermal
What three things should a sharps container be?
spill proof, puncture proof and tamper proof
When is a bleeding time test performed?
before surgery
PT/PTT test are performed using what color tube and additive?
light blue and sodium citrate
What color tube does not have an additive?
red
What may cause a vein to collapse?
traumatic venipuncture
Name a test that should be kept warm at body temp.?
cold agglutinins
If a patient Is being kept in a protective isolation, who is being protected?
patient
What is medical ethics?
knowing the right from wrong in the medical field
If a therapeutic drug level is being drawn, what must the patient be asked?
last two doses of medication
What additives are in the gray tube?
sodium fluoride and potassium oxalate
When should tubes be mixed after draw?
immediately
Why would you use a dermal puncture instead of a venipuncture?
when a little amount of blood is needed
What might be the problem if no blood is obtained from a venipuncture?
needle depth
What is it called when a liquid becomes unclear?
lipemic or turbidity
How does one handle stress at work?
10 min. breaks , breathe and relax
Define the patients bill of rights
a list of guarantees for those receiving medical care
If a patient cannot roll up their sleeves for a draw, can they be gowned?
yes
What are some time dependent test?
gtt and bleeding time
What microorganism cannot live in human fluid?
fungus
If the top of an evacuated tube is popped, what can occur?
aerosol mist contamination
What is the function of the cardiovascular system?
blood circulation and removal of carbon dioxide to oxygen
What is quality assurance?
refers to engineering activities implemented in a quality system so that requirements for a product or service will be fulfilled
What do the hazard signs and colors represent?
chemical hazards and how crucial
If a patient requires a lipid panel, what information must be given to the patient?
must be fasting
What test is performed to confirm diabetes?
glucose tolerance test
How is the blood site cleaned?
concentric circles
What do anticoagulation tubes do?
keep the blood from clotting
How can the transmission of blood borne pathogens be prevented?
wear ppe, sterilize and wash hands
What is MSDS and what information is on the sheets?
material safety data sheet and chemical info in the lab
What are the three layers of a centrifuge sample?
red blood cells, buffy coat and plasma
Where is a heel stick on an infant performed?
medial lateral aspect of the heel
How long must a patient fast for a GTT?
10-12 hours
Name a light sensitive test?
bili, vitamin A/B12
A hemolysed sample is cause by what?
insufficient mixing
What is it called when someone donates blood for their own personal use?
autologous
What is the function of RBC?
transport oxygen and helps remove carbon dioxide
What is the topical antiseptic used for children called?
EMLA-topical cream
What are the components of blood?
plasma, red blood cells, white blood cells and platelets
Define hemostasis
the stopping of blood flow (vasoconstriction)
What analytical phase is the phlebotomist involved in?
pre-analytical
What is glucose meter used for?
measure blood glucose (sugar) in blood
What is the life of RBC?
120 days or 4 months
What are the tough and peak levels?
trough is the lowest and peak is the highest level to test drug levels in the body
What is a VAD?
venous access device which are small, flexible tubes placed in large veins for people who require frequent access to the bloodstream
Define reservoir host?
a host that serves as a source of infection (animals, people, plants)
Define negligence
failure to take proper care or to fail in resulting in damage or injury to another person
How are lab samples mailed?
watertight container, double bagged with biohazard label
What is chain of custody?
documentation or paper trail showing custody, control, transfer and analysis of everyone who comes in contact with the specimens
What is CAP?
college of American pathologist (leader in quality assurance)
What do WBC's do?
help the body fight infection
What does POCT stands for and explain it
point of care testing or bedside testing is defined as medical diagnostic testing at or near the point of care, that is at the time and place of patient care
What suffix means blood?
-emia
What is it called is a patients arm is swollen with excessive fluid?
lymphedema
When a pt. voluntarily permits to touching or an examination by a HCW they have given their what?
implied consent
What does the acronym R.A.C.E stand for with the actions of a fire?
rescue, alert, confine and escape
What vein is your last choice to use during a venipuncture?
basilic
What organization requires employees to be assessed for competency?
joint commission, CAP, COLA
An individual who has little resistance to an infectious microbe is referred to as the?
susceptible host
What are the three layers of a blood vessel?
tunica intima, tunica media, tunica adventitia
ESR
erythrocyte sedimentation rate
The term that describes an infection that infects the entire body is?
asymptomatic
The "right to know" law primarily deals with?
osha which requires manufactures of hazardous material to provide info
What is the correct order for removing protective closing
?
gown, gloves, mask
How can you visually tell serum from plasma?
plasma is liquid (cell-free) that has been centrifuge and serum is the liquid part of blood after coagulation
Hemoconcentration can be caused by?
insufficient mixing and traumatic venipuncture
What is the medical term for fainting?
syncope
If a patient refuses to let you draw blood from them what should your first step be?
slightly persuade them
What are the characteristic of capillaries?
thin walled, form microscopic pathways and connect arterioles and venules
A common name for thrombocytes is what?
platelets
What blood test is done to separate the WBC's?
cbc with diff
What is the primary function of the endocrine system?
controls the body to maintain homeostasis
Cleaning the site with betadine for a skin puncture may interfere with the analysis of?
alcohol and bilirubin
What is bilirubin?
a orange-yellow pigment formed in the liver by the breakdown of hemoglobin and excreted in bile
H&H is the abbreviation for?
hematocrit and hemoglobin
What is hematocrit?
the ratio of the volume of red blood cells to the total volume of blood
What is QNS and what are some reason's that will cause this?
quantity not sufficient. insufficient amount of blood and wrong order of draw