Hemoconcentration
Condition which the concentration of blood cells is increased in proportion to the plasma
Hemolysis
The destruction or dissolution of red blood cells, with subsequent release of hemoglobin
Plasma
The liquid portion of blood that contains an active clotting agents.
Serum
The liquid portion of blood that remains after the blood has clotted
Thixotropic gel
Material that appears to be a solid until subjected to a disturbance, such as centrifugation, where it becomes a liquid
Main artery leaving the heart
Aorta
Carries oxygenated blood to body from heart
Arteries
Smaller vessel branches
Arterioles
Near The surface where O2 ( oxygen) is released
Capillaries
Erythrocytes are ___. Leukocytes are _____.
Red blood cells. White blood cells.
______is the most common method of obtaining blood
Venipuncture
nearly ____% of physicians decisions are based on laboratory blood tests
80%
Phlebotomy is performed primarily for ______ and to _____ a pts condition
Diagnoses, monitor
In bloodletting, barbers advertised with red/white striped pole. Red represented____,and white represented the____
Blood, tourniquet
The circularly system consists of :
�heart, chambers and valves
�blood vessels
�blood
Circulatory system consists of everything except_____
Capillaries
The heart, chamber & valves pumps to____from____.
To body, from ventricle
Blood vessels are 3 layers:
_� outter: tunica adventitia (connective tissue)
�middle: tunica media(smooth muscle)
�inner: tunica intima(endothelium)
Average adult has ___ to____ liters of blood
5 to 6
Blood has liquid plasma of___% and solid plasma of____%
Liquid 55%
Solid 45%
All blood cells originate from stem cells in the ____ ____
Bone marrow
What is found in liquid plasma?
Proteins, amino acids, gases, electrolytes, sugars, hormones, minerals, vitamins and water(92%), and waste products
What is found in Solid form plasma
-Erythrocytes- red blood cells (99%formed elements
- Leukocytes- white blood cells
- thrombocytes- platelets
Blood vessels
�blood vessels:
- Aorta- main artery leaving the heart
- Arteries- oxygenated blood to body from heart
- Arterioles- Smaller vessel branches
- Capillaries- near surface where O2 is released
- Venules- smaller vessel between capillaries and veins; starting
Erythrocytes carry oxygen by _______, to the body
Hemoglobin
Normal Erythrocytes (RBC's) is ___ to ___ million per microliter of blood.
4.2 to 6.2
_____ is the average lifespan of erythrocytes (RBC's)
120 days
_____ protects the body against infection
Leukocytes( White blood cells)
Normal Leukocytes ( WBC's) is ___ - ___per microliter
5,000 to 10,000
NPA
National phlebotomy association
ASPT
American society of phlebotomy technicians
IAPS
International Academy of phlebotomy sciences
ASCP
American Society of clinical pathologist
If a patient has a history of syncope, it is best to perform phlebotomy while the patient is?
Lying on in exam table
When performing venipuncture you will likely seat a patient in a _______, which has an adjustable locking armrest to protect the patient if he or she should faint
Venipuncture chair
Keep in mind that the tourniquet should be tied for no longer than?
One minute
Tourniquets are tied ____to_____ above the elbow before venipuncture.
3 to 4 inches
A tourniquet prevents venous blood flow out of the site, causing the veins to _______.
Bulge
When applying a tourniquet the vein should bulge, but it should not restrict__________.
Arterial flow
Tie a tourniquet so it can be released with only?
One hand
Leaving A tourniquet on for longer than one minute greatly increases the possibility of__________.
Hemoconcentration
The most commonly used anti-septic for Cleaning a site for venipuncture is ___%, ______________,( known as rubbing alcohol)
70% isopropyl alcohol(prep pads)
A rubbing alcohol prep pad used for venipuncture, is rubbed on the skin in a ________ motion, and the alcohol is allowed to dry.
Circular
To be most effective alcohol should remain on the skin for ___to___ seconds before drawing venipuncture
30 to 60 seconds
What are the 4 antiseptics used for cleansing the skin before performing venipuncture
�alcohol pads( 70% isopropyl alcohol
�sterile soap pads
� benzalkonium chloride
� providone iodine ( betadine)
Equipment used in routine venipuncture
Gloves, bandages, gauze pads, alcohol swabs, marking pen, tourniquet, wing infused sets( butterfly needles), evacuated stopper tubes, double pointed safety needles, syringes, sharps container, needle holder
_______ is the most common collection system in use.
Evacuated tube ( vacutainer ) system.
Be sure to match the _____gauge to the size of the tube.
Needle
Tube additives contain ______, _______.
Anticoagulants, clot activators/or gel
Tube volumes range from ____ to ____mL.
2mL to 15mL
All tubes except the _____ topped one contain an additive.
Red-topped
_________ an additive added to tubes to prevent blood from clotting.
Anticoagulants
_______ is an additive that quickly promotes clotting and is used in tubes drawn for stat chemistry testing or in the event a sample is needed from a pt taking a prescribed anticoagulant.
Thrombin
_____ is a blood thinner.
Heparin
Liquid portion of blood is called _____.
Plasma
Without a clot activator, blood clots in ___ to ____ minutes, after which it must be_____.
� 30 to 60 minutes
� centrifuged
Order of draw
�Yellow- blood culture
�Light Blue-sodium citrate. Coag.
�Red-none, serum tests
�Green-Heparin
�Lavender- EDTA. CBC.
�Gray- sodium fluoride, and oxalate
ADDITIVE & FUNCTION--
�SPS, prevents blood from clotting & stabilizes bacterial growth.
LAB USE:
�blood or body fluid cultures
OPTIMUM VOL & MIN VOL-5ml/NA
Yellow 5ml
ADDITIVE AND FUNCTION:
�Sodium citrate; removes calcium to prevent blood from clotting.
LAB USE:
�Coagulation testing
OPTIMUM VOL & MIN VOL: 4.5mL/4.5mL
Light Blue 4.5mL/4.5mL
ADDITIVE & FUNCTION:
�None
LAB USE:
� Serum tests, chemistry studies, blood bank, serology.
OPTIMUM VOL & MIN VOL: 10mL/NA
Red 10mL/NA
ADDITIVE & FUNCTION:
� Heparin,( sodium/lithium/ammonium); inhibits thrombin formation to prevent clotting.
LAB USE:
�Chemistry
OPTIMUM & MIN VOL: 10mL/3.5mL
Green
ADDITIVE & FUNCTION:
�EDTA, removes calcium to prevent blood from clotting.
LAB USE:
Hematology testing .
OPTIMUM & MIN VOL: 7mL/2mL
Lavender( used for complete blood counts)
ADDITIVE & FUNCTION:
Potassium oxalate and sodium fluoride; remove calcium to prevent blood from clotting; fluoride inhibits glycolysis.
LAB USE:
Chemistry testing, especially glucose and alcohol levels.
OPTIMUM & MIN VOL: 10mL/10mL
Gray
_____, is found in the lavender topped tube, removes calcium to prevent blood from clotting
EDTA
Needles have two parts
Hub and shaft
Shafts differ in length, ranging from ____ to ____ inches.
3/4in to 1 1/2inches
The end of the shaft is cut at an angle and forms the ______.
Bevel
The hole in the bevel is called the_____
Lumen
Lumen size is important in venipuncture and is referred to as the ____
Gauge
The gauge is designed by a numeric value; the higher the number gauge, the smaller the _____ is.
Lumen
The smaller the number gauge, the bigger ____ is.
Lumen
Normal adult draw is __ - __ size gauge.
20-21 g
A pediatric draw is ___ gauge
23g
Blood donation gauge size ___
16g
The smallest gauge needle is the___gauge. It is used to collect the blood from small or fragile veins.
23g
Multisample needles are used when several tubes are to be drawn during a single venipuncture. These needles are _____ ______. The point that enters the tube is sheathed with a rtractable rubber sleeve that allows tubes to be changed.
Double pointed.
Used when there is concern that the strong vacuum in a stopper tube might collapse the vein.
Syringe
Designed for use on small veins, such as those in the hand or in pediatric patients.
Butterfly Needle
The most common needle size for a butterfly needle is
23g, 1/2 to 3/4 inches long.
Double pointed needles must be firmly placed into a needle adapter or
Tube Holder
These devices, which are attached to the phlebotomy needle or to a winged infusion needle, are manually engaged after the needle has been removed from the vein.
Hinged or sliding safety mechanism.
- immediately after injury, the wound is inspected for foreign material which is removed. The site is washed for 10 minutes with an antimicrobial soap, 10% iodine solution, or chlorine based antiseptic.
- The injury is reported to the supervisor and an in
Postexposure management of needlesticks
All blood collections begin with a form from the patient's physician requesting a test. They may be computer-generated or hand written.
Requisition Form
What information must be included on a requisition form.
-patients name
-date of birth
-identification number
-name of the physician making the request
-type of test requested
-test status
(Timed, fasting, stat, etc)
Which venipuncture site is first choice and runs at a slight angle in the antecubital area
Median cephalic vein
Which venipuncture site is second of choice and runs lateral or to the outside of the antecubital area on thumb side.
Cephalic Vein
Which vein lies on the inside antecubital pinky side and is last of choice.
Basilic vein
What are the 5 unsuitable veins.
- sclerosed veins
-thrombotic veins
-trotuous veins
- arms with Iv's
- arms w/shunts(dialysis pt.)
___ veins feel hard and cordlike. May be damaged from disease, inflammation, chemotherapy, or repeated venipunctures.
Sclerosed veins
___ veins contain clots
Thrombotic
___veins are winding crooked veins. Blood flow will be impaired.
Trotuous veins
Name two patient identifiers
Name, DOB
___ is the laboratory procedure most frequently ordered for blood specimens.
CBC, ( complete blood count)
A CBC routinely includes the following
-RBC COUNT
- WBC COUNT
- Hemoglobin determination
- hematocrit determination
- differential WBC count
- estimation platelet numbers
- red cell indices
Larger veins that returns deoxygenated blood back to the heart( goes to lungs or refill)
Veins
Leukocytosis
Bacterial infection and leukemia
Leukopenia
Viral infections and chemotherapy
___ is a measurement of the percentage of packed red blood cells in a volume of blood
Hematocrit
The ____ determination is a rough measurement of the oxygen carrying capacity of blood
Hemoglobin
Is A large painful bruised area at the puncture site caused by blood leaking into the tissue, which causes the tissue around the puncture site to swell.
Hematoma
In hematocrit testing, two or three drops of blood are collected from a capillary puncture in two capillary tubes and are placed in a ____.
Microhematocrit centrifuge
What test is based on The principle of separating the cellular elements from plasma by centrifugation
Spun microhematocrit test
What machine is used to test hemoglobin
Stat-site system
Inflammation of a vein due to repeated venipuncture
Phlebitis
Blood clot at site, usually not applied enough pressure
Thrombus
Inflammation of a vein with formation of a clot
Thrombophlebitis
Systemic infection ( organisms ), introduced during venipuncture
Septicemia
Injury to underlying tissues caused by excess of probing
Trauma
Ruptured capillaries due to tourniquet left on too long
Petechia
Factors to consider when drawing venipuncture
- fasting
- edema - swelling
- fistula- surgical connection between artery and vein,( dialysis pt )
When should you label tubes
After draw at pts. side
Glass or plastic tubes that draw blood by capillary action, the blood fills into these tubes without the need for section
Capillary tubes
Equipment needed for capillary punctures
- alcohol pad
- gauze
- lancet
- capillary tube
Depth of capillary puncture for infant and adult
Infant - 0.85 to 2.0
Adult- 0.85 to 3.0
For a heel puncture do not go deeper than____mm
2.0
____ contains tissue fluid
Capillary samples
Order of draw for capillary specimens
-lavender
- additives
- without additives
Restraints for children
Papose boards
____ is a legal term that refers to the ability to guarantee the identity and integrity that the specimen from collection to reporting of test results. May be used for drug and alcohol testing, DNA analysis, or parentage testing in court
Chain of custody
part of the whole specimen that has been taken off for use or storage and transferred from one tube to another
aliquot
____ samples is a mixture of venous and arterial blood
Capillary samples
Hemoglobin and glucose are higher in?
Capillary blood