Phlebotomy Worksheet D

Aliquot

A portion of a blood sample that has been removed/separated from the primary specimen tube.

Bilirubin

A chemical constituent in blood that is light sensitive that will decompose if exposed to light.

Centrifugation

Spinning a mixture in a centrifruge to separate components in difference in mass.

Critical value

A laboratory result that indicates a pathophysiologic state at such variance with normal as to be life threatening; these values should be defined and reported to the patient's physician as soon as possible. Also called a "panic value".

Pneumatic tube systems

Transportation system used in many health care facilities for specimens and paper-based documentation. Considerations for use of the these systems involves evaluation of speed, distance, control mechanisms, shock absorbency, sizes of carriers, and breakag

Requisition form

Paper-based method for requesting lab tests.

Sample integrity

When a specimen is stored correctly and is able to be tested by the lab means it has specimen integrity.

Turn around time (TAT)

The time it takes for a blood specimen to be ordered, collected, transported, processed, analyzed, and a result reported.

Acid Citrate Dextrose

An additive commonly used in specimens collected for blood donations to prevent clotting. It ensures that the red blood cells maintain their oxygen-carrying capacity.

Anticoagulants

Substance introduced into the blood or a blood specimen to keep it from clotting.

Capillary tubes

Disposable narrow-bore pipettes that are used for pediatric blood collections and/or micro hematocrit measures. The tubes may be coated with anticoagulant such as heparin, and for safety reasons are usually made of plastic.

Citrates

Type of anticoagulant additive for blood collection tubes; prevents the blood-clotting sequence by removing calcium and forming calcium salts.

Ethylenediaminetetraacetic acid (EDTA)

Anticoagulant additive used to prevent the blood-clotting sequence by removing calcium and forming calcium salts. It prevents platelet aggregation and is useful for platelet counts and platelet function tests. Fresh EDTA samples are also useful for making

Heparin

An anticoagulant that prevents blood clotting by inactivating thrombin and thromboplastin, the blood-clotting chemicals in the body.

Material safety data sheet (MSDS)

Required information about any chemical used in the workplace.

Oxalates

Anticoagulants that prevent blood-clotting sequence by removing calcium and forming calcium salts.

Sodium fluoride

An additive (antiglycolytic agent) present in specific blood collection tubes that is used to glycolytic inhibition tests.

Vacuum (evacuated) tubes

Color-coded specimen collection tube that contains a vacuum so as to aspirate blood when a needle enters a patient's vein.

Basal state

For phlebotomy procedures, this refers to the patient's condition in the early morning, approximately 12 hours after last ingestion of food.

Edema

Swelling.

Fistula

An artificial shunt or passage, commonly used in the arm of a patient undergoing kidney dialysis; the vein and artery are fused through surgical procedure.

Hematoma

A localized leakage of blood into the tissues or into an organ. In phlebotomy, it can occur as a result of blood leakage during the vein puncture, therefore causing a bruise.

Anemia

Medical condition whereby there is a reduction in hemoglobin.

Lipemia

Increased lipid content in the blood.

Mastectomy

Removal of breast tissue.

Syncope

The transient (and frequently sudden) loss of conscience due to a lack of oxygen to the brain and resulting in an inability to stay in an upright position. Patients usually recover their orientation. (Fainting)

Thrombi

Blood clots formed somewhere within the cardiovascular system; they may occlude a blood vessel or attach to the wall of a vessel.

List three laboratory tests that would require a sample to be chilled:

Ammonia, Blood gases, catecholamines, gastrin, lactic acid, parathyroid hormone, and pyruvate.

List the three steps of "labeling the specimen correctly", and what information it should contain?

1. Label should be placed or written in the correct orientation on the tube.
2. Healthcare workers should sign and initial each specimen.
3. The labeled tube should be compared to the pt's identification bracelet or have pt verbally confirm identity.
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Briefly describe the centrifugation process and the quality control measures the phlebotomist should take to ensure it is completed properly:

1.Serum specimens should be allowed to clot before centrifuge, complete clotting takes 30-60 mins. 2.Tubes should be centrifuged with stoppers/capes in place. 3.Specimens should be balanced in the centrifuge where as tubes with the same size and volume sh

List five reasons why a sample might be rejected by the lab:

1. Stored at wrong temp or humidity.
2. If it was exposed to light and was not supposed to be.
3. Method used for centrifuge.
4. Delay in transport.
5. Labeling inaccuracy.

What is the difference between serum and plasma?

Plasma contains fibrinogen and serum does not.

Briefly describe how EDTA and sodium citrate prevent blood clotting:

EDTA prevents clotting by binding calcium. Sodium citrate have calcium salts that remove calcium and inhibits clotting.

For each item, provide a statement of something the phlebotomist should remember:

Fasting blood test: The patient should not eat or drink anything 12 hours before the procedure to be considered fasting.
Fistula: Only specialized personnel can collect, avoid arm with fistula for site of venipuncture, NEVER put a tourniquet or BP cuff on

Which blood specimen should be chilled for a transport greater than thirty minutes?

Blood gases.

List and briefly explain three examples of how the phlebotomist's technique can impact the safety of the patient, the quality of the samples drawn, and/or your own safety:

...

What causes an elevated sodium level?

Drawing a gray top tube too early.

Order of draw:

Blood Cultures
Coagulants
Serum
Plasma
Whole blood
Molecular diagnostic testing

Why do we deliver micrbiological specimens quickly?

To avoid contamination.

When drawing a PT-INR with a butterfly:

The nonadditive tubes need to be drawn before the light blue top because the air in a butterfly needle can affect the ration.

SST tubes

Need to sit at least 30 minutes to clot but no more than two hours.
Also the SST and Gold are interchangeable.

To obtain plasma:

The blood cannot clot.

To obtain serum:

The blood need to clot.

Samples that need light protection:

Beta carotene, bilirubin, warfarins, folate, porphyrins, vitamin A, and vitamin B6.

When doing a blood draw from a pediatric patient:

You cannot take as much blood due to their size.