Alzheimer's disease
A disease that causes loss of intellectual abilities and mood disorders such as depression and combativeness. It is more prevalent in the elderly.
Calcaneus
Heel bone.
Capillary Blood Gas Analysis
Using microcollection methods on infants (usually the heel site) to collect specimens for blood gas analyses; these tests measure the carbon dioxide and oxygen in the blood.
Geriatric
Elderly Patient.
Heel Stick
Pediatric phlebotomy procedure that requires puncturing one of the specified areas of an infants heel.
Neonatal screening
Typically refers to mandatory lab testing of infants for specified disorders such as PKU and hypothyroidism.
Neonates
Newborn infant. Less than 28 days old.
Parkinson's disease
Neurological disease characterized by muscular tremors and rigid movements.
Pediatric phlebotomies
Procedures performed on infants and children that require specialized training and management.
Aerobic
Microbes that live only in the presence of oxygen.
Anaerobic
Microbes that live without the presence of oxygen.
Acid Citrate Dextrose (ACD)
Additive commonly used in specimens collected for blood donations to prevent clotting. RBCs maintain their oxygen carrying capacity.
Phenylketonuria
Congenital disorder, usually diagnosed at birth that can cause brain damage resulting in severe retardation, often with seizures and other neurological abnormalities.
Blood Gas Analysis
Analytical test that measures carbon dioxide and oxygen in the blood.
Diabetes Mellitus
Metabolic disease in which carbohydrate utilization is reduced due to a deficiency in insulin and characterized by hyperglycemia, glycosuria, water, and electrolyte loss, ketoacidosis, and in serious conditions, coma.
Insulin
A chemical produced by the pancreas that is released into the bloodstream to facilitate glucose absorption from the blood into the tissues where it is used for energy.
LDL Cholesterol
Bad" cholesterol. LDL stands for low density lipoprotein. High values are linked to heart disease.
HDL Cholesterol
Happy" cholesterol. HDL stands for high density lipoproteins.
Point-of-Care Testing
Testing performed near the patient or bedside.
Triglycerides
Fatty acids and glycerol that circulate in the blood and are stored as body fat.
Troponin T
A protein released and detected after a myocardial infarction (MI); it is elevated when heart damage has occurred.
Blood cultures
Tests that aid in identifying the specific bacterial organism causing infection in the blood.
Arterial Blood Gases (ABGs)
Analytical test that measures the oxygen and carbon dioxide in the blood.
Bacteremia
Presence of bacteria in the blood.
Cannula
A tube that can be inserted in a cavity or blood vessel and used as a channel for transporting fluids.
Glucose Tolerance test (GTT)
Diagnostic test for monitoring diabetes.
Chain of custody (COC)
Process for maintaining control and accountability of a specimen from the point of collection to its final disposition.
Clean Catch Midstream
A urine specimen that is used for detecting bacteria and/or microscopic analyses.
Creatinine Clearance
Analytic procedure to determine whether or not the kidneys are able to remove creatinine from the blood.
Culture and Sensitivity
Microbiologic test to determine the growth of infectious microorganisms in bodily specimens and to determine which antibiotics are most effective.
Diurnal Variation
Variations in the body's function of fluids that occur during the day or within a 24 hour period.
Fever of unknown origin
Indicates the pt has an undiagnosed infection.
Fistula
Artificial shunt or passage.
Modified Allen Test
Procedure used prior to drawing specimens from radial artery. It assures that the ulnar and radial arteries are providing collateral circulation to the hand area.
Postprandial Glucose Test
Glucose test performed after ingestion of a meal; useful in screening pt for diabetes.
Septicemia
Presence of toxins or multiplying bacteria in the blood.
Sodium Polyanethole Sulfonate (SPS)
An additive commonly used in blood culture bottles to prevent clotting.
Clincal record
Definitive documents that contain a chronological log of a pts care.
Computerized patient record
Computerized version of a medical record.
Electronic medical record
Computerized version of a medical/clinical record.
Requisition
Paper-based method for ordering labs.
STAT
Immediate.
How should you identify a pediatric patient in a hospital setting?
Identification bracelet, DOB, Requisition, and hospital room number.
Why is it important to monitor the amount of blood obtained from geriatric and pediatric patients?
Withdrawing too much blood can cause iatrogenic anemia, children have less blood volume to spare, and both groups may have had multiple blood draws that reduce their total blood volume.
List five tips for good communication that you feel are important to remember when working with pediatric patients and their parents:
1. Introduce yourself.
2. Allow child to touch clean equipment.
3. Allow time for questions.
4. Question parent about previous blood collection experience.
5. Demonstrate procedure with a doll.
What special instructions do you want to remember concerning heel sticks for infants:
Place the infant in a supine position, wipe the first drop of blood away, and warm the site but no longer than 20 minutes.
What special considerations should be made when performing a dermal/capillary stick for a pediatric blood gas sample:
Use a heparinized safety plastic capillary tube and warm the site. The specimen must be collected with no air bubbles because they can distort values obtained from a specimen.
What special instructions were provided in the presentation for conducting a PKU screening?
1. Each circle on the PKU form should be filled completely with only 1 drop of blood.
2. Do not add a 2nd drop of blood.
3. Dry blood spots on a cleat flat surface for 4 plus hours.
4. Send to the lab within 24 hours.
Aging challenges and strategies to help patients with them:
1. Mobility challenges: Use adjustable chairs, walk alongside to provide aid.
2. Memory loss and Alzheimer's: Approach calmly, explain slowly, use simple and short sentences.
3. Thinner skin, narrowed blood vessels, and bleeding issues: Tie tourniquets sn
Provide three example of blood tests that require the patient to fast , along with the hours they must fast:
Lipid profile: 9-12 hours
Glucose - 8 hours
Triglycerides - 12 hours
Cholesterol - 12 hours
Provide three reasons why blood test might require specific timing for the collection:
1. To measure diurnal variation.
2. To monitor medication levels.
3. To monitor bloods ability to clot.
Explain the purpose of blood culture samples, the special procedures involved, and the special equipment required for these samples.
Blood culture samples are drawn from patients who have a fever of unknown origin or a spreading infection such as septicima or bacteremia. The equipment used is a plastic or glass culture bottle, tube holder, special bottle for pediatric patients. The spe
Briefly explain what is meant by POC testing and provide an example and record any special procedures that you remember:
POC testing are tests done near the patient or bedside. Lipid profile is an example and the pt must be fasting 9-12 hours prior.
How do venipuncture procedures for blood donations differ from venipuncture procedures performed for blood test?
The gauge is larger for a blood donation procedure to keep from clotting.
Why do arterial blood sample procedures require special training?
An artery is deeper, harder to stick, and the flow of blood is harder to stop.
Why does it require special training to collect a blood sample from a fistula/cannula?
It requires sterile technique, Flushing the site prior is required, and further training is needed.
Provide two examples of special factors that must be considered for collecting fecal samples:
They may require special tubes. Ova and parasites testing must have a preservative or screen to be used during testing.
Blood cholesterol test
Must fast for 12 hours
Triglycerides
Must fast for 12 hours
Glucose levels
Must fast for 8 hours
Vitamin levels
Must fast for 8 hours
Lipid profiles
Must fast for 9-12 hours
Time sensitive tests
GTT, 2 hour GTT, gestational diabetes test, lactose tolerance test, and therapeutic drug monitoring.
Trough level
When monitoring drug levels, it's the level drawn before a drug or antibiotic is given.
Peak level
When monitoring drug levels, it's the level drawn after a drug or antibiotic is given.
Septicemia
Infection in the blood
When drawing a blood culture using a butterfly draw the aerobic first.
If using a straight needle, draw the anaerobic first.
Hematocrit
The percentage of RBC in the blood.
Hemoglobin
Used for the diagnosis and analysis of blood anemias.
Heel stick
A dermal/capillary puncture in an infant.
Pediatric Phlebotomy
Do not take more than 3% in one sitting.
Pediatric phlebotomy
Do not take more than 10% in one month.
Tips for quality pediatric blood collection
1. Communication
- Verify pt identity, obtain informed consent
- Question parent about previous blood collection experience
- Instruct parent on how they can assist
2. Plan an approach
3. Assistance in restraining a child
4. Work quickly and calmly
5. PPE
Communicating with children and young adults
- eye level with child
-demonstrate with a doll
- inform pt about procedure
- be honest about procedure and what they can expect
-Allow time for questions
- Provide info on care of site post collection
Pediatric capillary puncture
- Warm site for no longer than 20 minutes
- Clean with 70% isopropyl alcohol pad; let dry to avoid hemolysis
- Place lancet firmly against skin and align blade to cut across the grooves of the heel print or finger print
- The depth of the puncture should
Appropriate puncture sites for a heel stick
- Medial section of the plantar (sole of the foot)
- Avoid calcaneus (heel bone)
- May need to pre warm the site no longer than 3-5 minutes
- Never place bandage on an infant
Equipment needed - disposable lancet, gloves, alcohol pads, capillary tubes, 2x2
Neonatal screening
1. Each circle on the PKU form should be filled completely with just 1 drop of blood
2. Do not add a 2nd drop of blood to a previously used circle
3. Dry blood spots on a clean flat surface for 4+ hours
4. Send screening to the lab within 24 hours
Important steps in working with special needs patients
1. Patient identification
2. Communication
3. Venipuncture
4. Documentation
Tips for documenting Medical information
1. Be accurate, concise, and legible
2. Written records should be done in ink.
3. Electronic errors should be screened before submission of document.
4. Include all procedures and interventions as they are performed on the patient.