You can never stop an IV to
draw blood
Departments of a laboratory and test performed
Microbiology / Culture & sensitivity, histology/ process & stains tissues
What is Hemolysis?
It is the destruction of red blood cells, it affects the results & can happen no matter how hard we try not to.
A CBC test is most affected by?
Hemolysis
What happens to urine components if not processed in a timely fashion?
Bacteria multiplies, cellular components decompose and glucose breaks down
Where is the primary choice vein that is used for venipuncture?
Median Cutaneous Fossa
What is the ideal place to draw blood first?
Median Cubital Vein
An artery
has a pulse
The saphenous vein
is the longest vein in the body
To avoid hemolysis you must
allow alcohol to dry on the skin before performing skin punctures
An evacuated tube system
is the most common system used for collecting blood
Ethylenediaminetracetic Acid (EDTA)
is an anticoagulant used in tube for CBC
A Sclerosed Vein
feels hard & cord like
Red/Gray top tube contains:
Gel separator / activator
Reasons to recollect blood samples:
Hemolyzed specimen especially for K+(potassium) anticoagulant tube (lavender or light blue) has a clot partially filled tube
What is the most crucial step in performing a venipuncture?
Identify the patient
How many times should you attempt to draw blood before asking for help
2
Skin puncture blood is:
Arterial & contains interstitial fluid
Skin punctures with lancets should always:
Be made perpendicular to the whorls of the fingerprint
Always wipe the 1st drop of blood away when:
Performing skin punctures
A blood culture test requires:
Strict aseptic technique
What is a Bilirubin Test?
Most common light sensitive test
Critical volume tube:
Used for coagulation test 9:1 ratio of blood to anticoagulant
When performing a blood alcohol test:
Never use isopropyl alcohol as antiseptic
Chain of custody:
Important in any legal / forensic testing
Therapeutic phlebotomy:
Procedure used to remove a unit of blood for diagnosis. Example: Polycythemia
What is Phlebitis?
Inflammation of a vein
The Median brachial nerve:
Is the largest nerve that runs through the arm and should be avoided during venipuncture
Leg, Ankle, and foot veins can be used:
If no other sites are available with the permission of the patients physician
Parts of a syringe:
Plunger, needle, barrel, and needle hub
What is the most common complication of a routine venipuncture?
Hemolysis
The Cephalic Vein is :
Lateral to median cubital vein / 2nd choice for venipuncture
The Urine C & S is:
A test used to check for presence of an UTI
The Plain red top tube is used:
When serum sample test has to be sent out
Examples of antiseptics:
Peroxide, alcohol and Iodine
Massaging the forearm from the elbow to wrist, heat application on the are, palpating the vein site will:
Aid in increasing peripheral dilation of the vein
Gloves are the protective barrier:
Used when performing venipunture
What is the 1st action used when a hematoma begins to form while performing venipuncture?
to remove the tourniquet
What is Hexachlorophene?
Antiseptic of choice for collecting alcohol levels
The Radial artery:
is used for blood gas sampling
Sodium fluoride:
is an additive used to keep glucose values stable in plasma
What are some complications that can occur from leaving a tourniquet on too long?
Hemoconcentration, discomfort to the patient and erroneous lab results
What is the Sagittal plane?
It divides the body into right and left halves
Allen Test: Why is it performed?
To assess circulation
What is the single most important way to prevent the spread of infection?
Hand washing
Which tube is used for CBC?
Lavender tube
What are the parts of a needle?
Bevel, hub, lumen, and shaft (measured in inches)
Why is it necessary to control the depth of a lancet insertion during a skin puncture to avoid?
To avoid bone penetration
Why is it important to anchor a vein during venipuncture?
It keeps veins from rolling
Why are specimens rejected?
Discrepancy between the requisition and label, unlabeled tubes, partially filled tubes & clots in anticoagulant tubes
What is citrate?
An Anticoagulant
Tourniquets should not be left on for more than:
60 seconds
What is the proper order in which to fill evacuated tubes from the syringe method, evacuated tube system?
Tubes are filled the same way for both
Vacutainer needles:
Are not reuseable
What does the Green top tubes contain?
Sodium heparin
What is Thixotropic gel?
A serum separator
OSHA standard of possible infectious fluid refers to what fluids?
Vomitus, serat sputum, nasal secretions, stool, urine and blood
What are example of susceptible host?
Diabetic patients, HIV/HEP B positive patients, elderly patients and an infant (everyone)
What is the procedure for entering a patients room (awake and sleeping)?
Always knock introduce yourself and what department you are from. If patient is sleeping gently wake the patient then begin venipunture
What is an outpatient?
Someone who is not admitted into the hospital
Serum contains:
All clotting factors have been removed
What tubes are used for a Glucose tolerance test?
Gray top tubes and test is drawn every hour
Why is the syringe method used to draw blood?
Patient who has fragile or small veins
When do you remove the tourniquet?
Before the needle is withdrawn
Tourniquet placement:
2 to 4 inches or 3 to 4 inches
PT test is automatically rejected if:
Clots are detected in the tube
Class capillary tubes are primarily used to test for?
Hematocrit determinations
The smaller the gauge number:
the larger the lumen diameter
According to universal precautions:
All blood is considered infected with HIV & HBV and all body fluids are considered infected with bloodborn pathogens
What is a Stat Test?
Immediate response/ Emergency room
How to approach a child when needing to draw blood?
Explain what you are going to do in simple terms and ask the child to cooperate
Gauze pads are used to cover sites when holding pressure rather than cotton balls because?
cotton fibers tent to stick to the site
When performing a capillary collection most commonly used is the?
Third finger
If you are filling a tube with a syringe and need to stop:
pull back on the plunger (if you don't want the tube filled completely)
Ethics are?
Principles of right and wrong conduct as they apply to professional problems
What is Informed consent?
a patient agrees to a procedure after being told the consequences associated with it
Patients Bill of rights is:
A patient has the right to be treated with respect and refuse care
What are the Primary responsibilities of a phlebotomist?
Collect blood samples
What are expanded duties of a phlebotomist?
Lab, computer operations
Which tube is used for Cardiac Enzymes?
Red or tiger top
Which tube is used for PT/PTT?
Light blue
Which tube is used for electrolytes?
Light green or red
The department for the yellow tube is:
Microbiology
What additives are in the yellow tube ?
Sodium polyethylene Sulfonate (SPS)
Does the yellow tube contain Serum or plasma?
Neither
What department for the light blue tube?
Coagulation
What additive are in the light blue tube?
Sodium citrate
What departments does the Red glass tube go?
Chemistry, Blood bank, Serology, Immunology or throw away
The red glass tube contains
Serum
What department does the red plastic tube go?
Chemistry
What additives are in the red plastic tube?
Clot activators, silica thrombin (also called SST)
The red plastic tube contains?
Serum
What additives are in the Gold / Red / Gray (tiger top)?
Clot activators and gel separators (thixotropic gel)
What department does the Gold / Red / Gray (tiger top) go?
Chemistry
The Gold / Red / Gray (tiger top) contains?
Serum
The light green, green gray tube contains?
Plasma
Light green, green gray tube goes to which department?
Chemistry
What additives are in the Light green, green gray tube?
Lithium heparin and gel separator also called PST
The tan glass tube goes to which department?
Chemistry
What additives are in the tan glass tube?
Sodium heparin
The tan glass tube contains:
Plasma
The Dark Green tube contains:
Plasma
What additives are in the dark green tube?
Lithium or sodium heaparin
The dark green tube goes to which department?
Chemistry
The lavender tube goes to which department?
Hematology
The lavender tube contains:
Plasma
The additive in the lavender tube is?
EDTA Ethylenediaminetetraacetic acid
The pink tube contains:
Plasma
The pink tube belongs to which department?
the blood bank
What additive is in the pink tube?
EDTA Ethylenediaminetetraacetic acid
The royal blue tube belongs to which department?
Chemistry
Royal Blue Tube contains:
Plasma
Royal blue tube:
Red label: no additives
Lavender label: EDTA
Green Label: Sodium Heparin
Tan plastic tube contains:
Plasma
The additives in the tan plastic tube is:
EDTA (Checking lead levels)
The Grey tube contains:
Plasma
The additive in the grey tube is:
Sodium Fluoride potassium oxalate
What department does the Grey tube go?
Chemistry
List the tube colors in order
Yellow
Light Blue
Red Glass
Red Plastic
Gold/Red/Gray (tiger top)
Light Green, Green Gray
Tan Glass
Dark Green
Lavender
Pink
Royal Blue
Tan Plastic
Grey