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ASCP American Society of Clinical Pathologists
NPA National Phlebotomy Association
NCA National Certification Agency
OSHA Occupational Safety & Health Administration/ They establish rules for safety in the workplace
Define Hemoconcentration A condition in which the concentration of blood cells is increased in proportion to the plasma
Define Hemolysis The destruction or dissolution of red blood cells, c subsequent release of hemoglobin
Define Plasma The liquid portion of whole blood that contains active clotting agents
Define Serum The liquid portion of whole blood that remains after the blood as clotted
Define Thixotropic Gel A material that appears to be solid until subjected to a disturbance, such as centrifugation, where upon it becomes a liquid
What do tourniquets do? Block the blood from flowing (venous)vasodilation
Where do you place tourniquets? 3-4" above site
How long can you leave tourniquets on? 1 Minute
What are the complications of leaving tourniquets on too long? Hemoconcentration, Interstitial fluid leaks into veins & cause hemolysis, numbness, tingling
Can you place tourniquets over clothing? Yes
What's the best time to release tourniquet? When last tube is 3/4 full before taking needle out
What can Happen if the needle comes out before the tourniquet is released? hemoconcentration
What is the action of alcohol? Clean area where needle will go/inhibit bacteria
What is the proper way to clean the venipuncture site? With alcohol pad in a circle inner/outer
How long does alcohol need to remain on the skin? until dry 30-60secs
When is alcohol contraindicated? Allergy, blood draw for alcohol level, blood culture
What 3 antiseptics can be used for blood cultures? Iodine, cholorhexidine gluconate, benzo
Light Blue (Click on this box) 1. What additive? 2. how does the additive work? 3. Hematology/coagulation study/Chemistry Test? 4. What is a waste tube and why is it drawn with a light blue tube? 1.Sodium Citrate (Click on this box) 2. Removes calcium to prevent blood from clotting 3. Coagulation Study 4. Pull clotting factors out, and to clean tube on butterfly
Gold/Red Grey 1. What additive? 2. Hematology/coagulation/chemistry 1. Clot activator/gel 2. Chemistry
Red 1. What additive? 2. Hematology/coagulation/chemistry 1.Clot Activator 2. Chemistry
Green 1. What additive? 2. Hematology/coagulation/chemistry 1.Heparin 2. Chemistry
Lavender/pink 1. What additive? 2. How does the additive work? 3. Hematology/coagulation/chemistry 1.EDTA 2.Removes calcium, prevents from clotting 3.Hematology
Grey: Glucose 1. What additive? 2. Hematology/coagulation/chemistry 1. Potassium oxalate, sodium chloride 2. Chemistry
Why is order of draw is important? So that you don't mix additives
Which tubes will always be first in the order of draw? Blue
Do larger tubes have more or less vacuum? Are they more or less likely to collapse a vein? More More
How much serum/plasma can you get from 6ml of blood? 3ml
What is thixotropic gel and how does it work in the venipuncture tube? a material that appears to be solid until subject to a disturbance, such as centrifuge, where it becomes liquid
When a tube contains thixotropic gel, what is it called? red-gray serum separator/pst(green-grey) plasma separator tube
How does it take blood to clot in a tube when there is no clot activator? 30-60min
What is a short draw? not enough blood in tube
What is the normal adult gauge? 21gauge(-20)
What is a multidraw needle and what is its purpose? They are used when several tubes are drawn during a single venipuncture. They are double printed....
When should you consider using a butterfly needle? On small veins. Pediatric, elderly, dehydration
How does butterfly tubing affect the vacuum applied to the veins? less powerful. Decreases it and prevents from collapsing.
When should you consider doing a syringe draw? When you think the section in a vacuum will collapse vein
When should you transfer the blood to the tube and why? Immediately, because it will clot in the barrel.
How do you choose the correct size syringe? Depending on how much blood you draw
How do you know if you are pulling the plunger back too fast? headspace more than 1ml
What are the 3 blood borne pathogens? HBV, HIV, HCV
Who writes the needle safety guidelines? OSHA
What is an SESIP and what is its purpose? Sharp c engineered sharps injury protection/device to prevent needle sticks
What do you do when there is an accidental needlestick? Wash for 10 minutes with antibacterial soap. Squeeze, tell supervisor, report (HIV) same day, 6 weeks;12 weeks;6months blood draw
What should you do if you patient has limited language skills? Have a family member or caregiver present
How do you obtain consent for routine venipuncture? Nonverbal, implied
What position should your patient be in for routine venipuncture? Seated in a chair or laying down
What position should your patient be in if they have problems getting their blood drawn? Laying Down
How do you choose your venipuncture site? By palpating to feel for veins
Which veins are most commonly used for venipuncture? Forearm or elbow(Antecubital) hand, cephalic, median basilic
Which Conditions might cause you to use an alternate site for venipuncture? Nerve Damage
What symptoms might suggest you are too close to a nerve? What should you do? Numbness, tingling, or shooting pain/ Stop and find another site.
What is the purpose of making a fist? Encourages vein easy to find
Why do we tell patients not to "pump" their fist more than one or two times? Because it may increase potassium and ionized calcium in the blood.
What angle of needle insertion do you use for the antecubital site? 15 degrees
What are the complications of inserting the needle too deeply? Hitting an artery, causing hematoma
What is the purpose of anchoring the vein or "pulling taut"? So blood will flow, easy to puncture,, stops vein from rolling
When should you tell your patient to release their first? When blood enters the tube
What is the proper way to change out your tubes? With your thumb
Why is venipuncture considered a surgical procedure? Because you are puncturing the skin.
When should you invert your tubes? Immediately, AFTER DRAW
What are the inversions for each of the following tubes: 1. Light Blue 2. Gold/red/red grey 3. Green 4. Lavender/pink 5. Gray 1. 3-4 2. 5 3. 8-10 4. 8-10 5. 8-10
What can happen to your specimen if you don't invert the tubes properly? The additive wont mix properly and it can develop small clots
What do you do to the site right after the needle is removed? Hold gauze over puncture site . Apply pressure tostop bleeding
If bleeding at the site doesn't stop, what techniques, in addition to pressure, can you use to stop the bleeding? Continue applying pressure, elevatearm above the heart, ice
How long do you observe the site before applying the bandage? 5-10secs
What is a hematoma? A large painful bruised area at the puncture site caused by blood leaking in tissue.
What are the most common causes of a hematoma? Excessive probing, failure to insert needle far enough, needle goes through the vein. Take needle out before tourniquet, not enough pressure.
What do you do if a hematoma forms during the venipuncture procedure? Discontinue stat apply pressure for a minimum of 3 minutes and then an ice pack to area.
What should you do if your patient faints? Remove tourniquet and needle secure pt. call for help
What are smelling salts and how do you use them? Amonia, crus, 4" under the nose(Wave)
What should you do if your patient complains of nausea? Keep going, talk to them, cool compression
What is the most common cause of specimen rejection? Hemolized specimen
List 7 Common Cause of Specimen rejection? Unlabeled or mislabeled specimens. Insufficient quantity . Hemolysis clotted blood in anticoagulated tube defective tube improper handling incorrect tubes used for test
Hemolysis rupture or destruction of red blood cells
What is a hemolyzed specimen? Broken RBC's in specimenBubbles
What is frothing? Bubbles in the blood
What are the 4 causes of frothing? Loose connection, pulling needle out of vein before tube is completely full, needle too big needle to small
How does frothing cause hemolysis? Creates a turbulence and air breaks cell
List 5 other causes of hemolysis from your book and how they cause hemolysis 1. Alcohol not dry 2. Specimen gets too hot or cold 3. Not transported upright inverting too vigorously 4. Prolong tourniquet time 5. Short draw-ratio chemical/blood
What size and type of needle used for children under 2? Butterfly 23guage/pediatric vacuum
What site for children under 2? Dorsal hand
What is the preferred method to collect blood in children under 2? Dermal Puncture
When should serum specimens be spun down in the centrifuge? After 30 minutes/within 2hrs of blood clotting
How long can whole blood be refridgerated? 72hrs
How should filled venipuncture tubes be transported? Biohazard bag, upright
What does chain of custody mean and what is its purpose? A legal term that refers to the ability to guarantee the identity and integrity of the specimen from collection to reporting test results.....
What kind of testing requires chain of custody? Drug and alcohol testing, DNA analysis or parentage testing
Created by: Lakisha Gill Lakisha Gill