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Blood Collection
Blood collection variables, complications, and procedural errors
| Question | Answer |
|---|---|
| Basal State | early in the morning while the body is at rest and approximately 12 hours after last intake of food, exercise, or activity. |
| collapsed vein | abnormal retraction of blood vessel walls, temporarily shutting off blood flow. |
| CVC | type of line inserted into a large vein and advanced into the superior vena cava, proximal to the right atrium. |
| diurnal variations | normal fluctuations throughtout the day |
| edema | accumulation of fluid in the tissues |
| fistula | internal shunt created by permanent fusion of an artery and a vein |
| hematoma | swelling or mass of blood caused by leakage of blood from a vessel during or after venipuncture or arterial puncture |
| hemoconcentration | decrease in blood fluid content with an increase in nonfilterable components such as RBC's |
| hemolysis | DESTRUCTION of RBCs and liberation of hemoglobin into the fluid portion of a specimen |
| heparin lock | special winged needle set or cannula that can be left in a patient's arm for up to 48 hours and used to administer medication and draw blood |
| iatrogenic | induced by the effects of medical treatment, facilities, and personnel |
| lipemic | term used to describe cloudy serum or plasma caused by increased fat or lipid content |
| patency | state of being freely open, as in a patient's vein |
| petechiae | small, non-raised red spots that appear on a patient's skin when a tourniquet is applied because of a defect in the capillary walls or platelets |
| reflux | backflow of blood from a collection tube into a patent's vein during venipuncture |
| sclerosed | hard, cord-like, and lacking resiliency |
| synocope | fainting |
| thrombosed | clotted |
| VAD | tubing inserted into a main vein or artery and used for administering fluids and medications, monitoring pressures, and drawing blood |
| basal state specimens | establishing inpatient reference ranges |
| patient closes to basal state | awakened at 0600 hours after fasting since the previous evening meal |
| creatinine clearance | timed tests that measures amount of waste product in your blood and urine, and requires the patient's age when calculating |
| Red Blood Count | test that is most affected by altitude? |
| hemoconcentration of the blood | persistent diarrhea in the absence of fluid may cause? |
| serum or plasma of a lipemic specimen | cloudy and is a clue that the patient most likely was not fasting |
| triglycerides | 12-hour fast is normally required when testing for this analyte? |
| corisol | blood component exhibits diurnal variation with peak levels occurring in the morning |
| timed (collected at a specific time) | tests influenced by diurnal variation are often ordered? |
| 4-24 | College of American Pathologists (CAP) guidelines state that drugs known to interfere with blood tests should be discontinued how many hours before the test? |
| what can falsely decrease test results | a drug that competes with the test reagents for the analyte being tested |
| enzymes | analytes is most affected by muscular activity before specimen collection? |
| presence of fever influences the levels | insulin, glucagon, and corisol |
| analyte has higher reference values for males than for females | hematocrit (measure of the volume of red bloods cells in a patients blood) |
| icteric | relating to or marked by jaundice and is used to describe serum, plasma, or urine specimens that have an abnormal deep yellow to yellow-brown color due to high bilirubin levels |
| icteric speciman | may indicate that the patient has hepatitis, may yield erroneous test results for some analytes, and will most likely have a high bilirubin level |
| what physical changes occur when a patient goes from supine to standing? | nonfilterable blood elements increase |
| why do pregnant patients have lower reference ranges for red blood counts? | body fluid increases in pregnancy have a diluting effect on red blood cells |
| analytes that may increase in smokers | corisol, hemoglobin, and white blood count |
| it is not a good idea to collect a complete blood count from a screaming infant because | can temporarily elevate the white blood count |
| factors known to affect basal state, which would be automatically accounted for when reference ranges are established | geographic enviroment |
| reasons to control temperature and humidity in laboratory | to establish reference values under controlled conditions, to ensure proper functioning of equipement, and to maintain speciman integrity |
| scarred or burned areas should be avoided as blood collection sites because | newly burned sites may be painful and are susceptible to infection, scarred sites may have impaired circulation, and veins are difficult to palpate in such areas |
| veins that feel hard and cord-like and lacks resiliency | thrombosed |
| if you have no choice but to collect a specimen from an arm with a hematoma, collect the specimen | distal to the hematoma |
| drawing blood from an edematous extremity may cause | erroneous results (due to contamination with tissue fluide or altered blood composition caused by swelling) |
| a venipuncture made through a hematoma can cause | can result in the collection of hemolyzed blood, is painful to patient, may cause inaccurate test results on the specimen |
| avoid collecting a specimen from an arm on the same side as a mastectomy because | arm is usually edematous, effects of lymphostasis may cause erroneous results, and veins in that arm may collapse more easily |
| you must collect a protime specimen from a patient with IV's in both arms. The best place to collect the specimen is | below one of the IV's |
| a phlebotomist must collect a hemoglobin on a patient in the intensive care unit. There is an IV in the patient's left arm. There is no suitable antecubital vein or hand vein in the right arm. What should the phlebotomist do? | collect the specimen by skin puncture of a finger of the right hand |
| which of the following should be avoided when selecting a venipuncture site? | a previous IV site within 24 hours of IV removal, an arm that has a heparin lock in the wrist area, and an arm with an arteriovenous (AV) shunt in the forearm |
| a type of line that is commonly used to collect blood gas specimans | arterial line |
| a vascular access pathway that is surgically created to provide access for dialysis is called? | arteriovenous (AV) shunt |
| when a blood specimen is collected from a heparin lock, it is important to draw | a 5 ml dicard tube before collecting the specimen |
| central venous catheters include all the following | broviac, groshong, and hickman |
| a subcutaneous vascular access device consisting of a small chamber attached to an indwelling line that is implanted under the skin and located by palpating the skin | implanted port |
| how do you bandage a venipuncture site if the patient is allergic to the glue in adhesive bandages? | use paper tape over a folded gauze square placed over the site |
| you may have to be careful about what type of equipment is brought into the room if a: patient or roommate is severely allergic to what? | latex (nonlatex gloves, tourniquet, and bandges) |
| if blood collection site continues to bleed after 5 minutes: | notify the patient's physican or nurse |
| which patient should be asked to lie down during a blood draw? | history of syncope during blood draws |
| what should a phlebotomist do if a patient feels faint during a blood draw? | immediately discontinue the draw and lower the patients head |
| an outpatient becomes weak and pale following blood collection. What should the phlebotomist do? | have the patient lie down |
| if an outpatient tells you that she is feeling nauseous, you should | give her an emesis basin in case she vomits, hold a cold damp washcloth to her forhead, and tell her to breathe slowly and deeply |
| Which vein is often the one that is easiest to feel on obese patients? | cephalic |
| what should a phlebotomist do if the patient goes into convulsions while in the middle of a venipuncture | remove the needle as soon as possible, prevent the patient from injuring himself or herself, and notify appropriate first aide personnel |
| phlebotomist is in the process of collecting a blood specimen on a patient with difficult veins. You have just started to fill the first tube slowly. The skin around the venipuncture site starts to swell. What should the phlebotomist do? | remove tourniquet and discontinue the draw immediately |
| What can cause a hematoma formation | inadequate pressure is applied to site after needle removal, the needle has penetrated through the back of the vein, and needle bevel is only partially inserted in the vein |
| What is the best indication that you have accidentally punctuated an artery | the blood pulses into the tube |
| term used to describe anemia brought on by withdrawal of blood for testing | iatrogenic |
| if you suspect that you have accidentally collected an arterial specimen instead of a venous specimen | keep the specimen and label it as a possible arterial specimen |
| infection at the site following venipuncture can result from | touching the site after it has been cleaned |
| escessive or blind probing for a vein can cause | nerve damage |
| a patient complains of significant pain does not subside and raidates down his arm. What should you do | discontinue the draw immediately |
| stinging sensation when a needle is first inserted is most likely the result of | not allowing the alcohol to dry properly |
| what is the best way to avoid reflux? | make certain the tube fills from the bottom up |
| what is the least likely way to impair vein patency? | performing numerous venipuntures in the same area |
| prolong tourniquet application may cause a change in blood composition primarily because of | hemoconcentration |
| serum or plasma of a hemolyzed speciman appears | pink or reddish |
| which action is least likely to cause hemolysis of a specimen? | collecting more than one tube of blood |
| the ratio of blood to anticoagulant is most critcal for which of the following test? | prothrombin time |
| a phlebotomist has tried twice to collect a light blue top on a patient with difficult veins. Both times the phlebotomist has been able to collect only a partial tube. What whould the phlebotomist do? | have another phlebotomist collect the spciman |
| what is the best way to avoid contamination of the specimen? | cleaning with isopropyl alcohol before performing a fingerstick |
| you are in the process of collecting a blood specimen. Blood flow has been established. As the the tube is filling, you hear ahissing sound and there is a spurt of blood into the tube and the flow then stops. What has most likely happened is: | needle bevel came partly out of the skin and vacuum escaped from the tube |
| which of the following situations could indicate that the needle has gone through the vein? | fail to get blood flow until you pull back on the needle, felt the needle go into the vein but you fail to get blood flow, and filled one tube but the second one failed to fill with blood |
| you are in the process of collecting a specimen. The needle is inserted but blood is filling the tube very slowly. You see a hematoma forming very rapidly. What has most likely happend is | the needle only partly inserted in the vein |
| performing a multi-tube blood draw. the first tube collects w/out a problem. second tube fails to fill. You adjust the needle and rotate bevel nothing happens. What should you do? | discontinue the draw and try at another site |
| A vein may collap because the | tourniquet is applied to tightly, tourniquet is too close to the venipuncture site, or the tube vacuum is too much for the size of vein |
| Bilirubin | product of the breakdonw of red blood cells |
Created by:
jkc
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