venipuncture
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| ASCP | American Society of Clinical Pathologists
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| NPA | National Phlebotomy Association
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| NCA | National Certification Agency
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| OSHA | Occupational Safety & Health Administration/ They establish rules for safety in the workplace
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| Define Hemoconcentration | A condition in which the concentration of blood cells is increased in proportion to the plasma
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| Define Hemolysis | The destruction or dissolution of red blood cells, c subsequent release of hemoglobin
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| Define Plasma | The liquid portion of whole blood that contains active clotting agents
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| Define Serum | The liquid portion of whole blood that remains after the blood as clotted
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| Define Thixotropic Gel | A material that appears to be solid until subjected to a disturbance, such as centrifugation, where upon it becomes a liquid
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| What do tourniquets do? | Block the blood from flowing (venous)vasodilation
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| Where do you place tourniquets? | 3-4" above site
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| How long can you leave tourniquets on? | 1 Minute
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| What are the complications of leaving tourniquets on too long? | Hemoconcentration, Interstitial fluid leaks into veins & cause hemolysis, numbness, tingling
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| Can you place tourniquets over clothing? | Yes
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| What's the best time to release tourniquet? | When last tube is 3/4 full before taking needle out
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| What can Happen if the needle comes out before the tourniquet is released? | hemoconcentration
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| What is the action of alcohol? | Clean area where needle will go/inhibit bacteria
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| What is the proper way to clean the venipuncture site? | With alcohol pad in a circle inner/outer
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| How long does alcohol need to remain on the skin? | until dry 30-60secs
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| When is alcohol contraindicated? | Allergy, blood draw for alcohol level, blood culture
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| What 3 antiseptics can be used for blood cultures? | Iodine, cholorhexidine gluconate, benzo
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| 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
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| Gold/Red Grey 1. What additive? 2. Hematology/coagulation/chemistry | 1. Clot activator/gel
2. Chemistry
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| Red 1. What additive? 2. Hematology/coagulation/chemistry | 1.Clot Activator
2. Chemistry
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| Green 1. What additive? 2. Hematology/coagulation/chemistry | 1.Heparin
2. Chemistry
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| 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
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| Grey: Glucose 1. What additive? 2. Hematology/coagulation/chemistry | 1. Potassium oxalate, sodium chloride
2. Chemistry
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| Why is order of draw is important? | So that you don't mix additives
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| Which tubes will always be first in the order of draw? | Blue
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| Do larger tubes have more or less vacuum? Are they more or less likely to collapse a vein? | More
More
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| How much serum/plasma can you get from 6ml of blood? | 3ml
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| 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
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| When a tube contains thixotropic gel, what is it called? | red-gray serum separator/pst(green-grey) plasma separator tube
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| How does it take blood to clot in a tube when there is no clot activator? | 30-60min
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| What is a short draw? | not enough blood in tube
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| What is the normal adult gauge? | 21gauge(-20)
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| 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....
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| When should you consider using a butterfly needle? | On small veins. Pediatric, elderly, dehydration
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| How does butterfly tubing affect the vacuum applied to the veins? | less powerful. Decreases it and prevents from collapsing.
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| When should you consider doing a syringe draw? | When you think the section in a vacuum will collapse vein
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| When should you transfer the blood to the tube and why? | Immediately, because it will clot in the barrel.
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| How do you choose the correct size syringe? | Depending on how much blood you draw
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| How do you know if you are pulling the plunger back too fast? | headspace more than 1ml
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| What are the 3 blood borne pathogens? | HBV, HIV, HCV
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| Who writes the needle safety guidelines? | OSHA
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| What is an SESIP and what is its purpose? | Sharp c engineered sharps injury protection/device to prevent needle sticks
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| 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
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| What should you do if you patient has limited language skills? | Have a family member or caregiver present
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| How do you obtain consent for routine venipuncture? | Nonverbal, implied
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| What position should your patient be in for routine venipuncture? | Seated in a chair or laying down
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| What position should your patient be in if they have problems getting their blood drawn? | Laying Down
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| How do you choose your venipuncture site? | By palpating to feel for veins
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| Which veins are most commonly used for venipuncture? | Forearm or elbow(Antecubital) hand, cephalic, median basilic
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| Which Conditions might cause you to use an alternate site for venipuncture? | Nerve Damage
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| 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.
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| What is the purpose of making a fist? | Encourages vein easy to find
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| 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.
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| What angle of needle insertion do you use for the antecubital site? | 15 degrees
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| What are the complications of inserting the needle too deeply? | Hitting an artery, causing hematoma
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| What is the purpose of anchoring the vein or "pulling taut"? | So blood will flow, easy to puncture,, stops vein from rolling
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| When should you tell your patient to release their first? | When blood enters the tube
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| What is the proper way to change out your tubes? | With your thumb
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| Why is venipuncture considered a surgical procedure? | Because you are puncturing the skin.
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| When should you invert your tubes? | Immediately, AFTER DRAW
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| 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
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| 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
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| What do you do to the site right after the needle is removed? | Hold gauze over puncture site . Apply pressure tostop bleeding
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| 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
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| How long do you observe the site before applying the bandage? | 5-10secs
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| What is a hematoma? | A large painful bruised area at the puncture site caused by blood leaking in tissue.
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| 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.
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| 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.
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| What should you do if your patient faints? | Remove tourniquet and needle secure pt. call for help
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| What are smelling salts and how do you use them? | Amonia, crus, 4" under the nose(Wave)
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| What should you do if your patient complains of nausea? | Keep going, talk to them, cool compression
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| What is the most common cause of specimen rejection? | Hemolized specimen
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| 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
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| Hemolysis | rupture or destruction of red blood cells
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| What is a hemolyzed specimen? | Broken RBC's in specimenBubbles
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| What is frothing? | Bubbles in the blood
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| 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
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| How does frothing cause hemolysis? | Creates a turbulence and air breaks cell
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| 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
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| What size and type of needle used for children under 2? | Butterfly 23guage/pediatric vacuum
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| What site for children under 2? | Dorsal hand
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| What is the preferred method to collect blood in children under 2? | Dermal Puncture
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| When should serum specimens be spun down in the centrifuge? | After 30 minutes/within 2hrs of blood clotting
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| How long can whole blood be refridgerated? | 72hrs
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| How should filled venipuncture tubes be transported? | Biohazard bag, upright
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| 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.....
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| What kind of testing requires chain of custody? | Drug and alcohol testing, DNA analysis or parentage testing
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