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The antiseptic most commonly used for routine blood collection is
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Phlebotomy Ch 7
| Question | Answer |
|---|---|
| Antiseptics | Substances used to prevent sepsis, the presence of microorganisms or their toxic products in the bloodstream. They prevent or inhibit the growth and development of microorganisms but do not necessarily kill them |
| The antiseptic most commonly used for routine blood collection is | 70 percent isopropyl alcohol in individually wrapped prep pads |
| Antiseptics are considered safe to use on | Human skin |
| Clean 2 x 2-inch gauze pads folded in fourths are used to | Hold pressure over the site following blood collection procedures |
| Use of cotton balls to hold pressure is not recommended because | They tend to stick to the site and reinitiate bleeding when removed |
| Used needles, lancets, and other sharp objects must be disposed of immediately in special containers referred to as | Sharps containers |
| All sharps containers, when full, must be properly disposed of as | Biohazardous waste |
| Tourniquet | A device that is applied or tied around a pt's arm prior to venipuncture to restrict blood flow |
| A properly applied tourniquet is | Tight enough to restrict venous flow out of the area, but not so tight as to restrict arterial flow into the area |
| The end of a needle that pierces the vein is called the | Bevel because it is cut on a slant |
| Coring | Removal of a portion of the skin or vein |
| The long, thin, cylindrical portion of the needle is called the | Shaft |
| The internal space of the needle is called the | Lumen |
| The hub of a needle is | The end of the needle that attaches to the blood collection device |
| Needle gauge | A number that relates to the diameter of the lumen |
| The larger the gauge number, | The smaller the actual diameter of the needle |
| What needle size is considered the standard for most routine phlebotomy situations? | 21 gauge |
| Blood typically flows more quickly through | Large-diameter needles (smaller gauge ) |
| The needle gauge is selected according to | The size and condition of the pt's vein, the type of procedure, and equipment being used |
| 15-17 gauge needle is a special needle attached to a collection bag. It is used for: | Collection of donor units, autologous blood donation, and therapeutic phlebotomy |
| 20 gauge needle is used when | Large-volume tubes are collected or large-volume syringes are used on pts with normal-size veins |
| 21 gauge needle is considered | The standard venipuncture needle for routine venipuncture on pts wit normal veins or syringe blood culture collection |
| 22 gauge needle is used on | Older children and adult pts with small veins or syringe draws on difficult veins |
| 23 gauge needle is used on | Veins of infants and children and difficult or hand veins of adults; termed the "butterfly" needle |
| Manufacturers typically color-code needles by _ for easy identification. | Gauge |
| Butterfly needles oftend have color-coded | "Wings" |
| Needle color codes vary among | Manufacturers |
| Bitterly needles are typically how many inches long? | .5 to .75 of an inch |
| Most multisample (20, 21, 22, 23 gauge) needles come in what lengths? | 1 inch or 1.5-inch |
| What is the evacuated tube system (ETS)? | It is a closed system in which the pt's blood flows through a needle inserted into a vein, directly into a collection tube without being exposed to the air or outside contaminants. The system allows numerous tubes to be collected at once |
| ETS needles are called multisample needles because | They allow multiple tubes of blood to be collected during a single venipuncture |
| Tube holder | A clear, plastic, disposable cylinder with a small threaded opening at one end (often called the hub) where the needle is screwed into it, and a large opening at the other end where the collection tube is placed |
| The large end of a tube holder has flanges or extensions on the sides that aid in | Tube placement and removal |
| What is the syringe method? | Blood is collected in a syringe and must be immediately transferred into the tubes |
| Evacuated tubes | Type of tubes used in blood collection that have a premeasured vacuum and are color-coded to denote the additive inside |
| Vaccuum | Negative pressure, or artifically created absence of air |
| Evacuated tubes fill with blood automatically because there is a _ in them | Vacuum |
| The vacuum is premeasured by the manufacturer so that the tube will draw | The precise volume of blood indicated |
| To reach its stated volume, a tube must be allowed to fill with blood until | The normal vacuum is exhausted |
| Tubes do not fill with blood all the way to the stopper. When filled properly, there is always a consistent amount of headspace between | The level of blood in the tube and the tube stopper |
| Premature loss of vacuum can occur from | Improper storage, opening the tube, dropping the tube, advancing the tube too far onto the needle before venipuncture, or pulling the needle bevel partially out of the skin during venipuncture |
| An undefilled tube is called a | Partial draw or short draw |
| What causes a short draw? | Premature loss of vacuum, removing the tube before the vacuum is exhausted, or stoppage of blood flow during the blood draw |
| Some manufacturers offer special short draw tubes designed to | Partially fill without compromising test results |
| Short draw tubs are used in situations in which it is difficult or inadvisable to draw | Large quantities of blood |
| Additive | Any substance placed within a tube other than the tube stopper or the coating of the tube |
| Blood collected in additive tubes may or may not clot, depending on | The additive type |
| If the additive prevents clotting, the result is a | Whole blood specimen |
| If the additive is a clot activator, the blood will clot and the specimen must be _ to obtain the serum (fluid portion). | Centrifuged |
| Some whole blood specimens are used directly for testing; others are _ to separate the cells from the plasma (fluid portion). | Centrifuged |
| The amount of additive in a tube will function optimally with the amount of blood it takes to fill the tube to | The capacity or volume indicated |
| Specimen quality can be compromised if the tube is | Undefilled |
| An undefilled tube that contains an additive will have an incorrect | Additive-to-blood ratio, which can cause inaccurate test results |
| Any non-additive plastic tubes are to be used for | Clearing or discard purposes only |
| Blood collected in a tube will _ when there is nothing (such as an additive) in the tube to prevent it. | Clot. (Consequently, nonadditive tubes yield serum samples) |
| Tube stoppers (tops or closures) are typically made of | Rubber |
| Tube stoppers are _-coded. | Color |
| For most tubes, the stopper color identifies a type of _ placed in the tube by the manufacturer for a specific purpose. | Additive |
| For some tubes, the stopper color indicates a _ _ of the tube. | Special property |
| A royal blue stopper indicates | A trace-element-free-tube |
| Although color-coding is generally universal, it may vary slightly by | Manufacturer |
| Manufacturers guarantee reliability of additives and tube vacuum until | An expiration printed on the label, provided the tubes are handled properly and stored between 4 and 25 degrees Celsius |
| ETS tubes must be stored between | 4 and 25 degrees Celsius |
| Always check the _ _ before using it, and never use a tube that has been expired or has been _. Discard ut instead. | Expiration date; dropped |
| Describe the light blue tube top | Additive is sodium citrate; coagulation |
| Red tube top (glass) | No additive; chemistry, blood bank, serology/immunology |
| A syringe system is sometimes used for pts with | Small or difficult veins |
| The most common syringe volumes used for phlebotomy are | 2, 5, and 10 mL |
| Syringes have what two parts? | A barrel (cylinder with graduated markings in either milliliters or cubic centimeters) and a plunger (a rodlike device that fits tightly into the barrel) |
| When drawing venous blood by syringe, the phlebotomist | Slowly pulls back the plunger, creating a vacuum that causes the barrel to fill with blood |
| Blood collected in a syringe must be transferred into | ETS tubes |
| A syringe transfer device | Allows the safe transfer of blood into the tubes without using the syringe needle or removing the tube stopper |
| After completing the draw and exiting the vein, what are the next steps? | The needle safety device is activated and the needle removed and discarded into the sharps. The transfer device is then attached to the hub of the syringe. An ETS tube is placed inside it and advanced onto the needle until blood flows into the tube. |
| A winged infusion blood collection set is aka | Butterfly |
| The butterfly needle collects blood from | Small or difficult veins such as hand veins and veins of elderly and pediatric pts, as it allows more flexibility and precision than a needle and a syringe |
| The first tube collected with a butterfly will underfill due to | The air in the tubing |
| If an additive tube is the first tube to be collected via butterfly, it is important to do what first? | Draw a few milliliters of blood into a nonadditive tube and discard it prior to collecting the first tube |
| Collecting a "clear" or discard tube is especially critical when collecting | Coagulation tubes using a butterfly |
| Plastic extensions that resemble butterfly wings are attached to the needle where it is joined with the tubing. During use, the needle may be held | From above by gripping the "wings" together between the thumb and index finger, allowing the user to achieve the shallow angle of needle insertion required to access small veins |
| What gauge for a butterfly needle is most commonly used? | 23 |
| In rare situations a _ gauge is used to collect blood from scalp or other tiny veins of _ _ and other _. | 25; premature infants; neonates |
| Caution: using a needle smaller than 23 gauge increases the chance of | Hemolyzing the specimen. |
| Caution: NEVER transfer blood collected in an additive tube into another additive tube, as | Different additives may interfere with each other or the testing process. Even if the additives are the same, mixing them together creates an excess of additive and possible interference in testing |
| Additives are available in what 3 forms? | Liquid, spray dried, and powder |
| A tube with a powdered additive should be | Lightly tapped prior to use to settle it to the bottom of the tube |
| An additive must be gently inverted | 3 to 8 times, depending on the type, immediately after collection to adequately mix the additive with the specimen. |
| Caution: NEVER shake or otherwise vigorously mix a specimen; it can cause | Hemolysis, which makes most specimens unsuitable for testing |
| Anticoagulants | Substances that prevent blood from clotting (coagulating) |
| There are 2 anticoagulation methods. Describe each. | Chelating (binding) or precipitating calcium so it is unavailable to the coagulation process or by inhibiting the formation of thrombin needed to convert fibrinogen to fibrin in the coagulation process. |
| If a test requires whole blood or plasma, the specimen must be collected in a tube that contains | An anticoagulant |
| Anticoagulant specimens must be mixed immediately after collection to prevent | Microclot formation |
| Because the cells are free flowing and not clotted, a specimen collected in anticoagulant will | Separate through settling or centrifugation and can be resuspended by intentional mixing of the specimen |
| What are the four most common anticoagulants? | EDTA, citrates, heparin, and oxalates |
| Describe EDTA | It prevents coagulation by binding or chelating calcium. It is primarily used to provide whole blood specimens for hematology tests because it preserves cell morphology and inhibits platelet aggregation or clumping. |
| How many inversions are required for EDTA (lavender or pink) tubes? | 8 |
| Caution: If microclots are detected in a hemotolgoy specimen | Then it cannot be used for testing and must be recollected |
| Describe citrates | They prevent coagulation by binding or chelating calcium. Sodium citrate in light-blue-top tubes is used for coagulation tests because it does the best job of preserving the coagulation factors. |
| Caution: There is a critical 9:1 ratio of blood to anticoagulant in light-blue sodium citrate tubes, so it is important to | Fill them to the stated capacity. Undefilled tubes cause artificially prolonged clotting times and will not be accepted for testing by most labs. |
| How many gentle inversions are required for citrate (light blue) tubes? | 3 to 4. However, vigorous mixing or an excessive number of inversions can activate platelets and shorten clotting times. |
| Coagulation tests are performed on | Plasma |
| For a coagulation test, the specimen must first be _ to separate the plasma from the cells. During testing, _ is added back to the specimen so the _ _ can be initiated and times. | Centrifuged; calcium; clotting process |
| Describe heparin | Prevents clotting by inhibiting thrombin formation. |
| Thrombin | An enzyme needed to convert fibrinogen into the fibrin necessary for clot formation |
| Heparinized plasma is often used for | Stat chemistry tests and other rapid response situations when a fast turn-around time (TAT) for chemistry tests is needed. Faster TAT is possible because time is eliminated that would normally be required for a specimen to clot before serum is obtained |
| How many inversions are required on heparin (green top) tubes? | 8 |
| Heparin is contained in tubes and microcollection containers with | Green stoppers and in royal blue top tubes with green on the label |
| What are the three heparin heparin formulations? | Ammonium, lithium, and sodium heparin |
| What heparin formulation causes the least interference in chemistry testing and is the most widely used anticoagulant for plasma and whoke-blood chemistry tests? | Lithium heparin |
| Heparinized plasma is preferred over serum for potassium tests because | When blood clots, potassium is released from cells into the serum and can falsely elevate results |
| It is essential to choose the right heparin formulation for the type of _. | Test |
| Lithium heparin must not be used to collect | Lithium levels |
| Sodium heparin must not be used to collect | Sodium specimens or electrolyte panels because sodium is part of the panel. |
Created by:
L'amour