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Phlebotomy Terms
| Term | Definition |
|---|---|
| Interstitial Fluid | fluid between the cells |
| Intracellular Fluid | Fluid within the cells |
| Cyanotic | Bluish in color from lack of oxygen |
| Edematous | swollen with fluid |
| Whorls | Spiral pattern of the fingertips |
| Calcaneus | heel bone |
| Plantar Surface | Bottom of the heel on the sole side |
| Posterior Curvature | back (rounded part on backside) of the heel |
| Neonate | Newborn |
| Newborn Screening (NBS) | -State mandated testing of newborns for detecting genetic, hormonal or functional disorders -done when an infant is 24-72 hours old -performed by heel puncture by filling the blood circles on the NBS form |
| *Phenylketonuria (PKU) | Genetic disorder characterized by the inability to metabolize phenylalanine |
| the end, or distal segment of the ring or middle finger | the preferred capillary puncture site for children one year and older. |
| lateral plantar surface of the heel | the only puncture site that can be used on infants- 1 year of age. |
| CLSI recommended depth of lancet insertion for an infant | no more than 2mm deep in order to avoid puncturing the calcaneus, or heel bone. |
| *depth of a premature infant's calcaneus or heel bone | as little as 2.4 mm deep at the lateral plantar surface and half that depth at the posterior curvature |
| *feather/ feathered edge | -The thinnest area of a properly made blood smear -one cell thick |
| Sepsis | -occurs when an overwhelming amount of microorganisms are present in the blood inflammatory responses throughout the body due to blood infection -leading cause of death from infection |
| Bacteremia | Blood infection caused by bacteria in the blood |
| Septicemia | Blood infection caused by microorganisms or their toxins in the blood |
| Autologous donations | -a donation of a patient intended for their own use -are done prior to surgeries where it is anticipated they will need a transfusion. |
| Therapeutic Drug Monitoring (TDM) | used to establish drug dosages for patients. |
| Peak level | drawn to ensure that the dosage is not toxic |
| trough levels | test to ensure that even at its lowest point, the drug remains at therapeutic levels in the blood. |
| Therapeutic phlebotomy | blood drawn from a patient in measured amounts (typically 1 pint, or 470 ml) as a treatment for a condition. |
| Hemochromatosis | a condition in which blood is withdrawn to relieve excess iron in the body of an affected individual. |
| Arterial Blood Gasses (ABGs) | -evaluated to manage respiratory disorders and measure ventilation, acid base balance and oxygenation. -a measure of respiratory function. |
| collateral circulation | -arterial flow to an area from more than one artery -the primary site collection criteria |
| Radial artery | -the 1st choice artery due to ease of access & there is normally collateral circulation to the hand by the ulnar artery. |
| Brachial artery | -the 2nd choice. -less painful than the radial artery, but harder to puncture as its deeper. |
| Femoral artery | only drawn by a physician |
| steady state | a condition in which there has been no exercise, suctioning, or respirator change for at least 20 to 30 mins before draw |
| isopropanol | the typical antiseptic prior to draw |
| Arteriospasm | -the most common arterial puncture complication, even it is performed correctly. -involuntary contraction of the artery that can be caused by pain or irritation -may result form patient's anxiety during arterial puncture |
| A 22-gauge 1-inch needle | typically used for an ABG. |
| A 22-gauge 1 ½ inch needle | used for a femoral ABG. |
| A 40-45 % angle | used to draw in the radial or brachial artery |
| A 90% angle | needed to draw the femoral artery. |
| *The Joint Commission (TJC) | -The oldest and largest standard setting body in healthcare. -strives to improve healthcare for the public. -a non profit organization commonly associated with “The Standard of Care” |
| *Clinical Laboratory Improvement Amendment of ’88 (CLIA ’88) | -Federal regulations passed by congress that establish quality standards for all facilities in the U.S. -aim to ensure accuracy, consistency and reliability of patient test results regardless of location, size or type of laboratory. |
| *Clinical Laboratory Standards Institute (CLSI) | -a global, non-profit standards developing organization. -Their mission is to develop clinical and laboratory practices and promote their use worldwide. |
| Quality Assurance (QA) | -A program designed to guarantee quality service & processes used to create standardization of service. -QA takes a broad look forward and backward to prevent problems. |
| Quality Control (QC) | -a component of QA that look at the output and compares to ensure procedures are performed correctly and accurately |
| *Threshold value | A level of acceptable practice beyond which quality patient care cannot be assured |
| Tort Law | Most common civil action in healthcare deals with tort law |
| Tort | A wrongful act committed against a person |
| Assault | Act or threat causing another to be in immediate fear of battery |
| Battery | Intentional harmful or offensive touching |
| Invasion of Privacy | Violation of one’s right to be left alone |
| Malpractice | A type of negligence committed BY A PROFESSIONAL |
| Negligence | Failure to exercise due care – commonly known as the reasonable person standard |
| Informed Consent | Implies voluntary or competent permission for a medical procedure, test, or medication |
| Express Consent | Can be given verbally or in writing |
| Implied Consent | Actions or circumstances imply consent without verbal or written consent (Arm extended, patient unconscious) |
| Consent for Minors | Parent or guardian consent on behalf of the minor child |
| Refusal of Consent | An individual has a right to refuse medical care and procedures |
| procedure manual | -provides written policy and procedure in regard to every test or procedure performed by the lab staff |
| Nosocomial Infection/HAI (Healthcare Associated Infection) | Infection acquired in hospitals & other healthcare settings |
| Communicable | infections that are able to spread from human to human |
| Chain of Infection | How the infectious agent reaches the susceptible host |
| Personal Protective Equipment (PPE) | ex. gloves, masks, goggles, fluid resistant lab coats, respirators, masks |
| Biohazard | Anything harmful or potentially harmful to health |
| Bloodborne pathogen (BBP) | infectious microorganism in blood or any other body fluid or tissues. |
| Occupational Safety and Health Administration (OSHA) | |
| Hazard Communication Standard (HazCom, HCS) | -Commonly known as the “right to know law”. -All chemicals must be evaluated for health hazards and labeled as such and this information communicate to employees. |
| Safety Data Sheet (SDS) | Used to communicate general and precautionary information about chemicals used in the workplace |
| Center for Disease Control and Prevention (CDC) | An agency in the US Department of Health and Human Services charged with the investigation and control of communicable diseases |
| Microbes | -also known as microorganisms -can invade the body and cause disease. Microbes include bacterial, fungi, protozoa, and viruses. |
| Pathogens | microbes with can cause disease. |
| *Clostridium Difficile (C DIFF) | # 1 HAI pathogen |
| *urinary tract infections (UTI) | #1 HAI infection |
| Infectious agent | the pathogenic microbe responsible for infection |
| Reservoir | source of the agent (ex.human, animal, soil, water, or fomites) |
| *fomite | any object that can harbor infectious material. (ex.pens, phones, equipment, etc.) |
| Exit pathway | secretions or body fluid, urine, feces |
| Means of Transmission | How the pathogen travels from the reservoir to the susceptible host. These include: airborne, droplet, vector, vehicle transmission |
| Airborne transmission | -(ex. sneeze, cough, talking) -Particles are very small and can remain suspended in the air for long periods of time. -tuberculosis is a common airborne pathogen. |
| Droplet transmission | -transmission transfers to mucous membranes. -differ from airborne as they normally travel no more than 10 feet. |
| vector transmission | - can be carried from an animal, arthropod or insect. -(ex.Bubonic Plague from rodent fleas, or West Nile Virus through infected mosquitoes) |
| Vehicle transmission | -transmission through infected water, food, or drugs -Contaminated blood transfusions would also be a vehicle transmission. |
| Entry pathway | -How the agent enters the host. -(ex.Eyes, nose, percutaneous, orifices.) |
| Susceptible hosts | -have lower immunity or ability to resist infections. -(ex. Newborns, elderly, people with weakened immune systems) |
| PPD testing | -a common employee screening -Tests and screens out individuals with active tuberculosis. |
| *Hand hygiene | -most common workplace practice to protect against pathogens. |
| Donning (putting on) PPE sequence | Gown, mask, goggles, gloves |
| Doffing (removing) PPE sequence | Gloves, goggles, gown, mask (THIS CAN DIFFER DEPENDING ON PROTOCOLS) If you are following gown, gloves, mask sequence – wash hands before removing mask. |
| Isolation procedures | Used to separate patients suspected of having contagious diseases. |
| *Protective or Reverse Isolation | Used for patients who are highly susceptible to infection. Burn patients, organ transplant patients, AIDS patients, neutropenic chemotherapy patients. (Neutropenic means having a low neutrophil count. A neutrophil is a type of white blood cell. |
| Universal Precaution | Blood and body fluids are considered to be potentially contaminate and must be treated as such. |
| Body Substance Isolation | Any moist body substance requires the use of gloves. |
| *NFPA (National Fire Protection Agency) | -order of action in the event of fire: RACE R – rescue A – alarm C – Contain E – extinguish |
| *class C fires | -Most common fire hazard in labs -electrical fires and require non conducting agents to extinguish. |
| Airborne | can be inhaled through fumes or aerosol. |
| Ingestion | smoking, eating, licking fingers. |
| Non-Intact Skin | cover sores, chapped hands, do not bite your nails! |
| Percutaneous | -through the skin -needle or other sharp contaminated object breaks skin. |
| Permucosal | -through mucous membranes -splash or spray into mucous membranes. |
| accidental needle stick | -remove sharp and wash hands for at least 30 seconds with soap and running water & report exposure immediately. |
| Mucous membrane exposure | flush the site with water for a minimum of 10 minutes & report exposure. |
| Chain of Infection components | 1. Infectious agent 2. reservoir 3. exit pathway 4. means of transmission 5. entry pathway |
| Contact transmission | -Direct (ex. kissing, touching) -Indirect (ex. contaminated objects) |
| *hepatitis B virus (HBV) | -#1 bloodborne pathogen exposure risk |
| *1:10 bleach to water ratio | for larger spill |
| *1:100 bleach to water ratio | for daily routine disinfection |
| *Principles of radiation exposure | distance, shielding, time |
| *QA forms | -equipment check forms, internal reports |
| sensitive services | -provided in confidence to adolescents and adults without barrier -parental consent is not required for children age 12 years and older -ex. STD, abortion, HIV testing |
| blood culture | -determine presence & extent of infection -identify type of organism responsible & best antibiotic to use |
| glucose tolerance test (GTT) | -used to diagnose problems of carbohydrate metabolism -monitors patient's tolerance to high levels of glucose |
| hyperglycemia | increased blood glucose level |
| hypoglycemia | decrease blood glucose level |
| blood alcohol (ethanol) specimens | -normally ordered by physician for treatment purposes -gray sodium fluoride tude |
| drug screening | -may detect a specific drug or screen for up to 30 drugs -typically performed on urine than blood -chain of custody is required |
| capillary reference values | -glucose concentrations are higher in capillary blood -total protein, calcium & potassium concentrations are lower in capillary blood |
| order of capillary puncture | -BEOS 1.blood gas specimens 2.EDTA specimens 3. other additive specimens (except for sodium fluoride) 4. serum specimens |
| Requisition | -The form on which test orders are entered -the 1st step in the phlebotomy process |
| DOB | Date of Birth |
| Belonephobia | Irrational fear of pins and needles |
| Recumbent | Lying down |
| Palpate | Examine by touch or feel |
| Anchor | Secure firmly |
| Taut | Pulled tight |
| Iatrogenic | A term used to describe adverse conditions brought on as result of treatment |
| Iatrogenic Anemia | Anemia caused by repeated blood draws (common in infants and children) |
| Pre-examination/pre-analytical | begins when the test is ordered and ends when specimen testing begins -50%-70% of all laboratory errors occur during this phase -specimen handling is a citical part of this phase |
| Analyze | term used for the substance undergoing analysis (e.g., calcium, glucose, cholesterol) |
| Reference range/ reference interval | a range of values with highs and lows established for different populations, or compared to an individual’s previous results |
| Basal State | Resting metabolic state of the body early in the morning following sleep and fasting |
| Turbid | specimen appearing cloudy |
| Lipemic | Referring to the evidence of fats in a specimen |
| Diurnal | Daily fluctuation |
| Circadian | Cyclic variation (24-hour cycle) |
| Jaundice/Icteric | Marked by a deep yellow appearance |
| Sclerosed/Sclerotic | Hardened |
| Edema | Abnormal accumulation of fluid in the tissues |
| Hematoma | Mass of blood caused by blood leaking into the tissue at a venipuncture site. |
| Lymphostasis | Obstruction or stoppage of Lymph flow |
| Vascular access device (VAD) | tubing or devices allowing entry to veins of arteries for ease of access |
| IV/Intravenous | -catheter inserted in peripheral vein -avoid drawing blood from arm containing IV |
| AV Fistula | Permanent surgical connection of an artery and a vein for the purpose of dialysis |
| Central Vascular Access Device (CVAD) | A tube inserted into a main vein or artery |
| *Peripherally Inserted Central Catheter (PICC) | A line inserted in periphery vein and threaded into the central vascular system. |
| Syncope | medical term for fainting |
| Vasovagal syncope | Fainting related to pain, stress or trauma |
| Petechiae | Tiny non raised dots that appear at the surface of the skin upon tourniquet application |
| Exsanguination | Blood loss to the point where life cannot be sustained |
| physiological changes | -affect the blood components and can affect tests -ex.Age, altitude, basal state, dehydration, diet, diurnal or circadian variations, drugs therapy, exercise, fever, sex, position, pregnancy, and smoking |
| drug that interfere with testing | -should be stopped 4-24 hours prior to blood testing -48-72 hours before urine testing. |
| Hemoconcentration | -occur if a tourniquet is left on for too long, or if a patient is dehydrated. -The filterable components of the blood will pass through the vein walls and leave an increase in the larger, protein-based molecules such as RBCS |
| Hemolysis | -results when the RBCs are broken. -Do not shake or vigorously mix specimens. -Do not use a needle that is too small for the vein. |
| Vein collapse | -occurs when the blood is taken too quickly from a vein and the sides temporarily draw together. -can be avoided by tying the tourniquet 3-4 inches above a VP site and not using large volume tubes on small veins or use syringe for slow blood flow |
| hematoma | -a swelling or mass of blood -caused by blood leaking from vessel during venipuncture -can be painful, contaminate blood sample, obstruct blood flow |
| mastectomy | -surgical breast removal -lymph flow is obstructed with removal of lymph nodes -swelling & infection may present |
| Central venous catheter | -inserted into larger vein -advanced into superior vena cava |
| inadvertent arterial puncture | -blood spurts/ pulses into tube -blood appears bright red in color -rapid hematoma formation |
| reflux | -blood flow back into vein from collection tube |
| Antiseptics | -substances used to prevent sepsis -used on humans -Most common in VP is isopropyl alcohol (ex. 70% isopropyl alcohol, isopropanol) -only reduce the amount of microbes, but do not kill them. |
| *Disinfectants | -Chemical substances used to remove or kill microorganisms. -Not safe for use on skin, used to clean instruments and surfaces. -Ex. Bleach, known as sodium hypochlorite, #1 most commonly used in hospitals and clinics. |
| Gauge | A number that given an indication of the size of the lumen of the needle. |
| anticoagulants | -substances that prevent blood from clotting -common anticoagulants: ECHO E: EDTA C: Citrates H: Heparin O: Oxalates -must be mixed immediately |
| Heparin | -additive for green STAT tube -inhibits thrombin |
| EDTA | ethylene/diamine/tetra/acetic acid -must be mixed immediately to prevent platelet clumping and micro clot formation. |
| Antiglycolytic agents | -prevent the breakdown of glucose by the blood cells. -most common: sodium fluoride |
| Thixotropic gel | -present in tubes to form a barrier between serum or plasma following centrifugation -additive for gold/ tiger top serum tube |
| Carry over/ cross contamination | -occurs when an additive is transferred by the needle to subsequent tubes. -the reason to follow the order of draw |
| Laboratory Information System (LIS) | A software package designed to interface between the lab, physicians and patient portals |
| Accession Number | -A unique identified generated as a battery of tests is ordered. -This number will follow the test(s) until results are sent, or the order has been cancelled |
| Examination phase/Analytical | during testing |
| Postexamination/Postanlytical | After analysis |
| Thermolabile | Altered or destroyed by heat |
| Quantity not sufficient (QNS) | -short draw - blood is not drawn to a sufficient amount to test, or may not be sufficient to mix with additives |
| secondary/ aliquot tube | -created when multiple tests will be conducted from the content of one tube. |
| special handling requirements for Light Blue | 9:1 blood to additive ratio |
| special handling requirements for Bilirubin | No UV light exposure |
| special handling requirements for Lactic Acid & Ammonia | On ice |
| special handling requirements for ETOH | use soap and water to clean arm, no isopropyl alcohol wipe |
| EDTA specimens for ESR | need to be tested prior to 4 hours, or refrigerated for up to 12 hrs. |
| EDTA specimens for CBC | should be tested before 6 hours – but can sit at room temperature for 24 hrs |
| Centrifuge | -a machine that spins blood tubes at high rpm -force separates cells & plasma/ serum -needs to be balanced to avoid breakage of tubes |
| midstream clean catch | require a towelette to wipe the external genital area prior urine collection. |
| Culture and sensitivity tests | -given for symptoms of UTI -requires midstream clean catch -should be transported & processed immediately or else refrigerated |
| *Human Chorionic Gonadotropin (HCG) | -a hormone secreted by embryonic cells. -detect pregnancy -HCG easier to be detected in the first morning urine as specimen will be more concentrated |
| Gastric fluid (stomach fluid) | requires a gastric stimulant be given through IV to obtain additional samples. |
| Nasopharyngeal Secretions (NP) | detect microorganisms including pertussis (whooping cough) |
| Serous Fluid | -pale yellow fluid surrounds pericardium. -Too much serous fluid results in a condition called Ascites. -The fluid is called ascitic fluid. |
| Sputum | -can be stained and used in the detection of TB (tuberculosis) |
| *Sweat | -collected and the amount of chloride is tested. -The sweat chloride test is used to diagnose cystic fibrosis. |
| *Ova and Parasite testing | -not generally suited for refrigeration. |
| Hair samples | -can detect drugs of abuse and heavy metals. -with a detection window of 3-6 months |
| Nail clippings | -can also be tested for heavy metals. |
| Phlebotomy | Derives from Greek origin, meaning “vein incision” |
| Ambulatory | Outpatient care |
| Non-Ambulatory | Inpatient care |
| *Continuing Education Units (CEU) | needed every couple of years to update knowledge or skills in a given profession |
| Protected Health Information (PHI) | Individually identifiable health information transmitted in any way, electronic or otherwise |
| *Health Insurance Portability Accountability Act (HIPAA) | -safeguards confidentiality of PHI -established national standards for electronic exchange of PHI -states that patients must be inform of rights |
| Kinesics | Study of non-verbal language |
| Kinesic Slip | Verbal and non-verbal language do not match up |
| Proxemics | Study of an individual’s use of space |
| Primary Care | Patient care given by patient’s main source of care |
| Secondary Care | Medical care given by a specialist or facility of expertise |
| Tertiary Care | Highly specialized care |
| Certified Phlebotomy Technician (CPT) | |
| Current Procedural Terminology (CPT) | provides terminology and coding system for physician billing |
| Certification | awarded to a person completing academic and training in a specific area of expertise & upon completing an exam proving proficiency. |
| License | an official document that gives legal permission to work in a field. |
| *Proximal | nearest to the center of the body or point of attachment |
| *Distal | farthest form center of the body, origin, or point of attachment |
| Homeostasis | “steady state” or balanced state which the body always strives to be in |
| Integument | covering or skin |
| Papillae | elevations in the skin joining the dermis and epidermis that give rise to fingerprints |
| Anatomy | structural composition of the body |
| Physiology | function of the body |
| *Epithelial tissue | covers and protects the body, lining organs, vessels, and cavities. |
| integumentary system | make up by the skin and its appendages (hair, sweat and oil glands, blood vessels, nerves, and nails) |
| Layers of skin | 1. *Epidermis-outermost and thinnest layer 2. Dermis-true skin; inner thick layer composed of elastic & fibrous connective tissue 3. Subcutaneous-cross section of the skin |
| *skeletal system | comprised of muscle and is under voluntary control (the only voluntary system) |
| Central nervous system (CNS) | consists of the brain and the spinal cord |
| meninges | -layer of tissue that cover the central nervous system -filled with cerebrospinal fluid |
| cerebrospinal fluid (CSF) | drawn by physicians in a procedure called lumbar puncture to test for diseases related to the CNS. |
| Endocrine system | a system of glands that regulate hormones. |
| *pituitary gland | referred to as the master gland |
| urinary system | -comprised of the kidneys, ureters, a urinary bladder, and a urethra. -functions as a filter for waste, regulating body fluid and maintains electrolyte balance. |
| *skin | largest organ in the body |
| anatomic position | -standing erect -arms at sides -eyes & palms facing forward |
| supine | lying horizontal on the back, face up |
| prone | lying face down, palm facing down |
| body planes: frontal | front & back |
| sagittal | left & right |
| transverse | upper & lower |
| anterior | in front of |
| posterior | in the back of |
| medial | toward the midline of the body |
| lateral | away from the midline of the body |
| Myocardial Infarction | Heart attack, death of heart tissues |
| Pulse | -Rhythmic throbbing caused by blood passing through the artery. -only felt in an artery. |
| Systolic | measurement of pressure on the artery as the ventricles are contracted |
| Diastolic | measurement of pressure on the artery as the ventricle are relaxed |
| Sphygmomanometer | Blood pressure cuff, an instrument used in measuring blood pressure. Can be used as a tourniquet. |
| Arteries | blood vessels carrying blood away from the heart |
| Capillaries | microscopic vessels that connect arterioles and venules |
| Lumen | Internal space of the vein |
| Valves | Leaflets of tissue that move blood back towards the heart along vein walls. |
| Antecubital (AC) | -in front of the elbow -preferred area to perform phlebotomy. |
| Fossa | Shallow depression |
| Embolus | A blood clot, part of a blood clot or other undissolved matter circulating in the bloodstream. |
| Embolism | Blood vessel obstructed by an embolus |
| Phlebitis | vein inflammation |
| Thrombophlebitis | vein inflammation with thrombus formation |
| Thrombus | blood clot in vessel or organ |
| Plasma | -the liquid portion of the blood – appx 91% water -the yield of a specimen spun after mixing with an anticoagulant -has fibrinogen -look the same as serum |
| Erythrocytes | Red blood cell (RBC) -are the most numerous cells -made in the bone marrow -have intravascular function, carrying oxygen |
| Leukocyte | White blood cell -capable of intervascular function, diapedesis, slipping through capillaries into tissue. -main function is to fight pathogens. |
| Hemostasis | The stoppage of bleeding |
| Thrombocyte | Platelet |
| atria | Upper chambers of the heart that receive blood |
| ventricles | the lower chambers that constrict, pushing blood through the arteries. |
| Blood pressure | the measured to determine the amount of force on the arteries as the ventricles contact (Systolic pressure) and relax (Diastolic pressure) |
| arteries | -carry blood away from the heart -larger & thicker than veins |
| Veins | -carry blood back to the heart -have one-way valves |
| Proper direction of blood flow (ACV) | from arterioles to capillaries to venules. |
| median cubital (mid arm) | 1st choice vein |
| cephalic (thumb side) | 2nd choice |
| basilic (pinky side) | 3rd choice |
| ABO blood group system | recognizes 4 major blood groups, A, B, AB and O as identified by an antigen attached to the red cell. |
| Serum | -fluid remaining following the blood clotting and centrifugation. -lacks fibrinogen as the fibrinogen has been used up in the clotting process. |
| Whole blood | -used for testing in anticoagulant tubes -The blood is mixed and not centrifuged |
| lymph system | -extends through the body similar to blood vessels. -functions as a filtration system, removing impurities and delivering fat to the bloodstream. |
| *aorta | the largest artery |
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