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Phlebotomy Chapter 4
| Term | Definition |
|---|---|
| Do you anchor with the same hand you are using the needle with? | NO! This increases the risk of a needle stick! |
| What arm range angle should be used when you are doing a veinipuncture? | 15-30 degree angle This means you are in the Lumen. Lumen: (basically the middle of the vein) the hollow, internal space within the vein's wall through which blood flows. |
| What is a tourniquet? | Bands used for venipuncture, can be Latex and latex free. Should be placed 3-4 inches above the antecubital fossa |
| What is a bevel? | The pointed end of the needle. •Should be inspected •Should be intact, to prevent injury •Bevel should always be up |
| Where is a hub attached? | Attached to the needle and used to guide tubes towards the needle to initiate blood flow into the evacuated tube. ETS: Evacuated Tubing System |
| The anticoagulant tubes require blood to be….. | NOT CLOTTED! Anticoagulant plasma tubes require blood NOT be clotted for testing. |
| What is the winged infusion set also called? | Butterfly needles! 21-23 gauge needles Butterfly needles are used for small or difficult to access veins. |
| How many tubes contain EDTA? | 4 •Lavender •Pink •Tan •Royal Blue Tubes (EDTA, no additive) contains clot activator or EDTA. Used for trace element testing such as zinc, copper, etc |
| How long is an adult blood collection tube? | 3 inches long 1/2-3/4 inches wide. The vaccine pressure inside adult collection tubes are higher that the pressure inside a child vessel |
| During venipuncture, you do not exceed what degree? Why? | Going any greater than 30 degrees or below 15 degrees can cause an injury. Possibly hitting a curve or going coming through the vein, causing a hematoma. |
| If you see blood pooling around the insertion site is that okay? | Yes, that can mean that the needle only partially penetrated the vein. Inserting too deeply can give you no blood as you might have went through the vein. |
| Angle for DORSAL hand blood collection Dorsal: Back | About 10 degrees •(The dorsal is shallower because of the # of nerves and tendons that can be hit) •Remember to use a quick and smooth motion when puncturing the skin to prevent pain and also to prevent the vein from moving |
| Anchoring…think below | You want to always anchor BELOW the venipuncture site *place the thumb of your NON-DOMINAT hand 2 inches BELOW the site •slight distal tub downwards, pulling taunt Distal: farther away from the center of the body |
| Hematoma: 1. What is it? 2. What happens? 3. What should you do? | 1. The most common complication 2. The needle punctures both wait if the vein, basically going through it. 3. If this happens, you should STOP the collection immediately! |
| Outpatient | •Phlebotomy chair/recliner *Make sure the chairs are sitting next to the desk/sharps |
| Inpatient Settings | •cart •tray table •phlebotomy caddy/cart |
| Patient Prep for Venipuncture | 1. Review the script 2. Review the test (make sure you get ALL the supples/equipment needed) 3. Double check to make sure you aren’t missing any test/collection tubes 4. Check expiration dates & defects 5. Organize for space and pt safety |
| Venipuncture vs Dermal Puncture | Venipuncture: blood testing from the vein •antecubital fossa •dorsal side of hand Dermal Puncture: capillary collection, collecting from capillary collection- collection from finger stick or heel |
| 3 Most Important D’s in Phlebotomy | Depth Dimension Direction |
| Observation and Palpation | AFTER the tourniquet is applied, palpate the vein •light pressure •veins should feel soft and spongy (tendons feel like bone, avoid them) *Palpate for direction & Depth; this will also help decide which gauge needle/type to use |
| Light Blue Tube Invert 3-4x (BC, Blue, Red, SST Greens, Lavender, Gray, Yellow) | Sodium Citrate Used for coagulation Common test *PT *D-Dimer *PTT *INR *Fibrogen |
| Red Tube Clot Activator/Thrombin (No activator in glass tubes) | Used for Chemistry and bloodwork Invert 4-5x Common Test *Type & Screen *Crossmatch *Therapeutic Drug Levels (Vanco, Keppra) •Clot activator/Thrombin is used to aide blood in clotting for further testing |
| Gold Tube SST: Serum Separator Tube used for chemistry | SST Gold Tube is also sprayed with Thrombin to help aide blood to clot for further testing. •Has a gel buffer coat that separates cells from the serum once the sample has been centrifuged |
| Yellow Tube Contains ACD: Acid Citrate Dextrose | Used for Genetics and Blood Banks Invert 8-10x Common Test *DNA Testing *HLA Typing *Paternity |
| Green Tube with Lines Sodium Heparin Inverts 8-10x | Common Test *Ammonia *STAT Test *ABGs *Special Chemistry *Electrolytes |
| Quality Control vs Quality Assurance | Quality Control (QC): ensures precision, same results over time Quality Assurance (QA): Ensures Accuracy •procedures •QC Test (Quality Control Test) •Maintenance |
| Capillary Finger Stick Order of Draw *capillary blood clots faster than venous blood *additives can contaminate other specimens *some test like gases and CBCs must be processed quickly | Blood Gas (results fade quickly) EDTA/Lavender (need free flowing blood & capillary blood clots fast) Heparin/Green (prevents clotting) Other colored tubes SST/Gold MUST BE LAST (needs fully clotted blood) |
Created by:
Brandi’Jay