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Phlebotomy Review
Phlebotomy
| Question | Answer |
|---|---|
| What is the order of draw for blood culture tubes/bottles? | First |
| What is the order of draw for light blue top tubes (Sodium Citrate)? | Second |
| What is the order of draw for red top, red/gray mottled, and gold top tubes (Serum tubes)? | Third |
| What is the order of draw for light/dark green and green/gray mottled top tubes (Heparin)? | Fourth |
| What is the order of draw for lavender/purple, pink, or white/pearl top tubes (EDTA)? | Fifth |
| What is the order of draw for gray top tubes (Sodium Flouride)? | Sixth |
| The study of non-verbal communication is called | Kinesics |
| The study of an individual's concept and use of space is called | Proxemics |
| What are the types of certification? | RPT (AMT), CPT (ACA), CPT (NHA), and NCPT (NCCT) |
| What are some of the behaviors and characteristics that make up professional image? | Self-confidence, integrity, compassion, self-motivation, dependability, and ethical behavior. |
| Examples of communication barriers include | language, cultural diversity, emotions, age, gender, and disabilities (ex: hearing loss) |
| Elements of healthcare communication includes | empathy, control, respect and confirmation, and trust |
| Health departments provide | vital statistics, health education, cancer, hypertension, diabetes screening, nursing services, TB screening, immunizations, vaccines, operation of health centers and venereal disease clinics |
| The four main characteristics of hospitals are | permanent inpatient beds, 24-hour nursing service, therapeutic and diagnostic services, organized medical staff |
| Clinical analysis areas of the lab include | hematology, coagulation, chemistry, serology, urinalysis, microbiology, cytogentetic, flow cytometry, and blood bank (immunohematology) |
| Anatomical and surgical pathology areas of the lab include | histology and cytology |
| Reference laboratories are | large independent laboratories that receive specimens from many different facilities located in the same city, other cities in the state, and cities out of state |
| Clinical Laboratory personnel include | laboratory director (pathologist), lab manager, technical assistant, phlebotomist, and other personnel |
| The Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) is | a federal law that allows the CMS in the Department of HHS to regulate all sites performing laboratory testing in the US |
| The Joint Commission | the oldest and largest standard-setting body in health care. A survey team visits hospitals every 3 years and a lab every 2 years |
| A sentinel event (SE) is | any unfavorable event that is unexpected and results in death or serious physical or psychological injury |
| As of 2014, the NPSGs for the clinical laboratory are as follows: | identify patients correctly, improve staff communication, and prevent infection |
| The Clinical and Laboratory Standards Institute (CLSI) is | a global, nonprofit, standards-developing organizations with representatives from the profession, industry, and government |
| What is CLSI's mission? | To develop clinical and laboratory practices and promote their use worldwide |
| Quality Indicators (QA) is defined as | a program or process that is designed to prevent problems in the future by evaluating present and past performance |
| Quality Indicators must be | measurable, well defined, objective, and specific |
| A threshold value is | a level of acceptable practice beyond which quality patient care cannot be assured. They must be established for all quality indicators. |
| A correction action plan is established if | the data identifies a problem or opportunity for improvement |
| Quality Control (QC) is | the use of checks and controls |
| A correction action plan is established if | the data identifies a problem or opportunity for improvement |
| A correction action plan is established if | the data identifies a problem or opportunity for improvement |
| Quality Control (QC) is | the use of checks and controls |
| Delta check | compares current results of a lab test with previous results for the same test on the same patient. A major difference in results would be flagged and could indicate an error that requires investigation |
| Some examples of QC done by a phlebotomist includes | expiration date checks, equipment maintenance, and temperature checks |
| The Safety Manual contains policies and procedures related to | chemical, electrical, fire, and radiation safety; exposure control; and disaster plans as well as complete details on how to handle hazardous materials |
| The Infection Prevention and Control Manual outlines policies and procedures for | all employees in all areas of the HCO and must be in compliance with federal regulations and accreditation. |
| The Infection Prevention and Control Manual addresses such items as | hand hygiene, precautions to take when dealing with patients or handling specimens, and how to handle accidental contamination, including procedures to be implemented following exposure incidents. |
| Risk management | an internal process focused on identifying and minimizing situations that pose risk to patients and employees |
| The most common civil actions in health care are based on | tort law |
| A phlebotomist who attempts to collect blood specimens without the patient's consent | can face assault and battery as well as a civil suit for damages. |
| Invasion of privacy is | a violation of one's right to be left alone |
| A claim of malpractice implies | that a greater standard of care was owed to the injured person than the "reasonable person" standard associated with negligence |
| The failure to exercise due care would be | negligence (leaving a needle out on the tray) |
| Res ipsa loquitur | "the thing speaks for itself" (amputating the wrong leg) |
| Resondeat superior | "let the master respond" |
| Vicarious liability | liability imposed by law on one person for acts committed by another |
| Types of patient consent include | informed, expressed, implied, HIV, and consent for minors |
| Four phases of the litigation process include: | phase one: when incident occurred, phase two: information gathering phase, phase three: when the people go to court, phase four: if person doesn't like court's decision, then they can appeal it |
| Infection is | a condition that results when a microorganism is able to invade the body, multiply, and cause injury or disease |
| Microorganisms include | bacteria, fungi, protozoa, and viruses |
| Nosocomial infection or Healthcare-associated infection (HAI) | are infections acquired in the hospital. |
| According to the institute of medicine _ to _% of patients in all types of US healthcare facilities are exposed to and contract an injection after admission | 5 to 15% |
| The most common type of HAI reported to NHSN is | urinary tract infections (UTIs) accounting for over 30% of all HAIs, usually caused by improper catheter procedures |
| Examples of antibiotic-resistant infections include | C. Difficle, methicillin-resistant Staphylococcus aureus (MRSA), and Enterococcus |
| The infectious agent is the | pathogenic microbe responsible for causing an infection (bacteria, fungus, protozoan, rickettsia, or virus) |
| The place where the microbe can survive, grow, or multiply would be the | reservoir (animal, human, equipment, food, soil, or water) |
| An exit pathway is | a way an infectious agent is able to leave a reservoir host |
| The means of transmission is | the method an infectious agent uses to travel from a reservoir to a susceptible individual (airborne, contact, droplet, vector, vehicle) |
| The entry pathway is | the way an infectious agent is able to enter a susceptible host |
| A susceptible host is | someone with a decreased ability to resist infection |
| Ways to break the chain of infection | effective hand hygiene, good nutrition + rest, reduction of stress, immunization against common pathogens, proper decontamination of surfaces +instruments, proper disposal of sharps and infectious waste, use of gloves + other PPE, needle safety devices |
| Employee screening test typically includes a | tuberculosis (TB) test; employees with positive TB test results receive chest x-ray evaluations if they develop signs and symptoms |
| When donning a complete set of PPE such as gown, mask, and gloves what is put on first? | The gown, next is the mask or respirator, then goggles or face shield, gloves are put on last and pulled over cuffs of the gown. Removal is the opposite with respirator being removed after leaving the room |
| Asepsis is | a condition of being free of contamination |
| Aseptic technique is | a healthcare practice used to reduce the chance of microbial contamination with the goal of protecting patients |
| One way in which an infection control program minimizes the spread of infection is | through establishment of isolation procedures |
| Protective or reverse isolation is used for | patients who are highly susceptible to infections (burn patients, organ transplant patients, AIDS patients, and neutropenic chemotherapy patients |
| Universal Precautions | blood and certain bodily fluids of all individuals would be considered potentially infectious |
| Routes by which healthcare workers can be exposed to biohazards include | ingestion, parenteral routes, airborne, non-intact skin, percutaneous and permucosal |
| The series in a HBV vaccination includes | a shot today, another shot 30 days after the first, and a third shot 6 months after the first shot |
| An employer should offer an employee HBV vaccination within | 10 days of employment |
| The Needlestick Safety and Prevention Act directed OSHA to revise the BBP standard in the following 4 key areas: | a.Revision + updating of exposure control plan b.solicitation of employee input in selecting engineering + work practice controls c.modification of definitions relating to engineering controls. d. new recordkeeping requirements including sharps injury log |
| If a person accidentally sticks themselves with a needle or any sharp object, they should | carefully remove shards of glass or other objects that may be embedded in the wound and wash the site with soap and water for a minimum of 30 seconds |
| Classification of fires based on fuel source | Class A: ordinary combustible material (paper, wood) Class B: flammable liquids and vapors Class C: electrical Class D: combustible metals Class K: cooking oils, grease, fats |
| The National Fire Protection Agency (NFPA) code word for the order of action in the event of a fire is | RACE = Rescue, Alarm, Confine, Extinguish |
| The principles involved in radiation exposure are | distance, shielding, and time |
| OSHA developed the Hazard Communication (HazCom) Standard (HCS) to | protect employees who may be exposed to hazardous chemicals. This standard is known as "the right to know" law |
| The label of hazardous chemical must include | a precautionary statement and a GHS hazard statement, signal word, and pictogram for each hazard class and category signal word specifies the severity of the hazard faced. |
| There are two GHS signal words: | "Danger" if the hard is severe or "Warning" if the hazard is less severe |
| Safety data sheet (SDS) communicates | general and precautionary information about the hazard to users. HCS requires manufacturers to supply SDS to consumers |
| Hemorrhage can be stopped by | applying pressure |
| It is estimated that back injuries account for | approximately 20% of all workplace injuries and illnesses |
| Stress is | a condition or state that results when physical, chemical, or emotional factors cause mental or bodily tension |
| A word root is | the subject of a medical term and the foundation upon which the term is built |
| A prefix is | a word element that comes before a word root. It modifies the meaning of the word root by adding information such as presence, absence, location, number, or size. |
| A suffix is | a word ending. It follows a word root and either changes or adds to the meaning of the word root |
| A combining vowel is | a vowel ("o" is most common, followed by "i") that is added between the two word roots or a word root and a suffix to make pronunciation easier. A word root combined with a vowel is called a combining form. |
| To help reduce the number of medical errors related to incorrect interpretation of terminology, the JC created | a list of dangerous abbreviations, symbols, and acronyms that must be included on a "Do Not Use List" by every organization it accredits. This list applies to handwritten laboratory reports but printed and electronic laboratory reports are exempted |
| The human body contains approximately how much blood? | 5 liters |
| A person in the anatomic position is | standing erect, with feet parallel, arms at the sides, and eyes and palms facing forward |
| A body plane is | a flat surface resulting from a real or imaginary cut through a body in the normal anatomical position |
| Frontal plane | divides the body vertically into front and back portions |
| Midsagittal (medial) plane | divides the body vertically into equal right and left portions |
| Transverse plane | divides the body horizontally into upper and lower portions |
| Proximal | nearest to the center of the body, origin, or point of attachment |
| Distal | farthest from the center of the body, origin, or point of attachment |
| Homeostasis | The human body constantly strives to maintain its internal environment in a state of equilibrium or balance, a "steady state" |
| Metabolism | the sum of all the physical and chemical reactions necessary to sustain life |
| The 4 basic types of normal tissue: | connective, epithelial, muscle, and nerve |
| Connective tissue | supports and connects all areas of the body |
| Epithelial tissue | covers and protects the body and lines organs, vessels, and cavities |
| Muscle tissue | contracts to produce movement |
| Nerve tissue | transmits electrical impulses |
| The skin is | the largest organ of the body, the cover that protects the body from bacterial invasion, dehydration, and harmful rays of the sun |
| The layers of the skin include | epidermis (avascular), dermis (vascular), and subcutaneous (vascular) |
| The muscles consist of | the involuntary muscles of smooth and cardiac and the voluntary skeletal muscles |
| Skeletal disorders include | arthritis, gout, and osteoporosis |
| The spinal cord and brain cavity is completely enclosed and protected by three layers of connective tissue called the | meninges |
| Multiple sclerosis (MS) | a disease involving destruction of the myelin sheath of CNS nerves |
| The kidneys | help maintain water and electrolyte balance and eliminate urea |
| The basic working unit of the kidney is the | nephron. As the blood travels through a nephron, water and dissolved substances including wastes are filtered from it through a tuft of capillaries called the glomerulus. |
| Creatine clearance | a common urinary 24 hour test |
| Respiratory syncytial virus (RSV) | is a major cause of respiratory distress in infants and children |
| The circulatory system | carries oxygen and food to the cells of the body and carries carbon dioxide and other wastes away from the cells to the excretory organs, kidneys, lungs, and skin |
| The three layers of the heart are | the epicardium (the thin outer layer), the myocardium (the middle muscle layer), and endocardium (the thin inner layer) |
| The right atrium receives | de-oxygenated blood from the body via both the superior and inferior vena cava and pumps it into the right ventricle |
| The right ventricle receives | blood from the right atrium and pumps it into the pulmonary artery (only artery with de-oxygenated blood) and pumps it into the left ventricle |
| The left atrium receives | oxygenated blood from the lungs via the pulmonary vein (the only vein with oxygenated blood) and pumps it into the left ventricle |
| The left ventricle receives | oxygenated blood from the left atrium and pumps it into the aorta. |
| The walls of the left ventricle are | nearly three times as thick as those of the right ventricle owing to the force required to pump the blood into the arterial system |
| Systole | the contracting phase of the cardiac cycle |
| Diastole | the relaxing phase of the cardiac cycle |
| The normal heart rate averages | 72 beats per minute |
| Cardiac output | the volume of blood pumped by the heart in 1 minute |
| Average cardiac output | 5 liters per minute (approximate blood in the body) |
| Bradyccardia | under 60 beats per minute |
| Tachycardia | over 100 beats per minute |
| Veins have ___ to keep blood from backflow (arteries do not) | values |
| Capillaries | microscopic, one-cell-thick vessels that connect the arterioles and venules, forming a bridge between the arterial and venous circulation |
| Lumen | internal space of a blood vessel through which the blood flows |
| The flow of blood is | artery-arteriole-capillary-venule-vein |
| H-pattern antecubital veins: | Median cubital (first choice), Cephallic vein (second choice), Basilic vein |
| M-pattern veins: | Medidan vein (first choice), median cephalic vein (second choice), and Median Basilic vein |
| The main function of erythrocytes is | to carry oxygen from the lungs to the cells |
| Leukocytes are said to have extravascular function because | they are are able to leave the bloodstream and do their job (phagocytosis) in the tissue |
| An individual's blood type is inherited and is determined by | the presence or absence of certain proteins called antigens on the surface of the red blood cells |
| Normal fasting plasma is what color? | Clear to slightly hazy pale-yellow fluid visually indistinguishable from serum |
| Hemostasis | the arrest or stoppage of bleeding, is the body response that stops the loss of blood after an injury (coagulation process) |
| The hemostatic process includes | vasoconstriction, primary platelet plug formation, secondary hemostatic plug formation and fibrinolysis |
| Lymph fluid | excess tissue filtered into the lymphatic capillaries, similar to plasma but is 95% water |
| Who regulates glove quality? | The United States Food and Drug Administration |
| Which antiseptic is most commonly used for routine blood collection? | 70% isopropyl alcohol in individually wrapped prep pads |
| If tourniquet is left in place longer than 1 minute | restriction of blood flow can change blood components, so it must fasten in a way that is easy to release with one hand during blood collection procedures or in emergency situations |
| If disposable tourniquets are reused, they must | be discarded if dropped or contaminated with blood or other visible contaminants |
| What is the most common and efficient system for blood collection? | Evacuated Tube System (ETS) |
| What needles are used in phlebotomy with the ETS? | Multisample needles, hypodermic needles, and winged infusion needles |
| Bevel | the part of the needle that is "beveled" and is always facing up during venipuncture |
| A needle's diameter and gauge have an ___ relationship | inverse |
| The higher the gauge number, the ___ the diameter of the needle | smaller |
| The size of needle is selected according to | the size and condition of the vein, the type of procedure, the volume of blood needed, and the equipment used |
| A tube holder is | a clear, plastic, disposable cylinder with a small threaded opening at one end where the needle is screwed into it and a large opening at the other end where the tube is inserted |
| OSHA regulations require that the tube holder with needle attached be disposed of | as a unit after use and never be removed from the needle and reused |
| Evacuated tubes fill with blood automatically because | there is a vacuum in them, to reach its stated volume, a tube must be allowed to fill with blood until the normal vacuum is exhausted |
| A winged infusion blood collection set, or butterfly, is an | indispensable tool for collecting blood from small or difficult veins such as hand veins and veins of elderly or pediatric patients as it allows much more flexibility and precision than a needle and syringe |
| The most common reason for using an additive is to | prevent clotting of the specimen |
| Anticoagulants | substances that prevent blood from clotting by either of 2 methods: chelating 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 coagulation |
| The most common anticoagulants are | Ethylenediamineteraacetic acid (EDTA), Citrates, Heparin, and Oxalates (remember ECHO) |
| Heparin | prevents clotting by inhibiting thrombin |
| An antiglolytic agent is a | substance that prevents glycolysis, the most common is sodium flouride |
| Glycolysis | the breakdown of metabolism of glucose by blood cells |
| Clot activator | a substance that enhances coagulation in tubes used to collect serum specimens. Include substances that provide more surface for platelet activation such as glass (silica) particles and clotting factors such as thrombin |
| Thixotropic gel | an inert synthetic substance initially contained in or near the bottom of certain blood collection tubes, in the centrifuge it separates blood from serum |
| Before a test is drawn a ___ needs to be written | requisition |
| A bar code is | a series of black stripes and white spaces of varying widths that correspond to letters and numbers |
| Before entering a room, | knock lightly, open the door slowly, and say something like "good morning" before proceeding |
| If the draw is not stat, timed, or other urgent priority, | go draw another patient and check back after |
| If the patient is with a doctor or member of clergy | check back later |
| If a patient cannot be located, | fill out a form stating unable to draw patient |
| Obtaining a specimen from the wrong patient can | have serious, even fatal, consequences, especially specimens for type and crossmatch |
| In case of discrepancies with ID | ask the nurse |
| What might be used for a patient that cannot be identified? | A three part identification band |
| How can needle phobia be helped? | experience drawing, having the patient lie down, and applying an ice pack to the arm to numb it |
| If the patient was supposed to fast but didn't | consult the doctor, if the doctor tells you to draw the specimen make sure to label it non-fasting |
| The basilica vein or other veins in the medial aspect shouldn't be chosen unless it appears no other vein can be safely used. Why? | The possibility of nerve injury and damage to the brachial artery |
| Fist pumping most notably affects | levels of potassium and ionized calcium |
| Do not select a vein that feels hard and cord-like or lacks resilience because | it is probably sclerosed or thrombosed |
| The evaporation of the alcohol helps | destroy microbes and avoids a burning/stinging sensation when the needle is inserted |
| Why should you not shake or vigorously mix blood specimens? | This can cause hemolysis |
| Never tell a child | "it won't hurt" instead, say it may hurt just a little bit, but it will be over quickly |
| Elderly veins can roll and be harder to anchor due to | sagging skin and loss of muscle tone |
Created by:
rhaines26