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Arterial line (A-line)
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Arteriouvenous (AV) shunt,fistula,graft
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Chapter 9
Preanalytical considerations
| Question | Answer |
|---|---|
| Arterial line (A-line) | A line that is placed in an artery most commonly placed in a radial artery used 2 provide accurate and continuous measurement of patients blood pressure to collect blood gas specimens and other blood specimens and administrating of drug such as dopamine |
| Arteriouvenous (AV) shunt,fistula,graft | Permanent surgical connection of an artery and vein by direct fusion (fistula) resulting in a bulging vein,or a piece of vein/tubing (graft) that creates a loop under the skin - used for the purpose of hemodialysis |
| The preanalytical phase of the testing process begins for the laboratory when a | Test is ordered by patient's physician |
| Most referenced ranges are based on normal laboratory test values for | Healthy people |
| Basal state | Refers to the resting meabolism state of the body early in the morning after fasting for a approximately 12hrs |
| Central vascular access device (CVAD) | Indwelling line-consisting of tubing inserted into a main vein or artery. Primarily for administering fluids and medication,monitoring pressures, and drawing blood |
| Bilirubim | A product of the breakdown of red blood cells |
| Central venous catheter (CVC) | A line inserted into a large vein such as the subclavian and advanced into the superior vena cava,proximal to the right atrium. the exit end is surgically tunneled under the skin to a site several inches away in the chest aka:central venous line |
| Circadin | Biologic rhythms or variations having a 24hrs cycle |
| Diurnal | Happening daily |
| Exsanguination | Blood loss to a point where life cannot be sustained |
| Hematoma | A swelling or mass of blood (ofter clotted) such that caused by blood leaking from a blood vessel during or following venipuncture |
| Hemoconcentration | A decrease in the fluid content of the blood with a subsequent increase in non-filterable large molercule or portein based blood components such as red blood cells |
| Hemolysis | Damage or destruction of RBC and release of hemoglobin into the fluid portion of a specimen causing the serum color to range from pink (slightly hemolysis) to red (gross hemolysis) |
| Heparin lock | A special winged needle set or cannula with a stop-cock or cap and a diaphragm to provide access for administering medication or drawing blood periodically flushed with saline or heparin to prevent clotting-lower arm above the wrist area |
| Iatrogenic | An adjective used to describle an adverse condition brought on by the effect of treatment |
| Implanted port | A small chamber attched to an indwelling line that is surgically implanted under the skin in the upper chest or arm |
| Intraverous (IV) | Pertaining to or within a vein |
| Jaundice | A condition characterized by increased bilirubin (breakdown of RBC) in the blood leading to the deposiion of yellow bile pigment in the skin mucous membranes and sclerae (white of the eyes) giving the patient a yellow appearance aka: Icterus |
| Lipemia | Increase liped content in the blood |
| Lipemic | Describing serum or plasma that appears milky (cloudy white) or tubid due to high lipid content |
| Lymphostasis | Obstruction or stoppage of normal lymph flow |
| Petechiae | Tiny nonraised red spots that appear on a pt. skin upon tourniquet application. They r min drops of blood that escape the capillaries and come to the surface of the skin below the tourniquet,as a result of capillary wall defects/platelet abnoralities |
| PICC | Peripherally inserted central catheter |
| Preanalytical | Prior to analysis |
| Pre-examination | Prior to analysis a term the International organization for Standardization (ISO) uses in place or preanalytical |
| Reference ranges | Normal laboratory test values for healthy individuals |
| Sclerosed | Hardened |
| Syncope | Medical term for fainting, the loss consciousness and postural tone that results from insufficient blood flow to the brain |
| Thrombosed | Clotted refers to a vessel that is affected by clotting |
| Vasovagal syncope | Sudden faintness or loss of consciousness due to a nervous system response to abrupt pain, stress or trauma |
| Venous stasis | Stoppage of the normal venous blood flow |
| Icteric | A term meaning "marked by jaundice" used to describe serum plasma or urine specimens that have an abnormal deep yellow to yellow-brown color due to high bilirubin levels |
| Hemolyzed | The condition of serum or plasma that contains hemoglobin from broken RBC |
| Mastectomy | Breast excision or removal |
| Edema | Swelling due to abnormal accumulation of fluid in the tissue |
| Diurnal variaton associated with some blood components are | Normal fluctuations throughout the day |
| A patients arm is swollen. The term used to describe this condition is | Edematous |
| Which of the following is a prodcut of the breakdown of red blood cells (RBC) | Bilirubin |
| The patient has an IV in the left forearm and a large hematoma in the antecubital area of the right arm. The best place to collect a specimen by venipucture is the | Right arem distal to the hematoma |
| Which of the following is not rue of hematomas | All of the above are correct |
| Hemoconcentration from prolonged tourniquet applicaation increases | Non-filterable analytes |
| In which instance is the patient closest to basal state. The patient who | Is awakened for a blood draw at 0600 after fasting since 0800 last night |
| The best specimens to use for establishing inpatient reference ranges for blood tests are | Basal-state specimens |
| Which test requires the patients age in calculating results | Creatine clearance |
| Which of the following tests is most affected by altitude | RBC count |
| Persistent diarrhea in the absence of fluid replacement may cause | Hemoconcentration |
| The serum or plasma of a lipemic specimen appears | Cloudy white |
| A lipemic specimen is a clue that the patient was probably | Not fasting |
| A 12hr fast is normally required in testing for this analyte | Triglycerides |
| This blood component exhibits diurnal variation with peak levels occurring in the morning | Cortisol |
| Tests influenced by diurnal variation are typically ordered | Timed |
| A drug known to interfere with a blood test should be discontinued for this many hours before the test ranges for RBC counts | 4-24 |
| A test result can be falsely decreased if | A drug completes with the test reagents for the test analyte |
| Which of the following analytes can remain elevated for 24hrs or more after exercise | Ck - Creatine kinase |
| Which hormone is most affected by the presence of a fever | Insulin |
| Which analyte has a higher reference range for males than for females | Hematocrit |
| An icteric blood specimen indicated that: | bilirubin test results could be elvevated |
| What changes occur in the bloodstream when a patient goes from supine to standing | Non-filterable elements increase |
| Why do pregnant patients have lower reference ranges for RBC counts | Increased body fluids result in the dilution of the RBC |
| Which of the following analytes is typically increased in chronic smokers | Hemoglobin |
| It is not a good idea to collect a cbc from a screaming infant because the: | WBC may be temporarily elevated |
| Of the following factors known to affect basal state, which is automatically accounted for when reference ranges ae established | Geographic locale |
| Temperature and humidity control in a laboratory is important because it: | Maintains the integrity of speciments |
| Scarred or burned areas should be avoided as blood collection sites because: | Circulation is typically impaired |
| A vein that feels hard, cord-like and lacks resiliency is most likely | Sclerosed |
| Drawing blood from an edematous extremity may cause: | Erroneous specimen results |
| If you have no choice but to collect a specimen from an arm with a hematoma collect the specimen | Distal to it |
| One reason collecting blood specimens from an arm on the same side as a mastectomy without permission from the patients physician is probilited is becasue: | tourniquet application my injury it |
| Which of the following veins is often the easiest to feel on obese patient | Cephalic |
| You must collect a protime speciment from a patient with IV's in both arms. The best place to collect the specimen is | Below one of the IV's |
| A phlebotomist must collect a hemoglobin specimen from a patient in the ICU. There is an IV in the patients left wrist. There is no suitable antecubital vein or hand vein in the right arm. What should be phlebotomist do | Perform a fingerstick on the right hand |
| Is selecting a venipuncture site, do not use an arm with | An active av shunt or fistula |
| A type of line commonly used to monitor blood pressure and collect gas specimens is | An A-line |
| A vascular access pathway that is surgically created to provide access for dialysis is: | An AV shunt |
| When a blood specimen is collected from a heparin lock, it is important to drawn: | A 5-ml, discard tube before the specimen tubes are filled |
| Which of the following is a type of CVC | Broviac |
| A subcutaneous vascular access device consisting of a small chamber attached to an indwelling line that is implanted under the skin and located by palpating the skin is: | An implanted port |
| The way to bandage a venipuncture site when the patient is allergic to the glue in adhesive bandages is to: | Wrap it with self-adhering material |
| You may have to be careful about what type of equipment is brought into the room if a patient is severely allergic to: | Latex |
| What is the best thing to do if a venipuncture site continures to bleed after 5 minutes | Report it to the patients physician or nurse |
| Which patient should be asked to lie down during blood draw. a patient with a: | History of syncope |
| An outpatient becomes weak and pale after a blood draw. What should the phlebotomist do | Have the patient lie down until recovered |
| If an outpatient tells you before a blood draw that she is feeling nauseated, you should: | Advise her to begin slow, deep breathing |
| Pain associated with venipuncture can be minimized by: | Putting the patient at ease with a little small talk |
| A site could potentially be used for venipuncture even if: | Petechiae appear below the tourniquet |
| A vein with walls that have temporarily drawn together and shut off blood flow during veipuncture is called a: | collapsed vein |
| U r in the process of collecting a bld spec on a pt.w/difficult veins.You had 2 redirect the needle but is is now in the vein,and the 1st tube has just started to fill.The bld is filling the tube slowly.The skin around the site starts to swell.more tubes | Stop the draw at once and apply pressure to the site |
| Which of the following can cause a hematoma to form during venipuncture procedures | Failing to apply adequate pressure after the draw |
| Which of the following is the best indication that you have accidentally punctured an artery | Blood pulses into the tubes |
| Amemia brought on by the withdrawal of blood for testing purposes is described as: | Iatrogenic |
| If you suspect that you have accidentally collected an arterial specimen instead of a venous specimen: | See if the lab will accept it, and if so, label it as possibly an arterial specimen |
| Blind or deep probing for a vein can result in: | An arterial puncture |
| A patient complains of marked pain when you insert the needle. The pain reaiates down his arm and does not subside. What should you do | Discontinue the venipuncture immediately |
| A stinging sensation when the needle is first inserted is most likely the result of: | Not letting the alcohol dry thoroughly |
| Which is the best way to avoid reflux | Make certain that tubes fill fromt he bottom up |
| Which of the following is least likely to impair vein patency | Leaving a tourniquet on too long |
| Prolonged tourniquet application can affect blood composition becauses: | Hemoconcentration |
| The serum or plasma of a hemolyzed specimen appears | Pink or reddish |
| Which action is least likely to cause specimen hemolysis | Transferring blood from a syringe to a tube |
| The ratio of blood to anticoagulant is most critical for which of the following test | Prothrombin time - 9 to 1 ratio |
| A phlebotomist has tried twice to collect a light blue top tube on a patient with difficult veins. Both times the phelbotomist has been able to collect only a partial tube. What should be phlebotomist do | Have someone else collect the speciment |
| Which of the following situations is least likely to cause contamination of the specimen | Cleaning a fingerstick site with isopropyl alcohol |
| You are collecting a blood specimen. The needle is in the vein and blood flow has been established | Bevel came out of the skin and the tube vacuum escaped |
| A needle that has gone through the back wall of the vein may cause: | Blood to enter the tube slowly or not at all |
| When a vein rolls, the needle typically | Slips beside instead of in the vein |
| You are in the process of collecting a blood specimen. The neelde is inserted but the tube is filling very slowing. A hematoma starts to form rapidly. What has most likely happened is that the: | Needle is only partly in the vein |
| U r performing a multitube bld draw.U collect 1st tube w/o a problem.2nd tube fails to fill w/bld.u pull the needle back and nothing happens.You push the needle in a little deeper and nothing happens.U remove thetube,pull back the needle alittle turnbevel | Try a new tube in case it is a vacuum issue |
| U insert the needle during a venipuncture.U engage the tube in the tube holder but do not get blood flow.U determine that the needle is beside the vein. you redirect it 2 times and still do not get blood flow,even after trying a new tube.What should u do | Discontinue the draw and try again a new site |
| Which of the following if most apt to be the cause of vein collapse during venipucture | Tube vacuum is too great for the size of the vein |
| During a blood draw, a patient says he feels faint. What should the phlebotomist do | Discontinue the draw and lower his head |
Created by:
mmfleischer