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Questions And Answers 2024
- When patients need more than one test performed, requiring more than one tube to be filled, the same multi-sample is used to fill all of the tubes. This leads to potential of material from earlier tubes
needle, contam- ination, Clinical and Laboratory Standards Insti- into subsequent tubes. As a result, the tute (CLSI) has developed a standard order of draw for multitube draws. This applies to both syringe samples and multi-sample needle draws.
- CLSI Order of Draw (name colors in order)
- Sterile Tube (blood cultures): top
- Coagulation Tube: top
- Serum Tube: top (glass or plastic tube)
- SST (Serum Separator Tubes): Speckled Red/Gray, Tiger top, or BD Hemoguard
- PST (Plasma Separator Tubes): Light or Dark top
- EDTA Tube: top
- Glycolytic Inhibitor Tube: top
- It is very important that a , found in the work- place, be followed regarding specimen collection and order-of-draw standards, even if they differ from the order above.
- The first and most important step in venipuncture procedures is to properly the patient.
- Erroneously drawing blood from the wrong patient could lead to serious consequences, including incor- rect or treatment of the intended patient, which could result in injury or death, of the phle- botomist, and the potential for a lawsuit.
- To reduce the risk of incorrect identification of a pa- tient, two of the following three main identifiers should be used before drawing a patient's blood:
Yellow, Light Blue, Red, Gold, Green, Lavender, Gray
Procedure Manual
identify
diagnosis, termi- nation
name, DOB, ID
Questions And Answers 2024
- Patient's
- D (abbrev.)
- Hospital-issued (abbrev.) number
- The following supplies are needed in order to perform venipuncture:
- Phlebotomy containing vacutainers, holders, needles, and syringes
- T
- Specimen labels
- Disposable gloves
- container
- % isopropyl alcohol
- Gauze pads
- Bandages
- While evacuated tubes are more commonly used when drawing blood from veins, in some patients, especially those with fragile veins, the strong vacuum of these tubes may cause the vein to. To avoid such complications, a is used in place of the evacuated tubes. A smaller gauge needle is usually used for these types of draws and discarded once the draw is complete. The blood is then transferred from the syringe to the evacuated tubes through the use of a needleless blood.
- Parts of a multi-sample needle:
- Bevel
- Shaft
- Threaded
- Rubber over the needle
- Parts of a syringe system:
tray, Tourniquet, Sharps, 70%
collapse, syringe, transfer device
hub, sleeve
barrel, Plunger
Questions And Answers 2024 Capillary/Dermal Puncture:
Child younger than 1 year
and lateral borders of the surface of the heel
For older infants, the may be used if an alter- native site is needed
Depth: 2.0 mm
- Capillary/Dermal Puncture:
Premature infants or neonates
and lateral borders of the surface of the heel
Puncture is made to the heel lines
Depth: 0.65-0.85 mm or 0.35-1.6 mm (McCall, p. 311)
- When performing dermal punctures, it is important to avoid contact with the underlying.
- The depth of the dermal puncture is determined by the of the patient.
- Bone puncture complication:
is painful inflammation of the bone or cartilage
- Bone puncture complication:
is a potentially fatal bone infection
- (Part 1) The following procedure should be used when performing a dermal puncture:
- Review the physician's in order to ensure that it
Medial, plantar, big toe
Medial, plantar, perpendicular
bone
age
Osteochondritis
Osteomyelitis
order, capillary, Identify, prepared, equipment, hands
Questions And Answers 2024 contains all the necessary information. If any part of the order is unclear, contact the appropriate person for confirmation. (Be sure to note on the requisition that you are performing a collection.)
- the patient, introduce yourself, and then escort him/her to the appropriate area (if necessary).
- Verify that the patient is for the procedure.
- Assemble the necessary.
- Wash your.
- (Part 2) The following procedure should be used when performing a dermal puncture:
- Select an appropriate dermal puncture site depend- ing on the of the patient.
- Warm the site with either a warm cloth or warming device. This practice can increase the up to seven times the normal amount.
- Clean the site using 70% isopropyl. Allow the site to thoroughly air-dry for maximum antiseptic action.
- Prepare the , and position and hold the finger or heel.
- Make the puncture. Ensure that the blade has made puncture to the full depth and fully retracted before lifting the device. Properly dispose of the b .
- (Part 3) The following procedure should be used when performing a dermal puncture:
- Wipe away the drop of blood with a clean gauze pad to prevent contamination. Keep the site in a downward position to promote blood flow.
- Collect the sample by lightly touching the mi- crosample container to the blood drop and allowing the blood to flow into the t. Be sure not to overfill the container. Properly close the container.
- Apply to the site using a clean gauze pad.
age, blood flow, alcohol, lancet, blade
first, tube, pres- sure, choking, La- bel
Questions And Answers 2024
- Clean the antecubital area in a circular motion, using 70% isopropyl alcohol (or other antiseptic as necessary), and allow the site to for 30 to 60 seconds.
- Assemble the and tube holder.
- Place the patient's arm in a downward position. Using the non-dominant hand, firmly grasp the pa- tient's arm, making sure to keep the elbow straight and to the vein by gently pulling the skin taut using your thumb 1-2 inches below the venipuncture site. Angle the needle 15 to 30 degrees, and insert the needle, bevel up, in one smooth, quick motion.
- Firmly hold the needle in place with the dominant hand and push the tube toward the holder using the thumb of the non-dominant hand. Use your fingers on the same hand to pull back on the of the holder to prevent pushing the needle in farther. Continue push- ing the tube in this way until the stopper is punctured.
- (Part 3) The following procedure should be used when performing routine venipuncture:
tourniquet, order of draw, safe- ty, Discard, label,
- As soon as blood is flowing free, release the , bandage, hand and politely ask the patient to release his or her fist.
- Remove the tube when blood stops flowing and insert the next tube. Be sure to follow the correct inversion guidelines for tubes with additives, as well as the correct.
- After removing the last tube, gently hold folded gauze over the venipuncture site and withdraw the needle. Once the needle is withdrawn, activate its feature immediately, and use the gauze to apply pres- sure to the puncture site until the bleeding stops.
- D needles and collection systems properly.
- Accurately each tube, noting the patient's name and ID number, the time and date of collection, and your initials. Prepare the specimens for transport to the laboratory, being mindful of special handling requirements (i.e. warming or exclusion from light) if
Questions And Answers 2024 applicable.
- Check the venipuncture site to ensure that bleed- ing has stopped, then the area.
- Remove and properly dispose of gloves. Then per- form proper hygiene
- (Part 1) The following procedure should be used when performing venipuncture with a syringe:
- Perform the beginning steps for routine venipunc- ture (steps 1-11 from above)
- Twist the needle onto the syringe. Pull the plunger back to ensure that it moves freely, and then push it all the way in to expel any.
- Place the patient's arm in a downward position. Us- ing the non-dominant hand, firmly grasp the patient's arm, making sure to keep the elbow straight and to the vein by gently pulling the skin taut using your thumb 1-2 inches below the venipuncture site. Angle the needle 15 to [ # ] degrees, and insert the needle, bevel up, in one smooth, quick motion.
air, anchor, 30, plunger, safety
- Pull back the is filled.
slowly and gently until the syringe
- Gently hold folded gauze over the venipuncture site and withdraw the needle. Once the needle is with- drawn, activate its feature immediately, and use the gauze to apply pressure to the puncture site until the bleeding stops.
- (Part 2) The following procedure should be used when performing venipuncture with a syringe:
- Remove the needle from the syringe and dispose of it in the proper container. Attach a needleless blood transfer device to the syringe. Transfer the blood to e tubes following proper order of draw guidelines.
- Dispose of the syringe and device together in the appropriate container.
- Accurately label each tube, noting the patient's
evacuated, trans- fer, handling, stopped, gloves
Questions And Answers 2024 sample and interfere with results of certain tests, such as bilirubin, , and phosphorous tests.
- To prevent analysis interference, the phlebotomy technician should be mindful of the following vari- ables:
selection - This from which a specimen is col- lected may cause interference as well. The following should be avoided when performing venipunctures:
Site, Hematoma, mastectomy, IV, distal
o H - Test results may be altered cause blood drawn from this is not as fresh as venous blood. o The side of the body that has undergone - lymph stasis here can affect test results o (abbrev.) sites - when possible, avoid drawing blood from an arm that has this in place. If no alternate site is available, be sure to perform specimen collec- tion from a site that is to (or below) this thing. The 5 mL of blood should be discarded to prevent interference by medications and fluids
- To prevent interference, the phlebotomy technician should be mindful of the following variables:
Specimen - Collecting specimens in the correct tubes and following the proper will help to prevent contamination or interference. It is also important to ensure the correct sample v and to invert tubes properly.
- To prevent interference, the phlebotomy technician should be mindful of the following variables:
application - Tying this too tightly can result in h n or an increase in the proportion of cells to plasma. This can affect many results, including plas- ma proteins, enzymes, (abbrev.) counts, iron and potassium levels, among others. To prevent is, release the tourniquet as soon as blood begins to in the
Collection, order of draw, volume
Tourniquet, hemoconcentra- tion, RBC, flow
Questions And Answers 2024 first tube, and never leave it in place for longer than 1 minute
- In some situations, special precautions should be tak- en in regard to special needs of the patient.
PEDIATRIC PATIENTS o Physiological needs - It is important to keep in mind that children have a much lower total volume than adults. To prevent cardiac arrest and iatrogenic anemia, pediatric patients should not have more than % of their blood drawn within a 24-hour period. o Psychological needs - Children may often experi- ence anxiety and f when undergoing medical pro- cedures. Excessive crying can alter blood test results, specifically affecting (abbrev.) count and blood pH levels. It is important to always calm pediatric patients, explain procedures, and involve the p whenever possible. Anesthetics, most commonly (abbrev. for eutectic mixture of local anesthetics) may be useful in numbing venipuncture sites before the procedure.
- In some situations, special precautions should be tak- en in regard to special needs of the patient.
GERIATRIC PATIENTS o Physical changes - Reduction in the collagen and elasticity in the skin of geriatric patients can lead to easy bruising and longer c times. o Other considerations - Geriatric patients may ex- perience other disorders that should be taken into consideration when performing specimen collection,
blood, 5%, fear, WBC, parents, EMLA
coagulation, Parkinson's, ID, dermal, tourniquet, anchored
such as hearing loss, visual impairment, P ease, arthritis, or dementia.
dis-
Guidelines for collecting specimens from geriatric pa- tients o Be sure to identify the patient using his/her
Questions And Answers 2024 common UA ( ). C&S (culture and sensitivity) testing is used for UTI symptoms and must be a clean catch specimen. Drug screening is a sample in a clean covered container.
- Urine Specimens
A major drawback of a 24-hour urine collection is patient - often patients get tired of participating and the entire test is then null and void. Pregnancy testing is used to identify the presence of usually present in body after 10 days post conception. - specimen is preferred.
- Types of Urine Collection:
voided specimen, also known as random urine specimen, is collected for urinalysis. No special mea- sures are required. It can be collected at any time.
- Types of Urine Collection:
specimens are specimens that are collected at specific times.
- Types of Urine Collection:
- specimens are collected immediately after the patient awakens. The high of these specimens allows for testing and detection of chemicals or mi- crobes that may not be detected in more dilute speci- mens. These specimens are also referred to as 8-hour specimens.
- Types of Urine Collection:
Timed - specimens are samples collected over a period of 24 hours in a single container to provide one large specimen. The patient discards the -
cooperation, HCG, First-morning
Regular
Timed
First-morning, concentration
24-hour, first-morning
Questions And Answers 2024 urine. He or she then collects all urine samples for the next 24 hours, ending with the first urine the following morning (or at the same time that the patient started testing the previous day.)
- Types of Urine Collection:
, clean catch specimen is the most common pro- cedure for urine collection. The area around the ure- thra is cleaned with alcohol towelettes. The patient then voids some urine into the toilet and begins filling the specimen cup midstream. This produces a sterile specimen used for testing to determine if the patient has a UTI.
- Types of Urine Collection:
specimens are collected through use of a catheter that is inserted through the urethra into the bladder
- Types of Urine Collection:
Suprapubic specimens, or collections, can only be performed by a physician. These samples are collected through the use of a needle inserted through the abdominal wall directly into the.
- Stool or specimens are collected to test for bac- terial or viral intestinal infections. They may also be used to screen for blood, indicative of colorectal cancer. These samples must be collected in a clean, dry container with a tightly fitted lid.
- specimens are used in fertility testing, to deter-
Midstream, culture and sensitivity
Catharized
suprapubic aspira- tion, bladder
fecal, occult
Semen, sexual, mine the effectiveness of a vasectomy, or for forensic body analysis as part of a rape kit. (When being used for the latter, specially trained personnel collect the sample.) Patients are advised to abstain from activity or ejaculation for 3 days prior to the specimen collection. For collection, the sample is ejaculated into a sterile
Questions And Answers 2024
- Amniotic fluid is found surrounding the fetus in the in pregnant women. These specimens are collected through a special procedure known as an , which may only be performed by a physician. A needle is inserted through the mother's abdominal wall and directly into the amniotic sac, from which fluid is removed and transferred into a sterile con- tainer. Special precaution must be taken to protect amniotic fluid from light. Laboratory testing on these specimens reveal information regarding the health of
amniotic sac, am- niocentesis, fetus
the.
- Possible Complications Occurring with Specimen Collection:
Syncope - Sudden can occur during specimen collection. Therefore, communication is essential be- tween the phlebotomist and the patient. If syncope is a known possibility, draw blood in a (lying) position. Do not turn your back on the patient and stay with the patient for at least 15 minutes after the blood collection to assure the patient's safety. If syncope occurs during collection, the draw immediately following proper procedure and call for assistance.
- Possible Complications Occurring with Specimen Collection:
- This occurs when blood is leaking into the sur- rounding tissues. A hematoma can be caused by ad- vancing the needle too far or at the wrong angle, causing it to go through the vein, by failing to apply appropriate pressure after needle withdrawal, or by the arm at the antecubital area after needle with- drawal. Not following proper procedure and removing the needle before removing the can also cause this.
fainting, recum- bent, end
Hematoma, bend- ing, tourniquet
Questions And Answers 2024 Possible Complications Occurring with Specimen Collection:
Petechiae, blood, tourniquet
- These are small, red, smooth, hemorrhagic spots appearing on a patient's skin, which indicates that minute amounts of have leaked in the skin ep- ithelium. This can be caused by applying the too tightly.
- Possible Complications Occurring with Specimen Collection:
bleeding, thinner, elderly
Excessive - Coagulation times may vary if the patient is on a blood. Be sure to apply appropriate pressure for a longer period of time for patients taking anticoagulants. Physical changes in patients lead to longer healing times, requiring pressure to be ap- plied for longer periods for these patients after needle withdrawal as well.
- Possible Complications Occurring with Specimen Collection:
Hemoconcentra- tion, tourniquet
- A decrease in the plasma volume with an in- creased concentration of cells and molecules may be caused by prolonged application, or massaging, squeezing, or probing a site.
- Possible Complications Occurring with Specimen Collection:
Hemolysis, red, vein
- This occurs when RBC's are lysed; hemoglo- bin is released and serum, which is normally straw colored, becomes tinged with pink or. There are many causes of this, including, but not limited to draw- ing blood too quickly into a syringe, excessively or vigorously inverting tubes after collection, and using too small a needle with respect to size.
Questions And Answers 2024
- 1-Hr GTT
1 hr (no fasting)
1 tube
Screening for
- 3-Hr GTT
Fasting, 1 hr, 2 hr, and 3 hr
4 tubes
Screening for
- 5-Hr GTT
Fasting, 1 hr, 2 hr, 3 hr, 4 hr, and 5 hr
6 tubes
Screening for
- Special Procedures/Special Testing
(LTT) - This is used to determine if lactase is present in the patient's digestive system. This test follows the same procedures as the GTT, but the pa- tient must drink rather than glucose.
- Special Procedures/Special Testing
(BT) - A BT test is performed on the forearm and uses a blood pressure cuff inflated to 40 mm Hg. Phlebotomist will use an automated incision device to puncture skin and will use to blot the blood drops. This is a timed test and the phlebotomist will blot blood every 30 seconds until patient stops bleeding.
Gestational Dia- betes
Hyperglycemia
Hypoglycemia
Lactose Tolerance Test, lactose
Bleeding Time Test, filter paper
Questions And Answers 2024
- Special Procedures/Special Testing
A DNA test is done by swabbing the inside of the cheek - also known as a.
- Guidelines for appropriate post-puncture care:
- Place folded gauze over the venipuncture site and withdraw the needle. Apply pressure until the bleed- ing.
- Keep in mind, bleeding times will vary from patient to patient, and puncture sites may require additional to stop bleeding. As a general rule, the puncture site should stop bleeding within [ # ] minutes. Prolonged bleeding times should be documented, and the nurse or physician should be notified.
- Check the venipuncture site to see whether the bleeding has stopped, then bandage the area. can pose a choking hazard to children under 2 years of age and should not be used for these patients.
- Extra info about post-puncture care:
For instance, patients tend to have a longer bleed- ing time and may require pressure to be applied for at least 2 minutes. Patients taking a or who are on an aspirin regimen may require additional pressure at the puncture site. In any case, continue to apply pressure until the bleeding has.
- Accurate s helps ensure quick and efficient treatment of patients. Specimens with inaccurate or incomplete (plural) are unable to be processed, requiring the specimen to be redrawn, and possibly prolonging patient care.
- Guidelines for accurate specimen labeling:
- Label tubes i a finishing the specimen collec-
buccal swab
stops, pressure, 5, Bandages
elderly, anticoagu- lants, stopped
specimen labeling, labels
immediately after, room, date, initials
