Phlebotomy chapter 8 (certification exam prep)
Equipment used in routine venipuncture
- anti-septic cleaning solution - Bandages - Collection tubes - Gauze pads - gloves - marking pens - Needle disposal containers - Needle holders - Needles - syringe with transfer device - Tourniquet - Winged infusion set (butterflies)
3) How many times my needle be used before discarding it?
1
There are three types of blood specimens:
1) WHOLE BLOD (hematology) : is mixed with anticoagulant so that it will not clot. Testing: blood type, cell count, hormone level, metals 2) SERUM is the fluid portion of the blood that remains after clotting (chemistry, serology, blood bank) many laboratory tests including most chemistry and immunology test. Unlike plasma, Serum does not contain fibrinogen ( protein present in blood plasma, from which fibrin is produced by the action of the enzyme thrombine) or some other clotting factors. 3) PLASMA is fluid proportion of the blood, Including fibrinogen and other clotting factors.Plasma is obtained by collecting whole blood you need to continue an anticoagulant.
The appropriate tube for STAT sodium level is:
Lithium heparin Would be the most appropriate choice for a STAT sodium. Although SST and red glass stopper tube skin be used for sodium essays, they require clotting time before Centrifugation and thus Are not the best choice for STAT testing.
The needle gauge describes the diameter of the needles
Lumen
What is tube advancement.
Mark indicating how far the tube can be pushed in without losing the vacuum
Gray tube ( chemistry)
Tests: Lactic Acid measurement, glucose tolerance test, fasting blood sugar (FBS), blood alcohol levels. Additives: Anticolytic agent (iodoacetate or sodium fluoride) that preserves glucose, perhaps the anticoagulant potassium oxalate or heparin. Specimen: Plasma *Notes: Iodoacetate preserves glucose for 24 hours; sodium fluoride preserves glucose for 3 days.
Green top tube (chemistry)
Tests: stat in routine chemistry test, ammonia, electrolytes, Arterial blood gases ( ABGs), depending on hampering additive. Additives: sodium heprin, lithium heparin, or ammonium heparin.
Which of the following additives promotes coagulation?
SILICIA or glass particles are commonly used in clot activator tubes to provide increase surface area for platelet activation that promotes the clotting process.
Order of draw
SPS Blood Cultures (yellow) -Microbiology Sodium Citrate (light blue) -Coagulation Serum (red or tiger strip) -Chemistry serology Heparin (green) - Chemistry EDTA (lavendar) -Hematology Glucose (gray) - Chemistry
A devise that uses hi intensity progress and white LEDs that penetrate deep into the patients subcutaneous Tissue to highlight veins is called a:
Venoscope transilluminator
Phlebotomy trays should be disinfected with bleach
Very week
24. Antiseptics chlorhexidine gluconate Should not:
be used on infants younger than two months
6) Serum contains: a. Fibrinogen b. Clotting factors c. Plasma d. None of the above
d. None of the above
What is hemolysis?
destruction of RBCs( Red blood cells) usually by shaking the tube
EDTA
ethylenediaminetetraacetic acid
FBS
fasting blood sugar/glucose (gray)
PSTs
plasma separator tubes
21 )To draw blood, first you need to apply a tourniquet that helps to:
prevent Venous blood flow out of the arm, causing the vein to bulge.
RBCs
red blood cells
SSTs
serum separator tubes
Stat
short turnaround time
Phlebotomist has an order for manganese (Metal) testing and drawers which tube
Royal blue Trace metals test such as manganese Tests are drawn in royal blue top tube
4) Which of the following indicates the largest size needle?
16 gauge
15) Blood banks use a ——————gauge needle to collect blood from donors for transfusion.
16-18
14) The most common gauge used for a routine venipuncture is:
21 gage
What is the most common needle size in butterflies?
22 gauge 3/4 inch long
The most common size gauge for surrenders:
22 gauge, 1 inch long
The phlebotomist, preparing to draw blood on and elderly patient with small fragile beans, selects a needle gauge off;
23 gage
5) Complete clotting of a blood sample in a SST (serum separator tube) Gold or red gray tube takes
30 minutes at the room temperature.
The type of specimen use for STAT chemistry testing in the laboratory is:
Clotted blood
20) blood collected in a light blue top tube is used for which test?
Coagulation
What is prothrombin?
A protein needed for blood clot formation
What is winged infusion used for?
Also called butterflied, is used for veni puncture On small beans, such as those in the hand, elderly and pediatric patients
What is heparin?
Anticoagulant, haprin( linked with sodium,lithium, or ammonium), inhabits Claudine by preventing the conversion of prothrombin to thrombin.
8) EDTA prevents coagulation in blood tubes by:
Binding calcium
17) Tubes containing the SPS anticoagulant are used for:
Blood culture SPS ( sodium polyanetholesulfonate)
Needle safety device issued:
By OSHA In November 2000 to help reduce the number of sharps injuries
Advantages to using syringe include all of the following except no need to evacuate tubes
C. A. Control vacuum B. Vein less likely to collapse C. No need to evacuate tubes D. Vlad appears in the heart on enter into the vein
18) Blood collected in lavender top tubes is used for which test.
CBC
CDC
Centers for Disease Control and Prevention
CLSI
Clinical and Laboratory Standards Institute
The phlebotomist is in the midst of difficult prop drive for a CBC, PT, PTT, and electrolytes. After placing the last tube in the tube holder, the phlebotomist picks up the previous two tubes to continue inversions and noticed that the PT/ PTT tube did not completely fill. The proper course of action is to:
Draw an appropriate discard( git rid of) tube first, then collect the PT, PTT. The correct order of draw is PT/PTT, electrolytes, and then CBC . The last two on the needle is the CBC and could cross containment need a blue top tube If subsequently placed on the needle. Because this is a difficult draw the best solution would be to draw out several milliliters of blood in discord tube,Such as red glass or another blue top tube, followed by a new blue top tube. If a discard cannot be drawn, then the patient will need to be read drawn. The previews Bluetop my have a bad vacuum, hence The short draw, so using a new tube is the best choice.
The phlebotomist has an order for CBC, maybe a walk, or age, anti-bodies screen, hepatitis panel, kidney panel, or PR, CRP, or eight, thyroid panel, and PT. The best course of action in drawing the patient's blood is too:
Draw one each tube first, then go back and collect the remaining tubes. If the routine order of draw requires that a large number of a single type to be drawn before others, it is advisable that the phlebotomist draw at least one of each required to color before the remaining of the larger group. The Rationale is that if the patient is a difficult stick, at least the majority of tests can be completed and aliguots made the draw is short .
What are needle adapters?
Example
19) blood collected in gray top tubes is used for which test?
FBS (Fasting blood sugar - glucose)
What is polymer or ( thixotropic) gel
Forms a barrier between red cells and plasma when centrifuged (It is found in the green-gray marbled topped tubes)
Which of the following tubes does not contain EDTA?
GRAY Grey stop her tubes contain potassium 0XALATE plus an ANTIGLYCOLYTIC agent. Royal blue stoppers are labeled to identify the type of additive: EDTA, Heparin, or no additive Pink and lavender stoppers to contain EDTA.
A test STAT electrolytes has been ordered, so the phlebotomist select which tube to draw?
GREEN STAT testing requires a fast turnaround time, so the best choice would be the green top tube, because it goes not require clotting time and can be configured immediately on receipt in the laboratory
9) Tubes with gray tops are used for:
Glucose tolerance test
The phlebotomist has an order for a routine CBC, metabolic panel, and a blood typing. The phlebotomist will select which of the following set of tubes?
Gold lavender and pink METABOLIC panel is typically drawn in a GOLD stopper tube CBC in a LAVENDER Blood typing in a LAVENDER or PINK tube.
What is Heprin use for. (Green tube)
Heparin is preferred for plasma chemistry determination and for a blood gas determinations. Potassium oxalate, combined with sodium fluoride is used for glue close determination.
What are the features of needles?
Hub (needle attachment) Shaft ( length) Bevel (angle of the needle) Lumen (hole in the needle) Point
Anticoagulant modes of action include all of the following, except:
Interfere with hepatic synthesis of coagulation proteins. The modes of action include binding, CHELATING, or forming an insoluble complex with calcium: sodium citrate, EDTA, and potassium oxalate, respectively. Heparin inhibits the conversion of prothrombin to thrombin The synthesis of coagulation proteins occurs in Vino, not in vitro.
16) Blood collection tubes containing anticoagulant should be:
Inverted gently and repeatedly after blood collection.
2) The most common anti-septic used in routine venipunture:
Isopropyl alcohol
11) The smaller the gauge number, the:
Larger the lumen diameter.
What is the most common double ended needle?
Multi sample needle
Engineering practice for needle safety recommended by OSHA include all of the following
Needle cutting device
Even though the blood bank can use lavender top two for compatibility testing, some labs prefer to use which of the following tubes?
Pink
What type of tubes are used for blood collection?
Rubber stopper and plastic tops.... They're available from 2 to 15 ml
1)Which of the following is not an anticoagulant? a) polymer gel b)sodium heparin c) EDTA
Polymer gel
What is EDTA?
Potassium ethylenediaminetetraacetic acid or sodium ( EDTA) binds calcium, there by inhabiting coagulation.
Did tube advancement work on the needle adapter functions to:
Prevent loss of two vacuum when assembling Needle/tube adapter.
13) The additive sodium citrate is used in blood collection to test for:
Prothrombin time. (PT) BLUE TUBE.
The phlebotomist has a request from the blood bank to draw non-edited to own a specific patient in addition to the pink top tube
Red glass
7) Which color code tube does not contain any additives?
Red, glass tube
The phlebotomist selects a winged infusion set with a syringe to draw blood from an infant. On completion of the draw, the phlebotomist begins to transfer blood into the appropriate tubes by:
Removing the syringe from the hub adapter and attaching a blood transfer device
The difference between a single sample needle in multi sample needle is:
Retractable sheath
Many tubes are coded inside with:
Silicone, to prevent blood from adhering to wall of the tube and to slow the clotting process
Antiglycolytics include which of the following
Sodium Flouride Antiglycolytics our agents guard preserve glucose and are use for most often when there might be a delay between the time of the draw and separation of plasma from cells
Other additives that binds calcium include:
Sodium citrate, potassium oxalate and sodium polyanetholesulfonate (SPS).
10) Tubes with green tops may contain:
Sodium heparin. ( they also can be with or without separator)
The additive that inhabits both complement in PHAGOCYTOS I am S is:
Sodium polyethanol sulfonate The additive that inhibits both complement and PHAGOCYTOS is (SPS ) Sodium polyethanol sulfonate
22.None latex tourniquets are made from:
Synthetic rubber or nitrile.
Patients with small and fragile veins sometimes use:
Syringe ( when the vacuum of the collection tube is likely to collapse the vein)
Which tube is formulated to contain less than 0.1 lead ug/ml
TAN Lead analysis requires a two guard is virtually lead free. 10 top tubes are designed to contain less than 0.1 of lied
Light Green Top
Test: (stat) and routine chemistry test Additives: Heparin, polymer gel Specimen: plasma Note: these are also cold plasma separator tube (PST)
Orange tube ( chemistry)
Test: STAT serum chemistries Additive: thrombin Specimen: serum Notes: This tube type allows for a five minute clotting time. It is used for patients on anticoagulant therapy.
Royal blue tube
Test: Used got toxicology, trace metals, and nutritional analysis Additive: heparin, EDTA, or non Notes: These tubes or chemically clean, and the staffers or specially formulated to prevent the release of small amount of materials that could contaminate the sample and give error test results
Pink tube
Test: blood bank Compatibility test ( blood bank) Additive: K2 EDTA Specimen: plasma or whole blood Note: do you still be similar to the standard lavender top tube but it's closure and label met the standards set by the American Association of blood banks
Red, Plastic or Glass Tube
Test: chemistry, serology, Blood bank Additives: Clot activators in plastic, none in glass Specimen: Serum Notes: plastic tubes should be inverted gently five times. Blood collected in a red top plastic or glass takes 60 minutes to clot. Serum is separated by Centrifugation after clotting.
Light Blue Tube
Test: coagulation Additives: sodium citrate Specimen: plasma Notes: Feel the tube completely to maintain the ratio of nine parts blood toone part sodium citrate.
Lavander tube (hematology)
Test: complete blood count ( CBC) sedimentation rate, routine immunohematology testing Additives: EDTA Specimen: whole blood Note: Dipotassium ( K2) EDTA Is spray dried on the side of the tube. This is the form preferred by the clinical and laboratory standards institute( CLSI) (K3) EDTA is in liquid form. (Na2) EDTA Is in powder form.
Tan Tube
Test: lead analysis Additives: Heparin Specimen: plasma Note: the tube is formulated to contain less than 0.1 mg of led.
Gold tube & Tiger top ("STAT") Tubes
Test: most chemistry test: Additives: clot activators, polymer gel Specimen: serum Notes: these are also called serum separator tubes (SST)or tiger tubes, or tiger -speckled. Invert five times. 30 min to clot
YELLOW, STERILE tube (Micro biology, blood cultures)
Tests: Blood Culture Additives: SPS to inhibit complement and phagocytosis Specimen: Whole Blood *Notes: Use this tube to recover microorganisms that are causing blood infection.
What are clot activators?
They promote coagulation: Clotting in plain serum tube( red glass) takes about 16 minutes,while clotting in Serum tubes with clot activators takes about 30 minutes.
23. What is antiseptic used for?
To clean skin prior to a service ( 70% isopropyl alcohol)
What is plasma used for
Used for coagulation studies. Used also for STAT chem tests when there is no time to wait for clotting to occur before centrifuging.
The use of anticoagulation will yield which type of blood specimen?
Whole blood and plasma Anticoagulants prevent the blood from clotting and would yield a whole blood sample or, centrifugation, a plasma sample.
12) The syringe method of draw is useful because:
a. It allows for control of blood flow b. It shows the appearance of blood at the hub
21ABGs
arterial blood gases (green top)
The following antiseptic should not be used on infants under the age of two months:
chlorhexidine gluconate
CBC
complete blood count ( lavender)
HLA
human leukocyte antigen
MRSA
methicillin-resistant staphylococcus aureus
SPS
sodium polyanethol sulfonate
What is SPS?
sodium polyanethol sulfonate, used blood Cultures because it inhibits certain Immune system components that could otherwise destroyed blood-borne bacteria in neutralizes antibiotic that the patient might be taking.
