Phlebotomy Chapter 5, 9, 10
blood smears are for the evaluation of which type cellular content?
-RBC -WBC -Platelets
specimen required for chilling
-ammonia -lactic acid -gastrin
specimen that should be protected from light:
-bilirubin -vitamin B6
order of draw for dermal punctures:
-blood gases -EDTA specimen -other tubes w/ additives -serum tubes
specimen kept at body temperature:
-cold agglutinins -cryofibrinogen
please list at least 5 problems that are common in older individuals
-diabetes -arthritis -COPD -Parkinson's disease -Alzheimer's disease
Name 8 reasons for skin puncture
-fragile veins -obese patient -only need 1 blood test -fearful/ anxious venipuncture -IV therapy in both arms -thrombotic tendencies -severe burns or scarring -home testing
list four reasons for specimen rejection
-label is unreadable -improper blood collection tube -lipemic blood specimen -improper specimen transport temp or storage
how should the incision for a dermal puncture run?
-left/ right of fingerprint -3rd/ 4th of non-dominant
what are the benefits of dermal puncture collection?
-less blood -less invasive
what is sputum? how should a patient be instructed to collect?
-mucus from the lungs that people can cough up -collect it early in the morning & let the patient cough very hard into a cup
what does an ABG blood test evaluate?
-pH -oxygen -carbon dioxide
list the ten components of a medical record:
-personal info -medical history -ordering documentation -informed consent -plan of care -test results -med administration record -progress note -discharge plan -financial info
depths for dermal punctures (preemies, newborns, toddlers)
-preemies: 0.85mm -newborns: 1.25mm -toddlers: 1.75mm
Serum should be transported to the laboratory for testing and separated from cells within which of the following time periods to prevent erroneous test results?
2 hours
puncture depth for adults
2.0-2.5 mm
never puncture a baby's heel deeper than?
2.00mm
how long should a heel warmer be used?
3-5 mins
what is the angle of the spreader slide when making a blood smear?
30 degrees
specimens without anti-coagulated additives take how long to clot?
30-60 mins
tubes with additives should be inverted how many times?
5-10 times
what is the normal range for a blood sugar?
60-120
A patients medical info in a facility is known as?
EMR
dermal punctures are not recommended for which of the following tests:
ESR
what does RFID stand for?
Radio Frequency Identification
Sites that are NOT recommended for skin puncture: Swollen, infected or previously punctured sites
accumulated fluid may contaminate the specimen
criteria for determinations for heel as opposed to finger sticks on children are based on?
age
what is the specimen of choice for arterial blood gas testing (ABG)?
arterial blood
Sites that are NOT recommended for skin puncture: Earlobe
b/c interference w/ pierced earrings & close to eyes
the most reliable method for avoiding transcription error is
bar coding
specimens that require protection from light include those for:
bilirubin & vitamin B6
why should a site not be milked or squeezed excessively?
blood can become diluted & cause hemolysis
warming a site is recommended to improve:
blood flow
what should be selected prior to dermal puncture?
check antecubial
Sites that are NOT recommended for skin puncture: Fingers on the site of a mastectomy
excessive lymph fluid
blood films should have a
feathered edge
blood for neonatal screening should be collected on what type of paper?
filter
which of the following is identical for venipuncture and capillary puncture procedures?
greeting, ID, hand hygiene
Sites that are NOT recommended for skin puncture: Thumb
has a pulse
To chill a blood specimen as it is transported, the health care worker should use:
icy water or commercial ice pack
anti-coagulated specimens should be centrifuged when?
immediately after collection
The best location for performing venipuncture on a hospitalized 7 year old is:
in a treatment room
why are bandages not preferred for infants?
infants have delicate skin that may be irritated by the bandages
if someone has poor skin integrity it could result in?
infection
osteomyelitis is defined as:
inflammation and infection of the bone
Sites that are NOT recommended for skin puncture: Index finger
more sensitive
where is the preferred site for dermal puncture on the third & fourth fingers for adults and children?
moved slightly to the left or right of non-dominant hand
what is the preferred site for a heel stick?
on the left/ right side of the heel
a PKU test is done where on an infant?
on their heel
skin puncture depth is important to avoid causing what complication?
osteomyelitis
which os a complication that can result from multiple heel sticks on an infant?
osteomyelitis
what is the psychological response to pain in children 3-5 years old?
perceive pain as a punishment for bad behavior
describe pre & post centrifugation:
pre: before centrifugation post: after centrifugation to remove the serum & plasma
what information is mandatory on every requisition?
providers info
what is the first action taken if an error is detected in a medical record?
report it immediately to a supervisor & document it
Sites that are NOT recommended for skin puncture: Fingers of newborns
risk of hitting the bone & causing infections
Sites that are NOT recommended for skin puncture: Infant's heel
risk of injuring nerves, tendons, cartilage & bone
define cryoglobulin
specimen that should be kept at a normal body temp
cooling a blood specimen causes:
stabilizes most constituents
what determines whether a heel puncture or dermal puncture will be performed?
the age will determine
when preparing spot testing what is important about the circles?
they have to be completely full w/blood & allowed to dry
Sites that are NOT recommended for skin puncture: Pinky fingers
tissue is thinner than the others so can hit bone
why do blood volumes need to be monitored closely on newborns & infants?
to avoid iatrogenic anemia
why should venipuncture be avoided in children whenever possible?
to reduce the effects of blood volume reduction
generally speaking, what should the phlebotomist do with the first drop of blood after a dermal puncture is performed?
wipe it off with gauze
can capillary blood be used for ABG testing?
yes, because this procedure is safer than an arterial puncture
