Phlebotomy Chapter 7

After a blood spill, a disinfectant is applied and must have at least

10 minutes of contact time for cleanup to be effective A spill involving large amount of blood or other body fluids requires at least 10 minutes with contact time.

88. Identify the tubes needed to collect a PT, STAT lytes, and BC in the proper order of collection

D: A PT is collected in a light blue-top tube, STAT electrolytes require a green top or a PST, and a blood culture (BC), although usually collected in special bottles, is sometimes collected in a yellow-top SPS tube. BC is collected first, then the PT, and finally the STAT lytes

Heparin prevents blood from clotting by

D. inhibiting thrombin

This needle gauge is used for autologous blood collection.

15-17

Which needle gauge has the largest bore or lumen?

18

A solution used to clean the site before routine venipuncture is:

70% isopropyl alcohol

89. Which one of the following tubes is additive free?

A: A BD clear top or glass red-top tube has no additive. A plastic red-top tube has a clot afctivator. A plasma separator tube contains heparin and barrier gel. A serum separator tube has clot activator and barrier gel (Table 7-3).

77. If a blood pressure cuff is used for venipuncture in place of a tourniquet, the pressure used must be

A: A blood pressure cuff may be used in place of a tourniquet by those familiar with its operation. The patient's blood pressure is taken, and the pressure is then maintained below the patient's diastolic pressure. In the absence of a blood pressure reading the cuff pressure should not exceed 40 mm Hg.

73. The best choice of equipment for drawing difficult veins is a

A: A butterfly needle (Fig. 7-16) is an indispensable tool for collecting blood from small or difficult veins because it allows much more flexibility and precision than either a regular needle and evacuated tube holder or needle and syringe. A lancet and microtainer can be used to collect some specimens by skin puncture, but there are several tests that cannot be collected by this method.

62. Which is the best tube for collecting an ETOH (ethanol) specimen?

A: A gray-top tube typically contains sodium fluoride, which prevents glycolysis. It is used for alcohol determinations and glucose tests. Alcohol values are stable because glycolysis (the metabolism of glucose or sugar in the form of alcohol) is prevented. Sodium flouride also inhibits growth of bacteria and protects the specimen from an increase in alcohol resulting from fermentation by bacteria.

86. A pink-top tube containing EDTA is primarily used for

A: A pink-top EDTA tube typically has a special label for ID information and is used primarily for blood bank tests

93. Due to allergic reactions, which type of glove is not recommended to be used in healthcare facilities?

A: Because of the prevalence of latex allergies in glove users and patients, latex gloves and other items made of latex are not recommended for use in healthcare facilities.

61. Glass particles present in serum separator tubes

A: Glass (silica) particles are called clot activators and are present in serum separator tubes to make the blood clot faster. Glass particles enhance or accelerate clotting by providing increased surface for platelet activation, aggregation, and adhesion. Other substances that functions as clot activators in other types of tubes include inert clays such as siliceous earth, kaolin, and celite, and the clotting components thromboplastin and thrombin.

91. Which additive can be found in four separate tubes with different stopper colors?

A: Lavender, pink, royal blue (lavender label), and BD tan stopper tubes all contain the anticoagulant EDTA.

65. Which one of the following tubes is filled when multiple tubes are filled from a syringe?

A: Tubes or containers for specimens such as blood cultures that must be collected in a sterile manner are always collected first in the order of draw for both the syringe and ETS system of venipuncture (Table 7-2).

CLSI standards advise against using these on infants and children under 2 years old:

Adhesive bandages because of the danger of aspiration and suffocation if they accidentally removed from the site.

What is the advantage of collecting STAT chemistry in a green-top tube?

All of the above, green-top tubes contain heparin, the big advantage of performing STAT chemistry tests on heparinized specimens relates to a faster turnaround time (TAT) for test results than when serum is used. Heparinized specimens for plasma tests can be centrifuged right away, wheresa serum specimens must be clotted which can take up to 30 minutes or more.

Needle safety features work by?

All of the above...Covering or shielding the needle, retracting the needle after the use, using a device to blunt the needle

Types of ETS tube additives include

All of the choices are correct. Most of ETS tubes contain some type of additive , An additive is any substance placed within a tube other than the stopper or the coating of the tube.

Which of the following is preferred solution to use to clean up blood spill?

An EPA- approved bleach product

68. This tube stopper color indicates that the tube contains EDTA

B: A lavender (or purple) top indicates that the tube contains EDTA. Most hematology tests are collected in lavender-top tubes. A green stopper indicates a heparin-containing tube, and a light blue stopper indicates the presence of sodium citrate unless it has a special yellow label. A royal blue stopper indicates that the tube and stopper are as free of trace elements as possible. A royal blue stopper sometimes contains EDTA, but only if it has lavender color coding on the label or EDTA is written on the label. Figure 7-13 shows a variety of tubes that have different colors of stoppers.

79. Needle safety devices must

B: A needle safety device (Fig. 7-17) should allow the user's hand to remain behind the needle at all times, create a barrier between the hands of the user and the needle after use, be activated using a one-handed technique, and provide permanent (not temporary) containment of the needle. A needle safety feature should never be a temporary measure.

74. Mixing equipment from different manufacturers can result in

B: Although evacuated tube collection system components from different manufacturers are similar, they are not necessarily interchangeable. Mixing components from different manufacturers can lead to problems such as improper needle fit and needles coming unscrewed, or tubes popping off of the needle during venipuncture procedures. Color coding of tube tops is generally universal, with only a few minor variations in each company's product, so selecting the proper additive tube is not normally an issue. Carryover of additive is typically related to errors in specimen collection technique.

80. This gel separator tube contains EDTA

B: An EDTA tube that contains a separator gel is called a plasma preparation tube, or PPT. A plasma separator tube (PST) contains heparin and gel. A serum separator tube (SST) contains silica particles or clot activator and gel. There is no separator gel tube called an EST.

78. In general, an anticoagulant is unable to

B: An anticoagulant prevents coagulation or clotting of the blood either by binding calcium and making it unavailable to the coagulation process, or by inhibiting thrombin formation, which is needed in the coagulation process. A specimen that is not allowed to clot because of the addition of an anticoagulant remains as it was in the body and is called a whole blood sample. Anticoagulants do not inhibit glucose metabolism.

64. During venipuncture the tourniquet should not be left on longer than

B: Proper tourniquet application allows arterial blood flow into the area below the tourniquet but obstructs venous flow away from the area. This causes the veins to enlarge and makes them easier to find and pierce with a needle. However, the obstruction of blood flow can change blood components if the tourniquet is left in place for more than 1 minute.

71. The part of a syringe that shows measurements in cc or mL is called the

B: The barrel of a syringe holds the fluid being aspirated or administered and is measured in cubic centimeters (cc) or milliliters (mL). The plunger is a rodlike device that fits tightly into the barrel. Pulling on the plunger creates the vacuum that allows the barrel to fill with the fluid being aspirated. The hub is where the needle attaches to the syringe. Syringe components are shown in Figure 7-14.

72. This part of the evacuated tube holder is meant to aid in smooth tube removal.

B: The flanges or extensions on the sides of the tube end of the holder are there to aid in tube placement or removal. Figure 7-15 shows proper placement of fingers and thumb when advancing a tube in an ETS holder.

76. The purpose of a tourniquet in the venipuncture procedure is to

B: The purpose of a tourniquet in the venipuncture procedure is to block the venous flow, not the arterial flow, so that blood flows freely into the area but not out. This causes the veins to enlarge, making them easier to find and penetrate with a needle. The tourniquet does not redirect blood flow but does change the volume of the flow. The tourniquet must not be left on for longer than 1 minute because obstruction of blood flow changes the concentration of some analytes, leading to erroneous test results.

82. Which type of test can potentially be affected by tissue thromboplastin contamination?

B: Tissue thromboplastin affects coagulation tests the most because it is a substance found in tissue that activates the extrinsic coagulation pathway.

Multisample needles are typically available in these gauges

C. 20-22

Decontamination of hands after glove removal is essential because

C. Hand contamination might not be visible to the naked eye Any type of glove may contain defects and contamination is not always visible

Which statement is incorrect? A properly applied tourniquet should

C. Restrict venous and arterial blood flow

It is best if tourniquets are

C. Used once and then discarded

63. Identify the tubes needed to collect a CBC, PTT, and STAT potassium by color and in the proper order of collection fro a multiple tube draw.

C: A CBC is a hematology test collected in a lavender-top tube. A PTT is a coagulation test collected in a light blue-top tube. A STAT potassium is a chemistry test collected in a green-top tube. The proper order of draw for these tubes is light blue first, green next, and lavender last (Table 7-2).

85. A trace-element specimen tube should be collected

C: A needle can pick

69. What anticoagulant is contained in a PST?

C: A plasma separator tube (PST) contains heparin. Some gel-barrier tubes, such as plasma preparation tube (PPT), contain EDTA. Serum separator tubes (SST) are gel-barrier tubes, but they do not contain anticoagulant. Anticoagulants are used to obtain either whole blood or plasma specimens. In the separator tubes, the plasma can be removed from the cells so that the integrity of the specimen is maintained.

66. This test is collected in a light blue-top tube

C: A prothrombin time (PT) is a coagulation test and is collected in a light blue-top tube containing sodium citrate. The best tube for collecting a glucose speciment is a gray top containing an antiglycolytic agent such as sodium flouride. A platelet count is sometimes ordered to assess coagulation, but it is a hematology test collected in a lavender-top tube. A red blood count is a hematology test and is collected in a lavender-top tube.

95. AN ETS holder and a syringe transfer device look very similar. What is the difference between the two?

C: A syringe transfer device is similar to an ETS tube holder but has a permanently attached needle inside the holder.

60. What is the purpose of an antiglycolytic agent?

C: An antiglycolytic agent is a substance that inhibits or prevents glycolysis (metabolism of glucose) by the cells of the blood. The most common glycolytic inhibitors are sodium flouride and lithium iodoacetate.

94. Which of the following additives is most commonly used for chemistry tests?

C: Both lithium and sodium heparin are used by the chemistry department. ACD is used for certain immunohematology tests. Sodium citrate is most commonly used for coagulation tests. Sodium polyanethol sufonate (SPS) is used for blood cultures which are microbiology tests.

90. Which chemistry tube could contain either of two different forms of an anticoagulant because both have the same stopper color?

C: Green stopper color means the additive in the tube is heparin. Heparin is an anticoagulant that is available in ETS tubes in two forms, lithium heparin and sodium heparin. Each form has its own tube; however, both lithium heparin and sodium heparin tubes have green stoppers. Consequently, the phlebotomist must be careful in selecting the right tube for the ordered test because the two forms of heparin are not normally interchangeable.

83. Which of the following tests would be most affected by carryover of K2EDTA?

C: K2EDTA contains potassium. Carryover of potassium EDTA formulations into tubes for potassium testing have been know to significantly increase potassium levels in the specimen, causing erroneously elevated test results

84. Carryover from this tube has a greater potential to negatively affect the specimen in the next tube drawn

C: Lavender stoppers contain the coagulant EDTA. Carry over from an underfilled additive tube has a greater potential to negatively affect the rest results in a subsequent tube. Carryover from a nonadditive tube would not affect the next tube. A gray-top tube is drawn last so there is no subsequent tube to affect.

67. Which of the following STAT tests is typically collected in a lithium heparin tube?

C: Most chemistry tests have been traditionally performed on serum, but to save the time it takes for a serum specimen to clot before it can be tested, STAT electrolytes and other STAT chemistry tests are often performed on plasma specimens collected in lithium heparin tubes. (Sodium heparin tubes must not be used for STAT electrolytes because sodium is one of the electrolytes measured.) In addition, heparinized plasma may be the best specimen for all potassium tests because cells release potassium when they clot, which can artificially elevate serum results. Regardless of whether serum or plasma is used, the type of specimen should be consistent for any additional potassium tests on the same patient.

81. Which additive contains a substance that inhibits phagocytosis of bacteria by white blood cells?

C: Sodium polyanethol sulfonate (SPS) is used in tubes for blood culture collection because in addition to being an anticoagulant, this additive is formulated to inhibit phagocytosis of bacteria by white blood cells.

Which additive is used to collect donor units of blood?

CPD stands for citrate phosphate dextrose, which is used to collect units of blood for transfusion.

It is important to fill oxalate tubes to the stated fill capacity because excess Oxalate

Causes hemolysis of blood specimens

A specimen collected in this type of additive will separate if allowed to stand

Citrate, heparin, and oxalates are all anticoagulants, so the cell will be free flowing and not clotted, that means they will separate from the plasma if allowed to stand for extended amount of time or if it centrifuged.

Why are gauze pads a better choice than cotton balls for covering the site and holding pressure following venipuncture?

Cotton ball fibers can stick to the site

Which of the following tubes will yield a serum sample?

D. Red top

70. The purpose of sodium citrate in specimen collected is to

D: Sodium citrate is the anticoagulant contained in light blue-top tubes used to collect plasma for coagulation tests. It is used for coagulation tests because it does the best job of protecting the coagulation factors. The ratio of blood to anticoagulant is critical in coagulation testing, so it is important for sodium citrate tubes to be filled to their state capacity.

75. You are most likely to increase the change of hemolyzing a specimen if you use a

D: The 25-gauge butterfly needles are sometimes successfully used to collect blood specimens from infants and others with difficult veins. However, any time a needle smaller than 23 gauge is used to collect blood, the chance of trauma to the red blood cells and resulting hemolysis is increased.

87. The blood collection equipment shown in Figure 7-1 can be used

D: The S-Monovette Blood Collection System shown is a complete system for blood collection in which the blood collection tube and collection apparatus are combined in a single unit.

92. Which stopper color is the same for two completely different types of additives used by two different departments?

D: The sodium polyanethol sulfonate tube that is processed in the microbiology department has a yellow stopper, as does the tube containing acid citrate dextrose (ACD) that is used by the immunohematology department for DNA testing.

59. Which of the following substances is contained in a serum separator tube?

D: Thixotropic gel is an inert (nonreacting) synthetic substance that forms a physical barrier between the cellular portion of a specimen and the serum or plasma portion after the specimen has been centrifuged. The gel is normally found in or near the bottom of the tube. When used in a serum tube it is called serum separator, and the tube is referred to as a serum separator tube (SST) or a gel-barrier tube. When used in a tube that contains heparin, it is called plasma separator and the tube is referred to as a plasma separator tube (PST). If it is used in a tube that contains EDTA, the tube is called a plasma preparation tube (PPT). At this time, there is no gel tube that contains sodium citrate. Gel can be seen in the second and fourth tubes from the left in Figure 7-13.

Which of the following items is unnecessary when performing a routine venipuncture?

Disinfectant Antiseptics are routinely used when performing venipuncture.

Which disinfectant is preferred by the HICPAC for use on surfaces and instruments?

EPA-registered sodium hypochlorite product

Which of the following is one reason the evacuated tube system (ETS) is the preferred blood collection system?

Exposure of the blood to contaminats is avoided.

A royal blue-top tube with green color coding on the label contains hi

Heparin

Which of the following is disinfectant?

Household bleach Or 5.25% sodium hypochlorite, is effective disinfectant

Which of the following stopper colors identifies a tube used for coagulation testing?

Light blue

The blood to additive ratio is most critical for a specimen collected in this tube.

Light blue top for accurate results coagulation tests require 9:1 ratio of blood to additive, if tube not filled to 90% of their stated volume, the result can be falsely elevated.

The purpose of a transillumination device is to

Locate veins for venipuncture

Lithium heparin is a suitable anticoagulant for which of the following tests?

Lytes Lithium heparin causes the least interference in chemistry testing and is the most widely used unticoagulant for plasma and whole -blood chemistry test.

Which department would most likely perform the test on a specimen collected in an SPS( Sodium polyanethol sulfonate) tube?

Microbiology SPS, tubes are used to collect blood cultures, which are performed in the microbiology department, SPS is an anticoagulant with special properties that inhibit proteins that destroy bacteria.

which blood specimen additive can inhibit the metabolism of glucose by the cells?

NaF glocolytic inhibitor or antiglycolytic agent

Wearing gloves during phlebotomy procedures is mandated by the following agency:

OSHA

Which one of following substances is an anticoagulant?

Oxalate

Which of the following plays no role in deciding what size tubes to use for ETS blood collection?

Patient's allerg to antiseptics.

The antiseptics has been traditionally used to obtain the high degree of skin antiseptics required when collecting blood cultures

Povidone- iodine

In a successful venipuncture, evacuated tubes fill automatically as soon as the tube stopper is pierced because of

Premeasured vacuum in each tube.

The purpose of the rubber sleeve that covers the tube end of a multiple- sample needle is to

Prevent leakage of blood during tube changes

This would be the best tube for collecting a STAT test that must be performed on serum

RST A rapid serum tube contains thrombin, which normally clots the blood in 5 minutes

Which of the following should be deleted from a list of required characteristic of a sharps containers?

Red in color

Which of the following tube stopper colors indicates something other than the presence (or absence) and type of additive in the tube?

Royal blue

A serum specimen is requested. Which of the following evacuated tubes can be used to collect it?

SST a gel barrier tube from Becton Dickinson (BD) , this tube does not contain anticoagulant, so blood collected in it will yield serum.

Antiseptics are

Safe for use on human skin

What criterion is used to decide which needle gauge to use for venipuncture?

Size and condition of the vein

Which of the following are all anticoagulants that remove calcium from the specimen by forming insoluble calcium salts and therefore prevent coagulation?

Sodium citrate, EDTA, oxalate.

The headspace in an evacuated tube is

a consistent amount of air space left when a tube is filled properly

The cleaning agent in hand sanitizers used in healthcare is?

alcohol based

The slanted tip of a needle is called the

bevel

Plastic red-top tubes used to collect blood specimens usually contain:

clot activators plastic red-top tubes are for collecting serum specimens and contain a clot activator.

Which one of the following additives can be found in a royal blue-top collection tube?

contain EDTA, heparin, or no additive to meet various test requirements.

Improper handling or storage of evacuated tubes can affect:

d. all of the above Why, may effect additive integrity and tube vacuum.

If hands are heavily contaminated with organic material and a sink is not available, the phlebotomist should clean them with?

detergent-containing wipes followed by a sanitizer or alcohol based hand cleaner

To what does the "gauge" of a needle relate?

diameter

Lvander stopper tubes are most commonly used to collect

hematology tests. EDTA prevents coagulation and is primarily used to proivide whole blood specimen for hematology tests .

Tubes designed by the manufacturer to be "short draw" are:

made to fill only partially Why, some manufacturers offer special "short draw" tubes designed to partially fill without compromising test results, used in situations in which is difficult to draw larger quantities of blood

A phlebotomy needle that doesn't have a safety feature

must be used with a holder that has a safety feature.

Measurement of copper, a trace element, requires blood collection in a tube with a

royal blue top.

If phlebotomists have dermatitis, they should?

see if wearing glove liners will help Dermatitis is a condition that can be caused by wearing gloves, required frequent hand washing and drying effects of alcohol-based hand sanitizer.

Mixing additive tubes involves

slowly rocking them back and forth

OSHA regulations requires that after use

tube holders with needle attached be disposed of as a unit.