Plebotomy

The appropriate needle gauge to use for most venipuncture collection is?

21 (21 gauge needle is long enough and thin enough to access most veins and the internal diametrer si wide enough to permit blood collection with little concern about mechanical when using evacuated tubes)

Which patient description is correctly matched with the appropriate site selection

A 53 yr old male with a central line has a specimen collected from the dorsal side of the hand (Patients with central lines would be candidates for specimen collection from dorsal side of the hand;veins are accessible from the dorsal side. )

An infant is brought to the clinic for a CBC. After performing a heelstick, not enough blood is collected to perform the test. Which of the following actions should the medical assistant take?

Apply a warm compress (The heat from a warm compress will encourage capillary vasodilation resulting in increased blood flow. Warming helps make blood collection easier and faster. Warm the heel for 3-5 minutes, which allows sufficient time for the capillaries to dilate)

An entry level medical assistant goes to collect blood from a 70-year-old woman with diabetes who had a mastectomy of the left breast. The medical assistant notices a PICC line in the patient's right arm. For this specimen collection, the medical assistant should

Ask a nurse to collect the specimen (ask a nurse to draw the sample. PICC line draws are outside an entry level MA's scope of practice. It should be noted that a facility may offer special training for PICC line draws, but specific training must be completed and competency assessed before any personnel collect such specimens. )

Which of the following is an appropriate alternative to using a rubber tourniquet when attempting a venipuncture on a known patient who is difficult to obtain a sample from?

Blood pressure cuff (Occlusion pressure may be adjusted as needed to ensure circulation. Cuff can provide uniform constricition as long as the phlebotomist doesn't inflate the cuff beyond 40mm of mercury)

A CMP is ordered for an older adult patient whose veins continue to collapse despite drinking water. Which of the following is the best collection method for this patient?

Butterfly needle ( butterfly is a smaller gauge needle device and is used for smaller veins, including fragile veins on all patients, elderly adults and small children.)

Which of the following forms is the medical assistant responsible for having the patient sign when a specimen is being collected for substance abuse screening for employment?

Chain of custody (form is used to maintain a legal record of individuals who have had physical possession of the specimen. It prevents the possiblity of tampering. )

While performing a venipuncture using an evacuated tube, a small amount of blood enters the tube and then stops. Which of the following conditions is likely to lead to this?

Collapsing vein (When blood ceases to flow during the venipuncture process, the likely culprit is a collapsing vein. The walls of the vein lose tension, stopping blood flow.)

After a phlebotomist has successfully followed all the steps for blood collection, the patient informs the phlebotomist that he tends to bleed longer than the average person. What would be the next course of action for the phlebotomist?

Confirm hemostasis + apply paper tape ( proper phlebotomy procedure includes confirmation of hemostasis, regardless of whether or not a patient bleeds longer than normal. This definitely applies to this case when a patient admits a tendency to bleed longer than the average person.)

Which of the following arteries provides direct blood flow to the foot?

Dorsalis pedis (Dorsalis pedis artery is located on the upper surface [dorsal region] of the foot, and provides direct blood flow to the foot. )

Identify the CLSI recommended micro-collection order of draw for a BMP, CBC & Bilirubin

EDTA, Heparin, Serum Separator (The recommended Order of Draw for capillary blood collection is different from blood specimens drawn by venipuncture. CLSI recommends the following order of draw for skin puncture: Blood gases, EDTA tubes, Other additive tubes, then Serum tubes.)

When performing a CBC on a six year old, the parent insists upon using an anesthetic at the venipuncture site. Which would be correct?

EMLA (The topical anesthetic of choice for pediatric venipuncture.)

The physician orders a sedimentation rate for a patient recovering from an infection. This is indicated on the lab requisition as which of the following?

ESR (The Erythrocyte Sedimentation Rate (ESR) is a common test to detect inflammation by measuring the rate at which red blood cells settle to the bottom of a tall, thin tube. Since inflammation can cause cells to clump, these clumps are heavier than single cells and settle more quickly. The test measures the distance settled in one hour. This test is most useful in combination with other more specific laboratory tests.)

Since special precautions are needed for patients with Vascular Access Devices, which of the following devices are contraindicated for any type of blood draws?

Fistula (AV fistula requires the surgical connection of a vein and artery, typically in the forearm. It is predominately used for patients in renal failure who may need long term dialysis. To avoid any complications, blood draws are contraindicated.)

Which of the following additives protects serum from interacting with red blood cells after a specimen has been centrifuged?

Gel separators (creates a barrier between the serum and formed elements of the blood.)

Which of the following actions should the medical assistant take to prevent hemolysis of a blood specimen in an EDTA tube?

Gently invert he tube after collecting the specimen (Since an EDTA tube contains anticoagulant, it is important to immediately mix the blood as soon as it is collected to ensure that it doesn't clot. The medical assistant should gently invert the tube after collecting the specimen to maintain specimen integrity and prevent rupture of RBC's in the sample)

Which of the following evacuated tubes should the medical assistant select for collection of electrolytes?

Green Top (Green tubes contain heparin. Used for collection of heparinized plasma or whole blood for special test. Green top can contain ammonium, lithium, and sodium. Electrolytes can also be collected in a red top tube.)

Which of the following tests is drawn in an EDTA tube for the hematology department of the laboratory?

HGB ( abbreviation for Hemoglobin, typically measured as part of a Complete Blood Count and collected in an evacuated tube containing Ethylenediaminetetraacetic acid [EDTA]. Hemoglobin is a protein inside red blood cells that carries oxygen to organs and tissues, while also transporting carbon dioxide back to the lungs.)

Which of the following characteristics applies to veins

Have valves to prevent back flow of blood (Veins have valves which maintain the unidirectional flow of blood, even against gravity. Veins are also the blood vessels which carry the blood from peripheral tissues towards heart. They carry the deoxygenated blood, which is bluish in color and for the same reason veins appear blue.)

The medical assistant is instructed to perform a capillary stick for newborn screening. Which of the following collection devices should the medical assistant use?

Heel Stick Lancert (EG., Tenderfoot, is required for infants) (How to use: Apply a warming device for 3-5 minutes to the heel to increase blood flow to the area.)

A phlebotomist is staffing the outpatient clinic at a remote site. There is a centrifuge at the site, but it is not functional. The courier will be arriving to pick-up all samples collected at 1300, and will deliver to the testing laboratory at 1500. A patient arrives at 1200 with orders for Complete Blood Count, Prothrombin Time, and Basic Metabolic Panel. Which tubes should the phlebotomist use for blood collection?

Lavender, Blue, Green, Gray [Complete Blood Count (CBC] = lavender top tube [EDTA] Prothrombin Time [PT]/INR = light blue top tube [sodium citrate] Basic Metabolic Panel [BMP] = green top tube [heparin]; since the centrifuge is not functional and there is a bit of a delay between draw time and courier pickup/delivery to the laboratory, a gray top tube would best preserve the glucose value within the BMP.)

Which of the following Vacutainer tubes is routinely used for hematology testing?

Lavender-topped (Hematology= branch of medicine that studies blood, the organs that form blood, + blood disorders + disease. most common hematology test is a complete blood count [CBC])

The phlebotomist should send a specimen collected in a yellow stopper tube with SPS additive to which of the following laboratory departments?

Microbiology (Blood cultures are collected in yellow-top tubes with SPS [sodium polyanethole sulfonate], a constituent in blood culture media used to grow bacteria from patients suspected of bacteremia, i.e. bacteria in the blood. SPS prevents the patient's blood from killing any bacteria in the sample though the blood's own immune response to infection, allowing the bacteria to multiply so they can be identified.)

The phlebotomist is drawing blood from a patient that is taking blood thinners. Which of the following is a necessary piece of additional equipment to have at the drawing station?

Non adhering bandage (helpful for pt.s on anticoagulant therapy who may bleed more extensively than typical pt .after venipuncture. Adhesive might bruise once removed from a pt. who has anticoagulated blood. )

Which of the following tests is required in all 50 states to screen newborns for metabolic disease?

PKU (reatment of Phenylketonuria [PKU]. It is an inherited disease that may lead to mental retardation if not detected. The specimen for the test is usually collected in the newborn nursery via heel stick between 48-72 hours of life)

A phlebotomist has received a requisition to collect a blood culture. Using a butterfly, three milliliters of blood is collected. Into which of the following bottles is the proper dispensation of the specimen?

Place all three mLs in the aerobic bottle (phlebotomist was only able to obtain three milliliters of blood, place all three mLs in the aerobic bottle. The aerobic bottle would be the first bottle to innoculate if there is limited sample)

Which of the following sites should the medical assistant use for newborn screening blood collection?

Plantar Surface of the heel (Heel stick should be performed on the lateral or medial portions of the plantar surface of the heel-skin surface [left & right] NEVER stick the center, the arch or the back of the heel.

Which of the listed tubes can contain ethylenediamine tetraacetic acid?

Royal blue ( may be purchased with EDTA, sodium heparin, or no additive at all. They are used for trace element testing via plasma or whole blood. They can also be used for toxicology and nutritional studies)

The phlebotomist is drawing plain red, lavender, and blue top tubes. Upon completion of the blood draw, the phlebomist noticed that an order that requires a SST has been missed. What would be the next action?

Share the plain red top specimen for the SST test. (red tube and an SST tube both will yield serum once clotted and centrifuged. Therefore, it is possible to share the plain red top specimen for the SST test)

A medical assistant has active symptoms of the common cold. Under which of the following conditions may he perform venipuncture?

The medical assistant may perform venipuncture provided he is wearing a mask and afebrile. (it is uncommon for people to be able to work with the common cold. Use good judgement ad not transmit disease to their patients.)

When performing a skin puncture on an infant what is the preferred site?

The plantar surface of the heel (The heel of an infant is the recommended skin puncture site. Avoid puncturing the bone by targeting the plantar surface)

After centrifuging a blood specimen, the medical assistant notes the serum has a reddish appearance. Which of the following has occurred?

The specimen is hemolyzed (Normal serum should be amber-colored. If it's reddish in appearance, the specimen is hemolyzed. The reddish color is caused by broken red blood cells, not neutrophils [which are white blood cell].)

A phlebotomist is asked to collect a CBC, PT and Chem 7 on a patient that requires a hand stick with a butterfly needle into evacuated tubes. The correct order of draw for this collection would be

Two Light Blue Top Tubes, Green Top Tube, Lavender Top Tube ( two light blue top tubes [one waste and one for PT which is a coagulation test], green top tube [for the Chem 7], and the lavender top tube [for the CBC])

After several minutes of searching the medical assistant can only palpate a small vein. The patient is prepared and the venipuncture is performed. The blood is filling the tube, but slows and then stops even though the patient and medical assistant remained still. Which of the following actions should the medical assistant take?

Use a smaller tube because the vein has collapsed (Since blood was once filling the tube, the needle was once in the vein. Since the phlebotomist knew this was a small vein at palpation, the fragility of the vein may have caused the vein to collapse if the vacuum of a regular size collection tube was too strong.)

Which of the following types of additives is present in an EDTA tube?

anticoagulant (EDTA tube contains the anticoagulant sodium ethylenediamine tetra-acetic acid, which prevents clotting)

Capillary blood specimens are typically collected on patients that

are extremely obese (Capillary blood samples are advisable on patients when veins are not palpable, which includes patients who are morbidly obese, among others.)

The laboratory requisition indicates that you are to collect a venous blood specimen for hematology CBC testing, serum chemistry testing, and coagulation studies. What is the proper order of collection for these tubes?

light blue, red, lavender (Light blue [coagulation studies], red [serum chemistry], then lavender [hematology CBC])