unit 1 phlebotomy

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Questions and Answers

What is the primary reason for verifying patient identification in venipuncture?

To comply with standard precautions for infection control

To prevent lab errors and ensure accurate results (correct)

To meet hospital administrative requirements

To ensure patient comfort during the procedure

What should you do if you find any discrepancies in patient identification during venipuncture?

Continue with the procedure and hope for the best

Ask the patient to sign a waiver

Call the lab to report the error

Get the information corrected before proceeding (correct)

Why is it essential to ensure the patient has followed dietary instructions before a specific test?

To ensure accurate lab results (correct)

To meet hospital policy requirements

To prevent bleeding complications

To reduce the risk of patient discomfort

What is the primary purpose of applying the tourniquet during venipuncture?

To facilitate a successful blood draw Signup and view all the answers

Why is it crucial to position the patient's arm correctly during venipuncture?

To facilitate a successful blood draw Signup and view all the answers

What is the primary reason for washing hands and putting on gloves during venipuncture?

To meet standard precautions for infection control Signup and view all the answers

What should you do if you notice any discrepancies in the patient's arm band during venipuncture?

Get the information corrected before proceeding Signup and view all the answers

Why is it essential to ensure 100% accuracy when identifying a patient during venipuncture?

To prevent lab errors and ensure accurate results Signup and view all the answers

What is the primary purpose of asking the patient to spell their name during the venipuncture process?

To verify patient identification and prevent errors Signup and view all the answers

Why is it essential to apply gloves during the venipuncture process?

To comply with standard precautions Signup and view all the answers

What is the primary reason for positioning the patient's arm straight and slightly downward during venipuncture?

To facilitate easy insertion of the needle Signup and view all the answers

Why is it important to palpate the vein before inserting the needle?

To locate the vein and ensure correct insertion Signup and view all the answers

What is the primary purpose of assembling the needle and syringe during the venipuncture process?

To ensure the correct order of draw for the test tubes Signup and view all the answers

Why is it essential to anchor the vein during the venipuncture process?

To ensure the vein is stable during needle insertion Signup and view all the answers

What is the primary reason for cleansing the site with alcohol and letting it dry before inserting the needle?

To reduce the risk of infection transmission Signup and view all the answers

What is the primary purpose of re-palpating the vein after re-applying the tourniquet?

To locate the vein and ensure correct insertion Signup and view all the answers

What is the primary reason to avoid using a vein with a pulse?

It is an artery Signup and view all the answers

Why is it important to palpate above and below the initial vein location?

To trace the path of the vein for proper entry point Signup and view all the answers

What is a common complication associated with using a vein in an arm with a fistula or vascular graft?

Blood contamination Signup and view all the answers

Why is it necessary to do a 2-minute shutdown before collecting a blood sample from a site above an IV cannula?

To prevent contamination from the IV fluid Signup and view all the answers

What is a characteristic of a good vein for venipuncture?

It has a spongy feeling Signup and view all the answers

Why is it important to avoid using veins in areas with tissue fluid accumulation?

It can alter test results Signup and view all the answers

What is a potential consequence of using a sclerosed vein for venipuncture?

Impaired blood flow Signup and view all the answers

Why is it important to follow a correct order of collection when multiple tubes are required?

To prevent contamination between tubes Signup and view all the answers

What is the primary reason for removing the tourniquet during venipuncture?

To prevent hemoconcentration and unnecessary discomfort Signup and view all the answers

Why is it essential to palpate the vein carefully during a hand draw?

To avoid hitting a bone Signup and view all the answers

What is the primary purpose of assembling the butterfly apparatus during venipuncture?

To secure the tubing and Luer adapter Signup and view all the answers

Why is it crucial to reclamp the tourniquet after releasing it during venipuncture?

To secure the needle in place Signup and view all the answers

What is the primary consequence of failing to follow dietary instructions before a lab test?

Inaccurate lab results Signup and view all the answers

Why is it essential to position the patient's arm correctly during venipuncture?

To ensure the needle is inserted at the correct angle Signup and view all the answers

What is the primary purpose of cleansing the site with alcohol during venipuncture?

To prevent infection Signup and view all the answers

Why is it crucial to fill the tubes according to the correct order of draw during venipuncture?

To ensure accurate lab results Signup and view all the answers

What is the primary purpose of cleaning the venipuncture site with 70% Isopropyl alcohol?

To reduce the risk of infection and kill microorganisms Signup and view all the answers

Why should you anchor the vein during venipuncture?

To prevent the vein from rolling during the procedure Signup and view all the answers

Why is the 'C' hold or two-finger technique discouraged during venipuncture?

It can cause the needle to recoil and spring back into the phlebotomist's arm Signup and view all the answers

What is the recommended angle for inserting the needle during venipuncture?

15° - 30° with the bevel up Signup and view all the answers

Why should you avoid depressing the skin by pushing down on the needle during venipuncture?

It may cause pain to the patient and increase the risk of blood leakage Signup and view all the answers

What should you do if the patient moves their arm during venipuncture?

Remove the needle and start the procedure again Signup and view all the answers

Why is it important to remove the needle cover right before the puncture during venipuncture?

To prevent the needle from becoming contaminated Signup and view all the answers

What should you do after inserting the needle and checking for blood return during venipuncture?

Smoothly push the tube into the holder without moving the needle Signup and view all the answers

Match the following steps with their corresponding actions during venipuncture:

Step 17 = Fill the syringe by slowly and firmly pulling on the plunger with the non-drawing hand. Step 18 = Withdraw the needle and immediately apply pressure for 3-5 minutes with a clean gauze. Step 21 = Place a vacuum tube in the transfer device in order of draw. Step 23 = Label all tubes immediately. Signup and view all the answers

Match the following steps with their corresponding reasons during venipuncture:

Step 17 = To prevent hemolysis and vein collapse. Step 22 = To draw blood from the syringe into the tube. Step 24 = To reduce the chance of a needle stick injury. Step 27 = To prevent biohazard contamination. Signup and view all the answers

Match the following steps with their corresponding equipment used during venipuncture:

Step 20 = Transfer device Step 21 = Vacuum tube Step 22 = Internal needle Step 19 = Needle safety guard Signup and view all the answers

Match the following steps with their corresponding safety precautions during venipuncture:

Step 19 = Applying needle safety guard to prevent needle stick injury. Step 24 = Disposing of syringe assembly in a sharps container. Step 27 = Removing and discarding contaminated items in a biohazard container. Step 18 = Applying pressure for 3-5 minutes with a clean gauze to prevent bleeding. Signup and view all the answers

Match the following steps with their corresponding actions after blood collection during venipuncture:

Step 24 = Dispose of syringe assembly immediately in one piece in a sharps container. Step 25 = Examine the patient's arm 5-10 seconds before applying a bandage. Step 26 = Thank the patient and say goodbye. Step 27 = Remove and discard all contaminated items into a biohazard container. Signup and view all the answers

Match the following steps with their corresponding purposes during venipuncture:

Step 16 = To release the tourniquet once there is evidence of blood in the hub of the needle. Step 17 = To fill the syringe by slowly and firmly pulling on the plunger with the non-drawing hand. Step 21 = To place a vacuum tube in the transfer device in order of draw. Step 23 = To label all tubes immediately. Signup and view all the answers

Match the following steps with their corresponding post-venipuncture care during venipuncture:

Step 25 = Examine the patient's arm 5-10 seconds before applying a bandage. Step 26 = Thank the patient and say goodbye. Step 27 = Remove and discard all contaminated items into a biohazard container. Step 18 = Apply pressure for 3-5 minutes with a clean gauze to prevent bleeding. Signup and view all the answers

Match the following steps with their corresponding equipment handling during venipuncture:

Step 19 = Placing needle safety guard on the needle. Step 20 = Attaching transfer device to syringe. Step 21 = Placing vacuum tube in the transfer device. Step 24 = Disposing of syringe assembly in a sharps container. Signup and view all the answers

Match the following steps of the phlebotomy procedure with their corresponding descriptions:

Step 11 = Dispose of the lancet device Step 12 = Apply gentle pressure to the patient's finger Step 13 = Wipe away the first blood drop Step 14 = Collect hematology samples Signup and view all the answers

Match the following precautions with their corresponding reasons in phlebotomy:

Puncturing a bone = Osteomyelitis or osteochondritis Not wiping away the first blood drop = Unnecessary tissue fluid dilution Not applying gentle pressure = Insufficient blood flow Not disposing of the lancet device = Blood contamination Signup and view all the answers

Match the following steps of the phlebotomy procedure with their corresponding purposes:

Step 15 = To prevent platelet clumping Step 16 = To minimize blood flow decrease Step 17 = To ensure blood collection Step 18 = To prevent blood contamination Signup and view all the answers

Match the following phlebotomy procedures with their corresponding age groups:

Heel stick = Less than 1 year old Venipuncture = More than 1 year old Arm stick = More than 2 years old Finger stick = Adults Signup and view all the answers

Match the following phlebotomy procedures with their corresponding precautions:

Heel stick = Avoid puncturing a bone Venipuncture = Avoid using a vein with a pulse Finger stick = Wipe away the first blood drop Arm stick = Apply gentle pressure Signup and view all the answers

Match the following phlebotomy procedures with their corresponding consequences:

Not wiping away the first blood drop = Unnecessary tissue fluid dilution Puncturing a bone = Osteomyelitis or osteochondritis Not disposing of the lancet device = Blood contamination Not applying gentle pressure = Insufficient blood flow Signup and view all the answers

Match the following phlebotomy procedures with their corresponding steps:

Heel stick = Step 1-5 Venipuncture = Step 6-10 Finger stick = Step 11-15 Arm stick = Step 16-20 Signup and view all the answers

Match the following phlebotomy procedures with their corresponding importance:

Heel stick = High importance for children less than 1 year old Venipuncture = Moderate importance for adults Finger stick = Low importance for blood sampling Arm stick = High importance for blood collection Signup and view all the answers

Match the following steps with their corresponding actions during venipuncture:

Step 19 = Fill the vacuum tubes according to the correct order of draw Step 21 = Remove the tourniquet and withdraw the needle Step 20 = Mix the tubes gently Step 22 = Engage the needle safety guard and dispose of the needle Signup and view all the answers

Match the following steps with their corresponding reasons during venipuncture:

Step 19 = Prevent contamination Step 20 = Prevent hemolysis Step 21 = Prevent hematoma Step 22 = Prevent needle sticks Signup and view all the answers

Match the following venipuncture steps with their corresponding precautions:

Step 19 = Prevent repositioning the needle Step 20 = Avoid vigorous mixing Step 21 = Apply pressure to the puncture site Step 22 = Dispose of the needle immediately Signup and view all the answers

Match the following venipuncture steps with their corresponding consequences:

Step 20 = Hemolysis Step 21 = Hematoma Step 22 = Needle sticks Step 19 = Contamination Signup and view all the answers

Match the following venipuncture steps with their corresponding tube handling techniques:

Step 19 = Use the opposite hand to insert each tube Step 20 = Mix the tubes gently Step 21 = Invert the filled tubes Step 22 = Label the tubes immediately Signup and view all the answers

Match the following venipuncture steps with their corresponding safety measures:

Step 19 = Use the correct order of draw Step 20 = Avoid vigorous mixing Step 21 = Apply pressure to the puncture site Step 22 = Dispose of the needle in a sharps biohazard container Signup and view all the answers

Match the following venipuncture steps with their corresponding sample handling techniques:

Step 19 = Fill the tubes according to the correct order of draw Step 20 = Invert the filled tubes gently Step 21 = Label the tubes immediately Step 22 = Dispose of the needle and holder Signup and view all the answers

Match the following venipuncture steps with their corresponding error prevention measures:

Step 19 = Use the correct order of draw Step 20 = Avoid vigorous mixing Step 21 = Apply pressure to the puncture site Step 23 = Label the tubes immediately to prevent errors Signup and view all the answers

Match the following actions with what to do if a patient faints:

Call for help = Do not leave the patient alone until they are fully recovered Put the patient in a semi-prone position if possible = Allow the patient to rest until they feel better Offer a glass of water or juice = Place a cold compress on the patient's forehead and neck Do not panic = All of the above Signup and view all the answers

Match the following actions with what to do if a patient has a seizure:

Remove the needle from the patient's arm immediately = Do not restrict movement Call for help = Ease the patient to the floor Do not panic = Loose clothing, especially around the neck Place something soft under the head = Do not put anything in the mouth Signup and view all the answers

Match the following conditions with petechiae:

Prolonged straining = Coagulation problems or abnormalities Certain medical conditions = Injuries and sunburn Medications = Bleeding from capillaries into the skin Specific types of injuries = Tiny non-raised red spots on the skin Signup and view all the answers

Match the following actions with what a phlebotomist should do if a patient has petechiae:

Make sure bleeding stops prior to leaving the patient = Be aware of the patient's bleeding history Be cautious of excessive bleeding after blood collection = Apply direct pressure to the bleeding site Monitor the patient's vital signs = Check for any underlying medical conditions Avoid using the affected vein for blood collection = None of the above Signup and view all the answers

Match the following with the correct description of petechiae:

Tiny blood vessels = Linking arteries to veins Capillaries = Bleeding into the skin Small red spots on the skin = Tiny non-raised red spots on the skin Phlebotomy complication = May be caused by coagulation problems or abnormalities Signup and view all the answers

Match the following actions with what to do if a patient is about to faint:

Call for help = Place a cold compress on the patient's forehead and neck Put the patient in a semi-prone position if possible = Offer a glass of water or juice Do not leave the patient alone until they are fully recovered = Allow the patient to rest until they feel better All of the above = None of the above Signup and view all the answers

Match the following with the correct description of a seizure:

Sudden, uncontrolled electrical disturbance = In the brain Uncontrolled muscle movement = May be due to coagulation problems or abnormalities Loss of consciousness = A sudden, uncontrolled electrical disturbance in the brain Bleeding from capillaries into the skin = None of the above Signup and view all the answers

Match the following actions with what to do during a seizure:

Remove the needle from the patient's arm immediately = Do not panic Call for help = Ease the patient to the floor Loose clothing, especially around the neck = Do not restrict movement Place something soft under the head = Do not put anything in the mouth Signup and view all the answers

Match the following steps with their reasons:

Removing gloves = Standard precautions Wiping up spills with 1:10 bleach solution = Standard precautions Observing sites for 5-10 seconds before applying bandage = To prevent hematoma Thanking the patient and saying goodbye = Customer satisfaction Signup and view all the answers

Match the following equipment with their uses:

Butterfly infusion set = Fragile veins or small volume of blood Butterfly needle = Hands, elderly or children Winged-shaped plastic extensions = Gripping the needle 5-12 inch tubing = Connecting stainless steel needle Signup and view all the answers

Match the following steps with their purposes:

Removing and discarding contaminated items = Standard precautions Drawing a discard tube first = Maintaining blood/anticoagulant ratio Removing gloves and washing hands = Standard precautions Documenting any deviations from SOP = Compliance with standard operating practices Signup and view all the answers

Match the following types of tubes with their uses:

Coagulation tube = First tube drawn with butterfly No additive tube = Discard tube Light blue tube = Alternative discard tube Biohazard container = Disposing contaminated items Signup and view all the answers

Match the following complications with their prevention methods:

Hematoma = Observing sites for 5-10 seconds before applying bandage Blood contamination = Removing and discarding contaminated items Incorrect patient identification = Verifying patient identification Hemolysis = Using correct needle and syringe assembly Signup and view all the answers

Match the following steps with their purposes:

Assembling the butterfly apparatus = Preparing for venipuncture Cleansing the site with alcohol = Preventing infection Reclamping the tourniquet = Maintaining blood flow Documenting deviations from SOP = Compliance with standard operating practices Signup and view all the answers

Match the following types of samples with their characteristics:

Lipemic samples = High lipid content Icteric samples = High bilirubin content Hemolyzed samples = Ruptured red blood cells Normal samples = No abnormalities Signup and view all the answers

Match the following precautions with their purposes:

Standard precautions = Preventing blood contamination Using gloves = Preventing skin contact with blood Wiping up spills with bleach solution = Disinfecting surfaces Documenting deviations from SOP = Compliance with standard operating practices Signup and view all the answers

Hemolysis is caused by the breakdown of WBC and release of hgb.

False Signup and view all the answers

Nerve damage can be caused by lateral redirection of the needle.

True Signup and view all the answers

Hemolysis can be detected by a bluish coloring of the plasma/serum.

False Signup and view all the answers

Icteric samples are characterized by a dark yellow to dark brown color due to the presence of bilirubin.

True Signup and view all the answers

A partially filled tube can cause an incorrect blood-to-additive ratio.

True Signup and view all the answers

Using a needle with too large a gauge can cause hemolysis.

False Signup and view all the answers

Reflux of additive can cause an adverse reaction in the patient.

True Signup and view all the answers

Lipemic samples are rejected due to their high fat content.

True Signup and view all the answers

Blind probing can cause vein damage.

True Signup and view all the answers

Shaking tubes can cause hemolysis.

True Signup and view all the answers

Hemoconcentration is caused by an increase in fluid content of blood.

False Signup and view all the answers

Centrifuging at too low a speed can cause hemolysis.

False Signup and view all the answers

Using jerky movements during venipuncture can cause nerve damage.

True Signup and view all the answers

Hemolysis can be caused by drawing blood through a hematoma.

True Signup and view all the answers

Paralysis can increase the chance of thrombosis during venipuncture.

True Signup and view all the answers

Icteric samples are typically rejected due to their high bilirubin content.

True Signup and view all the answers

Probing is a recommended technique to find a vein during venipuncture.

False Signup and view all the answers

A vein with a pulse can be used for venipuncture.

False Signup and view all the answers

You can only attempt to get a blood sample once.

False Signup and view all the answers

Tourniquet is too tight is a cause of loss of vacuum due to damage of the tube.

False Signup and view all the answers

If the needle is not inserted far enough, the needle will not enter the vein.

True Signup and view all the answers

The primary reason for repositioning the needle is to cause hemolysis.

False Signup and view all the answers

You should remove the tourniquet during the draw.

True Signup and view all the answers

Collapsing of the vein is a cause of loss of vacuum due to bevel partially out of skin.

False Signup and view all the answers

Sclerosed veins are typically easy to puncture and yield accurate results.

False Signup and view all the answers

Edema is a normal accumulation of fluid in tissues.

False Signup and view all the answers

A hematoma is a normal response to venipuncture.

False Signup and view all the answers

Applying inadequate pressure after venipuncture can help prevent hematomas.

False Signup and view all the answers

Mastectomy sites are ideal for venipuncture.

False Signup and view all the answers

Inserting the needle through the vein can help prevent hematomas.

False Signup and view all the answers

Bending the arm after venipuncture can help prevent hematomas.

False Signup and view all the answers

Using a vein that is too small or fragile for the needle size can help prevent hematomas.

False Signup and view all the answers

Heparin is an anticoagulant that binds with Calcium to prevent blood clotting.

False Signup and view all the answers

EDTA is used in Immunohematology and has a pink stopper tube.

True Signup and view all the answers

Sodium Citrate is an anticoagulant that inhibits thrombin formation.

False Signup and view all the answers

Oxalates are an example of anticoagulants that inhibit the formation of thrombin.

False Signup and view all the answers

Heparin is used in Chemistry Department for electrolytes, cholesterol, and glucose tests.

True Signup and view all the answers

EDTA is used in whole blood hematology studies, including CBC and sedimentation rate.

True Signup and view all the answers

Citrates are used in Ammonia and HgbA1C tests.

False Signup and view all the answers

EDTA is used in trace metal tests, such as lead and zinc, in the Royal Blue Tube.

True Signup and view all the answers

Study Notes

Patient Identification and Verification

Verify patient identification by matching the patient's first and last name, date of birth, and PHIN number (or other unique identifier) with the information on their Manitoba Health Card or hospital arm band.
Ask the patient to spell their name and provide their birth date to ensure accuracy.
Make sure all necessary information is correct before proceeding.

Importance of Accurate Patient Identification

Accurate patient identification is crucial to prevent lab errors.
The patient must be positively identified to ensure the correct test results.
If any information is incorrect or missing, do not perform the procedure. Get the information corrected before continuing.

Pre-Procedure Preparation

Make sure the patient has followed dietary instructions if required for a specific test.
Wash hands and put on gloves as a standard precaution.
Position the patient for venipuncture with their arm straight and slightly downward.

Venipuncture Procedure

Apply the tourniquet 3-4 inches above the intended venipuncture site.
Palpate a vein to determine its depth and patency.
Assemble all necessary supplies and equipment, including the needle and syringe.
Position the equipment and pop the barrel of the syringe to remove any air.
Reapply the tourniquet and re-palpate the vein before inserting the needle.
Cleanse the site with alcohol and let it dry before inserting the needle.
Anchor the vein and insert the needle at a 15° angle with the bevel up, following the direction of the vein.

Importance of Proper Venipuncture Technique

Use a proper venipuncture technique to prevent rolling of the vein.
Do not use the two-finger technique (also called the "C" hold) for safety reasons.
Do not depress the skin by pushing down on the needle as it is inserted, as this can cause pain to the patient and increase the risk of blood leakage.

Post-Procedure Care

Remove the needle cover and put the needle into the holder.
Smoothly push the tube into the holder without moving the needle.
Release the tourniquet when blood begins to flow.
Fill the tubes according to the correct order of draw and invert additive tubes to mix.

Inappropriate Sites for Venipuncture

Avoid using arms with mastectomy, edematous areas, hematomas, or sites above an IV cannula.
Do not use arms with fistulas or vascular grafts, or those that are being transfused.
Avoid using sclerosed veins, as they are hardened due to numerous punctures and may lead to errors in lab results.
Avoid using arms with paralysis, as it increases the chance of thrombosis.

Phlebotomy Procedure

Release the tourniquet once there is evidence of blood in the hub of the needle.
Fill the syringe by slowly and firmly pulling on the plunger with the non-drawing hand to prevent hemolysis and vein collapse.
Withdraw the needle and immediately apply pressure for 3-5 minutes with a clean gauze.
Apply needle safety guard and place needle in a sharp container.

Syringe Transfer Device

Attach the transfer device to the syringe.
Place a vacuum tube in the transfer device in the order of draw.
Push the tube onto the internal needle until the stopper is pierced.
Blood from the syringe is drawn into the tube without pushing the plunger.

Labeling and Disposal

Label all tubes immediately with patient's name, identification number, date, time of collection, and initials.
Dispose of syringe assembly immediately in one piece in a sharps container to reduce the chance of a needle stick injury.
Dispose of contaminated items into a biohazard container, wiping up any spills with 1:10 bleach solution.

Patient Care

Examine the patient's arm 5-10 seconds before applying a bandage to prevent hematoma.
Thank the patient and say goodbye for customer satisfaction.
Remove and discard all contaminated items into a biohazard container, wiping up any spills with 1:10 bleach solution.

Heel Stick

Recommended for children less than 1 year old.
Be careful not to puncture a bone, as it may cause osteomyelitis or osteochondritis.

Butterfly Method

Used for fragile veins, hands, elderly, or children, when a small volume of blood is sufficient.
23-gauge needle is the most common.
If a coagulation tube is the first tube drawn, a discard tube should be drawn first to fill up the dead space and maintain blood/anticoagulant ratio (9:1).

Patient Complications

If a patient faints, allow them to rest, offer a glass of water or juice, and do not leave them alone until fully recovered.
If a patient has a seizure, remove the needle, call for help, ease them to the floor, and do not restrict movement.

Petechiae

Tiny non-raised red spots that appear on the skin when a tourniquet is applied.
May be due to coagulation problems or abnormalities.
Phlebotomist must be aware that the patient may bleed excessively after blood collection and ensure bleeding stops prior to leaving the patient.

Order of Draw

Fill vacuum tubes according to the correct order of draw.
Do not move the hand used to insert the needle, and use the opposite hand to insert each tube into the holder and invert the filled tubes.
Mix tubes gently to prevent hemolysis and clotting.

Safety Precautions

Remove gloves and wash hands after the procedure.
Document any deviations from the approved procedure (SOP – Standard Operating Practices).
Dispose of all contaminated equipment in a biohazard container.

Hemolysis

Detected by a pink or reddish coloring of the plasma/serum
Affects tests such as K, LD, AST, CBC, Glucose, and Coagulation tests
Causes of hemolysis include:
- Using a needle with too small a gauge
- Using a small needle with a large tube
- Improperly attached needle (frothing)
- Pulling the plunger back too fast
- Drawing blood through a hematoma
- Shaking tubes
- Forcing blood from a syringe into a tube
- Collecting blood above an IV
- Tourniquet too close to puncture site
- Tourniquet too tight
- Using fragile hand veins
- Not allowing alcohol to dry
- Prolonged contact of plasma to RBCs
- Centrifuging at too high a speed
- Underfilled grey stopper tube

Icteric

Characterized by a dark yellow to dark brown color
Caused by the presence of bilirubin, a hemoglobin waste product from red blood cells
Symptoms of jaundice include:
- Yellow tinge to the skin and whites of the eyes
- Dark urine
- Itchiness

Lipemia

Caused by accumulation of lipoprotein particles
Lipemic samples have a higher fat content, making them thicker and milkier
Specimens are rejected if lipemic

Problem Sites

Obesity: use longer tourniquet and try median cubital or cephalic vein
Paralysis: avoid drawing blood from paralyzed arm, increased chance of thrombosis and difficulty detecting nerve injury
Nerve Damage: avoid by selecting proper vein, using smooth movements, not inserting the needle too far, and minimizing patient movement
Infection: avoid by following proper sterilization and venipuncture procedures

Vein Damage and Reflux

Vein Damage: avoid numerous venipunctures in the same area over time, and avoid blind probing and improper technique
Reflux of Additive: blood flows back into the vein from the collection tube, causing adverse reactions; keep the arm in a downward position and the tube below the venipuncture site

Hemoconcentration and Partially Filled Tubes

Hemoconcentration: a decrease in fluid content of blood, causing an increase in non-filterable large molecules; caused by stagnation of normal venous flow due to tourniquet
Partially Filled Tubes: incorrect blood-to-additive ratio, causing erroneous results; underfilled tubes can lead to hemolysis or incorrect test results

Collection Tube Issues

Wrong or Expired Collection Tube: incorrect or outdated tubes can cause erroneous results or contamination

Tube Vacuum

Loss of Vacuum: due to bevel partially out of skin, damage to the tube, or incorrect insertion
Solutions: reposition the needle, advance the needle slightly farther into the vein, or release the tourniquet slightly

Needle Position

Correct Needle Position: blood can flow freely into the needle
Incorrect Needle Position: needle not inserted far enough, or needle not in the vein

Damaged Veins

Sclerosed Veins: hardened veins
Thrombosed Veins: clotted veins
Solutions: use another site if possible, or draw below (distal to) damaged veins

Edema

Causes: abnormal accumulation of fluid in tissues, IV infiltration, or swelling
Effects: veins are harder to locate, and tissue is fragile

Hematoma

Causes: blood leaking from vessel during venipuncture, failure to remove the tourniquet, applying inadequate pressure, excessive probing, or failure to insert the needle in the vein
Effects: painful, contaminates blood sample, and obstructs blood flow

Anticoagulants

Definition: substances that prevent blood from clotting
Examples: EDTA, citrates, heparin, oxalates
Methods: binding or precipitation of calcium, or inhibiting the formation of thrombin

Specific Anticoagulants

EDTA: used for whole blood hematology studies, immunohematology, and ammonia testing; binds with calcium and interrupts the coagulation process
Heparin: used for chemistry tests, inhibits thrombin, and is the most common anticoagulant used in the chemistry department
Sodium Citrate: used for coagulation studies, binds with calcium and interrupts the coagulation process

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Learn about the importance of accurate patient identification and verification in healthcare. Verify patient information through multiple methods to ensure accuracy.

unit 1 phlebotomy

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Questions and Answers

What is the primary reason for verifying patient identification in venipuncture?

What should you do if you find any discrepancies in patient identification during venipuncture?

Why is it essential to ensure the patient has followed dietary instructions before a specific test?

What is the primary purpose of applying the tourniquet during venipuncture?

Why is it crucial to position the patient's arm correctly during venipuncture?

What is the primary reason for washing hands and putting on gloves during venipuncture?

What should you do if you notice any discrepancies in the patient's arm band during venipuncture?

Why is it essential to ensure 100% accuracy when identifying a patient during venipuncture?

What is the primary purpose of asking the patient to spell their name during the venipuncture process?

Why is it essential to apply gloves during the venipuncture process?

What is the primary reason for positioning the patient's arm straight and slightly downward during venipuncture?

Why is it important to palpate the vein before inserting the needle?

What is the primary purpose of assembling the needle and syringe during the venipuncture process?

Why is it essential to anchor the vein during the venipuncture process?

What is the primary reason for cleansing the site with alcohol and letting it dry before inserting the needle?

What is the primary purpose of re-palpating the vein after re-applying the tourniquet?

What is the primary reason to avoid using a vein with a pulse?

Why is it important to palpate above and below the initial vein location?

What is a common complication associated with using a vein in an arm with a fistula or vascular graft?

Why is it necessary to do a 2-minute shutdown before collecting a blood sample from a site above an IV cannula?

What is a characteristic of a good vein for venipuncture?

Why is it important to avoid using veins in areas with tissue fluid accumulation?

What is a potential consequence of using a sclerosed vein for venipuncture?

Why is it important to follow a correct order of collection when multiple tubes are required?

What is the primary reason for removing the tourniquet during venipuncture?

Why is it essential to palpate the vein carefully during a hand draw?

What is the primary purpose of assembling the butterfly apparatus during venipuncture?

Why is it crucial to reclamp the tourniquet after releasing it during venipuncture?

What is the primary consequence of failing to follow dietary instructions before a lab test?

Why is it essential to position the patient's arm correctly during venipuncture?

What is the primary purpose of cleansing the site with alcohol during venipuncture?

Why is it crucial to fill the tubes according to the correct order of draw during venipuncture?

What is the primary purpose of cleaning the venipuncture site with 70% Isopropyl alcohol?

Why should you anchor the vein during venipuncture?

Why is the 'C' hold or two-finger technique discouraged during venipuncture?

What is the recommended angle for inserting the needle during venipuncture?

Why should you avoid depressing the skin by pushing down on the needle during venipuncture?

What should you do if the patient moves their arm during venipuncture?

Why is it important to remove the needle cover right before the puncture during venipuncture?

What should you do after inserting the needle and checking for blood return during venipuncture?

Match the following steps with their corresponding actions during venipuncture:

Match the following steps with their corresponding reasons during venipuncture:

Match the following steps with their corresponding equipment used during venipuncture:

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Match the following steps with their corresponding actions after blood collection during venipuncture:

Match the following steps with their corresponding purposes during venipuncture:

Match the following steps with their corresponding post-venipuncture care during venipuncture:

Match the following steps with their corresponding equipment handling during venipuncture:

Match the following steps of the phlebotomy procedure with their corresponding descriptions:

Match the following precautions with their corresponding reasons in phlebotomy:

Match the following steps of the phlebotomy procedure with their corresponding purposes:

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Match the following phlebotomy procedures with their corresponding steps:

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Match the following steps with their corresponding actions during venipuncture:

Match the following steps with their corresponding reasons during venipuncture:

Match the following venipuncture steps with their corresponding precautions:

Match the following venipuncture steps with their corresponding consequences:

Match the following venipuncture steps with their corresponding tube handling techniques:

Match the following venipuncture steps with their corresponding safety measures:

Match the following venipuncture steps with their corresponding sample handling techniques:

Match the following venipuncture steps with their corresponding error prevention measures:

Match the following actions with what to do if a patient faints:

Match the following actions with what to do if a patient has a seizure:

Match the following conditions with petechiae:

Match the following actions with what a phlebotomist should do if a patient has petechiae:

Match the following with the correct description of petechiae:

Match the following actions with what to do if a patient is about to faint:

Match the following with the correct description of a seizure:

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Match the following types of tubes with their uses: