MLT 102 Phlebotomy Final Exam Review PDF

MLT 102 Phlebotomy Study Guide for Final Exam The final exam will be cumulative covering all material covered in the course from the beginning. It will consist of 100 multiple-choice questions in Canvas. It is best to review all previous exam guides 1-4 and listen to the recordings because they ar...

MLT 102 Phlebotomy Study Guide for Final Exam The final exam will be cumulative covering all material covered in the course from the beginning. It will consist of 100 multiple-choice questions in Canvas. It is best to review all previous exam guides 1-4 and listen to the recordings because they are more detailed. The following is an outline to assist in your review for the exam: I. Safety: Standard Precautions, BBP (which diseases?), PPEs, needle safety devices, labeling requirements, sharps containers, fire extinguishers. II\. Equipment and supplies for the routine venipuncture --supplies (variety of needles, most common needle) and additives and anticoagulants for all tubes and what tests each tube can be used for. Which tubes go to what department? **See handouts posted on Canvas in the Lectures-\>review-\>"exam 1" folder (you have the printed copies).** - Ex. Lavender top tube is used for a CBC (hematology = whole blood) and an Hemoglobin A1c (=glycosylated HGB) -- also whole blood, can be done in Chemistry or Hematology. Most of the serum and plasma test are done in Chemistry (drug levels, electrolytes, glucose). Blue top (citrate tube=plasma) -- for coagulation study, must be completely full (to maintain 1:9 anticoagulant to blood ratio). Blood bank -pink or lavender. - Serum vs. plasma (know which color tubes produce serum/plasma) The main difference between serum and plasma is that **Serum** is depleted of fibrinogen because it was used in the **Coagulation/clotting** process. Visually you can't tell them apart. - The anticoagulants EDTA and Citrate prevents clotting by binding Calcium. Heparin additives prevent clotting by inhibiting thrombin. Clot activator (glass or silica particles) promotes clotting. No clot activator tube- nothing in it, must wait 30 min for clotting process. III\. Anatomy and Physiology -- special attention to the veins in the antecubital area of the arm (order of vein selection), the arteries used for ABGs and the circulatory system, body fluids. Body planes (ex. transverse cut of the body). There will be a few questions on the other body systems. Order of vein selection for routine VP: 1 **median cubital, 2 cephalic, 3 basilic -- last choice because:** - The **basilic** vein is the last choice vein for venipuncture in the antecubital area because it overlies the **brachial artery** and several **major nerves** of the arm. Blood constituents: RBC, Platelets, WBC (lymphocytes, neutrophil, eos, basos, monocytes). IV\. HIPAA regulations -- confidentiality issues. V. Complications of a venipuncture -- fainting, nausea, nerve injury, hematoma, excessive bleeding, etc. VI\. Difficult situations in blood collections -- edema, obesity, cast on arm, IV both arms, no ID bracelet etc. Avoid using an arm with lymphedema alert -- patient had mastectomy and an underarm lymph node removal. It can cause edema. What causes vein to collapse? What causes hematoma- needle partially inserted, "miss", probing. If it forms after -- patient on too much anticoagulant. VII\. Blood cultures -- equipment, cleansing the site is most important (alcohol and iodine or Chlorhexidine/alcohol -- preferred, BC bottles -- aerobic and anaerobic. Which to fill first when a butterfly set. VIII\. Capillary punctures - sites, equipment, procedure, order of draw, blood glucose testing, newborn screening -- common tests. When is a capillary draw needed? What can happen if lancet goes to deep into the hill? Warming of the site increases blood flow to the area. Can't perform capillary draw if blood culture or regular coagulation tests are ordered (due to needed volume). IX\. Isolation Precautions and aseptic techniques -- categories of isolation, hand washing. - Respiratory droplet isolation for TB- special respirator needed N-95. - Protective or reverse isolation is for: newborns, patients after chemotherapy, patients with burns, patients with low white cell count (neutropenic) -- to protect them due to low immune status. - What is nosocomial infection? X. Special collections -- newborn nursery, GTT (when glucose drink is used, post prandial meaning), timed collections, peak and trough levels for drugs, ABGs (which artery), collection on ice, protection from light, point of care testing. - Chain of custody -- forensic specimens. - Therapeutic phlebotomy -- Hemochromatosis and Polycythemia vera. XI\. Non blood specimens: urine -- first morning (best specimen, most concentrated), random, sterile for culture, drug screen, 24 hour collection; spinal fluid, other body fluids: ascetic, amniotic fluid, etc. XII\. Rejection of specimens -- unlabeled, mislabeled, wrong tube, QNS, volume low in light blue tube, clotted, hemolyzed, etc. - What causes hemolysis? - mixing tube too vigorously, pulling blood into a syringe too quickly, using a needle with too small of a bore. - What causes clotting of EDTA tube? XIII\. Health Care Delivery System -- places where phlebotomists work. Other healthcare workers -- what degree is needed and what their job skills are. XIV\. The clinical Lab -- anatomic and clinical sections, tests done in each department, who works there. Ex: CBC in performed in Hematology, Pt/PTT- coagulation, autopsy is performed in the Anatomic pathology section, BMP, glucose - performed in Chemistry, cultures -- microbiology, Type and screen -- Blood bank XV\. Specimen Processing and Transport -- how to safely centrifuge, log in and transport. Pneumatic tube systems -- fastest way, specimens need to be protected from leaks and breakage. XVI\. Pediatric Phlebotomy -- methods to use at each age, size and stage. Holding techniques. Child sits on parent's lap and they hold legs and the arm not being used, lying down and parent lies across legs, papoose board. XVII\. Geriatric patients -- how their body changes naturally and what we can do to make it easier. XVII\. Patient relations -- verbal and nonverbal communications. XVIII\. Medical Legal issues -- terminology, how to protect yourself from being sued. XIX\. Blood Donations -- We must screen all prospective donors to ensure their safety as well as the safety of the patients that will receive their blood. review handouts from Lab **Blood donations** -- page 360-362. Donors criteria (weight, temp etc) - [Autologous] - to be used by the patient during elective surgery, - [Allogenic] - to be used for any patient that needs the blood or [Directed] donations to be used by a specific patient. - Screening of donors to protect both the donor and the recipient of the blood. Review information in lab packet. - What happens when the wrong blood type is transfused? XX\. Quality Control in Specimen Collection - what a phlebotomist needs to do to make sure that all specimens are collected accurately. Extra: **Choosing the correct equipment for each patient by size and age:** - Newborns to 10 months: heel stick - 10 months to 2 years: finger stick or VP using a butterfly and peds size tubes - 2 -- 6 years -- VP using peds tubes and a butterfly set in the AC area - 7 years and up -- May use regular needle and regular tubes