Blood collection variables, complications, and procedural errors Flashcards

Venipuncture
Terms Definitions
Basal State
early in the morning while the body is at rest and approximately 12 hours after last intake of food, exercise, or activity.
collapsed vein
abnormal retraction of blood vessel walls, temporarily shutting off blood flow.
CVC
type of line inserted into a large vein and advanced into the superior vena cava, proximal to the right atrium.
diurnal variations
normal fluctuations throughtout the day
edema
accumulation of fluid in the tissues
fistula
internal shunt created by permanent fusion of an artery and a vein
hematoma
swelling or mass of blood caused by leakage of blood from a vessel during or after venipuncture or arterial puncture
hemoconcentration
decrease in blood fluid content with an increase in nonfilterable components such as RBC's
hemolysis
DESTRUCTION of RBCs and liberation of hemoglobin into the fluid portion of a specimen
heparin lock
special winged needle set or cannula that can be left in a patient's arm for up to 48 hours and used to administer medication and draw blood
iatrogenic
induced by the effects of medical treatment, facilities, and personnel
lipemic
term used to describe cloudy serum or plasma caused by increased fat or lipid content
patency
state of being freely open, as in a patient's vein
petechiae
small, non-raised red spots that appear on a patient's skin when a tourniquet is applied because of a defect in the capillary walls or platelets
reflux
backflow of blood from a collection tube into a patent's vein during venipuncture
sclerosed
hard, cord-like, and lacking resiliency
synocope
fainting
thrombosed
clotted
VAD
tubing inserted into a main vein or artery and used for administering fluids and medications, monitoring pressures, and drawing blood
basal state specimens
establishing inpatient reference ranges
patient closes to basal state
awakened at 0600 hours after fasting since the previous evening meal
creatinine clearance
timed tests that measures amount of waste product in your blood and urine, and requires the patient's age when calculating
Red Blood Count
test that is most affected by altitude?
hemoconcentration of the blood
persistent diarrhea in the absence of fluid may cause?
serum or plasma of a lipemic specimen
cloudy and is a clue that the patient most likely was not fasting
triglycerides
12-hour fast is normally required when testing for this analyte?
corisol
blood component exhibits diurnal variation with peak levels occurring in the morning
timed (collected at a specific time)
tests influenced by diurnal variation are often ordered?
4-24
College of American Pathologists (CAP) guidelines state that drugs known to interfere with blood tests should be discontinued how many hours before the test?
what can falsely decrease test results
a drug that competes with the test reagents for the analyte being tested
enzymes
analytes is most affected by muscular activity before specimen collection?
presence of fever influences the levels
insulin, glucagon, and corisol
analyte has higher reference values for males than for females
hematocrit (measure of the volume of red bloods cells in a patients blood)
icteric
relating to or marked by jaundice and is used to describe serum, plasma, or urine specimens that have an abnormal deep yellow to yellow-brown color due to high bilirubin levels
icteric speciman
may indicate that the patient has hepatitis, may yield erroneous test results for some analytes, and will most likely have a high bilirubin level
what physical changes occur when a patient goes from supine to standing?
nonfilterable blood elements increase
why do pregnant patients have lower reference ranges for red blood counts?
body fluid increases in pregnancy have a diluting effect on red blood cells
analytes that may increase in smokers
corisol, hemoglobin, and white blood count
it is not a good idea to collect a complete blood count from a screaming infant because
can temporarily elevate the white blood count
factors known to affect basal state, which would be automatically accounted for when reference ranges are established
geographic enviroment
reasons to control temperature and humidity in laboratory
to establish reference values under controlled conditions, to ensure proper functioning of equipement, and to maintain speciman integrity
scarred or burned areas should be avoided as blood collection sites because
newly burned sites may be painful and are susceptible to infection, scarred sites may have impaired circulation, and veins are difficult to palpate in such areas
veins that feel hard and cord-like and lacks resiliency
thrombosed
if you have no choice but to collect a specimen from an arm with a hematoma, collect the specimen
distal to the hematoma
drawing blood from an edematous extremity may cause
erroneous results (due to contamination with tissue fluide or altered blood composition caused by swelling)
a venipuncture made through a hematoma can cause
can result in the collection of hemolyzed blood, is painful to patient, may cause inaccurate test results on the specimen
avoid collecting a specimen from an arm on the same side as a mastectomy because
arm is usually edematous, effects of lymphostasis may cause erroneous results, and veins in that arm may collapse more easily
you must collect a protime specimen from a patient with IV's in both arms. The best place to collect the specimen is
below one of the IV's
a phlebotomist must collect a hemoglobin on a patient in the intensive care unit. There is an IV in the patient's left arm. There is no suitable antecubital vein or hand vein in the right arm. What should the phlebotomist do?
collect the specimen by skin puncture of a finger of the right hand
which of the following should be avoided when selecting a venipuncture site?
a previous IV site within 24 hours of IV removal, an arm that has a heparin lock in the wrist area, and an arm with an arteriovenous (AV) shunt in the forearm
a type of line that is commonly used to collect blood gas specimans
arterial line
a vascular access pathway that is surgically created to provide access for dialysis is called?
arteriovenous (AV) shunt
when a blood specimen is collected from a heparin lock, it is important to draw
a 5 ml dicard tube before collecting the specimen
central venous catheters include all the following
broviac, groshong, and hickman
a subcutaneous vascular access device consisting of a small chamber attached to an indwelling line that is implanted under the skin and located by palpating the skin
implanted port
how do you bandage a venipuncture site if the patient is allergic to the glue in adhesive bandages?
use paper tape over a folded gauze square placed over the site
you may have to be careful about what type of equipment is brought into the room if a: patient or roommate is severely allergic to what?
latex (nonlatex gloves, tourniquet, and bandges)
if blood collection site continues to bleed after 5 minutes:
notify the patient's physican or nurse
which patient should be asked to lie down during a blood draw?
history of syncope during blood draws
what should a phlebotomist do if a patient feels faint during a blood draw?
immediately discontinue the draw and lower the patients head
an outpatient becomes weak and pale following blood collection. What should the phlebotomist do?
have the patient lie down
if an outpatient tells you that she is feeling nauseous, you should
give her an emesis basin in case she vomits, hold a cold damp washcloth to her forhead, and tell her to breathe slowly and deeply
Which vein is often the one that is easiest to feel on obese patients?
cephalic
what should a phlebotomist do if the patient goes into convulsions while in the middle of a venipuncture
remove the needle as soon as possible, prevent the patient from injuring himself or herself, and notify appropriate first aide personnel
phlebotomist is in the process of collecting a blood specimen on a patient with difficult veins. You have just started to fill the first tube slowly. The skin around the venipuncture site starts to swell. What should the phlebotomist do?
remove tourniquet and discontinue the draw immediately
What can cause a hematoma formation
inadequate pressure is applied to site after needle removal, the needle has penetrated through the back of the vein, and needle bevel is only partially inserted in the vein
What is the best indication that you have accidentally punctuated an artery
the blood pulses into the tube
term used to describe anemia brought on by withdrawal of blood for testing
iatrogenic
if you suspect that you have accidentally collected an arterial specimen instead of a venous specimen
keep the specimen and label it as a possible arterial specimen
infection at the site following venipuncture can result from
touching the site after it has been cleaned
escessive or blind probing for a vein can cause
nerve damage
a patient complains of significant pain does not subside and raidates down his arm. What should you do
discontinue the draw immediately
stinging sensation when a needle is first inserted is most likely the result of
not allowing the alcohol to dry properly
what is the best way to avoid reflux?
make certain the tube fills from the bottom up
what is the least likely way to impair vein patency?
performing numerous venipuntures in the same area
prolong tourniquet application may cause a change in blood composition primarily because of
hemoconcentration
serum or plasma of a hemolyzed speciman appears
pink or reddish
which action is least likely to cause hemolysis of a specimen?
collecting more than one tube of blood
the ratio of blood to anticoagulant is most critcal for which of the following test?
prothrombin time
a phlebotomist has tried twice to collect a light blue top on a patient with difficult veins. Both times the phlebotomist has been able to collect only a partial tube. What whould the phlebotomist do?
have another phlebotomist collect the spciman
what is the best way to avoid contamination of the specimen?
cleaning with isopropyl alcohol before performing a fingerstick
you are in the process of collecting a blood specimen. Blood flow has been established. As the the tube is filling, you hear ahissing sound and there is a spurt of blood into the tube and the flow then stops. What has most likely happened is:
needle bevel came partly out of the skin and vacuum escaped from the tube
which of the following situations could indicate that the needle has gone through the vein?
fail to get blood flow until you pull back on the needle, felt the needle go into the vein but you fail to get blood flow, and filled one tube but the second one failed to fill with blood
you are in the process of collecting a specimen. The needle is inserted but blood is filling the tube very slowly. You see a hematoma forming very rapidly. What has most likely happend is
the needle only partly inserted in the vein
performing a multi-tube blood draw. the first tube collects w/out a problem. second tube fails to fill. You adjust the needle and rotate bevel nothing happens. What should you do?
discontinue the draw and try at another site
A vein may collap because the
tourniquet is applied to tightly, tourniquet is too close to the venipuncture site, or the tube vacuum is too much for the size of vein
Bilirubin
product of the breakdonw of red blood cells
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