Introduction to Phlebotomy
In the 19th century, why did we stop bloodletting for therapeutic purposes? The discovery of...?
Microorganisms
Describe the following terms:
Infection
Non-Pathogenic
Pathogenic
Infection: A condition that results when a microorganism invades the body, multiplies and causes injury or disease
Non-Pathogenic: Microorganism that does not cause disease under normal conditions
Pathogenic: Causing or producing disease
These microorganisms referred to as pathogens.
Approximately how much blood is found in an adult human?
And what is the blood made up of?
5L
45% Formed elements 55% Plasma
Why use tourniquets?
Restricts blood flow causing:
Distends/inflates veins
Makes them larger
Easier to find
Stretches vein walls (thinner)
Easier to pierce with needle
Name an Engineering Control in phlebotomy.
Self Sheathing needles
What are some causes of premature loss of vacuum?
Improper storage
Opening the tube
Dropping the tube
Advancing tube too far on the needle before venipuncture
Bevel comes partially out of skin during venipuncture
What's the difference between a non-additive glass tube and non-additive plastic tube?
Plastic tubes are so smooth that it inhibits platelet aggregation and adhesion causing delayed clotting times, where as the glass is rough so it encoura0.025% SPS (Sodium polyanethol sulfonatenges) Typically glass tubes will have a silicone coating inside so the clots do not stick to the sides.
Iron overload
What is an infection acquired in hospital called?
Nosocomial
List the functions of the following:
Veins
Arteries
Capillaries
Veins: Return blood back to the heart (De-oxygenated)
Arteries: Carry blood away (oxygenated)
Capillaries: Connection between the two (where the exchange happens)
How long can you have the tourniquet on? How long to wait after releasing?
1 minute; 2 minutes
Name a Work Practice Control
Handwashing
What is found in blood culture bottles and what are blood cultures used for?
0.025% SPS (Sodium polyanethol sulfonate) and Nutrient broth
To find infection in the blood
At what angle do you insert a butterfly needle?
5-15/deeper veins go in at 30
Why do we do phlebotomy today?
Diagnostic Purposes/ Monitor Treatment
Remove blood for transfusion
Therapeutic purposes
Point of care testing
What is an infection spread from person to person called?
Communicable
Describe the physical features of the following:
Arteries
Veins
Capillaries
Arteries: Thick, elastic walled, small lumen
Veins: Think wall, large lumen, with valves
Capillaries: Single cell wall
Where do we apply the tourniquet? How about on the hand?
3-4 inches above puncture site
2-3 inches above wrist bone
Most common antiseptic?
Antiseptics used for Blood Cultures?
70% Isopropyl Alcohol
2% chlorhexidine gluconate OR Iodine
What is Light blue top tube used for and what's in it?
9:1 sodium citrate in coagulation
When would a syringe be used? What MUST be done first when using a syringe?
Hard draw, fragile, rolly veins, collapsing veins
MUST BREATHE SYRINGE
Why is the lab seen as a "Black Box"?
Specimens go in and results come out
Tell me the 6 links in the chain of infection.
1. Infectious agent: Hep B virus
2. Reservoir: Patient with Hep B
3. Exit Pathway: Blood from venipuncture
4. Means of transmission: Contact with blood
5. Entry Pathway: Needlestick with dirty needle
6. Susceptible Host: Healthcare workers have Hep B vaccination series less susceptible
What are the 3 layers to a blood vessel?
Tunica Interna/Intima:
Inner layer or lining of blood vessel
Made of single layer of cells, connective tissue, elastic.
Tunica Media:
Middle layer of a blood vessel.
Made of smooth muscle and elastic fibers.
Thicker in arteries than veins
Tunica Externa/Adventitia:
Outer layer of a blood vessel.
Made of connective tissue.
Thicker in arteries than veins
How do we transport blood and other specimens to the laboratory?
Biohazard bag
Plasma is made up of...
90% water
10% dissolved substances
What is a gold top tube?
Serum Separator Tube (SST)/ Thixotropic gel
What is an electronic/computer requisition?
Barcode label
What are some traits an MLA should have?
Professional attitude! -kind, caring, nice, supportive
Professional attire! - clean scrubs, no wrinkles, hair tidy and put up, no jewelry
Hygiene! - No scents, clean, deodorant, clean clothes, brushed teeth, short finger nails, no lashes,
What are 4 ways to break the chain of infection?
- Hand hygiene
- Disposal of sharps & infectious waste
- Needle safety devices used during collection
- Immunization
What use do the valves have in our veins?
To keep the blood flowing one way
Needle size by color:
Light blue
Green
Dark Blue
Black
LB: 23 butterfly
G: 21 straight/butterfly
DB: 25 butterfly (newborns)
B: 22
What are the formed elements in blood?
Erythrocytes, Leukocytes and Thrombocytes
What is a light green top tube?
Plasma separator tube (PST), gel and Lithium Heparin
List some problem sites
Damaged veins, scars or burns, tattoos, edema, hematoma, mastectomy, obesity, paralysis, casts
Things that can be monitored to ensure quality in phlebotomy
1. Phlebotomist response time (for inpatients)
2. Patient waiting (for outpatients)
3. Time it takes to perform a phlebotomy procedure
4. Number of redraws due to inappropriate amount of specimen
5. Number of incorrect tubes drawn
6. Number of patients requiring a second attempt
7. Number and size of hematomas
When would you use Standard Precautions?
All patient care-All fluids.
Where is the Antecubital Fossa found?
Front of the arm in the elbow bend
The 3 types of needles are...
Multisample-ETS
Hypodermic-Syringe
Winged infusion-Butterfly
What are the different WBC and their roles?
Granulocytes:
Neutrophils-Destroy pathogens
Eosinophils- Increase with allergies/parasitic infection
Basophils- Release Histamine (immune response)
Agranulocytes:
Monocytes- Phagocytosis of pathogens
Lymphocytes- Produce antibodies (B cells) & attack infected cells (T cells)
What is in a dark green top tube?
Lithium heparin or sodium heparin
Can MLA's draw from VADs?
NO NEVER ABSOLUTELY NOT
What are we looking for in phlebotomy relating to quality assurance?
Quality of sample- bad quality sample = bad quality results
When would you use Airborne Precautions?
For patients suspected to be infected with microorganisms transmitted by airborne droplets
Name the 3 veins we typically use and where they are. Which vein is our preferred choice? Which vein is our last choice? Why?
Median Cubital vein -First choice, located in the middle
Cephalic Vein- located on the outside of arm
Basilic Vein- Last choice, located o the inside of arm, close to nerves and artery
Which part of the needle pierces the vein?
Bevel
What are the 2 most important blood groups?
ABO Rh
What is in a lavender top tube?
K2EDTA &????
Patient has a running IV in both arms, what do you do?
Ask nurse to turn off an IV, wait 2 minutes, collect from below IV site (maybe discard tube), when done tell nurse.
What is our collection priorities? (time wise)
STAT, Urgent, (Timed), Routine
When would you use Droplet Precautions?
Patients infected with microorganisms transmitted by droplets
If you needed to poke a leg, ankle or foot, what is required?
A DOCTORS PERMISSION
What happens with a short draw?
Additive to blood ratio is not correct.
What is Primary Hemostasis? What is Secondary Hemostasis?
Platelet plug formed
Clot formation & Fibrinolysis
What is in a grey top tube and what is it used for and why?
Sodium Fluoride and Potassium Oxalate, used for glucose as it prevents glycolysis
If your patient has a big, biiig vein, what will you do?
DO NOT POKE! Probably a fistula/shunt.
If a patient asks for their test results, what would you say?
You'll have to discuss with your doctor/ This is not in my scope of practice
When would you use Contact Precautions?
When patient infected with microorganisms that can be transmitted by:
direct contact with patient
indirect contact with surfaces
What are the 3 arteries found in the arm and their locations?
Brachial Artery-Brachial part of arm (between antecubital fossa and bicep area)
Radial Artery- Thumb side of wrist
Ulnar Artery- Pinky side of wrist
What are the 3 functions of additives?
1. Prevent clotting
2. Separate cells from serum/plasma
3. Clot activators
Where is Heparin formed?
Liver
What is in an orange top tube?
Thrombin (RST)-rAPID sERUM tUBE
Are you READYYYYYYY
YEAHHHHHHHH