Phlebotomy
Potpourri
Techie
It's all about
the tubes
Supporting
Roles
Location, Location,
Location
100

Term meaning 'all patients, bodily fluids and blood should be treated as potentially infectious.'

Standard precautions

100

Why must the alcohol be dry before performing venipuncture?

Prevent patient discomfort, contamination of the specimen and hemolysis of the specimen.
100

The additive in lavender top tubes and one or more department(s) they are collected for.

K:EDTA, used in hematology, also in blood bank (large lavender), Hgb A1C (central chemistry) and some hospital chemistries (PTH).

100

What steps should be taken immediately following needle removal?

1. Apply pressure to gauze

2. Engage safety device

100

In the antecubital area which vein would you choose first, second and third?

Median cubital, cephalic, basilic.

200

What resource provides the steps to take following an accidental dirty needle stick?

Emergency response cards located in all work areas.
200

Why is stretching the skin before performing venipuncture useful?

To anchor the vein and thin the skin for less painful and quicker entry.

200

What does sodium fluoride do to RBCs?  Why is this important for lactic acid testing and in certain circumstances glucose tolerance testing?

Sodium fluoride inhibits glycolysis of RBCs.  In the absence of O2 RBCs will continue to metabolize glucose anaerobically producing lactic acid.  In glucose tolerance testing, if the specimen cannot be spun immediately sodium fluoride tubes may be used to prevent glycolysis, preventing a falsely decreased glucose value.

200

What information is needed for identifying patients (inpatient and outpatient)?

Inpatient - Compare MRN and name/DOB on patient's wristband. If there is no wristband, ask nursing staff to band patient. If they refuse, ask the nurse to verbally ID patient asking open ended questions, name and DOB. Document on line 14 nurse's name who verified patient.


Outpatient - Ask patient to state their first, last name and DOB. If the patient is unable to verbally verify, use the patients ID (license, state ID, military ID, school ID). If family member verifies patient's ID, document on line 14.

200

What 3 pieces of information do you assess when palpating for a vein?

Size, depth and direction.

300

What device is used to sterilize the site of collection for blood culture bottles and why?  This device should not be used in which patients?  Describe the procedure for each device.

Chloraprep sponge device should be used on patients >2 months old using a 30 sec friction rub.  For patients <2 months, a 60 second friction rub with alcohol should be used.

300

Why must the bevel of the needle be facing up?

Easier entry into the skin and allows maximum blood flow into the tube.
300

Specimens collected in sodium citrate tubes are collected for which department(s)? Name a test for each department.

Coag - PT, PTT, fibrinogen, D-dimer, PFA

Flow cytometry - CD4/CD8, HLA typing, PNH, T-helper-inducer cell

300

Name 2 ways to minimize movement of the needle while performing venipuncture.

1. Apply pressure against the patient's arm with the hand holding the needle

2. Keep your eye on the needle

3. Use the phalange on the vacutainer holder when engaging/disengaging tubes.

300

3 ways to make it easier to find a difficult vein.

1. Warm compress 

2. Tie tourniquet tighter

3. Rotate wrist

4. Lower the arm/hyperextend elbow

5. Closed fist (not pumping of the fist)

400

Why is it important to remove the tube from the vacutainer holder prior to removing the needle?`

Prevent backflow (injecting the contents of the tube back into the patient who may go into anaphylactic shock).

400

What is the angle of insertion and why?

15-30 degrees, this allows blood to flow more freely and increases the chance of a successful needle stick (increases the distance the needle can travel before exiting the vein). 

400

Specimens in heparin tubes are collected for which department(s)? Name a test for each department.

Hospital chemistry - CMP, BMP, glucose, electrolytes etc.


Special chemistry - Ionized calcium, EtOH, Quantiferon

Cytogenetics - B cell, chromosome analysis

Flow cytometry - leukemia/lumphoma panel

400

When you have no Antrim labels, what information must be on all tubes?

Outpatient - full name, DOB, date/time of collection and phlebotomist's initials

Inpatient - full name, DOB, date/time of collection, phleb initials and MRN number.

400

3 reasons you may not be able to perform venipuncture in the antecubital region.

1. Cast or dressing   2. Bruising    3. Edema    

4. Scarred or burned    5. Overused vein    

6. Above an IV    7. Fistula, cannula or shunt

500

What is the effect of having a tourniquet on too long? 


Hemoconcentration can affect multiple tests (Ca, K, lactic acid).


500

What is the best way to draw blood from a patient with an IV?  What steps should be taken if drawing from the side of an IV?

It is best to draw from the other side.  If this isn't possible ask the nursing staff if they can turn off the IV.  If not, they may choose to do an arterial draw.
500

You accidentally draw a lavender tube before an SST tube. How would you proceed?

If you have access to a waste tube you can use it to decontaminate needle then draw the SST tube.  

If you do not have access to a waste tube the phlebotomist should stop venipuncture, restick the patient and draw the SST tube.

500

When do you label your specimens. What steps come after?

After venipuncture and before letting the patient go. Patient must verify information on tube is correct.

500

Why are veins on the foot our last choice for veinipuncture?

Patients with poor circulation (diabetics) are more prone to thrombosis (clot circulating in blood), which could cause potentially life-threatening pulmonary or coronary embolism.