Order of Draw
A primary reason phlebotomists follow a standardized order of draw.
What is to prevent cross contamination of tube additives between samples?
Should a CBC microcollection be collected before or after a chemistry microcollection for capillary sticks.
What is before?
What are the basic elements needed for the chain of infection to occur?
Infectious agent (pathogen), reservoir (habitat), portal of exit (how it leaves host), mode of transmission (spreads), portal of entry (how it enters), and new host
What is the first step a phlebotomist should take before beginning blood draws on a patient?
Introduce self, ID patient, hand hygiene
What is the most common vein used for venipuncture?
Median Cubital
Tube color that usually contains an anticoagulant used for complete blood count (CBC) testing.
What is lavender?
When performing a heel stick on an infant, name a reason to avoid squeezing the site too hard?
Hemolysis of the cell, sample contamination (fluid with blood), pain/trauma, and inaccurate results
What is one common reservoir for pathogens in a clinical setting?
hands and fomites (commonly touched items)
Why is patient identification critical before venipuncture?
Lab results going into the incorrect chart can delay care for a patient that needs it or initiate unnecessary treatment to a healthy patient which could have drastic consequences (side effects)
What angle should the needle be inserted for antecubital venipuncture?
15-30 degrees
Additive in tubes can cause clotting to occur, and therefore is used in serum collection tubes.
What is silica?
Site used for capillary sampling in older children and adults.
Define mode of transmission and one example relevant to phlebotomy
mode of transmission is the pathway that pathogens travel from one source to a host and a great example is touching a patient
List three pieces of equipment the phlebotomist should prepare before venipuncture.
Tourniquet, Gauze, Alcohol, Needle, Tube, etc
Name two contraindications for using a particular arm for venipuncture.
Mastectomy, Burns, Edema, Dialysis fistula, IV line, cellulitis, hematoma, and/or scarring.
Explain why mixing tubes gently (inverting) after collection is important.
What is to immediately mix additives, anticoagulants, or clot activators with the sample?
correct order for capillary micro-collection when both EDTA and serum samples are needed
EDTA first then serum samples (blood gases, lavender, green, gray, gold/red)
What is a standard precaution phlebotomists use to break the chain of infection?
frequent hand washing
Describe the immediate steps a phlebotomist should take if a patient experiences syncope?
Remove the tourniquet and stop the procedure
Explain the reason for anchoring the vein during needle insertion.
To stabilize the vein (keep it from rolling)
List in correct sequence, the typical adult venous order of draw for light blue, gray, blood cultures, red, lavender, and green tube.
What is blood cultures, light blue, red, green, lavender, and gray?
Explain how alcohol not fully dried on skin can affect capillary test results.
Dilutes the sample and can cause false low results and physical discomfort
How could a phlebotomist interrupt the chain of infection besides hand washing?
keeping surfaces clean, opening packages only immediately before use, using proper disposal, etc.
What is the proper procedure for labeling tubes?
Tubes must be labeled at the bedside in front of the patient at the time of venipuncture. Labels include patients name, DOB, ID #, date and time of collection and phlebotomist initials at a minimum.
A patient has a small, fragile vein that tends to roll, how should the phlebotomist proceed
Apply warm compress, use the tourniquet correctly, anchor the vein well, use butterfly needle, etc.