case scenarios
You are called to the Emergency Department to draw a STAT CBC, LYTES, and BILI from a 33-year-old male who appears very ill. You notice that the whites of his eyes are almost yellow, as is his skin tone, and that he is very weak. He has an IV running in his left hand.
What do these tests typically check?
LYTES=checks electrolyte balance of blood stream
CBC= Complete Blood Count provides cell counts, hemoglobin (Hb), hematocrit (Hct), and other tests for things like anemia
BILI= Bilirubin levels check liver function
Can you explain why a patient's blood does not normally clot as it is flowing through the patient's bloodstream?
Blood flows freely in the bloodstream unless the coagulation mechanism is activated for some reason.
what is PKU
Phenylketonuria
During an evacuated tube system draw, the phlebotomy technician properly positions the needle in the vein and inserts the blood tube into the tube holder to collect a blood sample, but there is no blood return. Which of the following should the phlebotomy technician do next to obtain the specimen?
replace the initial tube with another tube to check vacuum
what is ACD
Acid citrate dextrose
You will be performing venipunctures on three patients in a row. The first patient has orders for Electrolytes only. The second patient has a blood culture ordered. Your last patient has a CBC ordered. You wash your hands and put on new gloves before drawing your first patient. You take off your gloves, fill out some paperwork, and then go back to draw your second patient's blood work. You grab a new pair of gloves and perform the blood culture draw. You discard the gloves when finished and move toward your third and final patient. After greeting her, you look for another new pair of gloves.
How would cleansing the draw site differ between patients 1 and 2?
Routine venipuncture requires cleansing the site with alcohol. Blood culture specimen collection requires a different cleansing technique to minimize the chance of contaminating the blood specimen with bacteria from the skin. Two commonly used cleansing methods are chlorhexidine gluconate and alcohol/iodine. When chlorhexidine gluconate is used it generally a one-step procedure: The solution is released from the sponge and a back and forth friction scrub is performed for at least 30 seconds. The site must be allowed to air-dry before a venipuncture is performed. When alcohol and iodine are used for cleansing it is a two-step method: First, an alcohol wipe or alcohol sponge is used to gently rub the venipuncture area in a back and forth method for 30 seconds. The site is allowed to dry. The iodine solution is then applied at the center of the venipuncture site and moved outward in concentric circles to the periphery. The site must be allowed to air-dry before a venipuncture is performed.
Can you explain how a "cut" heals itself?
When skin is "cut", "tissue factors" activate the extrinsic clotting system that is measured by the Prothrombin Time (protime) test. The coagulation factors interact in a sequence that is known and predictable. At the same time, platelets form a plug to shore up the vessel break until the body can do more permanent repairs. This also activates the "intrinsic" coagulation pathway, and sets yet another series of coagulation factors to work activating one another in sequence that can be tested by an aPTT. Together, the intrinsic and extrinsic pathways of coagulation combine to activate a common pathway, which eventually leads to the conversion of prothrombin to thrombin. Thrombin then activates fibrinogen to form fibrin—which is the framework for the formation of a more permanent plug—which remains until tissue repair is complete. Calcium is needed for this to occur, which is why blood does not clot in the presence of EDTA, as it binds up all the calcium.
There is also a natural body system for getting rid of products of clotting or coagulation. This is called the fibrin-lysis or fibrinolytic system.
what is DHL Cholesterol
high density lipoprotein
Capillary blood specimen collection is contraindicated in patients that
have edema of the hands and feet
what is thrombosis?
a blod clot within the circulatory/ vascular system
After drawing a blood sample on Mrs. Baxter in the hospital, you discard your needle in an approved sharp's container on your tray and finish up your paperwork. As you are about to leave the room, you notice a capped needle on the floor next to Mrs. Baxter's bed, some obviously "used" gloves (turned inside out) close by, and some liquid spilled on the floor. It looks like water but you aren't sure.
Describe your course of action.
Depending upon the location of the items on the floor to your own location, you would assess the needs that should be addressed first. If the needle is closed, you might very carefully pick it up and dispose of it in your own sharps container.
Next, you would assess the spill danger. You would want to make sure that no one would slip on the spilled liquid, including yourself, the patient, and any visitors—while awaiting cleanup. You must assume the liquid is hazardous since you do not know its origin, and whoever cleans the spill must use universal precautions.
Finally, with gloved hands, you could pick up the used gloves and dispose of them as you would your own.
Which of the following forms is the phlebotomist responsible for having the patient sign when a specimen is being collected for substance abuse screening for employment?
1. advance directive
2. chain-of-custody
3. informed consent
4. release of medical information
what is MRSA
Methicillin-resistant Staphylococcus Aureus
While performing a venipuncture on an obese patient, the appropriate angle of insertion is _to_ degrees
15-30 degrees
what is polycythemia
increased number of RBCs, WBCs, and platelets in the blood
Here is a partial list of equipment on your drawing tray:
-21 gauge needles (for syringes and multisample adapters)
-23 gauge needles (for syringes and multisample adapters)
-Microsampling lancets
-Adult size red and speckled tops, lavender top, light blue top, and green top tubes
-Small volume red and lavender containers
-Assorted microcollection containers
What would you consider using to draw a creatinine on a 45-year-old male with large veins?
21 gauge needle and an adult speckled top tube (a plain red top tube would also be acceptable in this scenario)
Which of the following is the minimum PPE requirement when drawing lab work on a patient with suspected HIV?
1. gown, gloves, and mask
2. gloves only
3. mask only
4. gloves and mask only
gloves only
what is PCO2
pressure of carbon dioxide in the blood
Which of the following statements by a new phlebotomist indicates the need for further education on standard precautions?
"I will wear a gown, gloves, and mask for inpatient collections.“
what is PICC
peripherally inserted central catheter
Here is a partial list of equipment on your drawing tray:
-21 gauge needles (for syringes and multisample adapters)
-23 gauge needles (for syringes and multisample adapters)
-Microsampling lancets
-Adult size red and speckled tops, lavender top, light blue top, and green top tubes
-Small volume red and lavender containers
-Assorted microcollection containers
What would you consider using to draw a CBC order on a 5-year-old?
23 gauge needle and the small volume lavender top tube; maybe the syringe if needed
When disposing of hazardous materials, the phlebotomist must adhere to the guidelines and standards set forth by
1. OSHA
2. CLIA
3. FDA
D. CMS
OSHA
what is PPD
Purified protein derivative (tb test)
The phlebotomist is preparing to remove her gloves after a venipuncture and notices blood on the gloves. Where should the phlebotomist dispose of her gloves?
Biohazard waste container
what is AML
acute myelogenous leukemia