Best Clinical Practices & Non-Blood Specimens
How can you identify a patient?
Name, DOB, verify their bracelet matches requisition, check in w/ nurse/family member if patient cannot communicate
A patient reportedly ate breakfast before arriving for a fasting required blood draw. What should the Phlebotomist do?
Tell them to reschedule another test. If fasting rq then specimens needs to be collected while pt is fasting
What is the primary method for breaking the Chain of Infection?
Handwashing
Clinical Laboratory Improvement Amendments of 1988 are federal regulations that establish a standard for clinical labs
What is the purpose of the Light Blue Tube and what is distinct about it?
Coagulation & rq 4 inversions
Fusion of Artery and Vein to increase the presence of that BV. For dialysis patients
In what order should blood cultures be filled for direct(butterfly/direct) inoculation vs. syringe inoculation?
Syringe: If blood cultures are filled through a syringe, anaerobic first then aerobic
What is the most common type Healthcare Associated Infection?
Urinary Tract Infections
What is CLSI?
Clinical Laboratory Standard Institute is a nonprofit that suggest quality improvements
What is the composition of blood and explain each component.
Blood
- 55% Plasma (water portion of blood) > Serum & Proteins
- 44% Formed Elements: WBC, RBC, Platelets
What is hemolysis and what causes it?
RBC breaking down due to mixing tubes to vigoursly
Rank the preferred veins in the antecubital area for VP and why.
2) Cephalic
3) Basilic
What organism causes the most Healthcare Associated Infections?
Clostridium difficile (C. Diff)
What is an CVAD? Give an example.
CVAD: Central Vascular Access Device--large catheters going into blood vessels that are guided into larger blood vessels
Central Lines: Type of CVAD inserted into subclavian vein and into vena cava
Peripherally Inserted Lines (PICC): Type of CVAD inserted in extremities
Requisition wants to measure cbc, electrolytes, and glucose. What are the appropriate tubes and what is the order of draw?
Gold - Chem > electrolytes
Lav - CBC
Gray - Glucose
Lumbar punctures involves collecting Cerebral Spinal Fluid using a long needle from the Lumbar Spine. Performed by doctors, not by phlebotomist. Used to ID infections in CNS.
A patient has a right sided mastectomy. Where should the phlebotomist draw and why?
A mastectomy is a surgical removal of the breast tissue to treat breast cancer. Often, parts of the lymphatic system is also removed. Lymphatic system has immune function, therefore immunity is decreased when removed. Hence, draw on left AC area
What bleach to water concentration should I use to clean up a lab spill?
1:10 (1 unit bleach: 10 units water)
What does SPS stand for?
Sodium Polyethanol Sulfate
Royal Blue tubes measure [trace elements]. Define trace elements and provide 2 examples.
Aluminum, arsenic, copper, lead, iron, & zinc
Give 3 examples of non blood samples a Phlebotomist could collect.
Urine, Feces
Sputum
Amniotic Fluid
Hair, nails
What is the VP order of draw? Include tube color, additive, inversions, and what it's testing for.
Blood Cultures, SPS, 8 inv, Sepsis
Light Blue, Sodium Citrate, 4 inv, Coagulation
Red, Silica/Selite/No Additives, 8 inv, [Therapeutic Drugs]
Gold/Tiger, SST, 8 Inv, Gen Chem
Green, Heparin (Lithium,Sodium), 8 inv, Stat Chem
Pink, EDTA, 8 Inv, Type & Cross
Pearl, EDTA, 8 Inv, Viral Load
Lav, EDTA, 8 Inv, CBC
Tan, EDTA, 8 Inv, Lead Poisoning
Gray, Sodium Fluoride/Potassium Oxalate, 8 Inv, [Glucose]
Yellow, ACD, 8 Inv, DNA
Royal Blue, EDTA/ACD, 8 Inv, Trace Elements
What is the Chain of Infection?
Infectious Agent > Reservoir Host >Exit Pathway > Means of Transmission > Entry Pathway > Susceptible Host
What does EDTA stand for?
Ethylenediaminetetraacetic Acid
What is the capillary order of draw? Order your draw by additives.
Blood Gas Specimens
Tubes w/ Sodium Citrate
Tubes w/ EDTA
All other tubes w/ additives
Serum Seperator Tubes