What is the most important thing you do as a phlebotomist?
Identify your patient
What are the three parts of the "2 out of 3" rule?
1. What is the patients name? Ask them.
2. Ask them their birthdate.
3. Medical record number
Give an example of the "2 out of 3" rules use.
Define Standard of Care
Following acceptable conduct as determined by national standards
Give an example of what could happen if standard of care is not followed.
Infection; Not properly disposing needle after use & accidently using it on another patient.
What is negligence?
Failure to perform an action consistent with the accepted standard of care.
What are the 4 parts of proving malpractice?
Duty, Dereliction, Injury, Direct Cause
What is the difference between assault and battery?
Assault is the threat or attempt to touch someone without permission. Battery is the intentional touching of another person without consent.
How do you obtain permission if the patient is unconscious?
Consent if implied. Check institutions policy.
Give 4 reasons why a dermal puncture might be performed.
Infants, point of care testing, elderly with fragile veins, mastectomy patients.
List 4 different collection devices for the skin puncture blood (what does the blood go in?).
Microcollection tubes (bullets), Capillary tubes, Micro hematocrit tubes, Peripheral blood smear
What is the maximum depth of an infant lancet?
What is the maximum depth of an adult lancet?
Why are infant and adult lancets different?
Because of the site and patient. (Infants have less fat)
What are the 3 parts to the "chain of infection"?
Reservoir, Means of Transmission, Susceptible Host
What happens if you break the chain of infection?
Then it's more likely it won't be transferred to another source
What is a nosocomial infection?
Got the infection in the hospital & didn't have it before.
What is HAI?
Health-Care Associated Infection
What is the means of transmission for an insect bite?
What is the means of transmission for drawing blood without gloves on?
What is the means of transmission for sneezing, including small particles that can travel thru the air?
What is the means of transmission for salmonella on the spinach at the salad bar?
What is the means of transmission for sneezing, including large particles that don't travel far?
What is a fomite?
Give 3 examples of fomites.
Needles, bedrails, phone.
Which "Means of transmission(s)" involve fomites?
What is the best way to stop the spread of infection?
Wash your hands with soap & water.
Define the term BBP
Infectious agents in the blood
List 3 BBP's.
Hep B, C, D
List 3 ways a BBP could be transmitted
Ingestion, Inoculation, aerosol
What does "PPE" stand for?
Personal Protection Equipment
Give 3 examples of PPE
Gloves, safety glasses, face mask.
Define standard or universal precautions.
The minimum level of protection when coming in contact with all patients.
How many times should you invert vacutainer tubes after filling them with blood?
What happens if you don't invert them soon enough?
The blood in the tube will have clots in it.
What's the difference between serum and plasma?
Serum is the clotting factors and fibrinogen are not present because they were used up with the specimen clotted. Plasma is the anticoagulant in the tube keeps the blood from clotting so the specimen still has the clotting factors and fibrinogen.
What is hemolysis?
The destruction of red blood cells, releasing the hemoglobin inside.
List 4 reasons a specimen might be hemolyzed.
Shaking or mixing a tube of blood too hard, not letting the alcohol dry before drawing blood, forcing blood through a needle with too much pressure, not attaching the needle tightly making the blood froth/foam.
List the veins in the antecubital area
Median cubital, cephalic, basilic
Which vein is our first choice for venipuncture? Why?
Median cubital because it is large and well anchored; it has the least risk to the patient.
Which vein is our last choice for venipuncture? Why?
Basilic because it is near nerves, near the brachial artery, and less well anchored; it has the most risk of complications for patients.
Comparing venipuncture methods (syringe, multidraw/evacuated tube or butterfly: which is the safety, fastest, and cheapest?
Comparing venipuncture methods (syringe, multidraw/evacuated tube or butterfly: which is the most dangerous to the phlebotomist?
List four reasons the lab might reject a blood specimen that you collected.
Incorrectly labeled, drawn in the wrong color tube, tube with anticoagulant is clotted, not enough blood in the tube (QNS)
When do we label a patient's blood collection specimen?
After the blood collection and before leaving the patient's room
Why is it important when we label a patient's blood collection specimen?
If you leave a patient's room with unlabeled blood, you may get distracted and label it later with a different patient's labels. If you label the tubes before collection the specimen, and then are unable to complete the draw, those labeled tubes might be used for a different patient's blood collection. In either case a patient could die.
What is a hematoma?
A bruise that forms from blood leaking from the vein, and under the skin during a venipuncture
How can we prevent a hematoma from happening to our patients?
Be sure your needle is in the vein and not only partially in, Apply pressure on the draw site after removing the needle, remove the tourniquet BEFORE removing the needle.
What should we do if the patient has visitors in the room?
Allow them to stay if it is not disruptive, otherwise ask them to step into the hall while you collect the blood
What should we do if the patient's doctor is present?
Say you will come back later, unless it is a stat. If a stat, ask the doctor if they want you to come back, or draw it now.
What if their clergy or pastor is present?
Say you will come back later, unless it's a stat
How should we respond if the patient refuses to be drawn?
Explain the doctor has ordered some tests to be done. If they refuse a second time, thank them and leave. Do not draw their blood.
Who should we report the patient's refusal to?
Let the patient's nurse or the unit coordinator know that the patient refused. Then document who you notified.
Convert 3:15 AM to military time.
Convert 12:30 PM to military time.
Convert 10:15 PM to military time
On the arm, how far above the draw site do we put the tourniquet?
3-4 inches above the draw site
How long can we leave the tourniquet on?
20 X 1. What does the "20g" mean?
The gauge, or size of the interior diameter (lumen) of the needle
20 X 1. What does the "1" mean
The length of the needle is 1 inch
Compare a 20g X 1 to a 23g X 3/4. Which needle has the larger lumen?
20g x 1
Compare a 20g X 1 to a 23g X 2/4. Which needle has the longer shaft?
20g X 1
When using a needle for venipuncture, what is the correct angle of insertion?
15-30 degrees, bevel up.
Put tubes in the correct order of draw.
Yellow, Light blue, Red, SST/tiger/GOLD, Green, Lavender, Gray
What does the gel in a gold hemogard do?
When the specimen is spun-down the gel falls between the serum at the top of the tube and the cells at the bottom. This makes the solutes in the serum more stable, so testing can be done for longer time periods.
What is reflux?
When blood from one vacutainer tube is drawn back into the needle/arm, and then that blood goes into the next vacutainer tube that is attached to the needle. This can cause possible contamination of the blood in the second tube.
How do you prevent reflux?
Position the vacutainer holder so that the tubes fill from the bottom up.
What is the purpose of the anti-coagulant in the vacutainer tubes?
The purpose is the prevent the blood in the tubes from clotting.
Which vacutainer tubes give you serum?
Red tops, SST/Tiger tops, Gold hemogards, orange tops, Some dark blue tops.
What is the additive in the green tube?
What is the additive in the gold hemogard?
Clot activator and gel
What is the additive in the yellow tube?
What is the additive in the lavender tube?
What is the additive in the gray tube?
What is the additive in the light blue tube?
What is the additive in the SST/Tiger top?
Clot activator and gel
What is the additive in the red top?
No additive or clot activator
What tests are the green tube used for?
Stat chemistry tests
What tests are the gold hemogard used for?
Most chemistry tests
What tests are the lavender top used for?
CBC's and hematology testing
What tests are the yellow top used for?
What tests are the gray top used for?
What tests are the light blue top used for?
What tests are the SST/Tiger top used for?
Most chemistry tests
What tests are the red top used for?
Blood bank, serology, chemistry
What body system breaks down food into nutrients the body can use?
What body system deals with emotions?
What body system does movement occur?
What body system protects the body?
What body system is associated with pancreas?
What body system is associated with the joints?
What body system is associated with the spinal cord?
What body system is associated with the liver?
What body system is associated with the tendons?
What body system is associated with neuron?
What body system is associated with gout?
What body system is associated with multiple sclerosis (MS)?
What body system is associated with ulcer?
What body system is associated with arthritis?
What body system is associated with stroke?
What body system is associated with melanoma?
What body system is associated with bilirubin?
What body system is associated with uric acid?
What body system is associated with creatine kinase (CK)?
What body system is associated with calcium?
What body system is associated with aspartate aminotransferase (AST)?
What body system is associated with amylase and lipase?
What body system is associated with CSF analysis?
What is "O & P"?
Ova & parasites
What kind of specimen is O&P?
What body system is associated with O&P?
What does a KOH prep test for?
What body system is associated with KOH?
The lab test "occult blood" needs what type of specimen?
What would cause occult blood test to be positive?
Blood in stool
What body system is occult blood test used for?
What is C&S ?
Culture & Sensitivity
Give an example of a specimen type, and its corresponding body system.
Infection; UTI- Urinary system
Formation & development of blood cells
What body system is associated with hematopoiesis?
Property of a system in which variables are regulated so that internal conditions remain stable & relatively constant.
What body system is associated with homeostasis?
What body system is associated with regulating body hydration?
What body system regulates & produces hormones?
What body system is associated with exchanging of oxygen & carbon dioxide?
What body system is associated with the thyroid?
What body system is associated with nephron?
What body system is associated with alveoli?
What body system is associated with Pituitary?
What body system is associated with ovary/testes?
What body system is associated with kidney?
What body system is associated with diabetes mellitus?
What body system is associated with asthma?
What body system is associated with herpes?
What body system is associated with hypothyroidism?
What does UTI stand for?
Urinary tract infection
What system is associated with UTI?
What does STI stand for?
Sexually Transmitted Infections
What system is associated with STIs?
What body system is associated with Creatinine?
What body system is associated with T3, T4, TSH?
What body system is associated with Human chorionic gonadotropin (HCG)?
What body system is associated with Testosterone?
What body system is associated with Blood urea nitrogen (BUN)?
Name two tests for syphilis.
Rapid Plasma Region, Fluorescent treponemal antibody absorption
What body system is associated with syphilis?
What are "ABG's"?
Arterial Blood Gases
What body system is associated with ABG?
What is a UA test?
What body system is associated with UA?
What four tests are included in Electrolytes?
Sodium, Potassium, Chloride, Carbon Dioxide
What body system is associated with electrolytes?
Respiratory & Urinary
What does PSA stand for?
Prostate specific antigen
What body system is associated with PSA?
Name 2 tests for cardiac risk (risk of a heart attack).
Name three tests for ruling out a heart attack.
CK-MB, myoglobin, troponin
What body system is associated with the tests for cardiac risk & ruling out a heart attack?
The elbow is _______ to the shoulder.
The ear is ____________ to the nose
A patient who is lying in bed having their blood drawn is ______________.
Which blood vessel carries blood away from the heart?
Which blood vessel carries blood to the heart?
Which blood vessel carries oxygenated blood?
Which blood vessel carries deoxygenated blood?
Where do gas, nutrient, and waste exchange take place in the tissues?
The blood - specifically in plasma.
List the order of choice for vein use in the anticubital area.
Median cubital, Cephalic, Basilic
Solutes are found in which part of the blood?
Name 5 different solutes.
Proteins, Nutrients, Gases, Electrolytes, Wastes.
What is another name for RBC?
What is the RBC's job?
Carry oxygen (by attaching it to hemoglobin).
What is another name for WBC?
What is WBC's job?
To kill bacteria and pathogens
What is another name for platelet?
What are the platelets job?
Form a plug to stop bleeding.
List the four phases of hemostasis in the order they occur
Vascular phase, platelet phase, coagulation phase, firbrinolysis
The mucus in our nose is a part of our immune system. Is it considered to be a type of specific immunity or non-specific immunity?
Who is responsible for the doctors and medical interns on staff?
Chief of staff
What kind of doctor is trained in laboratory medicine?
MD pathologist or PhD
Who does the hiring and firing in the lab?
What hospital department is responsible for helping patient regain everyday skills?
Name the four areas that report to the CEO of the hospital.
Fiscal/Information Services, Support Services, Nursing Services, Professional Services
Name the laboratory department that monitors the blood clotting system
Name the laboratory department where CBC's are done.
Name the laboratory department where C&S is done.
Name the laboratory department where toxicology testing is done.
Name the laboratory department that processes tissues for the pathologist to read.
Name the laboratory department where PAP smears are done
Name the department that does the most tests including, ABG's and glucoses
In addition to blood collection, name 4 additional responsibilities that a phlebotomist might be expected to do.
EKG tech, POC Testing, Basic respiratory therapy responsibilities, Lab assistant for CLIA waived tests
Who can do the highly complex testing in the lab, and what degree do they have?
Medical Technologist - Bachelor's.
What does CLIA88 stand for and what is it's role in the lab/health care?
Clinical Lab Improvement Act of 1988. Includes POL & Clinical labs. Waived tests, physician performed microscopy, moderately complex tests, highly complex tests
What does CLSI stand for and what is it's role in the lab/health care?
Clinical Laboratory Standards Institute. Non-profit education organization, publishes guidelines for standards, procedures, methods, evaluations.
What does JC stand for?
What does OSHA stand for?
Occupational Safety and Health Administration.
What does CDC stand for?
Center for disease control
List 3 ways being in the hospital can affect patients
Decreased mobility. Disruption of time patterns, loss of individuality.
What is jaundice?
Yellowing of skin due to liver function
What blood test measures jaundice?
Why would bilirubin be done on a newborn?
To monitor liver function.
What special handling needs to happen to the sample for accurate results?
Document amount of blood collected.
What is a VAD?
Vascular access device.
Who can draw blood from a VAD?
Trained staff only
Why is sterile technique necessary?
Those indwelling lines could be in there for a long duration of time.
Why would a discard tube be needed?
For butterfly draws.
Name the 2 VAD's that dialysis patients may have
Arteriovenous (AV) shunt cannula/fistula
Can a phlebotomist draw blood from dialysis patients?
Yes, but from the arm without the shunt.
Can a phlebotomist draw blood from the arm with a shunt?
You are not able to obtain blood on your first attempt, and the patient is upset. How would you handle this?
Look for signs that patient is getting upset. Ask for another phlebotomist to draw the blood.
What is EMLA?
It's an anesthetic
What is EMLA used for?
To numb the draw site.
What are the problems associated with EMLA's use?
You have to choose the site of draw at time of applying the EMLA & you have to apply it an hour before the draw.
When drawing blood from an elderly patient, list 4 issues specific to these patients that can make blood collection more difficult.
Fragile skin, patient confusion, may be heard of hearing, rolling veins.
List 3 things you can do to make this collection easier for you and the elderly patient.
Use ID band, face them when you talk, tourniquet over clothing.
Why is it sometimes not a good idea to use band-aids on young children?
They can choke on them.
What do you use on young children instead of bandaids?
Gauze, then hold.
What special preparations must a patient follow before having a glucose tolerance test performed?
High carb diet for 3 days prior to test, fast for 12 hours before test, water encouraged, medications ok as directed by doctor, no food, caffeine, smoking during test.
What does it mean for a patient to be fasting before a blood draw?
No eating 8-12 hours before test
How long should the fasting last?
A patient's blood glucose level is elevated in the 2nd hour specimen. What does this mean?
Patient has diabetes mellitus.
What does 2-hour PP mean?
2 hour post prandial test used to test for diabetes mellitus.
What special disinfection method is used for blood culture collection?
Alcohol and Iodine/Betadine
Why is a special disinfection method necessary for blood culture collection?
It reduces the possibility of infection, sepsis or putrefaction
Why do we usually collect 2 different bottles when obtaining blood cultures?
Air from tubes
When would a chain of custody collection be required?
What are some special requirements for legal testing collection?
Patient signs consent form, use picture ID, cannot clean draw site with any alcohol for legal blood alcohol test.
List the four requirements for correctly collecting a urine C&S.
Patient should clean area with cleansing cloth, patient pees into toilet, after several ml patient holds sample cup under stream and collects in cup, temperature of urine is immediately checked.
What is therapeutic phlebotomy?
Removal of blood from patient's system as part of treatment.
What 2 patient disorders require therapeutic phlebotomy?
Polycythemia & Hereditary hemochromatosis
Name 3 requirements of a Red Cross blood donor.
Must be at least 17 years old, weigh at least 110 lbs, Not have donated in the last 8 weeks.
Approximately how much blood is collected in one donor unit?
What gauge needle is used for blood donations?
What does a Bleeding Time Test check for?
Process of hemostasis
List 3 pieces of special equipment used when performing Bleeding Time Test?
Filter paper, special lancet, butterfly bandage.
Name 2 things that can cause the Bleeding Time Test to have an abnormal result.
Taking aspirin/ibuprofen & may cause scarring
What does POCT stand for?
Point of care testing
What is an advantage of performing a test as a POCT?
Short turn-around-time, so faster diagnosis and treatment, can be done in ER, a clinic, a doctor's office, a health fair, a home care.
What is the disadvantage of performing a test as a POCT?
The cost per test is more than doing the same test in a lab.
What does the term CLIA waived test mean?
It's not subject to regulatory oversight by government authorities
List 3 rules that must be followed when performing a CLIA waived test, or a POCT test.
Follow manufacturer's instructions, have proper training, document quality controls and maintenance
List 3 common POCT blood tests
Lead, Glucose, PT/PTT
Give an example of a common urine POCT test.
How would you safely transport a blood specimen to the lab?
Well mixed specimen, labeled correctly, transported in leak-proof zip locked bag, tubes should remain upright during transport.
List 2 things that could delay lab results getting to the doctor.
Wrong color tube, hemolysis
Once you draw a patient's blood, how long do you have to get that specimen to the lab?
What is centrifugation?
Equipment that spins the sample at a very high speed, separating components based on density.
How long after blood collection does the lab have to centrifuge or process a specimen?
What does it mean to aliquot a specimen?
To create multiple samples from the original tube of blood
Why would a specimen need to be protected from light?
Because the light breaks down what we're trying to measure
Name a test that needs to be protected from light.
Why would a specimen need to be transported on ice?
Slows the metabolic process
Name a test that needs to be transported on ice.
Why would a specimen need to be collected at a specific time (timed collection)?
Values in the specimen change the longer blood cells and serum/plasma are in contact due to glycolysis
Name a test that needs to be collected at a specific time.
What special considerations are there when processing and transporting a specimen to a reference lab?
Serum or plasma separated first in central processing, use leakproof, unbreakable containers, sample must be processed exactly to specific instructions to assure accurate and reliable test results.
List 3 reasons why a specimen might be rejected by the lab.
Hemolysis, Wrong color tube, expired tube
What does CQI stand for?
Continuous Quality Improvement
What does TQM stand for?
Total Quality Management
What does QA stand for?
What does QC stand for?
What requires that staff have continuing education?
A specimen comes to the lab with incorrect or incomplete labeling. How should this problem be resolved?
Documentation of problem and actions taken to solve problems.
What department includes proficiency testing?
What department represents all the hospitals plans and policies for the hospital?
What is the overall goal of CQI?
Always finding ways to do better.
What is a delta check?
Compares changes from current labs to previous labs per patient.
Define pre-analytical variables.
Done before test is done.
List 6 specific things a phlebotomist can do to ensure a quality specimen goes to the lab.
Requisition, equipment, patient identification, patient preparation, specimen collection, specimen handling.
You need to review the procedure for a bleeding time test. Where would you look?
You need to know if a patient needs to be fasting for a triglyceride level. Where do you find this information?
A dr asks you if he orders an ANA now, when will the results be back. Where will you find this info?
When performing a capillary blood gas, how do we mix the sample?
Well with flea
When performing a capillary blood gas, what do we collect the blood in?
Heparinized capillary tube with metal flea for mixing
When performing a capillary blood gas, when do we warm the site first?
It increases arterial blood to capillaries
Comparing the arteries femoral, radial & brachial: which artery is our first choice for arterial blood gas (ABG) collection?
Why is the radial artery our first choice for ABG?
Easy to access, easy to compress after puncture, good collateral circulation
What does the Allen Test check for?
To find out if the blood flow to your hand is normal
Why and when do we do the Allen Test?
To make sure that both radial and ulnar arteries are open and working correctly. For ABG testing.
What is the pH test for?
What is pO2 used for?
partial pressure of oxygen in blood; assess oxygenation
What is pCO2 used for?
Partial pressure of CO2, assess ventilation
What is O2 saturation test used for?
Percentage of oxygen bond to hemoglobin
What antiseptic is normally used to clean the puncture site before performing the arterial stick?
Alcohol & povidone-iodine/chlorhexidine
What gauge needle is used for blood gas collection?
21 or 22
What anticoagulant is used for blood gas collection?
Where is the tourniquet placed for an ABG collection?
A tourniquet isn't needed.
How long must pressure be applied to the puncture site following an arterial blood gas collection?
5 minutes; 15 minutes for patients on anticoagulant precautions.
Where is the radial artery located?
Deep in the antecubital area
Name 3 hazards to the patient when performing an ABG collection, and describe what each one is
Arteriospasm - involuntary contraction of an artery due to pain, prevents oxygen from reaching tissues; hematoma - inadequate pressure on site, common in elderly; thrombosis - clot forms within an artery.
How long is an ABG sample stable if it is on ice?
How long is an ABG sample stable if not on ice?
What do the letters OSHA stand for?
Occupational Safety and Health Administration
What is OSHA's job?
regulates workplace safety
List the 3 ways to reduce exposure to radiation.
Distance, time, and shielding
List 3 ways to keep safe when using chemicals.
Never mix chemicals unless following a written procedure, always pour acid into water and then mix, never store chemicals above eye level.
List 3 ways to keep safe when using needles.
Never recap a used needle, never remove a used needle from syringe by hand, use biohazard sharps container, keep within reach.
If you are stuck with a used needle, what should you do (list 3 things)?
Immediately flood with exposed area with water and clean any wound with soap and water or a skin disinfectant, Report this immediately to your employer, seek immediate medical attention including counseling for exposure to HIV, HBV, and HCV.
What 3 types of reactions are associated with latex usage?
Irritant contact dermatitis, allergic contact dermatitis, and anaphylaxis
What type of fire is electrical socket?
What extinguisher is used for an electrical socket fire?
BC or ABC
What type of fire is trash in a waste paper basket?
What type of extinguisher is used for fire in a waste paper basket?
A, AB, or ABC
What type of fire is an alcohol spill in workplace?
What type of extinguisher is used for a fire caused by alcohol spill in workplace?
AB, BC, or ABC
What is a SDS?
Safety Data Sheet
What important information does SDS provide (list 3 things)?
Info about chemicals, hazard of chemicals, first aid for exposure, clean-up procedure