Phlebotomy National Exam Study Guide – Flashcards
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OSHA
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Occupational Saftey & Health Administration
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What vaccination does OSHA require all health care personnel get?
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OSHA requires that all health care personnel exposed to blood and other bodily fluids must receive a vaccination against Hepatitis B
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Pulmonary Edema
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Fluid in the lungs
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How much blood can a person donate in a session?
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500 mL
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Patients have the right to what?
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Under the Patient Bill Of Rights they always have the option to decline medical treatment and to know what tests are being performed on them.
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What can you NOT give a patient?
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Results or a diagnosis. Because you are not medically qualified to do so.
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Negligence is?
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Failure to give appropriate care. DON'T BE NEGLIGENT!
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PPE stands for?
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Personal Protective Equipment
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One of the most important practices is?
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Hand Washing is one of the most important (and easiest) practices used to prevent transmission of bloodborne pathogens
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Needles should never be
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recapped
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Sharps containers must be what?
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puncture-resistent, leak proof on the sides and bottom and must be labeled or color-coded
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Types of Hazards
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Biologic - Infectious agents that can cause bacterial, viral, fungal or parasitic infections Sharps - Needles, lancets and broken glass can puncture and cut, causing blood-borne pathogen exposure Chemical - Preservatives and chemicals used in the laboratory. Exposure to Toxin, Carcinogenic or caustic substances Fire or explosive - bunsen burners, oxygen and chemicals can cause burns or dismemberment Physical - wet floors, heavy lifting ance cause falls, sprains and strains * ALLERGIC reaction ** - Latex sensitivity is a PHYSICAL reaction to care worker allergic reation to the patient
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In infection control WHO is the agent?
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Person
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In infection control WHAT is portal of exit?
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Needle
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In infection control WHAT can we control?
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Mode Of Transmission OR exit of infection
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In infection control WHAT is a portal of entry?
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Mucas membrane
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In infection control WHO is a susceptible host?
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Person
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Mode of Transmission
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Specific ways in which microorganisms travel from the reservoir to the suseptible host
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Five main types or mode of transmission
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contact - direct and indirect (fomite) Droplet - Cold, Flu and sneezing Airborne - viral - breath in common vehicle - person, fomite and not handwashing vector borne - illness that is transmitted through an invertebrate, such as an insect
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Mode of infection
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the point in the infection chain where we aim at preventing the spread of infectious disease
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Standard precautions do what?
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Infection control method designed to prevent direct contact with blood and other body fluids and tissues by using a barrier of protection and work control practices.
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What do we assume all patients to be?
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Patients are presumed to be infective for blood-borne pathogens
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Standard precautions consist of what itmes?
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Gloves - when collecting and handling body fluids, or tissue specimen Face shield - when danger of splashing on mucous membranes Disposal - dispose of all needles and sharp objests in punture-proof containers, WITH OUT RECAPPING Disinfectants - clean fluid spills, thus killing pathogenic organisms
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Medical Asepsis
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This condition is best defined as "the destruction of pathogenic microorganisms after they leave the body". It also involves enviromental hygien measures such as equipment cleaning and disinfection procedures. Methods of medical asepsis are Standard Precautions and Transmission-based Precautions
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What are barrier protections?
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Masks Gloves Face Shields Resirator Gloves
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How do you remove PPE equipment?
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1st - Gloves 2nd - Gown 3rd - Shield
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What type of soap should be used?
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Non-abrasive, antibacterial soap.
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What do you do if blood splashes in the eye or mucous membane?
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Flush with warm water (hotter the better) for 15 minutes Report incident exposure to your supervisor ASAP!
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Who cannot be identified in an incident report?
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a minor
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Bedside manner includes?
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introduce yourself, ask patient name and b-day. Explain what you will be doing. Chat with patient to keep mind off poke. ADVISE them WHEN you are poking! Speak to them on a first name basis
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What phase is best practice
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"pleasant with the patient and professional with the poke".
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If patient has an I.V. where do you draw blood?
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Downstream from the I.V.
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Double Mastectomy patients should ONLY have blood drawn from what?
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Hands
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Left Mastectomy patients should have blood drawn from what side?
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Right side
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What is a Fistula?
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artificial connections of veins
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What is a Graft?
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artificial artery connection to vein
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Sclerosis is?
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Hard and cord like veins
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For obese patients what vein is used?
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Cephalic Vein is most likely to be the one you can palpate and draw blood from in an obese patient
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Cephalic means what?
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Head
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Most common complication in Phlebotomy
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Hematoma
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To prevent a Hematoma
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prevented if pressure is placed on the venipuncture site until bleeding stops
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If a patient faints what is the 1st thing to do?
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GET the needle out of the arm
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Vasovagal Syncope is
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fainting, dizziness before, during or after venipuncture
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Circulatory System funtion
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is todeliver oxyge, nutrients, hormones and enzymes to the cells. Transport cellular waste such as carbon dioxide and urea to the organs where they can be expelled from the body.
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Circulatory exchange is done where?
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capillary level
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45% of blood is
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formed elements - Erythrocytes (red blood cells) = 99% of formed elements. Leukocytes (white blood cells) and Thrombocytes (platelets)
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All blood cells originate from
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stem cells in the bone marrow
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The heart acts as what?
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two pumps (right and left sides)
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Left and right sides of heart are connected by
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two circulations, with each pump equipped with two valves the function of which is to maintain a one way flow of blood
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Pulmonary circulations
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carries deoxygentated blood from the right ventricle to the lungs. (alveoli) and return oxygenated blood from the lungs to the left atrium
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Oxygenation takes place
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at the alveoli - sacks in the lungs
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Systemic circulation
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carries oxygentated blood from the left ventricle throughout the body
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Tricuspid valve
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an atrioventricular valve, being situated between the right atrium and the right ventricle
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Pulmonic valve
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semi lunar valve situated between the right ventricle and the pulmonary artery
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Mitral valve
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(bicuspid valve) is another atrioventricular valve, being situated between the left atrium and the left ventricle
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Aortic valve
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semi lunar valve situated between the left ventricle and the aorta
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How long does it take for a full circulation?
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one minute
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The average person weighting 155 pounds has
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approximately 5-6 liters of blood in their system.
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Blood composes of
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7-9 percent of total body weight of a person
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Blood has how much plasma?
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55% is plasma
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Plasma is what?
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a clear, pale yellow fluid
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what does plasma do?
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it carries nutrients, lipids, glucose, sodium, magnesium, calcium, potassium, oxygen, carbon dioxide, nitrogen, antibodies, as wells as vitamins and hormones ect.
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What is 45% of blood?
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Red blood cells, White blood cells and Platelets. Known as the formed cellular elements
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How long does your body take to regenerate RBC you lose during donation
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6 to 8 weeks if you donate the maximum of 500 mL
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Three layers of the heart are?
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Endocardium Myocardium Epicardium
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Endocardium
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the endothelial inner layer lining of the heart
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Myocardium
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the muscular middle layer. This is the contractile element of the heart
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Epicardium
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the fibrous outer layer of the heart. The coronary arteries, which supply blood to the heart are found in this layer
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Blood vessels are
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Aorts, arteries, arterioles, capillaries, venules and veins, superior and inferior vena cava
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Erythrocytes
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Red blood cells or RBC's
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Erthrocytes contain
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hemoglobin, the oxygen-carrying protein.
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Hemoglobin
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enters the blood as an immature reticulocyte where in one to two days, it matures into erythrocyte.
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How many RBS's per microliter
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4.2 to 6.2 million RBC's per microliter of blood.
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What is the normal life span of RBC's
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is 120 days
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What is leukocytes function
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provide the body protection against infection.
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How many WBC's for adults per microliter
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5,000 to 10,000
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Leukocytosis is?
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an increase in WBC's, is seen in the case of infection and leukemia.
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Leukopenia is what?
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a decrease in WBC's, is seen with viral infection or chemotherapy
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How many types of WBC's are in the blood
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Five
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A differential count does what?
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determines the percentage of each type
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Neutrophils are what?
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phagocytic cells, meaning, they engulf and digest bacteria. Their number increase in bacterial infection.
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Neutrophils comprise how much of the WBC's population?
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40 to 60% of the WBC population
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Lymphocytes do what?
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their numbers increase in viral infection, they also play a role in immunity.
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Lymphocytes comprise how much of the WBC population?
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20 to 40% of the WBC population
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Monocytes do what?
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Increase in intracellular infections and tuberculosis
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Moncytes comprise how much of the WBC population?
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3 to 8%, they are also the largest WBC's
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Eosinophils do what
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they are active against antibody-labeled foreign molecules.
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Eosinophils increase
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in allergies, skin infections and parasitic infections
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Eosiniphils come
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first in allergic reactions. During an allergic reaction it would show an increase in Eosinophil count
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Basophils do what
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release histamine
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Basophils count for what of the WBC population?
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0 to 1% in the blood
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Thrombocytes are essential for what?
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blood coagulation
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Thrombocytes are also know as
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platelets are small irregularly shaped packets of cytoplasm formed in bone marrow
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Three major veins are located
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in the antecubital fossa
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The three major veins are?
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Median cubital vein Cephalic vein Basilic vein
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1st order of draw
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Red topper tube
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Red top tube also known as
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plain vacume tube and contains no additive or anticoagulant.
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collected blood clots, by normal coagulation process is
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30 minutes
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Do you need to invert a Red Tube
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No
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Common test for red tubes are
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Serum chemistry, Serology, Blood bank
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Arteria Blood Gas (ABG) sample must be run within
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15 minutes of collection
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Arterial blood is used to determine
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blood gas levels and blood PH. Usually collected by a nurse or respiratory therapist
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Basal state is
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When the patient has fasted and not excersiced in 12 hours
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Do you note if a patient has not fasted?
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YES!
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2nd order of draw tube color is
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Light blue
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Light blue tube has what additive
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Sodium Citrate Different ratios
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Light blue tubes MUST be inverted how many times
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5 to 10
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Light blue tubes are used to test
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coagulation determinations on plasma specimens. * Certain test require chilled specimens* Always fill to MAX fill line
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3rd order of draw tube color is
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Tiger top or gold top (gold in Utah)
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Tiger top / Gold top tubes have what additives
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Clot activator - (silica in Utah) or glass particles Fixotropic gel
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Blood cagulates with additive in
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15 to 30 minutes
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4th order of draw tube color(s) are
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Green top Mint top Hash marks on label
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Green top tube has what additives
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Heparin combined with sodium, lithium or ammonium ion
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Mint green top tube has what additive
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PST - Plasma Seperator tube
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Hash marked tube has what additive
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Sodium Heparin
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Common tests for Green tubes are
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Ammonia Carboxyhemoglobin ( HCg preg test) STAT Lytes
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LYTES are
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electoliytes - potassium, sodium
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BMP Panel is
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Basic Metobolic Panel
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A Panel is
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A group of tests ordered together
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Sodium additive tubes test for
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Lithium
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5th order of draw tube color is
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Lavendar
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Lavendar tube has what additive
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EDTA - Ethylenediaminetetraacetate
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BMP - chem 8 Tiger/Gold tube
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Basic Metobolic Panel
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CMP - chem 14 Tiger/Gold tube
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Comprehensive Metobolic Panel
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Drk purple tube has
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7. mL of EDTA - calcium binding agent
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Lt purple tube has
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3.6 mL of EDTA - calcium binding agent
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Pink top tubes are used for
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Blood banks / transfusion - for blood typing
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Lavendar top tubes are used for
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CBC = Complete Blood Count CBCAN = Complete Blood Count Automatice Differential CBCDN - Complete Blood Count Manual Differential
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ESR - Lavendar top tub
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Erythocyte Sedimentation Rate
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ESR tests for
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Sickle Cell Screening
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EDTA
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inhibits coagulation by binding to calcium in the specimen
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What tube is used for coagulation studies?
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Light Blue
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Tubes must be filled
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at least two-thirds full
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Tubes must be inverted
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8 times
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Hematocrit measures
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the percentage of the RBC's (Red Blood Cells) in a given volume of whole blood
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What test is ALWAYS given before blood donation
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Hematocrit
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1- blood enters the heart
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Superior & Inferior Vena Cava (V-C)
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2- goes to
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Right Atrium
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3- from there to
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Tricuspid Valve
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4- then onto
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Right Ventricle
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5- and now out to the
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Pulmonary Artery - and lungs
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6- back into the
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Pulmonary Veins
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7- then onto the
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Left Atrium
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8- moves onto the
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Bicusped Valve
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9- down to the
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Left Ventrical
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10- finally to your hot bod via the
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Aorta
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Veins have
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Valves
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ABG (Arterial Blood Gas)
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Analyes arteial blood for oxygen, carbon dioxide and bicarbonate content in addition to blod PH * used to determine the effectiveness or respiration
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Aseptic
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The absence of microoganisms or by contrast, something that just discourages the growth of microoganisms is antiseptic
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Basilic Vein
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The large vein on the inner side of the bicep and is often chosen for tntravenous injections and blood drawing
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Battery
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The basis of tort in this case the unprivileged touching of one person by another.
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Informed Consent
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Patient gives consent for a procedure to be performed in full knowledge of the procedure and the risk it entails
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Bleeding Time
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A test done to ascertain platelet function.
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A Plug is
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A special paper applied to a wound (small incision) in the forearm. The paper is applied and then timed to see how long it takes for platelets to form a "plug" and stop the bleeding
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Asprin will affect
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bleeding time results
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Blood Clot
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The conversion of blood from a liquid form to solid through the process of coagulation
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Thrombus is
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a clot which forms inside of a blood vessel
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an embolism is
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a clot that moves inside the vessel it is referred to as an embolus
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Blood borne infection
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an infection transmitted from blood to blood
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Butterfly
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a small needle with two plastic wings attached which are squeezed together to form a tab that is used to manipulate the needle. A long 6-12" plastic tubing is attached which again offers better manipulation. This assembly is then attached to a syrings or Vacutainer holder for the purpose of drawing a blood sample
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CDC
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Centers for Didease Control and Prevention
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Circulation
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movement of fluid in a regular or circuitous cource. Heart failure is and example of a problem with circulation
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Citrate
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A compound that is an intermediate in the citric acid cycle (krebs cycle) Citrate chelates (binds) calcium ions, preventing blood clotting and thus is an effective anticoagulant
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Coagulation Factors
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Group of plasma protein substances (Factor I-XIII) contained in the plasma which act together to bring about blood coagulation
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Complete Blood Count
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The number of RBC's (red blood cells), WBC's (white blood cells) and platelets (per cubic millimeter) that are present in the patient's sample of blood is determined. Also included is the HEMOTACRIT (%), hemoglobin concentration (gm%) and the differential. *Most common test done on the blood*
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Contamination
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The soiling of pollution by inferior material, as by the introduction of organisms into a wound
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Coumadin
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Trademark for the preparation of warfarin sodium
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Cyanotic
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Bluish skin color due to lack of Oxygen
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Defamation of character
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Consists of injury to another person's reputation, name or character through spoken (slander) or written (libel) words.
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Differential
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A count made on a strained blood smear of the proportion of the different leukocytes (WBC's) and express as a percentate. A differential is a normal part of a complete blood count (CBC)
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Ecchymosis
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The skin discoloration caused by a bruise (contusion)
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EDTA
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Ethylenediaminetetraacete. A calcium chelating (binding) agent that is used as an anticoagulant for laboratory blood specimens
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Electrolyte
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A substance that will acquire the capacity to conduct electricity when put into solution. Electrolytes include sodium, potassium, chloride, calcium and phosphate. informally know as "LYTES"
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Embolus
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A sudden blockage of a blood vessel by a blood clot or some other obstruction which has been transported through blood vessels and lodged at a site to small for passage. Examples of emboli are detached blood clot, a clump of bacteria or other foreign material such as air. Contrast to thrombus
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Fibrin
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A protien formed during normal blood clotting tht is the essence of the clot
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Fibrinogen
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The protein form which fibrin is formed/generated in normal blood clotting
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Flash
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Relative to venipuncture, the appearance of a small amount of blood in the neck of a syringe or the tubing of a butterfly. This is a sign the the vein has been properly accessed.
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Fomite
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An inanimate object that transports microoganisms
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Formed Elements
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Red Blood Cells, White Blood Cells and platelets
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Gauge
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Needle Diameter is measured by gauge; the larger the needle diameter, the smaller the gauge. For example, a very large diameter needle (16 ga) may be used to hemodialysis, whereas a much smaller needle (23 ga) would be used to draw blood for laboratory testing
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Germicide
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An agent that kills pathogenic microoganisms
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Good Samaritan Law
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This law deals with the rendering of first aid by health care professionals at the scene of an accident or sudden injury. It encourages health care professionals to provide medical care within the scope of their training without fear of being sued for negligence
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Glucose
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The sugar measured in the blood an urine specimens to determine the presences or absence of diabetes. Glucose is the end product of carbohydrate metabolism and is the cheif source of energy for all living organisms
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Heparin
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An anticoagulant that acts to inhibit a number of coagulation factors, especially factor Xa. Heparin is formed in the liver
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Hematocrit
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The ratio of the total RBC (red blood cell) volume to the toal blood valume and expressed as a percentage
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Hematoma
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A localize collection of blood within tissued due to leakage from a wall of a blood vessel, producing a bluish discoloration (ecchymosis) and pain
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Hemoconcentration
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A decrease in the fluid content of the blood (plasma), resulting in an increase concentration. This is determined by an increase in the hematocrit. Caused by a filtration of plasma into the body tissue and often created by dehydration
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Hemoglobin
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The oxygen carrying pigment of the RBC's (red blood cells)
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Hemolyze
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The breakin of the RBC's (red blood cells) membrane releasing free hemoglobin into the cirulating blood. In phlebotomy, this is usually a result of mechanical damage due to poor technique
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Hyerglycemia
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Abnormally high blood sugar level
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Hypoglycemia
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Abnormally low blood sugar level
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Indirect Infection
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An infection transmitted through body fluids to blood
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Informed Consent
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Giving the patient adequate information concerning the method, risk and consequences to a specific procedure, it's reisks, expected outcome and alternatives
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Invasion of privacy
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This is the release of medical records without the patient's knowledge and permission
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Lipemic
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After blood is spun and seperated in a centerfuge the serum/plasma portion is milky in apprearance. Hyperlipidema would cause the blood to be lipemic
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Lymphedema
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Lymphedema is a type of swelling wich occurs in lymphatic tissue when excess fluid collects in the arms or legs because the lymp nodes or vessels are blocked or removed. Regarding Phlebotomy, this can be a major complication of mastectomies
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Multi-Sample Adapter
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A device used with a butterfly and Vacutainer holder to allow for then withdrawl of multiple tubes of blood during a venipuncture
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Negligence
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This is the failure to exercise the standard of card that a resonable person would give under similar circumstances and someone suffers injury because fo another's failur to live up to a required duty of care
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Four elements of negligence
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1-Duty of care 2-Derelict: breah of duty if care 3-Direct cause: legally recognizable injury occurs as a result of breach of duty of care 4-Damage: wrongful activity must have been caused the injury or harm that occurred
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Nosocomial
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Healthcare setting acquired infections
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Oncology
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The study and treatment of cancer
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Oxyhemoglobin
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Hemoglobin that has be bound with oxygen in the lungs for the purpose of transport of oxygen to cells of the body. In the cells oxygen is exchanged for carbon dioxide
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Papate
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To examine of feel by the hand. The technique is used to help determine the size, depth and direction of a vein
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Pathogen
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Any microorganism that produces disease
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Pathogenic
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Having the capability of producing disease
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Peripheral Blood
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Blood obtained from the circulation away from the heart, such as from the fingertip, heel pad and earlobe or from an antecubital vein
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Petechiae
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These are tiny non-raised red spots that appear on the skin from rupturing of the cappillaries due to the tourniquest being left on to long or to tight
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Phlebitis
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Inflammation of a vein as a result of repeated venipuncture on that vein
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Pipette
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A glass or transparent plastic tube used to accurately measure small amounts of liquid
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Plasma
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The fluid protion of the blood in which the cellular components are suspended. PLASMA IS DIFFERENT FROM SERUM!
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Platelets
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Also known as a thrombocyte, this is a particulate component of the blodd, approximatley 2-4 microns in diameter and known for it's invlovement in blood coagulation. This structure, which has no nucleus or DNA, is formed by breaking off from the cytoplasm of the parent cell, known as a megakaryocte in the bone marrow. Under normal conditions, platelets will aggegate at the site of a break in vascular intergity, by forming the beginning stages of a clot. Normal platelets counts rage from 150,000 - 450,000/cm3
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Point-of-care-testing (POCT)
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Defined as diagnostic testing near the dite of patient care. The driving notion behind POCT is to bring the test conveniently and immediately to the patient. This increased the likelihood that the patient will receive the results in a timely manner.
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Red Blood Cells (RBC's)
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One of the solid compontents of the blood which is notmally a biconcava disc without a nucleus. This is the component of the blood that contains hemoglobin with is responsibel for oxygen and carbon dioxide exchange. A Red Blood Cell count is performed as part of a complete blood count and ranges from 4,200,00 - 5,00,000 RBC's per cubic millimeter
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Sclerosis
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A hardening; especially from inflammation and certain disease states. Though sclerosis may occur in many areas of the body, the term is most often associated with blood vessels.
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Septicimia
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This is systemic infection associated with the presence of pathogenic organism introduces during a venipuncture
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Serum
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Referring to blood, the clear liquid portion of blood that separates out after clotting has taken place. Since clotting has accurred, the serum is fibrinogen deficient. Contrast to plasma
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Trauma
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This is injury to underlying tissues carused by probing of the needle
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Thrombophlebitis
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Inflammation of a vein with formation of a clot
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Thrombus
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This is blood clot usually a consequence of insufficient pressure applied after the withdrawl of the needle.
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Tort
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Tort is a wrongful act that results in injury to one person by another
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Touriquet
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In regards to venipuncture, a constrictive band, placed over an extrenity to disten veins for the purpose of blood aspiration or intravenous injectons. Materials used may be rubber, latex or synthetice elastic material. Blood pressure cuff may also be used.
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Universal Precaustions
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The name used to describe a prevention strategy in which all blood and potentially infectious materials are treated as if they are, in fact, infectious, regardless of the perceived status of the source individual. In other words, wether or not you think blood/body fluid is infected with blood borne pathogens, you treat it as if it is. This approach is used in all situations where exposure to blood or potentially infectious materials is possible. This also means that certain engineering and work practice controls shall alsy be utilized in situations where exposure may occur
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Vacutainer
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Vacutainer is a federally and internationally registered trademark owned by BD (Becton, Dickinson and Company) that is used in connection with a complete system of tubes, needles and needle holders, sharps collectors and safety devices in blood collection. The Vacutainer evacuated tube, for example, automatically aspirates the correct aount of blood into a tube. It is used indtead of a syringe. Despite the fact that BD owns the Vacutainer trademark, the term has become so widley used to describe similar blood collection tubes and devices, that it has become a generically used term
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Vacutainer Holder
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A cylindrical shaped holder that accepts a Vacutatiner tube on one end and Vacutainer needle on the other, The holder tube and needle comprise the Vacutainer system used to draw multiple tubes of blood with one venipuncture
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Vacutainer Needle
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The needed is used to attach to a Vacutainer holder. The needle has a male thread on one end which screws into the holder. The threaded end also has a large guage needle, enclised by a rubber sheath. This needle will puncture the stopper of a Vacutainer tube allsoing blodd to enter the tube. Upon withdrawal of this needle from the tube, the rubber sheath covers the needle bevel, stopping the flow of blood. Thus, any number of tubes may be drawn with ony one single venipuncture
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Warfarin Sodium
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The sodium salt of warfarin, one of the synthetic coumarin anticoaulants. Coumadin
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White Cell Count (WBC)
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The number of white blood cells (leukocytes) found in the peripheral blood and measure per cubic millimeter
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Whole Blood
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Blood from which none of the elements have been removed. It is usually referred to as blood, collected from a doner and anticoagulated for the purpose of blodd replenishment for a recipient
