Phlebotomy Exam Study Guide, Exams of Nursing

Download Phlebotomy Exam Study Guide and more Exams Nursing in PDF only on Docsity! Phlebotomy Exam Study Guide Table of Contents Didactic Lecture Notes: p.1 Didactic Practice Quizzes: p. Phlebotomy Training Manual: • History of Phlebotomy: a) Phlebotomy: An Overview b) Therapeutic Phlebotomy: • Your Role as a Phlebotomist: a) Professionalism b) ethical behavior c) Patient consent d) bedside manner, care and attitude • PPE, work practice controls and engineering controls a) Barrier protection b) sharps container c) broken glassware d) decontamination e) needle stick safety and prevention act f) exposure • venipuncture a) venipuncture supplies and equipment • Recognizing patient injury • requisition form • venipuncture procedure a) Steps to end a blood draw b) making difficult draws less difficult c) venipuncture problems • Capillary punctures a) site selection for capillary collection • heel stick a) • Homeostasis the healing process a) Prothrombin time tests b) partial thromboplastin time • Specimen handling an procurement a) fasting specimens b) 3 𝗌 Infant heel is essential for Blood Gases and pH.𝗌 70 % isopropyl alcohol.𝗌 Helicobacter Pylori Act.𝗌 HbA1c is drawn on lavender tube .𝗌 Order of draw for micro-collection capillaries? ⟶ Pink ⟶ Dark Green ⟶ Mint Green (x2) ⟶ Grey ⟶ Yellow (x2) ⟶ Red National Exam - Study Guide: PHLEBOTOMY: 4 𝗌 The act of drawing or removing blood, from the circulatory system through a cut (incision) or puncture to obtain a sample for analysis and diagnosis! ⟶ The amount of draw depends on the purpose of the phlebotomy! o Tests requiring a very small amount of blood , the Phlebotomist may choose to do a finger stick or dermal puncture ! o A Lancet or a very small needle makes a tiny cut in the surface of a fingertip, and a small amount of blood is collected in a narrow glass tube or Microtainer collection tubes! ⟶ Ancient art of "Blood Letting": the concept was to rid the body of infected fluids ! ⟶ "phlebo"= vein / "tomy"= to make an incision ! ⟶ "The Barber Pole Stripe Method": Red stripe = blood/ white stripe = bandages/gauze! ⟶ Phlebotomy AKA: Venesection! ⟶ Antiseptic Wipe: 70% ISOPROPYL ALCOHOL! ⟶ Venipuncture: begins AFTER an elastic band or tourniquet is tied around the arm. o the tourniquet is tied around the arm 4"- 6" above the draw site! o slowing blood flow in the arm! o makes veins more palpable!𝗌 Most Common Practices of Phlebotomy: 1. Extraction of blood for donation! 2. Testing the substances contained withing it! 3. & Other Medical Uses! Therapeutic Phlebotomy: ⟶ Patients with Polycythemia Vera : (patient w/ high red blood cell count)! 5 o Most common use for Therapeutic Phlebotomy! ⟶ Patients w/ high iron in their blood ! ⟶ Patients w/ Hemochromatosis: an inherited condition where iron levels in the body slowly build up over many years! ⟶ Patients w/ Pulmonary Edema (Fluid in the Lungs)!𝗌 Therapeutic Phlebotomy extracts large amounts of blood to bring certain values in blood levels! (Removing blood to reduce iron overload!) Your Role as a Phlebotomist:𝗌 The primary function of a Phlebotomy Technician: to obtain blood specimens from patients by venipuncture or capillary puncture techniques! ⟶ Phlebotomy Technicians may also draw for transfusion, donation, and research! ⟶ Phlebotomy Technicians may also assist in the collection and transportation of many other laboratory specimens and patient data entry ! 𝗌 SAFETY IS KEY! ⟶ All precautions must be taken to prevent the transmission of possible infectious diseases. ⟶ the technician must be accurate, work well under pressure, and communicate affectively, especially with patients who may feel a level of anxiety associated with depending procedure ⟶ Professionalism: an attitude and a set of personal characteristics needed to succeed. ⟶ Negligence: failure to provide adequate care (ex: Battery, Malpractice, Slander, etc.) Ethical Behavior: ⟶ Conforming to a certain standard of right or wrong! ⟶ Avoiding harming the pt. in any way! ⟶ Remember Patient Bill of Rights ! ⟶ pt.’s have the right to know what test are being conducted on them. 8 ⟶ Glassware that has been contaminated may be disposed of in an appropriate sharps container (closable, puncture resistant, leak proof on sides and bottom, with appropriate labels) ⟶ Uncontaminated broken glassware may be disposed of in a closable, puncture resistant container such as a cardboard box ⟶ All regulated waste must be disposed of in properly labeled containers or red biohazard bags. Decontamination: • All surfaces, tools, equipment and other objects that come in contact with blood or potentially infectious materials must be de contaminated and sterilized ASAP! • Decontamination can be accomplished by using the following liquids: ⟶ A solution of sodium hypochlorite (household bleach / Clorox) diluted between 1:10 and 1:00 with water ⟶ Lysol or some other EPA-registered tuberculocidal disinfectant. Check the label of all disinfectants to make sure they meet this requirement. ⟶ If you are cleaning up a blood spill, carefully pour the 10% solution of bleach over the blood and leave it for at least 10 min. This will help to ensure that any blood- borne pathogens are killed before you begin cleaning or wiping the material up! Needle Stick and Safety Prevention Act: 𝗌 Sharps injury log must contain, at a minimum: 1. The type and brand of device involved in the accident. 2. The department or work area where the exposure incident occurred. 3. An explanation of how the incident occurred. Exposure: 9 𝗌 If you are exposed to blood or any other potentially infectious material, you should: 1. Wash the exposed area thoroughly with soap and running water. Use non-abrasive, antibacterial soap. If blood is splashed in the eye of the mucous membrane, flush the affected area with running water for at least 15 min. 2. Report the exposure to your supervisor as soon as possible. 3. Refer to an MSDS! - It is intended to provide workers and emergency personnel procedures for handling or working with that substance in a safe manner and includes personnel with procedures for handling or working with that substance in a safe manner and includes information such as physical data (melting point, boiling point, flash point, etc.) - Fill out at exposure report form. This form will be kept in your personnel file for 40 years so that you can document workplace exposure to hazardous substances. 𝗌 Apart from the exposure itself, all other findings or diagnosis by testing facility will remain entirely confidential. 1. Document the route(s) of exposure and the circumstances under which the exposure incident occurred. 2. Identify and document the source individual unless such documentation is impossible or prohibited by law. 3. Test the source individual’s blood for HBV and HIV ASAP, after consent is obtained. If the source individual is known to be seropositive for HBV or HIV, testing for that virus need not done. 4. Collect your blood as soon as feasible and test it after your consent is obtained. 10 Four types of OSHA Compliance Inspections: 1. The Compliant Inspection: ⟶ occurs after an employee files a formal complaint with OSHA ⟶ most common type of inspection! 2. The Fatality/ Accident Inspection: ⟶ occurs after OSHA receives notice from the employer of a workplace facility ⟶ after an accident resulting in the hospitalization of three or more employers ⟶ OSHA takes notice of media reports! (will frequently investigate accidents that do not result in any fatality or hospitalizations. 3. The Programmed Inspection: ⟶ an inspection conducted of randomly chosen workplaces determined to be engaged in particularly hazardous types of work according to their Standard Industry Classification (SIC) Codes. 4. The Imminent Danger Inspection: ⟶ occurs when OSHA receives a report that a condition of danger exists at a workplace. ⟶ least common type of inspection! 13 𝗌 Taken when patient shows symptoms of systemic infection or FUO (Fever of Unknown Origin)!𝗌 Blood cultures are performed to determine the presence pathogenic microorganisms in the blood stream!𝗌 Blood culture bottles contains SPS (Sodium Polyanethole Sulfonate) ⟶ In certain situations, a yellow top tube (containing SPS) may be used for bacterial and fungal blood cultures!𝗌 If infectious microorganisms are present, the nutrient broth will promote rapid growth of microorganisms!𝗌 Once assessed and positively identified, the infection can be controlled and treated with antibiotics)! 𝗌 Blue Cap : Aerobic (Bacterial)𝗌 Gold Cap : Anaerobes (Bacterial)𝗌 Pink Cap : Pediatric (Bacterial)𝗌 Red Cap : (Fungal Culture) Additive: Nutrient Broth Yields: N/A Laboratory: Microbiology Inversion Time: N/A Common Test: • Blood Culture (BCX) ⟶ commonly drawn in sets of two! ⟶ Each set consisting of two bottles; aerobic with oxygen and anaerobic without oxygen! ⟶ Usually ordered STAT (times specimen)! ⟶ It is also advisable to cleanse the top of the collection bottles! ⟶ Requires strict aseptic technique! (to minimize risk of contamination, must prep site with Chloraprep) 14 ⟶ Some employers require BCX be draw using butterfly needle: to prevent the nutrient brother inside the bottle from the introduction to the blood stream! • C + S (Culture and Sensitivity): #2 - Light Blue Top Tube: Additional Information: • Sodium Citrate prevents coagulation by binding to calcium in the specimen! ⟶ It is the additive used for coagulation factors in the specimen! ⟶ Sodium Citrate is a liquid additive that required specific blood to additive ratio: 9 parts blood to 1-part additive . ⟶ The light-blue top tube MUST be filled completely to avoid an inadequate ratio of additive of blood! ⟶ After the specimen in collected, it must be inverted 3-4 times to mix blood and additive properly! • Draw a red tube before this tube if blood cultures are not drawn first! • How thin/ How thick! Additive: Sodium Citrate (anticoagulant) Yields: Plasma Laboratory: Coagulation / Hematology Inversion Time : 3-4 Times Common Test: • PT- Prothrombin Time: ⟶ evaluates the extrinsic system of the coagulation cascade ! ⟶ used to evaluate coagulation when patient on Coumadin • PTT-Partial Thromboplastin Time: ⟶ Evaluates the intrinsic system of the coagulation cascade ! ⟶ used to determine coagulation when patient in on Heparin! 15 • Active Partial Thromboplastin Time (APPT): informal reference to APTT #3 - Red Top Tube: Additional Information: • this tube is mainly used for storage or back-up testing! ⟶ Red top/ Plain Tubes are frequently use as a “discard” tube to prevent sample contamination! • AKA: “plain vacuum tube”! • It contains NO additives or anticoagulants! • It is sometimes used to “clear the line” to obtain a purer sample! • In this tube, the blood will clot naturally within 30-60 min! • No need to invert this tube after sample collection! Additive: None Yields: Serum Laboratory: Chemistry Inversion Time : 8 times (if it is in the order of draw!) Common Test: • Serum Pregnancy Test #4 - Tiger Top Tube: Additional Information: • AKA: “speckled top”, “Marble top”, “gel” • SST – Serum Separation Tube! 18 • Heparin, the anticoagulant in green-top tubes, works by inhibiting thrombin in the coagulation cascade! Additive: Sodium Heparin (anticoagulant) Yields: Plasma Laboratory: Chemistry Inversion Time : 8 Times Common Test: • Ammonia: ⟶ High volume of ammonia in the blood is an indication that the liver is not functioning properly! ⟶ The liver is responsible for converting ammonia into urea to be expels from the body via urine! ⟶ Specimen must be placed on ice! #7 - Lavender or Light/Dark Purple: Additional Information: • A CBC should NEVER be centrifuged! (CAN NOT be performed on hemolyzed substances!) • If tube is damaged in any way, the lab WILL reject it. • EDTA binds to calcium to inhibit coagulation! • This tube is NOT used for coagulation studies! • Lavender, purple, and pink-top tubes MUST be filled at least 2/3rds full! • Lavender and Dark Purple Tubes are used for the same test - the only difference is the amount of blood the tube can draw and the amount of EDTA in each tube. • Must be inverted 8 times to properly mix blood and anticoagulant! • C- Reactive Protein can be drawn in a lavender top tube of plasma is required for the test! Additive: EDTA (ethylene/diamine/tetra/acetic acid) Yields: Plasma Laboratory: Hematology 19 Inversion Time : 8 Times Common Test: • Erythrocyte Sedimentation Rate (ESR): this test requires a full tube for accurate collection! • Sickle Cell Screenings! • CBC: Complete Blood Count (can be tested using blood from dermal puncture!) a) CBC is an extensive test that evaluates the formed cellular elements of the blood. Including: - WBC (White Blood Cells) - White Blood Cell Differential - Hematocrit – measures the volume percentage of RBC (red blood cells) in the blood! ⟶ (This test is always checked prior to blood donation!) ⟶ (This test is always checked prior to blood donation!) - Platelets - number of platelets in a given volume of blood! ⟶ Both increases and decreases in platelet count can point to abnormal conditions of excess bleeding or clotting! ⟶ Most common bleeding disorders includes: hemophilia, Factor IV, V, V!!, X or XII and von Willie brand's disease! - Differential counts can be run automatically & manually! ⟶ Manual Diff. – performed by certified lab technician! ⟶ Automatic Diff. – performed by a lab calibrated machine! (ESR= ⟶ Draw when patient has low grade fever! #8 - Pink Top Tube: Additional Information: • Similar to Lavender/Dark Purple Tubes, contains EDTA! (binds to calcium to prevent clotting) • Purple top tubes can be used in places of Pink top tubes! • Pink Tubes can hold larger volume and has more EDTA! (More Blood=More Anticoagulant! • Larger volume of blood is required for Blood Banking: testing for blood type and antibodies! 20 • This tube is used by blood banks for molecular diagnostics and testing of viral loads! Additive: Potassium EDTA Yields: Plasma Laboratory: Blood Bank Inversion Time: 8 Times Common Test: - TSR: Type Screen Ratio: ⟶ this test provides a basic understanding of patient's blood type! and categorizes it into one of the four groups: A+/- , B+/-, AB+/-, or O+/- ⟶ Also screens for antibodies present in plasma and serum! ⟶ determines RH factors - Cross Match: ⟶ This test is required prior to blood transfusion! ⟶ Also used to determine donor blood compatibility match for the recipient! #9 - Grey Top Tube: Additional Information: • Sodium Fluoride is an antiglycolytic! (prevents glycolysis: the breakdown of sugar)! • Preserves integrity of gluclose for three days! • All glucose testing is done in this tube! Additive: Sodium Fluoride - antiglycolytic agent: (glucose preservative) & Potassium Oxalate (anticoagulant) Yields: Plasma Laboratory: Chemistry Inversion Time: 8 Times Common Test: • BAC: Blood Alcohol Test! 23 17. Chloride Basic Metabolic Panel (BMP) : 9 TEST! 1. Glucose 2. Blood Urea Nitrogen 3. Creatine 4. BUN/ Creatine Ration 5. Sodium 6. Potassium Calcium 7. CO2 8. Chloride 9. Calcium Electrolyte Panel: 4 TEST! 1. Sodium 2. Potassium 3. CO2 4. Chloride Lipid Panel (must be transported following requirements for chilled specimens!): 4 TEST! 1. ÇÓOLESTOROL 2. Triglycerides 3. High- Density Lipoproteins 4. Low-Density Lipoproteins Acute Hepatitis Panel (goes to serology!): 4 TEST! 1. Hepatitis B Surface Antigen 2. Hepatitis B Core antibody, IgM 3. Hepatitis A Antibody 4. Hepatitis C Antibody (HCV) 24 Hepatic Function Panel : 7 TEST! – Liver Function Panel: SST 1. Albumin 2. Total Bilirubin 3. Direct Bilirubin 4. Alkaline Phosphatase 5. AST (SGOT): Liver function test 6. ALT (SGPT): live damage test 7. Total Protein Obstetric Panel/ Prenatal Panel: 6 TEST! – SST, Lavender, Pink 1. CBC with Differential 2. Hepatitis B AG 3. RPR 4. Rubella 5. ABO/RH Type 6. Antibody Screen Renal Function Panel – Kidney Function Panel: 10 TEST! 1. Albumin 2. Calcium 3. Carbon Dioxide 4. Chloride 5. Creatine 6. Glucose 7. Phosphorus 8. Potassium 9. Sodium 10. Blood Urea Nitrogen (BUN) 25 Safety: • The Occupational Safety and Health Administration (OSHA) is responsible for: ⟶ the identification of various hazards present in the workplace! ⟶ creation of rules and regulations to minimize exposure to such hazards! ⟶ employers are mandated to institute policies that will ensure safe working conditions!𝗌 Health care workers have an obligation to know and follow those policies! Types of Hazards: 1. Biologic: 2. Sharps: 3. Chemical: 4. Electrical: 5. Fire or explosive: 6. Physical: 7. Allergic Reaction: National Fire Protection Association (N.F.P.A): 𝗌 The N.F.P.A diamond is the standard label that displays a "Quick Look" at the potential hazards that exists in your work environment! • The inner diamonds are color coded to specify what KIND of Hazards are present and how GREAT those hazards can be! • Each colored area will display a number ranging from 0-4: 28 • ASAP: As Soon as Possible 29 • C & S: Culture and Sensitivity • CDC: Center of Disease Control and Prevention • CLIA: Clinical Laboratory Impact Amendment • CLSI: Center Laboratory Standards Institute • CRP: C- Reactive Protein • EDTA: Ethylenediaminetetraacetic acid • ESR: Erythrocyte Sedimentation Rate • H & H: Hemoglobin and Hematocrit • Hct: Hematocrit • Hg: Mercury • Hgb: Hemoglobin • HIPAA: Health Insurance Portability and Accountability Act • HIV: Human Immunodeficiency Virus • INR: International Normalized Rate • K: Potassium • Lab: Laboratory • LIS: Laboratory Information System • MSDS: Material Safety Data Sheet • Na: Sodium • NB: Newborn • neg: Negative • O + P: Ova + Parasite • OGTT: Oral Glucose Tolerance Test • OSHA: Occupational Safety Health Administration • POCT: Point of Care Testing • Petechiae: Small Red Dot Capillaries: tourniquet left on too long/ too tight • PPE: Personal Protective Equipment • PSA: Prostatic Specific Agent • PKU: Phenylketonuria • PTT: Partial Thromboplastin Time • PT: Prothrombin Time 30 • RBC: Red Blood Cells • STAT: ASAP/Immediately • WBC: White Blood Cells Acronyms: 𝗌 TANTACT: - T: Tourniquet - A: Alcohol - N: Needle - T: Tape - A: Adapter (hub) - C: Cotton/ Gauze - T: Tube 𝗌 AIDET: - A: Acknowledge - I: Introduce - D: Describe - E: Explain - T: Think 𝗌 RACE: - R: Rescue (rescue patients and co-workers) - A: Alarm (sound the alarm and alert those around you) - C: Confine (confine the fire – close doors & window) - E: Extinguish (use the nearest fire extinguished) 𝗌 PASS: - P: pull the pin - A: aim at the fire 33 ⟶ If Allen’s Test is passed, we now know that during obtaining ABG sample, if the radial artery were to become thrombosed and blocked, the collateral supply will prevent any ischemia from occurring. ⟶ If Allen’s Test is negative: look for alternative site for ABG sample Equipment for ABG sample: • Set up equipment on sterile tray: • sterile gloves • Antiseptic skin prep • Gauze • Dressing • Sharps Container • ABG Needle & Syringe ⟶ ABG needle has protective sleeve, can be placed back over needle once sample is obtained! ⟶ The syringe being used contains heparin (prevents sample from clotting)! Performing ABG: • Position patient’s wrist, so it is slightly extended (this causes radial artery to sit slightly more superficially, which makes accurately locating easier) • Wash hands w/ antimicrobial soap, then put on gloves. • Clean site with antiseptic skin prep. • Palpate and identify the radial artery. ⟶ Very Important Part of Procedure! ⟶ The more accurately you can determine the location of the artery, the better the chances of successful puncture on first attempt! ⟶ Easiest to palpate 3 cm proximal to the wrist skin crease! 34 ⟶ When palpating, try to visualize its course underneath the skin! • Now prepare the needle and syringe: hold between thumb, index, and middle finger. (same way you would hold a pen) • While palpating the artery proximal to the point where we are going to insert the needle, slowly introduce the needle at 45 degrees to the skin in the same direction as the artery • As the needle punctures the lumen of the artery, there will be a flashback and the syringe will automatically be felt with bright red arterial blood, often in a pulsating fashion. • If you see a flashback but the syringe doesn’t start to fill, you most likely passed through the back wall of artery. If this occurs, gently withdrawal the needle a small amount and the syringe should fill. • Once syringe is completely full, withdrawal needle completely and immediately apply pressure using the sterile gauze ⟶ Apply pressure for min of 1 min but may require as long as 5 min! ABG Post-Procedure Care: • Closely monitor patient for early signs of complications • Apply prolonged pressure to stop any bleeding Complications of ABG Sampling: • Bleeding or hematoma – indicative of laceration to the artery • Compartment Syndrome • Arterial vasospasm and occlusion • Infection of Injection Site • Injury to adjacent structures • Post-procedure pain • Needle stick injury 35