1
Q
What was the concept of bloodletting in the past
A
To rid the body of excess fluids
2
Q
How does the barber’s pole relate to phlebotomy
A
B;ppd was collected from an incision made by barber’s razor. Red = blood. white = bandages.
3
Q
HIPAA
A
Health Insurance Portability and Accountability Act
~written permission before disclosing healthcare info
~gossip, social media
4
Q
PHI
A
Protected Health Information
~transmitted or stored electronically
5
Q
TJC
A
The Joint Commission
~1951
~oldest watchdog group in healthcare facility oversight
~SOLEY LOOK OUT FOR PATEINTS
~establish standards and practices for all healthcare settings.
6
Q
POCT
A
Point-of-Care Testing
7
Q
CLSI
A
Clinical and Laboratory Standards Institute
~global, non profit
~develops standards using representatives directly from the fields they oversee
8
Q
Illegal and unethical behaviors
A
~NEGLIGENCE
~ASSAULT
~Batter
~Slander
~Libel
~Duty of Care
~Breath of Duty
~ Malpractice
9
Q
Informed Consent
A
~competent person gives voluntary permission for a medical procedure after receiving adequate information about risks/methods/consequences
10
Q
Expressed Consent
A
~permission is given by patient verbally or in writing
11
Q
Implied Consent
A
~The patients actions permit the procedure wihtou verbal or written consent. Ex. patient going to ER or holding out an arm.
12
Q
HIV Testing Consent
A
Special permssion is needed to administer a test that detects HIV
13
Q
Parental Consent for Minors
A
A parent or guardian must permit procedures administered to underage patients.
14
Q
Can you eat, drink, smoke or chew gum in the lab
A
No
15
Q
Can you place pens and pencils in your mouth?
A
No
16
Q
Can you put food or drinks in the speciman refrigerator?
A
No
17
Q
Can you wear long chains, large earrings, or loose bracelets?
A
No
18
Q
Can you apply cosmetics, perfume, or cologne in the lab?
A
No
19
Q
Do you need to wear a fully buttoned lab coat in the lab?
A
Yes
20
Q
Can you wear lab attire outside of the lab?
A
No
21
Q
Do you need to wear comfortable, non-slip shoes made of impenetrable materials?
A
Yes
22
Q
Do you need to tie back long hair?
A
Yes
23
Q
Do you need to make sure fingernails are short?
A
Yes
24
Q
Can you bite your fingernails?
A
No
25
Do you need to report unresponsive patients immediately?
Yes
26
Can you run?
No
27
Can you touch electrical equipment in patient care rooms while drawing blood?
No
28
Do you need to report IV catheter problems?
Yes
29
Complaint Inspection
This inspection occurs after an employee files a formal complaint with OSHA. Most common
30
The Fatality or accidents inspection
This inspection occurs after OSHA receives notice from the employer of a workplace fatality or accident resulting in three or more employee hospitalizations. OSHA also notes media reports and frequent investigatons that do not result in deaths or hospitalization.
31
The Programmed Inspection
this kind of inspection is conducted on randomly chosen workplaces determined to be engaged in particularly hazardous work types according to their Standard Industry Classification (SIC) codes.
32
The Imminent Danger Inspection
This inspection type occurs when OSHA receives a report that a condition of imminent danger exists at a workplace. Least common type.
33
Hemostasis
Process by which blood vessels repair after injury. Uses vessels, platelets, coagulation factors.
34
4 stages of hemostatis
1. Vascular Phase
2. Platelet phase
3. Coagulation Phase
4. Fibrinolysis
35
Vascular Phase
Injury to a blood vessel causes it to constrict, slowing blood flow.
36
Platelet Phase
Injury to endothelial lining causes platelets to adhere.
37
Prothrombin time test (PT/INR)
Used to evaluate extrinsic pathway. This test also monitors anticoagulant therapy, such as for patients on the following blood thinners: (Coumadin, Warfarin, and Heparin).
38
Coagulation Phase
Involves a cascade of interations between coagulation factors that convert temportary platelet plug to a stable fibrin clot.
39
INR
International Normalized Ratio, meaning that no matter where you get your blood tested, the ratios will always be calculated correctly to administer medications.
40
Fibrinolysis
Breakdown and removal of the clot.
41
Hemochron
A device used for PCOT (point of care testing) regarding PT/INR is the Hemochron Signature Elite. Comprehensive point of care coagulation monitoring system
42
Plasma
Liquid portion of the unclotted blood and still contains clotting factors
43
Tubes with anticoagulants
~Lavender
~Green (light or dark)
~Pink
~Royal blue with LAVENDER stripe
~Light blue
~Gray
44
Serum
The liquid portion of blood that has been allowed to clot (coagulate). clotting factors are no longer present because they have been used to clot the blood.
45
Tubes without anticoagulants
~Clear - used as a discard tube
~Red - glass
~Red - plastic - will have clot activator
~Tiger top/Gold/Marble
~Royal blue with RED stripe
46
If there is a mislabeled tube with a specimen, should you transfer into another tube
no, because original additive could be altered
47
ORDER OF DRAW
~Blood culture Bottles (Broth)
~Discard tube (red or clear)
~Light blue (Sodium Citrate)
~Dark blue with red stripe
~Red top (clot activator if plastic
~Gold / Tiger / Marble (Silica Gel) (SST)
~Light green top (lithium Heparin / gel)
~Dark green top (Sodium Heparin)
~Pink top (Potassium EDTA)
~Lavender top (EDTA)
~Dark Blue with Lavender stripe
~Gray top (Sodium Flouride / Potassium Oxalate)
48
Blood Cultures
when presented for a systemic infection or a fever of unknown origin (FUO), blood culture is performed to determine presence of pathogenic or infectious microorganisms. The nutrient broth will promote rapid growth of microorganisms.
49
Sterile Bottles (BCX)
SPS (sodium polyanethole sulfonate) (nutrient broth).
50
What are blood culture bottles cleansed with
Chloraprep to minimize risk of contamination.
51
Collection method of blood cultures
ordered in sets of 2. each consist of aerobic (with O2) and anaerobic (without O2)
52
Clear top tube = discard
Discarded to avoid thrombin and other cells polluting the samples drawn into different tubes.
53
Light Blue Top Tube additive
Sodium Citrate - anticoagulant
54
Tests for Light blue top tube
Prothrombin time (PT) - evaluates extrinsic system of coagulation cascade. therapeutic drug monitoring requires partial thromboplastin time to be drawn when patient is on Heparin regimen.
Partial Thromboplastin Time (PTT) - evaluates intrinsic system of coagulation cascade. Therapeutic drug monitoring requires to be drawn when patient is on Heparin regimen
Activated Partial Thromboplastin Time (aPTT) - evaluates how long patient's blood takes to form a clot
D Dimer
55
Light blue top tube yield
plasma
56
Light blue top tube lab
Coagulation
57
Light blue top tube special considerations
Must be filled completely.
Inverted 3-4 times.
58
Red top tube additive
none - glass
clot activator - plastic
59
red top tube yield
serum
60
Red top tube lab
Chemistry
61
what is the red top used for
discard tube to prevent sample contamination. no need to invert. alcohol (ETOH) levels can also be drawn in a red top tube
62
plastic red top tube
a clotting agent is added.
63
Tests for red top tube
Plain vacuum tube. serum pregnancy test. ETOH
64
Tiger Top, Marble, Speckled, Gold top additive SST, gel tube.
Silica (clot activator) and Thixotropic Gel (serum separator)
65
Tiger top yield
Serum
66
Tiger top lab
chemistry
67
Tiger top inversion
8 times
68
Tiger top common tests
~Basic Metabolic Panel (BMP) - this group of tests provides general info about metabolism, kidney function, electrolytes, fluid balance.
~Complete / Comprehensive Metabolic Panel / Profile (CMP) - more complete look at patient's metabolism of chemicals. info about liver function and performance.
~Serum Pregnancy Test - With clotting factors left in blood, a marble top tube can also be used for pregnancy test.
~ Lipids and Cholesterol - this test is performed to identify possible circulatory system health issues.
~ C-reactive protein test (CRP)
69
Light green top tube (PST plasma separation) additive
Lithium Heparin, anticoagulant, thixotropic gel, plasma separator
70
Light green yield
Plasma
71
Light green lab
Chemistry
72
Light green common tests
STAT electrolytes (LYTES) - measurement of electrolytes for diagnosing and treating renal and endocrine conditions. low electrolyte - arrhythmia (irregular heartbeat) and tachycardia (rapid heartbeat). high levels - heart failure
hCG - plasma pregnancy test
hCG qualitative - +/-
hCG quantitative - how much hCG
73
Dark green top tube additive
Sodium Heparin, anticoagulant
74
dark green tube yield
plasma
75
dark green tube lab
Chemistry
76
Dark green tube common test
Ammonia - high ammonia is an indication that liver is not functioning. correctly. liver converts ammonia to urea to be expelled. ammonia tests must be placed on ice.
77
pink tube additive
potassium EDTA
78
pink tube yield
Plasma
79
pink tube lab
blood bank
80
pink tube how full
2/3 inverted 8 times
81
pink tube common tests
Type and Screen Ratio (TSR) 0 provides a basic understanding of patients blood types. also screens for antibodies present.
Cross match - required before blood transfusion. used to determine if donor blood is compatible with recipient
82
Purple tube additive
Ethylenediaminetetraacetic Acid (EDTA)
83
purple tube yield
plasma
84
purple tube lab
Hematology
85
purple tube how full
2/3 full 8 inversions.
86
Complete blood count (CBC)
not performed on hemolized samples. do not centrifuge. hemolization happens when membranes of red blood cells break releasing free hemoglobin into circulating blood.
87
Purple tube common tests
Erythrocyte Sedimentation Rate (ESR) - requires a full tube.
Sickle Cell - Screen for misshapen red blood cells
Complete Blood Count (CBC) - using blood from dermal puncture. evaulates formed cellular elements of blood including. white blood cell count, white blood cell differential
Hematocrit - Volume percentage of red blood cells in blood. performed before whole blood donation
Hemoglobin - amount of oxygen-carrying protein in blood. test is always performed before whole blood donation
Platelets - number of platelets in given volume of blood. both increases and decreases in platelet count can point to abnormal conditions of excess bleeding or clotting.
88
Most common bleeding disorders
Hemophilia, Factor II, V, VII, X, XII, and von Willebrand's disease
88
Gray tube additive
Sodium Flouride, antiglycolytic agent (glucose preservative), potassium oxalate, anticoagulant
89
gray tube yield
plasma
90
gray tube lab
Chemistry
91
Potassium Oxalate
Anticoagulant that prevents clotting by binding to Calcium. invert 8 times.
91
sodium fluoride
preservative that prevetns breakdown of sugar. preserve integrity of glucose in sample for 3 days.
92
OGTT
old gray top tube
oral glucose tolerance test
93
Gray tube common tests
OGTT - blood aqnd urine samples are glucose tolerance tested. evaluate blood sugar.
3 hour test for hyperclycemia - high blood sugar and diagnose diabetes mellitus. baseline, 1 hour, 2 hour, and final draw. Pregnant women undergo routine glucose tolerance test to evaluate gestational diabetes.
5 hour test for hypoglycemia - low blood sugar for carbohydrate metabolism disorders.
Lactic Acid - Abnormal Lactic acid results are an indication that body is not receiving proper oxygenation.
without statis, so no tourniquet. place on ice
Alcohol (Ethanol or ETOH levels) - when drawing an alcohol level, do NOT clean site with alcohol as it may cause a false positive.
94
Royal blue tube additive
Red stripe - none
lavender stripe - EDTA
95
Royal blue tube yields
Red stripe - serum
Lavender stripe - plasma
96
Royal blue tube lab
Toxicology
97
Royal blue tube common tests
invert 8 times
Lead Pb poisoning
Heavy metal Toxicology
98
NSPA
Needlestick Safety and Prevention Act. safer medical devices. sharps injury log.
99
Sharps injury log requirements
~type and brand of device involved in incedent
~department or work area where exposure incident occured
~an explanation of how the incident occured
100
Biological Hazards
Infectious agents can cause bacterial, viral, fungal, or parasitic infections.
101
Sharps Hazards
Needles, lancets, and broken glass can puncture, cut, and cause bloodborne pathogen exposure
102
Chemical Hazards
Preservatives and chemicals used in the lab can create possible exposure to toxic, carcinogenic, or caustic substances
103
Electrical Hazards
High-voltage equipment can cause burns or electrical shock.F
104
Fire or explosive hazards
Bunsen burners, oxygen, and chemicals can cause burns or dismemberment.
105
Physical Hazards
Wet floors and heavy lifting can cause falls, sprains, and strains.
106
Allergic reaction hazards
Latex senstivity can cause allergic reactions ranging from superficial dermatitis to anaphylaxis. use nitrile gloves if there is a latex allergy.
107
Bloodborne pathogens
A biohazard that are microorganisms (viruses, bacteria), that are carried in blood and can cause disease. HBV, HIV
108
Hepatits B
Most commonly occuring nosocomial infection. Affects liver.
~Causes liver inflammation, but can lead to more severe cirrhosis and liver cancer conditions.
~It is essential to note that there are different kinds of hepatitis.
~No specific cure for hepatitis B, but there are treatment.
~can survive in dried blood for 7 days.
109
HBV symptoms
~flu like
~can show no symptoms
~1-9 months for symptoms to be noticable
~fatigue, stomach pain, loss of appetite, nausea
~jaundice.
110
Universal precautions
blood and intentially infectious materials are treated as contagious.
111
Blood precautions
Avoid all bodily fluids, secretions, and excretions (besides sweat) regardless of whether or not they contain visible blood.
112
Non intact skin precautions
Mucous membranes are designed to reduce risk of transmission of microorganisms from recognized and unrecognized sources of infections.
113
Standard precautions
~Wear gloves when collecting and handling blood, bodily fluids, or tissue specimen. NEVER double glove
~Wear face shields when there is a danger of splashing onto mucous membranes.
~Dispose of all needles and sharp objects in puncture-resistant containers without recapping. always activate safety mechanism.
~Be aware that disinfectants are used to clean fluid spills, thus killing pathogenic organisms
114
Contact Isolation
Reduce risk of transmission of microorganisms by direct or indirect contact
1. Direct contact isolation.
115
What is a capillary
A microscopic blood vessel.
116
What tests do you use capillary punctures
Micro samples.
117
How far do capillary lancets go
0.85mm for infants to 3.0mm for adults.
118
First drop of blood in a capillary stick
wipe away with gauze. never use earlobe.
119
Fingerstick
~Done when patient is over 2 years old.
~Use when you can't find a vein
~patient has burns, scars, or non intact skin
~severely obese and no vein can be found.
~if the DR only wants a small amount of blood
~if they need to save vein integrity for other procedures
120
How to choose fingerstick site
3rd or 4th finger of non dominant hand. in flesh portion slightly offcenter. warm the area and use a lancet to puncture.
121
Heel stick
Dermal puntures on infants up to 2 years. medial and lateral portions of plantar surface.
122
AAP
American Academy of Pediatrics.
123
Nursing
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