PMLS LAB EXAM 3

• ETS system - This system is preferred because it is direct, efficient, relatively safe for the patient and the blood drawer, and allows multiple tubes to be easily collected.
• test request - is reviewed for completeness, date and time of collection, status, and priority.
• accession - process records the request and assigns it a unique number used to identify the specimen and related processes and paperwork.
• Name, DOB, and MR number - must be verified and matched to the test order and inpatient's ID band .Preparing the patient by explaining procedures and addressing inquiries helps reduce patient anxiety.
• Proper hand hygiene - plays a major role in infection control by protecting the phlebotomist, patient, and

  others from contamination. Gloves are sometimes put on at this point. Follow facility protocol.
• clenched fist - makes the veins easier to see and feel and helps keep them from rolling.
• median cubital - is the first choice, followed by the cephalic.
• basilic should not be chosen unless no other vein is more prominent in either arm. Releasing the tourniquet and opening the fist helps prevent hemoconcentration
• Warn the patient. Line the needle up with the vein and insert it into the skin using a smooth forward motion. Stop when you feel a decrease in resistance, often described as a "pop," and press your fingers into the arm to anchor the holder.
• Materials such as needle caps and wrappers are normally discarded in the regular trash. Some facilities require that contaminated items such as blood-soaked gauze be discarded in biohazard containers
• pneumatic tube system


  Prompt delivery to the lab protects specimen integrity and is typically achieved by personal delivery, transportation via a ___________, or by a courier service.
• winged infusion set


  A phlebotomist may elect to use a ______ (butterfly) in attempting to draw blood from antecubital veins of infants and small children or from difficult adult veins, such as small antecubital veins or wrist and hand veins.
• butterfly needle


  (i.e., 23 gauge) is appropriate in these situations because it is less likely to collapse or "blow" (rupture) the vein. A butterfly can be used with an ETS tube holder or a syringe
• Small-volume tubes


  should be chosen when a butterfly is used with an ETS holder because the vacuum of large tubes may collapse the vein or hemolyze the specimen.
• 10 and 15 degrees


  Insert the needle into the vein at a shallow angle between _______ . A "flash" or small amount of blood will appear in the tubing when the needle is in the vein.
• "Seat"


  the needle by slightly threading it within the lumen of the vein to keep it from twisting back out of the vein if you let go of it.
• evacuated tube method


  The preferred method of obtaining venipuncture specimens is the
• clot


  If the syringe fills too slowly, however, there is the possibility that the specimen will begin to ___ either before enough blood is collected or before it can be transferred to the appropriate tubes.
• special syringe transfer device


  is required to safely transfer blood from the syringe into the ETS tubes.
• butterfly or syringe


  If the patient's veins are small or fragile, it may be necessary to use a _____ on the second attempt.
• transfer device


  greatly reduces the chance of accidental needlesticks and confines any aerosol or spraying that may be generated as the tube is removed.
• hemolyze


  Forcing blood into a tube by pushing the plunger can____ the specimen or cause the tube

  stopper to pop off, splashing tube contents.
• arterial puncture


  should not be used as an alternative to venipuncture on difficult veins. If it appears to be the only choice, the patient's physician should be consulted first
• notify the patient's nurse or physician


  Whatever the reason, if the specimen cannot be obtained, _______. You may be required to fill out a form stating that the specimen was not obtained and the reason why.
• • Phlebotomist attempted but was unable to draw blood.

  • Patient refused to have blood drawn.

  • Patient was unavailable.

  The following are the most common and generally accepted reasons for inability to obtain a specimen:
• antecubital fossa and forearm


  the most accessible veins of infants and toddlers are the veins of the
• Capillary collection


  is normally recommended for pediatric patients, especially newborns and infants up to 12 months, because their veins are small and not well developed and there is a considerable risk of permanent damage.
• anemia


  Removal of large quantities of blood at once or even small quantities on a regular basis, as is often the case when an infant or child is in intensive care, can lead to
• shock and cardiac arrest.


  Removing more than 10% of an infant's blood volume at one time can lead to
• phlebotomy-induced anemia.


  The CLSI recommends that procedures be in place to monitor amounts of blood drawn from pediatric, geriatric, and other vulnerable patients to avoid
• eutectic mixture of local anesthetics (EMLA)


  Interventions to ease pain include the use of a p _______ (easily melted) ___________ for newborns through adults and oral sucrose and pacifiers for infants and toddlers.
• EMLA


  is a topical anesthetic containing lidocaine and prilocaine; it can be applied to intact skin by a nurse or physician.

  It is available in a cream that must be covered with a clear dressing or a patch after application. It takes approximately 1 hour (a major drawback to its use) for it to anesthetize the area to a depth of approximately 5 mm.
• 12% to 24% solution of oral sucrose


  has been shown to reduce the pain of procedures such as heel puncture and venipuncture in infants up to 6 months of age.
• 24% solu- tion of sucrose


  (prepared by mixing 4 teaspoons of water with 1 teaspoon of sugar) can be administered by dropper, nipple, oral syringe, or on a pacifier provided that it will not interfere with the tests to be collected or diet restrictions.
• sucrose


  must be given to the infant 2 minutes before the procedure, and its pain-relieving benefits last for approximately 5 minutes.

  
  

  Studies have shown that infants given sucrose or even a regular pacifier by itself cry for a shorter time and are more alert and less fussy after the procedure.
• Immobilization of the patient


  is a critical aspect in obtaining an adequate specimen from infants and children while ensuring their safety.
• physical restraint


  A newborn or young infant can be wrapped in a blanket, but______ is often required for older infants, toddlers, and younger children.
• Geriatric


  means relating to old age.
• Skin changes


  include loss of collagen and subcutaneous fat, resulting in wrinkled, sagging, thin skin with a decreased ability to stay adequately hydrated.
• Lack of hydration along with impaired peripheral circulation


  caused by age-related narrowing of blood vessels make it harder to obtain adequate blood flow, especially during skin puncture.

  
  

  In addition, aging skin cells are replaced more slowly, causing the skin to lose elasticity and increasing the likelihood of injury.