PMLS LAB EXAM 3

• ESR - Detect inflammation; identify collagen vascular diseases
• SPEP, IPEP - Identify protein or immune globulin disorders that lead to nerve damage
• VDRL/FTA - Diagnose or rule out syphilis, which can cause nerve damage and dementia
• 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, andothers 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
• Prompt delivery to the lab protects specimen integrity and is typically achieved by personal delivery, transportation via a pneumatic tube system, or by a courier service.
• A phlebotomist may elect to use a winged infusion set(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.
• Insert the needle into the vein at a shallow angle between 10 and 15 degrees. 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.
• The preferred method of obtaining venipuncture specimens is the evacuated tube method
• If the syringe fills too slowly, however, there is the possibility that the specimen will begin to clot 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.
• If the patient's veins are small or fragile, it may be necessary to use a butterfly or syringe 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.
• Forcing blood into a tube by pushing the plunger can hemolyze 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
• Whatever the reason, if the specimen cannot be obtained, notify the patient's nurse or physician. You may be required to fill out a form stating that the specimen was not obtained and the reason why.
• The following are the most common and generally accepted reasons for inability to obtain a specimen: • Phlebotomist attempted but was unable to draw blood.• Patient refused to have blood drawn.• Patient was unavailable.
• the most accessible veins of infants and toddlers are the veins of the antecubital fossa and forearm
• 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/
• 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 anemia
• Removing more than 10% of an infant's blood volume at one time can lead to shock and cardiac arrest.
• The CLSI recommends that procedures be in place to monitor amounts of blood drawn from pediatric, geriatric, and other vulnerable patients to avoid phlebotomy-induced anemia.
• Interventions to ease pain include the use of a eutectic mixture of local anesthetics (EMLA)(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% solution 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.
• A newborn or young infant can be wrapped in a blanket, but physical restraint is often required for older infants, toddlers, and younger children.
• Geriatric - means relating to old age.