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116 Cards in this Set
- Front
- Back
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What is the definition for universal precautions?
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The treating of all human blood, body fluids, and tissues as if they were infectious
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What safety practices are required by OSHA in the lab?
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Hand washing.
No eating or drinking. No mouth pipetting. Sharp objects, like needles and slides, must be thrown away in a sharp's container. You must wear protective clothing, no open toed shoes. |
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What are some of the hazards of working in a Medical Laboratory?
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Fire.
Chemical hazards. Electrical hazards. Needle punctures. |
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If you had to make your own cleaner for the lab, how much bleach would you need?
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10%, or one part in every 10.
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What does MSDS mean?
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Material Safety Data Sheet.
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In case of fire, what procedure should you follow? (Hint: RACE)
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Rescue Alarm Close Extinguish
RACE |
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What does PPE stand for?
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Personal protection equipment.
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Name some examples of personal protection equipment.
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Close toe shoes
Lab coat Gloves |
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What does HPV stand for?
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Hepatitis B vaccine.
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What are some procedures to follow in the interest of infection control?
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Take lab coat off when leaving the lab.
Remove gloves when leaving the lab. Wash hands. Clean your work area. Good hygiene. |
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What are the 3 basic components of whole blood?
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Erythrocites (red blood cells, or RBCs)
Leukocytes (white blood cells, or WBCs) Platelets |
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How is blood plasma different from blood serum?
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Blood plasma will clot and contains fibrinogen.
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What are the 3 layers of a blood specimen?
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Plasma (top layer)
Buffy coat Red Blood Cells |
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What parts of whole blood can be found in the buffy coat?
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White blood cells
Platelets |
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What color are normal plasma and serum?
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Pale yellow
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When does hemolysis occur?
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Hemolysis occurs is the rupturing of erythrocytes (red blood cells) and the release their contents (hemoglobin) into surrounding fluid (e.g., blood plasma).
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What color is hemolized blood?
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Pink-red
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What are icteric blood specimens?
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They have increased bilirubin.
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What is bilirubin?
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Bilirubin is the yellow breakdown product of normal heme catabolism. Heme is found in hemoglobin, a principal component of red blood cells. Bilirubin is excreted in bile and urine, and elevated levels may indicate certain diseases. It is responsible for the yellow color of bruises, the yellow color of urine (via its reduced breakdown product, urobilin), the brown color of faeces (via its conversion to stercobilin), and the yellow discoloration in jaundice.
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What do icteric blood specimens look like?
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They appear dark yellow.
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What do lipemic blood specimens look like?
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They are milky yellow.
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What makes a blood specimen lipemic?
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Increased lipids.
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What equipment is used during venipuncture (phlebotomy)?
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Evacuated tubes
Antiglycolytic Anticoagulant Clot activator Separator gel Needles and holders – 22 or 21 gauge Tourniquet Syringes and butterflies Solutions for skin preparation – 70 % isopropyl or betadine |
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What is the most important step in the process of drawing blood?
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Confirming the patients ID.
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What are the 3 basic parts of an evacuated tube's design for drawing blood?
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Sterile multipurpose needle
A holder (where the Vacutainer tube goes) An evacuated glass or plastic tube, such as a Vacutainer. |
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What are the 6 parts of an evacuated tube needle?
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From top to bottom, they are:
Point Bevel Shaft Hub Stopper (puncturing end) Sheath |
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What are the 4 parts of the adapter, or holder?
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Needle
Tube advancement mark Rubber sleeve Adapter |
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Name 4 types of tourniquets.
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Flat latex strips
Velcro/buckle closures Rubber tubing Blood pressure cuffs |
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Why do we use tourniquets when drawing blood?
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They make it easier to find veins to draw blood. They also reduce the chance of bruising.
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What are the 6 basic colors of evacuated tubes we will use to draw blood?
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Lavender, Light Blue, Green, Gray, Yellow, Red (LYLGRG-"Lil-grig")
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What does the lavender tube have and what is it used for?
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It has EDTA. It is used for Hematology.
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What is EDTA?
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An anticoagulant.
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What does the light blue tube have and what is it used for?
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It has sodium citrate. It is used for coagulation.
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What does the green tube have and what is it used for?
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It has Heparin. It is used for chemistry and some hematology.
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What is the grey tube and what is it used for?
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It has K oxalate/NaF. It is used for glucose assays.
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What is the yellow tube used for and what does it have?
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It has SST (serum separator tube).
It is used for chemistry. |
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What does the red tube have and what is it used for?
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The red tube has no additives. It is used for chemistry.
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What are 3 types of anticoagulants that use calcium binding?
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EDTA
Sodium citrate Potassium/ammonium oxalate |
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What are 4 types of anticoagulants that use thrombin inhibition?
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Heparin
Sodium Ammonium Lithium (SHAL) |
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What are 4 things you should know about patient ID?
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Checking patient ID is the most important step in the process of drawing blood.
Always compare the information their ID bands against the requisition. These must be worn by the patient. Do not trust room and bed signs. |
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What are 4 things you should in preparing a patient for a blood draw?
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Reassure the patient.
Explain the procedure to the patient. Do not explain the test that will be performed with the sample. Do not tell them the procedure is painless. |
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Name 4 pretest conditions you should check for.
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Fasting
Is the patient on any medications? Ask about activities they may have performed prior to having blood drawn. Look for unusual conditions. (Fasting, medication, activities, unusual conditions) |
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What are the 2 biggest things to look for when positioning a patient to have their blood drawn?
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Make sure the patient's location is convenient and comfortable.
Make sure all safety precautions are in place. |
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What the 3 basic safety precautions you should take when positioning a patient for a blood draw?
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Patient is sitting or lying down.
Remove any objects from patient's mouth. Be alert for signs of fainting (syncope). |
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What are 3 things to look for regarding convenience of patient positioning when drawing blood?
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Place a pillow under the patient's arm.
Place a fist under the patient's elbow. Make sure the arm is at a downward angle to prevent reflux. |
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What are the 8 basic pieces of equipment you need on hand when drawing blood?
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Antiseptic pads.
Gauze. Bandage. Needle disposal system (Sharps) Exam requisition form. Form should tell you the number and type of tubes you should be using. Extra tubes in case of loss of vacuum. Attach needle to the adapter. |
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Name 5 steps you should know when applying a tourniquet to a patient for blood draw?
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Maximum time it can stay on is 1 minute.
Apply it for site selection (makes veins stand out more) Release for 2 minutes Then reapply the tourniquet Release tourniquet once blood flows into tube |
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Three things you should know about selecting the proper site for applying a tourniquet are ?
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Apply tourniquet 3-4 inches above site of blood draw.
Avoid or cover arms with skin conditions. Avoid arms on the side of a mastectomy. |
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What are the 3 preferred veins for drawing blood from the arm?
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Cephalic vein
Basilic vein Median cubital vein |
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What are 3 alternate sites to drawing blood from the antecubital region?
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Wrist
Hand Feet |
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Name 2 reasons why it might be preferable to draw blood from the foot than the elbow?
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Diabetes
Thrombotic prone (blood clots easily) |
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Six things to know about palpation:
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Feeling (more important than site)
Probe with middle and index fingers Push, don't stroke Wear gloves Determine size, depth, and direction of vein Veins are spongy - tendons are rigid, arteries have a pulse |
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Two things to remember when you're having trouble finding a vein are ?
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Check both arms
Listen to patient suggestions |
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What should you remember about a patient receiving intravenous fluids?
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Use other arm for blood draw if possible.
Avoid sites of previous IVs for 24-48 hours. If you have to get blood draw on same arm as an IV, note it on requisition. Try to select a site below the infusion or use a different vein. |
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What should you use when cleaning a site for blood draw?
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70% isopropyl alcohol
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How should you wipe the site for a blood draw?
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Using a circular motion cleanse from inside to outside.
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What are 5 things to remember about cleaning the site of a blood draw?
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Apply 70% isopropyl alcohol using a circular motion cleanse from inside to outside,
Allow to air dry, 30–60 seconds will give maximum bacteriostatic action Avoid wiping off with gauze Failure to let alcohol dry causes a stinging sensation for patient Specimen hemolysis |
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What 3 situations make using a butterfly to draw blood?
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IV fluid infusion
Very small adult veins Pediatric specimens |
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Three things to remember when actually inserting the needle are ?
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The bevel faces up.
Insert needle at a 15-30 degree angle. Resistance lessens when needle enters the vein. |
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What are 2 ways of preventing needle movement?
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Brace the hand holding the adapter against the patient's arm.
Gently twist tubes on and off the needle. |
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Three steps to remember when withdrawing the needle.
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Remove tourniquet before removing the needle.
Patient may relax his fist. Apply pressure with gauze while withdrawing the needle. |
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Three things to remember about applying pressure are ?
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Capable patients can apply pressure to site themselves.
Arm should be raised and outstretched, not bent. Apply pressure to the site yourself if needed. |
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Three things to remember about disposing of needles?
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Dispose of needle as soon as possible after blood draw.
Put in the sharps container. Never bend, cut, or recap the needle. |
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Three things to remember about labeling tubes after a blood draw are ?
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Label the tube before leaving the patient.
Use a pen. Verify information on preprinted labels. |
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What are the 4 things that need to be on a tube's label after drawing blood?
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Patients name and ID number.
Date and time of collection. Collector's initials. Blood bank ID and any additional information. |
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You should do the following 4 steps when bandaging a patient's arm.
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Check the arm before you bandage it.
Apply bandage over gauze for extra pressure. Tell the patient to avoid carrying heavy objects. Tell patient to remove bandage within one hour. |
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Name 7 problems that may occur when performing a venipuncture.
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Hemolysis (damaged blood cells)
Burned or scarred tissue may prevent venipuncture. Seizures or tremors may result. Vomiting or choking may occur. Allergies may affect the procedure. Mastectomy patients (especially if they've had a double mastectomy) Inability to obtain a specimen |
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Name 6 factors that may affect venipuncture results.
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Posture
Diurnal rhythm Exercise Stress Diet Smoking |
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Eight reasons for specimen rejection are ?
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The requisition and ID do not match.
The tube is unlabeled or labeled incorrectly. Hemolysis Wrong time to collect specimen Wrong tube for specimen Blood was clotted when test required whole blood Contaminated with intravenous fluid Lipemic specimen |
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What are 3 legal issues to remember about drawing blood?
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Avoid breaching patient confidentiality
Patient mis-ID Ways to minimize risk of legal action |
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What makes a compound microscope a compound microscope?
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It has two lens systems, whereas a simple microscope only has one.
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What are the 2 lens components of a compound microscope?
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Oculars
Objectives |
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What are the parts and functions of the microscope (from the Chapter 4 sheet)?
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Eyepieces or oculars
Interpupilary control Optical tube Neck or arm Stand Nosepiece with objectives |
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What level of magnification is used for scanning?
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4x
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What is low power on a microscope?
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10x
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What is high power when the slide is dry?
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40x
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What magnification is used with oil?
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50x or 100x (ours uses 100x)
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What are chromatic aberrations?
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concentric rings of color near the periphery of the lens
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What are spheric aberrations?
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light waves travel through the varying thickness of the lens, blurring the image
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What does a Achromatic or Plan-achromatic Lens do?
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Planachromatic corrects for curvature, giving a flat filed of view.
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What does it mean when a microscope has a parfocal lens?
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It has a set of lenses with corresponding focal points all in the same plane
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What is the advantage of parfocal lenses?
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You don't have to make as much of an adjustment to keep it in focus when changing objectives.
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How should you carry a microscope?
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With two hands. One of the base (bottom) and one on the arm.
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What are the 2 kinds of focus controls on a microscope?
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Coarse and fine adjustment
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What does the condenser on a microscope do?
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organizes and directs the incoming light
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What light sources do our microscopes use?
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Tungsten-halogen bulb
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What does parcentric mean?
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the ability to center a cell in question in the microscopic field, rotating from one magnification to another.
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T or F: You can use oil immersion with 40x power objectives.
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False. Oil immersion should only be used with the 100x objectives on our microscopes.
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Why do we use immersion oil?
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Purpose-to increase the refractive index. In other words, it makes the image sharper and lets in more light.
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What are the 3 types of immersion oil?
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Type A- very low viscosity, fluor., darkfield
Type B- high viscosity, brightfield Type C –very high viscosity special applications |
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Why should you move the 100x objective from left to right after immersing it in oil?
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To eliminate bubbles.
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What are the 4 types of microscopes used in the clinical lab field?
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Light Microscopes
Phase-Contrast Microscopes Polarized Light Microscopes Darkfield Microscopes |
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What is quality control?
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control of the testing process to ensure that the test results meet the quality needs
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What is a standard regarding quality control?
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A highly purified material of known composition which can be used as a reference or calibration solution for a method of analysis
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What is a primary standard?
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Reference material that has a fixed and known composition (values)
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What is a secondary standard?
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reference material in which the analyte concentration has been proven by the use of a primary standard
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What is a calibrator?
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A calibrator is a preserved human or artificial cell suspension whose parameters have been determined by multiple reference labs.
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What is accuracy?
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The closeness of the test value to the true result
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What is precision?
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The closeness of obtained values to each other
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What are some examples of quality control and assurance?
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Making sure patient has fasted. Making sure tubes are properly labeled. Washing hands. These avoid pre-analytical problems.
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What are delta checks?
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Comparing the results from the analysis of a sample with the result from the previous sample for the same analyte. Checks precision and accuracy.
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Name 4 reference intervals?
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Range of values for an analyte in healthy persons.
Each lab should define their own “normal range” Age intervals Normal range should be determined with a significant number of patients |
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What is a mean?
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the average value of a sample or set of values.
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What is a standard deviation?
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The S.D. is a measurement of the variation of any single result (value) from the mean or the spread of any obtained value from the mean. To determine the standard deviation (S.D. or s) one must first get the variance (s2) of a sample:
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What is a Gaussian curve?
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When a sample of values is plotted on a graph, the distribution of the value around the mean forms a Gaussian curve.
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What is the coefficient of variation?
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The coefficient of variation is the calculated value, which is used to compare the relative variability between two different sets of values. The comparison can be made by expressing each standard deviation as a percentage of the mean
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What are systematic errors?
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Errors within the test system or method; calibration, components, failure to perform accurately or precisely.
These errors are constant or rise in proportionality over time. |
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What are random errors?
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Mistakes that occur without prediction or regularity, due to instability of the instrument, temperature change, operator problems.
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What is a shift on the Levie Jennings control chart?
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When the control values suddenly move above or below the mean on a consistent basis over six days
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What is a trend on the Levie Jennings control chart?
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Control value will consistently increase or decrease during the time which is covered by a quality control chart
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What is the 1-2s rule of Westgard Analysis?
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12s Rule control values is outside 2s limit. Possible error of instrument or method malfunction.
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What is the 1-3s rule of the Westgard Analysis?
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13s Rule control values is outside 2s limit. Possible error of instrument or method malfunction
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What is the 2-2s rule of Westgard Analysis?
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22s Rule investigate as out of control
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What is the R-4s rule of Westgard Analysis?
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R4s Rule two consecutive values are more than 4s apart involving both control materials. One control is beyond the +2 limit and the other beyond the –2 limit. Investigate
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What is the 4-1s rule of Westgard Analysis?
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41s Rule four consecutive values have been plotted on the same side of the 1s range. Maybe within range. Indicates shift or trend in the analytic process
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What is the 10x rule of Westgard Analysis?
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10x Rule 10 consecutive values fall on the same side of the mean either within the same control or across both controls, shift
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