Phlebotomy - Specimen Collection And Complications

Front 1

List 3 types of blood collection

Back 1

Capillary/Fingerstick

Arterial

Venous

Front 2

Describe capillary/fingerstick draw

Back 2

• Flows slowly and evenly due to low pressure and small size of capillaries
• Easily controlled
• Color between that of arterial & venous blood

Front 3

Describe arterial blood draw

Back 3

• Blood is bright red
• Blood will be pulsing noticeably
• blood flow harder to control, requires assistance
• Patient must be monitored until bleeding stops

Front 4

Describe venous blood draw

Back 4

• Blood is dark red
• blood flow is steady
• Blood flow is easily controlled and stopped with gentle pressure

Front 5

Define Hemoconcentration

Back 5

Increase in red blood cells and other cells and solids in the blood resulting from loss of fluid in the surrounding tissue of the venipuncture site

Can be caused by prolonged tourniquet use, massaging or squeezing site, long-term IV therapy, or occluded veins

Front 6

What should a specimen label include?

Back 6

• Patient's full name
• Identifying number (admission #, medical record #, etc)
• Date of collection
• Time of collection
• Initials of the health care worker who collects
• Optional: patient room number, bed assignment, outpatient status

Front 7

List some things that can affect specimen integrity

Back 7

• Method of transport
• timing delays
• temperature
• movement/agitation
• light exposure (for bilirubin)
• centrifugation methods

Front 8

List some reasons for rejecting a sample

Back 8

• Test request doesn't match label(s)
• Label is unreadable, destroyed, missing
• Anticoagulated tube has clotted
• Excessive delays
• Hemolyzed, lipemic, or icteric samples
• Improper transport or storage
• Improper volume in tube
• Patient Non-fasting (for tests requiring fasting)
• Expired supplies
• Patient's posture (affect on analyte)
• timed specimens drawn at wrong time
• contamination

Front 9

Plasma specimen vs. Serum specimen

Back 9

Plasma

contains anticoagulant, unclotted cellular components collect at bottom of tube, liquid portion (plasma) is straw colored. Will be layered in tube from top to bottom: plasma, buffy coat, RBCs

Serum

does not have anticoagulants, cellular components from clot at tube bottom, liquid portion (serum) is clear or straw colored. Will be layered in tube from top to bottom: serum, serum separator gel, blot clot.

Front 10

Problems associated with specimen processing?

Back 10

• Hemolyzed specimens
• Icteric specimens
• Lipemic specimens
• Buffy coats/increased cell counts

Front 11

Hemolyzed specimens - describe

Back 11

Results when RBCs are lysed, releasing hemoglobin. Serum or plasma will become pink or red.

Front 12

Hemolyzed specimens - cause?

Back 12

• Improper phlebotomy techniques (needle too small, expelling blood vigorously into tube, shaking tube, performing blood draw before alcohol has dried @ collection site, pulling syringe plunger too fast)
• Physiological abnormalities
• Infection (extreme septicemia)

Front 13

Problems caused by hemolyzed specimen?

Back 13

• Frequently falsely increases results for analytes
• Increased potassium or liver enzymes detected
• Falsely increased RBC count, hemoglobin, and hematocrit
• Interferes with photometric analysis

Front 14

Lipemic specimen - describe

Back 14

Increase of fats or lipids in serum or plasma

Sample will be hazy, opaque, or milky white

Front 15

Problems caused by lipemic specimen?

Back 15

• Interfere with photometric analysis
• Solution: sample can be diluted or ultrafuged for testing

Front 16

Causes of lipemic specimen?

Back 16

• Post prandial draw (after meal)
• abnormal/chronic production of lipids and fats

Front 17

Icteric specimens - describe

Back 17

Increased bile pigments, bilirubin. Causes sample to turn deep yellow, brown or green.

Front 18

Causes of icteric specimens?

Back 18

Most commonly due to hepatitis

Front 19

Problems caused by icteric specimens?

Back 19

Color interferes with photometric analysis

Front 20

Buffy coat excess - explain

Back 20

Increase of WBCs can lead to thickened buffy coat, can interfere with analysis.

Dilute sample for testing

Front 21

Anterior forearm veins for venipuncure?

Back 21

1) median cubital

2) cephalic

2) basilic