URINALYSIS EXAM 1: PHLEB | GUARANTEED
SUCCESS STARTS HERE! LEARN, PRACTICE &
EXCEL!
Describe reasons for acquiring capillary blood specimens Answer: - Burned or scarred
patients
- Patients receiving chemotherapy who require frequent tests & and whose veins must be
reserved for therapy
- Patients with thrombotic (bleeding) tendencies
- Geriatric or other patients with very fragile veins
- Patients requiring glucose monitoring & point of care tests
- Babies or young children
-extremely obese patients
why would you do capillary collection Answer: collect blood by skin puncture if veins:
- are difficult to access
- if a small blood sample is required
Skin puncture is performed on infants and children when venipuncture is hazardous or
could result in anemia.
what test require skin puncture? Answer: Tests that require skin puncture:
- PKU or neonatal screening
- point of care testing (POC)
- infant bilirubin and CBCs, etc
Identify the proper sites for performing a skin (dermal) puncture procedure:
1. Answer: a. Heel
· Infant < 1 years old
· Collection site: Medial and lateral plantar (bottom) surface
· Max depth of 2.0 mm
APPHIA – Crafted with Care and Precision for Academic Excellence.
1
,· Do not use the back of the heel or arch of area
Identify the proper sites for performing a skin puncture procedure:
2. Answer: b. Finger
· 3rd and 4th fingertips palmer side of non-dominant hand
· Collection site: Fleshy area/center
depth of skin puncture: 1.75 to 3 mm for adults and 1.25mm for children
Explain why capillary blood from a skin puncture is different from blood taken by
venipuncture Answer: blood from dermal puncture is from capillaries, arterioles, and
venules
--not from veins
does not contain veinous blood
-can sometimes contain tissue fluid
capillary blood impact on lab tests Answer: Capillary blood is more arterial
--has higher oxygen and glucose levels than venous blood and
--lower levels of other components, such as calcium, potassium and total proteins.
--more tissue (interstitial fluid); potassium results may be falsely evaluated if there is
excess tissue or hemolysis
why it is necessary to control the depth of the incision in capillary blood collection Answer:
to minimize infection and inflammation
making too deep a puncture or puncturing in the wrong place can cause injury to the bone
such as:
osteomyelitis - bone inflammation due to infection
osteochondritis - inflammation of the bone & cartilage
calcified nodules
Other common puncture mistakes can cause:
infection
abscesses
cellulitis
APPHIA – Crafted with Care and Precision for Academic Excellence.
2
,an increased risk of blood exposure
Identify the names and locations of the veins suitable for phlebotomy:
1.
2.
3. Answer: 1. Median cubital vein
· First choice
· In the middle
2. Cephalic vein
· Second choice
· Runs down the thumb
3. Basilic vein
· Last choice
· Runs down the pinky
· Very close to the arteries and veins
What degree should you insert the needle: Answer: 15-30 degree angle
Explain procedural errors and discuss remedies for each Answer: 1. Defective evacuated
tube (vacuum is depleted, exp tube or crack)
2. improperly positioned needle
3. missing the vein
4. tourniquet not on right or on for too long
5. failure to collect on first try
Procedural errors and discuss remedies for each Answer: Lack of blood flow:
1. Defective tube:
- remove and replace with a new tube
2. Improperly positioned needle:
- bevel is stuck to the vein wall
- needle passed through both sides of the vein
- needle is not advanced enough into the vein
APPHIA – Crafted with Care and Precision for Academic Excellence.
3
, 3. the vein was missed completely: take out needle, palpate vein and insert the needle
again
4. tourniquet not on right or on for too long:
- take it off and retry. Do not leave it on longer than 1 minute
5. failure to collect on first try:
- A second attempt is acceptable
- A new needle and tube must be used
- For the second try, go below the previous site or use the other arm
2. Improperly positioned needle:
what to do when:
bevel is stuck to vein wall:
needle passed through both sides of the vein:
needle is not advanced enough into the vein:
the vein was missed completely: Answer: 2. Improperly positioned needle:
- bevel is stuck to the vein wall: rotate the needle until blood flows
- needle passed through both sides of the vein: slightly pulled back on the needle until
blood flows
- needle is not advanced enough into the vein: slowly advance the needle slowly into the
vein until blood flows
- the vein was missed completely: take out needle, palpate vein and insert the needle again
what are suboptimal specimens?
what are examples? Answer: Suboptimal specimens refer to blood or other biological
samples that do not meet the quality standards required for accurate laboratory test
results.
1. hemolyzed specimens
2. lipemic specimens- high conc. of fats
3. clotted specimens
4. insufficient volume (partially filled tube)
APPHIA – Crafted with Care and Precision for Academic Excellence.
4
SUCCESS STARTS HERE! LEARN, PRACTICE &
EXCEL!
Describe reasons for acquiring capillary blood specimens Answer: - Burned or scarred
patients
- Patients receiving chemotherapy who require frequent tests & and whose veins must be
reserved for therapy
- Patients with thrombotic (bleeding) tendencies
- Geriatric or other patients with very fragile veins
- Patients requiring glucose monitoring & point of care tests
- Babies or young children
-extremely obese patients
why would you do capillary collection Answer: collect blood by skin puncture if veins:
- are difficult to access
- if a small blood sample is required
Skin puncture is performed on infants and children when venipuncture is hazardous or
could result in anemia.
what test require skin puncture? Answer: Tests that require skin puncture:
- PKU or neonatal screening
- point of care testing (POC)
- infant bilirubin and CBCs, etc
Identify the proper sites for performing a skin (dermal) puncture procedure:
1. Answer: a. Heel
· Infant < 1 years old
· Collection site: Medial and lateral plantar (bottom) surface
· Max depth of 2.0 mm
APPHIA – Crafted with Care and Precision for Academic Excellence.
1
,· Do not use the back of the heel or arch of area
Identify the proper sites for performing a skin puncture procedure:
2. Answer: b. Finger
· 3rd and 4th fingertips palmer side of non-dominant hand
· Collection site: Fleshy area/center
depth of skin puncture: 1.75 to 3 mm for adults and 1.25mm for children
Explain why capillary blood from a skin puncture is different from blood taken by
venipuncture Answer: blood from dermal puncture is from capillaries, arterioles, and
venules
--not from veins
does not contain veinous blood
-can sometimes contain tissue fluid
capillary blood impact on lab tests Answer: Capillary blood is more arterial
--has higher oxygen and glucose levels than venous blood and
--lower levels of other components, such as calcium, potassium and total proteins.
--more tissue (interstitial fluid); potassium results may be falsely evaluated if there is
excess tissue or hemolysis
why it is necessary to control the depth of the incision in capillary blood collection Answer:
to minimize infection and inflammation
making too deep a puncture or puncturing in the wrong place can cause injury to the bone
such as:
osteomyelitis - bone inflammation due to infection
osteochondritis - inflammation of the bone & cartilage
calcified nodules
Other common puncture mistakes can cause:
infection
abscesses
cellulitis
APPHIA – Crafted with Care and Precision for Academic Excellence.
2
,an increased risk of blood exposure
Identify the names and locations of the veins suitable for phlebotomy:
1.
2.
3. Answer: 1. Median cubital vein
· First choice
· In the middle
2. Cephalic vein
· Second choice
· Runs down the thumb
3. Basilic vein
· Last choice
· Runs down the pinky
· Very close to the arteries and veins
What degree should you insert the needle: Answer: 15-30 degree angle
Explain procedural errors and discuss remedies for each Answer: 1. Defective evacuated
tube (vacuum is depleted, exp tube or crack)
2. improperly positioned needle
3. missing the vein
4. tourniquet not on right or on for too long
5. failure to collect on first try
Procedural errors and discuss remedies for each Answer: Lack of blood flow:
1. Defective tube:
- remove and replace with a new tube
2. Improperly positioned needle:
- bevel is stuck to the vein wall
- needle passed through both sides of the vein
- needle is not advanced enough into the vein
APPHIA – Crafted with Care and Precision for Academic Excellence.
3
, 3. the vein was missed completely: take out needle, palpate vein and insert the needle
again
4. tourniquet not on right or on for too long:
- take it off and retry. Do not leave it on longer than 1 minute
5. failure to collect on first try:
- A second attempt is acceptable
- A new needle and tube must be used
- For the second try, go below the previous site or use the other arm
2. Improperly positioned needle:
what to do when:
bevel is stuck to vein wall:
needle passed through both sides of the vein:
needle is not advanced enough into the vein:
the vein was missed completely: Answer: 2. Improperly positioned needle:
- bevel is stuck to the vein wall: rotate the needle until blood flows
- needle passed through both sides of the vein: slightly pulled back on the needle until
blood flows
- needle is not advanced enough into the vein: slowly advance the needle slowly into the
vein until blood flows
- the vein was missed completely: take out needle, palpate vein and insert the needle again
what are suboptimal specimens?
what are examples? Answer: Suboptimal specimens refer to blood or other biological
samples that do not meet the quality standards required for accurate laboratory test
results.
1. hemolyzed specimens
2. lipemic specimens- high conc. of fats
3. clotted specimens
4. insufficient volume (partially filled tube)
APPHIA – Crafted with Care and Precision for Academic Excellence.
4
