Chapter 9 and 10 Case Studies Questions With Complete Solutions.

Charles is a phlebotomist who works in the positions office laboratory. One morning shortly after the drawing station opens he is asked to collect blood specimens for a CBC and a glucose test from a very heavyset woman who appears quite ill. The patient tell Charles that she vomited all night and was unable to eat or drink anything. She also mentions that she has had a mastectomy on the left side and the last time she had blood collected she was stuck numerous times before the phlebotomist was able to collect a specimen. - What physiological variables may be associated with the collection of the specimen and how should they be dealt with? - Physiological variables associated with this collection site include the following: the patient is ill and may be dehydrated from vomiting, she is overweight, she has had a mastectomy on the left side, and she is normally a difficult draw. Charles will be limited to drawing from the right arm. He will most likely need to draw the specimen using a butterfly and and the smallest tubes available. He should check the cephalic vein if he does not find another suitable antecubital vein. He may have to draw from a vein in the right hand, and he may have to warm the site to enhance blood flow. Because it is a physician office laboratory, he should check with the patient's physician to see if it is advisable to offer the patient water, because she is probably dehydrated. Dehydration would make it even more difficult to find a vein. What complications might Charles expect and how should he prepare for them? - Because the patient appears ill, she should be asked to lie down to prevent her from fainting during specimen collection. An emesis basin or wastebasket should be close at hand in case she vomits. How to Charles go about selecting the blood collection site? - Charles should check the antecubital area of the right arm first, paying particular attention to the area of the cephalic vein if the median cubital veins not palpable. If not suitable vein is found, he should check for a hand vein on the right arm, followed by veins on the right dorsal wrist and forearm. He should never consider using veins on the underside (ventral or palmar area) of the wrist or forearm. What options does Charles have if he is unable to collect a proper venipuncture site? - If Charles is unable to find a proper venipuncture site, he should consider capillary puncture. Both the CBC and glucose specimens can be easily collected by capillary puncture. The site will have to be warmed to enhance blood flow because the patient may be dehydrated. A phlebotomist name Sarah is in the process of collecting a pro time and CBC from a patient. The needle is in the patients vein. As Sarah pushes the first tube onto the needle in the tube holder, there is a spurtof blood into the tube and she hears a hissing sound. Then the blood stops flowing. She re -position the needle but is not able to reestablish blood flow. -