CCMA Phlebotomy Review (NHA) Questions and Answers

CCMA Phlebotomy Review (NHA) Questions and Answers Requisition form for ALL patients having blood drawn must have: name of physician who ordered it pt. name: first, middle initial, last pt. DOB type of test date of test test status (ex. fasting, timed) special precautions (ex. latex allergy) Requisition form for inpatient blood draw must also have: room #, bed #, id # Requisition for for outpatient blood draw must also have: billing information and ICD9 codes What are the 3 veins acceptable for blood draws in adults? Median cubital, Basilic, Cephalic If you can't access the Median Cubital, Basilic or Cephalic veins, what should use next in adult patients? Dorsal part of hand Site of blood draws in patients 1 y/o scalp, wrists, medial ankle Site of capillary collection in patients 2+ y/o side of middle or ring finger Site of capillary collection in patients 1 y/o medial or lateral plantar portions of heel If a patient has been fasting for the blood draw, the question you must ask is: "When was the last time you ate or drank anything other than water?" If it's a basal state blood draw, the questions you must ask are: "When was the last time you exercised? And when was the last time you ate or drank anything other than water?" If a patient has eaten or had anything to drink before having blood drawn and the Doctor decides to go ahead with blood draw, what must you note on the pt.'s requisition form? Pt. non-compliant Equipent needed to draw blood: gloves, isopropyl alcohol swabs, gauze pads, bandages, tourniquet, needles, blood collection tubes Which needle is best for smaller veins? Winged infusion or butterfly A vacutainer is what type of sterile needle? Double-ended; one end has protective cap and the other has a rubber sheath What is the order of the draw for venipuncture? LIGHT BLUE (Sodium Citrate) RED (non-additive) GREEN (Heparin) LAVENDER (EDTA), GRAY (Potassium oxalate) What is the order for capillary collection? EDTA additive (lavender) , other additive, serum tubes (red) Red-stopper tubes are used for: blood that needs to clot tests: serum, chemistry or immunological Gold, black or red tiger speckled ("tiger") colored stoppers: gel separator, clot activator tests: chemistry and immunological Light blue-colored stoppers additive Sodium Citrate Lavender or pink-colored stoppers additive EDTA Green-colored stoppers Heparin Pale yellow-colored stoppers ACD Yellow-colored stoppers SPS Gray-colored stoppers Potassium oxalate Sodium Citrate (blue) preserves blood best tests: blood coagulation tests EDTA (lavender or pink) reduces blood clumping tests: hematology and blood banking Heparin (green) is a blood thinner tests: plasma, whole blood and STAT chemistry ACD (pale yellow) has little impact on platelets and cells tests: DNA (paternity) SPS (yellow) culture media tests: cultures for microorganisms Potassium Oxalate (gray) prevents glucose deterioration tests: blood glucose levels What color tube would be used for a Prothrombin test (PT)? Blue- Sodium Citrate prevents clotting First thing you do when performing venipuncture on a patient? Correctly identify the patient After correctly identifying the patient, what should you do next when performing venipuncture? Check the order form and chart What is the position a patient cannot be situated in for venipuncture? standing After assembling materials, washing hands and donning gloves, you should palpate and locate vein Before applying a tourniquet and after you don gloves you should clean the site with an alcohol swab After the site of injection is clean, you should apply the tourniquet Outline steps for inserting needle: 1. spread skin tight- not too tight 2. remove needle cap, inspect, then insert at a 15-30 deg angle with bevel side up 3. attach tube to infusion set, release the tourniquet and ask patient to unclench fist What are the three issues that can arise if you do not release the tourniquet within 1 minute? Hemolysis, Petechiae, Hemo-concentration Hemolysis blood serum becomes concentrated with electrolytes like potassium which are not normally there; skews blood test results Petechiae tiny hemorrhages that appear as red or purple spots on the skin; NOT dangerous, but may indicate hemolyzation of the blood sample Hemo-concentration fluid is forced out of the veins and into the surrounding tissues which causes an increase in the concentration of the blood components After tubes are filled appropriately, outline the first steps to take 1. place a gauze pad over the needle, remove 2. apply pressure with gauze then have pt. hold for 30 sec. 3. apply an adhesive and tell pt. to leave for 15 mins. *If pt. uses Warfarin or Aspirin, pressure may be needed for longer After patient is situated with a bandage, what must you do next? MUST INVERT THE TUBES to avoid blood clotting Blue-color stoppered tubes must be inverted 3-4 times Red-color stoppere tubes must be inverted 5 times Lavender or green color stoppered tubes must be inverted 8-10 times You should __ recap needles never Where should a finger stick be performed? Side of middle or ring finger If blood is reluctant to flow when performing capillary collection, what are two easy solutions? Have the patient open and close hand or have them drop their hand below heart-level Outline basic finger prick routine 1. clean site with alcohol 2. milk area and squeeze with a little pressure 3. puncture and wipe away first drop 4. drop the rest into the capillary tube 5. cap the tube, apply gauzed pressure to finger 6. adhesive bandage for adults NOT for kids Why do we avoid adhesive bandages for kids? Choking hazard Site for heel stick lateral or medial sides of heel Bruising caused by venipuncture or capillary testing will.. resolve over time Phlebitis a complication of phlebotomy; severe causes require treatment Tissue trauma caused by venipuncture or capillary collection is painful and due to poor technique DO NOT perform venipuncture in __ unless a Doctor explicitly says to an arm with a shunt or IV or on the same side as a mastectomy DO NOT perform venipuncture __ ever. through a hematoma or edematous area Give examples of a performance failure incorrect draw order, wrong tube, expired tubes, failure to properly prepare the patient place specimen labels __ directly on the sample Common issues pt. have with venipuncture and capillary collection include fainting or syncope If a pt. has a history of fainting while having their blood drawn, what pre-cautious measure can you take as a MA? have them lay day to have their blood drawn If a pt. gets faint during a blood draw withdraw the needle and have them lean forward Always ask a pt. before drawing their blood if they are on what type of medications? Give examples. Blood thinners, ex. Warfarin and Aspirin If a pt. is anemic and concerned about the amount of blood drawn, what could you say to reassure her? "I'm actually only drawing about 6 teaspoons of blood today and your body has about 5 L, so that's less than 1% of all the blood in your entire body." In a blood culture collection, on the bottle that is to hold the blood, you must mark with the level of blood needed (bcc) Remove the cap of each bottle to clean before applying the tourniquet After applying the tourniquet the first time, what do you do in blood culture collection? Palpate then remove the tourniquet After removing the tourniquet for the first time, what do you do in blood culture collection? Clean the area with an alcohol swab in a circle, inward-out After cleansing with alcohol, what do you do in blood culture collection? Clean with Povidone Iodine Once site is cleansed a second time during b.c.c., you reapply the tourniquet and ask the pt. to squeeze their fist How do you insert the needle during b.c.c.? 15-30 deg with bevel facing upwards In what order do you fill the bottles in b.c.c.? Aerobic then anaerobic Once all necessary blood has been collected in b.c.c, the patient can unclench his or her fist and you will remove the tourniquet As you are putting the bottles away, what should you do? Invert them Outline the steps to take to finish the blood culture collection procedure Remove the needle and apply gauze and pressure. Place sharp items in the sharps container and then observe the site of injection for 10 seconds before removing pressure If bleeding occurs after removing pressure in a blood culture collection, what should you do? Apply pressure and then bandage All newborns are tested for CF, which is Cystic Fibrosis; mucous secretions accumulate on a pt.'s lungs and other organs All newborns are tested for PKU, which is Phenylketonuria; a buildup of phenyl ketones All newborns are tested for a condition where the thyroid has decreased function which is __ Hypothyroidism All newborns are tested for Galactosemia, which is when a pt. can't break down galactose What is a genetic disorder commonly tested in newborns? Sickle cell What are two common infections tested for in newborns? HIV and toxoplasma