Phlebotomy (Day 1)

  1. What is the function of Public Health services?
    • To screen, monitor, and educate about infectious diseases
    • DO NOT provide treatment
  2. define kinesics
    STudy of nonverbal communication (body language)
  3. Who developed the Guideline for Isolation Precautions in Hospitals?
    • CDC (center for disease control) and HICPAC (healthcare infection control practices advisory committee)
    • *NOTE - OSHA BBP standard requires gloves during phlebo
  4. Right-to-know law?
    Requirement to provide MSDSs
  5. Layers of skin + what's found there
    • Epidermis: avascular
    • Stratum germinativum: layer of epidermis
    • Statum corneum: layer of epidermis
    • Corum (dermis): blood vessels
    • Subcutaneous: blood vessels, adipose tissue
  6. Layers of blood vessel (both names) + brief description
    • Tunica adventita (externa): outer layer
    • made of CT
    • thicker in arteries
    • Tunica media: middle layer
    • smooth muscle + elasic fibers
    • much thicker in arteries
    • Tunica intima (interna): inner layer
    • single layer of endothelial cells + basement membrane, CT layer, and elastic membrane
  7. Which are the anticubital veins?
    • Acessory cephalic, median basilic, median
    • *NOTE- subclavian is shoulder -> chest
  8. What are these things - CK, LD, ALP, ALT, BUN, PT, GTT, ESR
    • CK: creatine kinase - enzyme in cardiac muscle
    • LD: lactate dehydrogenase - enzyme in cardiac muscle
    • (both released during myocardial infarction)
    • ALP: alkaline phosphatase - enzyme that determines liver function
    • ALT: alanine aminotranfersale - enzyme that determines liver function
    • BUN: blood urea nitrogen - kidney function test
    • GTT: glucose tolerance test - glucose metabolism test 
    • ESR: erythrocyte sedimentation rate - nonspecific disease indicator (esp inflammatory conditions)
  9. NPO
    NPO (nil per os): nothing by mouth (not even water)
  10. Describe the methods of anticoagulation and their agents
    • binding/chelating or ppt calcium to make it unavailable for the coag process: Sodium citrate, oxalate, EDTA, SPS
    • inhibiting formation of thrombin: lithium and sodium heparin
  11. Most common antiglycolytic agents? Purpose?
    sodium fluoride and lithium iodoacetate prevent glycolysis (metabolism of glucose)
  12. When should a discard tube be used?
    When drawing for a coag test (not PT or PTT) because tissue thromboplastin activates extrinsic coag pathway
  13. what is accessioning the specimen?
    Steps taken to unmistakably connect a specimen and the accompanying paperwork to a specific individual
  14. What veins should you use?  Which should you avoid?
    • Use - cephalic or median cephalic
    • Don't use - basilic (too close to brachial artery)
  15. Tourniquet should not be left on for more than...
    • 1 minute
    • Release after blood flows into first tube
  16. What fluids are contained in a capillary specimen?
    • arterial blood
    • venous bloud
    • tissue fluids (interstitial and intracellular)
  17. What reference values shift with capillary draws?
    • increase: Glucose
    • decrease: Calcium, Phosphorous, and total protein
  18. What does an ABG req typically include?
    • body temp
    • respiratory rate
    • method of ventilation/delivery
    • patient activity
    • body position
    • normal patient ID info
  19. What is the modified Allen test?
    • compression of both the ulnar and radial arteries to stop arterial flow to the hand
    • hand should appear blanched
    • IF collateral circulation is present hand will flush pink when only ulnar artery is released (positive result)
  20. Name 4 analytes that need LP
    • bilirubin
    • vitamin C
    • vitamin B12
    • carotene
  21. Name 3 tests that require cooling.
    • Ammonia
    • glucagon
    • lactic acid
  22. name a tests that can be damaged/altered by cooling
    • potassium: cold inhibits glycolysis which causes accumulation of K outside the cell (elevated results)
    • Cold also causes hemolysis which elevates results
  23. How quickly must an ESR be performed on an EDTA spec at room temp?  When refriged?
    • room: 4 hours
    • ref: 12 hours
  24. Maximum time limit for serum/plasma separation?
    2 hours from collection (should be ASAP)
  25. What departments issue regulations re: off-site transportation of spec?
    • DOT (department of transportation)
    • FAA (federal Aviation administration)
    • OSHA (occupational safety and health administration)
  26. What is unique about an ammonia spec?
    • extremely volitile
    • must be transported ASAP and on ice
  27. serum vs plasma
    • Serum: does not contain fibrinogen (used during clotting)
    • Plasma: contains fibrinogen (no clotting)
  28. What is a C&S? What is it's purpose?
    • Culture and sensitivity
    • diagnosis of UTI
  29. what is AFP?
    • alpha-fetoprotein: antigen found in fetus, amniotic fluid, and maternal serum
    • abnormal values can indicate developmental issues
  30. What is POCT?
    Point-of-care testing (performed at/near site of patient care)
  31. Interpretations of a TB skin test
    • based on induration (firm, raised area)
    • <5mm: negative
    • 5mm-9mm: doubtful
    • 10mm+: positive
  32. What do POCT urine test strips usually detect?
    gluocse, bilirubin, bacteria, blood, pH, protein, specific gravity, urobilinogen
  33. What organizations offer certification to lab professionals?
    • AMT (american medical technologists)
    • ACA (american certification agency)
    • ASCP (american society for clinical pathology)
  34. what organizations accredit phlebotomy programs?
    • NAACLS (national accrediting agency for clinical laboratory services)
    • PHS (public health services)
  35. what is PHI?
    Protected health information
  36. What is CLIA '88?
    • clinical laboratory improvement amendments of 1988
    • established standards for regulation of laboratories
  37. CLSI standards state that heel puncture depth should not exceed ____
    2 mm
  38. What is CLSI?
    • Clinical & Laboratory Standards Institute
    • publishes standards for phlebotomy procedures
  39. What are diurnal variations?
    normal fluxuations that occur throughout the day (think diurnal cycle)
  40. Hematomas - where can you collect? Why?
    • Distal to, or below (blood flow least affected)
    • Collecting in the area of a hematoma can cause pain and yield erroneous results
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Phlebotomy (Day 1)