CLS00 - Phlebotomy

  1. Basic blood circulation in heart
    • DOB enters right side of heart
    • DOB goes to lungs
    • OB enters left side of heart
    • OB enters periphery
  2. Artery vs vein (structure)
    • Artery: endothelium (inner), smooth muscle/elastic CT (mid), fibrous CT (outer)
    • more rigid
    • Vein: thin muscle layer, thin CT layer, valves to prevent backflow
    • bouncy
  3. Artery vs vein (qty)
    • More veins than arteries
    • redundancy in case of injury
  4. Artery vs vein vs tendon (feel)
    • A: feel pulse, accessed w/o tourniquet
    • T: hard (even w/o tourniquet), painful if stuck
    • V: bouncy, expand w/ tourniquet
  5. What are the 3 veins most commonly used w/ location.
    • 1 - Median cubital: in center of arm (well anchored)
    • 2 - Cephalic: thumb side (less anchored)
    • 3 - basillic: pinky side (near artery AND nerve)
  6. What are the major anticoagulants? What do they bind and what are they normally used for?
    • EDTA (lav/pink): strongly chelates Ca2+
    • lav for hematology
    • pink for blood bank
    • Lithium heparin (green): uses Serine protease inhibtors that act directly on clotting cascade proteins
    • for chem panels
    • Na Citrate (lt blue): weakly binds cations, easily reversable
    • for coagulation
    • Acid Citrate Dextrose (ACD) (yellow): for HLA and DNA testing
  7. Order of draw by color
    • Blood cultures / SPS
    • Lt blue
    • Red
    • Gold
    • Green
    • Purple/Pink
    • Gray
    • *some facilities prefer red then lt blue
    • *skin puncture order is opposite (EDTA -> other -> serum)
  8. venipuncture procedure
    • greet patient, introduce self
    • describe procedure
    • ID patient (name/DOB, name/med record)
    • assemble equipment in easy reach
    • inspect arm
    • apply tourniquet
    • palpate
    • remove tourniquet
    • clean area
    • position needle bevel up
    • insert needle at 15-30deg angle
    • push first evac container into holder
    • change tubes
    • invert filled tubes
    • remove tourniquet during last tube (or 1 min)
    • place gauze over puncture, remove needle
    • apply pressure
    • activate needle safety device
    • discard needle into sharps container
    • ensure bleeding has ceased
    • secure gauze with tape
    • label tubes immediately (patient present)
  9. hematoma vs petichiae
    • hematoma: patients should apply pressure and keep arm straightened after procedure
    • punctured arm elevated above heart
    • discontinue draw if hematoma is noticed during draw
    • petechiae: may form during tourniquet application (even w/ correct technique)
  10. basic guidelines for abnormal/unique draw situations
    • draw distal to hardened veins
    • draw opposite to mastectomy
    • draw away from fistula
    • draw away from hematomas
    • anchor loose veins well
    • do not draw above an IV
    • do not draw through burned area
  11. describe skin puncture procedure
    • clean site to be punctured (ring or middle finger)
    • make puncture w/ device (perpendicular to fingerprint lines)
    • wipe away first drop
    • collect in microtainers
    • apply bandage
    • OPPOSITE ORDER OF DRAW (EDTA -> other -> serum)
  12. special precautions for children
    • Excessive crying increases leukocytes
    • milking site can cause hemolysis
    • NO pressure bandages
    • lancets should be limited in depth (Tenderfoot)
  13. blood culture basics
    • skin cleaned with iodine or chlorasepps
    • alcohol (bacteriostatic)
    • iodine in scrubbing motion, then circle 2-3 inches from site
    • clean bottle tops with alcohol
    • apply tourniquet
    • fill aerobic bottle first
  14. 3 categories of isolation
    • airborne
    • droplet
    • contact
Card Set
CLS00 - Phlebotomy
CLS00 - Phlebotomy