Phlebotomy (Day 1)
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. What would you like to do?
What is the function of Public Health services?
- To screen, monitor, and educate about infectious diseases
- DO NOT provide treatment
STudy of nonverbal communication (body language)
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
Requirement to provide MSDSs
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
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
Which are the anticubital veins?
- Acessory cephalic, median basilic, median
- *NOTE- subclavian is shoulder -> chest
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)
NPO (nil per os): nothing by mouth (not even water)
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
Most common antiglycolytic agents? Purpose?
sodium fluoride and lithium iodoacetate prevent glycolysis (metabolism of glucose)
When should a discard tube be used?
When drawing for a coag test (not PT or PTT) because tissue thromboplastin activates extrinsic coag pathway
what is accessioning the specimen?
Steps taken to unmistakably connect a specimen and the accompanying paperwork to a specific individual
What veins should you use? Which should you avoid?
- Use - cephalic or median cephalic
- Don't use - basilic (too close to brachial artery)
Tourniquet should not be left on for more than...
- 1 minute
- Release after blood flows into first tube
What fluids are contained in a capillary specimen?
- arterial blood
- venous bloud
- tissue fluids (interstitial and intracellular)
What reference values shift with capillary draws?
- increase: Glucose
- decrease: Calcium, Phosphorous, and total protein
What does an ABG req typically include?
- body temp
- respiratory rate
- method of ventilation/delivery
- patient activity
- body position
- normal patient ID info
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)
Name 4 analytes that need LP
- vitamin C
- vitamin B12
Name 3 tests that require cooling.
- lactic acid
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
How quickly must an ESR be performed on an EDTA spec at room temp? When refriged?
- room: 4 hours
- ref: 12 hours
Maximum time limit for serum/plasma separation?
2 hours from collection (should be ASAP)
What departments issue regulations re: off-site transportation of spec?
- DOT (department of transportation)
- FAA (federal Aviation administration)
- OSHA (occupational safety and health administration)
What is unique about an ammonia spec?
- extremely volitile
- must be transported ASAP and on ice
serum vs plasma
- Serum: does not contain fibrinogen (used during clotting)
- Plasma: contains fibrinogen (no clotting)
What is a C&S? What is it's purpose?
- Culture and sensitivity
- diagnosis of UTI
what is AFP?
- alpha-fetoprotein: antigen found in fetus, amniotic fluid, and maternal serum
- abnormal values can indicate developmental issues
What is POCT?
Point-of-care testing (performed at/near site of patient care)
Interpretations of a TB skin test
- based on induration (firm, raised area)
- <5mm: negative
- 5mm-9mm: doubtful
- 10mm+: positive
What do POCT urine test strips usually detect?
gluocse, bilirubin, bacteria, blood, pH, protein, specific gravity, urobilinogen
What organizations offer certification to lab professionals?
- AMT (american medical technologists)
- ACA (american certification agency)
- ASCP (american society for clinical pathology)
what organizations accredit phlebotomy programs?
- NAACLS (national accrediting agency for clinical laboratory services)
- PHS (public health services)
what is PHI?
Protected health information
What is CLIA '88?
- clinical laboratory improvement amendments of 1988
- established standards for regulation of laboratories
CLSI standards state that heel puncture depth should not exceed ____
What is CLSI?
- Clinical & Laboratory Standards Institute
- publishes standards for phlebotomy procedures
What are diurnal variations?
normal fluxuations that occur throughout the day (think diurnal cycle)
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
What would you like to do?
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