Chemistry and Lab Tests

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RV

Routine Venipuncture

BV

Butterfly Venipuncture

BS

Butterfly with syringe

S

Straight syringe

Use iodine when testing for alcohol

...

ETOH tube?

Grey

FBS - Glucose

fasting blood sugar

Site Selection - Site problems

burns, tattos, scars they are hard to palpate and penetrate, impaired circulation, painful

Site problems - damaged veins

schlerosed or thrombosed - difficult to penetrate, impaired circulation, may yield bad lab results

Edema

accumulation of fluids in tissues, may cause bad lab results due to excess fluid

Hematoma

swelling and blood that has leaked into surrounding tissue

Masectomy site problems

do not draw blood on same side as mastecomy due to lymphostasis.

Lymphostasis

stoppage of lymph flow - caused by lymph node removal

Masectomy site problems may cause...

infection, tourniquet may cause injury,

Obseity site problems

veins too deep and difficult to palpate, tourn. may not fit, use blood pressure cuff.

What to do when drawing an obese patient

two creases in the anticubital area, may find median cubital vein there. may turn arm so hand is prone to find cephalic vein, cephalic vein is usually the vein of choice

IV therapy pts problems. NEVER DRAW ABOVE IV SITE BECAUSE:

blood sample may be contaminated with IV fluids (drugs) If not other site is available draw below IV site.

Follow facility protocol for drawing below an IV - 7 steps

Turn off IV for 2 min, tourn below IV (distal), choose site distal to IV, look for vein other than one with IV, Discard first 5 cc of blood (10 for coag tests), notify RN when done, document

VAD (vascular access devices)

tubing inserted under skin then inserted into an artery or vein

VAD is used for (2)

administering fluids/medications and drawing blood

VAD patient procedures

Only done by trained personnel, discard first 5cc of blood, do not draw from this for coag tests because lines are flushed with heparin

Types of VADs

CVC, implanted port, PICC, Arterial line, Heparin, AV shunt, Fistula

Do not collect blood for 24 hours after IV is discontinued.

...

CVAD

central vascular access device

CVAD is used for what?

line in main artery or vein, flushed with heparin to prevent thrombosis, must discard first 5cc of blood to remove contamination, do not use for coag testing

Types of CVADs

CVC (central venous catheter), implanted port, PICC

CVC abbrev

Central venous catheter

PICC abbrev

peripherally inserted central catheter

Lavender Tubes - EDTH

blood does not clot, tests are done on whole blood.

Lavender Tubes - dept.

Hematology

Lavender tube tests (anything that has to do with counting blood cells & their characteristics)

CBC, WBC, RBC, Hemoglobin, Hematocit, Platelets, sed rate, Retic count, differential (slide made to look at cells)

Blue Tubes - sodium citrate

blood does not clot, tests are performed on the plasma

Blue tube dept.

coagulation dept.

Coagulation Dept. studies what?

blood clotting mechanism and blood clotting factors in plasma

Blue tube blood tests (anything that has to do with coagulation studies)

PT, PTT, d-dimer, DIC panel, Fibrinogen, Factor Assays

Green tube - heparin

blood does not clot, tests are performed on the plasma

Green tube dept

Chemistry

Chemistry studies what?

plasma analytes

Green tube tests

STAT (cause blood does not clot so it can be processed quicker), electrolytes (sodium, potassium, chrloride, CO2), basic metobolic panel (BUN, creat, electrolytes, Ca) Ammonia (must be on ice)

Examples of electrolytes

sodium N+, potassium K, Chloride, C02

BMP abbrev

basic metabolic panel

examples of BMPs

BUN, creat, electrolytes, Ca)

BUN abbrev

blood urea nitrogen

SST tubes (no anticoag, so the blood clots) additives

clot activator (some have the gel)

SST tubes dept.

chemistry (study of serum analytes)

SST the tests are done on the serum NOT the plasma

but this can vary with labs

SST tests

MI Panel (heart attack) this is a stat test that will be done in a green tube, Lipid Panel , Liver panel, Nutrition, basal metabolic panel, comprehensive metablic panel, renal panel, electrolytes, diabetes, thyroid.

CMP abbrev

comprehensive metabolic panel

Chemistry tubes include:

SST (serum), Green (plasma), PST (plasma), Gray (plasma)

SST tube has a

clot activator and gel in it

Green has

sodium or lithium heparin

PST

haparin and gel

Gray has

sodium flouride & potassium oxalate

PST or green tubes are used for STAT testing because

it is ready for testing sooner. SST tubes you must waitfor it to clot before spinning in a centrifuge

Gray tube tests

glucose, ETOH (alcohol), HgB, A1C,FBS (fasting blood sugar)

Other common chemistry tests

amylase, lipase, ammonia (NH3), iron, enzymes, uric acid, drugs of abuse (ETOH), therapeutic drugs, hormones, tumor markers

Drugs of abuse abbrev

ETOH

NH3 abbrev

ammonia

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