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Phlebotomy: Venipuncture and Capillary Puncture

Chapter 40 of Thomson Delmar Learning's Comprehensive Medical Assisting; 3rd edition
STUDY
PLAY
aliquot
part of the whole specimen that has been taken off for use or storage
anticoagulant
chemical in a blood tube that prevent the clotting of the blood by removing the calcium from the blood or by stopping the formation of thrombin
Buffy coat
layer of white blood cells and platelets that forms at the interface between the plasma and red blood cells in a tube of blood containing an anticoagulant
cannula
the blunting member in a bio-plexus puncture-guard needle
centrifuge
device that spins tubes using centrifugal force to separate the fluid portion of blood from the formed elements
constrict
to become smaller in diameter
dilate
to enlarge in diameter
edematous
abnormal accumulation of fluid in the tissues resulting in swelling
hematoma
accumulation of blood around the venipuncture site during or after venipuncture caused by the leakage of blood from where the needle punctured the vein
lipemia
excessive amount of fat (lipids) in the blood, resulting in a blood sample that has a milky appearance
palpate
to search for a vein using the fingertips with a pressure and release touch
phlebotomy
process of collecting blood
primary container
container that directly contains the specimen
serum
liquid portion of blood obtained after blood has been allowed to clot
thixotrophic separator gel
gel material capable of forming an interface between the cells and fluid portion of the blood as a result of centrifugation
tourniquet
device used to facilitate vein prominence
viscosity
degree of thickness of a liquid
hemolysis
rupturing of the red blood cells during the process of blood collection. The serum on plasma becomes contaminates and has a reddish color
hypoglycemia
increased levels of blood glucose. Does not mean diabetic but mabe an indication of prediabetics
how long can tourniquet stay on arm
60 seconds
which tubes contain anticoagulants
light blue, lavendar and green
most common type of venipuncture
vaccum tube
where are red blood cells produced
bone marrow
what does SST stand for
strain specific typing
what is the controversy over with plastic adapters/holders
if they are reuseable after disinfecting
MA responsibility with phlebotomy
collect blood as efficiently as possible, show concern for patients and provide high quality care
what should MA show toward patients
concern
how should MA collect blood
as efficiently as possible
how do you know what anticoagulants or additives are in the tube
by the color of the stopper
why are additives used in tubes
to accelerate specimen processing
what must be done to ensure quality control
each specimen has own label, label complete, no needle attached, appropriate tube, full tube, free of hemolysis
each specimen must have
own label
label must have completed
Patient name, birthdate, the date and time of venipuncture, ID number and MA initials
on preprinted labeled tubes the MA must still add
date and time of collection and their initials
what percentage must have blood to be a full container
75%
what percentage in a coagulation study tube must have blood to be a full container
90%
phlebotomy tray that is transported must have what
label indicating biohazard
order of site selection
ac, forearm, back of hand, wrist, and then with Dr. permission foot
AC means
antecubital
where is the antecubital space
opposite of elbow, in bend of arm
other then foot, what site selection did we not practice on and what number is it in the order of selection
wrist, 4
forearm falls where in the order of site collection
second
back of hand falls where in the order of site collection
third
what do we call the system that combines with either the syringe or the evacuated tube?
butterfly collection system
what is the usual capillary puncture site for adults
finger, normally ring or index
what is the most important step to a successful venipuncture
put the patient at ease
why do we use safety needles
to prevent accidental needle stick
what is first step in the proper method to palpate a vein
identify patient and introduce yourself
what do you do right before applying tourniquet when following the proper method to palpate
wash hands
when using method to palpate after you apply tourniquet what may you have patient do
make a fist
when palpating what are you feeling with
tip of index finger
when palpating what are you feeling for
soft, bouncy and roundness of vein
last two steps of the proper method to palpate a vein
mentally map and remove tourniquet
what are you mentally mapping
location of intended puncture
what is the 3rd step in the proper method to palpate a vein
apply tourniquet
what starts with introducing yourself and identifying patient and ends with removing the tourniquet
what is proper method to palpate a vein
list some factors that can affect laboratory values
alcohol not dry, diurnal rhythm, exercise, fasting or non-fasting, hemolysis, hemoconcentratio, insufficient volume of specimen
hemoconcentratio
tourniquet on too long
diurnal rhythm
timed intervals because of medication or daily rhythm
hemolysis know as
destruction of blood cells
what is the usual cause of hemolysis
alcohol not completely dry at site of puncture
how many liters of blood are in the body
six
what is the functions of blood
to carry oxygen to the body tissues, remove waste product and to carry nutrients to all parts of body
name one waste product that the blood carries
carbon dioxide
method for capillary blood draws
select site, gather equipment, cleanse site, perform capillary puncture, wipe away the first drop of blood, collect the following drops of blood for specimen
after capillary puncture, before wiping away the first drop of blood, what must be done
discard lancet in sharps container
why wipe away first drop of blood
it contains tissue fluid which dilutes blood
what do you use to wipe away the first drop of blood
dry, sterile gauze
when selecting site which part of finger is used
along side not across finger
what is the final step in serum formation
the clot contracts and the serum is extracted
serum formation is known as
clotting
what is the usual site of capillary puncture in infants
heel stick
what should the medical assistant do if you have attempted venipuncture twice and are unsuccessful
notify the physician of your attempts
what is the correct order of draw for evacuated tubes
yellow, light blue, red/tiger, green, lavender and gray
what separates the red blood cells from the plasma in anticoagulant tubes
buffy coat
which type of blood cells are responsible for transporting oxygen and carbon dioxide
red blood cells
what are some advantages of using latex tourniquet vs. velcro strips
latex can be cleaned easily and are less expensive to replace
when would the syringe be the most often used technique in venipuncture
when a small volume of blood is needed and only thin fragile surface veins are accessible
what information must be on the specimen tube label
patient name, patient birthdate, patient ID number, date and time drawn, and MA signature (initials)
what is the appropriate degree to inflate the BP cuff to when using a tourniquet?
slightly below diastolic pressure
when using a BP cuff as a tourniquet what extra step is required
blood pressure must be taken first to find the patient's diastalic pressure
what color tube is used for a CBC?
lavendar
a lavender tube is has
EDTA
proper technique for applying a tourniquet has it placed where
3 to 4 inches above intended puncture site
for patient comfort the tourniquet can be placed
over clothing or gauze
what is removed before removing needle from a puncture site
tourniquet
syringe order of draw
yellow, blue, green, lavendar, gray and red
yellow tubes are used for
blood culture
blue tubes used for
coagulation studies
green tubes are
heparin
gray tubes are
exalate/fluoride
red tubes are
nonadditive "clot" tubes
blood culture tubes topper are
yellow
citrate tubes topper are
light blue
non-additive tubes are
red
heparin tube toppers are
green
hematology tube toppers are
Lavendar
gel separator tub with heparin tubes toppers are
green/gray
glucose tube toppers
gray
invert tube
8 to 10 times
PST
plasma separator tubes
BMP
basic metabolic panel
ETOH
ethyl alcohol
FSH
follicle-stimulating hormone
PSA
prostate-specific antigen
RPR
rapid plasma reagin
ACD
acid dextrose citrate
SPS
polyanethoiesulfonate
sodium citrate is for what topper and in what order of draw
light blue, second
found 3rd in order of draw for vacuum tube or last in syringe, the topper color is
red
titers, RPR, blood bank-type and cross match are collected in what color and additive
red, none or glass particles
serum determinations, panels (lipids, thyroid etc) are collected in what combination color tube and what is additive abbreviation
Tiger (red/gray) and with SST
FSH and PSA testing are collected in what color tube (common and color name)
Tiger (red/gray)
prothrombin time (PT)-coumadin therapy, partial thromboplastin time (PTT)-heparin therapy are collected in what color tube and with what additive
light blue with sodium citrate
electrolytes and platelet counts are collected in what color tube
green
CBC, WBC and differentials are collected in what tubes with what additive abbreviation added
Lavendar, EDTA
EDTA
ethylenediaminetetraacetic
lavendar with EDTA are used for
hematocrits, glycohemoglobins, hemoglobins and sedimentation rates
tube used for DNA and paternity testing and with what additive abbrev
yellow, SPS
tube used for viral loads (cell morphology) and with what additive abbrev
yellow, ACD