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Phlebotomy National Exam Study Guide

I cannot be held responsible if you do NOT pass the National Exam. This information is ONLY for your review.
Occupational Saftey & Health Administration
What vaccination does OSHA require all health care personnel get?
OSHA requires that all health care personnel exposed to blood and other bodily fluids must receive a vaccination against Hepatitis B
Pulmonary Edema
Fluid in the lungs
How much blood can a person donate in a session?
500 mL
Patients have the right to what?
Under the Patient Bill Of Rights they always have the option to decline medical treatment and to know what tests are being performed on them.
What can you NOT give a patient?
Results or a diagnosis. Because you are not medically qualified to do so.
Negligence is?
Failure to give appropriate care. DON'T BE NEGLIGENT!
PPE stands for?
Personal Protective Equipment
One of the most important practices is?
Hand Washing is one of the most important (and easiest) practices used to prevent transmission of bloodborne pathogens
Needles should never be
Sharps containers must be what?
puncture-resistent, leak proof on the sides and bottom and must be labeled or color-coded
Types of Hazards
Biologic - Infectious agents that can cause bacterial, viral, fungal or parasitic infections

Sharps - Needles, lancets and broken glass can puncture and cut, causing blood-borne pathogen exposure

Chemical - Preservatives and chemicals used in the laboratory. Exposure to Toxin, Carcinogenic or caustic substances

Fire or explosive - bunsen burners, oxygen and chemicals can cause burns or dismemberment

Physical - wet floors, heavy lifting ance cause falls, sprains and strains

ALLERGIC reaction * - Latex sensitivity is a PHYSICAL reaction to care worker allergic reation to the patient
In infection control WHO is the agent?
In infection control WHAT is portal of exit?
In infection control WHAT can we control?
Mode Of Transmission OR exit of infection
In infection control WHAT is a portal of entry?
Mucas membrane
In infection control WHO is a susceptible host?
Mode of Transmission
Specific ways in which microorganisms travel from the reservoir to the suseptible host
Five main types or mode of transmission
contact - direct and indirect (fomite)
Droplet - Cold, Flu and sneezing
Airborne - viral - breath in
common vehicle - person, fomite and not handwashing
vector borne - illness that is transmitted through an invertebrate, such as an insect
Mode of infection
the point in the infection chain where we aim at preventing the spread of infectious disease
Standard precautions do what?
Infection control method designed to prevent direct contact with blood and other body fluids and tissues by using a barrier of protection and work control practices.
What do we assume all patients to be?
Patients are presumed to be infective for blood-borne pathogens
Standard precautions consist of what itmes?
Gloves - when collecting and handling body fluids, or tissue specimen
Face shield - when danger of splashing on mucous membranes
Disposal - dispose of all needles and sharp objests in punture-proof containers, WITH OUT RECAPPING
Disinfectants - clean fluid spills, thus killing pathogenic organisms
Medical Asepsis
This condition is best defined as "the destruction of pathogenic microorganisms after they leave the body". It also involves enviromental hygien measures such as equipment cleaning and disinfection procedures. Methods of medical asepsis are Standard Precautions and Transmission-based Precautions
What are barrier protections?
Face Shields
How do you remove PPE equipment?
1st - Gloves
2nd - Gown
3rd - Shield
What type of soap should be used?
Non-abrasive, antibacterial soap.
What do you do if blood splashes in the eye or mucous membane?
Flush with warm water (hotter the better) for 15 minutes
Report incident exposure to your supervisor ASAP!
Who cannot be identified in an incident report?
a minor
Bedside manner includes?
introduce yourself, ask patient name and b-day. Explain what you will be doing. Chat with patient to keep mind off poke. ADVISE them WHEN you are poking! Speak to them on a first name basis
What phase is best practice
"pleasant with the patient and professional with the poke".
If patient has an I.V. where do you draw blood?
Downstream from the I.V.
Double Mastectomy patients should ONLY have blood drawn from what?
Left Mastectomy patients should have blood drawn from what side?
Right side
What is a Fistula?
artificial connections of veins
What is a Graft?
artificial artery connection to vein
Sclerosis is?
Hard and cord like veins
For obese patients what vein is used?
Cephalic Vein is most likely to be the one you can palpate and draw blood from in an obese patient
Cephalic means what?
Most common complication in Phlebotomy
To prevent a Hematoma
prevented if pressure is placed on the venipuncture site until bleeding stops
If a patient faints what is the 1st thing to do?
GET the needle out of the arm
Vasovagal Syncope is
fainting, dizziness before, during or after venipuncture
Circulatory System funtion
is todeliver oxyge, nutrients, hormones and enzymes to the cells. Transport cellular waste such as carbon dioxide and urea to the organs where they can be expelled from the body.
Circulatory exchange is done where?
capillary level
45% of blood is
formed elements -
Erythrocytes (red blood cells) = 99% of formed elements.
Leukocytes (white blood cells) and Thrombocytes (platelets)
All blood cells originate from
stem cells in the bone marrow
The heart acts as what?
two pumps (right and left sides)
Left and right sides of heart are connected by
two circulations, with each pump equipped with two valves the function of which is to maintain a one way flow of blood
Pulmonary circulations
carries deoxygentated blood from the right ventricle to the lungs. (alveoli) and return oxygenated blood from the lungs to the left atrium
Oxygenation takes place
at the alveoli - sacks in the lungs
Systemic circulation
carries oxygentated blood from the left ventricle throughout the body
Tricuspid valve
an atrioventricular valve, being situated between the right atrium and the right ventricle
Pulmonic valve
semi lunar valve situated between the right ventricle and the pulmonary artery
Mitral valve
(bicuspid valve) is another atrioventricular valve, being situated between the left atrium and the left ventricle
Aortic valve
semi lunar valve situated between the left ventricle and the aorta
How long does it take for a full circulation?
one minute
The average person weighting 155 pounds has
approximately 5-6 liters of blood in their system.
Blood composes of
7-9 percent of total body weight of a person
Blood has how much plasma?
55% is plasma
Plasma is what?
a clear, pale yellow fluid
what does plasma do?
it carries nutrients, lipids, glucose, sodium, magnesium, calcium, potassium, oxygen, carbon dioxide, nitrogen, antibodies, as wells as vitamins and hormones ect.
What is 45% of blood?
Red blood cells, White blood cells and Platelets. Known as the formed cellular elements
How long does your body take to regenerate RBC you lose during donation
6 to 8 weeks if you donate the maximum of 500 mL
Three layers of the heart are?
the endothelial inner layer lining of the heart
the muscular middle layer. This is the contractile element of the heart
the fibrous outer layer of the heart. The coronary arteries, which supply blood to the heart are found in this layer
Blood vessels are
Aorts, arteries, arterioles, capillaries, venules and veins, superior and inferior vena cava
Red blood cells or RBC's
Erthrocytes contain
hemoglobin, the oxygen-carrying protein.
enters the blood as an immature reticulocyte where in one to two days, it matures into erythrocyte.
How many RBS's per microliter
4.2 to 6.2 million RBC's per microliter of blood.
What is the normal life span of RBC's
is 120 days
What is leukocytes function
provide the body protection against infection.
How many WBC's for adults per microliter
5,000 to 10,000
Leukocytosis is?
an increase in WBC's, is seen in the case of infection and leukemia.
Leukopenia is what?
a decrease in WBC's, is seen with viral infection or chemotherapy
How many types of WBC's are in the blood
A differential count does what?
determines the percentage of each type
Neutrophils are what?
phagocytic cells, meaning, they engulf and digest bacteria. Their number increase in bacterial infection.
Neutrophils comprise how much of the WBC's population?
40 to 60% of the WBC population
Lymphocytes do what?
their numbers increase in viral infection, they also play a role in immunity.
Lymphocytes comprise how much of the WBC population?
20 to 40% of the WBC population
Monocytes do what?
Increase in intracellular infections and tuberculosis
Moncytes comprise how much of the WBC population?
3 to 8%, they are also the largest WBC's
Eosinophils do what
they are active against antibody-labeled foreign molecules.
Eosinophils increase
in allergies, skin infections and parasitic infections
Eosiniphils come
first in allergic reactions. During an allergic reaction it would show an increase in Eosinophil count
Basophils do what
release histamine
Basophils count for what of the WBC population?
0 to 1% in the blood
Thrombocytes are essential for what?
blood coagulation
Thrombocytes are also know as
platelets are small irregularly shaped packets of cytoplasm formed in bone marrow
Three major veins are located
in the antecubital fossa
The three major veins are?
Median cubital vein
Cephalic vein
Basilic vein
1st order of draw
Red topper tube
Red top tube also known as
plain vacume tube and contains no additive or anticoagulant.
collected blood clots, by normal coagulation process is
30 minutes
Do you need to invert a Red Tube
Common test for red tubes are
Serum chemistry, Serology, Blood bank
Arteria Blood Gas (ABG) sample must be run within
15 minutes of collection
Arterial blood is used to determine
blood gas levels and blood PH. Usually collected by a nurse or respiratory therapist
Basal state is
When the patient has fasted and not excersiced in 12 hours
Do you note if a patient has not fasted?
2nd order of draw tube color is
Light blue
Light blue tube has what additive
Sodium Citrate
Different ratios
Light blue tubes MUST be inverted how many times
5 to 10
Light blue tubes are used to test
coagulation determinations on plasma specimens.
Certain test require chilled specimens
Always fill to MAX fill line
3rd order of draw tube color is
Tiger top or gold top (gold in Utah)
Tiger top / Gold top tubes have what additives
Clot activator - (silica in Utah) or glass particles
Fixotropic gel
Blood cagulates with additive in
15 to 30 minutes
4th order of draw tube color(s) are
Green top
Mint top
Hash marks on label
Green top tube has what additives
Heparin combined with sodium, lithium or ammonium ion
Mint green top tube has what additive
PST - Plasma Seperator tube
Hash marked tube has what additive
Sodium Heparin
Common tests for Green tubes are
Carboxyhemoglobin ( HCg preg test)
STAT Lytes
electoliytes - potassium, sodium
BMP Panel is
A Panel is
A group of tests ordered together
Sodium additive tubes test for
5th order of draw tube color is
Lavendar tube has what additive
EDTA - Ethylenediaminetetraacetate
BMP - chem 8 Tiger/Gold tube
Basic Metobolic Panel
CMP - chem 14 Tiger/Gold tube
Comprehensive Metobolic Panel
Drk purple tube has
7. mL of EDTA - calcium binding agent
Lt purple tube has
3.6 mL of EDTA - calcium binding agent
Pink top tubes are used for
Blood banks / transfusion - for blood typing
Lavendar top tubes are used for
CBC = Complete Blood Count
CBCAN = Complete Blood Count Automatice Differential
CBCDN - Complete Blood Count Manual Differential
ESR - Lavendar top tub
Erythocyte Sedimentation Rate
ESR tests for
Sickle Cell Screening
inhibits coagulation by binding to calcium in the specimen
What tube is used for coagulation studies?
Light Blue
Tubes must be filled
at least two-thirds full
Tubes must be inverted
8 times
Hematocrit measures
the percentage of the RBC's (Red Blood Cells) in a given volume of whole blood
What test is ALWAYS given before blood donation
1- blood enters the heart
Superior & Inferior Vena Cava (V-C)
2- goes to
Right Atrium
3- from there to
Tricuspid Valve
4- then onto
Right Ventricle
5- and now out to the
Pulmonary Artery - and lungs
6- back into the
Pulmonary Veins
7- then onto the
Left Atrium
8- moves onto the
Bicusped Valve
9- down to the
Left Ventrical
10- finally to your hot bod via the
Veins have
ABG (Arterial Blood Gas)
Analyes arteial blood for oxygen, carbon dioxide and bicarbonate content in addition to blod PH
* used to determine the effectiveness or respiration
The absence of microoganisms or by contrast, something that just discourages the growth of microoganisms is antiseptic
Basilic Vein
The large vein on the inner side of the bicep and is often chosen for tntravenous injections and blood drawing
The basis of tort in this case the unprivileged touching of one person by another.
Informed Consent
Patient gives consent for a procedure to be performed in full knowledge of the procedure and the risk it entails
Bleeding Time
A test done to ascertain platelet function.
A Plug is
A special paper applied to a wound (small incision) in the forearm. The paper is applied and then timed to see how long it takes for platelets to form a "plug" and stop the bleeding
Asprin will affect
bleeding time results
Blood Clot
The conversion of blood from a liquid form to solid through the process of coagulation
Thrombus is
a clot which forms inside of a blood vessel
an embolism is
a clot that moves inside the vessel it is referred to as an embolus
Blood borne infection
an infection transmitted from blood to blood
a small needle with two plastic wings attached which are squeezed together to form a tab that is used to manipulate the needle. A long 6-12" plastic tubing is attached which again offers better manipulation. This assembly is then attached to a syrings or Vacutainer holder for the purpose of drawing a blood sample
Centers for Didease Control and Prevention
movement of fluid in a regular or circuitous cource. Heart failure is and example of a problem with circulation
A compound that is an intermediate in the citric acid cycle (krebs cycle)
Citrate chelates (binds) calcium ions, preventing blood clotting and thus is an effective anticoagulant
Coagulation Factors
Group of plasma protein substances (Factor I-XIII) contained in the plasma which act together to bring about blood coagulation
Complete Blood Count
The number of RBC's (red blood cells), WBC's (white blood cells) and platelets (per cubic millimeter) that are present in the patient's sample of blood is determined.
Also included is the HEMOTACRIT (%), hemoglobin concentration (gm%) and the differential.
Most common test done on the blood
The soiling of pollution by inferior material, as by the introduction of organisms into a wound
Trademark for the preparation of warfarin sodium
Bluish skin color due to lack of Oxygen
Defamation of character
Consists of injury to another person's reputation, name or character through spoken (slander) or written (libel) words.
A count made on a strained blood smear of the proportion of the different leukocytes (WBC's) and express as a percentate.
A differential is a normal part of a complete blood count (CBC)
The skin discoloration caused by a bruise (contusion)
Ethylenediaminetetraacete. A calcium chelating (binding) agent that is used as an anticoagulant for laboratory blood specimens
A substance that will acquire the capacity to conduct electricity when put into solution. Electrolytes include sodium, potassium, chloride, calcium and phosphate. informally know as "LYTES"
A sudden blockage of a blood vessel by a blood clot or some other obstruction which has been transported through blood vessels and lodged at a site to small for passage.
Examples of emboli are detached blood clot, a clump of bacteria or other foreign material such as air.
Contrast to thrombus
A protien formed during normal blood clotting tht is the essence of the clot
The protein form which fibrin is formed/generated in normal blood clotting
Relative to venipuncture, the appearance of a small amount of blood in the neck of a syringe or the tubing of a butterfly. This is a sign the the vein has been properly accessed.
An inanimate object that transports microoganisms
Formed Elements
Red Blood Cells, White Blood Cells and platelets
Needle Diameter is measured by gauge; the larger the needle diameter, the smaller the gauge.
For example, a very large diameter needle (16 ga) may be used to hemodialysis, whereas a much smaller needle (23 ga) would be used to draw blood for laboratory testing
An agent that kills pathogenic microoganisms
Good Samaritan Law
This law deals with the rendering of first aid by health care professionals at the scene of an accident or sudden injury. It encourages health care professionals to provide medical care within the scope of their training without fear of being sued for negligence
The sugar measured in the blood an urine specimens to determine the presences or absence of diabetes.

Glucose is the end product of carbohydrate metabolism and is the cheif source of energy for all living organisms
An anticoagulant that acts to inhibit a number of coagulation factors, especially factor Xa. Heparin is formed in the liver
The ratio of the total RBC (red blood cell) volume to the toal blood valume and expressed as a percentage
A localize collection of blood within tissued due to leakage from a wall of a blood vessel, producing a bluish discoloration (ecchymosis) and pain
A decrease in the fluid content of the blood (plasma), resulting in an increase concentration. This is determined by an increase in the hematocrit. Caused by a filtration of plasma into the body tissue and often created by dehydration
The oxygen carrying pigment of the RBC's (red blood cells)
The breakin of the RBC's (red blood cells) membrane releasing free hemoglobin into the cirulating blood. In phlebotomy, this is usually a result of mechanical damage due to poor technique
Abnormally high blood sugar level
Abnormally low blood sugar level
Indirect Infection
An infection transmitted through body fluids to blood
Informed Consent
Giving the patient adequate information concerning the method, risk and consequences to a specific procedure, it's reisks, expected outcome and alternatives
Invasion of privacy
This is the release of medical records without the patient's knowledge and permission
After blood is spun and seperated in a centerfuge the serum/plasma portion is milky in apprearance. Hyperlipidema would cause the blood to be lipemic
Lymphedema is a type of swelling wich occurs in lymphatic tissue when excess fluid collects in the arms or legs because the lymp nodes or vessels are blocked or removed. Regarding Phlebotomy, this can be a major complication of mastectomies
Multi-Sample Adapter
A device used with a butterfly and Vacutainer holder to allow for then withdrawl of multiple tubes of blood during a venipuncture
This is the failure to exercise the standard of card that a resonable person would give under similar circumstances and someone suffers injury because fo another's failur to live up to a required duty of care
Four elements of negligence
1-Duty of care
2-Derelict: breah of duty if care
3-Direct cause: legally recognizable injury occurs as a result of breach of duty of care
4-Damage: wrongful activity must have been caused the injury or harm that occurred
Healthcare setting acquired infections
The study and treatment of cancer
Hemoglobin that has be bound with oxygen in the lungs for the purpose of transport of oxygen to cells of the body. In the cells oxygen is exchanged for carbon dioxide
To examine of feel by the hand. The technique is used to help determine the size, depth and direction of a vein
Any microorganism that produces disease
Having the capability of producing disease
Peripheral Blood
Blood obtained from the circulation away from the heart, such as from the fingertip, heel pad and earlobe or from an antecubital vein
These are tiny non-raised red spots that appear on the skin from rupturing of the cappillaries due to the tourniquest being left on to long or to tight
Inflammation of a vein as a result of repeated venipuncture on that vein
A glass or transparent plastic tube used to accurately measure small amounts of liquid
The fluid protion of the blood in which the cellular components are suspended. PLASMA IS DIFFERENT FROM SERUM!
Also known as a thrombocyte, this is a particulate component of the blodd, approximatley 2-4 microns in diameter and known for it's invlovement in blood coagulation.

This structure, which has no nucleus or DNA, is formed by breaking off from the cytoplasm of the parent cell, known as a megakaryocte in the bone marrow.

Under normal conditions, platelets will aggegate at the site of a break in vascular intergity, by forming the beginning stages of a clot.

Normal platelets counts rage from 150,000 - 450,000/cm3
Point-of-care-testing (POCT)
Defined as diagnostic testing near the dite of patient care. The driving notion behind POCT is to bring the test conveniently and immediately to the patient.

This increased the likelihood that the patient will receive the results in a timely manner.
Red Blood Cells (RBC's)
One of the solid compontents of the blood which is notmally a biconcava disc without a nucleus. This is the component of the blood that contains hemoglobin with is responsibel for oxygen and carbon dioxide exchange.

A Red Blood Cell count is performed as part of a complete blood count and ranges from 4,200,00 - 5,00,000 RBC's per cubic millimeter
A hardening; especially from inflammation and certain disease states. Though sclerosis may occur in many areas of the body, the term is most often associated with blood vessels.
This is systemic infection associated with the presence of pathogenic organism introduces during a venipuncture
Referring to blood, the clear liquid portion of blood that separates out after clotting has taken place. Since clotting has accurred, the serum is fibrinogen deficient.
Contrast to plasma
This is injury to underlying tissues carused by probing of the needle
Inflammation of a vein with formation of a clot
This is blood clot usually a consequence of insufficient pressure applied after the withdrawl of the needle.
Tort is a wrongful act that results in injury to one person by another
In regards to venipuncture, a constrictive band, placed over an extrenity to disten veins for the purpose of blood aspiration or intravenous injectons. Materials used may be rubber, latex or synthetice elastic material. Blood pressure cuff may also be used.
Universal Precaustions
The name used to describe a prevention strategy in which all blood and potentially infectious materials are treated as if they are, in fact, infectious, regardless of the perceived status of the source individual. In other words, wether or not you think blood/body fluid is infected with blood borne pathogens, you treat it as if it is.
This approach is used in all situations where exposure to blood or potentially infectious materials is possible. This also means that certain engineering and work practice controls shall alsy be utilized in situations where exposure may occur
Vacutainer is a federally and internationally registered trademark owned by BD (Becton, Dickinson and Company) that is used in connection with a complete system of tubes, needles and needle holders, sharps collectors and safety devices in blood collection.
The Vacutainer evacuated tube, for example, automatically aspirates the correct aount of blood into a tube. It is used indtead of a syringe. Despite the fact that BD owns the Vacutainer trademark, the term has become so widley used to describe similar blood collection tubes and devices, that it has become a generically used term
Vacutainer Holder
A cylindrical shaped holder that accepts a Vacutatiner tube on one end and Vacutainer needle on the other, The holder tube and needle comprise the Vacutainer system used to draw multiple tubes of blood with one venipuncture
Vacutainer Needle
The needed is used to attach to a Vacutainer holder. The needle has a male thread on one end which screws into the holder. The threaded end also has a large guage needle, enclised by a rubber sheath. This needle will puncture the stopper of a Vacutainer tube allsoing blodd to enter the tube. Upon withdrawal of this needle from the tube, the rubber sheath covers the needle bevel, stopping the flow of blood. Thus, any number of tubes may be drawn with ony one single venipuncture
Warfarin Sodium
The sodium salt of warfarin, one of the synthetic coumarin anticoaulants. Coumadin
White Cell Count (WBC)
The number of white blood cells (leukocytes) found in the peripheral blood and measure per cubic millimeter
Whole Blood
Blood from which none of the elements have been removed. It is usually referred to as blood, collected from a doner and anticoagulated for the purpose of blodd replenishment for a recipient