Chapter 7 8 & 9

Palpating a vein is necessary for several reasons. First, it helps to determine the angle of insertion, which is crucial for successful venipuncture. By feeling the vein, healthcare professionals can assess its direction and position, allowing them to choose the appropriate angle for inserting a needle. Second, palpating a vein indicates the size of the vein. This information is essential for selecting the correct needle gauge and ensuring a safe and effective procedure. Lastly, palpation also indicates the depth of the vein, which helps in avoiding complications such as puncturing through the vein or causing damage to surrounding tissues. Therefore, all of the given options are valid reasons for palpating a vein.

A "STAT" CBC refers to a complete blood count that needs to be done urgently. The lavender tube is commonly used for collecting blood samples for CBC tests. It contains an anticoagulant called EDTA which helps prevent the blood from clotting and allows for accurate testing of different components of the blood, such as red blood cells, white blood cells, and platelets. Therefore, to perform a "STAT" CBC, the lavender tube should be drawn.

OSHA (Occupational Safety and Health Administration) is a regulatory agency that sets standards to ensure safe and healthy working conditions. One of the standards set by OSHA is the requirement for the use of personal protective equipment, including gloves, in certain workplace situations where there is a risk of hand injuries or exposure to hazardous substances. HICPAC (Healthcare Infection Control Practices Advisory Committee) and CDC (Centers for Disease Control and Prevention) also provide guidelines and recommendations for infection control in healthcare settings, which may include the use of gloves. Therefore, the correct answer is OSHA, as it is the regulatory body that mandates the wearing of gloves in certain workplace situations.

The recommended order of draw is important to prevent additive contamination. Additives in blood collection tubes can interfere with the accuracy of test results if they mix with each other. By following a specific order, the risk of cross-contamination is minimized, ensuring that each tube contains only the intended additive. This helps maintain the integrity of the specimen and ensures accurate test results.

If the medical number does not match the one on the requisition, it is important to check with the nurse before proceeding. This is necessary to ensure that the correct patient is being treated and that there are no errors or misunderstandings in the documentation. Checking with the nurse will help to clarify any discrepancies and prevent any potential harm to the patient.

HBV, also known as Hepatitis B Virus, is the most commonly associated infection in laboratory workers. This is because laboratory workers may come into contact with blood or other bodily fluids that may contain the virus. HBV is highly infectious and can be transmitted through contaminated needles, accidental needle sticks, or exposure to infected blood or bodily fluids. Therefore, laboratory workers are at a higher risk of contracting HBV compared to other infections such as HIV, HCT, or LOC.

When blood or body fluid come in contact with hands, it is important to cleanse them thoroughly to prevent the spread of any potential infections or diseases. Alcohol can be effective in killing some germs, but it may not be as effective in removing visible dirt or contaminants. 10% bleach is too strong and can cause skin irritation. Soap and water, on the other hand, are highly effective in removing dirt, germs, and other contaminants from the hands. Therefore, soap and water is the best option for cleansing hands in this situation.

The phlebotomist should ask the patient to state his or her name when identifying a patient. This is the most reliable method to ensure that the correct patient is being attended to. Asking the patient directly allows for confirmation and eliminates any potential confusion or mistakes.

After eating too much fatty foods and not fasting, the patient's serum is expected to appear lipemic. Lipemia refers to the presence of an abnormally high level of lipids (fats) in the blood, which can cause the serum to appear cloudy or milky. This is commonly seen after consuming a high-fat meal, as the body releases chylomicrons (lipoproteins that transport dietary fats) into the bloodstream. These chylomicrons increase the lipid content of the serum, resulting in a lipemic appearance.

Placing the tourniquet on the right arm and locating an alternate vein is the best course of action in this situation. If the only vein in the left arm keeps rolling away, it may be difficult to successfully insert a needle. Placing the tourniquet on the right arm can help to distend the veins and make them easier to palpate and access. Locating an alternate vein ensures that you can still administer medication or draw blood without causing discomfort or harm to the patient.

Bandages should not be applied to anyone under 2 years of age because young children have delicate skin that is more prone to irritation and skin damage. Additionally, young children may not be able to communicate any discomfort or pain caused by the bandage, leading to potential complications. It is important to use alternative methods to protect and treat wounds in infants and young children.

The lavender top tube should be filled last in the recommended order of draw. This is because lavender top tubes are used for collecting blood samples for hematology tests, such as complete blood count (CBC) and blood typing. It is important to fill the other tubes first to avoid any cross-contamination or interference with the lavender top tube, which could affect the accuracy of the hematology tests.

The valves at the entrance of the ventricles in the heart are called the tricuspid and bicuspid valves. These valves play a crucial role in preventing the backflow of blood from the ventricles to the atria during the contraction of the heart. The tricuspid valve is located between the right atrium and right ventricle, while the bicuspid valve, also known as the mitral valve, is located between the left atrium and left ventricle.

It is important to prioritize one's own tasks and responsibilities. By refusing to finish labeling someone else's tubes, you are asserting your boundaries and ensuring that you are able to complete your own work effectively. This also promotes accountability and encourages the coworker to take ownership of their own tasks.

Plasma is the correct answer because it is the liquid portion of a blood specimen that is obtained after the blood has been anticoagulated. It contains various components such as water, proteins, electrolytes, hormones, and waste products. Plasma is separated from the cellular components of the blood through centrifugation and is used for various laboratory tests and diagnostic purposes. Serum, on the other hand, is the liquid portion of blood obtained after coagulation has occurred, and it does not contain clotting factors. Cellular components refer to the red and white blood cells, while the buffy coat is the thin layer of white blood cells and platelets that separates from the plasma during centrifugation.

In this situation, referring the patient to the provider is the correct response. As a person who is drawing blood, you may not have the necessary knowledge or authority to explain the meaning of each test. It is best to direct the patient to the provider who can provide accurate and detailed explanations regarding the tests ordered.

The gray tube is used when there is going to be a delay in processing a glucose test. This is because the gray tube contains an additive called sodium fluoride, which helps preserve glucose levels in the blood for a longer period of time. This tube is commonly used for glucose tolerance tests or when there is a need to measure glucose levels over a longer period of time.

An evacuated tube system consists of a multi-sample needle, an adapter, and a tube. This system is used for collecting blood samples for various laboratory tests. The multi-sample needle is used to puncture the vein and collect the blood, while the adapter connects the needle to the tube, allowing the blood to flow into it. The tube is where the blood sample is stored for further analysis. This system ensures a sterile and efficient collection of blood samples.

If proper pressure is not applied to the venipuncture site, it may cause a hematoma. A hematoma is a localized collection of blood outside the blood vessels, usually caused by a break in the vessel wall. In the context of venipuncture, if pressure is not applied after the needle is removed, it can lead to bleeding and the formation of a hematoma at the puncture site. This can be painful and may require additional medical intervention to treat.

In the event of a patient having a seizure during a procedure, the first response should be to remove the needle. This is because the needle may pose a risk of injury to the patient during the seizure. Removing the needle helps to ensure the safety of the patient and prevent any potential harm.

To accurately interpret the results of a fasting blood sugar test, it is important to know when the patient last ate or drank anything. This information helps determine if the patient has followed the necessary fasting period before the test. Asking whether the patient is fasting or when they last ate alone may not provide sufficient information, as the patient may have consumed beverages that can affect blood sugar levels. Therefore, asking when the patient last had something to eat or drink ensures a comprehensive understanding of their fasting status.

Evacuated tubes with anticoagulants should be mixed 5-10 times. Mixing the tubes helps to ensure proper mixing of the anticoagulant with the blood sample, preventing clotting and ensuring accurate test results. The range of 5-10 times allows for thorough mixing without excessive agitation, which could potentially affect the integrity of the sample.

If you notice that your patient's color has changed since you called them, it indicates a potential change in their condition. Asking if they are okay is the appropriate response as it allows you to assess their well-being and determine if further action is necessary. Ignoring it may lead to overlooking a serious issue, stopping the procedure without assessing the patient's condition may be unnecessary, and screaming for help may cause panic without addressing the immediate concern.

Before conducting a glucose tolerance test, it is important to obtain both a urine and blood specimen from the patient. This is necessary to assess the patient's glucose levels before and after consuming a glucose drink. The urine sample helps to measure glucose levels in the urine, while the blood sample provides a more accurate measurement of blood glucose levels. By obtaining both samples, healthcare professionals can accurately diagnose conditions such as diabetes or gestational diabetes and monitor the patient's response to glucose intake.

It is important for the patient to be fasting before a fasting blood sugar test in order to obtain accurate results. Consuming a can of soda can affect the blood sugar levels and invalidate the test. Therefore, it is necessary to ask the patient to come back tomorrow and explain the importance of fasting before the test.

The correct color of a biohazard sticker is black on florescent red or orange. This color combination is used to ensure high visibility and to indicate the presence of a hazardous biological substance. The black text stands out against the bright red or orange background, making it easily noticeable and recognizable as a biohazard warning.

The light blue tube is the most critical in filling because it is commonly used for coagulation testing, which is essential for diagnosing blood clotting disorders. Coagulation tests are crucial in determining the risk of excessive bleeding or blood clot formation, making the light blue tube an important tool in monitoring and managing these conditions.

The purpose of applying the tourniquet and palpating the venipuncture is to provide indication of the depth and size of the vein, as well as to help determine the angle to insert the needle. It does not serve the purpose of distracting the patient from the discomfort of the procedure.

The test that should be collected first is the STAT glucose in the ER. The term "STAT" indicates that the test is urgent and needs to be prioritized. Additionally, the fact that it is in the ER suggests that it may be related to a critical condition or emergency situation, further emphasizing the need for immediate attention. Collecting this test first would ensure timely diagnosis and treatment if necessary.

If an arterial specimen is accidentally drawn, it should be labeled as arterial. This is important because the specimen needs to be correctly identified to ensure proper handling and processing. Labeling it as arterial will help prevent any confusion or mistakes in the laboratory. It is important to follow proper protocols and inform the supervisor about the incident to ensure appropriate actions are taken.

Pulling back on the plunger of a syringe slowly will not cause the patient's veins to collapse. This is because drawing the plunger slowly creates a gentle suction that does not put excessive pressure on the veins. In contrast, pulling back too quickly or forcefully can create a high vacuum, which can cause the veins to collapse.

When anchoring a patient's vein, it is important to use the thumb below. This is because the thumb provides stability and control while the finger above helps in applying pressure to the vein. Using both the thumb below and the finger above ensures a secure grip and minimizes the risk of the vein slipping or moving during the procedure.

The best angle for needle insertion during a venipuncture is 15-30 degrees. This angle allows for proper access to the vein while minimizing the risk of puncturing through the vein or causing discomfort to the patient. A shallower angle (5-15 degrees) may result in the needle not entering the vein properly, while a steeper angle (30-45 degrees) may increase the risk of puncturing through the vein or causing hematoma formation. Therefore, the ideal angle for needle insertion is 15-30 degrees.

The correct answer is to continue with the procedure with the same professionalism as you would with a conscious person. This is because the wristband on the unconscious patient matches the requisition in your hand, indicating that the patient has been properly identified. Verifying with the nurse or attempting to wake the patient for verbal verification may not be necessary in this case, as the identification is already confirmed. It is important to maintain professionalism and follow proper protocols when dealing with unconscious patients.

The correct answer is 2, Discard tube. When arriving in the ICU and finding a patient with an IV running, the NAACLS recommends shutting off the IV for a minimum of 2 minutes and drawing a discard tube first. This is done to ensure that any residual IV fluid or medication is cleared from the IV line before collecting a sample for testing. The discard tube is used to remove any potential contamination that may have occurred during the IV administration.

VAD stands for Vascular Access Device. This is a medical device that is used to gain access to the bloodstream for the purpose of delivering medications, fluids, or obtaining blood samples. It is commonly used in hospitals and other healthcare settings to provide long-term access to the vascular system. Venous Access Device is incorrect because it only refers to accessing veins, whereas Vascular Access Device encompasses both venous and arterial access. Vascular Accessory Device is not a recognized term in the medical field. Therefore, the correct answer is Vascular Access Device.

When you arrive at the patient's room and find a member of the clergy with them, it would be appropriate to come back later. This is because the presence of the clergy indicates that the patient may be engaged in a religious or spiritual activity, and it would be respectful to give them privacy and allow them to finish their interaction before proceeding with any medical procedures or tasks.

The term "The river of life" is often used metaphorically to describe blood. This is because blood flows through our bodies, delivering oxygen and nutrients to all our cells, and removing waste products. It is essential for sustaining life, just like a river is necessary for the survival of a community or ecosystem. Therefore, "The river of life" is a fitting description for the meaning of blood.

Heparin is an anticoagulant that works by inhibiting thrombin, which is an enzyme responsible for the conversion of fibrinogen to fibrin. By inhibiting thrombin, heparin prevents the formation of blood clots and helps to maintain blood flow. EDTA, sodium citrate, and potassium oxalate are also anticoagulants, but they work through different mechanisms and do not specifically inhibit thrombin.

The shield of the needles are colored by gauge. This means that the color of the shield indicates the size or thickness of the needle. The gauge is an important factor in determining the appropriate needle for a particular medical procedure. Different gauges are used for different purposes, and the color-coding system helps healthcare professionals quickly identify the correct needle size for their needs. Therefore, the correct answer is Gauge.

Filling the tube from the stopper end first is not proper venipuncture technique because it can introduce air bubbles into the collected blood sample, which can affect the accuracy of the test results. It is important to fill the tube from the bottom to ensure that the blood is properly collected without any contamination or introduction of air.

Prolonged tourniquet application can cause hemoconcentration. When a tourniquet is applied for an extended period of time, it restricts blood flow to the area below the tourniquet. This can lead to an increase in the concentration of red blood cells and other components of the blood in that area, resulting in hemoconcentration. Hemolysis refers to the breakdown of red blood cells, which is not directly caused by tourniquet application. Hematoma refers to the collection of blood outside of blood vessels, which can occur as a result of trauma or injury, but is not directly caused by tourniquet application.

The correct answer is Blood bank. This department deals with the storage and transfusion of blood products, and any errors or contamination in the process can have serious consequences for the patients receiving the blood. If the wrong blood type is given or if the blood is contaminated with pathogens, it can lead to severe allergic reactions, transfusion reactions, or even death within minutes. Therefore, it is crucial for the blood bank staff to follow strict protocols and ensure the safety and compatibility of blood products before transfusion.

Hemostasis is the process of stopping bleeding and repairing an injury to a blood vessel. It involves vasoconstriction, the narrowing of the blood vessel to reduce blood flow, and the formation of a blood clot to seal the injured area. This process helps to maintain homeostasis, the balance of internal conditions in the body. Hemolysis, on the other hand, refers to the destruction of red blood cells, which is not relevant to the repair of a vessel injury.

The quality of the test results depends on the quality of the specimen. If the specimen collected for testing is of low quality or contaminated, it can lead to inaccurate results. The phlebotomist plays a role in ensuring the quality of the specimen by properly collecting and handling it. The quantity of the specimen is also important as it should be sufficient for the required tests. Therefore, all three factors - the quality of the phlebotomist, the quantity of the specimen, and the quality of the specimen - contribute to the overall quality of the test results.

EDTA (Ethylene Diamine Tetraacetic Acid) is the correct answer because it is known to preserve cell morphology by chelating calcium ions, which are essential for cell adhesion and aggregation. By removing calcium ions, EDTA prevents cells from clumping together or aggregating. Additionally, EDTA also inhibits platelet aggregation by preventing the activation of platelets and the formation of blood clots. Therefore, EDTA is commonly used as an anticoagulant in blood collection tubes to preserve cell morphology and inhibit platelet aggregation.

When identifying a patient, additional information such as a license can be used. A license typically contains the person's name, photograph, and other identifying details, making it a reliable form of identification. While a military ID and passport can also be used for identification, the given answer suggests that a license is a valid option as well.

Coagulation factors circulating in the tissue are part of the extrinsic pathway. The extrinsic pathway is initiated by tissue factor, which is released from damaged tissue. This pathway is responsible for the rapid initiation of blood clotting in response to injury. In contrast, the intrinsic pathway is initiated by factors within the blood itself. The common pathway is the final step in the coagulation cascade, where both the intrinsic and extrinsic pathways converge. Clot retraction is a separate process that occurs after clot formation and involves the contraction of platelets to consolidate the clot.

After a vessel injury, the first step is vasoconstriction, which helps to reduce blood flow and prevent excessive bleeding. This is followed by the formation of a platelet plug, where platelets adhere to the site of injury and aggregate to form a temporary seal. Next, fibrin clot formation occurs, where fibrinogen is converted to fibrin by the enzyme thrombin, creating a stable blood clot. Fibrinolysis is the final step, where the clot is gradually dissolved by the enzyme plasmin to allow for tissue repair.

A "STAT" test refers to a test that needs to be done urgently or immediately. In a medical setting, a urine test can often be performed quickly and provide immediate results, making it suitable for a "STAT" test. On the other hand, CSF (cerebrospinal fluid) test, CBC (complete blood count) test, and lipid test may require more time for sample collection, processing, and analysis, and therefore may not be considered "STAT" tests.