NCCT - Medical Procedures - Part C - Phlebotomy

The venipuncture site should be cleansed with an alcohol prep. This is because alcohol is an effective disinfectant that kills bacteria and other microorganisms on the skin. It helps to reduce the risk of infection at the site of the venipuncture. Using a damp solution, paper towel, or the back of your hand may not provide the same level of cleanliness and disinfection as an alcohol prep.

When performing a venipuncture, making a fist helps to increase blood flow and pressure in the veins. This increased blood flow causes the veins to become more prominent and easier to locate, making it easier to perform the venipuncture successfully.

The evacuated glass tubes in the blood collection system come in different sizes, and the stoppers are color coded to denote the type of additive or lack of one. This means that each color represents a specific additive or lack thereof, making it easier for healthcare professionals to identify the tube's purpose and use it correctly. This color coding system helps prevent errors and ensures accurate testing and diagnosis.

A lancet is a small, sterile, needle-like piece of metal used to make small punctures in the dermis. It is commonly used in medical procedures such as blood glucose monitoring or blood sampling. The sharp tip of the lancet allows for precise and controlled punctures, minimizing pain and tissue damage.

The standard point of the Lancet to be used when collecting blood from a newborn heel is 2.4 mm in length.

The correct answer is "CLOSED" because keeping the lid of the centrifuge closed is essential for safety and proper functioning. Closing the lid ensures that the contents inside the centrifuge remain contained and do not spill or cause any harm. Additionally, closing the lid creates a sealed environment, allowing the centrifuge to generate the necessary centrifugal force to separate the samples effectively.

When feeling for a vein, it is recommended to wrap the tourniquet around the arm approximately 3-4 inches above the area. This allows for proper constriction of the blood vessels, making it easier to locate and access the vein for procedures such as drawing blood or inserting an IV. Wrapping the tourniquet too tightly or too loosely can affect the accuracy of the procedure.

If a patient has a syncopal episode during a venipuncture, the best course of action would be to remove the needle and tourniquet and lower the patient's head and arms. This is because syncope is a temporary loss of consciousness caused by a decrease in blood flow to the brain, and lowering the patient's head and arms can help improve blood flow and prevent further injury. Removing the needle and tourniquet is important to stop the venipuncture procedure and ensure the safety of the patient.

The most important step in the performance of a venipuncture is positively identifying the patient. This is crucial to ensure that the correct patient is receiving the procedure and to prevent any potential errors or complications. Positive identification involves verifying the patient's identity using two unique identifiers, such as their name, date of birth, or medical record number. This step ensures that the right patient is receiving the right treatment and helps to maintain patient safety and prevent medical errors.

A centrifuge is a laboratory instrument that spins samples at high speeds to separate components based on their density. In the case of blood, it is used to separate the cellular portion (red blood cells, white blood cells, and platelets) from the liquid portion (plasma or serum). By spinning the blood at high speeds, the heavier cellular components settle at the bottom of the tube while the lighter liquid portion rises to the top. This allows for further analysis or processing of the separated components.

When performing a venipuncture, the tourniquet should be wrapped around the arm about 3-4 inches from where you are going to feel for a vein. This is because wrapping the tourniquet tightly above the intended venipuncture site helps to engorge the veins and make them easier to locate and access. By feeling for the vein, the healthcare professional can identify the best location for the venipuncture and ensure a successful blood draw.

The blood lancet is used for the collection of blood specimens by skin puncture. Skin puncture involves using a small, sharp lancet to create a small puncture or prick in the skin, usually on the finger or heel. This method is commonly used for collecting small amounts of blood for various tests, such as glucose monitoring or blood typing. Skin puncture is less invasive and causes less pain compared to other methods like injection or cutting, making it the preferred method for blood collection in certain situations.

The most commonly used needle gauges for venipuncture are 21-22. These gauges are ideal for drawing blood because they are large enough to allow for a smooth and efficient flow of blood, but not so large that they cause excessive pain or damage to the vein. This size range is considered standard for venipuncture procedures and is widely used in medical settings.

The cephalic, medial cubital, and basilic veins are primarily used for venipuncture. This means that these veins are the main or most commonly used veins for the procedure. Other veins may also be used in certain situations, but these three veins are the preferred choices for venipuncture.

When collecting blood by skin puncture on an infant, it is recommended to use a lancet. A lancet is a small, sharp instrument specifically designed for pricking the skin to obtain a small blood sample. It is safer and more suitable for infants as it minimizes the risk of injury and ensures a precise and controlled puncture. Using a larger needle or scalpel may cause unnecessary pain and increase the risk of complications. Therefore, a lancet is the most appropriate choice for collecting blood by skin puncture on an infant.

When cleansing the venipuncture site, it is good practice to cleanse the site from the inside out and allow it to air dry. This ensures that the site is properly cleaned and disinfected before the venipuncture procedure. Wiping the site back and forth quickly with an alcohol prep may not effectively clean the site. Blowing on the alcohol to dry it may introduce bacteria from the mouth to the site. Having the patient wave their arm in the air to dry it faster may not provide adequate drying time. Therefore, cleansing the site from the inside out and allowing it to air dry is the best practice.

The higher the gauge number, the smaller the needle. This is because the gauge number refers to the diameter of the needle. A higher gauge number indicates a smaller diameter needle, while a lower gauge number indicates a larger diameter needle. Therefore, the correct answer is "smaller".

When looking for a vein, it is important to use your index finger to palpate. Palpation involves using touch to feel for the vein's location and characteristics, such as size, depth, and direction. By using the index finger, which is sensitive and has a good sense of touch, healthcare professionals can better locate the vein and ensure a successful procedure, such as inserting a needle for injection or drawing blood.

Arterioles are the smallest type of arteries. Arteries are blood vessels that carry oxygenated blood away from the heart to the rest of the body. Arterioles are smaller branches of arteries that further divide into capillaries. They play a crucial role in regulating blood flow and blood pressure in the body.

PT (Prothrombin Time) and PTT (Partial Thromboplastin Time) are lab tests that monitor anticoagulation therapy. PT measures the time it takes for blood to clot, while PTT measures the time it takes for blood to clot in response to certain medications. These tests are commonly used to monitor the effectiveness of anticoagulant medications, such as warfarin, and to ensure that the blood is clotting within the desired range. By regularly monitoring PT and PTT levels, healthcare providers can adjust the dosage of anticoagulant medications to maintain a balance between preventing blood clots and avoiding excessive bleeding.

The question is asking which of the given evacuated tubes would be drawn first. Without any additional information or context, it is not possible to determine the exact reason why the red tube would be drawn first. However, in medical settings, it is common for red tubes to be used for blood collection as they typically contain a clot activator or gel separator. This allows for the separation of serum or plasma from the blood cells, making it easier for further testing and analysis. Therefore, based on this common practice, it can be inferred that the red tube would be drawn first for blood collection.

When drawing blood, it is recommended to tie a tourniquet on the upper arm for a maximum of 1 minute. Tying a tourniquet for longer periods can lead to venous congestion, which can affect the accuracy of blood test results. By limiting the time to 1 minute, healthcare professionals can ensure that blood flow is temporarily restricted without causing any adverse effects.

To cleanse the typical venipuncture site, it is recommended to work in a circle to the periphery. This means starting at the intended site of the draw and moving outward in a circular motion. This technique helps to ensure that the entire area is thoroughly cleansed and reduces the risk of contamination. By working in a circle to the periphery, any potential pathogens or debris are effectively removed from the site, promoting a clean and sterile environment for the venipuncture procedure.

Wiping away the first drop of blood is important when performing a capillary stick because the first drop may contain tissue fluids or contaminants that can affect the accuracy of the test results. By wiping away the first drop, a cleaner sample can be obtained for testing. This helps to ensure the reliability and accuracy of the test.

When using a centrifuge, it is important to make sure that equal weights are placed opposite each other. This is because a centrifuge operates by spinning samples at high speeds, causing a centrifugal force that pushes the samples towards the outer edges of the centrifuge tubes. Placing equal weights opposite each other helps to balance the centrifuge, preventing it from becoming imbalanced during operation. This ensures that the samples are spun evenly and that the centrifuge operates smoothly and safely.

During a venipuncture, a holder is needed to secure the needle during insertion into the tube stopper. The holder acts as a stabilizing device that keeps the needle in place and prevents it from moving or slipping during the procedure. It provides a firm grip and control over the needle, ensuring accurate and safe insertion into the tube stopper.

Capillary puncture is a common technique used to collect small amounts of blood for testing. The fingers are the most appropriate site for performing a capillary puncture in a healthy adult because they have a rich blood supply and are easily accessible. The capillaries in the fingertips are close to the surface of the skin, making it easier to obtain a blood sample. Additionally, the fingers are less sensitive compared to other areas such as the earlobes or forearms, making the procedure more comfortable for the patient.

When doing a venipuncture, the syringe or tube should be below the venipuncture site to prevent back-flow. Placing the syringe or tube below the site helps to ensure that gravity assists in the flow of blood into the collection container and prevents any blood from flowing back into the patient's vein.

When anticoagulated blood is centrifuged, plasma goes to the top of the tube. This is because plasma is the liquid component of blood that does not contain any cells or clotting factors. During centrifugation, the denser components of blood, such as red and white blood cells, settle at the bottom of the tube, while the less dense plasma rises to the top.

A glucose tolerance test requires the patient to be fasting and then blood is taken every hour for a predetermined time. This test is used to measure how well the body processes glucose and is commonly used to diagnose diabetes or gestational diabetes. During the test, the patient drinks a glucose solution and blood samples are taken at regular intervals to measure blood sugar levels. By monitoring the blood sugar levels over time, healthcare professionals can determine how effectively the body is able to regulate glucose and identify any abnormalities.

The patient should not eat, smoke, drink coffee or alcohol for 10 hours before or during the glucose tolerance test. This is because these activities can affect the results of the test by altering blood sugar levels. By abstaining from these activities for 10 hours, the patient ensures that their blood sugar levels are not influenced by external factors, allowing for accurate test results.

The color coding for a stopper of a tube with no additives is red. This is because red stoppers are typically used for tubes that are used for the collection of serum. The color coding system helps to easily identify the type of tube and its intended use, ensuring proper handling and processing of the specimen.

When anticoagulated blood is centrifuged, red blood cells go to the bottom of the tube. This is because red blood cells are denser than plasma and other components of the blood. Centrifugation applies centrifugal force, causing the denser red blood cells to separate and settle at the bottom. The lighter components, such as plasma and white blood cells, remain above the red blood cells in the tube.

The lavender top tube with ethylenediaminetetraacetic acid (EDTA) additive is used to collect a blood sample for a complete blood count (CBC). EDTA is an anticoagulant that prevents blood from clotting by binding to calcium ions. This allows for accurate measurement of various blood components, such as red blood cells, white blood cells, and platelets, which are important in determining overall health and diagnosing various conditions. The lavender top tube is specifically designed for CBC testing and is commonly used in clinical laboratories.

To perform a hemoglobin test, a blood sample with EDTA added is needed. EDTA is a common anticoagulant that helps prevent the blood from clotting, allowing for accurate measurement of hemoglobin levels. Serum only or white blood cells would not be suitable for this test as they do not contain the necessary components for measuring hemoglobin.

A hematocrit test is used to measure the percentage of red blood cells in the total blood volume. The lavender-top evacuated tube is used for this test because it contains an anticoagulant called EDTA, which prevents the blood from clotting. This is important because clotting can affect the accuracy of the hematocrit test results. Additionally, the lavender-top tube is specifically designed for hematology tests, making it the appropriate choice for collecting blood for a hematocrit test.

Erythrocyte sedimentation rates (ESR) are increased in infections and inflammatory diseases. ESR is a non-specific marker of inflammation and is used to assess the severity and activity of various conditions. During infections and inflammatory diseases, the body produces certain proteins called acute-phase reactants. These reactants cause red blood cells to clump together, leading to an increased sedimentation rate. Therefore, ESR is a useful diagnostic tool in identifying and monitoring infections and inflammatory diseases.

When performing a PKU test, a capillary blood sample is needed. This is because PKU tests measure the levels of phenylalanine in the blood, which can be accurately detected using a small amount of blood obtained from a capillary puncture. Venipuncture, on the other hand, involves drawing blood from a vein and is typically used for other types of blood tests. Therefore, in the context of a PKU test, a capillary blood sample is the correct choice.

In drug testing, the chain of custody refers to the process of documenting and maintaining the integrity of evidence from the time it is collected until it is presented in court. It ensures that the evidence is not tampered with or contaminated, and provides a clear record of who has had access to the evidence at all times. The chain of custody is crucial in maintaining the reliability and admissibility of evidence in legal proceedings.

When collecting blood for cholesterol tests, it is recommended to use a red top evacuated tube. This is because red top tubes typically contain no additives or anticoagulants, allowing for the collection of a serum sample. Serum is the preferred specimen for cholesterol testing as it provides accurate and reliable results.

Rubber sleeves on an evacuated tube system make it possible for multiple use. The rubber sleeves act as a barrier between the blood and the tube, preventing contamination and allowing the tube to be reused for collecting multiple samples. This is important in medical settings where multiple tests may need to be conducted on a patient's blood sample. The rubber sleeves ensure the integrity and sterility of the sample, allowing for efficient and cost-effective use of the evacuated tube system.

The correct answer is 2 because hematocrit tubes are used to measure the percentage of red blood cells in a person's blood. Typically, two tubes are collected to ensure accuracy and to allow for duplicate testing if necessary. Collecting only one tube may not provide enough blood for an accurate measurement or allow for duplicate testing if needed.

Veins do not pulsate. Pulsation is a characteristic of arteries, not veins. Arteries have a thick muscular wall that helps to pump blood away from the heart, causing pulsation. Veins, on the other hand, have thinner walls and rely on the surrounding muscles to help push blood back towards the heart. Therefore, the statement "Veins pulsate" is false.

Making sure that a tube is correctly labeled with the patient's complete name and identification number is part of the facility's quality control plan. Quality control ensures that all processes and procedures are followed correctly to maintain a high standard of care and accuracy in patient identification and record-keeping. By labeling tubes correctly, the facility can prevent errors and ensure that patients receive the correct treatment and medication. This is an essential aspect of quality control in healthcare settings.

Performing a hematocrit as part of a complete count determines the ratio of the volume packed red blood cells to that of whole blood. Hematocrit is a measure of the percentage of red blood cells in the total blood volume. By measuring the hematocrit, it is possible to assess the proportion of red blood cells in relation to the total blood volume, which can provide information about the oxygen-carrying capacity of the blood. This is important in diagnosing conditions such as anemia and polycythemia.

The correct answer is the RED-TOP TUBE. When using an evacuated tube for the collection of electrolytes, a red-top tube is used. This is because red-top tubes are typically used for serum collection, which is the preferred specimen for electrolyte testing. Serum is obtained by allowing the blood to clot and then separating the liquid portion from the clotted cells. Electrolytes are commonly measured in serum to assess the body's fluid and electrolyte balance.

The tube to collect whole blood with an additive in it has a lavender stopper. The color of the stopper indicates the type of additive present in the tube. Lavender stoppers are commonly used for tubes containing the anticoagulant EDTA (ethylenediaminetetraacetic acid), which is used to prevent blood from clotting. This type of tube is typically used for complete blood count (CBC) tests, as EDTA preserves the cellular components of the blood for accurate analysis.

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Sodium citrate is an anticoagulant of choice for coagulation studies because it protects certain amounts of the pro-coagulants. This means that it prevents the clotting factors in the blood from becoming activated and forming a clot, allowing for accurate measurement and analysis of the coagulation process. By inhibiting the clotting factors, sodium citrate helps to maintain the blood in a liquid state, making it easier to perform coagulation studies.

EDTA is a primary anticoagulant additive that removes calcium by forming insoluble or un-ionized calcium salts. This property of EDTA prevents platelet clumping and the formation of artifacts. Blood films are prepared by spreading a thin layer of blood on a slide for microscopic examination. The use of EDTA as an anticoagulant in blood collection tubes helps in preserving the integrity of the blood cells and preventing clotting, making it suitable for the preparation of blood films.