Take Home Quiz Chapter 8

If the patient is not available and will not be available for several hours, the best course of action would be to fill out a delay slip stating that the specimen collection was not possible. This ensures that the situation is properly documented and communicated to the relevant parties. Asking the nurse to bring the patient to the lab when available may not be feasible due to the extended unavailability of the patient. Reporting the situation to a supervisor and canceling the request may not be necessary if a delay slip can adequately address the issue. Returning to the lab and putting the request in the stack for the next sweep would not be appropriate as the specimen cannot be collected at that time.

A sclerosed vein feels hard and cord-like because sclerosis refers to the hardening and thickening of the vein walls. This condition is often caused by the buildup of plaque or scar tissue in the veins, leading to a loss of elasticity and a rigid texture. The cord-like feeling is due to the increased thickness and stiffness of the vein, which can be easily palpated.

The given answer states that "You did not have the right equipment on your tray" is not a valid reason for failure to obtain a blood specimen. This means that having the right equipment on the tray is a valid reason for obtaining a blood specimen. Therefore, if the healthcare professional does not have the necessary equipment, they may not be able to collect the blood sample successfully.

Asking another phlebotomist to collect the fasting specimen would be the best course of action in this situation. Since the phlebotomist has made two unsuccessful attempts, it would be wise to bring in another professional who may have more experience or expertise in drawing blood. This would increase the chances of successfully collecting the fasting specimen from the patient.

The correct answer suggests that it is best to discuss the test with the physician. This is the appropriate response because as a healthcare professional, it is important to ensure that patients have accurate information and understand their medical tests. By advising the patient to discuss the test with the physician, it allows for a proper explanation of the purpose of the test and any necessary precautions or preparations that need to be taken. It also respects the patient's right to receive information directly from their healthcare provider.

The medical record number on the patient's ID band must match the requisition information. This is important for accurate identification and tracking of the patient's medical history and test results. The medical record number serves as a unique identifier for the patient and ensures that the correct information is associated with the right individual.

Parkinson's disease is a neurodegenerative disorder that affects the nervous system, specifically the part that controls movement. One of the main symptoms of Parkinson's is tremors, which can make it challenging to perform tasks that require fine motor skills, such as blood collection. The tremors can cause the person's hand to shake uncontrollably, making it difficult to hold a needle steady and accurately collect blood. Therefore, Parkinson's disease can make blood collection difficult due to the associated tremors.

Filling anticoagulant tubes to the proper level ensures that there is a proper ratio of blood to anticoagulant additive. This is important because the anticoagulant additive prevents the blood from clotting, allowing for accurate testing. If the tube is not filled to the proper level, there may be an insufficient amount of anticoagulant additive, leading to improper clotting and inaccurate test results. Additionally, filling the tube to the proper level ensures that there is enough blood for the required tests and minimizes tissue fluid contamination of the specimen.

When a physician is with the patient and a specimen is ordered stat, it is important to introduce yourself and ask for permission to draw the specimen. This is the most appropriate and professional approach in this situation. It ensures that you communicate with both the physician and the patient, showing respect for their presence and consent. By introducing yourself and seeking permission, you establish a clear and respectful line of communication, ensuring that the procedure is conducted with the necessary consent and cooperation.

Having a patient pump his or her fist is prohibited during the vein selection process because it can cause the veins to collapse or move, making it difficult to locate and access a suitable vein for the procedure. Pumping the fist can also increase the risk of injury to the patient and may result in inaccurate vein selection or unsuccessful venipuncture.

If the patient is not wearing an ID band but the information on the requisition matches, the appropriate action would be to ask the patient's nurse to attach an ID band and proceed when it is attached. This ensures that the patient is properly identified before any procedures or specimen collection takes place, maintaining patient safety and preventing any potential mix-ups or errors.

Collecting a specimen before the requested time is unlikely to help a phlebotomist gain a patient's trust because it shows a lack of respect for the patient's needs and preferences. By not following the requested time, the phlebotomist may cause inconvenience or discomfort to the patient, which can lead to a breakdown in trust. It is important for a phlebotomist to prioritize the patient's comfort and preferences in order to establish trust and build a positive rapport.

The unique number assigned to a specimen request is called the accession number. This number is used to track and identify the specimen throughout the entire testing process. It helps ensure that the correct specimen is matched with the correct patient and that the results are accurately reported. The accession number is typically generated by the laboratory or healthcare facility and is an important component in maintaining the integrity and traceability of specimens in the healthcare system.

To verify that the patient in room 302B is indeed John Doe, it is important to ask him for his name and date of birth and match it to the requisition. This method ensures that the patient's identity is confirmed and matches the information provided in the requisition. It is a reliable way to ensure that the correct patient is being attended to and that the specimen collection is being done on the right individual.

The correct answer is "As soon as it is removed from the tube holder." This means that the additive should be mixed immediately after it is taken out of the tube holder. Mixing the additive at this point ensures that it is evenly distributed throughout the sample, providing accurate and consistent results. Waiting until after the next tube is placed in the tube holder or when all other tubes have been collected may result in inadequate mixing and potentially affect the accuracy of the test.

A geriatric patient is least likely to need his or her identity confirmed by the patient's nurse or a relative because geriatric patients are typically older individuals who are more likely to have stable identities and be able to communicate their personal information accurately. Unlike very young children or mentally incompetent patients who may have difficulty providing accurate information, geriatric patients are more likely to have a clear understanding of their identity and be able to confirm it themselves. Additionally, non-English-speaking patients may require assistance in confirming their identity due to language barriers.

The reason a test is ordered "timed" is to draw it at the best time for accurate results. Timing is crucial for certain tests as it can affect the validity and reliability of the results. Some tests need to be performed at specific times to capture the highest or lowest levels of certain substances in the body. This ensures that the results accurately reflect the patient's condition and help in making an accurate diagnosis or prognosis.

When using a syringe, a "flash" of blood appearing in the hub of the needle indicates that the needle has successfully entered a vein. This happens because the needle has punctured the vein wall, allowing blood to flow into the needle and be visible in the hub. This is a common method used by healthcare professionals to ensure that the syringe is correctly placed in a vein for procedures such as blood draws or administering medications.

The correct answer is "Immediately after the needle is withdrawn." This means that the needle safety feature should be activated right after the needle is taken out of the patient's body. Activating the safety feature at this point helps to prevent accidental needlestick injuries by ensuring that the needle is safely secured and cannot cause harm. It is important to activate the safety feature promptly to minimize the risk of any potential accidents or injuries.

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When the patient's veins are very fragile, it may be necessary to use a syringe instead of the evacuated tube system (ETS) for blood collection. Fragile veins can easily collapse or be damaged during the process of drawing blood, making it difficult to collect a sample using the ETS. In such cases, a syringe can be a safer and more effective alternative for blood collection.

When drawing blood from an older child, the most important consideration is explaining the importance of holding still. This is because older children have a better understanding of the procedure and can follow instructions more effectively. Holding still is crucial during blood collection to ensure accurate and safe extraction. Assuring the child that it won't be painful may be helpful, but it is not the most important consideration. Explaining all of the tests being collected and offering a reward for not crying are not as important as ensuring the child remains still during the procedure.

The CLSI-recommended way to clean a venipuncture site is to cleanse with a circular motion from the center to the periphery. This method ensures that the area is thoroughly cleaned and reduces the risk of introducing any contaminants into the site. It is important to clean the site properly before performing a venipuncture to minimize the risk of infection and ensure accurate test results.

Startling a sleeping patient who is about to have a specimen collected can negatively affect laboratory results. This is because the sudden shock or surprise can cause the patient's body to produce stress hormones, such as adrenaline, which can alter the composition of the blood. These changes in hormone levels can affect various laboratory parameters, including blood glucose levels, electrolyte levels, and even blood cell counts. Therefore, it is important for the phlebotomist to approach the patient calmly and gently to ensure accurate and reliable laboratory results.

If the tourniquet is too tight, it can cause several issues. Firstly, arterial flow below it may be stopped, leading to a lack of blood supply to the tissues. Secondly, the blood below the tourniquet may hemoconcentrate, meaning that the concentration of red blood cells and other components increases due to the restricted flow. Lastly, the pressure from the tight tourniquet can cause the arm to ache. Therefore, all of the above statements are correct.

A code is a system or method used to convey important information without alarming the public, transmit messages over a facility's public access system, and use numbers or words to represent important information. Therefore, the correct answer is "All of the above."

The best angle to use for needle insertion during routine venipuncture is 30 degrees or less. This angle allows for proper visualization of the vein and minimizes the risk of puncturing through the vein or causing unnecessary pain to the patient. It also helps to ensure that the needle is inserted at the correct depth and allows for proper blood flow during the procedure.

Hospice care is a type of care provided to patients who are terminally ill. It focuses on providing comfort and support to patients and their families during the final stages of life. Hospice care aims to improve the quality of life by managing pain and symptoms, addressing emotional and spiritual needs, and offering counseling and bereavement support. Unlike other types of care mentioned, such as elder care, home care, or long-term care, hospice care specifically caters to the needs of terminally ill patients.

Mixing anticoagulant tubes immediately after filling them helps to prevent microclot formation. When blood is drawn into a tube, it can sometimes form small clots due to the activation of the coagulation cascade. These microclots can interfere with accurate laboratory test results and may clog the needle or block the flow of blood in the tube. By mixing the blood and anticoagulant immediately after collection, the anticoagulant can prevent clotting and ensure that the blood remains in a liquid state, allowing for accurate testing and analysis.

Lytes, short for electrolytes, are commonly ordered stat. Electrolytes are essential minerals in the body that help maintain proper fluid balance, nerve and muscle function, and other important bodily functions. When there is an imbalance or disruption in electrolyte levels, it can lead to serious health complications. Therefore, it is crucial to quickly assess and monitor electrolyte levels in certain situations, such as in cases of dehydration, kidney dysfunction, or cardiac abnormalities. Ordering lytes as a stat test ensures that the results are obtained and acted upon promptly to prevent any potential harm to the patient.

The patient room number and bed information on a specimen label would be considered optional because it is not directly relevant to the identification and processing of the specimen. The patient's first and last name is crucial for accurate identification, while the phlebotomist's initials or ID help track who collected the specimen. The date and time of the draw are essential for monitoring the freshness and validity of the specimen. However, the patient's room number and bed are not necessary for these purposes and can be omitted if not required for specific organizational or administrative reasons.

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Misidentifying a patient specimen may lead to serious consequences such as a civil action malpractice lawsuit, being dismissed from the facility, or temporary suspension of duties. However, if no one was hurt as a result of the misidentification, there may be no reprimand since there was no harm caused.

Bending the arm up to apply pressure to the site after venipuncture does not enable the site to quickly stop bleeding after needle removal.

By assembling equipment after selecting and cleaning the blood collection site, you will be more likely to allow sufficient time for the alcohol to dry because you have already completed these steps beforehand. Additionally, you will have a better idea of what equipment you will need to use as you have assessed the site and its requirements. This helps in avoiding any unnecessary equipment and wastage. Therefore, all of the given options are correct explanations for why assembling equipment after selecting and cleaning the blood collection site is beneficial.

Outpatient requisitions are typically done manually. This means that the process of making a request for outpatient services, such as medical tests or consultations, is usually done by filling out a physical form or document. This manual method allows for proper documentation and record-keeping of the requisition, ensuring that all necessary information is provided and easily accessible. It also allows for easier tracking and processing of the request by the healthcare facility.

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The correct answer is to determine the problem before proceeding. The patient has expressed a reluctance to have their blood drawn, so it is important to understand the reason behind their hesitation. This could be due to fear, discomfort, or other concerns. By determining the problem before proceeding, the healthcare professional can address the patient's concerns and ensure their comfort and cooperation during the procedure.

The success of pediatric blood collection is most dependent on patient immobilization. This is because children tend to move and squirm during the procedure, making it difficult to locate and access the vein. Proper immobilization ensures that the child remains still, reducing the risk of injury and improving the accuracy of the blood draw. Aseptic technique, correct order of draw, and tourniquet application are also important factors in blood collection, but patient immobilization is crucial for a successful procedure in pediatric patients.

The correct answer is "Informing the patient that you are a student." This is part of informed consent for specimen collection because it is important for the patient to be aware if the person collecting their specimen is a student rather than a fully qualified medical professional. This allows the patient to make an informed decision about whether or not they are comfortable with a student performing the procedure.

When a test is ordered ASAP, it means that the results are needed soon for an appropriate response. This suggests that there is a sense of urgency in obtaining the test results in order to make a timely and informed decision or take appropriate action. It does not necessarily indicate that the patient is in critical condition or that the timing of collection is critical, although these factors could be possible reasons for ordering a test ASAP. Additionally, while the need for results for medication may be a valid reason, it is not specifically mentioned in the given options.

Tests are classified as routine if they are ordered in the course of establishing a diagnosis. This means that these tests are commonly ordered as part of the diagnostic process to help determine the underlying cause of a patient's symptoms or condition. By conducting these routine tests, healthcare professionals can gather valuable information that aids in the diagnosis and subsequent treatment planning for the patient.

The given answer states that it is acceptable to use an ankle vein if the physician gives permission. This implies that the decision to use an ankle vein depends on the physician's approval. The other options mentioned in the question, such as coagulation tests being requested, the patient being partially paralyzed, or there being no other suitable sites, do not directly determine the acceptability of using an ankle vein. Therefore, the physician's permission is the most crucial factor in this scenario.

It is important to have proper identification of the patient before starting any procedure to ensure patient safety and prevent any potential errors. Without an ID band, there is a risk of misidentification. Therefore, it is necessary to wait for the nurse to attach an ID bracelet before proceeding with any procedure.

The patient's identification number is included on the specimen tube labels to avoid confusing specimens from patients with the same name. This is important because multiple patients with the same name may have different medical conditions or require different treatments. By including the identification number, healthcare professionals can ensure that the correct specimen is used for diagnosis and treatment, reducing the risk of medical errors and improving patient care.

A timed test typically has the second priority. This means that it is not the most important task, but it is still important and should be completed within the designated time frame. Other tasks or priorities may take precedence over the timed test, but it should still be given attention and completed in a timely manner.

When using the evacuated-tube method, it is important to draw a small amount of blood into a discard tube before filling the actual collection tube. This is done to ensure that any residual anticoagulant or additive from the previous tube is not carried over into the next tube, which could potentially interfere with the test results. Therefore, in this situation, the correct action would be to draw several millimeters into a discard tube before filling the green-top tube to avoid any cross-contamination.

Cholesterol is the correct answer because it is a common and routine specimen that is frequently tested in medical laboratories. It does not require any special handling or precautions compared to the other specimens listed. Ammonia, bilirubin, and cryoglobulin may require specific handling instructions due to their unstable nature or potential for degradation.

The question is asking about the number of times nonadditive tubes are mixed. The answer "None" indicates that nonadditive tubes are not mixed at all.

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To minimize trauma associated with a venipuncture, it is important to choose the most skilled phlebotomist available to perform the procedure. This is because a skilled phlebotomist will have the expertise to perform the venipuncture accurately and efficiently, reducing the chances of any complications or additional trauma. A skilled phlebotomist will also be able to handle any unexpected situations that may arise during the procedure, ensuring a smoother and less traumatic experience for the patient.

The correct answer is "An artery has a distinct pulse." This is because arteries carry oxygenated blood away from the heart and have a stronger pulse due to the forceful contraction of the heart. Veins, on the other hand, carry deoxygenated blood back to the heart and have a weaker or no pulse. Therefore, feeling a distinct pulse can help distinguish an artery from a vein when selecting a venipuncture site.

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A three-part identification band with special tube labels would be the system of choice to identify laboratory specimens from an unconscious woman in the ER. This system ensures that the specimens are properly labeled and linked to the correct patient even if she is unconscious. The identification band includes information such as the patient's name, unique identifier, and other relevant details. The special tube labels also aid in accurate identification and tracking of the specimens. This system allows for efficient and reliable specimen identification, which is crucial for providing appropriate medical care to the patient.

The left forearm or hand would be the best place to collect a blood specimen for the diabetic outpatient who has had a mastectomy on her right side and cannot straighten her left arm due to arthritis. Using a butterfly for the collection would allow for easier access to the veins in the left forearm or hand, ensuring a successful blood draw. Collecting from the right arm or using a capillary puncture on the right hand may not be feasible due to the patient's condition.

If the patient is just finishing breakfast, it is likely that they have not fasted for the required amount of time before the specimen is collected. Checking with the patient's nurse is the appropriate course of action to determine if the specimen should still be collected or if the draw should be rescheduled.

Lowering a bed rail to make access to the patient's arm easier can lead to liability issues because it compromises the safety and security of the patient. Lowering the bed rail without proper precautions can increase the risk of falls or injuries to the patient. It is important to ensure that the bed rail is used appropriately and in accordance with the patient's needs and safety guidelines to avoid any potential liability issues.

This answer is correct because blood cultures, cardiac enzymes, and cortisol are examples of timed tests. Timed tests refer to laboratory tests that need to be performed at specific times to obtain accurate results. These tests may require specific timing for sample collection or may need to be done within a certain time frame after a specific event or medication administration. In the case of blood cultures, cardiac enzymes, and cortisol, these tests often require samples to be collected at specific intervals or during specific time periods to accurately diagnose and monitor certain conditions.

A cheerful, pleasant bedside manner and exchange of small talk may help to divert attention from any discomfort associated with the draw, increase the patient's confidence in the phlebotomist's abilities, and redirect the patient's thoughts away from what is going to happen. However, it is unlikely to keep the patient from fainting during the venipuncture procedure.

The proper arm position for toutine veil-puncture is downward in a straight line from shoulder to wrist, palm up. This position ensures stability and control while performing the puncture. It allows for a straight and accurate insertion of the needle, minimizing the risk of injury or complications. The palm being up helps in maintaining a steady grip on the needle and provides better visibility of the puncture site.

A manual requisition often serves as a test request, report, and billing form. This means that it can be used to request a test, provide a report on the results of the test, and also serve as a billing form for the services provided. Manual requisitions are typically filled out by hand and may require signatures or other forms of manual authorization. They are often used in situations where a physical form is needed for documentation purposes.

The correct order for the venipuncture procedure is to first clean the site to ensure it is free from any contaminants, then prepare the necessary equipment for the procedure, put on gloves to maintain a sterile environment, and finally apply the tourniquet to help locate and access the vein. This order ensures that the procedure is performed in a safe and hygienic manner.

When inserting a needle into a patient's arm, feeling a slight "give" is an indication that the needle has entered the vein. This "give" refers to a subtle resistance or change in the texture of the tissue, suggesting that the needle has successfully punctured the vein wall. This physical sensation is commonly used by healthcare professionals to ensure accurate needle placement and to avoid complications such as infiltration or puncturing through the vein.

Misidentification of a specimen for the Type and screen test is most likely to have fatal consequences because this test is performed before a blood transfusion to determine the patient's blood type and screen for any antibodies that may cause a transfusion reaction. If the specimen is misidentified, the patient could be given the wrong blood type, leading to a severe transfusion reaction, which can be life-threatening. It is crucial to ensure accurate identification and labeling of the specimen to prevent such fatal consequences.

To "seat" the needle in the vein means to thread part of the needle with the lumen. This refers to the process of properly inserting the needle into the vein so that the needle tip is positioned correctly within the vein's lumen. It ensures that the needle is securely in place and allows for the successful administration of fluids or medication through the vein.

Cotton balls may pull the platelet plug away from the puncture site upon removal. This is because cotton balls have loose cotton fibers that can get stuck to the platelet plug and disrupt the clotting process. Gauze, on the other hand, has a smoother surface and is less likely to disturb the clot when being removed. Using gauze instead of cotton balls helps to maintain the integrity of the clot and promote proper wound healing.

Accessioning the specimen refers to the process of assigning a unique identifier or accession number to a specimen and its accompanying paperwork. This ensures that the specimen and all relevant information are linked to a specific individual, allowing for accurate tracking and identification. Bar-coding specimen labels and collection verification may be part of the accessioning process, but the term "accessioning" encompasses the broader concept of connecting the specimen and paperwork to an individual. Patient identification, while important, is not specifically related to the steps taken to connect the specimen and paperwork.

Waiting 30 seconds for the alcohol to dry before needle insertion is important for several reasons. It allows the process of evaporation to help destroy any microbes, reducing the risk of infection. It also prevents hemolysis of the specimen, as alcohol in the needle can cause the breakdown of red blood cells. Additionally, waiting helps to avoid a stinging sensation when the needle penetrates the skin. However, giving the phlebotomist time to prepare equipment and supplies is the least important reason because it does not directly impact patient safety or the quality of the specimen.

SPEP stands for Serum Protein Electrophoresis, which is a test used to identify protein disorders that can lead to nerve damage. This test separates proteins in the blood based on their size and charge, allowing for the detection of abnormal protein patterns that may indicate underlying conditions such as multiple myeloma or amyloidosis. By identifying these protein disorders, appropriate treatment and management strategies can be implemented to prevent or minimize nerve damage.

Positioning the arm so that the tubes fill from the stopper end first would be considered an improper specimen collection technique. This is because it can lead to the introduction of air bubbles into the tubes, which can interfere with accurate test results. It is important to fill each tube until the normal vacuum is exhausted to ensure proper specimen collection. Collecting sterile specimens before all other specimens and drawing a "clear" tube before special coagulation tests are both appropriate techniques in specimen collection.

Moving the patient to a special phlebotomy collection area is unnecessary because the location where the blood specimen is collected does not affect the procedure or the patient's unconsciousness. The other options are necessary for the safety and comfort of the patient and to ensure proper communication and consent during the blood collection process.

H & H, which stands for hemoglobin and hematocrit, is a common postoperative test. This test measures the levels of red blood cells and hemoglobin in the blood, providing information about the patient's blood volume and oxygen-carrying capacity. Postoperative patients often undergo this test to monitor their blood loss, assess their overall health, and determine if they require any blood transfusions. The CBC (complete blood count) is a broader test that includes H & H, as well as other blood cell counts and indices. ESR (erythrocyte sedimentation rate) and PTT (partial thromboplastin time) are not typically performed as routine postoperative tests.

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When drawing a hand vein, a tourniquet is not required. However, if a tourniquet is used, it should be applied proximal to the wrist bone. This is because applying the tourniquet above the antecubital fossa or just distal to the wrist bone may not provide enough pressure to occlude the vein and make it easier to locate and access for drawing blood. Therefore, applying the tourniquet proximal to the wrist bone ensures a better chance of successful vein identification and blood collection.

Using a large-volume tube with a 23-gauge needle can result in specimen hemolysis. A 23-gauge needle has a larger diameter compared to smaller gauge needles, which can cause more trauma to the red blood cells during the collection process. Additionally, using a large-volume tube means that there is a greater amount of blood flowing through the needle, increasing the likelihood of hemolysis. Hemolysis occurs when the red blood cells rupture, releasing their contents into the plasma or serum, which can affect the accuracy of test results.

Flexible tubing allows for arm movement during venipuncture on a young child. This is important because children may be more likely to fidget or move their arm during the procedure. The flexible tubing allows for some movement without causing damage to the needle or the child's arm. This can help ensure a successful and safe venipuncture procedure.

Using several layers of gauze during needle removal helps to prevent blood from contaminating the gloved hand. This is important for infection control and to maintain a sterile environment. By having multiple layers of gauze, any blood that may be present on the needle or around the injection site can be absorbed, reducing the risk of exposure to bloodborne pathogens. It also helps to maintain a clean and safe working environment for both the healthcare provider and the patient.

Visual inspection of the needle tip before insertion cannot detect whether the needle is out of date. This is because the expiration date of the needle is not visible on its surface and requires checking the packaging or labeling. Visual inspection can, however, help identify external contamination, flaws that could damage a vein, and ensure the proper positioning of the bevel.

Applying pressure on the gauze as the needle is removed can cause the skin to be split. This is because when pressure is applied, it can cause the skin to stretch and tear, resulting in a split. This can be particularly true if the needle is being removed quickly or forcefully, as it increases the likelihood of the skin being split.

Allowing the child to sit with one arm bracing the other is the least effective way to immobilize a pediatric patient before a blood draw because it does not provide adequate restriction of movement. This position still allows the child to move their arms freely, which increases the risk of accidental movement during the procedure. Proper immobilization is essential to ensure the safety and success of the blood draw.

Prolonged tourniquet application can lead to changes in blood composition and analyte levels. Red cell count is least affected by this application because tourniquet mainly affects the plasma components of blood, such as proteins and electrolytes, while the red blood cells remain relatively stable. Therefore, red cell count is the least affected analyte in this scenario.

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Releasing the tourniquet as soon as blood flow is established helps decrease hemoconcentration of the specimen. Hemoconcentration refers to an increase in blood concentration due to the accumulation of cellular and protein components. By releasing the tourniquet, blood flow returns to normal, preventing the buildup of these components and ensuring a more accurate representation of the patient's blood composition. Allowing arterial blood flow to return to normal or increasing venous flow to the selected vein are not directly related to decreasing hemoconcentration.