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Phlebotomy
Complete collection of study notes for HOSA Phlebotomy 23-24
| Question | Answer |
|---|---|
| major job duties | correctly id pt, collect and label specimens, transport samples to lab, receive specimens sent to lab, process and direct specimens to correct testing depts, take bp, pulse, and respiration readings, explain and comfor pts. |
| are licenses required to practice | yes, some states (california, louisiana, nevada, washington) |
| most important legal issues | informed consent and confidentiality |
| informed consent | pt must be informed of intended tx and risks before performed (understand blood is to be drawn and must consent before proceeding), if consent not given, notify pt nurse and physician |
| confidentiality | all info regarding a pt condition, including tests and results, is confidential. never discuss pt info with coworkers, public, friends, or family |
| HIPPA | health insurance portability and accountability act. privacy of medical info is covered by HIPPA since 1996 to protect PHI (protected health info) |
| PHI | protected health info, including pt name, address, contact info, race, health statues, tx, or payment. Can be written, oral, or electronic. PHI is on requisitions, labels, etc. |
| monitoring system for institutions that train phlebotomists | accreditation |
| where can phlebotomists work | health maintenance org, clinics, urgent care, nursing homes, hospital labs, reference lab draw stations, physician's office labs |
| where do most phlebotomists work | hospital clinical lab in clinical pathology area |
| hospital organization - fiscal and info services | admissions, medical records, billing, accounting, other finances. possibly also human resources is here |
| hospital organization - support services | all aspects of physical plant of hospital, like cleaning, maintenance, security, food service and purchasing |
| hospital organization - nursing services | direct pt care. phlebotomists have a lot of contact w/ nurses. some nurse dept have their own phleb team |
| hospital organization - professional services | provide services as request of licensed practitioners (drs, PAs, NPs) who aid in dx and rx of pt. |
| clinical lab divided into what 2 areas | anatomic and surgical pathology (analyzes cells and tissues - divided into 3 dept: cytogenetics, cytopathology, histology) and clinical pathology (blood, body fluids) |
| type of blood bank tests | Type and Rh Antibody screen Cell panel Fetal screen Cross match/compatibility test Antigen type |
| type and Rh | determines pt blood group and Rh type |
| antibody screen | detects presence of antibodies to antigens in pt blood |
| cell panel | identifies atypical antibodies present in pt blood |
| fetal screen | identifies fetal cells in female pt blood |
| cross match/compatibility test | pretransfusion testing b/w donor and recipient blood |
| antigen type | determines antigen identity |
| color and acid of specimens for blood bank or immunohematology | plaid red or special pink with chemical ethylenediaminetetraacetic acid (EDTA) |
| blood type determined by | presence and type of antigens on surface of RBC. Routine blood type tests ABO group and Rh group. Other antigens used for other transfusions, such as for leukemia or anemia |
| what to look for in compatibility testing | clumping of cells when pt serum mixed with donor RBCs which is caused by reaction b/w pt antibodies and donor cell antigens |
| autologous donation | pt donate their own blood for later use, often several weeks before pt surgery |
| unit of blood in blood bank equivalent to | pint |
| how can blood be separated w/ centrifuge | - packed cells w/ RBCs, WBCs and platelets w/o plasma - fresh frozen plasma from a unit of blood and immediately frozen - platelets from several units of blood and combined in one packet - cryoprecipitate (component of fresh plasma w/ clotting factors) |
| why use cryoprecipitate | pts w/ clotting disorders |
| basic metabolic panel (BMP) | blood urea nitrogen (BUN), calcium, creatinine, electrolytes, and glucose --- for a general metabolic screen |
| coronary risk or lipid panel | cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, B-type natriuretic Peptide - BNP --- assesses risk for heart disease |
| electrolytes chemistry test/panel | bicarbonate, chloride (Cl-), potassium (K+), sodium (Na+) --- evaluates levels of ions in the blood |
| general health or comprehensive metabolic panel (CMP) | alkaline phosphatase (ALP), aspartate aminotransferase (AST), bilirubin, BMP, total protein or albumin --- asses overall health standard of pt |
| glucose chemistry test/panel | 2-Hour postprandial blood sugar (2-hr PPBS), fasting blood sugar (FBS), glucose tolerance test (GTT), glycosylated hemoglobin (Hb A|c) --- assesses risk for diabetes mellitus |
| liver function panel chemistry test/panel | alanine aminotransferase (ALT), albumin, alkaline phosphatase (ALP), aspartate aminotransferase (AST), bilirubin-conjugated, bilirubin-total, globulin, total protein, GGT- gamma-glutamyl transferase --- assesses liver function |
| myocardial infarction chemistry test/panel | creatine kinase (CK), creatine kinase-MB (CK-MB), troponin I --- determines occurrence and timing of a myocardial infarction |
| renal disease chemistry test/panel | albumin, creatinine clearance, phosphorus --- assesses kidney function |
| pancreas chemistry test/panel | amylase, lipase --- assesses pancreatic function |
| drug tests chemistry test/panel | drugs of abuse, alcohol --- detection of drugs and their metabolites in urine |
| toxicology test | analyze plasma for levels of drugs and poisons |
| immunochemistry test | use antibodies to detect range of substances in the blood |
| electrophoresis | separates chemical components of blood based on differences in electrical charge. Often used to analyze hemoglobin, enzymes, and other proteins |
| what are chemistry tests performed on | serum or plasma |
| serum collected in what | tube w/o anticoagulants, so a plain ret-top tube or in a serum separator tube (STT) |
| plain red-top tubes need how long for full clot activation | 45-60 minutes |
| STT need how long for full clot activation | 30 minutes |
| when and how would stat (short turnaround time) requisition be used | when results are needed quickly, collect blood/plasma in tube w/ clot activators |
| what anticoagulants is plasma collected with and why | heparin sodium or sodium fluoride prevent clotting, allowing immediate centrifugation which shortens TAT for reporting test results |
| resident flora | microorganisms that do not normally cause illness. found all over surface of body and GI tract |
| opportunistic microorganisms | when resident flora or other bacteria cause an infection by entering the body through breaks or cuts |
| types of pathogens | viruses, fungi, protists (single celled), helminths (wormlike), prions (molecules of infectious proteins) |
| are infectious agents in hospital more or less virulent and resistant to treatment | more |
| virulent | likely to cause more serious disease |
| nosocomial infections | aka healthcare-associated infections (HAI), infections contracted by pts during hospital stay |
| rate of HAI according to CDC | 1/25 hospitalized pts contract an HAI |
| cause of HAIs | most often by failure of hospital personnel to follow infection control practices like hand hygiene, especially with invasive medical devices and postsurgical wounds |
| what kind of devices are common to cause HAI | central line catheters (causes blood infection), urinary catheters (UTI), ventilators (pneumonia) |
| biggest risk for phlebotomist | contracting a BBP infection from an accidental needle stick |
| adenovirus | virus - upper respiratory infections |
| hepatitis virus (A to E and G) | virus - hepatitis |
| herpes simplex | virus - oral and genital herpes |
| human immunodeficiency virus (HIV) | virus - acquired immunodeficiency syndrome (AIDS) |
| influenza virus | virus - influenza |
| poliovirus | virus - polio |
| varicella-zoster virus | chickenpox and shingles |
| bordetella pertussis | bacteria - pertussis aka whooping cough |
| corynebacterium diphtheria | bacteria - diphtheria |
| escherichia coli | bacteria - food poisoning. some types are normal residents of the colon |
| haemophilus influenza | bacteria - meningitis, pink eye, and upper respiratory infections |
| mycobacterium tuberculosis | bacteria - tuberculosis |
| neisseria gonorrhoeae | bacteria - gonorrhea |
| neisseria meningitides | bacteria - meningococcal meningitis |
| salmonella | bacteria - food poisonin |
| staphylococcus aureus | bacteria - skin and wound infections and food poisoning |
| streptococcus | bacteria - strep throat, rheumatic fever, etc. |
| treponema pallidum | bacteria - syphilis |
| candida albicans | fungi - candidiasis |
| cryptococcus neoformans | fungi - cryptococcosis |
| entamoeba histolytica | protists - amebiasis and dysentery |
| giardia lamblia | protists - giardiasis |
| plasmodium | protists - malaria |
| trichomonas vaginalis | protists - trichomoniasis |
| how to minimize splatter when uncapping blood tube | use piece of gauze to pull stopper off the tube. always tilt top away and bottom toward you when remove stopper to direct droplets away. place stopper bottom side up on paper towel |
| chain of infection | pathogenic agent. reservoir. method of escape. mode of transmission. method of entry. susceptible host |
| modes of transmission | contact (direct and indirect), droplet, airborne, common vehicle (like food, water, medicine), vector (organisms not harmed by infectious agent like mosquitoes and ticks) |
| most important and effective means of preventing spread of infection and antibiotic resistant microorganisms | hand hygiene |
| hand hygiene includes | washing hands with plain or antimicrobial soap and water when visibly dirty or after known exposure to clostridium difficile (C. diff) AND rubbing hands with alcohol-based hand agent in all cases |
| should you wash hands entering pt room if you just washed hand when leaving the last pt room | YES |
| antiseptic | agent used to clean living tissue, preventing sepsis aka infection |
| proper hand washing technique | remove rings and wet hands with warm water, apply soap, scrub vigorously everywhere, rinse hands in a downward position, dry by blotting towel not rubbing, turn off faucet with a new dry paper towel |
| order to put on ppe | gown, mask, respirator, goggles/face shield, gloves over cuffs |
| order to remove ppe | remove gown and gloves, hand hygiene, remove goggles or face shield, remove mask/respirator, hand hygiene again |
| types of joints | synarthrosis (immovable like sutures of cranium), amphiarthrosis (partially movable like vertebral joints), diarthrosis (free moving like appendicular joints) |
| common lab tests for bone and joint disorders pt. 1 | Alkaline phosphatase (ALP) - bone metabolism marker Anticitrullinated protein (rheumatoid factor [RF]) - rheumatoid arthritis (RA) Ca - mineral ca imbalance Erythrocyte sedimentation rate (ESR) - general inflammation test Mg - mineral mg imbalance |
| common lab tests for bone and joint disorders pt. 2 | Synovial fluid analysis - arthritis Uric acid - gout |
| common lab tests for digestive system pt. 1 | Amylase, lipase - pancreatitis Carotene - steatorrhea (malabsorption causing fatty stools) CBC - appendicitis Gastrin (ALP, ALT, GCT, Bilirubin, HBsAG, Hep C antibody and virus by polymerase chain reaction, Ammonia) - Gastric malignancy + liver disease |
| common lab tests for digestive system pt. 2 | Occult blood - GI bleeding Ova and parasites (O&P) - parasitic infection Stool culture - stool pathogens |
| common lab tests for endocrine system pt. 1 | Ca - parathyroid function Catecholamines (epi, norepinephrine) - adrenal function Cortisol - adrenal cortex function and Addison Disease Fasting blood sugar (FBS) - diabetes mellitus FSH, LH, T - infertility Growth hormone (GH) - pituitary function |
| common lab tests for endocrine system pt. 2 | Parathyroid hormone (PTH) and Phosphorus and Vitamin D- parathyroid function Triiodothyronine (3), thyroxine (T4), and thyroid-stimulating hormone (TSH) - graves disease and hashimoto thyroiditis Thyroid function studies - thyroid disorder |
| common lab tests for integumentary system | Culture and sensitivity (C&S) - bacterial or fungal infection Potassium Hydroxide (KOH) prep - fungal infection Skin biopsy - malignancy |
| other common lab tests will be written down later | :) |
| which type of muscle tissue is involved in homestasis | smooth |
| blood is considered which type of tissue | connective |
| in which system does hematopoeisis occur | skeletal |
| what promotes the breakdown of glycogen back to glucose | glucagon |
| parathyroid hormone function | regulates amount of calcium and phosphorus in circulation |
| which hormone regulates water reabsorption by the kidney | ADH |
| ACTH | regulated by hypothalamic-pituitary axis, it regulates cortisol and androgen production and is associated with Addison disease, Cushing syndrome, and Cushing disease |
| MSH | melanocyte-stimulating hormone |
| hormone detected by early pregnancy tests | hCG (human chorionic gonadotropin) |
| thyroxine also known as | T4 |
| human leukocyte antigens tested where and why | tissue typing lab to determine compatibility for organ transplant |
| ischemia | lack of oxygen, which causes damage to muscles |
| tests used to diagnose a MI | CK total: Creatinine kinase total CK-MB fraction: Creatinine kinase MB fraction Myoglobin Troponin T (TnT) Troponin I |
| where is the ideal draw vein | medical cubital vein to reduce likelihood of complications |
| where is blood usually drawn | antecubital fossa |
| blood is typically drawn from what 3 veins | cephalic, median cubital, basilic |
| what nerves pass through and sometimes over which veins | external cutaneous close to cephalic and internal cutaneous nerve close to basilic |
| avg amount of blood in adult | 5-6L |
| plasma | fluid portion of blood, 55% of blood volume. It is 90% water, and rest is dissolved proteins, amino acids, gases, electrolytes, sugars, hormones, lipids, vitamins, and waste products like urea |
| most significant parts of plasma | albumin. (a protein responsible for osmotic pressure and transport of many types of molecules), immunoglobulins/antibodies, fibrinogen (for blood clotting) |
| complement | part of plasma that is a group of immune system proteins that when activated destroy target cells by puncturing membranes |
| electrolytes | major ions of plasma: Na+ Cl- K+ C(a)2+ (Mg)2+ (HCO3)- (PO4)3- (SO4)2- |
| collecting plasma | in a tube w/ anticoagulant. spin sample at high speed in a centrifuge to separate plasma from cells. It is yellow color that floats on top of other cells. Collected in light blue, royal blue, pink, pearl, gray, green, light green, or tan tube. |
| If 3mL plasma needed, how much blood drawn? | 6mL whole blood b/c plasma about half of blood |
| serum | plasma w/o clotting factors. formed when blood sample collected in glass or plastic container w/o additives and is induced to clot (a serum separator used for this) Serum can be separated by centrifuge |
| serum collection tubes | orange, royal blue, red, gold, tiger speckles (red and gold) |
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albinomaPAche
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