Question 1

Phil is performing a heel puncture. He is inspecting the infant's heel for an appropriate puncture site. Phil gently, yet firmly, holds the infants heel, while imagining a V-shaped boundary line, with the center point at the back of the heel. Phil chooses his puncture site on the left side of the heel, on the outside of the V-shaped boundary line. What (if anything) has Phil done wrong?

Accepted Answer

Using a V-shaped boundary, starting at the back of the heel, helps the phlebotomist to choose a puncture site that is less likely to contain bone, tendon, or nerve tissue underneath the skin. In the central portion of the heel (the inside portion of the V-shaped boundary) bone tissue is very close to the surface of the skin, and could easily be injured by a lancet. Choosing a puncture site outside of the V-shaped boundary keeps the puncture site options contained to a safer area (the sides of the heels).

Question 2

What is the difference between serum and plasma?

Accepted Answer

The difference between serum and plasma is that serum contains proteins and does not contain clotting factors, while plasma is the portion of blood that contains serum and clotting factors. Plasma is the fluid that blood cells reside in and represents about 55% of total blood volume. Plasma contains the clotting factors essential for formation of blood clots. Serum is the fluid left after a clot has formed, it does not contain clotting factors, but it does contain proteins such as serum albumin and serum globulin.

Question 3

What is glycolysis?

Accepted Answer

Glycolysis is the action of breaking down glucose for energy. In blood, RBC's and WBC's use glucose for energy. This natural occurring action can cause inaccurately lowered blood glucose and pH levels. Blood glucose levels are collected in specimen containers that contain an additive meant to prevent the breakdown of glucose (antiglycolytics). Specimens drawn for blood gas studies are transported to the laboratory immediately immersed in ice water, to slow the process.

Question 4

Phil has a stat draw. The patient and physician are in deep discussion when Phil enters the patients' room. He immediately leaves the room, respecting the patients' right to privacy. He plans to return after completing a routine draw from the patient across the hall. What (if anything) did Phil do wrong?

Accepted Answer

After introducing himself, Phil should explain to the physician and patient why he is in the room and ask permission to begin the procedure. A patient is assured privacy under the Patient Bill of Rights; however, in this scenario delay of a stat draw could delay important treatment. The physician will determine which is more important the stat draw or the discussion with his patient.

Question 5

Kendra is preparing to perform an arterial puncture. What area of the patient's body should Pheona examine first for a suitable site?

Accepted Answer

Pheona should examine the thumb side of wrist first. This radial artery is located in this area and is the first choice for arterial punctures. The brachial artery may be considered, if the radial artery is not an option. The brachial artery is large and easy to palpate; however, it is a more difficult stick because the brachial artery lies much deeper in the arm, very near the median nerve and basilic vein. The femoral artery is for punctures performed by physicians only.

Question 6

Phil is observing Kendra's technique while she performs an arterial puncture. One of the most striking differences he observes is the angle of the needle she is using. Pheona has inserted the needle at a 45-degree angle. Is Pheona demonstrating proper technique?

Accepted Answer

Kendra is demonstrating the proper angle for an arterial puncture. A higher angle is necessary to access arterial vessels that lie deeper than superficial venous veins.

Question 7

Phil is feeling a bit distracted. He is finishing one specimen collection and thinking about the stat draw he was just notified of, as well as the timed draw already scheduled on his run. After the collection tube is filled to the correct level, Phil quickly removes the needle, covers the puncture site with gauze, labels the specimen, and leaves the patients room. What (if anything) has Phil done wrong?

Accepted Answer

Phil did not remove the tourniquet before removing the needle. He also did not check the site for bleeding before leaving the patient's room. Both are steps in the venipuncture procedure. Part of a phlebotomist's duty is prioritizing work and recognizing when help from co-workers is needed to meet the volume of orders, while keeping patients safe.
Phil's error-leaving a tourniquet in place-could result in serious injury to the patient. If he had checked the site one more time before leaving the room, he may have noticed the tourniquet. The procedure for application of a tourniquet advises a tourniquet should not be applied for longer than one minute to prevent hemoconcentration. All venipuncture sites should be checked for bleeding before leaving the patient.

Question 8

Phil is selecting a needle for a butterfly syringe, intended for drawing a blood specimen from a pediatric patient. His patient's veins are small, so he wants a small sized needle. He chooses a 23-gauge needle. Has Phil made the correct selection?

Accepted Answer

A 23-gauge needle is considered a small-bore needle. A 23-gauge needle is frequently used with a butterfly syringe. Remember, the LARGER the number, the SMALLER the bore.

Question 9

Phil has been notified that yet another of his finger sticks has been rejected by the lab. The lab tech tells him, "Dude, quit milking so much!" Phil is not sure what that means. Can you tell Phil what is causing rejection of his capillary collections from finger puncture?

Accepted Answer

Milking is a term used to describe a squeezing and pulling action used with a finger puncture. Inexperienced techs may try this, in an attempt to collect a specimen. The milking action causes fluid normally found in the soft tissue of the fingertip to be squeezed out into the blood. It can also cause hemolysis. Fluid from soft tissue and ruptured blood cells can skew test results, in which case the lab will request another draw, and the tech's rejection rate will increase.

Question 10

Which of the following POCT devices is the only test that requires NOT wiping the first drop of blood away, before collecting the capillary specimen?

Accepted Answer

Many blood coagulation monitor devices instruct to not wipe away the first drop of blood after a puncture for capillary blood. The first drop of blood is considered rich in clotting factors as well as fluid from soft tissue. Blood coagulation monitors can measure the PT and APTT in three minutes.

Question 11

Which of the following is not a method of blood collection?

Accepted Answer

An intravenous infusion is a substance infused to the body by venous access. Syringe draws, vacutainer draws, and butterfly syringe draws are methods of collecting blood. The decision for which method to use is determined by the phlebotomist during assessment of the patient. The decision is based safety, effectiveness, and patient-specific concerns.

Question 12

A 22-gauge needle would be appropriately used for which group of the following patients?

Accepted Answer

In general, a 22-gauge needle is usually used in both children and senior adults. For most adults an 18-20 gauge needle is necessary, 24-gauge needles are used for infants and occasionally for seniors.

Question 13

What is an automatic incision device used for?

Accepted Answer

An automatic incision device is used to make two small, superficial incisions on the lower arm. It is a spring-loaded device that is pressure sensitive. When the phlebotomist is ready, the automatic incision device is pressed against the lower arm to create the small incisions necessary to perform the test.

Question 14

What is the disadvantage of using the radial artery for arterial puncture?

Accepted Answer

The disadvantage of using the radial artery for arterial puncture is that it is smaller than other arteries. However, while other arteries may be larger, the advantage of the radial artery's accessibility, proximity to skin surface, and lack of nearby nerve structures outweigh the disadvantages. Arterial puncture requires considerable skill and experience.

Quiz 5: Phlebotomy