(BQ) Part 2 book Phlebotomy from student to professuonal has contents: Collection by skin puncture, special blood collection procedures, urine tests, special considerations, common laboratory tests, communication skills for the phlebotomist, conflict management skills,... and other contents
6 Collection by Skin Puncture After studying this unit, it is the responsibility of the learner to be able to: List several situations in which the preferred method of blood collection is skin puncture “The differences in venous and skin-puncture blood should not restrict the use of skin-puncture blood.” —National Committee for Clinical Laboratory Standards (1986) Explain several situations in which skin puncture is not the preferred method of blood collection Describe the appropriate site selection criteria for heelsticks and fingersticks State the steps in performing a fingerstick Demonstrate the appropriate steps in performing a fingerstick State the steps to performing a heelstick Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it capillary action the process by which blood automatically flows into a thin tube during a capillary blood collection procedure cyanotic displaying blueness of the skin, as from imperfectly oxygenated blood lateral referring to the side osteomyelitis an inflammatory disease of the bone, resulting from infection plantar relating to the sole of the foot interstitial fluid fluid between the tissues Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it PART Blood and Urine Collection 118 S kin puncture, or capillary puncture, is a procedure in which the skin is punctured with a lancet to obtain a capillary blood sample for laboratory testing While laboratory tests are most often performed on venous blood, there are situations in which venipuncture is not appropriate CHOOSING THE SKIN PUNCTURE In several situations, the skin puncture may be preferable to the venipuncture These situations may arise when: • The patient is an infant, and a good vein is not found • The patient is a small child, and either a proper vein is not found or the child will not cooperate with the venipuncture • Tests are ordered that require only a few drops of blood • The patient is very apprehensive about a venipuncture and insists on a skin puncture (parents can also request this procedure for their child) • Repeated venipunctures are not successful • The patient has severe burns • The patient has thrombotic tendencies • The patient’s veins must be reserved for therapeutic purposes such as intravenous lines • The patient has fragile superficial veins A skin puncture is not appropriate when: • The patient is severely dehydrated • The patient is in shock • The patient has chronic poor circulation • The patient is extremely cold • More blood than can be obtained by a skin puncture is needed for testing Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it CHAPTER Collection by Skin Puncture 119 COMPOSITION OF SKIN PUNCTURE BLOOD Skin puncture blood is different in composition from venous blood Blood obtained by skin puncture is a combination of blood from capillaries, arterioles, and venules It more closely resembles arterial blood than venous blood Skin puncture blood may be used for laboratory testing so long as the technique is taken into consideration when interpreting the results of blood tests and when a small sample of blood is sufficient for the tests As the skin is punctured, tissue is damaged and interstitial fluid— the fluid present between tissues—is released The first drop of blood will be diluted by this and fluid will need to be wiped away SITE SELECTION A skin puncture (also called a capillary puncture) may also be performed on fingertips, heels, toes, or earlobes However, the earlobe is not recommended as a site of choice, due to poor capillary access Children and Adults Generally, the site of choice is the portion of the fingertip shown in Figure 6-1 Do not puncture the side or the tip of the finger The ring finger and the middle finger are the appropriate fingers for puncture Great Ring B Not this Delmar/Cengage Learning A Delmar/Cengage Learning This Figure 6-1 Finger puncture site Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it PART Blood and Urine Collection 120 The thumb, first finger, and fifth finger are not appropriate choices for skin puncture The tissue on the fifth finger is much thinner than on the other fingers The thumb and first finger are usually calloused The nondonimant hand may be a better first option since the fingers may be less calloused Patients requiring frequent fingersticks—such as for glucose monitoring, for example—should have the puncture site rotated The puncture should be made perpendicular to the fingerprint A perpendicular puncture will cause the blood to form a droplet A parallel puncture will cause the blood to flow down the finger instead of forming a nice round drop Edematous (swollen) sites should be avoided, because a free flow of blood is impossible Punctures in cold, or cyanotic, areas should also be avoided Blood obtained from these sites may result in falsely high hemoglobin or cell-count values Infants A Delmar/Cengage Learning The site of choice is the lateral (side) area of the plantar surface of the heel (“plantar” refers to the sole of the foot) The darkened areas in Figure 6-2 show the preferred areas in which to perform a heelstick Never use the area of the heel bone as a puncture site In addition, never puncture the area of the arch Puncturing either of these areas may have serious consequences for the infant Puncturing the heel bone may result in infection and osteomyelitis, an inflammatory disease of the bone Puncturing the arch area may cause damage to nerves Never perform a puncture that will go through a previous site Never perform a skin puncture on the fi nger of an infant The tissue on an infant’s finger is much too thin, and the procedure could damage the bone Figure 6-2 Heel puncture site Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it CHAPTER Collection by Skin Puncture 121 PREPARING THE SITE A free flow of blood is important for accurate test results Massaging the finger of the adult or child and the heel of the infant until the skin is pink will stimulate circulation Warming the skin will also increase blood flow A wet towel (or a packaged heating product) comfortably warmed to the touch may be applied to an adult’s or child’s finger or to the heel of an infant The heat source should be applied for at least minutes COLLECTION DEVICES Delmar/Cengage Learning A wide variety of devices are now used to collect, process, and transport blood obtained from a skin puncture Traditionally, blood is obtained with disposable capillary pipettes that resemble plastic straws The blood flows into the tube through capillary action The process of collecting skin puncture blood has been simplified by the introduction of different types of microcollection devices Figure 6-3 shows two such devices These collection devices allow for easier measuring, color coding, stoppering, centrifugation, and storage of the blood samples Collection caps, often shaped like a scoop, are used to collect the blood Figure 6-3 Microcollection devices Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it PART Blood and Urine Collection 122 Lancets A good flow of blood is obtained with the correct use of the skin puncture device As with the collection devices, a wide variety of skin puncture lancets are available Lancets are designed to control the depth of the puncture so that no damage will be done to the site Most lancets are either blades that the phlebotomist pushes into the skin or spring-loaded devices that lie on the surface of the skin and make an automatic puncture The spring-loaded devices have a button that, when pressed, releases the lancet into the skin Patients may be less frightened by this device, because they cannot see the actual blade penetrate the skin P ROC R O C EDURE EDURE Pe r fo rm i n g a Fi n g e rs t i c k Identify and greet the patient You must always be sure that the specimen is obtained from the correct patient Explain the procedure The explanation should help to calm the patient and instill confidence in your ability as a phlebotomist Assemble the equipment: gloves, lancet or puncture device, alcohol prep pads, gauze, and collection device Select a puncture site Massage or warm the puncture site The heel may be warmed with a warm cloth not to exceed 42ºC (107ºF) Commercial infant heel warmers are also available Put on gloves to prevent exposure to bloodborne pathogens Cleanse the fingertip with the alcohol prep pad to prevent microbiological contamination of the patient and the specimen Dry the fingertip to prevent hemolysis of the specimen from exposure to alcohol, and to reduce a stinging sensation for the patient Remove cover from lancet or other device to be used 10 Grasp patient’s finger, placing your thumb at the base of the fingernail Wrap your fingers around the inside of the patient’s finger This maintains your control of the patient’s finger while allowing you the best access to the puncture site 11 If using a lancet, make a quick down-and-up motion with the lancet to firmly puncture the skin One firm and quick puncture is less painful than a repeated puncture because of inadequate Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it CHAPTER Collection by Skin Puncture 12 13 14 15 16 17 18 19 20 21 22 23 24 123 penetration Many beginners bounce the lancet off the finger instead of achieving penetration Dispose of the lancet in a sharps container This prevents accidental puncture by the lancet Squeeze the patient’s finger gently to stimulate release of one drop of blood Wipe away the first drop of blood with gauze This drop of blood contains interstitial fluid that could dilute the sample Squeeze the patient’s finger gently again, and fill the collecting device(s) Collect hematology samples first to minimize the possibility of platelet clumping in the collection device Gently tap the EDTA tube periodically to mix the blood with the anticoagulant If filling capillary tubes or microhematocrit tubes, fill the tube approximately 2/3 full and seal with the appropriate sealing compound These tubes may be labeled by wrapping a label around all of them and placing them into a nonadditive collection tube Label the collection tube with the appropriate label information Slide your hand to the base of the patient’s finger Gently “milk” the patient’s finger by firmly sliding your hand grasp back toward the patient’s fingernail Do not squeeze excessively This could result in contamination of the specimen with interstitial fluid Allow the blood to flow freely into the tube Do not “scoop” the blood into the collection tube Doing so forces tissue fluids into the specimen When the collection device is sufficiently filled, place a clean, dry piece of gauze over the puncture site Have the patient apply pressure until the bleeding has stopped Do not use a bandage on the finger of a toddler Young children may swallow small bandages and choke Mix all collection devices containing anticoagulant This action prevents clotting of the specimen Dispose of all contaminated equipment, such as bloodied gauze, in a biohazard container Label specimen containers with appropriate information to ensure identification of specimen Remove gloves and dispose of them in a designated container to prevent contamination of the patient area Wash hands Gloves may have very small holes Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it PART Blood and Urine Collection 124 ORDER OF DRAW FOR SKIN PUNCTURE Slide for differential or stain Blood gas or pH specimen Hematology specimens (EDTA tubes) Chemistry or other specimens (additive tubes first, then nonadditive tubes) PERFORMING A HEELSTICK Delmar/Cengage Learning Performing heelsticks on infants requires extra care and attention (Please refer to Figure 6-4.) Selecting the appropriate puncture site is extremely important Caution should be taken when applying pressure to the infant’s foot Do not puncture bruised areas or previous puncture sites Collecting blood samples in the hospital nursery requires the use of isolation techniques Never take a collection tray into the nursery Wash your hands thoroughly This procedure may take as long as minutes Follow the instructions carefully for proper hand washing before entering a nursery Put on a long-sleeved gown and a mask, if required Follow all nursery protocols for interacting with infants Figure 6-4 Performing a heelstick Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it CHAPTER Collection by Skin Puncture P ROC R O C EDURE EDURE 125 Pe rfo rm i n g a H e e l s t i c k Identify the infant Assemble supplies Heelstick and fingerstick supplies are similar However, a short-point lancet of less than 2.4 mm must be used for the heelstick A puncture of more than 2.4 mm may cause bone damage Open the gauze, alcohol prep, and lancet packages, but leave items inside the packages Put on gloves Warm and/or gently massage the heel Select an appropriate puncture site, avoiding previous puncture sites and the curvature of the heel Grasp the infant’s foot firmly A firm hold will help prevent sudden movement Place your forefinger over the arch of the baby’s foot and your thumb below the puncture site Your remaining fingers should rest on top of the infant’s foot The baby’s foot will be resting between your index finger and your third finger Cleanse the area with an alcohol prep Dry the site with clean gauze Puncture the skin in a quick, firm, down-and-up motion Remember that the puncture should be perpendicular to the heelprint lines 10 Wipe away the first drop of blood This minimizes dilution with tissue fluid 11 Fill the appropriate collection device(s) Collect hematology samples first 12 When the collection device has been filled appropriately, elevate the infant’s foot, place a clean gauze over the puncture site, and press firmly until bleeding stops 13 Mix collection devices containing anticoagulant 14 Label specimen(s) Mix-ups in identification may require another heelstick, which should be avoided in any way possible 15 Dispose of contaminated equipment properly 16 Remove gloves and place them in designated disposal units 17 Wash hands Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it GLOSSARY 226 M median cubital vein—vein in the antecubital area that is most commonly used for venipuncture message—any communication, written or oral, from one person to another monocyte—a large leukocyte formed in bone marrow, with abundant cytoplasm and a kidneyshaped nucleus; ingests bacteria and debris in tissues morning rounds—a batch of laboratory test orders scheduled for early morning collection osteomyelitis—an inflammatory disease of the bone, resulting from infection P Needlestick Safety and Prevention Act—a bill signed November 6, 2000, that contains an amendment to OSHA’s bloodborne pathogen standard to ensure more widespread use of safer medical devices to prevent dangerous needlesticks The legislation requires employers to identify and provide safer equipment for their staffs nephron—structural and functional unit of the kidney neutrophil—leukocyte that engulfs and digests pathogens found in tissues Its granules stain with neither basic nor acid dyes NIOSH (National Institute for Occupational Safety and Health)—a federal agency responsible for conducting research and making recommendations for the prevention of work-related disease and injury It is part of the Centers for Disease Control and Prevention nosocomial—a disorder associated with being treated in a hospital, but unrelated to the patient’s primary condition pathogens—disease-producing agents patient-focused care—an approach to health care in which services are simplified, decentralized, and placed close to the patient Patient’s Bill of Rights—a protection of rights for the health care patient, such as the rights to human dignity, privacy, confidentiality, informed consent, and refusal of treatment peripheral circulation—includes both the systemic circulation and the pulmonary circulation personal protective equipment (PPE)— specialized clothing or equipment worn by a professional for protection against a hazard phenylalanine—amino acid essential for the growth in children and for the metabolism of protein phlebotomist—an individual trained and skilled in obtaining blood samples for clinical testing plantar—relating to the sole of the foot plasma—the yellow fluid component of blood point-of-care testing—collection of a blood sample and immediate testing at the site of client care polycythemia—abnormal increase in the number of erythrocytes in the blood portal vein—a short vein that receives branches from several veins leading from abdominal organs and then enters the liver pulmonary circulation— the flow of blood to the lungs O Q obligationism—an ethical theory that attempts to resolve ethical dilemmas by balancing distributive justice with the promotion of good and the prevention of harm occult—hidden OSHA (Occupational Safety and Health Administration)—a federal agency that develops and promotes occupational safety and health standards, develops and issues regulations, conducts investigations and inspections, and issues citations and proposes penalties for noncompliance with safety and health standards and regulations quality assurance—established policies and procedures to ensure that laboratory testing is carefully monitored from beginning to end, including collection of specimens N R reflective listening—repeating what has been heard back to the speaker reliability—accurate, dependable performance respiratory system—consists of the nose, nasal cavity, pharynx, larynx, trachea, bronchi, and lungs responsiveness—readiness to provide prompt service Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it GLOSSARY risk management—the monitoring of patterns and trends in the health care environment to assure the safety of patients and professionals routine collection—orders collected per individual laboratory policy S saline—a solution containing sodium chloride used as a plasma substitute and a means to correct electrolyte imbalances security—assurance, certainty, safety septicemia—the presence in the bloodstream of infectious microorganisms or their toxins sharp—an object that can penetrate the skin such as a needle, scalpel, broken glass, broken capillary tube, or lancet social contract theory—an ethical theory based on the assumption that the least advantaged are the norm, with income, liberty, opportunity, and selfrespect distributed equally standard precautions—combines many of the basic principles of universal precautions with techniques of body substance isolation stat—at once, immediately From the Latin word statim sterilize—to use a physical or chemical procedure to destroy all microbial life syringe—a device used for drawing out (or injecting) a quantity of fluid systemic circulation—the flow of blood to the body, exclusive of the pulmonary circulation systole—the active, or contracting, phase of the heart muscle’s contraction; the upper number of a blood pressure reading T tangibles—things that are actual and concrete teamwork—the subordination of the individual’s tasks or goals to the common purpose of the group teleology—an ethical theory that determines right or good based on an action’s consequences tetany—a disorder characterized by muscular twitching, cramps, and convulsions 227 thrombocyte—platelet thromboplastin—a lipoprotein that promotes blood clotting; found in platelets thrombosed—occluded, or blocked, by a blood clot thrombus—a clot of blood formed within a blood vessel and remaining attached to its point of origin timed collection—orders collected at a specified collection time tourniquet—a length of rubber or synthetic rubber tied around the arm to arrest blood flow and increase venous filling tunica adventitia—an enclosing tissue that makes up the outer layer of the artery wall tunica intima—the innermost membrane of the artery wall tunica media—the middle layer of the artery wall U understanding—appreciation, sensitivity, comprehension universal body substance precautions— an approach to infection control that considers all human blood and certain body fluids to be infectious and handles them as such infectious urinary system—consists of the kidneys, ureters, urinary bladder, and urethra urine—fluid secreted by the kidneys urobilinogen—compound formed in the intestine from the breakdown of bilirubin V values—strongly held personal and professional beliefs about worth and importance vein—a vessel that carries blood back to the heart venipuncture—a puncture of a vein with the purpose of withdrawing blood ventricles—the two chambers of the heart that receive blood from the corresponding atria and force it into the arteries venule—a small vein connecting the capillaries with the larger systemic veins Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it Index A abdominal aorta, 67 ABO blood typing, 168 access, definition, 205 accommodator as conflict style, 198–199, 201 definition, 197 acid phosphatase (ACP) test, 168–169 activated partial thromboplastin time (APTT) test, 169 aerobic, definition, 129 AIDS (autoimmune immunodeficiency syndrome) as biological hazard, 40 alanine aminotransferase (ALT) test, 169 alcohol (ethyl/legal/medical) test, 169 aldolase test, 169 alkaline phosphatase (ALP) test, 169 American Certification Agency (ACA), 209 American Hospital Association, patient rights and, 19 American Medical Technologists (AMT), 209 American Society of Clinical Pathologists (ASCP) on arterial punctures, as certifying agency, 209–210 ammonia test, 170 amylase test, 170 anaerobic blood cultures and, 133 definition, 129 anion gap, 176 antecubital alternative sites, 149–151 bloodletting and, definition, 3, 97–98 antibody testing, 177, 180 anticoagulant, definition, 79, 88 antinuclear antibody (ANA) test, 170 aorta definition, 59, 62 location, 67 arterial blood gases test, 170 arterial puncture, definition, 3–4 arteries blood flow and, 63 definition, 59, 63 first ligation of, overview of systemic circulation and, 67 arteriole, definition, 59 arterioles blood flow and, 63 definition, 63 arteriotomy, definition, articulation as communication skill, 189–191 definition, 187 ASAP (as soon as possible) definition, 97 prioritizing orders and, 99 aseptic, definition, 97–98 aspartate aminotransferase (AST) test, 171 atherosclerosis cholesterol test and, 172 definition, 167 triglycerides test and, 181 atria, definition, 59, 60 avoider as conflict style, 198–199, 201 definition, 197 axillary vein, 66, 68 B B lymphocytes, function/life span of, 72 Baptist Health South Florida, 25 basilic vein, 66, 68 definition, 3, 97 Harvey and, and site selection for venipuncture, 102 228 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX basophils, definition/function/life span of, 71–73 battery, definition, 3, 21 Becton Dickinson Eclipse Needle, 85 Bellevue Hospital Center (New York), 25 Betadine, definition, 79, 83 bevel, definition, 79, 83–84 bile bilirubin test and, 171 definition, 167 bilirubin bilirubin test and, 171 definition, 167 urinalysis test and, 181–182 bilirubin test, 171 biohazard symbol, 50–51 biological hazards chemical safety and, 52–53 electrical safety and, 53–54 engineering controls and, 42–44 glove removal and, 48–50 hand washing and, 45–46 hepatitis B vaccine and, 50–51 housekeeping and, 50 latex allergies and, 51–52 material safety data sheets (MSDS) and, 53 one-handed recapping method, 47 PPE and, 47–48 radiation safety and, 54 UBSP and, 40–41 work practices and, 44–45 bladder, 161–162 bleeding bowls, 9–10 bleeding, prolonged, 75 bleeding time test, 136–140, 171 blood ABO blood typing, 168 B lymphocytes, 72–73 basophils, 71–72 clotting of, 74–75 complete blood count (CBC) test, 173 composition of skin puncture blood, 119 eosinophils, 71–72 erythrocytes, 71–72 hematopoiesis and, 69–70 leukocytes, 71–73 major components of, 69–70 monocytes, 72–73 neutrophils, 71–72 occult blood in stool test, 178 229 plasma and, 66, 69 Rh typing test, 180 T lymphocytes, 72–73 thrombocytes (platelets), 72–75 transfusions as complicating factors of site selection, 105 blood bank department of pathology laboratory, 27 blood collection See collection procedures (special) blood collection equipment blood collection tubes (venipuncture), 88–90 blood transfer device (venipuncture), 87–88 collection supplies assembly, 105–106 collection tray (capillaries), 80, 92 cotton covering (venipuncture), 80–81 devices (capillaries), 91–93 disinfectant (venipuncture), 83 disposal units (venipuncture), 90–91 gloves (venipuncture), 91 hypodermic needles (venipuncture), 85 lancet (capillaries), 91–92 lancets, 9, 79, 122, 126 multiple-sample needles (venipuncture), 84–85 needle holder (venipuncture), 86 needle types (venipuncture), 83–84 syringe (venipuncture), 86–87 tape (venipuncture), 90 tourniquet (venipuncture), 81–83 wing-tipped (butterfly) needles (venipuncture), 86 blood cultures, 133–135, 172 blood dilution, 91–93 blood transfer device (venipuncture), 87–88 blood urea nitrogen (BUN) test, 172 blood vessels arteries, 63–64, 67 capillaries, 63–65 circulation and, 61–62 cross section, 64 veins, 63–66, 68–69 bloodborne pathogens, definition, 37 bloodletting arteriotomy as procedure, 10 cupping as procedure, 11 instruments for, leeching as procedure, 11–12 major points for, scarification as procedure, 11 venesection as procedure, 9–10 bone marrow, 70, 73 Bowman’s capsule, 160 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it 230 brachial artery, 66–67 brachiocephalic artery, 67 brachiocephalic vein, 68 burns as complicating factors, 105 butterfly needles definition, 79, 86 procedure using syringe/butterfly needle collection system, 112–114 C calcium test, 172 cannula as complicating factor, 105 CAP (College of American Pathologists) definition, 37 general information, 39 capillaries blood flow and, 63 definition, 59, 65 capillary action collection devices and, 121 definition, 117 capillary pipettes, 91–92 capillary puncture See also venipuncture (skin puncture) definition, 3–4 carbon dioxide content, 176 carotid artery, 67 CDC (The Centers for Disease Control and Prevention) definition, 37 general information, 39 Cedar -Sinai Medical Center (California), 25 cell counts, 73 See also leukocytes central venous catheters (CVC) definition, 143 PICC and, 151–153 cephalic vein, 66, 68 definition, 97–98 certification, 209–210 chemical safety, 52–53 chemistry department of pathology laboratory, 26 chloride, 175–176 cholesterol test, 172 chromosome analysis test, 172–173 circulatory system blood and, 66–75 blood vessels and, 61–65 definition, 59 INDEX early beliefs of, 6–7 heart and, 60–61 cirrhosis definition, 167 magnesium test and, 178 clean-catch urine specimen, 163–165 clinical assignment expectations for phlebotomists, 31–32 clinical laboratory departments, 26–27 clot blood cultures and, 134 definition, 3, clot activators, 88 CLSI (Clinical Laboratory Standards Institute) definition, 37 general information, 40 coagulation, definition, 59 coagulation department of pathology laboratory, 27 colitis definition, 167 magnesium test and, 178 collaborator as conflict style, 198–199, 201 definition, 197 collection by routine venipuncture See venipuncture (routine) collection by skin puncture See venipuncture (skin puncture) collection devices routine venipuncture and, 105–106 skin puncture and, 121–122 urine and, 162–164 collection procedures (special) bleeding time test, 136–140 blood cultures, 133–135 children, 146–147 elderly, 147–149 infants, 144–146 newborn screening, 130–132 oral glucose tolerance testing, 135–136 collection requisition/order, 99 collection tray, 92 Columbus, Realdus, communication, definition, 205 communication skills See also conflict management listening, 187, 191–192 speaking, 187–191 telephone techniques and, 192–193 compassion of phlebotomist, 14–15 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX competence, definition, 205 complete blood count (CBC) test, 173 compromiser as conflict style, 198–199, 201 definition, 197 conduct, 14 confidentiality definition, HIPAA and, 20–21 legal issues and, 21 conflict, definition, 197 conflict management conflict styles and, 198–199 problem-solving, 202 situational survey, 200–201 connective tissue, blood as, 66 contaminated definition, 37 and OSHA reduction of bloodborne pathogen exposure, 42 continuous quality improvement (CQI), 21 controller as conflict style, 198–199, 201 definition, 197 cortisol test, 173 costs, patient-focused care and, 155–156 courtesy, definition, 205 creatine kinase (CK) test, 173–174 creatinine clearance test, 174 creatinine test, 174 credibility, definition, 205 culture urine collection, 165 cupping, definition, 3, 11 customer, definition, 205 cyanotic definition, 117 heelsticks and, 120 cytogenetics department of pathology laboratory, 27 cytologic study of urine test, 174–175 cytopathology, definition, cytopathology department of pathology laboratory, 27 D decontaminate, definition, 37 deontology definition, as type of ethical theory, 17 dermatitis due to latex allergy, 52 231 diastole, definition, 59, 61 diet restrictions, 101 digoxin test, 175 disinfectant (venipuncture), 83 disposal of sharps See sharps disposal units (venipuncture), 90–91 dorsal and collection of blood from infants, 145 definition, 143 dorsal hand vein venipuncture, 145–146, 150–151 dorsalis pedis artery, 67 dorsalis venous arch, 68 drug-free workplace, 215 Duke bleeding time test, 137, 171 E earlobes and skin puncture, 119 edema as complicating factor, 105, 120 edematous, definition, 97 education clinical assignment expectations for phlebotomists, 26–27 study/testing skills for phlebotomists, 28–31 efficiency of phlebotomist, 15 egoism definition, as type of ethical theory, 17–18 elderly, blood collection in, 147–149 electrical safety, 53–54 electrolytes (Na/K/chloride/CO2 /content/anion gap) test, 175–176 emergency patients, 100 employment, 210–216 See also phlebotomist engineering controls definition, 37 and OSHA reduction of bloodborne pathogen exposure, 42–44 enzymes acid phosphatase (ACP) test and, 168, 168–169 alanine aminotransferase (ALT) test, 169 aldolase test, 169 alkaline phosphatase (ALP) test, 169 amylase test, 170 aspartate aminotransferase (AST) test, 171 creatine kinase (CK) test, 173–174 definition, 167 lactic acid dehydrogenase (LD) test, 178 renin test, 180 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX 232 eosinophils as component of blood, 70 definition/function/life span of, 71–73 Equal Employment Opportunity (EEO), 214–215 equipment See also blood collection equipment blood cultures and, 134 collection tubes See laboratory tests erythrocyte, definition, 59 erythrocyte sedimentation rate (ESR), 180–181 erythrocytes definition, 66, 69–70 production/function/life span of, 71–72 sedimentation rate (erythrocyte sedimentation rate, or ESR) test, 180–181 ethics definition, theories of, 16–18 ethylenediaminetetracetate (EDTA), 88 etiology blood cultures and, 133 definition, 129 evacuated blood collection system, 13 See also blood collection equipment definition, 79 performing, 106–111 tube guide, 89–90 excretory organs definition, 159 urinary system and, 160 external customer, definition, 205 F fainting, 154 family members, 149 fasting blood sugar (FBS), 176 fasting urine specimen, 162 feel/roll/trace/palpate, 103–104 femoral artery, 67 femoral vein, 68 ferritin test, 176 filter paper collection for newborns, 131–132 filtrate definition, 159 of urinary system, 160 fingerstick procedure for, 122–123 site selection, 119–120 first morning urine specimen, 163 fistula as complicating factor, 105 fleams, 9–10 flexibility, 213–214 Food and Drug Administration (FDA) on glass capillary tubes, 43 G Galen of Roman/Greek medicine, 6–7 gastric artery, 67 gauge, definition, 79, 83–84 gauze, definition, 79 geriatric blood collection, 147–149 glass capillary tubes, 43 glove removal, 48–49 gloves (venipuncture), 91, 106 glucose (2-hr postprandial) test, 176 glucose (random/fasting) test, 176 glucose tolerance testing (GTT), 135–136 gowns, 50 granulocyte, definition, 59 granulocytes definition/function/life span of, 71, 73 Groshong Lines, 151–153 H hand washing procedure, 45–46 Harvey, William, hazards See biological hazards HBV (hepatitis B virus) as biological hazard, 40 definition, 37 and OSHA reduction of bloodborne pathogen exposure, 50–51 HCV (hepatitis C virus) as biological hazard, 40 definition, 37 hearing loss, 148 heart, anatomy/physiology of, 60–61 heelsticks, 124–126 helpfulness of phlebotomist, 14 hematology department of pathology laboratory, 26 hematoma definition, 97–98 as reaction, 154 hematoma as complicating factor, 104–105 hematopoieses, definition, 59 hematopoiesis, definition, 69–70 hemoconcentration definition, 97 and site selection for venipuncture, 102 hemoglobin A1c test, 177 hemoglobin, definition, 59, 71 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX hemostasis bleeding time test and, 136 definition, 59, 129 heparin, definition, 143 heparin lock, definition, 151 hepatic artery, 67 hepatic vein, 68 herpes simplex virus (HSV), 177 Hevea braziliensis, 51 Hickman Line, 151–152 HICPAC (Healthcare Infection Control Practices Advisory Committee), definition, 37 HIPAA (Health Insurance Portability and Accountability Act) definition, provisions of, 20–21 Hippocrates, histopathology, definition, histopathology department of pathology laboratory, 27 historical aspects of phlebotomy bloodletting, 8–13 early beliefs/discoveries, 5–8 HIV (human immunodeficiency virus) as biological hazard, 40 definition, 37 HIV antibody test, 177 housekeeping, 50 and OSHA reduction of bloodborne pathogen exposure, 50 hub, definition, 79, 83–84 Hubbard, Elbert, 212–213 human chorionic gonadotropin (HCG) test, 177 Humoral Theory, humors, definition, 3, Hynson, Wescott, and Dunning, 13 hypodermic needles, 85 hypothyroidism in infants, 131 I IgE antibodies, 51 IgG/IgM test, 177 iliac artery, 67 iliac vein, 68 incident report forms, 23–24 infants collection of blood from, 144–146 heelsticks and, 124–126 hypothyroidism, 131 newborn screening, 130–132 233 phenylketonuria (PKU) screening, 130–131 procedure for filter paper collection for newborns, 131–132 skin puncture and, 120–121 urine collection and, 162 inpatients, 100 insulin, definition, 129 intelligence, 148 internal customer, definition, 205 Internet usage, 210 Interpersonal Conflict (Wilmot and Wilmot), 198 interstitial fluids, definition, 119 interstitital fluid, definition, 117 intravenous therapy as complicating factor, 104 iron test, 177–178 Ivy bleeding time test, 137, 171 J The Joint Commission (formerly JCAHO) definition, 37 general information, 40 jugular vein, 68 K kidneys, 160–161 L LabCorp, 25 laboratory tests ABO blood typing, 168 acid phosphatase (ACP), 168–169 activated partial thromboplastin time (APTT), 169 alanine aminotransferase (ALT), 169 alcohol (ethyl/lega/medical), 169 aldolase, 169 alkaline phosphatase (ALP), 169 ammonia, 170 amylase, 170 antinuclear antibody (ANA), 170 arterial blood gases, 170 aspartate aminotransferase (AST), 171 bilirubin, 171 bleeding time test, 171 blood culture, 172 blood urea nitrogen (BUN), 172 calcium, 172 cholesterol, 172 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX 234 laboratory tests (continued) chromosome analysis, 172–173 complete blood count (CBC), 173 cortisol, 173 creatine kinase (CK), 173–174 creatinine, 174 creatinine clearance, 174 cytologic study of urine, 174–175 digoxin, 175 electrolytes (Na/K/chloride/CO2 /content/anion gap), 175–176 ferritin, 176 glucose (2-hr postprandial), 176 glucose (random/fasting), 176 hemoglobin A1c, 177 HIV antibody, 177 human chorionic gonadotropin (HCG), 177 IgG/IgM, 177 iron, 177–178 lactic acid dehydrogenase (LD), 178 lipase, 178 magnesium, 178 occult blood in stool, 178 osmolality, 179 ova and parasites (O&P), 179 phenylketonuria (PKU), 179 prothrombin time (PT), 179 renin, 180 Rh typing, 180 rubella antibody, 180 sedimentation rate (erythrocyte sedimentation rate, or ESR), 180–181 throat culture, 181 triglycerides, 181 uric acid, 181 urinalysis, 181 vitamin B12, 182 lactic acid dehydrogenase (LD) test, 178 lancets as bloodletting instrument, definition, 79, 91–92 heelsticks and, 126 skin puncture and, 122 lateral definition, 117 heelsticks and, 120 latex allergy definition, 37 general information, 51–52 leech, definition, leeching, 11–12 legal issues confidentiality, 21 procedures for incompetent/illegal actions, 22–24 refusal of treatment, 21 leukocyte, definition, 59 leukocytes definition, 69–70 production/function of, 71, 73 ligate, definition, lipase test, 178 listening definition, 187 professionalism and, 191–192 loop of Henle, 160 loyalty, 212 lymphocyte, definition, 59 lymphocytes definition, 73 function/life span of, 72 lymphostasis and complicating factors of site selection, 104 definition, 97 M magnesium test, 178 masks, 50 mastectomy as complicating factor, 104 median cubital, 66–67 median cubital vein, definition, 97–98 message, definition, 187 microbiology department of pathology laboratory, 27 microtubes, 91–93 midstream urine specimen, 163 Modern Surgery, 11 monocyte, definition, 59 monocytes as component of blood, 70 definition, 73 function/life span of, 72 morning rounds, definition, multiple-sample needles, 84–85 muscle strength/flexibility, 148 N National Credentialing Agency (NCA), 210 NCCLS (National Committee for Clinical Laboratories Standards) See also CLSI (Clinical Laboratory Standards Institute) general information, 39 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX needle holder, 86 needles (venipuncture) collection supplies assembly and, 105 hypodermic needles, 85 multiple-sample needles, 84–85 needle holder, 86 syringes and, 86–87 types/sizes of, 83–84 wing-tipped (butterfly) needles, 86 Needlestick Safety and Prevention Act definition, 37 and OSHA reduction of bloodborne pathogen exposure, 42 nephron definition, 159 of urinary system, 160 neutrophils as component of blood, 70 definition/function/life span of, 71–73 newborn screening See infants NIOSH (The National Institute for Occupational Safety and Health) definition, 37 general information, 39 and OSHA reduction of bloodborne pathogen exposure, 43 nosocomial, definition, 37 nosocomial infections, hand washing and, 45 O obligationism definition, as type of ethical theory, 18 occult definition, 167 occult blood in stool test, 178 occult blood in stool test, 178 one-handed recapping method, 46 oral glucose tolerance testing, 135–136 order of draw skin puncture and, 124 tube guide, 108–109 OSHA (Occupational Safety and Health Administration) definition, 37 engineering controls (bloodborne pathogen reduction) and, 42–44 general information, 38–40 235 hepatitis B vaccine (bloodborne pathogen reduction) and, 50–51 housekeeping (bloodborne pathogen reduction) and, 50 PPE (bloodborne pathogen reduction) and, 47–48 work practices (bloodborne pathogen reduction) and, 44–45 osmolality test, 179 osteomyelitis definition, 117 heelsticks and, 120 outpatients, 100 ova and parasites (O&P) test, 179 P pathogens, definition, 59, 71 patient children, 146–147 communication skills for, 187–193 diet restrictions/time requirements and, 101 elderly, 147–149 and family members, 149 as identified inpatient, 100 as identified outpatient, 100 infants, 120–121, 124–126, 130–132, 144–146, 162 patient-focused care, 143, 155–156 point-of-care testing, 143, 156–157 special considerations, 155 as unidentified emergency patient, 100 patient-focused care, 155–156 definition, 143 patient rights HIPAA and, 20–21 Patients’ Bill of Rights, 18–19 Patients’ Bill of Rights, 19 pediatric blood collection children, 146–147 infants, 144–146 Penrose-St Francis Hospital (Colorado), 25 peripheral circulation, definition, 59, 61–62 peripherally inserted central catheters (PICC), 151 peroneal artery, 67 peroneal vein, 68 personal appearance of phlebotomist, 15–16 personal protective equipment (PPE) definition, 37 and OSHA reduction of bloodborne pathogen exposure, 47–48 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX 236 personnel policies drug-free workplace, 215 Equal Employment Opportunity (EEO), 214–215 on sexual harassment, 215 violence-free workplace, 215–216 worker’s compensation, 216 phenylalanine necessary for metabolizing protein definition, 129 phenylketonuria (PKU) test, 130–131, 179 phlebotomist certification, 209–210 clinical assignment expectations for, 31–32 clinical laboratory departments using, 26–27 communication and, 205, 208 communication skills for, 187–193 competence and, 205, 208 courtesy and, 205, 208 credibility and, 205, 208 customer satisfaction and, 205, 206–207 definition, ethics and, 16–18 external/internal patients and, 206 health care facilities using, 25–26 HIPAA and, 20–21 patient rights and, 18–19 personnel policies for, 214–216 professionalism in, 13–16 qualities for success, 212–214 reliability and, 205, 207 researching potential employment, 210–212 responsiveness, 205, 207–208 security and, 205, 208 study/testing skills for, 28–31 tangibles and, 205, 208 and understanding/knowing customer, 205, 208–209 values and, 18 phlebotomy definition, historical aspects of, 5–8 as pathology laboratory department, 27 physician’s order, 150 plantar, definition, 117 plasma definition, 59, 66, 69 vacuum collection tubes and, 90 volume of blood, 70 platelets See thrombocytes (platelets) point-of-care testing, 156–157 definition, 143 polycythenia bloodletting and, definition, popliteal vein, 68 portal vein definition, Galen and, 6–7 positioning patient, 101 potassium, 175 prefainting, 153–154 pride in work, 214 Principles of Biomedical Ethics, 21 prioritizing orders, 99 privacy, HIPAA and, 3, 20–21 problem-solving See also conflict management professionalism See also phlebotomist importance of, 13–16 listening and, 191–192 speaking and, 188–191 telephone techniques, 192–193 prothrombin time (PT) test, 179 pulmonary circulation definition, 3, 59, 60 discovery of, pus, 71 Q quality assurance definition, versus risk management, 24 Quest Diagnostics, 25 R radial artery, 66–67 radial vein, 68 radiation safety, 54 random/spot urine specimen, 162 reactions fainting, 154 hematoma, 154 prefainting, 153–154 recapping procedure, 46 red bone marrow, 70 reflective listening as communication skill, 191–192 definition, 187 refusal of treatment, 21 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX regulatory agencies (OSHA) See OSHA (Occupational Safety and Health Administration) reliability definition, 205 as quality for success, 213 renal artery, 67 renal vein, 68 renin test, 180 respiratory system definition, 159 as excretory organs, 160 responsiveness, definition, 205 Rh typing test, 180 risk management See also biological hazards definition, 3, 21 procedures for incompetent/illegal actions, 22–24 routine collection definition, 97 prioritizing orders and, 99 routine venipuncture collection supplies assembly for, 105–106 and complicating factors of site selection, 104–105 feel/roll/trace/palpate for, 103–104 procedure using evacuated system, 106–111 procedure using syringe/butterfly needle collection system, 112–114 site selection for, 102–103 rubella antibody test, 180 Rush, Benjamin, 13 S safety See biological hazards saline, definition, 143 saline lock, definition, 151 saphenous vein, 68 scar tissue as complicating factor, 105 scarification, 11 Seattle Children’s Hospital, 25 security, definition, 205 sedimentation rate (erythrocyte sedimentation rate, or ESR) test, 180–181 self-sheathing needles, 42 separating gel, 88 septicemia blood cultures and, 133 definition, 129 237 serum definition, 59, 75 vacuum collection tubes and, 90 sexual harassment, 215 SGPT See activated partial thromboplastin time (APTT) test sharp, definition, 37 sharps, and OSHA reduction of bloodborne pathogen exposure, 42–44 Sims Portex Needle Pro holder, 85 site selection alternative sites, 149–151 point-of-care testing and, 156 for routine puncture, 102–103 for skin puncture, 119–120 skin puncture blood composition and, 119 choosing, 118 collection devices for, 121–122 fingerstick procedure, 122–123 heelstick procedure, 124–126 order of draw, 124 site preparation for, 120 site selection for, 119–120 social contract theory definition, as type of ethical theory, 17 sodium, 175 speaking, 187–191 specimen collection tubes, 42–43 splenic artery, 67 standard precautions, biological hazards and, 40–41 stat definition, 97 prioritizing orders and, 99 Steil, Lyman, 191 sterilize definition, 37 and OSHA reduction of bloodborne pathogen exposure, 42 subclavian artery, 66–67 subclavian vein, 68 surgical pathology department of pathology laboratory, 27 Surgicutt bleeding time test, 137–140 symbols biohazard, 50–51 radiation, 54 syringe, definition, 79 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX 238 syringes, 86–87 systemic circulation definition, 59, 60 upper limbs of, 65–66 systole, definition, 59, 61 systolic, definition, 143 systolic pressure, reactions and, 154 T T lymphocytes, 72 tangibles, definition, 205 tape and bandages (venipuncture), 90 teamwork, 213 teleology definition, as type of ethical theory, 17 telephone techniques, 192–193 Template bleeding time test, 137–140 tests See laboratory tests tetany definition, 143 as reaction, 154 thoracic artery, 67 throat culture test, 181 thrombocyte, definition, 59 thrombocytes (platelets) definition, 69–70 function/life span of, 72 production/function of, 74–75 thrombosed, definition, 97 thrombosed vein as complicating factors of site selection, 105 and site selection for venipuncture, 102 tibial artery, 67 tibial vein, 68 timed collection definition, 97 prioritizing orders and, 99 timed-collection urine specimen, 164 toes and skin puncture, 119 tourniquet blood cultures and, 134 collection supplies assembly and, 105 definition, 79 triglycerides test, 181 tube guide, order of draw, 108–109 tunica adventitia, definition, 59, 64 tunica intima, definition, 59, 63–64 tunica media, definition, 59, 64 U ulnar artery, 66–67 understanding, definition, 205 universal body substance precautions (UBSP) definition, 37 OSHA and, 40–41 University of Texas M.D Anderson Cancer Center, 25 Unopette system, 91–93 ureter, 160–161 urethra, 160–162 uric acid test, 181 urinalysis department of pathology laboratory, 27 urinalysis test, 181 urinary system definition, 159 organs of, 160–162 urine definition, 159 general information, 162 urine tests clean-catch specimen, 163–164 containers, 162–163 culture collection, 165 fasting specimen, 162 first morning specimen, 163 midstream specimen, 163 random/spot specimen, 162 timed-collection specimen, 164 uric acid test, 181 urinalysis test, 181 urinary system, 160–162 urobilinogen definition, 167 urinalysis test and, 182 V vaccinations, hepatitis B vaccine, 50–51 vacuum tube and blood collection, 13, 89–90, 106–111 values, definition, 3, 18 values of tests See laboratory tests vascular access lines, central venous catheters (CVC), 151–153 veins of arm, 69 versus arteries, 63 blood flow and, 63 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX definition, 59, 60 elderly, 148 of hands/legs, 149–150 overview of systemic circulation and, 68 and site selection for venipuncture, 102–103 vena cava, 68 venesection, 9–10 venipuncture See also infants alternative sites for, 149–151 blood transfer devices and, 87–88 definition, 3–4 disinfectant (venipuncture), 83 disposal units and, 90–91 dorsal hand vein venipuncture, 145–146 gloves and, 91 hypodermic needles, 85 and interacting with patient, 100–102 multiple-sample needles, 84–85 needle holders and, 86 normal values See laboratory tests and organization of workload, 99 physiological reactions, 153–154 syringes and, 86–87 tape and bandages and, 90 types/sizes of needles, 83–84 wing-tipped (butterfly) needles, 86 venipuncture (routine) collection supplies assembly for, 105–106 and complicating factors of site selection, 104–105 feel/roll/trace/palpate for, 103–104 procedure using evacuated system, 106–111 procedure using syringe/butterfly needle collection system, 112–114 selecting site for, 102–103 239 venipuncture (skin puncture) blood composition and, 119 choosing, 118 collection devices for, 121–122 fingerstick procedure, 122–123 heelstick procedure, 124–126 order of draw, 124 site preparation for, 120 site selection for, 119–120 ventricles, definition, 59, 60 venules blood flow and, 63 definition, 59, 65 vertebral artery, 67 Vesalius, Andreas, violence-free workplace, 215–216 vision loss, 148 W Washington, George, 13 white blood cells See leukocytes Wilmot, Joyce, 198 Wilmot, William, 198 wing-tipped (butterfly) needles, 79, 86 work practices and OSHA reduction of bloodborne pathogen exposure, 44–45 work settings clinical laboratory departments using phlebotomists, 25–26 health care facilities using phlebotomists, 25–26 worker’s compensation, 216 Y yellow bone marrow, 70 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it ... subsequent rights restrictions require it CHAPTER Collection by Skin Puncture 12 13 14 15 16 17 18 19 20 21 22 23 24 123 penetration Many beginners bounce the lancet off the finger instead of achieving... babies and to give them soothing touches, every effort must be made to give all babies their share of attention Use a soft, soothing tone of voice to talk to the infant patient Take time to softly... Copyright 20 10 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook