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Chapter 9: Basal State, Problems Associated with Venipuncture
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- 1What is the basal state?Resting state of the body early in morning after 12 hours of fasting
- 2Why are basal-state specimens important?Ideal for establishing reference ranges
Effects of diet, exercise, etc. are minimized - 3What are the physiological variables of the basal state?Age, altitude, dehydration, diet, diurnal variation, drug therapy, exercise, IM injection, fever, gender, jaundice, position, pregnancy, smoking, stress, temperature, humidity
- 4How does age influence basal state?Newborns have an increased RBC and WBCs. Think about how they are young and new and need to fight off more and breathe more.
Advanced age: decrease kidney function, decreased hormone levels, etc. Everything starts slowing down - 5How does altitude affect basal state?Higher elevations mean higher RCB, Hgb, and Hct. (Need more RCB to carry HGB, need more HGB to carry oxy, higher HCT because more RCB)
- 6How does dehydration affect basal state?Can cause hemoconcentration with an increase in RBCs, enzymes, Fe, Ca, Na, and coagulation factors
Difficult to draw - 7How does Diet affect basal state?12 hour fast for lipids and glucose
Glucose levels should return to normal 2-hour PP
High protein diet causes increase uric acid, urea and ammonia
increase in water --> decrease Hgb - 8What is the difference between diurnal and circadian?Diurnal means happening daily.
Circadian means every 24 hours. - 9When does melatonin increase?At night
- 10When do cortisol levels peak?8 am
16 pm - 11How does drug therapy affect basals state?Chemotherapy decreases WBCs and platelets
Many drugs are toxic to the liver and increase liver enzymes (ex. AST, ALP, LDH) - 12How does exercise affect basal state?Increases glucose, insulin, lactic acid, K (pumping of hand), CK and LDH
- 13How does fever affect basal state?Increase cortisol and insulin levels
- 14How does gender affect basal stateRBC, HGB, and HCT are higher for males
- 15How do IM injections affect basal stateincrease CK levels
- 16How does jaundice affect basal stateincrease in bilirubin, causing specimens to be icterus/icteric (yellowing of the serum, plasma, or urine)
- 17How does position affect basal state?Plasma volume can decrease by 10% when sitting up
If having daily tests, patients should be sitting the same way each time - 18How does pregnancy affect basal state?Decreased RBC level due to dilution from increased body fluids
- 19How does smoking affect basal state?Chronic smokers: decrease pulmonary function, increase in RBC and Hgb levels
Smoking prior to collection can increase glucose, WBC, cholesterol and triglycerides levels - 20How does stress affect basal state?Increase wBC, ACTH, and cortisol
Decrease Fe - 21How does temperature and humidity affect basal state?Extensive sweating without fluid replacement can cause hemoconcentration
- 22What problems do tattoos, burns, and scars present in venipuncture?Difficult to palpate
May be imparied in circulation
New burns are painful
Tattoos susceptible to infection
Dyes can interfere with tests - 23Problems with damaged veins? What are sclerosed and thrombosed veins?Scelrosed are hardened
Thrombosed are clotted.
Difficult to puncture and give erroneous results - 24What is an edema and what problems does it cause?An edema is an accumulation of fluid in the tissue. Can happen when fluid from an IV infiltrates surrounding tissue.
Contaminate blood with tissue fluid, veins are harder to locate, tissue is fragile - 25What is a hematoma and what problems does it present?It is a swelling or mass of blood. Can be painful, contaminate sample, obstruct blood flow.
- 26What is a masectomy and the problem presented by it?Mastesctomy is the surgical removal of breast and sometimes lymph nodes. Swelling and infection can be present and the application of a tourniquet can cause injury. Changes blood composition.
- 27How does obesity contribute as a problem?Veins deeper and harder to find.
Median cubital or cephalic vein best. - 28What is an arterial line and what problems does it present?A catheter placed in artery.
NO tourniquet or venipuncture on arm - 29AV Shut or Fistula problemsNEVER puncture, stay away from, this is a LIFELINE
- 30Problems associated with Heparin/Saline lockThis is a catheter or cannula connected to stopcock with a diaphragm. Provide access for medicine. Flushed with heparin or saline to prevent clogging.
- 31Problems associated with IVsIVs are catheters inserted in a vein to administer fluids. Avoid collecting from the same arm, but if you must, collect below the IV
Avoid collecting from previous IV sites 24-48 hours - 32CVAD problemsKnown as indwelling lines that are tubes inserted into main vein or artery. Administer fluids and medications, monitor pressures, and drawing blood.
- 33What should you do if a patient has an adhesive allergy?USe pressure until bleeding quits or use gauze by itselfs
- 34Explain procedure for excessive bleedingThis may happen with patients on anticoagulants or asprin. Maintain pressure and if bleeding continues more than 5 minutes, tell someone
- 35What does emesis mean?Vomiting
- 36What is petechiae?Tiny, nonraised red spots that appear on arm when tourniquet is too tight
- 37What should you do if a patient has a seizure?Discontinue draw, hold pressure on site without restricting movement, nothing in mouth, protect patient from injury and call for help
- 38What if a hematoma forms?Discontinue draw and hold pressure over 2 minutes. Offer cold compress and ice pack if swollen
- 39Iatrogenic anemiaBlood loss after more than 10% is removed at once. Risky in children especially.
- 40What are the signs of inadvertent arterial puncture?Blood pulsing into tube, bright red color, forming hematoma
- 41How long should a patient keep a bandage on?15 minutes
- 42What can cause nerve injury?Improper site or vein selection
Inserting too deeply or quickly
Excessive lateral redirection
Blind probing - 43What is hemoconcetration?A decrease in fluid, increase in nonfilterable large molecules. Stagnation of normal venous flow
- 44What is hemolysisDamage or destruction of RBCs and the escape of Hgb
- 45What can cause specimen contamination?Wrong antiseptic
Dripping sweat into tubes
Getting glove power on blood films or cap speimens
Allowing alcohol residue, fingerprints, glove power, baby powder, urine on newborn screening samples - 46Why might a vein collapse?Vacuum of tube is too strong
tourniquet too tight
tourniquet removed too early
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- Fichas sobre Chapter 9: Basal State, Problems Associated with Venipuncture , creado por Alisha Whelan el 28/02/2019.
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