CHAPTER 17: REVIEW QUESTIONS

1. List the three major areas of blood collection included in phlebotomy?

Arterial puncture, venipuncture and skin puncture.
2. What is the purpose of performing a venipuncture?
Puncturing of a vein for the removal of a venous blood sample. It is performed when a large blood specimen is needed
for testing.
3. List the three methods that can be used to perform a venipuncture?
• Vacuum tube method (use of an evacuated tube, glass or plastic tube containing a vacuum)
• Butterfly and syringe methods (for difficult draws).
4. What are the advantages of using the vacuum tube method of venipuncture?
➢ Fastest ➢ Most convenient ➢ Most often used
5. When would the butterfly method of venipuncture be preferred over the vacuum tube method?
Butterfly method is preferred when veins are smaller or sclerosed (hardened veins).
6. Explain how to prevent venous reflux?
Venous reflux happens when blood flows from evacuated tube back into patient’s vein during the procedure. It could
cause patient to have adverse reaction to a tube additive, particularly EDTA.
To prevent venous reflux: keep patient’s arm in a downward position so that evacuated tube remains below the
venipuncture site and fills from the bottom up.
7. What is the purpose of the tourniquet?
Purpose of the tourniquet is to make patient’s veins stand out so that they are easier to palpate. Causes venous blood
to slow down and pool in veins in front of tourniquet which makes veins more prominent, more visible and palpable.
8. After locating a suitable vein for venipuncture, what three qualities should be determined with respect to
the vein?
Determine size, depth, and direction of a suitable vein.
9. Why are the antecubital veins preferred for performing a venipuncture?
Antecubital veins usually have wide lumen, are close to surface of skin which makes them easily accessible, usually
have thick walls therefore less likely to collapse, and skin in this area is less sensitive which means less painful for the
patient.
10. List four techniques that can be used to make veins more prominent?
Techniques to make veins more prominent:
• Remove tourniquet and have patient dangle arm over side of chair for 1 to 2 minutes
• Tap vein site sharply with index finger and second finger
• Gently massage arm from wrist to elbow
• Apply warm, moist washcloth for 5 minutes
11. Why should the veins of the hand be used only as a last resort when performing a venipuncture?
Use veins in hands as a last resort because of abundant supply of nerves in hand which makes procedure
uncomfortable for a patient. Hand veins have a tendency to roll, have thin walls which makes them susceptible to:
• Collapsing • Bruising • Phlebitis
12. How is a serum specimen obtained?
Serum specimen is obtained from clotted blood by allowing specimen to stand and then centrifuging it. Because tube
does not contain an anticoagulant, specimen separates into:
• Top layer: Serum
• Bottom layer: Clotted blood cells
13. How is a whole blood specimen obtained?
Whole blood specimen is obtained from tube containing an anticoagulant to prevent clotting of blood cells. Tube must
be gently rotated 8 to 10 times after collection > To mix anticoagulant with blood
14. List the three layers into which the blood separates when it is mixed with an anticoagulant?
• Top layer: Plasma
• Middle layer: Buffy coat (white blood cells and platelets)
• Bottom layer: Red blood cells (RBCs)
15. List the layers into which the blood separates when an anticoagulant is not added to it?
• Top layer: Serum • Bottom layer: Clotted blood cells
16. List four OSHA safety precautions that must be followed when performing a venipuncture and separating
serum or plasma from whole blood?
• Wear gloves when it is reasonably anticipate that you will have hand contact with blood.
• Avoid hand-to-mouth contact while working with blood specimens. (e.g. eating, drinking, applying makeup)
• Wear a face shield or mask in combination with an eye protection device whenever splashed, spray, splatter,
or droplets of blood may be generated.
• Perform all procedures involving blood in a manner so as to minimize splashing, spraying, splattering, and
generating droplets of blood.
• Bandage cuts and other lesions on the hands before gloving.
• Sanitize hands asap after removing gloves
• If your hands or other skin surfaces come in contact with blood, wash the area asap with soap and water
• If your mucous membranes (e.g. eyes, nose mouth) come in contact with blood, flush them with water asap.
• Do not bend, break, or shear contaminated venipuncture needles
• Do no recap a contaminated venipuncture needle
• Locate the sharps container as close as possible to the area of use. Immediately after use, place the
contaminated venipuncture needle in the biohazard sharps container
• Place blood specimens in containers that prevent leakage during collection, handling, processing, storage,
transport, and shipping.
• Handle all laboratory equipment and supplies properly and with care as indicated by the manufacturer. (e.g.
waiting until the centrifuge comes to a complete stop before opening it.
• Do not store food in refrigerators where testing supplies of specimens are stored.
• If you are exposed to blood, report the incident immediately to your physician-employer

17. What is the range for the gauge and size of the needle used for the vacuum tube method of venipuncture?
Gauge sizes for venipuncture: 20G to 22G, manufacturer often color-codes needle guard by gauge for easier
identification.
• 21 gauge - most commonly used
• 22 gauge - recommended for children and adults with smaller veins
• 20 gauge - when a large volume tube is used
Length of needle: 1 inch and 1½ inches. Length used is based on individual preference:
• 1 inch - less intimidating to patient; offers more control during stick
• 1½ inch - allows more room for stabilizing the vein

18. What is the purpose of the flange on the plastic holder of the vacuum tube system?
Flange is an extension on large opening of the plastic holder. It assists in insertion and removal of tubes and prevents
holder from rolling when placed on a flat surface.
19. What type of additive is present in each of the following evacuated tubes? Red, Lavender, Gray, Light
Blue, Green?
• Red: NO anticoagulant
• Lavender: EDTA (anticoagulant)
• Light blue: Sodium Citrate (anticoagulant)
• Gray: Sodium Fluoride/Potassium Oxalate
• Green: Heparin (anticoagulant)
20. What color stopper must be used to collect the blood specimen for each of the tests listed below?
• complete blood count - Lavender
• prothrombin time - Light Blue
• glucose tolerance test - Gray
• most blood chemistry tests - Red
• blood gas determinations – Green

21. Why is it important to use the correct order of draw when performing a venipuncture?
Following Order of Draw is important to prevent cross-contamination between different types of anticoagulants. Cross-
contamination may lead to inaccurate test results.
22. Why is it important to mix a tube containing an anticoagulant immediately after drawing it?
Rotating tube gently 8-10 times provides adequate mixing without causing hemolysis (the breakdown of blood cells >
shaking tube can result in hemolysis).
23. What is the range for the gauge and size of needle used for the butterfly method of venipuncture?
Gauge of needle: 21G to 23G / Length of needle: ½ to ¾ inch (Needle: short and sharp)
24. List four ways to prevent a blood specimen from becoming hemolyzed?
Hemolysis = breakdown of blood cells (blood cells are fragile, rough handling may cause hemolysis and produces
inaccurate test results)
To prevent hemolysis:
• Store tubes at room temperature (chilled tubes can result in hemolysis)
• Allow alcohol to air dry completely (alcohol entering specimen can cause hemolysis)
• Do not use a small-gauge needle to collect the specimen (causes RBCs to rupture as they pass through the
needle lumen)
• Practice good technique in collecting the specimen
• Always handle the blood specimen tube carefully (do not shake or handle roughly)
25. List examples of dissolved substances contained in the serum of blood?
Serum contains dissolved substances such as: Glucose, Cholesterol, Lipids, Sodium, Potassium, Chloride,
Antibodies, Hormones, Enzymes.
26. What is the purpose of performing laboratory tests on serum?
The purpose of laboratory tests on serum is to:
• To determine if substances are within normal range and
• To detect any substances that are not normally present
27. List the proper size tube that must be used to obtain the following serum specimens: 2 ml of serum, 6 ml
of serum, 4 ml of serum?
Must use a tube that is 2½ times amount required for test. Example: To obtain 2mL of serum > must use a 5mL red-
stoppered or SST tube (2 x 2½ = 5)
2mL serum = 5mL tube, 6mL serum = 15mL tube, 4mL serum = 10mL tube
28. What is a fibrin clot and why should it be avoided in a serum specimen?
A fibrin clot is a spongy substance that occupies space, interfering with adequate serum collection.
29. How does a serum separator tube function in the collection of a serum specimen?
A serum separator tube (SST), also known as gel barrier tube, is an evacuated tube specifically designed to facilitate
the collection of serum specimen. Its identified by red/gray stopper (or gold for Hemogard tubes) and is used for
collection and separation of blood.
It contains solid (thixotropic) gel which temporarily becomes fluid during centrifugation and moves to the dividing point
between serum and clotted cells, where it re-forms into solid gel serving as a physical barrier between the serum and
the clot.
30. List four types of solutes contained in the plasma?
• Plasma proteins: serum albumin, globulins, fibrinogen, prothrombin
• Electrolytes: sodium, chloride, potassium, calcium, phosphate, bicarbonate, magnesium
• Nutrients from breakdown of food substances: glucose, amino acids, lipids
• Waste products: urea, uric acid, lactic acid, and creatinine
• Respiratory gases: carbon dioxide and small amount of oxygen
• Substances that regulate and control body functions

31. What is the preferred site for a skin puncture for the following individuals? Adult? Infant?
Fingertip: preferred for adults, 3rd or 4th finger, must not be deeper than 3.1 mm
Earlobe is no longer recommended - blood in earlobe contains a higher concentration of hemoglobin than fingertip and
slower flow of blood which makes it harder to collect specimen
Plantar surface of heel: preferred for infants (birth to 1 year old), must not be deeper than 2.0 mm (never perform
finger puncture on an infant)
32. List two examples of microcollection devices?
• capillary tubes
• microcollection tubes
33. Why should a finger puncture not be performed on the index finger?
Do not use index finger because:
• Skin is more callused and harder to penetrate
• Patient uses index finger more and will notice pain longer
34. Using the principles outlined in the vacuum tube venipuncture procedure, state what might happen under
the following circumstances:
• An evacuated tube is used that is past its expiration date?
Outdated tubes may no longer contain a vacuum, and as a result they may not be able to draw blood into the tube.
• The vacuum tube is not labelled?
Proper labeling of tubes helps avoid a mixup of specimens.
• The tourniquet is not applied tightly enough?
When applying its important to obtain correct tension. Too loose >> veins don’t stand out enough to be palpated.
• The tourniquet is left on for more than 1 minute?
Never leave on for more than 1 minute; uncomfortable for patient, causes venous blood to stagnate - venous stasis;
plasma filters into tissues - causes hemoconcentration (an increase in the concentration of blood components).
• The area that has just been cleansed with an antiseptic is not allowed to dry before the venipuncture
is made?
Residual alcohol entering the blood specimen can cause hemolysis leading to inaccurate test results. In addition,
residual alcohol causes the patient to experience a stinging sensation when the puncture is made.
• The evacuated tube is inserted past the indentation in the plastic holder before the vein is entered?
The tube fills with air which prevents blood from entering the tube. Theres no vacuum.
• An angle of less than 15 degrees is used when performing venipuncture?
Causes the needle to enter above the vein, not deep enough.
• An angle of more than 15 degrees is used when performing venipuncture?
Resulting in needle puncturing through the vein, too deep leading to hematoma.
• The needle is moved after insertion?
Makes patient feel uncomfortable or experience pain during venipuncture.
• Venous reflux occurs when using an EDTA evacuated tube?
Venous reflux happens when blood flows from evacuated tube back into patient’s vein during the procedure. It could
cause patient to have adverse reaction to a tube additive, particularly EDTA.
To prevent venous reflux: keep patient’s arm in a downward position so that evacuated tube remains below the
venipuncture site and fills from the bottom up.
• The vacuum tube is not allowed to fill to the exhaustion of the vacuum?
Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. If a fibrin clot forms in
the serum layer of a blood specimen, it will lead to inaccurate test results.
• The needle is removed from the arm before the tourniquet has been removed?
If needle is removed first, the blood is forced out of the puncture site causing a hematoma (a swelling or mass of
coagulated blood caused by a break in a blood vessel)
• A gauze pad is not placed over the puncture site before removing the needle?
Placing the gauze pad above the puncture helps prevent tissue movement and damage as the needle is withdrawn
and reduces patient discomfort
• The patient bends the arm at the elbow after the needle is removed?
Don’t allow the patient to bend the arm at the elbow because this increases blood loss from the puncture site.
• The patient lifts a heavy object after the procedure?
Lifting a heavy object causes pressure on the puncture site, which could result in bleeding.