Safety + Compliance
26%of exam
Patient Preparation
20%of exam
Routine Blood Collections
28%of exam
Special Collections
12%of exam
Processing
14%of exam
Quick Facts
- Exam
- NHA CPT
- Items
- 100 scored + 20 pretest
- Time
- 2 hours
- Pass
- 390/500 scaled
- Current exam
- Jan 7 2026
- Renewal
- 2 years + 10 CE
- Pass rate
- 77.44% in 2025
- Skills
- 30 venipunctures + 10 capillary
PPE Doffing
Gloves leave first; hands clean last
Gloves: most contaminatedGown: inside outMask: straps onlyHands: final clean
Syncope vs Hematoma
Syncope
- Patient faints
- Stop collection
- Lower head
Hematoma
- Blood leaks
- Release tourniquet
- Apply pressure
Patient reaction vs site leak
Complication Picker
- Syncope signs→Stop draw
- Hematoma forms→Release/pressure
- Nerve pain→Remove needle
- Seizure occurs→Protect patient
- Needlestick→Wash/report
- Bleeding persists→Maintain pressure
Safety Rules
- Standard Precautions
- Treat blood infectious
- Hand hygiene
- Before and after
- Sharps
- Dispose immediately
- Needle recap
- Never by hand
- Exposure
- Wash, report, document
- SDS
- Chemical hazard sheet
- OSHA BBP
- Exposure control rules
- Engineering controls
- Built-in protection
Standard vs Transmission
Standard
- All patients
- Blood/body fluids
- Baseline PPE
Transmission
- Known risk
- Extra isolation
- Route-based PPE
Always vs added precautions
PPE + Isolation
- Gloves
- Every blood draw
- Mask
- Splash or droplet
- Gown
- Fluid exposure
- Goggles
- Eye splash risk
- Contact
- Gloves and gown
- Droplet
- Mask required
- Airborne
- Respirator route
- Reverse
- Protect patient
Patient ID
Ask, match, label before leaving
Ask patientMatch wristbandCheck requisitionLabel bedside
Patient ID
- Two identifiers
- Name plus DOB
- Wristband
- Match requisition
- Requisition
- Verify ordered tests
- Consent
- Explain and confirm
- Allergies
- Latex, adhesive, antiseptic
- Fasting
- Confirm before draw
- Syncope risk
- Seat or recline
- Language barrier
- Use interpreter
Patient Setup
- Tourniquet
- One minute max
- Arm position
- Downward and supported
- Fist
- Hold, do not pump
- Site cleanse
- Outward circles
- Alcohol dry
- Prevents sting/hemolysis
- Bevel
- Face up
- Angle
- 15-30 degrees
- Pressure
- After needle removal
Draw Order
Cultures, blue, red, green, lavender, gray
Cultures: sterileBlue: citrateRed/gold: serumGreen: heparinLavender: EDTAGray: fluoride
Blue vs Lavender
Light blue
- Citrate
- Coag tests
- Must fill
Lavender
- EDTA
- CBC tests
- Cell preservation
Coag ratio vs hematology
Tube Picker
- CBC ordered→Lavender(EDTA)
- Coag ordered→Light blue(Citrate)
- Serum chemistry→Gold SST(Clot first)
- Blood cultures→SPS/sterile(First draw)
- Glucose/lactate→Gray(Fluoride)
- Plasma chemistry→Green(Heparin)
- Blood bank→Pink(EDTA)
- Butterfly before blue→Discard tube(Air space)
Order of Draw
- Cultures
- Sterile first
- Light blue
- Citrate coag
- Red/SST
- Serum tests
- Green
- Heparin plasma
- Lavender
- EDTA hematology
- Gray
- Glucose/lactate
- SPS yellow
- Blood cultures
- Discard tube
- Blue after butterfly
Site Picker
- Best antecubital→Median cubital
- Second choice→Cephalic
- Artery risk→Avoid basilic
- IV same arm→Opposite arm
- Mastectomy side→Avoid side
- Burn/scar site→Choose another
Tube Additives
- Citrate
- Binds calcium
- Clot activator
- Speeds clotting
- Thrombin
- Rapid serum
- Heparin
- Inhibits thrombin
- EDTA
- Preserves cells
- Fluoride
- Stops glycolysis
- Oxalate
- Anticoagulant partner
- Gel
- Serum/plasma barrier
Vein + Needle
- Median cubital
- First choice
- Cephalic
- Second choice
- Basilic
- Last antecubital
- Butterfly
- Small fragile veins
- Straight needle
- Routine antecubital
- Syringe
- Control suction
- ETS
- Vacuum system
- Gauge
- Lower number wider
Collection Problems
- Hematoma
- Blood under skin
- Hemolysis
- RBC rupture
- Collapsed vein
- Too much suction
- Petechiae
- Tiny red spots
- Rolling vein
- Anchor firmly
- Nerve pain
- Stop immediately
- Reflux
- Additive backs up
- QNS
- Insufficient volume
Venipuncture vs Capillary
Venipuncture
- Venous blood
- Larger volume
- Tube order
Capillary
- Skin puncture
- Small volume
- Micro order
Vein draw vs skin puncture
Capillary Basics
- Fingerstick
- Adult capillary site
- Heel stick
- Infant site
- Lancet depth
- Avoid bone injury
- First drop
- Usually wipe away
- Warming
- Improves blood flow
- Microtainer
- Capillary collection tube
- Milking
- Causes hemolysis
- Newborn
- Lateral heel only
Special Draws
- Blood culture
- Strict asepsis
- GTT
- Timed glucose
- Timed draw
- Exact collection time
- Drug level
- Peak or trough
- Chain custody
- Legal traceability
- Blood bank
- Strict ID
- ABG
- Arterial specimen
- POCT
- Bedside testing
Tube Mixing
Blue 3-4; SST 5; EDTA 8-10
Invert gentlyNever shakeMix immediatelyPrevent clots
Serum vs Plasma
Serum
- Clotted blood
- No fibrinogen
- Red/gold tubes
Plasma
- Anticoagulated blood
- Contains fibrinogen
- Green/blue tubes
Clot vs anticoagulant
Processing Picker
- Serum needed→Let clot
- Plasma needed→Mix anticoagulant
- Light-sensitive→Amber wrap
- Cold analyte→Ice slurry
- STAT order→Hand carry
- Send-out aliquot→Secondary tube
Specimen Handling
- Bedside label
- Before leaving patient
- Inversions
- Gentle mixing
- Clot time
- Serum before spin
- Centrifuge
- Separate components
- Aliquot
- Transfer separated sample
- Light protect
- Wrap amber
- Chill
- Ice slurry transport
- STAT
- Immediate handling
Hemolysis vs Clotting
Hemolysis
- RBC rupture
- Pink/red serum
- False potassium
Clotting
- Fibrin formation
- Anticoagulant failure
- CBC rejection
Cells break vs clot forms
Rejection Flags
- Unlabeled
- Reject immediately
- Mismatch
- ID discrepancy
- Hemolyzed
- RBC rupture
- Clotted EDTA
- Improper mixing
- Underfilled blue
- Wrong ratio
- Leaking
- Biohazard risk
- Wrong tube
- Invalid additive
- Expired tube
- Vacuum/additive risk
Common Traps
ID shortcut
Ask two identifiers ≠ Never room number
Tourniquet time
Release within minute ≠ Avoid hemoconcentration
Blue fill
Fill to mark ≠ Ratio must hold
Alcohol wet
Let air dry ≠ Prevents hemolysis
Line draw
Avoid IV arm ≠ Document exception
Processing delay
Cells keep metabolizing ≠ Separate promptly
Last Minute
- 1.100 scored + 20 pretest
- 2.Domains: 26/20/28/12/14
- 3.Cultures blue red green lavender gray
- 4.Blue citrate fills completely
- 5.EDTA tubes need mixing
- 6.Label before leaving patient
- 7.Median cubital first choice
- 8.Basilic hides artery nerves
- 9.Serum clots; plasma anticoagulated
- 10.Stop for nerve pain
- 11.Unlabeled specimens get rejected
- 12.Renew every 2 years
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