Free AMCA PTC Exam Flashcards

Phlebotomy is a collection role, not a diagnostic one. Never interpret, quote, or predict results; refer the patient to the ordering provider. Commenting on results is outside your scope of practice and can be treated as practicing medicine without a license.

Access and share only the protected health information you need to complete the collection. Discussing a patient in a hallway, elevator, or on social media is a violation even when no name is used, because details can identify the person. Keep requisitions and labeled tubes out of public view.

CLIA (1988) regulates the quality and accuracy of laboratory testing performed on human specimens. OSHA regulates worker safety, including the Bloodborne Pathogens Standard. If the question is about test quality or lab certification, answer CLIA; if it is about protecting the employee, answer OSHA.

Expressed consent is spoken or written permission given after you explain the procedure. Implied consent is the patient rolling up a sleeve and offering an arm. Either form is acceptable for a routine draw, but some form of consent must exist before the needle enters the skin.

You may not collect the specimen. Drawing over a refusal is battery, which is unauthorized touching; threatening to draw anyway is assault. Document the refusal, notify the nurse or ordering provider, and let them resolve it with the patient.

The American Hospital Association document that replaced the Patient's Bill of Rights. It promises high-quality care, a clean and safe environment, involvement in care decisions, protection of privacy, help with billing, and help filing complaints. AMCA blueprint task 1.08 expects you to respect these rights during every collection.

Draw a single line through the error, write the correct entry, then initial and date the change. Never erase, scribble over, or use correction fluid; an altered record looks like a falsified record. Events that harmed or could have harmed a patient also require an incident or occurrence report.

Failing to do what a reasonable phlebotomist would do in the same situation, such as probing blindly, ignoring a complaint of shooting pain, or walking away from a fainting patient. Employers can also be held liable for an employee's negligent acts under respondeat superior.

AMCA certification is valid for 2 years from the test date and is renewed with 10 continuing education credits plus a $15 fee per certification. Expired credentials can be reinstated within one year for an added $25 fee; after one year the only path back is retesting.

Treat every patient's blood and body fluids, except sweat, as infectious regardless of the diagnosis. They apply to all patients all of the time, which is why you never need to know who is infected: hand hygiene, gloves on every draw, and safe sharps handling happen every time.

Alcohol-based rub is the routine choice, but wash with soap and running water for at least 20 seconds when hands are visibly soiled and after caring for a patient with Clostridioides difficile or norovirus. Alcohol does not kill C. difficile spores; only friction and rinsing remove them.

Don gown, then mask or respirator, then goggles or face shield, then gloves. Doff in the reverse risk order, most contaminated first: gloves, face shield or goggles, gown, then mask, followed by hand hygiene. Gloves go on last and come off first.

Contact (MRSA, C. difficile): gown and gloves. Droplet (influenza, pertussis, meningococcus): surgical mask within about 3 to 6 feet. Airborne (tuberculosis, measles, varicella): fit-tested N95 and a negative-pressure room. All three are used in addition to Standard Precautions, never instead of them.

Activate the safety device one-handed, then drop the entire assembly into the sharps container at the point of use. Never recap, bend, cut, or pass a contaminated needle. Replace containers at about two-thirds to three-quarters full and never reach inside one.

Wash the site immediately with soap and water, or flush a mucous membrane or eye with water or saline, then report to your supervisor at once and file an incident report. Speed matters because baseline testing and HIV post-exposure prophylaxis work best within hours and no later than 72 hours.

Requires a written Exposure Control Plan reviewed at least annually, engineering and work-practice controls, employer-paid PPE, annual training, a sharps injury log, and the hepatitis B vaccine series free within 10 working days of assignment to at-risk duties. Declining requires a signed declination form, and you may accept the vaccine later at no cost.

Glove up, cover and absorb the spill, remove the bulk, then disinfect with a 1:10 dilution of household bleach or an EPA-registered tuberculocidal agent, leaving the surface wet for the labeled contact time before wiping. All absorbent material goes into biohazard waste.

Ask the patient to state and spell their full name and give their date of birth, then match both against the requisition and the armband. Room number, bed number, and the chart on the door are never acceptable identifiers, and you must never ask a leading question such as 'Are you Mr. Diaz?'

Do not draw. Ask the nurse to attach a band and confirm identity first. For an unconscious, sedated, or pediatric patient, have a nurse, relative, or caregiver identify them and document who provided the identification. Any discrepancy must be resolved before the needle goes in.

Median cubital first because it is large, well anchored, and farthest from nerves and arteries. Cephalic on the thumb side is second, though it rolls more. Basilic on the little-finger side is the last resort: it lies next to the median nerve and brachial artery, so it carries the highest injury risk.

Avoid edema, hematoma, burns, scarring, tattooed or sclerosed veins, a dialysis fistula or graft, the same side as a mastectomy, and any site above a running IV. Fistula, mastectomy-side, and foot or ankle draws need a provider's approval; edema and scar tissue give diluted or unreliable results.

Ask the nurse to stop the infusion for at least 2 minutes, apply the tourniquet and draw below the IV site, discard the first 5 mL of blood, then collect the specimen and document that it was drawn below an IV. Skipping the discard leaves the sample diluted with IV fluid.

Apply 3 to 4 inches above the intended site and leave it on no longer than 1 minute. Longer application hemoconcentrates the blood and falsely raises potassium, total protein, calcium, and hematocrit. Never let the patient pump a fist, because muscle activity releases potassium into the sample.

Scrub with 70% isopropyl alcohol using friction and let it air-dry for about 30 seconds. Wet alcohol stings and hemolyzes the specimen; fanning, blowing, or wiping recontaminates the site. A legal blood alcohol collection requires a non-alcohol antiseptic instead.

A fasting specimen means 8 to 12 hours with water only. Standing shifts fluid out of the vessels and raises protein, calcium, cholesterol, and hematocrit compared with a supine draw. Cortisol and serum iron peak in the morning, so a timed test must be collected at the ordered hour, not when convenient.

The higher the gauge number, the smaller the bore. 21G is the routine venipuncture standard, 22G to 23G suits small or fragile veins and winged sets, and 16G to 18G is used for blood donation. A bore that is too small combined with full tube vacuum shears red cells and hemolyzes the sample.

Sodium citrate and EDTA both bind calcium: citrate loosely, so calcium can be added back for coagulation testing, and EDTA tightly, which preserves cell shape for counts. Heparin activates antithrombin to block thrombin. Silica clot activator speeds clotting for serum. Sodium fluoride is an antiglycolytic that stops cells from consuming glucose.

Yellow SPS: blood cultures. Light blue: 3.2% buffered sodium citrate for PT/INR, aPTT, D-dimer, and fibrinogen. Red: no additive or clot activator, used for serum chemistry and serology. Gold or tiger-top SST: clot activator plus separator gel for serum chemistry, and gel tubes are not used for blood bank testing.

Green: heparin for plasma chemistry, ammonia, and lactate. Lavender: EDTA for CBC, ESR, and HbA1c. Pink: EDTA for type and screen or crossmatch. Gray: sodium fluoride with potassium oxalate for glucose and blood alcohol. Royal blue: trace elements such as lead, zinc, and copper.

Inspect the needle bevel for burrs or bends and never use a tube past its expiration date: expired tubes lose vacuum and additive potency, which produces short draws and rejected specimens. Centrifuges, timers, and point-of-care analyzers need documented calibration and quality control on schedule.

Blood cultures, light blue citrate, serum tubes (plain red before gold or SST), green heparin, lavender EDTA, then gray fluoride/oxalate. Mnemonic: Better Learn Real Good, Great Lab Guys. Sterile always comes first and the glycolytic inhibitor always comes last.

Additive carried on the needle contaminates the next tube. EDTA carryover into a chemistry tube falsely raises potassium and lowers calcium; clot activator carried into a citrate tube shortens PT and aPTT; fluoride carryover raises sodium and inhibits enzyme assays.

Draw a discard tube first. The tubing's dead space would otherwise steal blood from the citrate tube and leave it short, and the discard only needs enough blood to fill that tubing. Citrate requires an exact 9:1 blood-to-additive ratio, so an underfilled tube falsely prolongs PT and aPTT.

Citrate 3 to 4; plastic red with clot activator and gold SST 5; heparin, EDTA, and gray fluoride tubes 8 to 10; plain glass red tubes none. Invert gently end over end immediately after collection: too few inversions leave microclots, and shaking causes hemolysis.

Anchor the vein by pulling the skin taut 1 to 2 inches below the site, then insert bevel up at 30 degrees or less and release the tourniquet as soon as blood flows. Never probe blindly or redirect the needle sideways, and stop after two failed attempts so another phlebotomist can try.

That is a hematoma: the needle passed through the vein, the bevel is only partly inside, or the tourniquet is still on. Release the tourniquet, remove the needle immediately, and hold firm pressure for 3 to 5 minutes with the arm elevated. Never keep drawing through a swelling site.

Stop the draw and remove the needle at once, lower the head or lay the patient flat, apply a cold compress to the forehead, and stay with them. Never leave a fainting patient alone and never use ammonia inhalants, which can trigger a reaction in asthmatic patients. Patients with a syncope history should be drawn lying down.

Both mean stop immediately. Sharp radiating pain, tingling, or numbness signals nerve involvement: remove the needle, do not re-stick that arm, and document and report it. Bright red blood that pulses and fills the tube quickly is an arterial puncture: remove the needle, hold firm pressure at least 5 minutes, notify a supervisor, and mark the specimen as arterial.

Alcohol not dried, too small a needle bore, vigorous shaking, forcing blood from a syringe through the needle, milking a finger stick, an underfilled additive tube, or a prolonged traumatic draw. Hemolysis falsely raises potassium, LD, AST, magnesium, and phosphorus, so the lab rejects the specimen.

Use the side of the middle or ring finger, slightly off center from the tip, and puncture across the fingerprint lines no deeper than 2.0 mm. Wipe away the first drop because it contains tissue fluid and alcohol. Skin puncture has its own fill order: blood gas, then EDTA, then other additives, then serum.

Puncture only the medial or lateral plantar surface of the heel, no deeper than 2.0 mm, never the posterior curve, the arch, or a previous site: the calcaneus is close and hitting it risks osteomyelitis. Warm the heel to about 42 C for 3 to 5 minutes to increase blood flow. Never perform a finger stick on an infant under 1 year.

Antisepsis is everything: scrub with chlorhexidine, or povidone-iodine for infants under 2 months, let it dry fully, and wipe bottle tops with 70% alcohol. Collect two sets from two separate sites, ideally before antibiotics, with roughly 8 to 10 mL per bottle in adults. Fill the aerobic bottle first from a winged set because of tubing air, and the anaerobic bottle first from a syringe.

For a GTT, collect the fasting sample first and time every later draw from the moment the patient finishes the glucose drink; the patient may drink water but may not eat, smoke, or chew gum. For therapeutic drug monitoring, a trough is drawn immediately before the next dose and a peak at the drug-specific interval after the dose.

Forensic and drug-screen collections need an unbroken documented record of every person who handled the specimen: photo-ID verification, a tamper-evident seal applied in front of the donor, and a signature with date and time at each transfer. A legal blood alcohol draw also requires a non-alcohol prep and a completely filled gray tube.

Clean-catch midstream urine: cleanse the area front to back, void the first portion into the toilet, then collect midstream. A 24-hour urine discards the first void and includes the final void at the same clock time the next day. Throat culture: swab both tonsillar areas and the posterior pharynx while avoiding the tongue and cheeks.

Label at the patient's side immediately after collection and before leaving the room. Never pre-label empty tubes and never label later from memory. The label carries the patient's full name, identification number, date, time of collection, and your initials.

Unlabeled or mislabeled tubes, hemolysis, clots in an anticoagulated tube, quantity not sufficient (QNS), the wrong or an expired tube, and delayed or improper transport. You may never relabel someone else's specimen or correct a label away from the patient; the collection has to be repeated.

Let the specimen clot completely, about 30 minutes at room temperature, before spinning for roughly 10 minutes. Balance tubes of equal size and fill opposite each other and keep stoppers on to prevent aerosols and evaporation. Never re-spin a gel tube once the barrier has formed.

Plasma comes from an anticoagulated tube and still contains fibrinogen; serum comes from a clotted tube and does not. Plasma yields more volume and a faster turnaround because there is no clotting time. Either way, separate the liquid from the cells within 2 hours of collection.

Ammonia, lactate, and blood gases travel on an ice slurry and go to the lab immediately. Cold agglutinins and cryoglobulins must stay at 37 C until the serum is separated. Bilirubin, vitamin B12, and folate need an amber tube or foil. Never refrigerate whole blood for potassium: cold makes potassium leak from the cells and falsely raises the result.