Free Phlebotomy Exam Flashcards

1) Blood cultures (yellow SPS or sterile), 2) Light blue (sodium citrate—coagulation), 3) Red (no additive—serum), 4) Gold/SST (gel separator—serum), 5) Green (heparin—chemistry), 6) Lavender/Purple (EDTA—hematology/CBC), 7) Gray (sodium fluoride—glucose). Remember: 'Boys Love Red Gold Greens, Lovely Gray.'

Light blue (sodium citrate): prevents coagulation for PT/INR, aPTT. Lavender (EDTA): chelates calcium for CBC, differential. Green (heparin): inhibits thrombin for chemistry panels. Gray (sodium fluoride/potassium oxalate): preserves glucose. Gold (clot activator + gel): serum separation.

The preferred venipuncture site. Located in the antecubital fossa, connecting the cephalic and basilic veins. Advantages: well-anchored, large, less painful, less likely to roll. Always the first choice for routine blood draws. Well-supported by surrounding tissue.

Second choice for venipuncture. Located on the lateral (thumb side) of the antecubital fossa. Advantages: easily accessible, good alternative when median cubital is unavailable. More prone to rolling than median cubital. Runs along the outer edge of the arm.

Third and last choice in the antecubital fossa. Located on the medial (pinky side) of the arm. Disadvantages: close to the brachial artery and median nerve—higher risk of accidental arterial puncture and nerve damage. Use only when other sites are unavailable.

Apply 3-4 inches above the intended puncture site. Keep applied no longer than 1 minute (prolonged application causes hemoconcentration and falsely elevated results). Release tourniquet before removing the last tube or after blood flow is established. Never apply over broken skin or fistula.

21-gauge: standard adult venipuncture (green hub). 22-gauge: smaller veins, elderly, pediatric (black hub). 23-gauge: very small veins, butterfly sets (light blue hub). Lower gauge number = larger needle diameter. Butterfly needles (winged infusion) best for hand veins and difficult draws.

Venipuncture: 15-30 degrees, bevel up. Capillary puncture: perpendicular to fingerprint lines. Arterial puncture: 30-45 degrees (radial artery). Insert with smooth, quick motion. Anchor the vein by pulling skin taut below the puncture site to prevent rolling.

Adults/children: palmar surface of distal phalanx of middle or ring finger, slightly off-center. Infants (<1 year): medial or lateral plantar surface of the heel. Never puncture: thumb (callused), index finger (more nerve endings), pinky (too thin), center/back of heel, fingers of infants.

1) Blood gas specimens (heparinized capillary tubes), 2) EDTA tubes (lavender—CBC), 3) Other additive tubes, 4) Tubes without additives (serum). Different from venipuncture order because EDTA contamination of other tests is a greater concern in small-volume draws.

Warm the site for 3-5 minutes before puncture using a warm washcloth or commercial heel warmer (no hotter than 42°C/108°F). Warming increases blood flow up to 7 times. Especially important for heel sticks on neonates. Wipe away the first drop of blood (contaminated with tissue fluid).

Treat ALL blood and body fluids as potentially infectious. Wear gloves for every blood draw. Change gloves between patients. Use sharps containers immediately after use. No recapping of needles (or use one-handed scoop technique if necessary). Hand hygiene before and after each patient.

1) Wash the area immediately with soap and water (eyes: flush with water). 2) Report to supervisor immediately. 3) Complete incident report. 4) Seek medical evaluation within 1-2 hours. 5) Source patient tested (with consent) for HIV, HBV, HCV. 6) Baseline blood draw from exposed worker. Follow-up testing at intervals.

HBV: highest transmission risk (6-30%) via needlestick. HCV: 1.8% transmission risk. HIV: 0.3% transmission risk. Prevention: HBV vaccination (series of 3 doses), standard precautions, safety-engineered devices, proper sharps disposal. Post-exposure prophylaxis available for HIV.

Place needles directly into puncture-resistant sharps containers immediately after use. Never recap, bend, or break needles. Containers should be at arm's reach during the procedure. Replace when 2/3 to 3/4 full. Red biohazard containers for contaminated items. OSHA regulates sharps safety.

Hemolysis = destruction of RBCs releasing hemoglobin into serum. Causes: using too small a needle, pulling syringe plunger too fast, vigorous tube mixing, forcing blood through needle, fist pumping. Falsely elevates: potassium, LDH, iron, magnesium. Most common reason for specimen rejection.

Increased concentration of large molecules (proteins, cells) in blood. Caused by prolonged tourniquet application (>1 min), fist pumping, massaging the site. Falsely elevates: potassium, calcium, total protein, lipids, RBC/WBC counts. Prevention: release tourniquet within 1 minute.

Fasting = no food or drink (except water) for 8-12 hours. Required for: glucose (fasting), lipid panel (9-12 hours), triglycerides, basic metabolic panel (some facilities). Non-fasting is acceptable for most other tests. Document fasting status on requisition form.

Label AT THE BEDSIDE immediately after collection. Required info: patient full name, date of birth, date and time of collection, phlebotomist initials, unique patient identifier (MRN). Never pre-label tubes. Mislabeled specimens must be rejected and recollected.

Required for forensic and legal specimens (drug testing, alcohol levels, paternity). Requires: witnessed collection, tamper-evident seals, documentation of every person handling the specimen, secure transport. Patient must show photo ID. Specimens without proper chain of custody are legally inadmissible.

Plasma (55%): water, proteins (albumin, globulins, fibrinogen), electrolytes, nutrients, waste products. Formed elements (45%): RBCs/erythrocytes (carry O2), WBCs/leukocytes (immune defense), platelets/thrombocytes (clotting). Hematocrit measures the percentage of RBCs.

Serum: liquid portion AFTER blood clots (no fibrinogen or clotting factors). Collected in red/gold tubes (no anticoagulant). Plasma: liquid portion WITH clotting factors. Collected in anticoagulant tubes (lavender, green, blue). Plasma is obtained by centrifuging anticoagulated blood.

Granulocytes: Neutrophils (60-70%—bacterial infection), Eosinophils (1-4%—allergies/parasites), Basophils (0.5-1%—inflammation/allergic response). Agranulocytes: Lymphocytes (20-25%—viral infection/immunity), Monocytes (3-8%—chronic infection). Remember: 'Never Let Monkeys Eat Bananas.'

Intrinsic pathway: activated by trauma inside the vascular system (tested by aPTT—blue tube). Extrinsic pathway: activated by external trauma (tested by PT/INR—blue tube). Common pathway: both converge to form fibrin clot. Platelets form initial plug; clotting factors form fibrin mesh.

Arteries: thick-walled, carry oxygenated blood AWAY from heart, pulsatile, deeper, higher pressure. Veins: thinner walls, have valves, carry deoxygenated blood TO heart, lower pressure. Capillaries: one-cell-thick walls, gas/nutrient exchange. Phlebotomy is typically from veins.

Causes: needle goes through the vein, insufficient pressure after draw, bending the arm (does NOT help). Prevention: proper technique, apply firm pressure for 3-5 minutes (longer for patients on anticoagulants). If hematoma forms during draw: release tourniquet, withdraw needle, apply pressure.

Signs: pallor, diaphoresis, nausea, lightheadedness, loss of consciousness. Actions: remove tourniquet and needle, apply pressure, lower head (or between knees if seated), use ammonia inhalant, cold compress to forehead. Never leave a fainting patient alone. Document the event.

Signs: sharp, shooting, electric pain radiating down the arm; numbness or tingling in fingers. Action: STOP the draw immediately, withdraw the needle, apply pressure. Never probe or redirect the needle if nerve symptoms occur. Document and report. May require medical follow-up.

Small red spots appearing on the skin after tourniquet application or after the draw. Indicate possible: platelet disorder (thrombocytopenia), coagulation problem, or prolonged tourniquet application. Document and report. May indicate patient is on anticoagulants or has a bleeding disorder.

Neonates/infants: heel stick preferred (capillary puncture). Toddlers/children: dorsal hand veins or antecubital. Use butterfly needles (23-25 gauge) for small veins. Microcollection tubes for small volumes. Maximum draw: should not exceed 10% of total blood volume. Comfort holds may be needed.

Fragile, thin veins—use smaller gauge needle (22-23). Anchor vein well (veins tend to roll). Apply tourniquet loosely. Avoid hand veins if possible (painful, prone to bruising). Skin may tear easily—use paper tape. Longer bleeding time may require extended pressure. Be patient and communicate clearly.

NEVER draw from the same arm as an active IV (contamination risk). If no other option: turn off IV for 2+ minutes, apply tourniquet BELOW the IV site, draw from a site distal to the IV, discard the first 5 mL. Label specimen as 'drawn below IV site.' Preferred: use opposite arm.

Do NOT draw blood from the same side as a mastectomy or lymph node removal (risk of lymphedema and infection). Do NOT use that arm for blood pressure either. If bilateral mastectomy, use ankle/foot veins with physician approval. Document which arm was used.

Collected in lavender/EDTA tube. Measures: RBC count, WBC count, hemoglobin, hematocrit, platelet count, MCV, MCH, MCHC, RDW. Differential counts types of WBCs. Most commonly ordered lab test. Used to diagnose anemia, infection, bleeding disorders, leukemia.

Collected in green (heparin) or gold (SST) tube. Includes: sodium, potassium, chloride, CO2, BUN, creatinine, glucose, calcium. Assesses kidney function, electrolyte balance, and blood sugar. Often ordered as routine screening or pre-surgical workup.

Both collected in light blue (sodium citrate) tube—must be filled completely (9:1 ratio blood to additive). PT/INR: monitors warfarin therapy (extrinsic pathway). Target INR: 2.0-3.0. aPTT: monitors heparin therapy (intrinsic pathway). Target: 1.5-2.5× control. Critical for patients on anticoagulants.

Collected FIRST in order of draw. Clean venipuncture site with chlorhexidine (30 seconds, air dry). Collect 2-3 sets from different sites, 15-30 minutes apart. Anaerobic bottle first (if using syringe), then aerobic. Do NOT draw from IV lines. Detects sepsis/bacteremia. Label with exact time and site.

Screens for gestational and Type 2 diabetes. Patient fasts 8-12 hours. Fasting glucose drawn. Patient drinks glucose solution (75g or 100g). Blood drawn at timed intervals (1hr, 2hr, possibly 3hr). Patient cannot eat, smoke, or exercise during the test. Nausea/vomiting may invalidate results.

Federal regulations ensuring quality laboratory testing. Labs must be CLIA-certified. Defines test complexity: waived (simple, low-risk), moderate complexity, high complexity. Waived tests include basic blood glucose, urine dipstick, rapid strep. Phlebotomy must follow CLIA standards for specimen handling.

Includes: proper patient identification (two identifiers), correct tube selection, proper order of draw, adequate specimen volume, correct labeling, appropriate transport conditions (temperature, time). Document any deviations. Rejected specimens must be recollected. QC ensures accurate, reliable results.

Most specimens: transport at room temperature within 45-60 minutes. Cold specimens (ammonia, lactic acid, ABGs): on ice. Protect from light: bilirubin, vitamin B12, folate (wrap in foil). Warm: cryoglobulin, cold agglutinins (37°C). Pneumatic tube systems acceptable for most but not all specimens.

Ask patient to STATE their full name and date of birth (do not read it to them). Compare to requisition form and wristband. Must match two unique identifiers. Outpatients: may use photo ID + DOB. NEVER draw blood without proper identification. If discrepancy exists, resolve before proceeding.

Patient has the RIGHT to refuse any medical procedure. Do not argue, threaten, or attempt to draw without consent. Document the refusal. Notify the nurse or physician. Explain the importance of the test calmly. The patient may change their mind later. Respect patient autonomy.

Protect patient health information (PHI). Do not discuss patient results or conditions in public areas. Requisition forms face down during transport. Computer screens locked when unattended. Only access information needed for your job. Violations can result in fines up to $250,000 and criminal penalties.

ASCP (American Society for Clinical Pathology): PBT(ASCP) credential—most widely recognized. NHA (National Healthcareer Association): CPT(NHA). AMT (American Medical Technologists): RPT(AMT). NCCT: NCPT. Most employers prefer ASCP or NHA certification. Requirements: training + clinical experience + exam.

Testing performed at or near the patient (bedside, clinic, ER). Examples: blood glucose meters, urine dipsticks, hemoglobin A1C, rapid strep, pregnancy tests, INR monitors. Advantages: rapid results (minutes vs. hours). Must still follow QC procedures. Results recorded in patient chart and confirmed by lab if abnormal.

Collected in pink-top (EDTA) tube or as specified by facility. Requires special labeling: patient name, DOB, MRN, date/time, phlebotomist signature on the LABEL (not just the requisition). Cannot be pre-labeled. Fresh specimen required (usually <72 hours old). Type & Screen determines ABO/Rh and checks for antibodies.

Type A: has A antigens, anti-B antibodies. Type B: has B antigens, anti-A antibodies. Type AB: has both antigens, no antibodies (universal recipient). Type O: no antigens, both antibodies (universal donor). Rh+ or Rh−. Mismatched transfusion causes hemolytic reaction—potentially fatal.

Collected from radial artery (most common), brachial, or femoral. Performed by specially trained personnel (not routine phlebotomists in most states). Modified Allen test required before radial puncture. Specimen on ice, transported immediately. Assess: pH, PaO2, PaCO2, HCO3, O2 saturation.

Three components: (1) Double-pointed needle (one end for vein, one for tube), (2) Tube holder/adapter (secures needle, holds tube), (3) Evacuated tubes (vacuum draws blood). Assembled: needle screws into holder, tube pushed onto interior needle. Most common system for routine venipuncture.