11.4 Phlebotomy and Specimen Reference Checklist
Key Takeaways
- Phlebotomy safety starts before the needle: identity, order, site, timing, and patient condition.
- Order of draw prevents additive carryover.
- Specimen labeling and handling preserve identity and integrity.
Phlebotomy Reference
Phlebotomy questions often include a small clue that should stop the draw. Before collection, verify two identifiers, match the requisition, check the ordered test and specimen type, review timing requirements, prepare supplies, assess the site, and explain the procedure.
Stop-Or-Proceed Table
| Clue | Action |
|---|---|
| Name or DOB mismatch | Stop and clarify before collecting |
| Missing or unclear order | Ask provider or lab; do not guess tube type |
| Patient refusal | Respect refusal, notify provider, document per policy |
| Active IV in preferred arm | Use another site or follow policy |
| Hematoma forming | Release tourniquet, remove needle, apply pressure |
| Patient feels faint | Stop draw safely and protect patient from injury |
Order Of Draw Anchor
The common venipuncture sequence is blood cultures or sterile tubes, light blue, serum tubes such as red or gold, green, lavender or pink, then gray. This sequence reduces additive carryover risk. Do not transfer blood between tubes to fix a fill or order problem.
Specimen Integrity
Label at the point of care in the patient presence. Underfilled light blue tubes may invalidate coagulation testing. Clotted lavender tubes may invalidate hematology testing. Hemolysis may result from traumatic technique, small needle, forceful transfer, or vigorous shaking. Leaking, unlabeled, delayed, or wrongly stored specimens should be handled by policy, often with recollection and notification.
Exam Cue Table
Use these cues during the last pass through this section. They are designed to make the answer choice obvious when a question mixes several topics at once.
| Cue in the question | Best decision habit |
|---|---|
| Identity mismatch | Stop collection and clarify. |
| Order of draw | Protect against additive carryover. |
| Rejected specimen | Notify and recollect by policy rather than fixing labels later. |
Last-Minute Self-Test
Cover the right column and explain the decision habit out loud. Then add one example from a practice question you missed. If the example involves a patient identifier, abnormal result, unclear order, privacy issue, failed QC, specimen problem, or urgent symptom, include the exact first action and the exact documentation or reporting step. This is the level of specificity needed for CCMA scenario questions.
What is the safest action for a patient identifier mismatch before venipuncture?
Which tube commonly comes after light blue and before green?
Why is an underfilled light blue tube a problem?