Phlebotomy

Appropriate needle gauge for a venipuncture

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After selecting the appropriate location to collect a blood sample, how many inches above that location should the phlebotomist fasten the tourniquet?

3 to 4 inches

The medical assistant is educating the patient on fasting diet requirements prior to a glucose tolerance test. Which of the following is the minimum time frame the patient must remain NPO before the start of the test?

8-12 hours Gum chewing, eating mints, and/or smoking are not allowed. Sips of water may be permitted depending on the provider NPO policy.

Which of the following evacuated tubes should the medical assistant draw first?

(e.g. blue closure) (e.g. red closure, gold shield,etc.) (e.g. green closure) (e.g. lavender closure, pearl closure) (e.g. gray closure)

Which of the following tests is drawn in an EDTA tube for the hematology department of the laboratory?

HGB HGB is an abbreviation for Hemoglobin, typically measured as part of a Complete Blood Count

A phlebotomist is asked to collect a CBC, PT and Chem 7 on a patient that requires a hand stick with a butterfly needle into evacuated tubes. The correct order of draw for this collection would be

Two Light Blue Top Tubes, Green Top Tube, Lavender Top Tube The correct order of draw would be: two light blue top tubes (one waste and one for PT which is a coagulation test), green top tube (for the Chem 7), and the lavender top tube (for the CBC).

After several minutes of searching the medical assistant can only palpate a small vein. The patient is prepared and the venipuncture is performed. The blood is filling the tube, but slows and then stops even though the patient and medical assistant remained still. Which of the following actions should the medical assistant take?

Use a smaller tube because the vein has collapsed.

Which of the following types of additives is present in an EDTA tube?

anticoagulant

An entry level medical assistant goes to collect blood from a 70-year-old woman with diabetes who had a mastectomy of the left breast. The medical assistant notices a PICC line in the patient's right arm. For this specimen collection, the medical assistant should

ask a nurse to collect the specimen. This scenario is a scope of practice example. The medical assistant should ask a nurse to draw the sample. PICC line draws are outside an entry level MA's scope of practice.

A phlebotomist has received a requisition for a PT/aPTT to evaluate the patient for Von Willebrand's disease. Because of the patient's potential diagnosis, the phlebotomist should be sure to

hold pressure on the draw site until bleeding has stopped. Von Willebrand disease is an inherited condition that can cause extended or excessive bleeding.

Which of the following should be avoided as a form of patient identification?

insurance number

Capillary blood specimen collections are contraindicated in patients with

peripheral edema. Patients with peripheral edema have a great deal of fluid in their tissue. Collection of capillary blood would provide a sample that is likely to be highly diluted with tissue fluid, affecting laboratory test results.

Which of the following is a likely complication from repeated phlebotomy procedures in the same area?

sclerosed veins Repeated punctures in a vein would cause hardening of the vessel tissue, known as sclerosis.

Which of the following is the additive in the light blue top tube?

sodium citrate Lavender top tube = EDTA, Light blue top tube = sodium citrate, Green (dark) top tube = heparin, Gray top tube = potassium oxalate

Which of the following arteries provides direct blood flow to the foot?

dorsalis pedis

Which of the following additives protects serum from interacting with red blood cells after a specimen has been centrifuged?

gel separators

A test tube with which of the following colored stoppers has a glycolytic inhibitor?

gray

Which of the following evacuated tubes should the medical assistant select for collection of electrolytes?

green-top

Since special precautions are needed for patients with Vascular Access Devices, which of the following devices are contraindicated for any type of blood draws?

Fistula The AV fistula requires the surgical connection of a vein and artery, typically in the forearm. It is predominately used for patients in renal failure who may need long term dialysis. To avoid any complications, blood draws are contraindicated

The medical assistant is collecting a sample on a 2 year old outpatient by finger stick. Following the collection, the medical assistant holds firm pressure on the site until bleeding has stopped. How should the medical assistant proceed?

Do not bandage the site. If the child has shown evidence of wanting to touch everything in sight, the phlebotomist should not add a bandage to the list of things within his reach as a 2 year old could easily decide to put it in his mouth. Putting a smiley face on the bandage might make it even more enticing. A pressure dressing is unwarranted if firm pressure was held on the site until bleeding stopped.

Which of the following tube tops contain silica particles to enhance clotting and a thixotropic gel to assist in the separation of serum and blood cells?

Marbled red and grey

A 53-year old male with a central line has a specimen collected from the dorsal side of the hand.

Patients with central lines would be candidates for specimen collection from dorsal side of the hand. Venous samples are not collected from the palmar side of the wrist; veins are accessible from the dorsal side. Fingersticks are not performed on newborns as the blade depth could injure nerves in the fingertips and blood would be difficult to extract. Heel sticks may be performed on newborns, but not in the central section of the plantar surface. Nerve and/or tissue damage could result.

A phlebotomist inserts a needle into a patient's vein and notices there is no blood flow into the tube. The needle is positioned against the wall of the vein. How should the phlebotomist proceed?

Relax the needle's angle slightly, and insert new tube If the needle is believed to be positioned against the vein wall, sometimes relaxing the needle's angle slightly will bring blood into the blood collection tube. In case the tube's vacuum was compromised, using a new tube should provide blood flow.

A medical assistant has active symptoms of the common cold. Under which of the following conditions may he perform venipuncture?

The medical assistant may perform venipuncture provided he is wearing a mask and afebrile.

A phlebotomist has received a requisition to collect a blood specimen on patient in isolation. When entering the patient's room, which should the phlebotomist do first? Your answer was correct!

The phlebotomist should put on the gown, followed by the mask and gloves. To reduce the risk of contaminating oneself with infectious agents, the order of removal of personal protective equipment is important. As a rule, remove items in the following order: gloves, mask, then gown.

After centrifuging a blood specimen, the medical assistant notes the serum has a reddish appearance. Which of the following has occurred?

The specimen is hemolyzed. Normal serum should be amber-colored. If it's reddish in appearance, the specimen is hemolyzed. The reddish color is caused by broken red blood cells

The physician orders a prothrombin time. Which of the following tubes should be used to collect the specimen?

light blue

The patient was sent to the lab to have CBC (lavender), PT/PTT (light blue), CMP (green), and glucose (grey). Place the evacuated tubes in the correct order of draw.

light blue, green, lavender, gray

The phlebotomist should send a specimen collected in a yellow stopper tube with SPS additive to which of the following laboratory departments?

microbiology Blood cultures are collected in yellow-top tubes with SPS (sodium polyanethole sulfonate), a constituent in blood culture media used to grow bacteria from patients suspected of bacteremia, i.e. bacteria in the blood. SPS prevents the patient's blood from killing any bacteria in the sample though the blood's own immune response to infection, allowing the bacteria to multiply so they can be identified. Additional antimicrobial susceptibility testing can help the physician in prescribing antibiotics.

Which of the following actions should the medical assistant take to make a vein more prominent when attempting to select a venipuncture site?

Apply a warm compress to the area for 5 minutes. The medical assistant should apply a warm compress to the area for 5 minutes. Warm moist heat promotes circulation and vasodilation and will help make the vein more visible

An infant is brought to the clinic for a CBC. After performing a heelstick, not enough blood is collected to perform the test. Which of the following actions should the medical assistant take?

Apply a warm compress.

Identify the CLSI recommended micro-collection order of draw for a BMP, CBC & Bilirubin.

EDTA, Heparin, Serum Separator CLSI recommends the following order of draw for skin puncture: Blood gases, EDTA tubes, Other additive tubes, then Serum tubes.

When performing a CBC on a six year old, the parent insists upon using an anesthetic at the venipuncture site. Which would be correct?

EMLA

The physician orders a sedimentation rate for a patient recovering from an infection. This is indicated on the lab requisition as which of the following?

ESR

A patient's past history indicates episodes of syncope. Which of the following would be the best course of action the phlebotomist would perform to prevent complications of syncope?

Have the patient lie down on a hospital bed or exam table. Syncope is a temporary loss of consciousness and posture, commonly referred to as fainting, which is usually related to insufficient blood flow to the brain for any number of reasons. If a patient has a history of syncope episodes, it would be advisable to position the patient to avoid the possibility of injury and to enable ease of oxygenated blood flow to the brain.

After a phlebotomy draw, the phlebotomist realizes the tourniquet was on the patient's arm for an extensive length of time. Which of these is the most common complication?

Hemoconcentration Hemoconcentration is decrease in the volume of plasma in relation to the number of red blood cells.

A phlebotomist is staffing the outpatient clinic at a remote site. There is a centrifuge at the site, but it is not functional. The courier will be arriving to pick-up all samples collected at 1300, and will deliver to the testing laboratory at 1500. A patient arrives at 1200 with orders for Complete Blood Count, Prothrombin Time, and Basic Metabolic Panel. Which tubes should the phlebotomist use for blood collection?

Lavender, Blue, Green, Gray Complete Blood Count (CBC) = lavender top tube (EDTA) Prothrombin Time (PT)/INR = light blue top tube (sodium citrate) Basic Metabolic Panel (BMP) = green top tube (heparin); since the centrifuge is not functional and there is a bit of a delay between draw time and courier pickup/delivery to the laboratory, a gray top tube would best preserve the glucose value within the BMP.

A physician asked you to draw a INR on Mr. Jones which tube and additive would you choose

Light Blue, Sodium Citrate An INR test refers to an International Normalized Ratio, which provides a standardized method of reporting prothrombin time results by comparing the ratio of the patient prothrombin time to the control prothrombin time.

Which of the following tests monitor anticoagulation therapy?

PT and PTT PT and PTT are coagulation tests (collected in blue top tubes). They are routinely collected to monitor a patient's anticoagulant drug therapy, In short, these tests monitor a patient's blood clotting time

Which of the listed tubes can contain ethylenediamine tetraacetic acid?

Royal blue

The phlebotomist is drawing plain red, lavender, and blue top tubes. Upon completion of the blood draw, the phlebomist noticed that an order that requires a SST has been missed. What would be the next action?

Share the plain red top specimen for the SST test. A plain red tube and an SST tube both will yield serum once clotted and centrifuged

Using the guidelines for any method of venipuncture, which of the following actions should the medical assistant perform directly after confirming patient identity?

To ensure accuracy and quality, it is important to anticipate your needs before beginning the actual venipuncture (i.e. tube color/size, minimum acceptable blood volume, whether or not the specimen needs to be placed on ice). Therefore, the medical assistant would identify the patient, then review the requirements for collecting and handling the blood specimen as ordered by the physician. Next, assemble the appropriate equipment and select the proper evacuated tubes for test to be performed. Then, apply the tourniquet and thoroughly palpate the selected vein. Finally, position the patient's arm and cleanse the site with an antiseptic wipe, then proceed with the venipuncture protocol.

When a complete metabolic profile (CMP) and complete blood count (CBC) are ordered at the same time, why should the CMP be drawn first?

Tubes without additives should be drawn before tubes with additives.

Filling evacuated tubes to the indicated level results in the correct ratio of

additive to blood

EDTA is an

anticoagulant.

At what time should a test tube be labeled with the patient's identification?

before leaving the patient's room, after drawing the blood Three crucial identification steps in phlebotomy must be performed in this sequence without interruption—(1) positively identifying the patient, (2) collecting the patient's blood into tubes, and (3) labeling the tubes immediately afterward. Any change in this sequence or any significant interruption between steps has been linked to significantly increased chances for error.

Which of the following specimens is most susceptible to cross contamination and should always be drawn first?

blood culture

The medical assistant has an order to collect a CBC with diff, PT, a basic metabolic panel (BMP), and blood cultures. Place the collection tubes in the correct order of draw. (Click and drag the options in the left column to their correct order in the right column).

blood culture bottles, light blue, red, lavender

A CMP is ordered for an older adult patient whose veins continue to collapse despite drinking water. Which of the following is the best collection method for this patient?

butterfly needle

Which of the following forms is the medical assistant responsible for having the patient sign when a specimen is being collected for substance abuse screening for employment?

chain-of-custody A Chain-of-custody form is used to maintain a legal record of individuals who have had physical possession of the specimen. It prevents the possibility of tampering

A medical assistant needs to draw a bilirubin on a jaundiced infant. The medical assistant should

collect the specimen in an amber tube to protect from light. Bilirubin is a photo-sensitive analyte (can degrade by as much as 50% with an hour of light exposure). A specimen submitted for bilirubin testing should be collected in an amber tube which will protect it from light (a regular tube wrapped in aluminum foil could also be acceptable)

After a phlebotomist has successfully followed all the steps for blood collection, the patient informs the phlebotomist that he tends to bleed longer than the average person. What would be the next course of action for the phlebotomist?

confirm hemostasis and apply paper tape A proper phlebotomy procedure includes confirmation of hemostasis, regardless of whether or not a patient bleeds longer than normal. This definitely applies to this case when a patient admits a tendency to bleed longer than the average person.

When collecting specimens for alanine aminotransferase (ALT) or aspartate aminotransferase (AST), avoid gray-topped sodium fluoride tubes because the anticoagulant

destroys many enzymes. The sodium fluoride in gray-topped tubes can destroy many enzymes. Since ALT and AST are enzyme tests, sodium fluoride should be avoided.

Venipuncture on the foot is performed in which of the following locations?

dorsal pedis

A patient with an order for a blood draw presents with burns covering both arms. Which of the following is the medical assistant's best option for collecting the largest amount of blood for this patient?

microtainer tube A microtainer tube would be the best choice in this case. If a patient has burns covering both arms, a routine venipuncture from a brachial vein is not an option. The person collecting the blood will have the best chance at getting the highest volume of blood from a smaller vein using a microtainer tube (has less vacuum pressure than a regular sized tube)

For which of the following patients is the use of an adhesive bandage contraindicated?

newborn with hyperbilirubinemia The person collecting a blood sample from a newborn with hyperbilirubinemia would not use an adhesive bandage post-stick. Bleeding would be stopped by direct pressure and no bandage would be utilized. It is not recommended to use a bandage on children under two years of age because it could introduce a choking hazard if the child works the bandage loose. Bandaging a newborn's foot is a controversial issue because of skin sensitivity and potential bandage aspiration. Sensitivity is of particular concern in newborns with hyperbilirubinemia as they must endure multiple sample collections. Still, the incision should be monitored for bleeding and inflammation.

The phlebotomist is drawing blood from a patient that is taking blood thinners. Which of the following is a necessary piece of additional equipment to have at the drawing station?

non-adhering bandage Non-adhering bandage material would be helpful for patients on anticoagulant therapy who may bleed more extensively than typical patients after venipuncture. It is necessary to contain the bleed with a bandage, but adhesive might bruise once removed from a patient who has anticoagulated blood.

A phlebotomist has received a requisition to collect a blood culture. Using a butterfly, three milliliters of blood is collected. Into which of the following bottles is the proper dispensation of the specimen?

place all three mLs in the aerobic bottle Since the phlebotomist was only able to obtain three milliliters of blood, place all three mLs in the aerobic bottle.

Which of the following sites should the medical assistant use for newborn screening blood collection?

plantar surface of the heel