- CLSI order of draw (venous)
- Blood culture → light blue (citrate) → red/gold serum (SST) → green (heparin) → lavender (EDTA) → gray (fluoride/oxalate).
- Three layers of a blood vessel wall (tunics)
- Tunica intima (inner endothelial lining), tunica media (middle muscle layer that controls diameter), tunica externa/adventitia (outer anchoring connective tissue).
- Function of the tunica media
- The middle muscular/elastic layer that controls vessel diameter and blood flow (vasoconstriction/vasodilation).
- Direction arteries carry blood
- AWAY from the heart, under high pressure, with thick muscular walls (no valves).
- Direction veins carry blood
- BACK to the heart, at low pressure, with one-way valves — the routine venipuncture target.
- Which artery is the exception that carries deoxygenated blood?
- The pulmonary artery — it carries deoxygenated blood from the right ventricle to the lungs.
- Where does gas/nutrient exchange actually occur?
- In the capillaries — vessels one cell thick where oxygen, nutrients, and waste diffuse between blood and tissue.
- Most muscular heart chamber and why
- The left ventricle — it pumps oxygenated blood into the aorta against the highest (systemic) pressure.
- Path of blood through the heart (simplified)
- Body → right atrium → right ventricle → lungs → left atrium → left ventricle → aorta → body.
- What does 'systole' mean?
- The contraction phase of the heart when blood is pumped out of the ventricles.
- What does 'diastole' mean?
- The relaxation phase of the heart when the chambers fill with blood.
- Which artery supplies the heart muscle (myocardium)?
- The coronary arteries (which branch off the aorta).
- Three formed elements of blood
- Red blood cells (erythrocytes), white blood cells (leukocytes), and platelets (thrombocytes).
- Function of red blood cells
- Carry oxygen (via hemoglobin) from the lungs to the tissues.
- Function of white blood cells
- Defend the body against infection (immune response).
- Function of platelets
- Initiate clotting (hemostasis) by forming a platelet plug at an injury.
- Approximate composition of whole blood
- About 55% plasma (liquid) and 45% formed elements (cells).
- Difference between plasma and serum
- Plasma (from an anticoagulated tube) still contains fibrinogen; serum (from a clotted tube) has NO fibrinogen or clotting factors.
- Which tube produces serum?
- A tube allowed to clot — red (no additive/clot activator) or gold SST (clot activator + gel).
- Which tubes produce plasma?
- Anticoagulated tubes — e.g. green (heparin), lavender (EDTA), light blue (citrate).
- Preferred vein for venipuncture
- The median cubital vein in the antecubital fossa — large, well-anchored, away from artery and nerve.
- Second-choice venipuncture vein
- The cephalic vein (lateral, thumb side of the forearm).
- Last-choice venipuncture vein and why
- The basilic vein (medial) — used last because it lies near the brachial artery and median nerve.
- Where is the antecubital fossa?
- The inner bend (anterior surface) of the elbow — the primary region for routine venipuncture.
- Best way to locate a vein
- Palpation (feel) — a vein you can feel bounce is patent; do not rely on sight alone.
- What is hemostasis?
- The body's process of stopping bleeding: vascular spasm, platelet plug, and the coagulation cascade forming fibrin.
- Role of fibrinogen in clotting
- It is converted to fibrin, the mesh that stabilizes a clot; it is present in plasma but absent in serum.
- Universal red-cell donor / recipient blood types
- Type O is the universal red-cell donor; type AB is the universal recipient.
- What does the Rh factor refer to?
- The D antigen on red blood cells — present = Rh-positive, absent = Rh-negative.
- What is hematology?
- The study of blood and blood-forming tissues, including cell counts like the CBC.
- What does 'lumen' mean?
- The hollow interior channel of a blood vessel through which blood flows.
- Sign of an accidental arterial puncture
- Bright-red, pulsing, rapidly filling blood — remove the needle and apply firm pressure.
- What are venules and arterioles?
- The smallest veins (venules) and smallest arteries (arterioles) that connect to capillary beds.
- Where are heart valves and their job?
- Between chambers and at the great vessels; they keep blood flowing one way and prevent backflow.
- What is an erythrocyte vs a leukocyte?
- Erythrocyte = red blood cell (oxygen carrier); leukocyte = white blood cell (immune defense).
- Why blood cultures are drawn first
- To keep the specimen sterile and avoid false-positive contamination from skin flora.
- Why EDTA (lavender) is drawn near the end
- EDTA carryover into a later tube falsely raises potassium and lowers calcium, skewing chemistry results.
- Light blue tube — additive and tests
- Sodium citrate; coagulation tests (PT/INR, aPTT, D-dimer).
- Red / gold (SST) tube — additive and tests
- None or clot activator (± gel); serum chemistry and serology.
- Green tube — additive and tests
- Heparin (lithium or sodium); plasma chemistry and stat electrolytes.
- Lavender / pink tube — additive and tests
- EDTA; CBC and HbA1c (pink top = blood bank).
- Gray tube — additive and tests
- Sodium fluoride + potassium oxalate; glucose and lactate.
- Yellow tube — additive and tests
- SPS (blood cultures) or ACD (blood bank / DNA / paternity).
- How sodium citrate prevents clotting
- It REVERSIBLY binds (chelates) calcium needed for clotting.
- How EDTA prevents clotting
- It IRREVERSIBLY binds (chelates) calcium, preserving cell shape for the CBC.
- How heparin prevents clotting
- It potentiates antithrombin, inhibiting thrombin and clot formation.
- How sodium fluoride preserves glucose
- It is antiglycolytic — it stops blood cells from consuming glucose.
- Required citrate (light blue) fill ratio
- 9:1 blood-to-additive; must be filled to the line.
- What happens if a citrate tube is underfilled?
- Excess citrate over-binds the lab's calcium reagent, falsely prolonging PT/aPTT (raising INR) — the lab rejects it.
- Routine venipuncture needle gauge
- 21–23 gauge (21 G is the standard).
- Butterfly (winged set) needle gauge
- 23–25 gauge — for small, fragile, or hand veins.
- Rule about needle gauge numbers
- A HIGHER number = a SMALLER bore (counterintuitive).
- Which way does the needle bevel face?
- Up (bevel-up) on insertion.
- Needle insertion angle
- About 15–30° to the arm.
- Maximum tourniquet application time
- No more than 1 minute.
- What does a prolonged tourniquet cause?
- Hemoconcentration — falsely elevated proteins, potassium, and cell counts.
- Where is the tourniquet applied?
- 3–4 inches above the intended puncture site.
- Minimum number of patient identifiers
- At least two — typically full name and date of birth.
- Identifier you must NEVER use
- The room or bed number (patients move).
- When and where are tubes labeled?
- At the bedside, in the patient's presence, immediately after the draw.
- Antiseptic for routine venipuncture
- 70% isopropyl alcohol — applied in a circular motion and allowed to air-dry.
- Antiseptic for blood cultures
- Chlorhexidine (or povidone-iodine), not plain alcohol, because sterility is critical.
- Antiseptic for a blood-alcohol draw
- A non-alcohol antiseptic (e.g. povidone-iodine) so the prep can't affect the result.
- Sites to avoid for venipuncture
- Mastectomy side, an arm with an IV, hematomas, scarred/burned/edematous skin, and AV fistulas.
- Why avoid the mastectomy side?
- Lymphedema and infection risk — draw from the opposite arm.
- Why avoid an arm with a running IV?
- IV fluid contaminates and dilutes the sample — use the other arm or draw below the IV.
- Reversed (capillary) order of draw
- Blood gas → EDTA (lavender) FIRST → other additives → serum LAST.
- Why EDTA is collected first in a skin puncture
- The puncture activates platelets immediately, so the cell count must be collected before clumping skews it.
- Infant heel-stick site
- The medial or lateral plantar (side) surface of the heel — never the center or arch (to avoid bone).
- Why warm an infant's heel before a heel stick?
- Warming increases blood flow to the site, improving collection.
- First drop in a capillary/dermal puncture
- Wipe it away — it contains tissue fluid that can skew results.
- Effect of 'milking' (excessive squeezing) a finger/heel
- It hemolyzes the sample and adds tissue fluid — apply only gentle, intermittent pressure.
- Equipment system preferred for multi-tube draws
- The evacuated tube system (ETS) — holder, double-ended needle, and self-filling vacuum tubes.
- When is a syringe used instead of ETS?
- For fragile or difficult veins where vacuum pressure might collapse the vein.
- Discard tube use with a butterfly + citrate tube
- Draw a discard tube first to fill the tubing's dead space so the citrate ratio is correct.
- STAT vs routine vs timed orders
- STAT = immediate; routine = standard turnaround; timed = drawn at a specific time (e.g. drug peak/trough, GTT).
- Number of inversions for an additive tube
- Gently invert (don't shake) — typically 8–10 times for most additive tubes, 3–4 for citrate.
- Glucose tolerance test (GTT) procedure
- Fasting baseline draw, a measured glucose load, then timed draws (e.g. 1- and 2-hour).
- Therapeutic drug monitoring — what to record
- The exact time of collection relative to the dose (peak vs trough).
- A trough drug level is drawn when?
- Just BEFORE the next dose (lowest concentration).
- A peak drug level is drawn when?
- After the dose has distributed (highest concentration), per the drug's timing.
- Best action for a fainting-prone patient
- Have them lie down or sit in a reclining chair for the draw.
- What is a fasting specimen?
- Drawn after no food or caloric drinks (water allowed), typically 8–12 hours, for tests like fasting glucose.
- Is a lipid panel still fasting?
- Current guidance makes non-fasting the routine default; a fast is reserved for very high triglycerides or a lipid workup.
- What is the basal state?
- Early morning, rested, fasting — the condition that gives the most reproducible results.
- Which analytes have diurnal variation?
- Cortisol and serum iron (both peak in the morning) — draw at the time the test specifies.
- Three types of consent
- Informed (understands procedure), expressed (explicit verbal/written), implied (inferred — e.g. arm extended).
- Consent for a minor
- Requires a parent's or legal guardian's permission.
- What if a patient refuses a draw?
- Do not force it — document the refusal and notify the nurse or provider.
- Anchoring the vein
- Pull the skin taut below the site to stabilize the vein before insertion.
- When is the safety device activated?
- Immediately when the needle leaves the arm — before disposal.
- Why never recap a used needle by hand?
- High needlestick risk; OSHA prohibits it — drop sharps directly into the container.
- Order: release tourniquet vs remove needle
- Release the tourniquet before withdrawing the needle.
- Two common tests using a lavender (EDTA) tube
- Complete blood count (CBC) and HbA1c.
- Test using a light blue (citrate) tube
- Coagulation studies — PT/INR and aPTT.
- What is the antecubital 'H' vs 'M' pattern?
- Common arrangements of the median cubital, cephalic, and basilic veins in the antecubital fossa.
- Best practice if you can't find a vein within a minute
- Release the tourniquet, wait, then reapply — don't leave it on.
- Recommended number of venipuncture attempts before escalating
- About two attempts, then ask another phlebotomist or escalate — avoid blind probing.
- Why let alcohol air-dry before puncture?
- Wet alcohol can cause a stinging sensation, hemolysis, and a false result; let it dry.
- What is a winged blood-collection set?
- A butterfly — flexible tubing with a small-gauge needle for fragile/hand veins.
- Why is the basilic vein risky?
- It sits near the brachial artery and median nerve — higher risk of arterial puncture or nerve injury.
- Patient position for an outpatient draw
- Seated with the arm supported and extended downward; reclining if syncope-prone.
- Blood culture set — how many and from where?
- Often two sets from two separate sites to distinguish true infection from contamination.
- Why adequate volume matters for a blood culture
- Too little blood is the most common cause of a false-negative culture.
- Order of draw memory phrase
- 'Studies Begin Right Going Lab Gray' — Sterile, Blue, Red, Green, Lavender, Gray.
- Tube for stat electrolytes
- Green (heparin) tube for rapid plasma chemistry.
- Pink-top tube use
- EDTA tube designated for blood bank (type and screen / crossmatch).
- Equipment to verify before a draw
- Tube expiration dates, the right additives, correct needle, and that supplies are sterile/intact.
- What is a 'short draw' / QNS coag tube outcome?
- Rejected — the 9:1 ratio is off, invalidating PT/aPTT.
- Why patient identification is so critical
- Misidentification is a leading cause of transfusion errors and one of the most serious pre-analytical errors.
- What does the requisition tell you?
- Which tubes to collect, required volume, special handling, and the timing of the draw.
- How to handle a discrepancy between order and wristband
- Stop and resolve it before drawing — never assume.
- Skin-puncture vs venipuncture — sample type
- Skin puncture yields capillary (mixed arterial-venous + tissue fluid) blood; venipuncture yields venous blood.
- Two reasons to choose a skin puncture
- Small sample volume needed (infants) or poor venous access.
- Why not perform a heel stick on an older child?
- The heel bone is close to the surface only in infants; older children/adults use a fingerstick.
- Preferred fingerstick site
- The side of the middle or ring fingertip, slightly off-center, perpendicular to the fingerprint lines.
- Common cause of clotted EDTA tube
- Failure to mix (invert) the tube promptly after collection.
- Why invert tubes gently rather than shake?
- Shaking hemolyzes the sample; gentle inversion mixes additive without rupturing cells.
- Most common specimen-rejection reasons
- Hemolysis, clotted tube, QNS/wrong fill, mislabeled/unlabeled, wrong tube/additive, and improper handling.
- What is hemolysis?
- Rupture of red blood cells releasing their contents — makes serum pink/red and falsely raises K, LDH, AST.
- Common causes of hemolysis
- Needle too small, forceful draw, shaking tubes, prolonged tourniquet, drawing from a hematoma.
- Action for a mislabeled tube
- Never relabel — reject and recollect using two identifiers.
- What does QNS mean?
- Quantity Not Sufficient — too little specimen (or wrong ratio) to run the test.
- What is accessioning?
- Logging a received specimen into the lab system and assigning a unique tracking number.
- Required tube label information
- Patient name, ID, date of birth, date and time of collection, and the collector's initials.
- Clotting time before spinning an SST
- About 30 minutes at room temperature for full clotting.
- Clotting time before spinning a plain red tube
- About 60 minutes at room temperature.
- What happens if you centrifuge serum too early?
- Incomplete clotting leaves fibrin strands that interfere with the analyzer.
- Time limit to separate serum/plasma from cells
- Within about 2 hours of collection.
- Why separate serum/plasma from cells promptly?
- Cells alter glucose, potassium, and other analytes over time.
- Can you re-centrifuge a gel (SST) tube?
- No — re-spinning can release analytes from cells trapped above the gel.
- Centrifuge balancing rule
- Always place tubes of equal weight opposite each other; an unbalanced centrifuge is unsafe.
- What is an aliquot?
- A measured portion poured off from the primary specimen for separate testing, labeled to match it.
- Specimens that must be CHILLED on ice
- Ammonia, lactate, and arterial blood gases.
- Specimen that must be PROTECTED from light
- Bilirubin (use an amber tube or wrap in foil).
- Specimens that must be KEPT WARM (37°C)
- Cold agglutinins and cryoglobulins (they precipitate when cooled).
- Risk of pneumatic-tube transport
- It can hemolyze fragile specimens — some samples must be hand-carried.
- What is a critical (panic) value?
- A result so abnormal it requires immediate provider notification.
- First action for an unlabeled specimen arriving in the lab
- Reject it; do not test or relabel — the patient must be recollected.
- Why measure temperature on a frozen-section / fresh specimen?
- To verify the specimen meets the test's required transport/storage conditions.
- How are most lab errors classified?
- Pre-analytical (collection/handling) — the phlebotomist's domain — outnumber analytical and post-analytical errors.
- Three phases of laboratory testing
- Pre-analytical, analytical, and post-analytical.
- What is lipemia and its effect?
- Cloudy, fatty serum (high triglycerides) that can interfere with some assays.
- What is icterus?
- Yellow serum discoloration from high bilirubin.
- Storage for a specimen that can't be processed immediately
- Follow the test's requirement — refrigerate, freeze, keep at room temp, chill, or keep warm as specified.
- Why is mixing additive tubes important?
- Inadequate mixing causes microclots that invalidate the result (especially the CBC).
- What invalidates a coagulation specimen besides clotting?
- An underfilled tube (wrong 9:1 ratio) or a hemolyzed/contaminated sample.
- Transport requirement for a 24-hour urine
- Keep cold (refrigerated/on ice) during the collection and transport.
- Acceptable add-on test window
- Depends on the analyte's stability in the already-collected specimen — some are too degraded to add on.
- Why label at the bedside, not at the desk?
- To prevent mixing up tubes from different patients — the most dangerous labeling error.
- What does centrifugation separate?
- Cells (bottom) from serum or plasma (top); a gel barrier forms in an SST.
- Effect of leaving blood on the cells too long (glucose)
- Glycolysis lowers the glucose result over time (unless a fluoride tube was used).
- Specimen requirement for potassium accuracy
- Avoid hemolysis and prolonged cell contact — both falsely raise potassium.
- Why does hemolysis raise potassium?
- Potassium is concentrated inside red cells; rupture releases it into the serum/plasma.
- Special handling for newborn screening cards
- Collected as dried blood spots on filter paper; air-dry, don't stack or contaminate, and mail promptly.
- What is specimen integrity?
- Whether the sample is suitable for testing — correct type, volume, additive, and handling, free of hemolysis/clots.
- First step if a specimen looks hemolyzed
- Note it, and recollect if the test is affected — many analytes can't be reported from a hemolyzed sample.
- Why is turnaround time tracked?
- It is a quality-improvement metric; delays can affect patient care, especially for STAT tests.
- What is point-of-care testing (POCT)?
- Laboratory testing performed at or near the patient (bedside, clinic) rather than in a central lab.
- What makes a test 'CLIA-waived'?
- The FDA cleared it as simple and low-risk for error, so it can run outside a high-complexity lab.
- Examples of CLIA-waived tests
- Glucose meters, hemoglobin/hematocrit, PT/INR, urine dipstick, and rapid strep/flu/pregnancy/COVID kits.
- Most critical step for POCT accuracy
- Run quality control and follow the manufacturer's instructions exactly.
- Internal vs external QC
- Internal = built-in electronic/onboard check; external = liquid control samples with known values.
- What to do if a control is out of range
- STOP — do not report patient results; troubleshoot, check reagent/storage, and rerun QC first.
- Cause of a falsely LOW point-of-care glucose
- Expired/improperly stored strip, insufficient sample, or a malfunctioning/cold device.
- Why follow manufacturer storage instructions for strips?
- Strips/cartridges are temperature- and humidity-sensitive; improper storage invalidates results.
- What does a POCT 'error' message mean?
- A problem with the sample or device — repeat with a fresh strip/sample per the instructions; don't force a result.
- What is calibration in POCT?
- Setting the device against a known standard so its readings are accurate; done per the manufacturer's schedule.
- Test monitored by PT/INR at the point of care
- Warfarin (anticoagulant) therapy.
- Common waived urinalysis method
- A reagent dipstick read for glucose, protein, pH, blood, leukocytes, ketones, etc.
- Sample type for a rapid strep test
- A throat swab of the tonsils and posterior pharynx.
- Sample for a urine pregnancy (hCG) test
- Urine (ideally first-morning, most concentrated) — or serum for a quantitative test.
- Why document POCT QC?
- Regulatory requirement (CLIA) and proof the result is reliable for patient care.
- Who may perform waived testing?
- Trained, competency-assessed operators following the manufacturer's instructions.
- What does a control with a KNOWN value confirm?
- That the device and reagent are working before patient samples are run.
- Hemoglobin vs hematocrit
- Hemoglobin = oxygen-carrying protein concentration; hematocrit = the % of blood volume that is red cells.
- Risk of an expired reagent strip
- Inaccurate (often falsely low/high) results — always check the expiration date.
- First action before any POCT patient test
- Confirm QC has passed and the device is calibrated and in date.
- What is competency assessment for POCT?
- Periodic verification that an operator can correctly perform the test and QC.
- Why is POCT used despite a central lab?
- Faster turnaround at the bedside for time-critical results (e.g. glucose, INR).
- Effect of an insufficient POCT blood drop
- An error or a falsely low result — apply enough sample per the device.
- Lot-to-lot verification for reagents
- When a new reagent lot is opened, run QC to confirm it performs like the previous lot.
- Document updated for each new reagent lot
- The QC log / reagent log (lot number, expiration, and QC results).
- Random urine specimen
- Any voided sample, collected at any time — used for routine urinalysis.
- Clean-catch midstream urine — why and how
- Cleanse first, begin the stream, then catch the middle — minimizes contamination for a culture.
- 24-hour urine collection procedure
- Discard the first void (note the time), collect every void for 24 hours kept cold, end with a final void.
- Why discard the first void in a 24-hour urine?
- To start the timed clock with an empty bladder so the result reflects exactly 24 hours.
- What invalidates a 24-hour urine?
- Missing or discarding any void during the collection window.
- First-morning urine — why preferred
- It is the most concentrated — best for pregnancy and microalbumin testing.
- Best time to collect a sputum culture
- Early morning, as a deep cough (not saliva).
- Stool occult-blood test prep
- May require avoiding red meat and certain medications for a few days beforehand.
- Sweat-chloride test — what it diagnoses
- Cystic fibrosis (collected by iontophoresis/pilocarpine stimulation).
- Throat swab technique
- Swab the tonsils and posterior pharynx, avoiding the tongue and cheeks.
- Nasopharyngeal swab use
- Recovering respiratory viruses/bacteria (e.g. flu, COVID, pertussis) — insert along the nasal floor.
- Breath test examples
- Urea breath test for H. pylori; hydrogen breath test for lactose intolerance.
- Why use transport media for swabs?
- To keep the organism viable until it reaches the lab for culture.
- Container for a 24-hour urine with a preservative
- A large container that may contain an acid or other preservative — verify the test requirement first.
- Specimen-test correlation example
- CSF for meningitis, urine for UTI, sputum for pneumonia — the right specimen for the right test.
- Why measure urine temperature in a drug screen?
- To confirm a fresh, unadulterated (not substituted) specimen right after collection.
- Chain of custody — definition
- Documented, unbroken, tamper-evident handling of a specimen from collection to testing, with signed transfers.
- When is a chain of custody required?
- For forensic/legal specimens — most often urine drug screens and blood-alcohol tests.
- Patient instruction for a clean-catch
- Wipe front-to-back/clean the area, void a little, then collect midstream into the sterile cup.
- CSF specimen — who collects it?
- A physician (lumbar puncture); the phlebotomist/lab processes and routes the tubes in order.
- Stool culture purpose
- Detect enteric pathogens (bacteria/parasites) causing GI infection.
- Why is a sputum sample sometimes rejected?
- If it is mostly saliva rather than lower-respiratory secretions.
- Buccal swab use
- Collecting cheek cells for DNA/genetic testing.
- Semen analysis handling
- Collected per strict instructions and delivered to the lab within a short, specified time, kept near body temperature.
- Sterile container — when required
- For any culture (urine, sputum, swab) to prevent contamination from skewing the result.
- Difference between QC and QA
- QC = day-to-day checks that a test runs correctly; QA = ongoing monitoring of the whole process (all three phases).
- What is a delta check?
- A QC comparison of a patient's current result with a recent prior one; a big unexpected change flags a possible error.
- What is proficiency testing?
- External unknown samples sent to the lab to verify its results agree with peer laboratories.
- What is competency assessment?
- Periodic verification that staff can correctly and safely perform their tasks.
- Phase where most lab errors occur
- Pre-analytical (patient prep, collection, handling, labeling).
- Purpose of an incident/occurrence report
- To document and track errors and near-misses for quality improvement.
- What does CLIA regulate?
- All clinical laboratory testing on humans in the U.S. (administered by CMS).
- Role of CAP and The Joint Commission
- Laboratory accreditation and inspection.
- Role of CLSI
- Develops consensus standards (e.g. the order of draw, specimen labeling and handling).
- Role of OSHA in the lab
- Workplace safety — including the Bloodborne Pathogens Standard.
- Role of DOT / IATA
- Regulate shipping/transport of infectious substances (Category A and B).
- OSHA Bloodborne Pathogens Standard citation
- 29 CFR 1910.1030.
- Key employer duties under the BBP Standard
- Provide free PPE, safety-engineered sharps, sharps containers, a free hepatitis B vaccine, and an exposure-control plan.
- Rule about used needles
- Never recap, bend, or break by hand — drop directly into the sharps container.
- Sharps container requirements
- Closable, puncture-resistant, leak-proof, biohazard-labeled, at the point of use.
- What are standard precautions?
- Treat every patient's blood and body fluids as potentially infectious — hand hygiene, gloves, PPE.
- Single most important infection-control measure
- Hand hygiene before and after every patient.
- PPE donning order
- Gown → mask → eye protection → gloves.
- PPE removal (doffing) order
- Gloves → eye protection → gown → mask, then hand hygiene.
- Immediate steps after a needlestick
- Wash the site with soap and water, report immediately, and follow the exposure-control plan.
- When to offer the hepatitis B vaccine
- Free, within 10 working days of assignment to at-risk duties.
- What is HIPAA?
- Federal law protecting a patient's protected health information (PHI).
- How to handle PHI
- Access/share only on a need-to-know basis; keep requisitions and screens secure; never discuss patients publicly.
- A phlebotomist's scope of practice
- Collect, handle, and process specimens — not diagnose or interpret results.
- Negligence vs malpractice
- Negligence = failure to exercise reasonable care; malpractice = negligence by a professional in their duties.
- What is a Safety Data Sheet (SDS)?
- A document describing a chemical's hazards, handling, storage, and first aid — kept accessible to staff.
- First action for a chemical spill
- Protect yourself/others and follow the SDS and facility spill procedure; contain and report it.
- What is the principle of 'lean' in the lab?
- Reducing waste and non-value steps to improve efficiency and turnaround.
- What is Six Sigma in the lab?
- A data-driven quality method aimed at reducing errors/defects in processes.
- Document updated when a new reagent lot is used
- The reagent/QC log (lot number, expiration, QC results).
- What does a 'critical value' require?
- Immediate notification of the provider and documentation of the read-back.
- What is turnaround time (TAT)?
- The time from order/collection to result reporting — a key quality metric.
- Routes of pathogen transmission
- Contact, droplet, airborne, vector, and vehicle (blood/fluids) — standard precautions reduce them.
- When are isolation/transmission-based precautions used?
- In addition to standard precautions for patients with specific contagious infections.
- Category A vs B infectious substance shipping
- Category A = capable of causing permanent disability/death (stricter packaging); Category B = most diagnostic specimens.
- Purpose of a fire-safety plan (RACE)
- Rescue, Alarm, Confine, Extinguish/Evacuate — the response to a lab fire.
- What is informed consent (lab context)?
- The patient agrees to the procedure after understanding its purpose and risks.
- Why decontaminate work surfaces?
- To kill pathogens between patients/spills — use an approved disinfectant per facility policy.
- What is an ABN (Advance Beneficiary Notice)?
- A notice that a test may not be covered, so the patient may be responsible for payment.
- Why is patient confidentiality a legal duty?
- HIPAA mandates it; breaches can result in penalties and loss of trust.
