- Order of draw (venipuncture)?
- Blood culture → light blue (citrate) → red/gold serum (SST) → green (heparin) → lavender (EDTA) → gray (fluoride).
- What does the light blue tube test?
- Coagulation — PT/INR, aPTT, fibrinogen, D-dimer. Additive: sodium citrate.
- What does the lavender tube test?
- CBC and HbA1c (hematology). Additive: EDTA.
- What does the gray tube test?
- Glucose and lactate. Additive: sodium fluoride + potassium oxalate.
- What does the green tube test?
- Plasma chemistry and stat electrolytes. Additive: heparin (lithium or sodium).
- Preferred venipuncture vein?
- The median cubital vein — large, well-anchored, away from the artery and major nerves.
- Needle angle for venipuncture?
- 15–30°, bevel up.
- Max tourniquet time?
- No more than 1 minute — longer causes hemoconcentration.
- Serum vs plasma?
- Serum = liquid after blood clots (no fibrinogen). Plasma = liquid from anticoagulated blood (has fibrinogen).
- Why is EDTA drawn near the end?
- EDTA carryover into a later tube falsely raises potassium and lowers calcium.
- Which tube is drawn first?
- Blood culture — to keep the specimen sterile and avoid contamination.
- Capillary order of draw?
- Blood gas → EDTA FIRST → other additives → serum last (reversed from venipuncture).
- Two patient identifiers?
- Full name and date of birth — verified against requisition and wristband (never the room number).
- Routine venipuncture needle gauge?
- 21–23 gauge (higher number = smaller bore).
- Butterfly (winged set) gauge?
- 23–25 gauge — for small, fragile, or hand veins.
- Light blue tube fill ratio?
- 9:1 blood-to-citrate; fill to the line. Underfill falsely prolongs PT/aPTT.
- What does hemolysis falsely raise?
- Potassium, LDH, and AST (intracellular contents released from ruptured red cells).
- What is syncope?
- Fainting — usually a vasovagal reaction. Stop, remove the needle, lay the patient flat.
- OSHA standard for bloodborne pathogens?
- 29 CFR 1910.1030 — PPE, safety sharps, no recapping, free hepatitis B vaccine.
- What does the red/gold (SST) tube test?
- Serum chemistry and serology. Additive: clot activator (± gel in SST).
- Where is the median cubital vein found?
- In the antecubital fossa (the inner bend of the elbow), crossing its center.
- Second-choice venipuncture vein?
- The cephalic vein — lateral (thumb side) of the forearm.
- Which antecubital vein is used last and why?
- The basilic vein (medial) — it lies near the brachial artery and median nerve.
- How is a vein selected?
- By palpation (feel) — a vein that bounces is patent — not by sight alone.
- Areas to avoid for venipuncture?
- Mastectomy side, arm with an IV, hematoma, scarred/burned/edematous tissue, AV fistula.
- Why not draw from the side of a mastectomy?
- Risk of lymphedema and infection — use the opposite arm.
- Why avoid drawing from an arm with an IV?
- IV fluid contaminates and dilutes the sample. Use the other arm.
- How far above the site is the tourniquet applied?
- 3–4 inches above the intended puncture site.
- When is the tourniquet released?
- Before withdrawing the needle (often once the last tube starts filling).
- Effect of a prolonged tourniquet?
- Hemoconcentration — falsely elevated proteins, potassium, and cell counts.
- What antiseptic for a routine draw?
- 70% isopropyl alcohol — applied in a circular motion and allowed to air-dry.
- Why let the alcohol dry before puncture?
- Wet alcohol stings and can hemolyze the sample, skewing results.
- What is the bevel and how is it oriented?
- The slanted opening at the needle tip — inserted bevel up.
- What is the evacuated tube system (ETS)?
- A holder, a double-ended needle, and self-filling vacuum tubes — preferred for multi-tube draws.
- When is a syringe or butterfly used?
- For small, fragile, rolling, or hand veins, or difficult draws.
- Why does a higher gauge mean a smaller needle?
- Gauge is inverse — the number is the count of needles per inch of bore, so higher = thinner.
- What is a hematoma?
- Blood pooling under the skin when it leaks from the punctured vein.
- Common causes of a hematoma?
- Needle through the far wall, draw at a bifurcation, or too little pressure afterward.
- Sign of nerve contact during a draw?
- Sharp, burning, or electric pain with tingling/numbness — withdraw the needle immediately.
- Signs of an arterial puncture?
- Bright-red, pulsing, rapidly filling blood — remove and apply firm pressure 10–15 min.
- What is petechiae?
- Tiny red/purple spots under the skin — may signal a platelet or coagulation problem.
- Causes of hemolysis?
- Needle too small, forceful draw, shaking tubes, prolonged tourniquet, vigorous mixing.
- How do you prevent hemolysis?
- Proper gauge, let alcohol dry, avoid probing, and invert tubes gently — never shake.
- What does 'failure to draw' suggest?
- Collapsed/rolled vein, bevel against the wall, or vacuum loss — adjust slightly, don't blind-probe.
- How many venipuncture attempts before escalating?
- About two — then ask another phlebotomist rather than continue.
- When are tubes labeled?
- At the bedside, in the patient's presence, immediately after the draw.
- Why mix additive tubes by inversion?
- To blend the additive (anticoagulant/clot activator) evenly with the blood, gently — never shake.
- Inversions for a citrate (light blue) tube?
- 3–4 gentle inversions.
- Inversions for an EDTA (lavender) tube?
- 8–10 gentle inversions.
- What does the pink tube test?
- Blood bank — type and crossmatch. Additive: EDTA (same as lavender).
- What is the yellow (SPS) tube for?
- Blood cultures. SPS also helps recover organisms.
- What does the royal blue tube test?
- Trace elements and toxicology — it has a special low-contaminant stopper.
- What does the tan tube test?
- Lead — a lead-free certified EDTA tube; draws with the EDTA group.
- Reversed capillary order — why EDTA first?
- A dermal puncture activates platelets fast; collect the cell count before clumping skews it.
- Discard tube with a butterfly + citrate first?
- Draw a discard tube first to fill the tubing's dead space so the citrate tube fills fully.
- What is a multisample needle?
- A double-ended needle with a rubber sleeve that reseals between tubes in the ETS.
- How is the vein anchored before insertion?
- Pull the skin taut below the site with the thumb to keep the vein from rolling.
- What is iatrogenic anemia?
- Anemia caused by drawing too much blood over repeated collections — use small-volume tubes.
- Why not have the patient pump a fist?
- Fist pumping causes hemoconcentration and falsely raises potassium.
- After the needle is removed, what comes first?
- Activate the safety device, then apply pressure to the site with gauze.
- What is hand hygiene's role?
- The single most important measure to prevent infection — before and after every patient.
- What are standard precautions?
- Treat every patient's blood and body fluids as potentially infectious.
- PPE donning order?
- Gown → mask/respirator → eye protection → gloves.
- PPE doffing order?
- Gloves → eye protection → gown → mask, then hand hygiene.
- How are used sharps disposed of?
- Dropped point-first into a closable, puncture-resistant, leak-proof, labeled sharps container — never recapped by hand.
- Hepatitis B vaccine rule (OSHA)?
- Offered free by the employer within 10 working days of assignment.
- What is an Exposure Control Plan?
- A written OSHA-required plan, reviewed at least annually, for preventing and responding to exposures.
- First action after a needlestick?
- Wash the site with soap and water, report immediately, follow the exposure-control plan.
- What is HIPAA?
- Federal law protecting patients' protected health information (PHI).
- What is PHI?
- Protected health information — individually identifiable health data that must be kept private.
- A phlebotomist's scope of practice?
- Collect and handle specimens — not diagnose, interpret results, or act beyond training.
- What is quality control (QC)?
- Day-to-day checking that a test or instrument runs correctly (e.g., running control samples each shift).
- What is quality assurance (QA)?
- Ongoing monitoring of the whole testing process — pre-analytical, analytical, post-analytical.
- What phase has the most lab errors?
- The pre-analytical phase — prep, collection, handling, labeling — the phlebotomist's domain.
- Is a mislabeled tube a pre- or post-analytical error?
- Pre-analytical — it happens during collection/labeling, before testing.
- Biohazard label color?
- Orange or orange-red with the biohazard symbol.
- What is a transmission-based precaution?
- Added PPE for specific organisms — contact, droplet, or airborne — on top of standard precautions.
- What should you do with a patient in distress?
- Stop, stay with the patient, call for help, and follow the emergency response plan.
- Managing a fainting patient?
- Stop the draw, remove the needle, lower the head or lay flat, apply a cool cloth, call for help.
- What setting requires CPR readiness?
- Any patient-care setting — recognizing cardiac/respiratory distress and activating the code is in scope.
- What are CLIA-waived tests?
- Simple, low-risk tests (e.g., glucose, urine pregnancy) a phlebotomist may run at the point of care.
- Why disinfect equipment between patients?
- To prevent cross-contamination — clean reusable cables, racks, and surfaces per policy.
- Who provides PPE under OSHA?
- The employer, at no cost to the employee.
- What are engineering controls?
- Devices that isolate or remove a hazard — e.g., safety-engineered, self-sheathing needles.
- What are work-practice controls?
- Behaviors that reduce exposure — no recapping, hand hygiene, proper sharps disposal.
- What is a requisition?
- The test order — patient, provider, tests requested, and timing — that starts every draw.
- STAT vs routine vs timed orders?
- STAT = immediate; routine = standard; timed = drawn at a specific time (e.g., GTT, drug peak/trough).
- Why never use the room number as an ID?
- Patients move between rooms; using it can lead to drawing the wrong patient.
- What if the wristband doesn't match the order?
- Stop and resolve the discrepancy before drawing — never assume.
- What is informed consent?
- Consent given after the patient understands the procedure, its purpose, and risks.
- What is expressed consent?
- Explicit verbal or written agreement — the usual basis for a routine venipuncture.
- What is implied consent?
- Consent inferred from behavior or circumstance — extending an arm, or an emergency.
- Who consents for a minor?
- A parent or legal guardian (the child may also give assent).
- What if a patient refuses a draw?
- Respect the refusal, document it, and notify the nurse or provider.
- What does fasting mean?
- No food or caloric drinks before the test; water is allowed.
- Fasting time for a fasting glucose?
- Typically 8–12 hours (water allowed).
- Is a lipid panel still fasting?
- Non-fasting is now routine; fast only if ordered or for very high triglycerides.
- What is the basal state?
- Early-morning, rested, fasting condition — gives the most reproducible results.
- What analytes show diurnal variation?
- Cortisol and serum iron both peak in the morning — draw early.
- What is a glucose tolerance test (GTT)?
- Fasting baseline draw, then a 75 g glucose load, then timed draws (2-hour value standard).
- Why introduce yourself and explain the draw?
- To gain cooperation and consent and reduce anxiety — a relaxed patient is easier to draw.
- How do you accommodate a non-English speaker?
- Use a qualified interpreter and verify identity and consent through them.
- What does the requisition tell you to assemble?
- The correct tubes, volumes, and any special handling before approaching the patient.
- How should a patient be positioned for a draw?
- Seated or reclined with the arm supported and extended downward.
- Why recline an anxious or fainting-prone patient?
- To prevent injury if they faint (vasovagal syncope).
- How long must serum clot before spinning (SST)?
- About 30 minutes at room temperature (about 60 minutes for a plain red tube).
- Within how long should serum/plasma be separated?
- About 2 hours of collection, to keep results accurate.
- What is centrifugation?
- Spinning a tube to separate cells from serum or plasma.
- What happens if you spin a serum tube too early?
- Incomplete clotting leaves fibrin strands that interfere with the analyzer.
- What is an aliquot?
- A measured portion poured off from the primary specimen, labeled to match it.
- Which specimens are chilled on ice?
- Ammonia, lactate, and blood gases (ABG) — and run quickly.
- Which specimen is protected from light?
- Bilirubin — collected in an amber tube or wrapped in foil.
- Which specimens are kept warm (37°C)?
- Cold agglutinins and cryoglobulins — cooling makes them precipitate.
- What must every tube label include?
- Patient name, ID, date of birth, and the date and time of collection.
- What does QNS mean?
- Quantity Not Sufficient — too little specimen (or wrong ratio) to test; the sample is rejected.
- What is chain of custody?
- Documented, tamper-evident, unbroken handling of a forensic or drug-screen specimen.
- What is a critical value?
- A result so abnormal it needs immediate provider notification.
- Why does serum potassium run higher than plasma?
- Clotting releases potassium from platelets into the serum.
- What is lipemia?
- Cloudy, fatty-looking serum from high triglycerides (often non-fasting) that can interfere with testing.
- What is icterus?
- Yellow serum caused by a high bilirubin level.
- Why must aliquots be labeled to match the primary?
- To preserve traceability to the correct patient and prevent mix-ups.
- What is whole blood?
- Blood with all cells and plasma still mixed, kept from clotting by an anticoagulant.
- When is a specimen re-collected?
- When it is hemolyzed, clotted, QNS, mislabeled, or otherwise compromised.
- Why are blood cultures drawn first?
- To protect sterility and avoid false-positive contamination from skin flora.
- Antiseptic for a blood culture?
- Chlorhexidine or povidone-iodine (not plain alcohol).
- Most common cause of a false-negative blood culture?
- Drawing too little blood — adequate volume is critical.
- How many blood-culture sets are often drawn?
- Two sets from two different sites.
- What is a capillary (dermal) puncture?
- A fingerstick or infant heelstick used to collect small-volume samples.
- Where is an infant heel stick performed?
- On the medial or lateral plantar (side) surface of the heel — never the center or arch.
- Why avoid the center of the heel?
- To avoid hitting the calcaneus (bone) and causing osteomyelitis.
- Why wipe away the first drop in a capillary draw?
- The first drop contains tissue fluid that would contaminate the sample.
- Why not squeeze (milk) a fingerstick?
- Excessive squeezing hemolyzes the sample and adds tissue fluid.
- How does warming the site help a capillary draw?
- It increases blood flow, improving yield.
- What is a newborn screen (PKU) specimen?
- A dried blood spot on filter paper from a heel stick, collected after the infant has fed.
- What does a phlebotomist do for a central-line draw?
- Assists licensed staff — the phlebotomist does not access the line themselves.
- Antiseptic for a blood-alcohol collection?
- A non-alcohol antiseptic (e.g., povidone-iodine) so it doesn't affect the result.
- What does a forensic/drug specimen require?
- A documented chain of custody with tamper-evident seals.
- What is point-of-care (POC) testing?
- Testing done at the bedside (glucose, Hgb/Hct, urine pregnancy) — run QC first.
- First step before running a POC test?
- Run quality control on the device to confirm it is working.
- Standard timing for an OGTT result?
- The 2-hour value is the standard for a glucose tolerance test.
- EDTA position: venipuncture vs capillary?
- Near LAST in venipuncture (carryover), but FIRST in capillary (platelet clumping).
- What does SPS do besides anticoagulate?
- It helps recover organisms in blood cultures (and inhibits some antibiotics/complement).
- What is a tolerance test?
- A timed series of draws after a challenge (e.g., glucose load) to assess the body's response.
- What is sodium citrate's mechanism?
- It reversibly binds (chelates) calcium to prevent clotting; calcium is added back in the lab.
- What is EDTA's mechanism?
- It irreversibly binds calcium, preventing clotting and preserving cell shape and counts.
- What is heparin's mechanism?
- It potentiates antithrombin, inhibiting thrombin and factor Xa.
- What does sodium fluoride do?
- It is antiglycolytic — it stops cells from consuming glucose, preserving the sample.
- What is a clot activator?
- Silica or thrombin that speeds clotting so the tube yields serum.
- What is an SST?
- Serum separator tube (gold) — clot activator + gel that separates serum after spinning.
- What is a PST?
- Plasma separator tube (light green) — heparin + gel for plasma chemistry.
- Why is the gray tube drawn last?
- Its fluoride/oxalate would disrupt most analytes if carried over to a later tube.
- Inversions for a serum (red/SST) tube?
- About 5 gentle inversions (a glass non-additive red needs none).
- What is the CLSI standard for venipuncture order of draw?
- CLSI PRE02 (formerly GP41) — Collection of Diagnostic Venous Blood Specimens.
- What is the CLSI standard for capillary collection?
- CLSI GP42 — Collection of Capillary Blood Specimens.
- Why is the citrate tube before the serum tube?
- A clot activator carried over would shorten coagulation times.
- What is the antecubital fossa?
- The inner bend of the elbow — the primary region for routine venipuncture.
- Why not draw above an IV site?
- It still risks IV-fluid contamination; draw from the opposite arm when possible.
- What is the purpose of the tourniquet?
- To distend the vein so it is easier to feel and enter.
- What gauge for a blood donation?
- A larger bore (lower gauge, e.g., 16–18 G) to protect red cells and speed collection.
- What screening precedes a blood donation?
- Checking hemoglobin/hematocrit, weight, and a health-history questionnaire.
- What is a basal-state draw best for?
- Establishing reproducible reference results (e.g., fasting metabolic panels).
- What does ACD (yellow) test?
- Blood bank, DNA, and HLA studies (acid-citrate-dextrose).
- Which tube tests HbA1c?
- The lavender (EDTA) tube.
- Which tube tests PT/INR?
- The light-blue (sodium citrate) tube.
- Which tube tests a CBC?
- The lavender (EDTA) tube.
- Which tube tests a basic metabolic panel?
- A serum tube (red/SST) or a plasma (green/PST) tube, per lab protocol.
- Why are blood cultures sensitive to skin prep?
- Skin flora carried into the bottle cause false-positive (contaminant) results.
- What is the role of the discard tube?
- To clear dead-space air (butterfly) or a possible tissue-thromboplastin first draw before a coag tube.
- What is hemoconcentration?
- Falsely elevated cells and large molecules from a prolonged tourniquet or fist pumping.
- How is a rolling vein managed?
- Anchor it firmly below the site before insertion so it can't slide away.
- What size needle worsens hemolysis?
- Too small a bore (too high a gauge) forces cells through and ruptures them.
- Why label at the bedside, not later?
- Labeling away from the patient is a leading cause of mislabeled specimens.
- What is the difference between a needle and a lancet?
- A needle is for venipuncture; a lancet makes a shallow dermal (capillary) puncture.
- What is the order of draw mnemonic by color?
- Yellow, light Blue, Red/Gold, Green, Lavender, Gray — culture to glucose.
- What effect does EDTA carryover have on calcium?
- It falsely lowers calcium (EDTA binds the calcium in the next sample).
- What effect does EDTA carryover have on potassium?
- It falsely raises potassium (K2/K3 EDTA salts add potassium).
- Which patients are at higher fainting risk?
- Anxious, fasting, young, or previously-fainted patients — recline them.
- What is the purpose of inverting a clot-activator tube?
- To mix the activator with the blood so it clots evenly and on time.
- Why is bilirubin collected in an amber tube?
- Bilirubin breaks down in light, falsely lowering the result.
- What is the danger of recapping a needle?
- Accidental needlestick and exposure to bloodborne pathogens — it is prohibited by OSHA.
- What is a vasovagal response?
- A reflex drop in heart rate and blood pressure causing fainting during a draw.
- Which arm if the patient had a mastectomy on both sides?
- Consult the provider; draw may use a hand vein or require an order, per facility policy.
- What does a serum specimen require that plasma does not?
- Complete clotting before centrifugation.
- What is the holder (adapter) in the ETS?
- The barrel that holds the double-ended needle and guides each tube onto it.
- Why can't you reuse a tube holder with the needle?
- OSHA requires single-use of the needle-holder unit to prevent exposure.
- What does the light-green (PST) tube contain?
- Lithium heparin plus a gel separator for plasma electrolytes.
- What is a timed (peak/trough) draw?
- A draw at a precise time around a medication dose to measure drug levels.
- How is patient identity confirmed for an outpatient?
- Have them state and spell their full name and date of birth against the requisition.
- Why keep the arm straight after a draw?
- Bending the arm can reopen the puncture and cause a hematoma.
- What is the purpose of a tube's vacuum?
- It draws a precise blood volume, ensuring the correct blood-to-additive ratio.
- What causes a coag tube to be rejected?
- Underfilling (wrong 9:1 ratio), clotting, or hemolysis.
- What are the three phases of testing?
- Pre-analytical, analytical, and post-analytical.
- What is the role of the requisition in billing?
- It captures the ordering provider, diagnosis codes, and insurance for charge capture.
- Why verify expiration dates on tubes?
- Expired tubes lose vacuum and additive potency, compromising the sample.
- What does a critical-value report require?
- Immediate notification of the provider and documented read-back.
- Why is the median cubital usually visible?
- It is large and superficial, so it distends well under a tourniquet.
- What if a vein collapses during a draw?
- Release the vacuum (loosen the tube) or use a smaller tube/syringe to reduce suction.
- What is the safest forearm vein by distance from the artery?
- The cephalic vein (lateral) — farthest from the brachial artery and median nerve.
- Why are two blood-culture sites used?
- To distinguish a true infection from a single-site contaminant.
- What documentation follows an incident (e.g., needlestick)?
- An incident report plus follow-up under the exposure-control plan.
- What is the calcaneus?
- The heel bone — avoided during an infant heel stick to prevent injury.
- What is the difference between assent and consent for a minor?
- Consent is the guardian's legal permission; assent is the child's agreement to cooperate.
- Why are gloves changed between patients?
- To prevent cross-contamination and transmission of infection.
- What is the first thing to check on a requisition?
- Patient identity and the tests ordered match the patient you are about to draw.
- What is the safest response to an unfamiliar request?
- Decline politely and check with your supervisor before acting outside your scope.
- What is a bifurcation and why avoid puncturing there?
- Where a vein branches — puncturing it risks a hematoma and poor flow.
- Why does a hemolyzed potassium look high?
- Ruptured red cells release intracellular potassium into the serum.
- What is a 'short draw'?
- An underfilled tube — wrong blood-to-additive ratio; often rejected (especially coag).
- What is the proper response to a clotted EDTA specimen?
- Reject and re-collect — clotting invalidates the CBC.
- Why is the order of draw a quality issue?
- Drawing out of order causes additive carryover, the most common pre-analytical error.
- What is the recommended skin-prep motion?
- A circular motion from the center outward (concentric circles), then let it dry.
- What is a winged infusion set used for besides veins?
- Hand and small/fragile veins, and difficult pediatric/geriatric draws.
- Why warm a cold agglutinin specimen?
- Cooling makes the agglutinins clump, invalidating the test; keep it at 37°C.
- What does 'plasma still contains fibrinogen' allow?
- Faster turnaround — no clotting wait — for stat chemistry on a heparin tube.
- What is the purpose of a sharps container's fill line?
- Replace the container before it overfills to prevent sticks; never force sharps in.
- What does a markedly high POC glucose require?
- Treat it as a critical value — notify the provider immediately.
- Why confirm the patient is fasting before a fasting glucose?
- Recent food falsely raises glucose and invalidates the result.
- What is the role of palpation pressure?
- Gentle pressure feels the vein's depth, direction, and resilience to choose the best site.
- Which tube color is for trace elements?
- Royal blue — with a special low-contaminant stopper.
- Which tube color is for lead testing?
- Tan — a lead-free certified EDTA tube.
- What is the NHA CPT credential?
- Certified Phlebotomy Technician — the National Healthcareer Association's phlebotomy certification.
- What does CLSI stand for?
- Clinical and Laboratory Standards Institute — sets phlebotomy collection standards.
- What is a butterfly set's advantage?
- Its flexible tubing and shallow angle make small, fragile, and hand veins easier to access.
- Why is the cephalic vein sometimes harder to anchor?
- It tends to roll more than the median cubital, so anchor it firmly.
- What is the danger of probing for a vein?
- Blind probing can hit a nerve or artery and cause a hematoma — adjust gently instead.
- What is the purpose of gauze and a bandage after a draw?
- Pressure stops bleeding and the bandage protects the site and prevents a hematoma.
- Why ask about latex allergy before a draw?
- To choose non-latex gloves, tourniquet, and bandage and avoid an allergic reaction.
- What is a STAT specimen?
- One that must be collected and tested immediately because of urgent clinical need.
- What is the role of read-back when reporting a result?
- The receiver repeats the value to confirm it was heard correctly — a patient-safety check.
- Why disinfect culture-bottle tops?
- To prevent skin/environmental organisms from contaminating the culture.
- What is the basal metabolic state ideal for?
- Fasting reference tests like a basic metabolic panel and fasting glucose.
- What is a contaminated blood culture?
- A false positive from skin flora entering the bottle during collection.
- What happens to glucose if a sample sits without a preservative?
- Cells consume it (glycolysis), falsely lowering the result — use a gray fluoride tube.
- Why is the order of inversions important?
- Too few leaves the additive unmixed (clots/microclots); shaking causes hemolysis.
- What is a tunneled vs non-tunneled line?
- Both are central venous catheters; a phlebotomist assists but does not access them independently.
- What is the purpose of the 2-identifier rule?
- To guarantee the specimen is matched to the correct patient and prevent fatal mix-ups.
- What does an SST gel barrier do?
- After spinning, the gel forms a stable barrier between serum and cells.
- Why is hemolysis worse with a small-bore needle?
- High shear force as cells pass through the narrow lumen ruptures them.
- What is the order of draw rationale in one line?
- Prevent additive carryover from one tube falsely altering the next tube's results.
- What is a 'difficult draw' adaptation?
- Use a butterfly/syringe, warm the site, lower the vacuum, or choose a hand vein.
- What is the antiglycolytic agent in a gray tube?
- Sodium fluoride (paired with potassium oxalate as the anticoagulant).
- Which is reversible: citrate or EDTA chelation?
- Citrate is reversible (lab adds calcium back); EDTA is irreversible.
- Why must serum tubes clot fully before spinning?
- Early spinning leaves fibrin that interferes with the analyzer.
- What is a key sign you should stop a draw at once?
- Sharp/burning/electric pain (nerve) or bright-red pulsing blood (artery).
- What is the phlebotomist's first duty on arrival?
- Verify the requisition and identify the patient with two identifiers.
- Why keep an Exposure Control Plan current?
- OSHA requires annual review to reflect new safer devices and procedures.
- What is a critical low glucose example?
- A severely low POC glucose — notify the provider immediately as a critical value.
- Why label aliquots immediately?
- To keep every portion traceable to the correct patient and primary tube.
- What is a lancet's depth concern in infants?
- Limited depth (about 2 mm or less) so it doesn't reach the heel bone.
- What is the difference between QC and a critical value?
- QC checks the instrument; a critical value is a dangerously abnormal patient result.
- Why is the median cubital safest?
- It is anchored and separated from the brachial artery/median nerve by the bicipital aponeurosis.
- What does diaphoresis during a draw suggest?
- Possible vasovagal reaction (fainting) — be ready to stop and recline the patient.
- Why not bend the arm to hold gauze?
- Bending can reopen the site and cause a hematoma; keep the arm straight and apply pressure.
- What is the role of facility policy in scope?
- It defines exactly which tasks a phlebotomist may perform at that site.
- What does ICD-10-CM on a requisition represent?
- The diagnosis code justifying the test for billing and medical necessity.
- Why is patient registration accuracy important?
- Errors cascade into mislabeled specimens and billing/result-matching problems.
- What is the chain-of-custody seal's purpose?
- A tamper-evident seal proves the specimen was not altered in transit.
- What does the LIS do?
- The Laboratory Information System records, tracks, and reports specimen and result data.
- Why might two full practice forms feel different?
- Each is randomly drawn and weighted to the blueprint, so the mix varies each time.
- What is the safest first move if you suspect arterial puncture?
- Remove the needle and apply firm, continuous pressure for 10–15 minutes; notify the provider.
- What is the recommended response to a seizure during a draw?
- Remove the needle, apply pressure, protect the patient from injury, and call for help.
- Why verify medication/fasting compliance before a draw?
- Non-compliance (recent food, missed/taken meds) can invalidate the result.
- What is a key infection-control step for shared equipment?
- Disinfect cables, racks, and surfaces between patients per policy.
- What is the difference between serum and whole blood?
- Serum is cell-free liquid after clotting; whole blood still contains all the cells.
- Why are most phlebotomists certified even where not required?
- Employers require a national credential (NHA, NCCT, ASCP, AMT) for hiring and quality.
