Your FREE Phlebotomy Flashcards 2026 – 250+ Cards

Blood culture → light blue (citrate) → red/gold serum (SST) → green (heparin) → lavender (EDTA) → gray (fluoride).

Coagulation — PT/INR, aPTT, fibrinogen, D-dimer. Additive: sodium citrate.

CBC and HbA1c (hematology). Additive: EDTA.

Glucose and lactate. Additive: sodium fluoride + potassium oxalate.

Plasma chemistry and stat electrolytes. Additive: heparin (lithium or sodium).

The median cubital vein — large, well-anchored, away from the artery and major nerves.

15–30°, bevel up.

No more than 1 minute — longer causes hemoconcentration.

EDTA carryover into a later tube falsely raises potassium and lowers calcium.

Blood culture — to keep the specimen sterile and avoid contamination.

21–23 gauge (higher number = smaller bore).

23–25 gauge — for small, fragile, or hand veins.

9:1 blood-to-citrate; fill to the line. Underfill falsely prolongs PT/aPTT.

Fainting — usually a vasovagal reaction. Stop, remove the needle, lay the patient flat.

Serum chemistry and serology. Additive: clot activator (± gel in SST).

In the antecubital fossa (the inner bend of the elbow), crossing its center.

The cephalic vein — lateral (thumb side) of the forearm.

The basilic vein (medial) — it lies near the brachial artery and median nerve.

By palpation (feel) — a vein that bounces is patent — not by sight alone.

Mastectomy side, arm with an IV, hematoma, scarred/burned/edematous tissue, AV fistula.

Risk of lymphedema and infection — use the opposite arm.

IV fluid contaminates and dilutes the sample. Use the other arm.

3–4 inches above the intended puncture site.

Before withdrawing the needle (often once the last tube starts filling).

Hemoconcentration — falsely elevated proteins, potassium, and cell counts.

70% isopropyl alcohol — applied in a circular motion and allowed to air-dry.

Wet alcohol stings and can hemolyze the sample, skewing results.

The slanted opening at the needle tip — inserted bevel up.

A holder, a double-ended needle, and self-filling vacuum tubes — preferred for multi-tube draws.

For small, fragile, rolling, or hand veins, or difficult draws.

Gauge is inverse — the number is the count of needles per inch of bore, so higher = thinner.

Blood pooling under the skin when it leaks from the punctured vein.

Needle through the far wall, draw at a bifurcation, or too little pressure afterward.

Sharp, burning, or electric pain with tingling/numbness — withdraw the needle immediately.

Bright-red, pulsing, rapidly filling blood — remove and apply firm pressure 10–15 min.

Tiny red/purple spots under the skin — may signal a platelet or coagulation problem.

Collapsed/rolled vein, bevel against the wall, or vacuum loss — adjust slightly, don't blind-probe.

About two — then ask another phlebotomist rather than continue.

To blend the additive (anticoagulant/clot activator) evenly with the blood, gently — never shake.

3–4 gentle inversions.

8–10 gentle inversions.

Blood bank — type and crossmatch. Additive: EDTA (same as lavender).

Trace elements and toxicology — it has a special low-contaminant stopper.

Lead — a lead-free certified EDTA tube; draws with the EDTA group.

Draw a discard tube first to fill the tubing's dead space so the citrate tube fills fully.

A double-ended needle with a rubber sleeve that reseals between tubes in the ETS.

Pull the skin taut below the site with the thumb to keep the vein from rolling.

Anemia caused by drawing too much blood over repeated collections — use small-volume tubes.

Fist pumping causes hemoconcentration and falsely raises potassium.

It reversibly binds (chelates) calcium to prevent clotting; calcium is added back in the lab.

It irreversibly binds calcium, preventing clotting and preserving cell shape and counts.

It potentiates antithrombin, inhibiting thrombin and factor Xa.

It is antiglycolytic — it stops cells from consuming glucose, preserving the sample.

Silica or thrombin that speeds clotting so the tube yields serum.

Serum separator tube (gold) — clot activator + gel that separates serum after spinning.

Plasma separator tube (light green) — heparin + gel for plasma chemistry.

Its fluoride/oxalate would disrupt most analytes if carried over to a later tube.

About 5 gentle inversions (a glass non-additive red needs none).

CLSI PRE02 (formerly GP41) — Collection of Diagnostic Venous Blood Specimens.

A clot activator carried over would shorten coagulation times.

The inner bend of the elbow — the primary region for routine venipuncture.

It still risks IV-fluid contamination; draw from the opposite arm when possible.

To distend the vein so it is easier to feel and enter.

Blood bank, DNA, and HLA studies (acid-citrate-dextrose).

The lavender (EDTA) tube.

The light-blue (sodium citrate) tube.

The lavender (EDTA) tube.

A serum tube (red/SST) or a plasma (green/PST) tube, per lab protocol.

To clear dead-space air (butterfly) or a possible tissue-thromboplastin first draw before a coag tube.

Falsely elevated cells and large molecules from a prolonged tourniquet or fist pumping.

Anchor it firmly below the site before insertion so it can't slide away.

Yellow, light Blue, Red/Gold, Green, Lavender, Gray — culture to glucose.

It falsely lowers calcium (EDTA binds the calcium in the next sample).

It falsely raises potassium (K2/K3 EDTA salts add potassium).

To mix the activator with the blood so it clots evenly and on time.

A reflex drop in heart rate and blood pressure causing fainting during a draw.

Consult the provider; draw may use a hand vein or require an order, per facility policy.

The barrel that holds the double-ended needle and guides each tube onto it.

Lithium heparin plus a gel separator for plasma electrolytes.

Bending the arm can reopen the puncture and cause a hematoma.

It draws a precise blood volume, ensuring the correct blood-to-additive ratio.

Underfilling (wrong 9:1 ratio), clotting, or hemolysis.

Expired tubes lose vacuum and additive potency, compromising the sample.

It is large and superficial, so it distends well under a tourniquet.

Release the vacuum (loosen the tube) or use a smaller tube/syringe to reduce suction.

The cephalic vein (lateral) — farthest from the brachial artery and median nerve.

Where a vein branches — puncturing it risks a hematoma and poor flow.

An underfilled tube — wrong blood-to-additive ratio; often rejected (especially coag).

Drawing out of order causes additive carryover, the most common pre-analytical error.

A circular motion from the center outward (concentric circles), then let it dry.

Hand and small/fragile veins, and difficult pediatric/geriatric draws.

Gentle pressure feels the vein's depth, direction, and resilience to choose the best site.

Royal blue — with a special low-contaminant stopper.

Tan — a lead-free certified EDTA tube.

Clinical and Laboratory Standards Institute — sets phlebotomy collection standards.

Its flexible tubing and shallow angle make small, fragile, and hand veins easier to access.

It tends to roll more than the median cubital, so anchor it firmly.

Blind probing can hit a nerve or artery and cause a hematoma — adjust gently instead.

Pressure stops bleeding and the bandage protects the site and prevents a hematoma.

Too few leaves the additive unmixed (clots/microclots); shaking causes hemolysis.

Prevent additive carryover from one tube falsely altering the next tube's results.

Use a butterfly/syringe, warm the site, lower the vacuum, or choose a hand vein.

Sodium fluoride (paired with potassium oxalate as the anticoagulant).

Citrate is reversible (lab adds calcium back); EDTA is irreversible.

Sharp/burning/electric pain (nerve) or bright-red pulsing blood (artery).

It is anchored and separated from the brachial artery/median nerve by the bicipital aponeurosis.

Possible vasovagal reaction (fainting) — be ready to stop and recline the patient.

Bending can reopen the site and cause a hematoma; keep the arm straight and apply pressure.

Each is randomly drawn and weighted to the blueprint, so the mix varies each time.

Remove the needle and apply firm, continuous pressure for 10–15 minutes; notify the provider.

Remove the needle, apply pressure, protect the patient from injury, and call for help.

29 CFR 1910.1030 — PPE, safety sharps, no recapping, free hepatitis B vaccine.

Activate the safety device, then apply pressure to the site with gauze.

The single most important measure to prevent infection — before and after every patient.

Treat every patient's blood and body fluids as potentially infectious.

Gown → mask/respirator → eye protection → gloves.

Gloves → eye protection → gown → mask, then hand hygiene.

Dropped point-first into a closable, puncture-resistant, leak-proof, labeled sharps container — never recapped by hand.

Offered free by the employer within 10 working days of assignment.

A written OSHA-required plan, reviewed at least annually, for preventing and responding to exposures.

Wash the site with soap and water, report immediately, follow the exposure-control plan.

Federal law protecting patients' protected health information (PHI).

Protected health information — individually identifiable health data that must be kept private.

Collect and handle specimens — not diagnose, interpret results, or act beyond training.

Day-to-day checking that a test or instrument runs correctly (e.g., running control samples each shift).

Ongoing monitoring of the whole testing process — pre-analytical, analytical, post-analytical.

The pre-analytical phase — prep, collection, handling, labeling — the phlebotomist's domain.

Pre-analytical — it happens during collection/labeling, before testing.

Orange or orange-red with the biohazard symbol.

Added PPE for specific organisms — contact, droplet, or airborne — on top of standard precautions.

Stop, stay with the patient, call for help, and follow the emergency response plan.

Stop the draw, remove the needle, lower the head or lay flat, apply a cool cloth, call for help.

Any patient-care setting — recognizing cardiac/respiratory distress and activating the code is in scope.

Simple, low-risk tests (e.g., glucose, urine pregnancy) a phlebotomist may run at the point of care.

To prevent cross-contamination — clean reusable cables, racks, and surfaces per policy.

The employer, at no cost to the employee.

Devices that isolate or remove a hazard — e.g., safety-engineered, self-sheathing needles.

Behaviors that reduce exposure — no recapping, hand hygiene, proper sharps disposal.

Accidental needlestick and exposure to bloodborne pathogens — it is prohibited by OSHA.

OSHA requires single-use of the needle-holder unit to prevent exposure.

Pre-analytical, analytical, and post-analytical.

An incident report plus follow-up under the exposure-control plan.

To prevent cross-contamination and transmission of infection.

Decline politely and check with your supervisor before acting outside your scope.

Replace the container before it overfills to prevent sticks; never force sharps in.

Certified Phlebotomy Technician — the National Healthcareer Association's phlebotomy certification.

OSHA requires annual review to reflect new safer devices and procedures.

It defines exactly which tasks a phlebotomist may perform at that site.

Disinfect cables, racks, and surfaces between patients per policy.

Employers require a national credential (NHA, NCCT, ASCP, AMT) for hiring and quality.

Full name and date of birth — verified against requisition and wristband (never the room number).

At the bedside, in the patient's presence, immediately after the draw.

The test order — patient, provider, tests requested, and timing — that starts every draw.

STAT = immediate; routine = standard; timed = drawn at a specific time (e.g., GTT, drug peak/trough).

Patients move between rooms; using it can lead to drawing the wrong patient.

Stop and resolve the discrepancy before drawing — never assume.

Consent given after the patient understands the procedure, its purpose, and risks.

Explicit verbal or written agreement — the usual basis for a routine venipuncture.

Consent inferred from behavior or circumstance — extending an arm, or an emergency.

A parent or legal guardian (the child may also give assent).

Respect the refusal, document it, and notify the nurse or provider.

No food or caloric drinks before the test; water is allowed.

Typically 8–12 hours (water allowed).

Non-fasting is now routine; fast only if ordered or for very high triglycerides.

Early-morning, rested, fasting condition — gives the most reproducible results.

Cortisol and serum iron both peak in the morning — draw early.

Fasting baseline draw, then a 75 g glucose load, then timed draws (2-hour value standard).

To gain cooperation and consent and reduce anxiety — a relaxed patient is easier to draw.

Use a qualified interpreter and verify identity and consent through them.

The correct tubes, volumes, and any special handling before approaching the patient.

Seated or reclined with the arm supported and extended downward.

To prevent injury if they faint (vasovagal syncope).

Establishing reproducible reference results (e.g., fasting metabolic panels).

Labeling away from the patient is a leading cause of mislabeled specimens.

Anxious, fasting, young, or previously-fainted patients — recline them.

A draw at a precise time around a medication dose to measure drug levels.

Have them state and spell their full name and date of birth against the requisition.

It captures the ordering provider, diagnosis codes, and insurance for charge capture.

Consent is the guardian's legal permission; assent is the child's agreement to cooperate.

Patient identity and the tests ordered match the patient you are about to draw.

Recent food falsely raises glucose and invalidates the result.

To choose non-latex gloves, tourniquet, and bandage and avoid an allergic reaction.

One that must be collected and tested immediately because of urgent clinical need.

Fasting reference tests like a basic metabolic panel and fasting glucose.

To guarantee the specimen is matched to the correct patient and prevent fatal mix-ups.

Verify the requisition and identify the patient with two identifiers.

The diagnosis code justifying the test for billing and medical necessity.

Errors cascade into mislabeled specimens and billing/result-matching problems.

Non-compliance (recent food, missed/taken meds) can invalidate the result.

Serum = liquid after blood clots (no fibrinogen). Plasma = liquid from anticoagulated blood (has fibrinogen).

Potassium, LDH, and AST (intracellular contents released from ruptured red cells).

Needle too small, forceful draw, shaking tubes, prolonged tourniquet, vigorous mixing.

Proper gauge, let alcohol dry, avoid probing, and invert tubes gently — never shake.

About 30 minutes at room temperature (about 60 minutes for a plain red tube).

About 2 hours of collection, to keep results accurate.

Spinning a tube to separate cells from serum or plasma.

Incomplete clotting leaves fibrin strands that interfere with the analyzer.

A measured portion poured off from the primary specimen, labeled to match it.

Ammonia, lactate, and blood gases (ABG) — and run quickly.

Bilirubin — collected in an amber tube or wrapped in foil.

Cold agglutinins and cryoglobulins — cooling makes them precipitate.

Patient name, ID, date of birth, and the date and time of collection.

Quantity Not Sufficient — too little specimen (or wrong ratio) to test; the sample is rejected.

Documented, tamper-evident, unbroken handling of a forensic or drug-screen specimen.

A result so abnormal it needs immediate provider notification.

Clotting releases potassium from platelets into the serum.

Cloudy, fatty-looking serum from high triglycerides (often non-fasting) that can interfere with testing.

Yellow serum caused by a high bilirubin level.

To preserve traceability to the correct patient and prevent mix-ups.

Blood with all cells and plasma still mixed, kept from clotting by an anticoagulant.

When it is hemolyzed, clotted, QNS, mislabeled, or otherwise compromised.

Too small a bore (too high a gauge) forces cells through and ruptures them.

Bilirubin breaks down in light, falsely lowering the result.

Complete clotting before centrifugation.

Immediate notification of the provider and documented read-back.

Ruptured red cells release intracellular potassium into the serum.

Reject and re-collect — clotting invalidates the CBC.

Cooling makes the agglutinins clump, invalidating the test; keep it at 37°C.

Faster turnaround — no clotting wait — for stat chemistry on a heparin tube.

Treat it as a critical value — notify the provider immediately.

The receiver repeats the value to confirm it was heard correctly — a patient-safety check.

Cells consume it (glycolysis), falsely lowering the result — use a gray fluoride tube.

After spinning, the gel forms a stable barrier between serum and cells.

High shear force as cells pass through the narrow lumen ruptures them.

Early spinning leaves fibrin that interferes with the analyzer.

A severely low POC glucose — notify the provider immediately as a critical value.

To keep every portion traceable to the correct patient and primary tube.

QC checks the instrument; a critical value is a dangerously abnormal patient result.

A tamper-evident seal proves the specimen was not altered in transit.

The Laboratory Information System records, tracks, and reports specimen and result data.

Serum is cell-free liquid after clotting; whole blood still contains all the cells.

Blood gas → EDTA FIRST → other additives → serum last (reversed from venipuncture).

Blood cultures. SPS also helps recover organisms.

A dermal puncture activates platelets fast; collect the cell count before clumping skews it.

To protect sterility and avoid false-positive contamination from skin flora.

Chlorhexidine or povidone-iodine (not plain alcohol).

Drawing too little blood — adequate volume is critical.

Two sets from two different sites.

A fingerstick or infant heelstick used to collect small-volume samples.

On the medial or lateral plantar (side) surface of the heel — never the center or arch.

To avoid hitting the calcaneus (bone) and causing osteomyelitis.

The first drop contains tissue fluid that would contaminate the sample.

Excessive squeezing hemolyzes the sample and adds tissue fluid.

It increases blood flow, improving yield.

A dried blood spot on filter paper from a heel stick, collected after the infant has fed.

Assists licensed staff — the phlebotomist does not access the line themselves.

A non-alcohol antiseptic (e.g., povidone-iodine) so it doesn't affect the result.

A documented chain of custody with tamper-evident seals.

Testing done at the bedside (glucose, Hgb/Hct, urine pregnancy) — run QC first.

Run quality control on the device to confirm it is working.

The 2-hour value is the standard for a glucose tolerance test.

Near LAST in venipuncture (carryover), but FIRST in capillary (platelet clumping).

It helps recover organisms in blood cultures (and inhibits some antibiotics/complement).

A timed series of draws after a challenge (e.g., glucose load) to assess the body's response.

CLSI GP42 — Collection of Capillary Blood Specimens.

A larger bore (lower gauge, e.g., 16–18 G) to protect red cells and speed collection.

Checking hemoglobin/hematocrit, weight, and a health-history questionnaire.

Skin flora carried into the bottle cause false-positive (contaminant) results.

A needle is for venipuncture; a lancet makes a shallow dermal (capillary) puncture.

To distinguish a true infection from a single-site contaminant.

The heel bone — avoided during an infant heel stick to prevent injury.

To prevent skin/environmental organisms from contaminating the culture.

A false positive from skin flora entering the bottle during collection.

Both are central venous catheters; a phlebotomist assists but does not access them independently.

Limited depth (about 2 mm or less) so it doesn't reach the heel bone.