Phlebotomy Practical Exams

What is blood classified as, and what are its two main components?

Blood is classified as connective tissue, composed of formed elements (cells) and plasma.

What are the three types of formed elements in blood?

Erythrocytes (red blood cells), leukocytes (white blood cells), and thrombocytes (platelets).

What percentage of blood is composed of formed elements, and what percentage is plasma?

Formed elements make up approximately 45%; plasma makes up approximately 55%.

What is plasma primarily composed of?

Approximately 90% water, with the remaining 10% being organic and inorganic substances like proteins, electrolytes, and glucose.

What is venipuncture?

The act of puncturing a vein for the removal of blood.

What substance is converted to fibrin during blood clotting?

Fibrinogen.

What is an anticoagulant, and what is its primary purpose in blood collection?

A substance added to blood to prevent clotting by inhibiting the activation of clotting factors.

What is the fluid portion of blood called when it is collected WITH an anticoagulant?

Plasma.

What is the fluid portion of blood called when it is collected WITHOUT an anticoagulant and allowed to clot?

Serum.

What is the key compositional difference between plasma and serum?

Plasma contains clotting factors; serum does not (they were used up in the clotting process).

What are the two main methods of venipuncture?

The syringe method and the evacuated tube/vacutainer method.

In evacuated tube systems, what force draws blood into the tube?

Vacuum action.

What is the relationship between needle gauge number and the bore size of the needle?

They are inversely related: a larger gauge number indicates a smaller bore; a smaller gauge number indicates a larger bore.

What is the most common use for a winged infusion set (butterfly needle)?

For patients with thin, fragile veins (e.g., elderly, infants, small children).

What is the most critical safety rule regarding needles after they have been used?

NEVER recap them; immediately activate the safety device.

What is the function of an adaptor (tube holder) in vacutainer systems?

It acts as a guide and support for the vacutainer tube, absorbing pressure during puncture and tube changes.

What device is used to safely transfer blood from a syringe to vacutainer tubes?

A blood transfer device (with a blunt needle and rubber sheath).

What are vacutainer tubes, and why are their stoppers color-coded?

Sterile tubes used as primary blood containers. The color indicates the type of additive or anticoagulant inside.

Why must blood collection tubes be drawn in a specific order?

To avoid cross-contamination of additives between tubes.

What is the primary purpose of applying a tourniquet during venipuncture?

To apply pressure to slow venous return, causing blood to pool and making veins easier to find and access.

What is the maximum recommended time a tourniquet should be left on a patient's arm?

One minute.

What adverse effect can occur if a tourniquet is left on for more than one minute?

Hemoconcentration (an increase in the concentration of cells and large molecules), which can affect test results.

How should a tourniquet typically be decontaminated between patients?

Using 70% isopropyl alcohol.

Where should a tourniquet be placed relative to the intended venipuncture site?

Approximately 8-10 cm (3-4 inches) above the site.

What should the patient NOT do to hold pressure gauze/cotton after needle removal?

Bend the arm at the elbow.

What is the most routinely used skin antiseptic for routine venipuncture?

70% isopropyl alcohol.

What type of skin disinfectant is used when testing for bacteremia or sepsis?

Iodine or chlorhexidine gluconate (to sterilize the skin).

After applying a skin decontaminant, what must you wait for before proceeding?

For it to air dry completely.

What is the main difference in the collection method for capillary blood gases compared to standard venipuncture?

Blood is collected via a lancet into anticoagulated glass capillary tubes using capillary action, not a needle into a vein.

What is a key practice for appearing professional and calming a patient before venipuncture?

Assembling all equipment (tubes, swabs, tourniquet, etc.) and appearing calm and organized before beginning the procedure.

What is the primary role of a phlebotomist in terms of patient interaction?

To be the main point of contact between the patient and the laboratory, focusing on positive customer relations.

What five fundamental factors contribute to differences among people, affecting their approach to healthcare?

Nationality, ethnicity, family background, life experiences, and individual challenges.

What must a phlebotomist be to provide appropriate care to diverse patients?

Compassionate, empathetic, and culturally aware.

What is an integral part of working in healthcare, guided by policies to safeguard patients?

Ethical behavior and decision-making.

What are all patients entitled to in any healthcare setting?

Rights, which must be upheld by every healthcare professional.

What is the term for the ethical and legal duty to protect private patient information?

Confidentiality.

With whom may sensitive patient information be shared?

Only with healthcare professionals directly involved in the patient's care.

According to the Healthcare Consent Act, what are the four required elements for valid consent to treatment?

1. The consent must relate to the treatment. 2. The consent must be informed. 3. The consent must be given voluntarily. 4. The consent must not be obtained through misrepresentation or fraud.

For consent to be "informed," what must a patient receive before giving it?

The information that a reasonable person in the same circumstances would require to make a decision, and responses to any requests for additional information.

What six specific matters must be addressed to provide the information required for informed consent?

1. The nature of the treatment. 2. The expected benefits. 3. The material risks. 4. The material side effects. 5. Alternative courses of action. 6. The likely consequences of not having the treatment.

What are the two main forms that consent to treatment can take?

Express consent or implied consent.

What is express consent, and when is it typically required?

Consent that is clearly and unmistakably stated, either verbally or in writing. It is required for surgeries, genetic testing, experimental drugs, and high-risk procedures.

What is implied consent, and how is it typically demonstrated?

Consent that is inferred from a patient's actions or the circumstances (e.g., offering an arm for venipuncture). It is often adequate in emergent situations.

Who must provide consent for a medical procedure involving a minor?

The parent or legal guardian.

What is a patient's right regarding consent after it has been given?

They have the right to withdraw consent at any time.

What must happen immediately if a patient withdraws consent during a procedure?

The procedure must stop to honor the patient's wishes.

What is the consequence for a phlebotomist who begins a procedure without first obtaining consent?

It can result in legal action and/or termination.

When must consent be obtained relative to the phlebotomy procedure?

PRIOR to beginning the procedure.

What are the first three pieces of information you should provide when introducing yourself to obtain consent?

1. Who you are. 2. What department you work in. 3. The purpose of your presence.

What are the final three pieces of information you should provide when obtaining consent for a procedure?

4. The procedure you want to perform. 5. Pertinent information about the procedure. 6. A request for consent.

What is the purpose of an anticoagulant in a blood collection tube?

To prevent the blood from clotting by inhibiting the activation of clotting factors.

What are the six most common types of anticoagulants listed?

EDTA, Citrates, Heparin, Oxalates, Fluorides, and SPS.

How are blood collection tubes easily identified by their contents?

They are color-coded according to the anticoagulant or additive present.

Why is a specific "order of draw" required when collecting multiple tubes?

To prevent anticoagulant carryover from one tube to the next, which could contaminate samples and affect lab results.

In the general order of draw, what type of tube is drawn first and why?

Microbiology blood culture tubes are drawn first because they require a sterile site, and the first tube is considered the most sterile.

In the general order of draw, what type of tube is drawn after blood cultures?

Non-anticoagulant tubes (e.g., red stopper serum tubes).

What are the main causes of laboratory errors, misdiagnosis, and fatal transfusion errors according to the text?

Clerical errors.

What document is required before performing a venipuncture on a patient?

A request form or requisition.

What five pieces of information must a requisition contain?

1. Patient's first and last name. 2. ID number. 3. Date of birth. 4. Doctor's name. 5. Tests ordered.

What three items must match exactly before drawing blood?

The patient's verbal response, the requisition, and the patient's armband.

When must a blood sample be labeled?

Immediately following collection.

Should tubes be pre-labeled before drawing blood?

No.

What is the minimum number of patient identifiers required on a sample label?

Two.

What is an example of two acceptable patient identifiers?

Full name and date of birth, OR full name and patient ID number.

What is the policy for specimens that are unlabeled or incorrectly labeled?

They must be discarded/rejected.

What is an accession number?

A unique identifier applied to a specific test request or sample when it is entered into the computer system.

Is an accession number considered an appropriate patient identifier?

No. It identifies the sample, not the patient.

In the described accessioning procedure, how is a new accession number generated?

By adding 1 to the accession number of the previously logged sample.

After accessioning, what should you consult to determine how to store a sample?

A test directory for the appropriate storage temperature.

What safety precaution must be taken when removing caps from tubes, for example, during aliquoting?

Caps must be removed behind a sample shield or inside a biological safety cabinet.

If a test ordered on a requisition was not successfully collected, how should it be logged?

It should still be accessioned in the logbook, but with a note indicating the sample was not obtained and the orders will be cancelled.

What is micro collection in phlebotomy?

Collecting small quantities of blood, one drop at a time, via an incision in the capillary bed.

What device is used to make the incision for a micro collection?

A sterile, disposable lancet device.

On what two sites can micro collections typically be performed?

Fingers (for adults/older children) and the heel (for infants).

What is the general rule of thumb for heel sticks regarding a baby's mobility?

If the baby is walking, the heel skin may be too thick; the big toe is then preferred.

For adults and older children, which fingers are the preferred sites for a fingerpick?

The ring and middle fingers of either hand.

Why is capillary blood considered a mixture?

It contains venous and arterial blood, as well as interstitial and intracellular fluid.

Why is it critical to document that a sample was a capillary draw?

Because some test reference ranges (e.g., for glucose, potassium) differ from those for venous blood.

Give an example of an analyte that is normally higher in capillary blood compared to venous blood.

Glucose.

Name three tests for which capillary collection (finger/heel stick) is typically UNACCEPTABLE.

Erythrocyte Sedimentation Rate (ESR), coagulation studies, and blood cultures.

What are the small containers used to collect blood drops during micro collection called?

Microtubes.

What is the primary risk that dictates the order of draw for micro collections (different from venipuncture)?

The risk of clotting due to thromboplastin release from tissue puncture.

In micro collection order of draw, which type of tube is filled first?

Blood gas tubes.

In micro collection order of draw, which type of tube is filled last?

Serum tubes.

Why is capillary blood the preferred specimen for newborn screens?

Because infants have a small total blood volume, making large venous draws dangerous.

When is the newborn screen typically collected?

24 hours after delivery.

What is the medical term for the condition that causes excess bilirubin in newborns, making them appear jaundiced?

Hemolytic Disease of the Newborn (HDN).

What is the first step in the micro collection procedure after patient identification and consent?

Position the patient appropriately (arm supported for finger, foot lower than torso for heel).

Why is warming the puncture site recommended before a micro collection?

It increases blood flow up to sevenfold, allowing for faster collection and reducing clotting risk/tissue fluid contamination.

What antiseptic is used to clean the site for a micro collection?

70% isopropanol (isopropyl alcohol).

What must you do after applying the antiseptic and before making the puncture?

Allow it to air dry.

What should you do with the first drop of blood that forms after the puncture?

Wipe it away with gauze, as it is heavily contaminated with tissue fluid.

Why is it good practice to relax your grip on the finger or heel between collecting drops?

To allow the capillary bed to refill with blood.

What should you do with the site once collection is complete?

Apply gauze, apply pressure, and elevate the site.

What is the final step after labeling samples and before applying a bandage?

Check the site to ensure bleeding has stopped.

Blood culture → Colour, additives, uses?

• yellow top bottle

• Sodium polyanethol sulfonate (SPS)

• Microbiology blood cultures

Sodium citrate → Colour, additives, uses?

• light blue top tube

• sodium citrate

• coagulation studies (e.g., INR)

Non-anticoagulent → Colour, additives, uses?

• red top tube

• no additives

• electrolytes, chemistry, serology, hormones

Serum separator tube (SST) → Colour, additives, uses?

• gold top tube

• serum separator gel

• electrolytes, chemistry, serology, hormones

Heparin → Colour, additives, uses?

• green top tube

• lithium (or sodium) heparin & plasma separator gel

• electrolytes, Chemistry hormones, gases, ammonia, osmotic tests