Phlebotomy Class

hemochromatosis

is a medical condition in which your body absorbs too much iron in the blood

polycythemia vera

is a rase, chronic disorder in which your bone marrow makes too many erythrocytes (rbcs) in the blood

Common Job Titles

• Certified Phlebotomy Technician (CPT)

• Patient Service Technician (PST)

• Laboratory Technician / Phlebotomy Tech

Patient Identification & Labeling

(e.g., full name + DOB or MRN).

 Order of Draw (Vacutainer System)

You Like Really Good Looking Guys Yeah Right

Negligence

Failure to follow the standard of care, leading to patient injury.

Informed Consent

Patient voluntarily agrees to a procedure after understanding risks, benefits, and alternatives.

1. Sites to Avoid for Venipuncture

• Scars

• Burns

• Hematomas

• (Also avoid the arm on the side of a mastectomy)

2. Preferred Veins for Venipuncture

• Median cubital vein (most commonly used)

• Cephalic vein

• Basilic vein

Coagulation

is the process of blood clotting, which helps prevent excessive bleeding.

5. Proper Needle Insertion Angle

The correct angle for needle insertion into a vein is 15–30 degrees.

Syncope

is another word for fainting. Always monitor patients who appear light-headed or dizzy.

Edema

Edema is the accumulation of fluid in body tissues, causing swelling.

8. Dealing with Rolling Veins

To stabilize a rolling vein, anchor the vein below the puncture site by pulling the skin taut.

10. Hemoconcentration

occurs when plasma volume decreases, leading to an increased concentration of red blood cells.
Cause: Leaving the tourniquet on for longer than one minute.

Hemolysis

rupture of red blood cells, releasing hemoglobin into the blood plasma. It can lead to inaccurate lab results.

12. Best Vein for Obese Patients

In obese patients, the cephalic vein in the antecubital fossa is often the easiest to locate and use for blood collection.

13. Correct Order of Removing Equipment

Untie the tourniquet → Remove the tube → Withdraw the needle.

14. Tourniquet Placement

Apply the tourniquet 3 to 4 inches above the venipuncture site.

15. IV and Mastectomy Protocol

• A mastectomy on the left side
  You must:

• Ask a nurse to pause the IV for at least 2 minutes

• Draw blood below the IV site
  Never draw above an active IV line to avoid dilution with IV fluids.

Definition of Assault

In healthcare, assault means the willful attempt or threat to harm or injure someone. Even without physical contact, a credible threat can be considered assault.

Fingerstick Site Selection

The proper site for a fingerstick is the 3rd and 4th fingers 

of the non-dominant hand, avoiding the thumb

and index finger

 due to nerve and tendon proximity.

When collecting blood for coagulation (e.g., light blue top tubes) with a butterfly needle:

Always use a discard tube first 

to prime the tubing and avoid underfilling.

Ensure the light blue tube is filled completely

to maintain the proper blood-to-additive rati

Post-Venipuncture Care

Do not have patients bend their arm after venipuncture — this can cause bruising or a hematoma

-apply pressure and keep arm straight

Capillary Puncture Order of Draw

Lavender (EDTA) 

 Green or other anticoagulants 

Serum tubes 

Composition of Whole Blood

55% plasma
 45% formed elements (RBCs, WBCs, platelets)

Erythrocytes (Red Blood Cells)

Carry oxygen using hemoglobin

Live about 120 days 

Produced in bone marrow 

Thrombocytes (platelets)

Aid in blood clotting 
Essential for hemostasis 

Leukocytes (White Blood Cells)

Fight infections and foreign substances 

Five types:

• Neutrophils

• Lymphocytes

• Monocytes

• Eosinophils

• Basophils

Serum

from clotted blood (no clotting factors remain)

Plasma

from unclotted blood and still contains clotting factors

Newborn Screening (PKU Test)

PKU is a California state-mandated test

for inborn errors of metabolism in newborn

Hemostasis

Refers to the stoppage of bleeding, a crucial step in the healing process .

EMR

A digital version of a patient's chart

used for managing medical data efficiently

.

SST Tubes

 Gold top
 Tiger top

Serum/Plasma Color

Normal appearance: Pale yellow, clear — not cloudy or hemolyzed .

Clotting and Tubes

n serum tubes, clotting factors are used up to form the clot.
Most laboratory tubes contain anticoagulants to prevent clotting (except serum tubes)

Monitoring Anticoagulant Medications

For patients on Warfarin or Coumadin, lab tests such as PT and PTT are used to monitor coagulation .

Lab Test Requisition Requirement

Patient’s full name

 Date of birth

 Address and phone number

 Diagnoses (Dx codes)

 Lab tests ordered

 Ordering provider's information

Heel Warming for Infants

When warming a baby’s heel, do not exceed 40°C (104°F

STAT Orders

Indicates that the test must be performed immediately 

— often for emergency or urgent clinical decisions

CLS (Clinical Laboratory Scientist)

Highly trained professionals who perform complex tests and analyze the results, often requiring advanced education and certification.

MLT (Medical Laboratory Technician)

These technicians assist in performing routine lab tests under the supervision of a Clinical Laboratory Scientist or Pathologist.

CPT (Certified Phlebotomy Technician)

• Responsible for drawing blood from patients, labeling specimens, and ensuring proper handling for testing

RN (Registered Nurse)

While RNs are essential healthcare providers, they do not typically work in the lab. Instead, they focus on patient care in clinical settings

Timing

 The time of day a sample is collected can influence test results, especially for time-sensitive tests like Therapeutic Drug Monitoring (TDM).

Stability

Some specimens degrade quickly if not handled properly, so timely processing is crucial.

Fasting

Tests like glucose and lipid panels often require the patient to fast before sample collection, as food intake can alter the results.

CBC (Complete Blood Count

• Evaluates the overall health of blood components, including red blood cells, white blood cells, and platelets. Used to diagnose anemia, infection, and more.

Hemoglobin A1C

Measures average blood sugar over the past 4–6 weeks, crucial for monitoring diabetes management.

Hypoglycemia

Low blood sugar levels; can cause dizziness, confusion, or loss of consciousness if untreated

Hyperglycemia

• High blood sugar levels; associated with diabetes and can lead to complications like diabetic ketoacidosis if untreated.

Peaks

Highest concentration of a drug in the bloodstream after administration.

Troughs

Lowest concentration just before the next dose. Monitoring ensures levels stay therapeutic without causing toxicity.

Hemolysis and Its Effects

Hemolysis is the destruction of red blood cells, releasing hemoglobin into plasma. This can interfere with tests, especially potassium levels. Handle blood samples gently to avoid hemolysis.

Protecting Light-Sensitive Tests: Bilirubin

Bilirubin tests require light protection to prevent degradation: wrap tubes in foil or use amber-colored tubes.

Specimen Integrity

ensures samples are suitable for accurate testing. Proper handling, storage, and timing prevent inaccurate diagnoses.

Fomite: A Potential Source of Infection

A fomite is an inanimate object (door handle, medical equipment, pen) that can carry infectious organisms. Sanitization prevents infection spread.

Purposes of Laboratory Tests

• Monitoring Medications

• Identifying Infections

• Diagnosing Diseases or Illnesse

TDM (Therapeutic Drug Monitoring)

Measures blood medication levels; timing is critical.

TDM (Therapeutic Drug Monitoring

• Measures blood medication levels; timing is critical.

GTT (Glucose Tolerance Test)

Diagnoses diabetes by measuring glucose processing over time. Fasting is usually required.

Pathologist

The most educated in the lab

A medical doctor (MD or DO) specializing in diagnosing disease through tissues, cells, and fluids. Holds advanced training in pathology.

Blood Alcohol Content (BAC)

Avoid alcohol-based antiseptics when drawing BAC blood; use soap & water if allergic. Collect in a gray top tube.

Hemoglobin A1C

Average Blood Sugar Test

Measures average glucose over 4–6 weeks; important for diabetes management and treatment adjustments.

Serum glucose

red top, tiger top, or gold top tube

Plasma glucose

gray top tube preferred (contains anticoagulant/preservative)

Nothing by Mouth

Patient should not eat or drink before certain tests or procedures.

Lipid Panel Processing

Measures cholesterol and triglycerides in Chemistry Department. Fasting is required for accuracy.

GTT: Diagnosing Diabetes

Multiple blood draws after glucose consumption to measure the body’s response.

Specimen Separation Time

Separate serum/plasma from cells quickly (within 2 hours) to avoid inaccurate results.

Personal Protective Equipment (PPE)

Treat all patients as potentially infectious.

Standard Precautions

Use barrier protection, proper hand hygiene, and PPE

Common Hazards in the Lab:

blood, chemicals, radioactive materials, other bodily fluids

Engineering Controls

safety needles, sharps containers, biohazard symbols, biohazard bags

Universal Precautions

Treat all blood and body fluids as if they are infectious.

Standard Precautions:

Safety practices used in all healthcare settings, including wearing PPE, hand hygiene , and disinfecting work surfaces

Chain of Infection

1. infectious agent

2. reservoir

3. portal of exit

4. mode of transmission

5. portal of entry

6. susceptible host

NFPA Label Color Coding: Blue

Health Hazard

NFPA Label Color Coding: Red

Fire Hazard

NFPA Label Color Coding: Yellow

Reactivity

NFPA Label Color Coding: White

Special Indication

PPE

gloves, lab coat, face shield,

Contact Isolation

gloves and gown

Respiratory Isolation

gown, gloves, and N95 mask

Reserve Isolation

for patients with weakened immune system, chemo or transplant

Biliruben

must be protected from light

TDM (Therapeutic Drug Monitoring)

measuring drug levels

GTT (Glucose Tolerance Test)

Diagnoses diabetes, time-sensitive

Serum/ Plasma

should be seperated from 2 cells within 2 hours

Diurnal Variation

Natural changes in the body throughout the day (e.g., cortisol levels )

Lymphatic System 

• Composed of fluid-filled vessels and lymphatic tissue.

• Functions in immune response and fluid balance.

Cardiovascular System

• Includes the heart and blood vessels.

• Transports oxygen, nutrients, and waste products throughout the body. 🚚💨

Integumentary System

• Consists of skin, hair, and nails.

• Acts as a barrier and helps regulate body temperature

Arteries

Carry oxygenated blood away from the heart and have a pulse

Veins

Return blood to the heart (usually deoxygenate

Capillaries

Tiny vessels where gas and nutrient exchange occurs

Leukocytes (WBCs

Fight infection

Thrombocytes (Platelets

Aid in clotting

Erythrocytes (RBCs)

Transport oxygen