Phlebotomy test

Yellow Tube: Sterile, Additive:

 (SPS) Sodium Polyanethol sulfate

Yellow Tube used for

blood cultures, paternity testing, DNA and tissue typing & organ donation.

Aerobic blood culture:

There IS air in this bottle

Anaerobic blood culture

There is NO air in this bottle 

directions for yellow top

* Scrub top of Aerobic/Anaerobic bottles with alcohol for 60 sec. 


* If you have to fill a yellow vacucontainer for the Anerobic/Anaerobic bottles. You would use a syringe to draw out the blood from the yellow tube, then insert the needle into the Anaerobic or Aerobic bottle but DO NOT push plunger. Allow the bottles vacuum to retrieve the blood. 

Light Blue Tube:  Additive:

Sodium Citrate

Light Blue Tube used for

used for PT, Special factor assays, hemostasis, coagulation studies. 

there is NO yellow tube first, but Blue is first

fill a red tube before the blue. Blue can NEVER come first!

SST (Serum separation Tubes) colors

mottled top, speckled top and gold. 

SST (Serum separation Tubes) use for

 PSA, Lipid panel, Thyroid, FSH, PSA, magnesium, **Chemistry** 

SST (Serum separation Tubes) special instructions

Takes 30 min to clot

RST (Rapid Serum Tubes) colors

orange, grey/yellow top

RST (Rapid Serum Tubes) special instructions

5 min to clot (Thrombin)

Green Tube: Additive:

HEPARIN (sodium heparin, ammonia heparin, lithium heparin. 

Green Tube affects

Sodium & potassium

green tube used for

Test for electrolytes, BMP, CMP, chromosome, erythrocytes, **Chemistry**

Purple Tube: Additive

(EDTA)

purple top tests

CBC, ALC, Dermal sample, Hematology, ESR, RBC, HGB, Prenatal profile, erythrocytes, sedimentation rate testing.

what tubes are used for blood smears?

purple top

direction for blood smear

* Blood smears should look feather like on the slide. 


* Blood smears: use 1 mm drop of blood, place blood on ½ edge from the side of the slide.

Pink Tube: Additive

(EDTA) blood collection 

Grey Tube: Additive:

Sodium Fluoride

Grey Tube: special instructions

On ice or ice slurry

Grey Tube tests

Glucose test, Lactide acid and antiglycolyitic 

Why is order of draw so important?

Because if you mix the additives up it could result in a false, wrong test results. Never cross contaminate additives.

Universal Donor:

O

Universal Recipient:

AB

 If you accidentally stick yourself with a needle, what do you do first?

Rinse area for a minimal of 15 minutes.

A patient has Cutaneous Diphtheria (infectious Skin ulcers) what PPE would you wear?

**Gown,** Contact precaution

A patient has Pneumonia what PPE would you wear?

 __**Mask**____, Droplet precaution__  

A patient has Scabies what PPE would you wear?

__Gown or gloves. This is a Contact Precaution__ 

A patient has TB (Tuberculosis) what PPE would you wear?

__**N95 Mask**__ __Airborne precaution__ 

A phlebotomy tech finishes performing blood draw in a isolation room. Which of the following PPE should be removed first?

__Gloves__

When testing a patient for streptococcal pharyngitis (Strep) a technician should implement which of the following transmission-based precautions?

**Droplet**

There are 3 phases when caring for a patient as a phlebotomist.

* PreExamination phase


* Exam Phase
* PostExamination phase

As a phlebotomist you’re needing to input the results of a lab test. Which phase is this?

The Exam Phase

When performing a blood culture collection, the technician should?

Scrub the site with isopropyl alcohol for 30 seconds using a back-and-forth motion. 

**OSHA**:

Works with the hospital to give safety and environment guidelines.

Per OSHA:

* When dealing with blood, gloves should be worn at all times. 


* Every employee should be offered a FREE Hep B shot/vaccine. 
* Safety devices on needles are recommended. 
* Replace sharps container when it is 2/3rd full

**Joint Commission**:

* Ensure quality healthcare for patients, prevent harm, and improve patient advocacy.


* ID patients correctly. Must have at least 2 identifiers.

CLIA:

**(Clinical Laboratory Improvement amendments)** 

**CLIA: (Clinical Laboratory Improvement amendments)** 

* **Ensures the technician is proficient at job duties and responsibilities.** 


* **External liquid controls for quality control on a CLIA waived point of care test should be performed with a NEW lot number or kit is opened.**

red=

fire

\
 Yellow

instability

blue

health

white

special

A chlorine bleach

A technician should use a 1:10 solution of bleach and water to clean a biohazard spill

Hemoconcentration:

 increased concentration of cells and solids in the blood usually resulting from loss of fluid to the tissues. __**Know:  Leaving a tourniquet on too long results in this**__.

Hemolysis:

The rupture or destruction of red blood cells. Know: When applying alcohol wipe to a patients arm you must allow it to dry. __**If you stick a patient before alcohol dries it causes the destruction of RBC (red blood cells)**__

Implied consent:

Example: A patient starts rolling up their sleeve for a blood draw without signing anything.

Informed Consent:

Patient signed a consent form

Emergency action:

**During an emergency situation, medical staff assume: Implied consent**

Hospital: (In-patient) Requires

2 patient identifiers. 1. Verbal name, 2. Check wrist band matches

Outpatient setting: requires

Verbal name and patient ID

 needle for blood donation

18 gauge

**angle of insertion** 

15-30 degree

**needle for all other laboratory**

21,22,23-gauge

Geriatric patient (older pt.) with fragile veins:

**You’d use a butterfly needle. Dorsal vein is best/ warm hand w/ bag over it.** 

needle for blood donation

16-gauge

During a patient’s blood donation and the blood STOPs You need to

dispose of the half full bag and get a new bag hung. 

You must ask a patient their …before blood donation

complete medical history

A patient with a pulse rate… **cannot** donate blood

> 100

Urine specimen for pregnancy test:

 **Get specimen 1st thing in the morning. HCG levels are at their highest.** 

Random urine test can be done

**with or without fasting**

Clean Catch Urine:

 **Instruction the patient to clean the labia with antiseptic mild soap, have them void (pee) into the toilet a little first then into the cup.** 

Fasting Glucose test:

 **Patient must fast (no food) for 12 hrs then you’ll test the urine every 1-2 hours.** 

Postprandial test:

**Have the patient void (pee) then they can eat.** 

Urine test with the use of medication:

**The urine is collected 2 hours after the medication is taken.** 

24-hour urine test:

**The patient will need to void in the toilet a little first, then fill up the entire 3-4 liter container with urine for 24 hours.** 

Drug Screen

**Temperature of urine needs to be checked, 90-100 degrees F-32-37 degrees C), Patient CANNOT flush the toilet, Chain of custody is important….you need identity of everyone who had possession of the specimen,  this test has a case number associated with it.** 

Buccal Test: (cheek swab)

test for things like DNA testing

Throat swabs:

Swab inflamed area around the tonsils, test for things like strep.

Sputum test:

This is done in the morning. Instruction patient nothing to eat or drink (NPO) have the patient take a deep breath in and spit THICK secretions in a container. 

Fecal test:

Tests for Bacterial infections and Parasites. DO NOT mix occult blood or urine in the fecal matter. 

Semin Test:

Patient cannot ejaculate for 2-7 days; The specimen needs to be brought into the lab within 2 hours at a temp of 36-38 degrees C/ 98.6 degrees F. Do NOT refrigerate and protect from light. It’s photosensitive. 

Neonatal testing is done

24-72 hours after born. 

newborn Blood is being tested for

Cystic fibrosis, hypothyroid, PKU (phenylketonuria) & galactosemia. 

newborn Screening card/ Blood spot collection:

Let blood dry for 4 hours. If running the same test on multiple babies, DO NOT stack the cards on top of each other. Keep away from heat, make sure the entire circle is full. Filter side of paper.

Lancet depth for a baby is:

2mm

Heel sticks are for babies 1 years old and younger: Always stick the

 **Medial lateral** part of the heel. 

Maximum level of blood to take from an infant is

1 percent

Example: Baby weights 3kg(6lbs)

3ml

what to use if patient is allergic to alcohol

 Chlorhexidine

A patient with a double mastectomy

draw from the oldest one

A patient has an IV running on the left arm and mastectomy on the RT arm:

 You would ask the nurse to shut off the IV and you would draw under the IV site. 

If a patient has a shunt placed in their arm:

Always AVOID IT

A patient just got done running.

 Give them 15 min to cool down before you draw blood, same for a patient who just had their blood pressure taken.

A patient tells you that they have a history of fainting during blood draw:

have them recline in a sims fowlers position

A patient tells you that they feel like they are going to faint:

You stop your draw, have the patient put their head between their knees. 

A patient that reports having nausea: Is experiencing light headiness Seizures:

 Involuntary movement

When a patient is in Shock

 Keep airways open, control bleeding and keep pt warm.

If a patient is convulsing:

 Lay them down

If a patient is vomiting:

Lay them on their side and apply cool compress 

When getting a requisition from a doctor for a blood draw:

Always make sure you only have 1 requisition form. 

Obese patients:

Median Cephalic is the easier vein to locate 

Syringe:

Only use for fragile and collapsed veins

Lancet:

Use on infants or diabetes finger sticks

Butterfly:

small veins

Syncope

Means to pass out or faint: it’s proceeded by dizziness 

How to access a patient for a capillary draw?

Perpendicular from fingertip