Phlebotomy Exam Review

Vocabulary flashcards covering key phlebotomy terms, equipment, procedures, safety regulations, specimen handling, and patient care concepts likely to appear on an exam.

Median Cubital Vein

First-choice vein for routine venipuncture due to its size, stability, and low risk of complications.

Petechiae

Tiny red spots that appear below a tourniquet, indicating capillary bleeding or platelet issues.

Hemolysis

Destruction of red blood cells, often caused by vigorous tube shaking, small needles, or alcohol not drying.

Sodium Citrate

Anticoagulant in light-blue tubes used for coagulation tests such as PT and PTT.

EDTA

Anticoagulant in lavender (and pink) tubes that preserves cellular components for CBCs and blood bank tests.

Sodium Fluoride

Additive in gray tubes that inhibits glycolysis to preserve glucose levels.

Heparin

Anticoagulant in green tubes that inhibits thrombin; used for chemistry tests and ABGs.

Silica

Clot activator in SST (gold/tiger-top) tubes that speeds serum formation.

Lavender-Top Tube

Contains EDTA; collected first for dermal samples and used for CBC, ESR, HgbA1c.

Light Blue-Top Tube

Contains sodium citrate; must be filled completely for coagulation studies.

Green-Top Tube

Contains heparin; used for plasma chemistry tests and STAT chemistries.

Gray-Top Tube

Contains sodium fluoride/potassium oxalate; used for glucose, lactic acid, blood alcohol.

Speckled / SST Tube

Serum-separator tube with clot activator and gel; used for most routine chemistry panels.

Amber/Brown Biohazard Bag

Light-protective transport bag required for photosensitive specimens (e.g., bilirubin, vitamin B6).

Winged Infusion Set (Butterfly)

Small-gauge device with flexible ‘wings’; ideal for small, rolling, or fragile veins and hand draws.

Point-of-Care Testing (POCT)

Bedside or near-patient testing such as glucose, cholesterol, or pregnancy kits.

Quality Control

Routine checks (e.g., daily glucometer controls) ensuring instruments give accurate results.

Chain of Custody

Documented tracking of a specimen from collection to disposal; required for drug screens, BAC, paternity tests.

HIPAA

Federal law protecting patient privacy and governing release of health information.

OSHA

Agency that sets standards for occupational safety, including sharps disposal and PPE use.

CLSI Order of Draw

Recommended tube sequence: blood cultures → light blue → SST/gold → green → lavender → gray.

CLIA-Waived Test

Simple, low-risk test (e.g., rapid strep, glucose) allowed in non-complex labs with minimal training.

Implied Consent

Permission inferred by patient actions, such as extending an arm for venipuncture.

Expressed Consent

Specific verbal or written permission for a procedure, required for high-risk tests.

Assault (Legal)

Threatening a patient with unwanted procedures or restraints, creating fear of harm.

Syncope

Fainting; signaled by pallor or dizziness during blood draw—requires patient safety measures.

Hematoma

Blood pooling under skin from vein leakage; stop draw, release tourniquet, and apply pressure.

Nerve Injury

Sharp, tingling pain radiating down limb during draw; withdraw needle immediately.

Iatrogenic Anemia

Anemia caused by excessive phlebotomy, especially in neonates or ICU patients.

Autologous Donation

Patient donates own blood ahead of planned surgery for later transfusion.

Therapeutic Phlebotomy

Removal of blood to treat conditions such as polycythemia vera or hemochromatosis.

Trough Level

Lowest concentration of a drug; blood drawn within 15 min before next dose.

Peak Level

Highest drug concentration; timing depends on route (e.g., 2 h after oral dose).

Basal State

Patient’s rest-and-fasting condition (typically 12 h fast, early morning) for accurate results.

Clean-Catch Urine

Midstream specimen collected after cleansing to reduce contamination; used for C&S.

Midstream Urine

Urine collected after initial flow is discarded; minimizes urethral contaminants.

Sputum Specimen

Deep cough sample collected in sterile cup, often early morning, for cultures or TB testing.

PKU Test

Newborn heel-stick screening for phenylketonuria and other inborn errors; blood saturates filter paper.

Newborn Screening Card

Filter paper card requiring full saturation on printed side; transported dry for metabolic testing.

Blood Culture

Test to detect bacteremia; collected in aerobic and anaerobic bottles with stringent skin antisepsis.

Aerobic Bottle

Blood-culture vial containing oxygen to grow organisms requiring O₂.

Anaerobic Bottle

Blood-culture vial without oxygen for anaerobes; filled first when using syringe method.

Sodium Polyanethol Sulfonate (SPS)

Anticoagulant and preservative in yellow blood-culture tubes.

Aseptic Technique

Practices like hand hygiene and sterile field maintenance to prevent contamination.

Airborne Precautions

Isolation measures (e.g., N95 respirator, negative-pressure room) for TB, measles, varicella.

Droplet Precautions

Mask and eye protection for infections spread by large droplets (e.g., influenza).

Contact Precautions

Gloves and gown required for pathogens spread by direct contact, such as C. difficile or scabies.

N95 Respirator

NIOSH-approved mask that filters ≥95 % of airborne particles; worn for TB patients.

Safety Data Sheet (SDS)

Document providing chemical details, hazards, and spill clean-up instructions.

Tourniquet

Device applied 3-4 in above site; limit application to ≤60 s to prevent hemoconcentration.

Sharps Container

Puncture-resistant, closable biohazard bin; replace at two-thirds full.

Accession Number

Unique lab identifier assigned to each specimen upon arrival.

Reagent Strip

POCT dipstick that screens urine for multiple analytes (glucose, protein, ketones, etc.).

Bilirubin Specimen Handling

Protect from light by wrapping tube in foil or using amber bag to prevent degradation.

Ammonia Specimen Handling

Collect in green tube and immediately place in ice-water slurry; transport on ice.

Lactic Acid Specimen Handling

Collect in gray tube; keep in ice bath or freeze if sent to reference lab.

Arterial Blood Gas (ABG)

Arterial sample kept on ice and analyzed quickly for pH, O₂, CO₂ levels.

Ice-Water Slurry Transport

Method of placing tubes in crushed ice and water mixture to maintain 0–4 °C.

Maximum Tourniquet Time

Do not exceed 1 minute to avoid hemoconcentration and hemolysis.

Tube Inversion Technique

Gently invert tubes 4–10 times in a figure-eight motion to mix additives without hemolysis.

Order of Draw Mnemonic

Boys Love Roses; Girls Like Guys. (Blood cultures, Light blue, Red/SST, Green, Lavender, Gray).

18-Gauge Needle

Large-bore needle commonly used for blood donation to reduce hemolysis.

23-Gauge Needle

Small butterfly needle used with 5 mL syringe for difficult or pediatric veins.

Butterfly & Syringe Method

Preferred technique for fragile, easy-to-collapse veins in elderly patients.

Daily Glucometer QC

Quality control test performed each day the meter is used to verify accuracy.

External Liquid Controls

Control solutions run when opening a new POCT kit or lot number to ensure validity.

Phenylketonuria (PKU)

Inherited disorder screened in newborns; untreated leads to intellectual disability.

Mycobacterium tuberculosis

Airborne pathogen requiring N95 mask and negative-pressure room.

Clostridium difficile

Contact-precaution pathogen causing severe diarrhea; wear gown and gloves.

Needlestick First Aid

Immediately wash site with soap and water, then report and initiate exposure protocol.

Post-Syncope Position

Have patient lower head between knees or lie recumbent until symptoms resolve.

Feathered Edge (Smear)

Thin, even tail of blood smear indicating proper slide preparation for differential.

Figure-Eight Inversion

Motion used to mix blood with additives gently without foam or hemolysis.

Dorsal Hand Veins

Alternative site for venipuncture when antecubital veins are inaccessible.

Semen Transport Temperature

Maintain 36–38 °C (body temperature) and deliver within 1–2 h for analysis.

Vitamin B6 Specimen

Light-sensitive test that must be transported in an amber bag or foil-wrapped.

Light-Sensitive Specimens

Analytes like bilirubin, carotene, vitamin B2/B6 that degrade in bright light.

Blood Spot Saturation

Each circle on filter paper must be fully soaked through for newborn screening.

Warm Towel Vein Technique

Place warmed towel in plastic bag for 3-5 min to dilate veins before draw.

Arm Dangle Method

Have patient hang arm 1–2 min to increase blood flow when no vein is visible.

Heel Puncture Sites

Medial or lateral plantar surface; avoids bone and nerve damage in infants.

1:10 Bleach Solution

Standard disinfectant ratio for cleaning blood spills on surfaces.

Nitrile Gloves

Latex-free gloves offering barrier protection with minimal allergy risk.

Downward Single Swipe

Technique for antiseptic application on venipuncture site using one firm downward motion.

Povidone-Iodine Potassium Impact

Iodine can falsely elevate potassium in capillary samples; avoid for potassium tests.

Chlorhexidine

Alcohol-free antiseptic alternative for patients allergic to isopropyl alcohol.

Rolling Sleeve Consent

Patient action interpreted as implied consent to proceed with venipuncture.

Test Requisition

Document that initiates blood collection; verify before patient contact.

Name and Date of Birth

Two unique identifiers required to confirm patient identity.

12-Hour Fasting

Standard fast required for lipid panel, fasting glucose, and GTT tests.

Glucose Tolerance Test (GTT)

Timed test requiring fasting and multiple glucose draws after glucose ingestion.

Urine Culture Sample

Requires clean-catch midstream urine of at least 45 mL for drug testing or C&S.

Drug Peak vs Trough Timing

Peak measured post-dose (e.g., 2 h oral); trough drawn just before next dose.

PT/PTT Test Tubes

Light-blue sodium-citrate tubes filled to capacity to maintain 9 : 1 blood-to-anticoagulant ratio.

Peripheral Blood Smear Prep

Place 1 mm blood drop 0.5 in from slide edge; spread at 30–35° angle to feather edge.

Specimen Storage 2–8 °C

Refrigeration range for many samples if delayed processing (e.g., CBC after hours).

Critical Value Reporting

Lab must immediately notify provider of life-threatening results (e.g., WBC 1.8 K/mm³).

Results to Ordering Provider

Only the requesting clinician receives lab results; phlebotomist directs patient to provider.

Label in Patient Presence

Tubes labeled immediately after draw, in front of patient, to prevent misidentification.

Sharps Container Replacement

Replace when two-thirds full to avoid overfilling and needlestick risks.