Phlebotomy NHA

What is the yellow top additive?

SPS

Common labs for yellow top?

Blood cultures

Inversion of yellow top?

8-10 times

What is the blue top additive?

Sodium citrate

Common labs for blue top?

PT, PTT, INR, D-dimer

Inversion of blue top?

3-4 times

What is the red top additive?

Usually none, some may have clot activator

Common labs for red top?

Serum test, serology/immunology (HIV/Hep B), therapeutic drug levels

Red top inversion?

5 times

What is the gold/tiger top/sst additive?

Clot activator and gel

Common gold/tiger/sst labs?

CMP, BMP, Lipid panels, liver/thyroid function tests

Inversion of gold/tiger/sst?

5 times

What is the additive in green top?

Heparin

Common green top labs?

CMP, BMP, electrolytes, STAT test

Inversion of green top?

8-10 times

What is the additive in lavender top?

EDTA

Common lavender top labs?

CBC, hemoglobin, hematocrit, hemoglobin A1C

Inversion of lavender tops?

8-10 times

What is the additive in pink?

Spray-dried potassium EDTA

Common labs for pink top?

Blood typing, cross matching, antibody screening

Inversion of pink top?

8-10 times

What is the additive in gray tops?

Sodium fluoride and potassium oxalate

Common labs for grey tops?

Glucose, lactic acid, blood alcohol content

Inversion of grey top?

8-10 times

Lavender top CBC: RBC (erythrocyte)

F: 4.0-5.5 M: 4.5-6.1

Lavender top CBC: WBCs (Leukocytes)

4,000-11,000

Lavender top CBC: Platelets (Thrombocytes)

150,000-450,000

Lavender top CBC: Hemoglobin

F: 12-16 M: 14-18

Lavender top CBC: Hematocrit

F: 36-48% M: 40-54%

Grey Top: Fasting (8-12 hr) Blood Glucose- Normal

70-99

Grey Top: Fasting (8-12 hr) Blood Glucose- Prediabetic

100-125

Grey Top: Fasting (8-12 hr) Blood Glucose- Diabetic

126+

Grey Top: Fasting (8-12 hr) Blood Glucose- If low?

Hypoglycemia, insulin overdose

Grey Top: Fasting (8-12 hr) Blood Glucose- If high?

Diabetes, stress, infection

Grey top: Random Blood Glucose- Abnormal

200+ symptoms (excess urination/thirst, fatigue, blurred vision) pt is diabetic

Lavender top: Hemoglobin A1C- Normal

Below 5.7%

Lavender top: Hemoglobin A1C- Prediabetic

5.7-6.4%

Lavender top: Hemoglobin A1C- Diabetic

6.5% or higher

Gold/Tiger/SST: Sodium

135-145

Gold/Tiger/SST: Sodium-If low?

Overhydration, kidney disease

Gold/Tiger/SST: Sodium-If high?

Dehydration

Gold/Tiger/SST: Potassium

3.5-5.0

Gold/Tiger/SST: Potassium- If high

Kidney disease, acidosis, cardiac arrythmias

Gold/Tiger/SST: Potassium- If low?

Vomiting, muscle weakness, heart abnormalities, potassium wasting diuretics

Gold/Tiger/SST: Calcium

8.6-10.2

Gold/Tiger/SST: Calcium- If low?

Hypoparathyroidism, VD deficiency, muscle spasms

Gold/Tiger/SST: Calcium- If high?

Hyperparathyroidism, cancer

Gold/Tiger/SST: AST (Liver Function)

10-40

Gold/Tiger/SST: AST (Liver Function)- If high?

Liver damage, muscle injury

Gold/Tiger/SST: ALT (Liver Function)

7-56

Gold/Tiger/SST: ALT (Liver Function)- If high?

Liver disease, hepatitis

Gold/Tiger/SST: ALP (Alkaline Phosphate) (Liver Function)

44-147

Gold/Tiger/SST: ALP (Alkaline Phosphate) (Liver Function)- If high?

Liver/Bone disease

Gold/Tiger/SST: Bilirubin

0.1-1.2

Gold/Tiger/SST: Bilirubin

Liver disease, hemolysis

Gold/Tiger/SST: Thyroid Stimulating Hormone

0.4-4.0

Gold/Tiger/SST: Thyroid Stimulating Hormone: Low/High

Low: Hyperthyroidism

High: Hypothyroidism

Blue top: Phyto Thrombin (PT)

11-13.5 sec

Blue top: Phyto Thrombin (PT)- If high?

Clotting disorders, liver disease

Blue top: Partial Phyto Thrombin

25-35 sec

Blue top: Partial Phyto Thrombin- If high?

Heparin therapy, clotting disease

Blue top: INR

0.8-1.2 (no coag)

2.0-3.0 (AFib/Deep vein thrombosis/Warfarin therapy)

Gold top: Total Cholesterol

less than 200

Gold top: Total Cholesterol- If high?

Cardiovascular risk

Gold top: Low density lipoprotein *bad cholesterol

Less than 100

Gold top: Low density lipoprotein *bad cholesterol- If high?

Atherosclerosis risk

Gold top: High Density Lipoprotein *good cholesterol

Greater than 40

Gold top: High Density Lipoprotein *good cholesterol- If low?

Cardiovascular risk

Gold top: High Density Lipoprotein *good cholesterol- If high?

Protective

Gold top: Triglycerides (lipid)

Less than 150

Gold top: Triglycerides (Lipid)- If high?

Cardiovascular disease, heart attacks, stroke, increased risk of diabetes

Red/Gold top: BUN

7-20

Red/Gold top: BUN- If low?

Overhydration, malnutrition, low protein diet

Red/Gold top: BUN- If high?

Kidney disease, high protein intake, dehydration

Red/Gold top: Creatinine

0.6-1.3

Red/Gold top: Creatinine- If low?

Decreased muscle mass, malnutrition, liver disease

Red/Gold top: Creatinine- If high?

Kidney disease

Red/Gold Top: GFR

60+

Red/Gold top: GFR- If low?

Kidney disease

How long should a patient fast for a fasting test?

8-12 hours. Pt should be asked when they last ate/drank before labs drawn.

What should the MA do if a patient has a negative physical outcome?

Stop procedure and alert provider

Pt should be asked how they have handled previous phlebotomy. If a patient has fainted before, what should MA do?

Ask to lie pt down for blood draw instead of sitting

If MA is unsure on what phlebotomy tube to draw what should they do?

Consult laboratory reference manual

Where should an MA first attempt to locate a vein?

Antecubital space (above forearm)

What should an MA prep a pt’s skin with before phlebotomy?

70% alcohol

Butterfly needles gauge?

22-gauge, ½ inch

Timed blood specimens can be used to monitor what medication levels?

Therapeutic medication levels

What is required on a lab requisition form for billing?

ICD-10-CM

If a lab reports a critical value, what should the MA do?

Notify provider immediately and document provider was notified

How should light sensitive samples be wrapped for transport?

In foil

What should the MA do if the lab reports an error in the sample?

Forward results and alert ordering provider

Adjusting order of draw is what error that can affect venipuncture results?

Pre-analytical

Where should an MA hold a butterfly needle to control during venipuncture?

By its wings

What angle should butterfly wings be inserted?

10-15 degrees

Before venipuncture, how should MA verify pt identity?

Full name and DOB. MA will compare to lab req and pt specimen labels.

What does elevating an extremity above heart level do?

Decrease blood flow and circulation to the site

How long should pt leave bandage on after venipuncture?

15 minutes

If an MA has orders to collect labs but forgets to draw one tube, what should they do?

Keep collected specimens and perform additional venipuncture to collect missing lab.

Where should a MA draw blood from an 18-month old toddler?

Superficial dorsal hand veins

When should an MA perform a scalp venipuncture on a newborn?

If more blood is needed than a capillary puncture from the heel can provide