Everything NHA CPT

What is the correct order of draw for venipuncture?

Blood culture → light blue → serum tubes → green → lavender → gray

What is the first tube collected in the order of draw?

Blood culture bottles

What additive is found in blood culture bottles and what does it do?

Culture media (prevents bacterial growth or supports it for testing)

What color tube is used for coagulation testing like PT/INR and aPTT?

Light blue

What is the additive in a light blue tube?

Sodium citrate

What does sodium citrate do?

Binds calcium to prevent clotting

What is the serum tube with clot activator and gel called?

SST (gold or tiger top)

What additive is found in SST tubes?

Silica clot activator and gel separator

What tests are commonly collected in SST (gold top)?

Chemistry panels, lipid panel, liver function, BMP, CMP

What is the green top tube used for?

Plasma chemistry tests

What additive is in a green top tube?

Heparin (lithium or sodium)

What does heparin do in green top tubes?

Prevents clotting by inhibiting thrombin

What tube is used for CBC testing?

Lavender top

What additive is in a lavender top tube?

EDTA

What does EDTA do?

Chelates calcium to prevent clotting

What tests use lavender tubes?

CBC, hemoglobin, hematocrit, blood bank testing

What tube is used for glucose testing?

Gray top

What additives are in a gray top tube?

Sodium fluoride and potassium oxalate

What does sodium fluoride do?

Inhibits glycolysis (preserves glucose)

What does potassium oxalate do?

Anticoagulant (prevents clotting)

Why is the gray top tube used for glucose testing?

It preserves glucose levels by stopping breakdown

What tube is drawn after blood cultures?

Light blue tube

Why must light blue tubes be filled completely?

Maintains correct blood-to-additive ratio (9:1)

What happens if a light blue tube is underfilled?

Incorrect coagulation results (false PT/INR)

What is the order of draw to prevent contamination?

Additive carryover between tubes

Why is order of draw important?

Prevents test interference from tube additives

What tube is collected before serum tubes?

Light blue tube

What tube is collected before lavender and gray tubes?

Green tube

What is the last tube in order of draw?

Gray top tube

What is a serum tube?

A tube without anticoagulant that allows clotting

What is a plasma tube?

A tube with anticoagulant that prevents clotting

What color tubes are serum tubes?

Gold, red (depending on lab type)

What color tubes are anticoagulant plasma tubes?

Light blue, green, lavender, gray

What is the main risk of incorrect order of draw?

False test results due to additive contamination

What additive is in blood culture bottles?

Culture media

What tube is used for ESR testing?

Lavender or black top (varies by lab)

What tube is used for STAT chemistry tests?

Light Green

What is the purpose of gel in SST tubes?

Separates serum from cells after centrifugation

What tube is used for blood banking?

Lavender top (EDTA)

What test requires sodium citrate tube?

PT/INR and coagulation studies

What tube is used for electrolyte testing?

Green top or SST

What tube is used for ammonia testing?

Green top (heparinized plasma)

What is the correct handling of tubes after collection?

Gentle inversion (not shaking)

What happens if tubes are shaken too hard?

Hemolysis

What is hemolysis?

Breakdown of red blood cells

What is the proper inversion method?

Gently invert 180 degrees

Why must additives mix properly?

Ensures accurate test results

What is a common error in tube collection?

Wrong order of draw

What tube should never be drawn first (except blood cultures)?

Light blue tube

What is the function of anticoagulants?

Prevent blood clotting

What is the function of clot activators?

Speed up clot formation

What is the first step in venipuncture?

Verify patient identity using 2 identifiers (Full Name and DOB)

When should hand hygiene be performed?

Before and after every patient contact

When should gloves be removed?

Immediately after blood draw and before touching anything else

What is the correct order of venipuncture steps after cleaning the site?

Insert needle → fill tubes → release tourniquet → remove needle → activate safety device → label at bedside

When should tubes be labeled?

Immediately at bedside after collection

What is the first action if a patient faints during a blood draw?

Stop procedure and ensure patient safety (lower head/feet, monitor)

What is the most important safety rule for needles?

Never recap used needles

What is the proper disposal method for needles?

Place immediately into sharps container

What should you do after a needle stick injury?

Wash area, report immediately, follow exposure protocol

What are the 2 patient identifiers?

Full name and date of birth

What should you do if a patient refuses a blood draw?

Respect refusal and document it

What is the correct response if a patient is unconscious?

Use ID band or have caregiver verify identity

What causes a hematoma?

Needle goes through vein or inadequate pressure after removal

How do you prevent hematoma formation?

Release tourniquet before removing needle and apply pressure

What causes hemolysis in a blood sample?

Shaking tube, small needle, or alcohol not dry

What is petechiae caused by?

Tourniquet left on too long or fragile capillaries

What should be done for excessive bleeding after a draw?

Apply pressure and check patient condition

Where is the best site for venipuncture?

Median cubital vein

Second choice vein for venipuncture?

Cephalic vein

Last choice vein for venipuncture?

Basilic vein

What is the first step in capillary puncture?

Warm the site if needed

Where should adult fingersticks be performed?

Side of fingertip

Where should infant heel sticks be performed?

Medial or lateral heel

What should be done with the first drop of blood in capillary collection?

Wipe away first drop

What specimens should be placed on ice?

Ammonia and lactic acid

What type of tests are light-sensitive?

Bilirubin tests

When should a specimen be rejected?

Incorrect labeling or hemolysis

What is centrifugation used for?

Separating plasma or serum from cells

What is a fasting test?

Test requiring no food or drink (except water) for a set time

What is a blood culture used for?

Detecting infection in the bloodstream

What is a glucose tolerance test used for?

Testing how the body processes sugar

What are therapeutic drug monitoring tests?

Measuring drug levels in blood for safety

What is the correct vein order preference?

Median cubital → Cephalic → Basilic

The most effective way to prevent the spread of infection during blood collection is

Hand hygiene before and after every patient contact

A phlebotomist should identify a patient using

Two patient identifiers

PPE that should always be worn during routine venipuncture

Gloves

A used needle should be

Disposed of immediately in a sharps container

Standard Precautions assume

Every patient may carry infectious disease

Purpose of OSHA's Bloodborne Pathogens Standard

Reduce workplace exposure to infectious materials

First action after a needlestick injury

Wash the area and report the incident

Primary purpose of a sharps container

Prevent accidental needlestick injuries

Goal when removing gloves

Avoid touching the contaminated outside surface

Agency that enforces workplace safety standards

OSHA

When should soap and water be used instead of hand sanitizer?

When hands are visibly soiled

What belongs in a biohazard bag?

Bloody gauze

Purpose of an Exposure Control Plan

Outline procedures for preventing bloodborne exposure

What is considered Protected Health Information (PHI)?

A patient's name linked with medical information

Primary purpose of HIPAA

Protect patient privacy

If a patient asks about another patient's test results

Refuse to discuss another patient's information