Phlebotomy Certification Test

What is the Order of Blood Draw

Blood Cultures

Light Blue Top

Red Top

Gold/Tiger Top

Light Green Top

Dark Green Top

Lavender Top

Pink Top

Gray Top

Royal Blue Top

Why is the correct order of Blood Draw important?

To prevent cross-contamination of additives between tubes.

What are the potential consequences of not following the Order of Draw?

Incorrect results, need for redraw, and possibly messing with the integrity of the smple.

What does cross-contaminzation mean in relation to blood collection?

The transfer of additives from one tube to another, which can alter the test results.

What is the fucntion of an anticoagulant in blood collection tubes?

To prevent blood clotting.

How does clot activation work in serum tubes?

Serum tubes contain clot activators that help the blood clot faster allowing serum seperation

What role does the additive in a blood tube play in laboratory testing?

Prevent clotting.

What should be done if a blood tube does not fill completely?

Check the needle for position and ensure the tube has vacuum.

How does tube inversion impact sample integrity?

Ensure proper mixing of the additive and blood to prevent clotting or hemolysis.

What are the two primary types of blood specimens collected (serum vs plasma)?

Serum - clot forms and separates from the liquid.

Plasma - contains anticoagulant which prevents a clot from forming.

What is the first tube in the Order of Draw?

Blood Cultures

How many bottles are in set of blood cultures?

2 bottles (anaerobic & aerobic)

Why is the blood culture tube collected first?

To avoid contamination from other tube additives.

When there are two sets of blood cultures, how are we drawing them ?

From two different sites.

What is the second tube in the Order of Draw?

Light Blue

What is the additive in the light blue tube?

Sodium Citrate

Why must the light blue tube be completely filled and how do you completely fill it when using a butterfly needle.

To maintain the correct blood to additive ration, when using a butterfly use a discard tube first and then get a couple drops of blood in the tube then insert the light blue tube and fill to arrow/line.

What tests are commonly performed using a light blue tube?

PT, PTT/aPTT, INR, and D-Dimer

What is the third tube in the Order of Draw

Red Top

What color is the serum tube without the clot activator?

Plain Red

What is the common test for the tube without the clot activator?

Serum chemistry tests, drug level tests, blood bank tests

What is the fourth tube in the Order of Draw?

Gold top (Serum Separator Tube) or Tiger Top (Serum Separator Tube with Clot Activator and Gel).

What is the purpose of the clot activator for the gold/tiger top tube?

To speed up clot formation so serum can be seperated from cells quickly.

What are the two common tests for the gold/tiger top tube?

CMP and BMP tests

What is the fifth tube in the Order of Draw?

Light green tube (PST: Plasma Separator Tube)

What is the additive in the light green tube?

Lithium heparin with gel for plasma sepeartion

What tests are commonly performed in the light green tube?

Plasma chemistry tests, electrolytes, STAT chemistry tests, troponin, lipid panels

What is the sixth tube in the Order of Draw?

Dark green tube

What is the additive for the dark green tube?

Sodium heprin or Lithium heprin (no gel).

How is the dark green tube transported to the lab?

On ice

What is the seventh tube in the Order of Draw

Lavender Top

What department does the lavender top get sent to?

Hematology

What are the common tests for the lavender top tube?

CBC (Complete Blood Count), HbA1C, ESR, and sickle cell tests

What is the eighth tube in the Order of Draw?

Pink top

What is the additive in this tube?

EDTA (anticoagulant)

What is the common test in the pink tube that cannot be centrifuged?

Type and crossmatch/Blood bank compatibility testing

What is the ninth tube in the Order of Draw?

Gray tube

What are the additives in the gray tube

Sodium flouride (preserves glucose) and potassium oxalate (anticoagulant)

Which common test for this tube cannot be drawn with a tourniquet on?

Lactic acid test must be drawn without tourniquer and transported on ice.

What is everything you know about the royal blue tube?

This tube tests for heavy metals and lead. Red Stripe means no additive. Lavender Stripe means additive like EDTA. Goes to toxicology or Chemistry.

What are the 3 main veins used for venipuncture?

Median Cubital

Cephalic

Basilic

What vein is the first choice for venipuncture?

Median cubital

What are the 3 layers of blood vessels?

Tunica media

Tunia media

Tunia adventita

Which blood vessels is only one layer?

Capillaries

What is hemolysis and what causes it>

The rupture of red blood cells and is caused by using a needle too big for the vein, excessive force during blood draw, and leaving the tourniquet on for too long

What is the role of erythocytes?

To carry oxygen to tissues and remove carbon dioxide

Which anticoagulant is found in the lavender tube top?

EDTA

What is the purpose on an anticoagulant in the tubes?

Prevents blood from clotting

Which tubes mkae serum

Red, Gold/Tiger, Royal Blue with Red Stripe

Which tubes make plasma?

Light blue, light green, dark green, lavender, pink, gray, royal blue with lavender stripe

What angles should the needle be inserted for a hand draw and an arm draw?

Hand - 5 degrees

Arm - 15-30 degrees

What is the max number of attempts a phlebotomist should make on a blood draw?

2 attempts

What are the steps to identify a patient before drawing blood?

Ask patients full name and DOB

Check band or ID

Compare to requisition form

Where should a tourniquer be tied on a patient before drawing blood?

3-4 inches above the draw site

Why should a tourniquet not be left on for more than a minute

To prevent hemoulsis/hemoconcentration

What is the best wat to prevent homoconcentration?

Remove the tourniquet before 1 minute

Why is it important to invert tubes after collection?

To mix the additive properly and prevent clotting

What is the technical term used when “feeling” for a vein?

Palpation

What is the correct method for performing a blood smear?

Place a drop of blood on a slide from a lavender tube top and spread the slide and a 30-45 degree angle.

When performing a heel stick what is the preferred area?

The sides of the feel of the foot

What is the test drawn that you should not use alcohol to clease the patient’s skin before the blood draw?

Alchohol/Ethanol

How should an ABG sample be transported to the lab?

On ice and immediatley after collection

What are the different ways to transport specicmens to the lab

Hand delivery, tube system, courier service

What is the proper procedure for collecting a 24-hour urine sample?

Discard the first urine that morninig, collect rest of the urine in the container for 24 hours and keep refrigerated.

How should bilirubin samples be protected during transport to the lab?

Keep in light -protected container ( amber tube) or wrap in paper towel/ aluminum foil.

What does OSHA stand for and what is its role in phlebotomy?

Occupational Safety and Health Administration

What is the purpose of standard precautions?

To reduce the risk of transmission of infections

What does Universal Precautions mean in phlebotomy?

Treat all blood and bodily fluids as potentially infectious

 How should a contaminated needle be disposed of?

In a sharps container without recapping

What is the most effective way to prevent the spread of infection?

Hand washing

What are the signs of a hematoma, and how can it prevented?

signs- swelling, bruising and pain

prevention- avoid fishing and apply pressure immediately afterwards

What are the different types of PPE (personal protective equipment)?

·       Gloves

·       Gown

·       Mask

·       Respirator

·       Goggles

What is the protocol for an accidental needlestick injury?

Wash area with soap and water, report to supervisor, fill or exposure/ injury form

What does HIPAA stand for, and how does it affect patient privacy?

Health Insurance Portability and Accountability Act, protects patient confidentiality

What are some examples of unethical and illegal behaviors?

·       Assault

·       Battery

·       Slander

·       Breech of duty

·       Malpractice

·       Negligence

How much blood is collected in the blood culture bottles for an adult? For a child?

adults: 8-10 ML

children: 3-5 ML

What is the largest department in the lab?

Chemistry

What are the two types of gloves used when drawing blood?

Vinyl and nitrile

What does CLSI stand for and what do they do?

Clinical Laboratory Standards Institiute, sets lab testing standards

What are the different types of consent?

·       Informed

·       Implied

·       Expressed

·       HIV consent

·       Parental consent for minors

Can you start or stop an IV?

NO

What does basal state refer to?

Fasting state after 8-12 hours without food or exercise

When the heel stick is not available for an infant, where else can you stick them?

Median cubital or the back of the hand

Can you tell a patient what test(s) are being drawn?

yes

When is a PKU test performed on an infant?

Within the first 72 hours of life

When is a PKU test performed on an infant?

·       Glucometer

·       PT testing

·       Lipids

Where do you stick a patient that has mastectomy on one arm? How do you handle a patient with a double mastectomy.

Single mastectomy- on the opposite side

Double mastectomy- ask provider

What agency does inspections for medical facilities?

OSHA

1.         Can you continue a blood draw if the information on the requisition does not match the patient provides to you?

NO

What are the 4 steps to ending the venipuncture procedure?

·       Remove tourniquet

·       Remove tubes

·       Remove needle and apply gauze

·       Activate safety

What is the function of platelets in the blood?

To help with blood clotting to prevent excessive bleeding when a blood vessel is injured

What is the difference between serum and plasma?

Plasma- liquid portion of blood that contains clotting factors ( additive)

Serum- liquid portion that remains in the blood after it has clotted

Which type of blood cell is responsible for carrying oxygen?

Red blood cells ( erythrocyte)

What gauge needles are commonly used for venipuncture?

21-23

What does nosocomial infection mean and which nosocomial infection is the most common for lab employees?

Nosocomial infection is a an infection contracted in the healthcare system, and HBV is the most common for lab employees

What should you do if the sharps container is more that half filled?

Either let your supervisor know or replace it if your facility allows you to

Can you give a patient the results to their test previously drawn?

No

What should you do with the first drop of blood when performing capillary stick?

Wipe it away

What is the number one mistake phlebotomist make?

Misidentifying patients

What should you do if a hematoma forms?

Remove needle, apply pressure, and alternate between hot and cold compress