#14 NHA CCMA: Identification, Injectables, Suture/Staples, and Venipuncture

What is demographic information in a medical record?

Name, address, phone number, insurance, and emergency contact.

How do EMR systems ensure each patient is unique?

By assigning a medical record number.

What are the two most common patient identifiers?

Full name and date of birth.

Why should you avoid saying the patient’s name and asking them to confirm it?

Patients may respond to the wrong name during stress, illness, or confusion.

What identifier is commonly used for billing purposes?

Last four digits of the Social Security number.

What five key elements must a medical assistant know before administering medication?

• Medication name

• Dosage

• Time

• Frequency

• Route of administration

What does "parenteral administration" mean?

Medication is injected and bypasses the gastrointestinal tract.

What does "nonparenteral" (enteral) administration mean?

Medication is given through the mouth or other non-injection routes and absorbed via the GI tract.

What is oral administration?

Medication taken by mouth.

What is sublingual administration?

Medication placed under the tongue for rapid absorption.

What is buccal administration?

Medication placed between the cheek and gums.

What is inhalation administration?

Medication inhaled through the mouth or nose into the lungs or nasal mucosa.

What is ocular or otic administration?

Ocular = eye drops; Otic = ear drops.

What is transdermal administration?

Medication applied to the skin via a patch, absorbed slowly into the bloodstream.

What is a subcutaneous injection?

Injected into the fat layer beneath the skin.

What is an intradermal injection?

Injected into the dermis layer of the skin.

What is an intramuscular injection?

Injected directly into the muscle.

What is an intravenous injection?

Injected directly into the vein.

What is the purpose of documenting procedures in the medical record?

Documentation provides legal proof the procedure was performed; “If it wasn’t documented, it wasn’t done.”

What does MAR stand for and what is it used for?

MAR = Medication Administration Record; it legally records all medications administered to a patient.

What key information must be included in a MAR?

• Medication name

• Dose

• Date and time

• Route of administration

• Special instructions

• Patient's reaction (if any)

Why is accurate MAR completion important?

It reduces the risk of medication errors and ensures correct treatment.

Where should the MAR be stored?

In a safe location near the medication storage area.

What formats can MARs take?

Pharmacy-provided paper forms or digital entries in an EMR system.

Can medical assistants remove sutures or staples?

Yes, under provider delegation.

What should be done before removing sutures or staples?

• Explain the procedure to the patient

• Inspect the wound

• Soak the area with saline if there is crusted blood or exudate

What should be included in a suture or staple removal kit?

• Sterile gloves

• Antiseptic (alcohol or povidone-iodine)

• Forceps

• Suture scissors or staple remover

• Sterile gauze

How are sutures removed?

• Cut below the knot close to the skin

• Remove every other suture first

• Observe for wound separation

• Never pull outside suture through skin

What should be done if bleeding, gaping, or exudate is present during removal?

Stop and notify the provider.

How should the wound be treated after suture/staple removal?

• Clean with antiseptic

• Allow to dry

• Apply dressing as ordered

What should be done with removed sutures and staples?

• Sutures: Dispose in biohazard waste

• Staples: Dispose in sharps container

Why should you count the number of sutures or staples removed?

To ensure all are accounted for and document the number in the patient’s health record.

What can be applied after removal for reinforcement?

Butterfly closures, depending on the wound condition and location.

What factors influence venipuncture site selection?

Vein condition, patient age, skin condition, overall health, and MA’s experience/judgment.

What is the preferred vein for venipuncture in the antecubital space?

The median cubital vein – it's less painful and least likely to roll.

What are alternatives to the median cubital vein?

The cephalic and basilic veins, located on either side of the median cubital vein.

What sites can be used if antecubital veins are inaccessible?

• Back of the hand (may roll, more nerves = more discomfort)

• Wrist

• Foot (only with provider supervision due to DVT risk)

When should alternative venipuncture sites be considered?

When both antecubital spaces are bruised, scarred, swollen, or burned.

Which venipuncture method is best for healthy adults?

The evacuated needle system.

Which method is best for hand draws or small/thin veins?

The butterfly (winged infusion) method.

What method is best for small-volume draws or difficult veins?

The syringe method.

What characteristics should a good vein have?

Bouncy, with good size, depth, and direction. Avoid visible veins that don’t bounce.

How should the patient position their arm for site selection?

Extend the arm and straighten the elbow.

How should you cleanse a venipuncture site?

With antiseptic, using up-and-down friction. Allow to air dry.

Can you touch the site after cleaning it?

No, even with gloves on.

What should be avoided when drying the site?

Blowing on it or waving hands—this can contaminate the skin.

When should the tourniquet be reapplied?

After the site has dried.

When should blood specimen tubes be labeled?

Immediately after the procedure, before moving the tubes away.

What information must be on a handwritten label?

• Patient’s full name

• Date of birth

• Date and time of collection

• MA’s initials

What should be used if printed labels aren’t available?

A permanent marker to handwrite the required information.

What is the purpose of matching specimen tubes to the requisition form?

To ensure accuracy and prevent lab errors.

Where should labeled specimen tubes be placed for transport?

In a biohazard transport bag with the completed lab requisition form.

What is one of the most common testing errors in the lab?

Mislabeled specimens.

What error may result from improper clean-catch urine instructions?

Contamination with excess bacteria, leading to inaccurate results and need for recollection.

What can happen if a patient does not follow test preparation instructions (e.g., fasting)?

The test may need to be delayed or rescheduled.

What happens in the preanalytical phase?

• Provider orders test

• Requisition completed

• Specimen collected, labeled, and processed

• Specimen transported or sent to lab

What are common preanalytical errors?

• Inappropriate test request

• Patient misidentification

• Improper labeling

• Wrong container

• Inadequate sample or incorrect anticoagulant ratio

What occurs during the analytical phase?

• Equipment is calibrated and maintained

• Controls are run

• Sample is tested and results compared to reference range

• Results logged in patient record

What are common analytical errors?

• Equipment malfunction

• Sample mix-up

• Skipped quality control steps

• Procedures not followed

What occurs in the postanalytical phase?

• Specimens discarded

• Control results reviewed over time

• Reports logged and interpreted

• Patient is notified

• Documentation of results and communication

What are common postanalytical errors?

• Failure to report results

• Improper data entry

• Delays in turnaround time

What is a key responsibility of the MA during the postanalytical phase?

Accurate documentation and reporting of test results.

What is the first step before performing any phlebotomy procedure?

Obtain and review the provider’s order for laboratory testing.

Can a venipuncture procedure be performed without a provider’s order?

No, a provider’s order is required.

What should you use if you're unfamiliar with a specific laboratory test?

Consult the laboratory directory (manual or online) for details on specimen, prep, container, and transport requirements.

What are two required patient identifiers before performing a procedure?

Full name and date of birth.

What information is included on a laboratory requisition form?

• Ordering provider’s name and contact info

• Test name and code

• ICD-10 diagnosis code

• Special requirements (e.g., fasting)

• Patient demographics

• Insurance/billing info

What general supplies are needed for a standard venipuncture?

• Alcohol wipes

• Gauze

• Adhesive bandage

• Biohazard sharps container

• Gloves (PPE)

• Tourniquet

• Collection tubes

• Needle system

What are the three standard needle systems for venipuncture?

1. Evacuated System (Vacutainer)

2. Winged Infusion Set (Butterfly)

3. Needle and Syringe System (not detailed here but used in some settings)

What is the most commonly used venipuncture system?

Evacuated tube system.

What is a key advantage of the evacuated system?

Allows multiple tubes to be drawn from a single venipuncture.

What gauge and length are typical for evacuated system needles?

20 to 22 gauge, ¾ inch to 1½ inches.

When is the winged infusion set (butterfly) preferred?

For small or fragile veins, such as in pediatric or elderly patients.

What are typical specifications for butterfly needles?

21 to 23 gauge, ½ inch to ¾ inch needle length.

When is a needle and syringe system used for phlebotomy?

When controlled suction is needed, though it only collects a small amount of blood.

What is one advantage of the syringe method?

The plunger allows for control over suction, rather than relying on vacuum.

What size needle is generally used in the syringe method?

16-gauge injection needle and syringe.

What is the lumen of a needle?

The hollow space inside the needle; determines gauge size.

How does gauge relate to needle size?

The larger the gauge number, the smaller the diameter.

What is the bevel?

The slanted tip at the end of the needle that forms the point.

How should phlebotomy supplies be arranged during a procedure?

In the order they will be used, within reach, and on the opposite side of the dominant hand.

Where should the sharps container be placed?

On the dominant side for immediate and safe disposal.

What should be done immediately after withdrawing the needle?

Activate the needle’s safety device and place it in the sharps container.

Why must tubes be drawn in the proper order?

To avoid cross-contamination from additives that could alter results.

What identifies a vacuum tube's additive?

The color of the stopper cap.

How do you anchor the vein before insertion?

Hold the skin taut 2–3 inches below the puncture site.

At what angle should the needle be inserted in the arm?

15–30 degrees, bevel up. venipuncture

At what angle should you insert the needle into a hand vein?

10–15 degrees, as hand veins are smaller and more fragile. venipuncture

What should be done after inserting the needle and establishing blood flow?

Release the tourniquet with the nondominant hand.

How should you remove the needle and apply gauze?

Apply gauze with the nondominant hand, then withdraw the needle with the dominant hand, activate safety, and dispose of the needle.

What is a common reaction patients may have after a blood draw?

Fainting or vasovagal syncope.

What should be done before allowing a patient to stand?

Check for unusual symptoms; involve a nurse or provider if needed.

What is the proper bandaging procedure post-venipuncture?

Apply pressure with gauze until bleeding stops, then bandage and instruct the patient to leave it on for at least 15 minutes.

Why is it important to follow specific handling instructions for blood specimens?

To preserve sample integrity and ensure accurate test results.

What are some common handling requirements for blood specimens?

Centrifugation, specific storage temperatures (room temp, refrigerated, frozen), and light exposure precautions.

Where should you look if you are unsure how to handle a specimen?

The laboratory directory or call the reference lab.

Why is time management important when handling blood specimens?

Because delays can compromise test accuracy.

What does a centrifuge do?

Separates components of blood by spinning at high speeds—heavier elements move to the bottom.

What must be done before centrifuging serum specimens?

Allow them to clot.

How should tubes be placed in a centrifuge?

In balanced pairs—opposite each other with equal weight/volume.