Week 2 Flashcards
What is the correct order of draw?
The following are the proper steps of patient
identification EXCEPT:
a) Ask the patient for his/her/their first, middle,
and last name, and date of birth
b) Use the labels on the patient’s door as
identification
c) Check the patient’s wristband to confirm
his/her/their full name
d) Check that the patient’s requisition matches
with the wristband
b) Use the labels on the patient’s door as
identification
In the case of a discrepancy between the
patient’s statement and the wristband, you
should do all of the following EXCEPT:
a) Document all action taken
b) Solve the problem before you proceed
c) Accept what the patient told you and
proceed
d) Ask the nurse for assistance in correcting
the discrepancy
c) Accept what the patient told you and
proceed
What should you do if you have specimens
drawn from 2 different patients but have the
same name on the labels?
a) Ask your supervisor to decide what to do
b) Go back to the patient and see if
he/she/they can identify the blood
c) Send it to the lab so they can fix it there
d) Discard both specimens and redraw each
patient
d) Discard both specimens and redraw each
patient
What should you do if your inpatient has no
wristband?
a) The wristband is not important as long as you
have the patient’s testimony and the requisition
that matches
b) Have the nurse put a wristband on the patient,
proceed with the draw, and then document
c) Use the wristband that is attached to the
patient’s bedrail
d) Use the signs on the door to identify the patient
b) Have the nurse put a wristband on the patient,
proceed with the draw, and then document
What is the order of preference in choosing
a vein for a venipuncture?
a) Basilic, cephalic, median cubital
b) Median cubital, cephalic, basilic
c) Cephalic, median cubital, basilic
d) Basilic, cephalic, jugular
What is the order of preference in choosing
a vein for a venipuncture?
a) Basilic, cephalic, median cubital
b) Median cubital, cephalic, basilic
c) Cephalic, median cubital, basilic
d) Basilic, cephalic, jugular
How many inches above the antecubital
fossa should the tourniquet be applied?
a) 3-4 inches
b) 1-2 inches
c) 5-6 inches
d) 2-3 inches
How many inches above the antecubital
fossa should the tourniquet be applied?
a) 3-4 inches
b) 1-2 inches
c) 5-6 inches
d) 2-3 inches
When cleansing the site for a routine
venipuncture, you should do all of the
following EXCEPT:
a) Insert the needle before the alcohol dries so
it is sterile
b) Use 70% isopropyl alcohol for a routine
draw
c) Use a back-and-forth motion
d) Allow the alcohol to dry completely before
inserting the needle
When cleansing the site for a routine
venipuncture, you should do all of the
following EXCEPT:
a) Insert the needle before the alcohol dries so
it is sterile
b) Use 70% isopropyl alcohol for a routine
draw
c) Use a back-and-forth motion
d) Allow the alcohol to dry completely before
inserting the needle
When performing a venipuncture, you
should insert the needle at a:
a) 15-30 degree angle with bevel up
b) 15-30 degree angle with bevel down
c) 30-40 degree angle with bevel up
d) 90 degree angle with bevel up
When performing a venipuncture, you
should insert the needle at a:
a) 15-30 degree angle with bevel up
b) 15-30 degree angle with bevel down
c) 30-40 degree angle with bevel up
d) 90 degree angle with bevel up
According to CLSI, the order of draw is:
a) Red top, green top, light blue top, gray top,
lavender top, blood culture
b) Blood culture, lavender top, gray top, green
top (light and dark), red top, light blue top
c) Blood culture, light blue top, red/tiger/gold
top, green top (light and dark), lavender
top, gray top
d) Blood culture, red/tiger/gold top, light blue
top, lavender top, green top (light and dark)
According to CLSI, the order of draw is:
a) Red top, green top, light blue top, gray top,
lavender top, blood culture
b) Blood culture, lavender top, gray top, green
top (light and dark), red top, light blue top
c) Blood culture, light blue top, red/tiger/gold
top, green top (light and dark), lavender
top, gray top
d) Blood culture, red/tiger/gold top, light blue
top, lavender top, green top (light and dark)
All of the following is true about tubes with
additives EXCEPT:
a) They must be mixed thoroughly by shaking
the vial vigorously for proper mixing
b) They must be mixed promptly to prevent
platelet clumping
c) They must be mixed gently 8 to 10 times to
avoid hemolysis
d) They must be drawn in a particular order to
minimize the effects of carryover
All of the following is true about tubes with
additives EXCEPT:
a) They must be mixed thoroughly by shaking
the vial vigorously for proper mixing
b) They must be mixed promptly to prevent
platelet clumping
c) They must be mixed gently 8 to 10 times to
avoid hemolysis
d) They must be drawn in a particular order to
minimize the effects of carryover
Define Hemolysis?
Damage or destruction of RBC’s and release of hemoglobin into the fluid portion of a specimen, causing the serum color to range from pink (slight hemolysis) to red (gross hemolysis)
When should you label the specimen tubes?
a) In the middle of the draw
b) After the blood is drawn, at the patient’s
bedside
c) In the lab before going to the patient’s
room
d) After the specimen reaches the lab
When should you label the specimen tubes?
a) In the middle of the draw
b) After the blood is drawn, at the patient’s
bedside
c) In the lab before going to the patient’s
room
d) After the specimen reaches the lab
Palpating the vein serves what purpose?
a) Helps determine the size of the vein and
what angle to insert the needle
b) Distracts the patient from discomfort
c) Increases the amount of blood in the vein
d) Helps to anchor the vein for the draw
Palpating the vein serves what purpose?
a) Helps determine the size of the vein and
what angle to insert the needle
b) Distracts the patient from discomfort
c) Increases the amount of blood in the vein
d) Helps to anchor the vein for the draw
What is the most common site for
venipunctures?
a) The dorsal side of the wrist
b) The middle part of the forearm
c) The antecubital fossa of the arm
d) The anterior side of the wrist
What is the most common site for
venipunctures?
a) The dorsal side of the wrist
b) The middle part of the forearm
c) The antecubital fossa of the arm
d) The anterior side of the wrist
What effect does warming the site have on
the venipuncture?
a) Prevents the vein from rolling
b) Makes artery stand out
c) Increases localized blood flow
d) Anchors the vein
What effect does warming the site have on
the venipuncture?
a) Prevents the vein from rolling
b) Makes artery stand out
c) Increases localized blood flow
d) Anchors the vein
How long should the tourniquet be left on
the patient’s arm?
a) Approximately 4 minutes
b) Until after the needle is removed
c) Approximately 3 minutes
d) No more than one minute
How long should the tourniquet be left on
the patient’s arm?
a) Approximately 4 minutes
b) Until after the needle is removed
c) Approximately 3 minutes
d) No more than one minute
If a patient is receiving IV solution in both
arms, the selected side should be?
a) Above the IV line
b) On the IV line
c) Below the IV line
d) Adjacent to the IV line
If a patient is receiving IV solution in both
arms, the selected side should be?
a) Above the IV line
b) On the IV line
c) Below the IV line
d) Adjacent to the IV line
What is the main purpose of applying a
tourniquet?
a) To help locate a vein
b) To help the patient hold his/her/their
hand still
c) To help obtain a concentrated specimen
d) To prevent the vein from rolling
What is the main purpose of applying a
tourniquet?
a) To help locate a vein
b) To help the patient hold his/her/their
hand still
c) To help obtain a concentrated specimen
d) To prevent the vein from rolling
Match the following tubes with their
anticoagulants?
Question 18
___ Lavender Top A. Sodium citrate
___ Gray Top B. Heparin (Na, Li, NH3)
___ Light Blue top C. None
___ Green top D. EDTA
___ Red top E. Potassium oxalate/
Sodium fluoride
Match the following tubes with their
anticoagulants?
Question 18
D Lavender Top A. Sodium citrate
E Gray Top B. Heparin (Na, Li, NH3)
A Light Blue top C. None
B Green top D. EDTA
C Red top E. Potassium oxalate/
Sodium fluoride
Match the following tubes with the
laboratory tests:
___ Lavender Top A. PT, PTT
___ Gray Top B. CBC
___ Light Blue top C. Glucose, EtOH
___ Green top D. Chemistries
___ Red top E. Chemistries, Serologies,
Immunology
Match the following tubes with the
laboratory tests:
B Lavender Top A. PT, PTT
C Gray Top B. CBC
A Light Blue top C. Glucose, EtOH
D Green top D. Chemistries
E Red top E. Chemistries, Serologies,
Immunology
Match the following:
___ To avoid A. Keep specimens in dark
agglutination due B. Keep specimens cold
to cold agglutinins C. Patient fasting for 10-12 hours
___ To avoid D. Keep specimen warm
degradation of
bilirubin
___ To handle arterial
blood gases
___ To avoid lipemia
Match the following:
D To avoid A. Keep specimens in dark
agglutination due B. Keep specimens cold
to cold agglutinins C. Patient fasting for 10-12 hours
A To avoid D. Keep specimen warm
degradation of
bilirubin
B To handle arterial
blood gases
C To avoid lipemia
Capillary blood is composed of:
a) Arterial, venous, capillary, interstitial, and
intracellular blood
b) Venous, cardiac, and peripheral blood
c) Arterial, cerebrospinal, pulmonary blood
d) None of the above
Capillary blood is composed of:
a) Arterial, venous, capillary, interstitial, and
intracellular blood
b) Venous, cardiac, and peripheral blood
c) Arterial, cerebrospinal, pulmonary blood
d) None of the above
The following are reasons for performing a
dermal puncture:
a) Patients with burns or scarring in
venous blood collection sites
b) Patients receiving IV therapy in both
arms and hands
c) Point-of-care testing where only a few
drops of blood are needed
d) All of the above
The following are reasons for performing a
dermal puncture:
a) Patients with burns or scarring in
venous blood collection sites
b) Patients receiving IV therapy in both
arms and hands
c) Point-of-care testing where only a few
drops of blood are needed
d) All of the above
Name the 2 types of lancing devices used
for collection of capillary blood:
a) Syringe and butterfly devices
b) Butterfly devices and evacuated tube
devices
c) Puncture devices and lancet devices
d) Puncture devices and the winged
infusion set
Name the 2 types of lancing devices used
for collection of capillary blood:
a) Syringe and butterfly devices
b) Butterfly devices and evacuated tube
devices
c) Puncture devices and lancet devices
d) Puncture devices and the winged
infusion set
The most common size of a puncture
device for a normal-sized infant is:
a) 1.2 mm
b) 2.0 mm
c) 3.6 mm
d) 4.0 mm
The most common size of a puncture
device for a normal-sized infant is:
a) 1.2 mm
b) 2.0 mm
c) 3.6 mm
d) 4.0 mm
The depth of the incision MUST be
controlled to avoid a complication named:
a) Osteomyelitis
b) Hematopoiesis
c) Osteomalacia
d) Phlebitis
The depth of the incision MUST be
controlled to avoid a complication named:
a) Osteomyelitis
b) Hematopoiesis
c) Osteomalacia
d) Phlebitis
The dermal incision site should be:
a) Free of scars, bruises, rashes, swellings,
blisters
b) Warm and pink
c) Free of bruises and swelling
d) All of the above
The dermal incision site should be:
a) Free of scars, bruises, rashes, swellings,
blisters
b) Warm and pink
c) Free of bruises and swelling
d) All of the above
For finger sticks, the two frequently used
fingers are:
a) The index finger and the little finger
(the pinky)
b) The thumb and the index finger
c) The 3rd and the 4th finger
d) All of the above
For finger sticks, the two frequently used
fingers are:
a) The index finger and the little finger
(the pinky)
b) The thumb and the index finger
c) The 3rd and the 4th finger
d) All of the above
The proper site of a finger stick is the:
a) Tip of the finger where blood is more
readily available
b) Fleshy pad at the end of the finger,
slightly off center
c) Bottom of the finger where there is
more blood available
d) All of the above
The proper site of a finger stick is the:
a) Tip of the finger where blood is more
readily available
b) Fleshy pad at the end of the finger,
slightly off center
c) Bottom of the finger where there is
more blood available
d) All of the above
What is the reason for wiping off the first drop
of blood after creating a dermal incision?
a) To avoid picking up alcohol residue,
contaminants, and interstitial tissue fluid
b) The second drop is usually larger and fuller
c) To give you time to grab the microtainer for
collection of sample
d) To reduce the pain at the incision site
What is the reason for wiping off the first drop
of blood after creating a dermal incision?
a) To avoid picking up alcohol residue,
contaminants, and interstitial tissue fluid
b) The second drop is usually larger and fuller
c) To give you time to grab the microtainer for
collection of sample
d) To reduce the pain at the incision site
The medial plantar surface of the heel is
located:
a) At the very back portion of the heel
b) In the middle of the bottom of the heel
c) On the big-toe side of the bottom of
the heel
d) On the little-toe side of the bottom of
the heel
The medial plantar surface of the heel is
located:
a) At the very back portion of the heel
b) In the middle of the bottom of the heel
c) On the big-toe side of the bottom of
the heel
d) On the little-toe side of the bottom of
the heel
The primary purpose of warming a
capillary puncture site is to:
a) Delay clotting
b) Increase the blood flow
c) Minimize contamination
d) Reduce hemoconcentration
The primary purpose of warming a
capillary puncture site is to:
a) Delay clotting
b) Increase the blood flow
c) Minimize contamination
d) Reduce hemoconcentration
Why do we need to draw blood?
a) Blood test results can help doctors
evaluate how well organs are working
b) A great deal of information can be
learned regarding the patients’ health
status and risk factors
c) Blood test results diagnose diseases
d) All of the above
Why do we need to draw blood?
a) Blood test results can help doctors
evaluate how well organs are working
b) A great deal of information can be
learned regarding the patients’ health
status and risk factors
c) Blood test results diagnose diseases
d) All of the above
What must the process of blood collection
always begin with?
a) Greeting the patient
b) Explaining the procedure to the patient
c) Lab requisition from the physician
d) None of the above
What must the process of blood collection
always begin with?
a) Greeting the patient
b) Explaining the procedure to the patient
c) Lab requisition from the physician
d) None of the above
Requisitions vary from facility to facility
and they can be:
a) Hand-written
b) Preprinted or computer-generated
(electronic)
c) Verbal orders from the ER physician
d) All of the above
Requisitions vary from facility to facility
and they can be:
a) Hand-written
b) Preprinted or computer-generated
(electronic)
c) Verbal orders from the ER physician
d) All of the above
The single most important task a
phlebotomist performs in blood collection
is:
a) Washing hands with antibacterial soap
before handling the patient
b) Wearing gloves while drawing blood
c) Accurately identifying the patient
d) Patient education
The single most important task a
phlebotomist performs in blood collection
is:
a) Washing hands with antibacterial soap
before handling the patient
b) Wearing gloves while drawing blood
c) Accurately identifying the patient
d) Patient education
What would you do if the patient is not
wearing an ID band?
a) Go ahead and draw blood as long as the
patient tells you who they are and grants
you permission
b) Go ahead and draw blood if the nurse
tells you that you have the right patient
c) Ask the nurse to place an ID band on the
patient; then proceed with the proper
procedure and document all action
d) None of the above
What would you do if the patient is not
wearing an ID band?
a) Go ahead and draw blood as long as the
patient tells you who they are and grants
you permission
b) Go ahead and draw blood if the nurse
tells you that you have the right patient
c) Ask the nurse to place an ID band on the
patient; then proceed with the proper
procedure and document all action
d) None of the above
What could go wrong if a patient is
misidentified?
a) The patient will get the wrong diagnosis
based on another patient’s result
b) The patient will get improper course of
treatment
c) In case of blood transfusion, the patient
might have a transfusion reaction which
could be fatal
d) All of the above
What could go wrong if a patient is
misidentified?
a) The patient will get the wrong diagnosis
based on another patient’s result
b) The patient will get improper course of
treatment
c) In case of blood transfusion, the patient
might have a transfusion reaction which
could be fatal
d) All of the above
If ever in doubt as to the identification of a
specimen during any time in the process of blood
collection, specimen transport, or specimen
processing:
a) Continue to use the specimen but notify your
supervisor and document
b) Continue with the testing of the specimen and
also redraw the specimen for comparison
c) Discard the specimen immediately and draw a
new sample
d) All of the above
If ever in doubt as to the identification of a
specimen during any time in the process of blood
collection, specimen transport, or specimen
processing:
a) Continue to use the specimen but notify your
supervisor and document
b) Continue with the testing of the specimen and
also redraw the specimen for comparison
c) Discard the specimen immediately and draw a
new sample
d) All of the above
Proper procedure for phlebotomists to
follow in labeling patient sample tubes is:
a) Pre-label tubes in order to save time
b) Label tubes immediately after drawing
at the patient’s bedside
c) Label tubes after returning to the lab
d) Never label your sample tubes
Proper procedure for phlebotomists to
follow in labeling patient sample tubes is:
a) Pre-label tubes in order to save time
b) Label tubes immediately after drawing
at the patient’s bedside
c) Label tubes after returning to the lab
d) Never label your sample tubes
If a patient is wearing an ID band that does not match the requisition or the patient’s testimony:
a) Go ahead and draw as long as the name given by the patient matches the requisition
b) Stop. Get the nurse to solve the discrepancy by re-banding the patient ensure that the patient’s testimony, the armband, and the requisition all match. Document!
c) Go ahead and draw as long as the nurse
approves it, then document
d) None of the above
If a patient is wearing an ID band that does not match the requisition or the patient’s testimony:
a) Go ahead and draw as long as the name given by the patient matches the requisition
b) Stop. Get the nurse to solve the discrepancy by re-banding the patient ensure that the patient’s testimony, the armband, and the requisition all match. Document!
c) Go ahead and draw as long as the nurse
approves it, then document
d) None of the above
In an effort to prepare the patient for a
draw, what steps must be taken?
a) Introduce yourself, then explain
(educate) the patient in simple terms
b) High-five the patient to gain his/her
confidence
c) Take a cookie from the lab to show
empathy towards the patient
d) All of the above
In an effort to prepare the patient for a
draw, what steps must be taken?
a) Introduce yourself, then explain
(educate) the patient in simple terms
b) High-five the patient to gain his/her
confidence
c) Take a cookie from the lab to show
empathy towards the patient
d) All of the above
When you go into a room and find the
patient sleeping:
a) This is your chance. Whistle a lullaby
and quietly draw the sample without
awakening the patient
b) Find the nurse for instructions
c) Gently awaken the patient before
beginning the procedure
d) None of the above
When you go into a room and find the
patient sleeping:
a) This is your chance. Whistle a lullaby
and quietly draw the sample without
awakening the patient
b) Find the nurse for instructions
c) Gently awaken the patient before
beginning the procedure
d) None of the above
If the patient is out of their room:
a) You may return later as long as it is not
a timed draw or a STAT draw
b) If it is a routine draw, come back later
when the patient is back in the room
c) If it is a timed draw or a STAT draw, ask
the nurse to locate the patient.
Document all activities.
d) All of the above.
If the patient is out of their room:
a) You may return later as long as it is not
a timed draw or a STAT draw
b) If it is a routine draw, come back later
when the patient is back in the room
c) If it is a timed draw or a STAT draw, ask
the nurse to locate the patient.
Document all activities.
d) All of the above.
If a patient refuses to have a venipuncture
performed, the phlebotomist should:
a) Never force the patient to undergo
venipuncture
b) Try to determine why and attempt to
alleviate their fears if possible
c) Report refusal to the nurse and your
supervisor and document
d) All of the above
If a patient refuses to have a venipuncture
performed, the phlebotomist should:
a) Never force the patient to undergo
venipuncture
b) Try to determine why and attempt to
alleviate their fears if possible
c) Report refusal to the nurse and your
supervisor and document
d) All of the above
Bandages, gloves and gauze that are
contaminated with potentially infectious
material must be placed in a:
a) Container that has the special
“Biohazard Symbol”
b) Container with a ”Caution,
Contaminated Items” sign
c) Sharps container
d) Recycling bin
Bandages, gloves and gauze that are
contaminated with potentially infectious
material must be placed in a:
a) Container that has the special
“Biohazard Symbol”
b) Container with a ”Caution,
Contaminated Items” sign
c) Sharps container
d) Recycling bin
All sharps (needles, lancets, slides, etc.)
must be disposed in:
a) A red bag with the Biohazard symbol
b) A brown bag with the Biohazard symbol
c) In a container with double red bags with
the Biohazard symbol
d) A sharps container with the biohazard
symbol
All sharps (needles, lancets, slides, etc.)
must be disposed in:
a) A red bag with the Biohazard symbol
b) A brown bag with the Biohazard symbol
c) In a container with double red bags with
the Biohazard symbol
d) A sharps container with the biohazard
symbol
Sharps container must be:
a) Leak-proof and puncture-resistant
b) Sealed and replaced when 2/3 full
c) Used for only sharp objects
d) All of the above
Sharps container must be:
a) Leak-proof and puncture-resistant
b) Sealed and replaced when 2/3 full
c) Used for only sharp objects
d) All of the above
Infectious waste is:
a) Waste that is produced by infectious
individuals
b) Waste material that must only be
handled by the Infectious Committee
c) Any material (wound dressing,
bandages, blood or body fluid-soaked
paper towels, etc) that can carry disease
d) None of the above
Infectious waste is:
a) Waste that is produced by infectious
individuals
b) Waste material that must only be
handled by the Infectious Committee
c) Any material (wound dressing,
bandages, blood or body fluid-soaked
paper towels, etc) that can carry disease
d) None of the above
When collecting blood cultures which antiseptic should you use?
Chloraprep
What is the order of draw mnemonic?
be, lighthearted, respectful, gentle, loving and gracious
What is a sclerosed vein?
Sclerosed veins
* Hardened veins
* Difficult to push needle through
What are the 3 types of sclerosed vein?
Tortuous veins
* Twisted veins
* Easy to push needle through wall
Thrombotic veins
* Blood clot in the vein
* Feels hard, inflexible, and tender
Phlebitic veins
* Inflammation of blood vessels
* Tender and warm to touch – appear red
Which of the following equipment is required when collecting blood with the syringe method?
Multisample needle
Transfer device
Tube holder
Lancet
Transfer device
A light blue topped tube is most often associated with tests in which department?
Chemistry
Hematology
Coagulation
Serology
Coagulation
What type of is 1st in your order of draw?
Blood culture (sterile tube)
What is the tube top color for a blood culture?
Can vary depending on brand and manufacturer but it is noted as “Blue and Red bottle, yellow SPS”
What additives will be found in a yellow topped Blood culture (sterile tube)?
Sodium Polyanethol Sulfonate (SPS) not used very often anymore
When drawing a blood culture which bottle should be drawn first and why does it matter?
Depends on method BUT if you are using a method where there is air introduced BEFORE the bottle then you must use the aerobic bottle first. Introducing oxygen into the oxygen poor environment of the Anaerobic bottle can ruin test results.
What is a Blood Culture test used for and by which department?
Microbiology uses the blood culture to determine the presence or absence of infection
When drawing a Blood culture you don’t need to wait 30 seconds after applying povidone-iodine/chloraprep before venipuncture, only with isopropyl alcohol.
T/F
FALSE
You must wait 30 seconds before venipuncture when drawing a blood culture, use the time to wipe the bottle tops
What is the 2nd tube type drawn in the proper order of draw?
Coagulation Tube
What is the top color for a Coagulation tube?
Light blue
What additive would you find in a Light Blue tube?
Sodium Citrate
What tube would you find Sodium Citrate in and what does it do?
Sodium Citrate is found in a Light Blue Coagulation tube and it prevents coagulation by binding to Calcium
What is blood collected in a Light Blue tube used for?
Coagulation Studies
Most commonly:
* PT = prothrombin time
* aPTT = activated partial thromboplastin time
You receive a requisition form for a PT and PTT test, which bottle top color will you grab?
Light Blue
Plasma comes from tubes that contain an anti-coagulant and Serum is the liquid part of blood after coagulation.
T/F?
TRUE
Plasma: cell-free liquid part of blood that has been treated with an anticoagulant
Serum: liquid part of blood AFTER coagulation, therefore devoid of clotting factors, like fibrinogen
What is the ratio of blood-to-anticoagulant necessary in Coagulation Tube?
Light Blue
9:1 ratio of blood-to-anticoagulant
If a butterfly needle is used, and the light blue is the only or first tube, a discard tube must be drawn first?
For collections with butterfly blood collection sets, a discard tube should be collected prior to collection of the blue top to ensure sufficient sample volume. Drawing a discard tube will displace the air from the blood collection set tubing to ensure proper blood draw volume.
How many times does a Coagulation Tube need to be mixed?
3-4 gentle turns
You can actually destroy the sample by over mixing or being too aggressive
What is the 3rd type of tube in the proper order of draw?
Non-Additive tube
What color top would you find on a Non-Additive tube?
Red
If you are draw requires a discard tube which tube should you grab and why?
A red top, Non-Additive tube.
Specifically because there are no chemicals to worry about cross contamination
What additives would you find in a Red Top tube?
None, it is a Non-Additive tube
Which department(s) would likely use a Red Top tube and what might they use it for?
Serology - the scientific study or diagnostic examination of blood serum, especially with regard to the response of the immune system to pathogens or introduced substances.
Serum chemistry tests so tests on blood serum without clotting factors
A requisition form asks you to draw blood for a Uric Acid, PSA or Lipid Panel. Which tube should you grab?
Red Top
What are the common tests that require collection via a Non-Additive tube?
Red top
Uric Acid, PSA, Lipid Panel
If you need a Serum Separator Tube (SST) which color tube top will you grab?
Gold / Tiger Top
SST = Serum Separator Tube
Contains gel at the bottom to separate serum from RBCs
What is an SST tube?
Serum Separator Tube (SST)
That includes Red, Gold / Tiger top tubes
What is the mode of action for a Red, Gold or Tiger Top tube?
Blood is allowed to clot.
You have to wait 30 minutes for the blood to clot before testing
If they are all SSTs, what is the difference between a Red top tube and a Gold / Tiger Top tube?
Red tops have no chemical additive
Gold/Tiget Tops include a clot activator or gel seperator
Which departments use Serum Separator Tubes?
Serology - the scientific study or diagnostic examination of blood serum, especially with regard to the response of the immune system to pathogens or introduced substances.
Serum chemistry tests so tests on blood serum without clotting factors
If your requisition form lists a Hepatic Panel, BMP or CMP which type of tube/color would you prepare?
Serum-Seperator Tube (SST)
Gold / Tiger Top
Because they do not contain anticoagulants ______, _______ and _______ tubes are used for serum testing.
Red, Gold and Tiger
When asked for a Heparin tube, which color should you grab?
Light green (Lithium Heparin) or Dark Green (Sodium Heparin), depending on the additive needed
Used for Chemistries
- For lithium level, use sodium heparin
- For sodium level, use lithium heparin
- For ammonia level, use either
What is the 4th type of tube used in the order of draw?
Heparin Tube (PST)
What is the difference between a Light Green and Dark Green top?
Light green contains lithium heparin and dark green contains Sodium Heparin
What is the mode of action for a Green top tube?
Heparin prevents coagulation by inhibiting
the action of thrombin
If coagulation is prevented because thrombin is inhibit the chemical anticoagulant is…?
Heparin
What kind of test requires collection in a Green top tube?
Plasma Chemistry Tests
You receive a requisition form that is asking for Electrolytes (Lytes) or Ammonia test, which bottle(s) do you grab?
Heparin Tube (PST) Light/Dark Green
What is the 5th tube we collect in the proper order of draw?
Lavender EDTA tube
What color is an EDTA tube?
Lavendar
What additives would you find in a Lavender tube?
Potassium EDTA or Sodium EDTA
What is EDTA and what does it do?
Anticoagulant that prevents coagulation by binding to calcium
- Forms calcium salts to remove calcium
- Prevents platelet aggregation
- Preserves the shape of the cell
NOTES
-Primarily used for whole blood testing
-Cannot be used for coagulation studies
-NEVER draw before heparin
Which tube prevents platelet aggregation?
Lavender EDTA tube
Which department is most likely to request a draw with an EDTA tube?
Hematology studies
When asked to draw a CBC which tube will you grab?
Lavendar EDTA tube
What is a CBC and which tube do you collect blood with for that test?
CBC = complete blood count
Lavender EDTA tube
Which tube is primarily used for whole blood specimens?
Lavendar EDTA Tube
What color is a Glycolitic Inhibitor Tube?
Gray top
What is the 6th tube in the correct order of draw?
Gray top Glycolitic Inhibitor Tube
Which tube contains Potassium Oxalate/Sodium Fluoride?
Gray top Glycolitic Inhibitor Tube
What additives would you find in a Gray top tube?
Potassium Oxalate/Sodium Fluoride
Antiglycolytic agent preserves
glucose for up to 5 days
What is the mode of action in a Grey top Glycolitic Inhibitor tube?
- Potassium oxalate = prevents coagulation by binding Ca2+
- Sodium fluoride = inhibits glycolytic activity
What department(s) my request test requiring a Grey top tube?
Chemistry and Toxicology
Common tests: Blood EtOH, Glucose, Lactic Acid
You are requested to draw blood for a Blood EtOH, Glucose or Lactic Acid test, which tube to you grab?
Gray top Glycolitic Inhibitor Tube
Your requisition form requests: Blood EtOH, Uric Acid, BMP and PT.
What tube tops are you getting and what is the proper order of draw?
Light blue (PT) > Red Non-Additive (Uric Acid) > Gold/TIger Serum Separator (BMP) > Gray Glycolitic Inhibitor (Blood EtOH)
Your requisition form requests: Electrolytes, CBC, Lipid Panel and Blood Cultures.
What tube tops are you getting and what is the proper order of draw?
Blood culture bottle Aerobic first (Blood Cultures) > Red Non-Additive(Lipid Panel) > Light green / Dark green Heparin Tube (Electrolytes) > Lavender EDTA (CBC)
Your requisition form requests: CMP, CBC, PTT and Glucose
What tube tops are you getting and what is the proper order of draw?
Light blue coagulation tube (PTT), Gold/Tiger Serum Seperator Tube (CMP) > Lavendar EDTA Tube (CBC) > Gray Glycolitic Inhibito Tube (Glucose)
What information MUST appear on a requisition form?
Patient info - First and Last name, Middle name or initial
ID Number or medical record number
Date of Birth
Location (in patient only)
Ordering Physicians’ name
Name(s) of test(s) ordered
Date and time of specimen collection
Phlebotomists’ ID number or initials
(or student phlebotomist)
What should you do if you have doubts while collecting a specimen?
- Report to supervisor IMMEDIATELY
- Seek help from nurse in charge
- Redraw specimen if necessary
What is the most important task the phlebotomist performs?
Identification of the patient
Per the Joint Commision a patient must be identified by atleast ___ number of steps.
2;
Step 1: Ask patient for full name and DOB
Step 2: Match patient information on requisition to patient’s ID band
If presented with a Pink top tube, what is it and where does it belong in your order of draw?
sPink top contains EDTA so it follow the Lavendar EDTA
It is used in blood banks for type and screen
If presented with a Yellow top tube, what is it and where does it belong in your order of draw?
Yellow top contains Acid citrate dextrose (ACD) which preserves WBCs and it follows the Gray tube
HLA typing and other tests that
require isolation of DNA
If presented with a Black top tube, what is it and where does it belong in your order of draw?
Black top contains Sodium citrate and would follow Light Blue tube
Coagulation
- Westergren sedimentation rate
Special filling requirement
4:1 ratio of blood to anticoagulant
If presented with a Brown top tube, what is it and where does it belong in your order of draw?
Brown top contains Heparin and would follow light/dark green tubes
Lead testing
If presented with a Dark Blue top tube, what is it and where does it belong in your order of draw?
Dark blue can actually contain different additives:
No additive
Sodium heparin
EDTA
This means they can be drawn, depending on the additive, in different places within the order of draw.
They are used in toxicology for trace metal assays
What are the special handling instructions associated with blood gases?
Keep cold
What are the special handling instructions associated with ACE
Keep cold
What are the special handling instructions associated with ACTH
Keep cold
What are the special handling instructions associated with Glucagon
Keep cold
What are the special handling instructions associated with Catecholamines
Keep cold
What are the special handling instructions associated with Ammonia
Keep Cold
What are the special handling instructions associated with Gastrin
Keep cold
What are the special handling instructions associated with Renin
Keep cold
What are the special handling instructions associated with Cold agglutinins?
Keep Warm
What are the special handling instructions associated with Bilirubin
Keep in the dark
What are the special handling instructions associated with Carotene
Keep in the dark
What are the special handling instructions associated with Vitamin B12
Keep in the dark
What are the special handling instructions associated with Folic Acid
Keep in the dark
When do we make blood smear slides?
