NHA Certified Phlebotomy Technician (CPT) flashcards

The optimal angle of needle insertion when using a winged infusion set (butterfly needle), typically shallower than standard venipuncture, to accommodate superficial and fragile veins.

• Used for small, fragile, or rolling veins.
• Commonly used for pediatric and geriatric patients.
• Shallower angle (10-15 degrees) reduces risk of vein perforation.
• Allows for greater flexibility and control during collection.

Memory trick: ANGLE Precision: Always Nudge Gently, Low Entry.

Choosing an appropriate venipuncture site when standard sites are contraindicated due to medical conditions or existing treatments.

• Avoid mastectomy side.
• Avoid IV arm, especially above or directly in the line.
• Consider alternative sites like dorsal hand or foot (with physician approval).

Memory trick: Mastectomy, IV, no go; find a clean flow.

Blood cultures are highly susceptible to contamination by skin flora. Preventing this requires meticulous antiseptic technique to ensure accurate diagnostic results.

• False positives lead to unnecessary treatment.
• Skin flora is the main source of contamination.
• Povidone-iodine or chlorhexidine are common antiseptics.

Memory trick: Clean skin, clean blood, clear results!

The specific, safe area on an infant's heel designated for dermal puncture to collect capillary blood, avoiding critical anatomical structures.

• Medial or lateral aspects of the plantar surface.
• Avoids the center, posterior curvature, and arch of the foot.
• Crucial for preventing osteomyelitis and nerve damage.
• Puncture depth should not exceed 2.0 mm.

Memory trick: HEEL Safely: Hot (warm), Edge, Avoid Center, Lancet Size.

An unexpected medical emergency during blood collection where the patient experiences uncontrolled electrical activity in the brain, requiring immediate safety interventions by the phlebotomy technician.

• Patient safety is the top priority.
• Remove needle immediately to prevent injury.
• Protect patient from self-harm (e.g., hitting head).
• Call for medical assistance after initial safety measures.

Memory trick: SEIZURE Safety: Secure, Evacuate, Identify, Zap (call for help), Understand, Report, Evaluate.

Measures taken to prevent or mitigate fainting episodes during venipuncture, often due to a sudden drop in heart rate and blood pressure.

• Often triggered by anxiety or pain.
• Symptoms include dizziness, lightheadedness, pallor, and nausea.
• Positioning is key to patient safety.

Memory trick: Fainting patients need a safe landing.

Collection of a blood specimen after a specified period of abstinence from food and drink (usually 8-12 hours), often required for tests like glucose and lipid panels.

• Water is generally permitted.
• Non-fasting can significantly alter results.
• Patient education is crucial for compliance.

Memory trick: Fasting facts: food invalidates, reschedule for accuracy.

When blood flow is slow or stops during venipuncture, the initial troubleshooting step is to gently adjust the needle's position to ensure it is properly seated within the vein lumen.

• Common causes: needle not fully in vein, bevel against vein wall, vein collapse
• Gentle adjustment is often sufficient
• Avoid excessive probing
• If unsuccessful after adjustment, remove and try new site

Memory trick: If the blood is slow, 'Adjust' and 'Assess' before you 'Abort'.

A standardized sequence for collecting multiple blood tubes during a venipuncture to prevent additive carryover from one tube to another, which could contaminate specimens and alter test results.

• Ensures accurate test results by minimizing additive interference.
• Different additives affect different test types.
• Common sequence: Blood culture, Light blue, Red/Gold SST, Green, Lavender, Gray.

Memory trick: BLGRGL: Blood Cultures, Light Blue, Red/Gold, Green, Lavender, Gray

To accurately begin a 24-hour urine collection, the patient should typically discard the first morning void on the starting day and then collect all subsequent urine for the full 24-hour period.

• Establishes precise collection start time
• Ensures all urine produced within a 24-hour window is collected
• Patient voids into toilet, then starts collection
• Last void collected is the first void of the next day

Memory trick: First pee 'Goes', then 'Collect All' for a full day's 'Show'.

When a patient has an IV infusion, venipuncture should ideally be performed on the opposite arm to prevent dilution of the specimen by IV fluids and avoid complications.

• Opposite arm is preferred.
• Avoid drawing above or below an active IV if possible.
• If no other site, IV must be turned off for a period (e.g., 2-5 min) and blood drawn below, then flushed.

Memory trick: IV in one, draw from the other, keep results pure!

Vein stabilization is the technique of using the thumb of the non-dominant hand to firmly anchor the vein below the intended puncture site, preventing it from rolling during needle insertion.

• Crucial for small, fragile, or rolling veins
• Prevents vein movement during needle entry
• Use sufficient downward pressure
• Technician's thumb should be 1-2 inches below the site

Memory trick: For a 'Rolling' vein, 'Anchor' it 'Firmly' to hold it 'Still'.

The specific blood collection tube type used for various common chemistry tests, often containing an anticoagulant to yield plasma or a clot activator to yield serum.

• Common chemistry tests include electrolytes, glucose, LFTs, kidney function.
• Green (heparin) or Gold/Red SST (serum separator) are typical choices.
• Heparin prevents clotting, yielding plasma.
• SSTs contain a clot activator and gel separator, yielding serum.

Memory trick: RED LIGHT GREEN LAVENDER GREY: Remember Each Different Lab's Great List.

The practice of discarding the initial drop of blood produced during a dermal (capillary) puncture before collecting the specimen, done to eliminate tissue fluid contamination.

• Tissue fluid can dilute the sample and affect test results.
• Ensures a more accurate and pure blood specimen.
• Especially important for glucose, potassium, and calcium tests.
• The second drop is typically used for collection.

Memory trick: WIPE First: Wipe, Impurity, Pure, Eliminate.

A common complication of venipuncture where blood leaks from the vein into the surrounding tissue, causing swelling, pain, and discoloration.

• Caused by needle through vein, partial bevel in vein, or insufficient pressure.
• Symptoms: rapid swelling, pain, bruising.
• Action: remove tourniquet and needle, apply direct pressure.

Memory trick: Swelling and pain? It's a hematoma's reign.

For infants (typically under 12 months), capillary punctures are safely performed on the heel to prevent bone damage and ensure adequate blood flow.

• Medial or lateral plantar surface of the heel.
• Avoid central arch of the foot.
• Depth of puncture should not exceed 2.0 mm.

Memory trick: For the littlest, stick to the heel!

A blood collection tube containing heparin, used to obtain plasma for various chemistry tests.

• Anticoagulant: Heparin.
• Specimen: Plasma.
• Common uses: Routine chemistry, electrolytes, liver function, renal function.

Memory trick: Green means go for general chemistry flow.

When blood flow stops suddenly during venipuncture despite correct needle placement, it often indicates the needle bevel is obstructed by the vein wall, a valve, or the vein has collapsed.

• Bevel against vein wall is common.
• Vein collapse can also occur.
• Gently adjusting needle can resolve.

Memory trick: Flow stops? Check the 'B' for 'Bevel' or 'C' for 'Collapse'!

Specific handling required for specimens collected for cold agglutinin tests, where the blood must be kept warm at body temperature (37°C) from collection to processing to prevent the agglutinins from reacting.

• Cold agglutinins are antibodies that clump red blood cells at cold temperatures.
• Specimen must be collected in a pre-warmed tube.
• Transport immediately to the lab while maintaining warmth (e.g., in a heel warmer or warm block).
• Prevents false positive or inaccurate results due to agglutination.

Memory trick: TEMP MATTERS: Temperature, Exposure, Moisture, Protection, Agitation, Timing.

Interruption of blood collection during a venipuncture while the needle remains in the vein, often due to needle displacement.

• Can be caused by needle against a valve or vein wall.
• Can be caused by needle going through the vein.
• Gentle adjustment is usually the first corrective action.

Memory trick: Needle stuck? Adjust, don't pluck!

For STAT (immediately needed) chemistry tests, a green top tube containing heparin is preferred because it allows for rapid plasma separation, providing results faster than serum tubes.

• Heparin prevents blood clotting
• Plasma can be separated immediately
• Faster turnaround time for critical results
• Commonly used for electrolytes, BUN, creatinine, glucose

Memory trick: For STAT 'Speed', think 'Green' for 'Go'.

The specific sequence in which blood collection tubes are filled during venipuncture to prevent cross-contamination of additives between tubes, ensuring accurate test results.

• Standardized by CLSI (Clinical and Laboratory Standards Institute)
• Prevents additive carryover
• Ensures accurate lab results
• Common sequence: Blood Cultures, Light Blue, Red/Gold, Green, Lavender, Gray

Memory trick: BLGRGLG: 'Blood Cultures' 'Light Blue' 'Red/Gold' 'Green' 'Lavender' 'Gray'… 'Go'!

The maximum safe puncture depth for infant heel sticks is 2.0 mm, crucial for preventing osteochondritis and other bone injuries.

• Max depth: 2.0 mm.
• Prevents calcaneus injury.
• Use appropriate lancet size.

Memory trick: Two millimeters, no deeper, for tiny heel's sake!

A tube collected prior to a light blue top (coagulation) tube when using a winged infusion set to remove air from the tubing and ensure proper fill volume.

• Only necessary with butterfly needles.
• Prevents underfilling of light blue top tubes.
• Ensures correct anticoagulant-to-blood ratio.

Memory trick: Butterfly's air is a snare, discard first, then blue, no despair.

Guidelines for safely collecting blood specimens from patients receiving IV infusions to prevent dilution or contamination of the sample.

• Always prefer the opposite arm if available.
• If opposite arm is not an option, draw below the IV site.
• Never draw above an IV site.
• If drawing below, ask nurse to stop IV for 2-5 minutes, discard first 5 mL of blood, or draw below the IV and document the site.

Memory trick: IV in one arm? Use the other arm's charm!

When a needle punctures or presses against a nerve during venipuncture, causing sharp, radiating pain.

• Symptoms: sharp, radiating, electric-shock-like pain.
• Immediate action: remove needle.
• Can lead to permanent nerve damage if not addressed promptly.

Memory trick: Sharp Radiating Pain? Escape the Nerve Lane!

A blood collection tube containing heparin, used to obtain plasma for chemistry tests.

• Contains anticoagulant heparin (lithium, sodium, or ammonium heparin).
• Prevents blood clotting by inhibiting thrombin.
• Yields plasma after centrifugation.
• Commonly used for routine chemistry, electrolytes, and STAT chemistry.

Memory trick: Remember the rainbow of tubes for different tests!

The specific blood collection tube and anticoagulant required for a Complete Blood Count (CBC) test.

• Tube color: Lavender top.
• Additive: EDTA (Ethylenediaminetetraacetic acid).
• Purpose: Prevents clotting while preserving cell morphology for hematology analysis.

Memory trick: CBC and EDTA: Lavender's the Way for Hematology's Play.

Bilirubin is a light-sensitive analyte; specimens collected for bilirubin testing must be protected from light exposure to maintain integrity.

• Bilirubin degrades rapidly when exposed to light.
• Light exposure causes falsely decreased bilirubin levels.
• Wrap tubes in foil or use amber-colored tubes for protection.

Memory trick: Bilirubin's a baby, sunlight makes it cry (degrade)!

Recommended finger sites for collecting capillary blood samples from adult patients to ensure safety and adequate sample volume.

• Middle or ring finger of the non-dominant hand.
• Puncture off-center, on the fleshy pad.
• Avoid areas with scars, bruises, or edema.

Memory trick: Middle and Ring, the Best Blood Bring.

Specific antiseptic requirements for blood alcohol content (BAC) testing to ensure accurate results by avoiding alcohol contamination.

• Must use non-alcohol-based antiseptic.
• Common choices: Benzalkonium chloride, Povidone-iodine.
• Alcohol-based wipes can falsely elevate BAC readings.

Memory trick: For BAC, No Alcohol in the Wipe, or your results will be a hype!

The technique of stabilizing a vein by pulling the skin taut directly below the intended puncture site, preventing it from rolling.

• Performed with the thumb of the non-dominant hand.
• Pull the skin taut in the direction of the hand.
• Helps prevent veins from rolling, especially in elderly or pediatric patients.
• Crucial for successful venipuncture, particularly with small or fragile veins.

Memory trick: Stable veins mean successful draws.

For infant dermal punctures, the safest and most appropriate site is the lateral or medial aspects of the plantar surface of the heel.

• Avoids injury to bone (calcaneus) and nerves.
• Puncture depth should not exceed 2.0 mm.
• Warm the heel prior to puncture to increase blood flow.

Memory trick: Infant heel: Sides are safe, middle means danger!

Systematic steps to identify and correct issues when blood flow is inadequate or stops during venipuncture.

• First check needle position relative to vein.
• Consider if the tube vacuum is compromised.
• Assess tourniquet application and patient position.
• Never 'fish' for the vein; gentle repositioning or withdrawing is safer.

Memory trick: Slow flow? Check the angle, then the tube, then the tourniquet.

The process of verifying a patient's identity using at least two unique identifiers before performing any medical procedure, including venipuncture, to ensure the correct patient receives the correct care.

• Crucial for patient safety.
• Requires at least two identifiers.
• Identifiers should be unique to the patient.

Memory trick: Two IDs for You and Me!

The complete blood count (CBC) is performed using a lavender (EDTA) top tube to prevent blood clotting and preserve cell structure.

• EDTA is an anticoagulant that binds calcium.
• Preserves cellular components for accurate counting and differentiation.
• Used for CBC, ESR, HgbA1c, and other hematology tests.

Memory trick: Every Color Has A Job!