NHA Certified Phlebotomy Technician (CPT)

B. Transport to the microbiology laboratory at room temperature.

Blood cultures are typically transported to the microbiology laboratory at room temperature to promote bacterial growth if present. Refrigeration or extreme temperatures can inhibit growth and affect test results.

C. Centrifuge and transport plasma at room temperature.

Coagulation specimens for PT/aPTT require prompt separation of plasma from cells. Once separated, the plasma can be transported at room temperature for up to 24 hours for PT and 4 hours for aPTT, or frozen for longer stability. Whole blood should not be transported for extended periods due to cellular metabolism affecting coagulation factors.

D. To determine if the patient has followed dietary restrictions for accurate test results.

Many laboratory tests, such as glucose and lipid panels, require the patient to fast for a specific period. Failure to fast can significantly alter test results, leading to misdiagnosis or inappropriate treatment.

C. Ensuring rapid delivery to the laboratory.

CSF specimens, especially those for microbiology or cell count analysis, must be delivered to the laboratory and processed rapidly to maintain cell viability and prevent degradation. Delays can lead to inaccurate results.

C. Patient communication.

Explaining the procedure and what the patient can expect (like the application of a tourniquet) falls under patient communication. It helps to inform the patient and reduce anxiety.

A. Notify the nurse and request an alternative method for blood collection.

Edematous areas should be avoided for venipuncture due to altered test results, difficulty in locating veins, and increased risk of infection. Notifying the nurse for an alternative collection method or further assessment is the safest and most appropriate action.

A. Centrifuging the specimen 5 minutes after collection.

Serum tubes (e.g., red-top or SST) require a specific clotting time, typically 30-60 minutes at room temperature, before centrifugation. Centrifuging too early (e.g., 5 minutes) will result in incomplete clotting, leading to fibrin strands in the serum and potential re-clotting, which can interfere with testing and cause instrument errors.

A. Stop the procedure and ask the patient if they would like to discuss their concerns.

Patients have the right to refuse medical procedures. If a patient expresses refusal, the technician must stop and attempt to understand their concerns. Proceeding without consent can be considered assault.

C. The right arm, if no other contraindications are present.

Venipuncture should always be avoided on the same side as a mastectomy due to the risk of lymphedema, infection, and altered lymphatic drainage. The right arm should be prioritized, assuming it has no other contraindications.

A. Ensure the specimen is not contaminated with urine or toilet water.

Stool specimens for ova and parasites must not be contaminated with urine or toilet water, as these can dilute or destroy the parasites, making detection difficult or impossible. The patient should collect the specimen in a clean, dry container.

B. Use a pipette with a safety bulb or mechanical device.

Using a pipette with a safety bulb or mechanical device prevents mouth pipetting, which is a significant biohazard risk when handling specimens. This is a primary safety measure during aliquoting.

A. Absorbent material.

Absorbent material is essential in the secondary container to contain any spills or leakage from the primary specimen container, preventing contamination and ensuring safety during transport.

C. Acknowledge their anxiety and offer simple, calming reassurance.

Acknowledging a patient's feelings validates their experience and helps build trust. Offering simple, calming reassurance can help de-escalate their anxiety before proceeding with other techniques.

A. Immediately withdraw the needle.

Sharp, shooting pain radiating down the arm during venipuncture indicates potential nerve involvement or damage. The immediate and most appropriate action is to withdraw the needle completely to prevent further injury.

B. Select a vein in the dorsal side of the hand or wrist.

Tattooed skin can obscure veins, mask signs of infection, and potentially increase the risk of infection or reaction. While some sources say it's acceptable if the skin is healthy and veins are visible, the safest practice is to select an alternative site without tattoos, such as the dorsal hand or wrist, if available.

A. Explain each step of the procedure clearly and answer their questions.

Providing clear, concise information about the procedure and allowing the patient to ask questions helps demystify the process, giving them a sense of control and reducing anxiety. This is often more effective than simple reassurance or distraction.

D. Notify the nurse or ordering provider to request a recollection.

Urine specimens for routine UA should be tested within 1 hour or refrigerated if a delay is expected. Sitting at room temperature for 4 hours can lead to bacterial overgrowth, cellular degradation, and changes in pH, making the results unreliable. A recollection is necessary.

D. Minimizing pain for the infant.

While all options are important, minimizing pain is paramount for infants to prevent trauma, distress, and to ensure cooperation for future procedures. This often involves specific techniques and site choices (e.g., heel stick for newborns, dorsal hand veins for older infants) and sometimes topical anesthetics.

C. Mix the tube thoroughly by inverting 8-10 times immediately after collection.

EDTA tubes contain an anticoagulant that must be thoroughly mixed with the blood to prevent clotting. Insufficient mixing will lead to microclots, which can consume platelets and affect cell counts, or cause erroneous results in other tests if serum/plasma is drawn off clotted blood.

B. A site on the foot, with physician's permission.

Drawing blood from a prosthetic limb is impossible. Drawing from an arm with an active IV, even below the IV, can dilute the sample. Therefore, with both arms compromised, a foot vein (with physician permission) is the most appropriate next consideration, especially for adults.

B. Isopropyl alcohol

Isopropyl alcohol is contraindicated for blood alcohol level (BAL) tests because it can falsely elevate the patient's blood alcohol results by contaminating the specimen. Non-alcohol-based antiseptics like povidone-iodine or chlorhexidine gluconate should be used.

D. Placing tubes of equal volume opposite each other.

Balancing the centrifuge by placing tubes of equal weight (volume) opposite each other is essential to prevent vibration, damage to the centrifuge, and potential breakage of tubes, ensuring safe and effective separation.

B. Ensure the centrifuge is balanced with tubes of equal volume.

Balancing the centrifuge with tubes of equal volume and opposite placement is crucial to prevent vibration and uneven forces that can cause hemolysis. Unbalanced centrifugation can damage red blood cells.

B. Wrapping the specimen tube in aluminum foil or using an amber-colored tube.

Specimens sensitive to light, such as bilirubin or vitamin B12, must be protected from photodecomposition. Wrapping in aluminum foil or using an amber-colored tube effectively blocks light exposure.

A. The tube has been inverted 5 times after collection.

Serum specimens (e.g., in red or gold top tubes) require a complete clotting time, typically 30 minutes at room temperature, before centrifugation. Inverting a plain serum tube is not part of the standard process, and if it's a tube with clot activator, 5 inversions may not be sufficient for complete activation and clotting.