NCCT Phlebotomy)NCCT Phlebotomy Preparation
What is the first step in performing a venipuncture? - ANSWER:identify the patient
To prevent error and maintain a culture of safety, at least 2 identifiers (ex. full name and date of birth)
must be verified prior to performing a procedure.
What is the proper way to identify a patient prior to performing a venipuncture? - ANSWER:Ask the
patient to state his/her full name and DOB and compare to the chart.
Before a venipuncture, the medical assistant should ask the patient to state his/her full name and DOB
(comparing what is stated to what is written in the chart or on a wrist band patient identifier). This
minimizes the risk for mis-identification errors because it cross-checks what the patient says against
written documentation. This provides a verified identity so that all tubes collected will be associated with
the correct patient (provided the medical assistant labels them properly).
Using the guidelines for any method of venipuncture, what action should the medical assistant perform
directly after confirming patient identity? - ANSWER:Review the requirements for collecting and handling
the blood specimen as ordered by the physician
To ensure accuracy and quality, it is important to anticipate your needs before beginning the actual
venipuncture (i.e. tube color/size, minimum acceptable blood volume, whether or not the specimen
needs to be placed on ice). Therefore, the medical assistant would identify the patient, then review the
requirements for collecting and handling the blood specimen as ordered by the physician. Next,
assemble the appropriate equipment and select the proper evacuated tubes for test to be performed.
Then, apply the tourniquet and thoroughly palpate the selected vein. Finally, position the patient's arm
and cleanse the site with an antiseptic wipe, then proceed with the venipuncture protocol.
What should be avoided as a form of patient identification? - ANSWER:insurance number
An insurance number is not a common means of positive patient identification (entire families can share
the same insurance policy number). Patients must be positively identified for medical services, whether
they have insurance or not. Insurance information is necessary for billing purposes. The only true unique
identifier listed among these choices is the social security number. Patient name and date of birth are
also commonly used to confirm identification.
Name the two most used patient identifiers. - ANSWER:Patient's name/date of birth
,Name and DOB are most often used as positive patient identifiers as they are easily documented and
work for inpatients or outpatients. Bed numbers should never be used as identifiers for inpatients or
outpatients, nor should physician name associations. Medical record numbers are valuable for
inpatients, with name and DOB being used most often.
Prior to any type of inpatient specimen collection, a phlebotomist must correctly verify their patient's
identity by using which two-step procedure? - ANSWER:Check ID bracelet, and ask patient to verbally
confirm their identity.
The correct answer is to check the ID bracelet and ask the patient to verbally confirm his/her identity.
Patients may not have foot bed charts or IV bags, and the goal is to select the BEST answer of all choices.
If a patient has both an ID bracelet and can verify his/her own identity, it is ideal.
The phlebotomist is drawing blood from a patient that is taking blood thinners. What is a necessary
piece of additional equipment to have at the drawing station? - ANSWER:non-adhering bandage
Non-adhering bandage material would be helpful for patients on anticoagulant therapy who may bleed
more extensively than typical patients after venipuncture. It is necessary to contain the bleed with a
bandage, but adhesive might bruise once removed from a patient who has anticoagulated blood.
In which of the following time frames should a tourniquet be routinely released on a patient while
performing a blood draw? - ANSWER:within one minute
The standard time limit for having a tourniquet on a patient is one minute. Inaccurate laboratory test
results may occur if a tourniquet is not removed within one minute. When a tourniquet is applied, the
local blood flow is stopped. This leads to concentration of the blood and blood entering the surrounding
tissue. This may result in falsely high values for all protein-based analytes, increased packed cell volume,
and changes in other cellular elements. The most current edition of the CLSI Procedures for the
Collection of Diagnostic Blood Specimens by Venipuncture, H3-A6, states that the tourniquet application
for preliminary vein selection should not exceed one minute. For most patients, it is easy to release the
tourniquet within the one-minute period. Most veins are easily located and the venipuncture procedure
can be completed quickly.
A medical assistant has active symptoms of the common cold. Under which of the following conditions
may he perform venipuncture? - ANSWER:The medical assistant may perform venipuncture provided he
is wearing a mask and afebrile.
It is not uncommon for people to be able to work with the common cold. However, it is important for
medical personnel to use good judgment and not transmit diseases to their patients. Medical personnel
should take precautions and handle patient contact in a responsible manner. They should not have
patient contact if they are febrile, since that is when colds are highly contagious. In this instance, the
medical assistant may perform venipuncture provided he/she is wearing a mask and afebrile. The
, medical assistant should wear the mask to keep from transmitting the cold via coughing or sneezing on a
patient.
What is an appropriate alternative to using a rubber tourniquet when attempting a venipuncture on a
known patient who is difficult to obtain a sample from? - ANSWER:blood pressure cuff
The only acceptable choice among the listed options is the blood pressure cuff. Occlusion pressure may
be adjusted as needed as an alternative to ensure circulation. In compliance with CLSI (Clinical and
Laboratory Standards Institute) standards, the blood pressure cuff can provide uniform constriction, as
long as the phlebotomist doesn't inflate the cuff beyond 40 mm of mercury.
What evacuated tube should the medical assistant select for collection of electrolytes? - ANSWER:green-
top
A green top tube contains heparin. Green tops are used for collection of heparinized plasma or whole
blood for special tests. Note: After the tube has been filled with blood, the tube is inverted several times
to prevent coagulation. Note: Green top tubes can contain ammonium, lithium, and sodium in addition
to the heparin. In this instance, lithium heparin would be the green-top of choice (and sodium heparin
would NOT be used for an electrolyte test). Electrolytes can also be collected in a red-top tube.
What additive protects serum from interacting with red blood cells after a specimen has been
centrifuged? - ANSWER:gel separators
Gel separators create a barrier between the serum and formed elements of the blood. Prolonged contact
of serum with formed elements can lead to pre-analytical variations in certain tests (such as serum
glucose levels). Tubes with clot activators, such as thrombin, actually expedite the clotting process.
Anticoagulant tubes keep the blood from clotting, yielding plasma instead of serum. Sulfosalicylic acid is
used in urine testing to precipitate proteins.
The medical assistant is instructed to perform a capillary stick for newborn screening. What collection
devices should the medical assistant use? - ANSWER:Heel stick lancet
The heel stick lancet (e.g., Tenderfoot) is required for infants. If a heelstick in an infant is being
performed, the phlebotomist should apply a warming device for approximately 3-5 minutes to the heel
to increase blood flow to the area, which will facilitate the collection of the capillary specimen. The
bones of the distal phalanx (located in the thickest part of the finger) may be injured or damaged by a
traditional finger stick lancet puncture.
What site should the medical assistant use for newborn screening blood collection? - ANSWER:plantar
surface of the heel
What is the first step in performing a venipuncture? - ANSWER:identify the patient
To prevent error and maintain a culture of safety, at least 2 identifiers (ex. full name and date of birth)
must be verified prior to performing a procedure.
What is the proper way to identify a patient prior to performing a venipuncture? - ANSWER:Ask the
patient to state his/her full name and DOB and compare to the chart.
Before a venipuncture, the medical assistant should ask the patient to state his/her full name and DOB
(comparing what is stated to what is written in the chart or on a wrist band patient identifier). This
minimizes the risk for mis-identification errors because it cross-checks what the patient says against
written documentation. This provides a verified identity so that all tubes collected will be associated with
the correct patient (provided the medical assistant labels them properly).
Using the guidelines for any method of venipuncture, what action should the medical assistant perform
directly after confirming patient identity? - ANSWER:Review the requirements for collecting and handling
the blood specimen as ordered by the physician
To ensure accuracy and quality, it is important to anticipate your needs before beginning the actual
venipuncture (i.e. tube color/size, minimum acceptable blood volume, whether or not the specimen
needs to be placed on ice). Therefore, the medical assistant would identify the patient, then review the
requirements for collecting and handling the blood specimen as ordered by the physician. Next,
assemble the appropriate equipment and select the proper evacuated tubes for test to be performed.
Then, apply the tourniquet and thoroughly palpate the selected vein. Finally, position the patient's arm
and cleanse the site with an antiseptic wipe, then proceed with the venipuncture protocol.
What should be avoided as a form of patient identification? - ANSWER:insurance number
An insurance number is not a common means of positive patient identification (entire families can share
the same insurance policy number). Patients must be positively identified for medical services, whether
they have insurance or not. Insurance information is necessary for billing purposes. The only true unique
identifier listed among these choices is the social security number. Patient name and date of birth are
also commonly used to confirm identification.
Name the two most used patient identifiers. - ANSWER:Patient's name/date of birth
,Name and DOB are most often used as positive patient identifiers as they are easily documented and
work for inpatients or outpatients. Bed numbers should never be used as identifiers for inpatients or
outpatients, nor should physician name associations. Medical record numbers are valuable for
inpatients, with name and DOB being used most often.
Prior to any type of inpatient specimen collection, a phlebotomist must correctly verify their patient's
identity by using which two-step procedure? - ANSWER:Check ID bracelet, and ask patient to verbally
confirm their identity.
The correct answer is to check the ID bracelet and ask the patient to verbally confirm his/her identity.
Patients may not have foot bed charts or IV bags, and the goal is to select the BEST answer of all choices.
If a patient has both an ID bracelet and can verify his/her own identity, it is ideal.
The phlebotomist is drawing blood from a patient that is taking blood thinners. What is a necessary
piece of additional equipment to have at the drawing station? - ANSWER:non-adhering bandage
Non-adhering bandage material would be helpful for patients on anticoagulant therapy who may bleed
more extensively than typical patients after venipuncture. It is necessary to contain the bleed with a
bandage, but adhesive might bruise once removed from a patient who has anticoagulated blood.
In which of the following time frames should a tourniquet be routinely released on a patient while
performing a blood draw? - ANSWER:within one minute
The standard time limit for having a tourniquet on a patient is one minute. Inaccurate laboratory test
results may occur if a tourniquet is not removed within one minute. When a tourniquet is applied, the
local blood flow is stopped. This leads to concentration of the blood and blood entering the surrounding
tissue. This may result in falsely high values for all protein-based analytes, increased packed cell volume,
and changes in other cellular elements. The most current edition of the CLSI Procedures for the
Collection of Diagnostic Blood Specimens by Venipuncture, H3-A6, states that the tourniquet application
for preliminary vein selection should not exceed one minute. For most patients, it is easy to release the
tourniquet within the one-minute period. Most veins are easily located and the venipuncture procedure
can be completed quickly.
A medical assistant has active symptoms of the common cold. Under which of the following conditions
may he perform venipuncture? - ANSWER:The medical assistant may perform venipuncture provided he
is wearing a mask and afebrile.
It is not uncommon for people to be able to work with the common cold. However, it is important for
medical personnel to use good judgment and not transmit diseases to their patients. Medical personnel
should take precautions and handle patient contact in a responsible manner. They should not have
patient contact if they are febrile, since that is when colds are highly contagious. In this instance, the
medical assistant may perform venipuncture provided he/she is wearing a mask and afebrile. The
, medical assistant should wear the mask to keep from transmitting the cold via coughing or sneezing on a
patient.
What is an appropriate alternative to using a rubber tourniquet when attempting a venipuncture on a
known patient who is difficult to obtain a sample from? - ANSWER:blood pressure cuff
The only acceptable choice among the listed options is the blood pressure cuff. Occlusion pressure may
be adjusted as needed as an alternative to ensure circulation. In compliance with CLSI (Clinical and
Laboratory Standards Institute) standards, the blood pressure cuff can provide uniform constriction, as
long as the phlebotomist doesn't inflate the cuff beyond 40 mm of mercury.
What evacuated tube should the medical assistant select for collection of electrolytes? - ANSWER:green-
top
A green top tube contains heparin. Green tops are used for collection of heparinized plasma or whole
blood for special tests. Note: After the tube has been filled with blood, the tube is inverted several times
to prevent coagulation. Note: Green top tubes can contain ammonium, lithium, and sodium in addition
to the heparin. In this instance, lithium heparin would be the green-top of choice (and sodium heparin
would NOT be used for an electrolyte test). Electrolytes can also be collected in a red-top tube.
What additive protects serum from interacting with red blood cells after a specimen has been
centrifuged? - ANSWER:gel separators
Gel separators create a barrier between the serum and formed elements of the blood. Prolonged contact
of serum with formed elements can lead to pre-analytical variations in certain tests (such as serum
glucose levels). Tubes with clot activators, such as thrombin, actually expedite the clotting process.
Anticoagulant tubes keep the blood from clotting, yielding plasma instead of serum. Sulfosalicylic acid is
used in urine testing to precipitate proteins.
The medical assistant is instructed to perform a capillary stick for newborn screening. What collection
devices should the medical assistant use? - ANSWER:Heel stick lancet
The heel stick lancet (e.g., Tenderfoot) is required for infants. If a heelstick in an infant is being
performed, the phlebotomist should apply a warming device for approximately 3-5 minutes to the heel
to increase blood flow to the area, which will facilitate the collection of the capillary specimen. The
bones of the distal phalanx (located in the thickest part of the finger) may be injured or damaged by a
traditional finger stick lancet puncture.
What site should the medical assistant use for newborn screening blood collection? - ANSWER:plantar
surface of the heel
