Blood Basics
What is phlebotomy?
Collection of blood for diagnostic, therapeutic, research, or donation purposes
Which common tube color and additive are used for a CBC?
Lavender; EDTA
When blood cultures and routine venous tubes are ordered together, which are collected first?
Blood cultures
Give two acceptable patient identifiers and one unacceptable substitute.
Full name and date of birth (medical record number is also acceptable); room number is not an identifier.
Which antecubital vein is usually the first choice for routine venipuncture?
Median cubital vein
What is the difference between serum and plasma?
Serum is the liquid remaining after clotting; plasma is the liquid portion of anticoagulated blood and retains clotting factors such as fibrinogen
Which tube and additive are commonly used for PT/INR testing?
Light blue; sodium citrate
Put these venous tubes in order: gray, light blue, lavender.
Light blue, lavender, gray
A patient says, "I faint during blood draws." How should the CCMA prepare the patient?
Position in an approved reclined chair or bed before collection and seek assistance as needed
Which vein is on the thumb side, and which little-finger-side vein requires extra caution?
Cephalic is on the thumb side; basilic is on the little-finger side and is near major nerves and the brachial artery.
Which protein in red blood cells carries oxygen?
Hemoglobin
What are the two additive functions in a typical gray fluoride/oxalate tube?
Oxalate prevents clotting; sodium fluoride slows glycolysis to help preserve glucose
Put these venous tubes in order: green, SST, blood cultures, light blue.
Blood cultures, light blue, SST, green.
A patient ate breakfast before a test ordered as fasting. What should happen next?
Pause; verify test instructions, notify appropriate staff, and document the deviation as required. Do not independently change medication instructions
A patient has an active IV in the left forearm and a suitable vein in the right arm. Which arm should be assessed first, and why?
The right arm; use the opposite arm when available to reduce infusion contamination risk
Anticoagulated blood is centrifuged. What are the three layers, from top to bottom?
Plasma; buffy coat (white blood cells and platelets); red blood cells
A chemistry order requires serum with a gel barrier. A second order requires plasma with a gel barrier. Name the separator tube for each.
Serum: SST, commonly gold or red/gray tiger top, with clot activator and gel. Plasma: PST, commonly light green or green/gray, with lithium heparin and gel.
State the complete routine venipuncture order by additive group.
Blood cultures; sodium citrate; serum; heparin; EDTA; oxalate/fluoride.
A trough medication level is ordered. What timing information must be verified before collection?
Verify the last dose time and the ordered collection time in relation to the dose. Follow the order; do not independently hold, delay, or administer medication
The easiest visible vein lies near a dialysis fistula. What is the safest next step?
Protect the fistula; do not use it for routine collection. Assess an unrestricted site or consult the nurse/appropriate clinician
A patient has both A and B antigens on red cells and no anti-A or anti-B antibodies. What is the ABO type?
Type AB
A yellow tube is available for a blood culture, but its label reads ACD. Should it be used? Explain.
No. ACD and SPS yellow tubes have different purposes. Verify the culture requirement and select the approved SPS tube or culture bottles; color alone is insufficient.
A lavender tube was drawn before a light-blue tube. What problem does correct order help prevent, and why does it matter?
Additive carryover. EDTA can bind calcium and interfere with coagulation testing, making results unreliable; report the sequence error and follow laboratory policy
The patient states a birth date that differs from the order, and then refuses collection. Name the two issues that must be respected or resolved
Stop to resolve the identification mismatch; honor the refusal, notify the appropriate professional, and document. Do not collect until identity is resolved and consent/cooperation is obtained
The only obvious site is swollen and bruised, and the other arm has an unclear surgery restriction. What should the CCMA do?
Avoid the compromised site. Check restrictions and consult the appropriate clinician before selecting another approved site; do not override restrictions or proceed without a safe site.