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APPEN DI X C Competency Checklists http://evolve.elsevier.com/Warekois/phlebotomy

COMPETENCY CHECKLIST

Radial Artery Puncture

Name ____________________________________ Date __________

Materials and Equipment

• Hand-washingequipment

• Personalprotectiveequipment

• Alcoholwipes

• Povidone-iodinetincture

• Localanesthetic

Instructions

1. Properly perform a radial artery puncture following the step-by-step procedure.

2. Demonstrate competency by demonstrating the procedure for performing a radial artery puncture for the instructor. All steps must be completed as listed on the Competency Checklist.

• Safetyneedle,needleblock,andLuercap

• Bloodgassyringe(heparinized)

• 232gauzepad

• Cupoficechips

• Bandage

• Sharpscontainer

• Biohazardwastecontainer

Performance Standard

Perform a radial artery puncture with accuracy and minimal discomfort. Maximum time to complete assignment: 12 minutes.

Procedure

Record in the comments section any problems encountered while performing the procedure.

You Must: S U Comments

1. Assemble the equipment.

2. Greet the patient, introduce yourself, and explain the procedure. Ask the patient to state his or her name. Use two identiﬁers to verify patient identity. Introduce yourself and explain the procedure.

3. Verify that the patient is in a respiratory steady state.

4. Verify the lab tests ordered against the requisition.

5. Wash your hands and don personal protective equipment.

6. Perform the modiﬁed Allen test to assess collateral circulation in the hand.

7. Locate the radial artery.

8. Cleanse the puncture site with 70% isopropyl alcohol and allow to air dry.

9. Cleanse the puncture site with povidone-iodine tincture and allow to air dry.

10. Administer local anesthetic and wait 1 to 2 minutes.

11. Cleanse your index ﬁnger with alcohol and place it above the area where the needle should enter the artery.

12. Hold the syringe like a dart, bevel up, and insert the needle at a 45- to 60-degree angle distal to your ﬁnger until blood appears in the needle hub.

13. Allow arterial pressure to ﬁll the syringe.

14. Remove the needle and apply direct pressure to the puncture site with folded gauze for at least 5 minutes.

15. While applying pressure, expel air from the syringe, activate the safety device, and plant the needle into the rubber block.

S 5 Satisfactory U 5 Unsatisfactory

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Procedure

Record in the comments section any problems encountered while performing the procedure.

—cont’d

S 5 Satisfactory U 5 Unsatisfactory

You Must: S U Comments

16. Mix the specimen with heparin.

17. Place the specimen in ice chips.

18. Check the site and remove the povidone-iodine with an alcohol wipe.

19. Apply a pressure bandage of gauze.

20. Check for a pulse distal to the puncture site.

21. Remove and discard the needle in a sharps container.

22. Place the Luer cap on the syringe, label the specimen, and return it to the ice chips.

23. Thank the patient.

24. Dispose of used supplies and materials; remove personal protective equipment and wash your hands.

25. Deliver the specimen immediately to the lab.

Performance Standard Met Comments

________ Yes ________ No Evaluator ________ Date _____

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APPEN DI X C Competency Checklists http://evolve.elsevier.com/Warekois/phlebotomy

COMPETENCY CHECKLIST

Blood Culture

Name ____________________________________ Date __________

Materials and Equipment

• Hand-washingequipment

• Personalprotectiveequipment

• Tourniquet

• Alcoholwipes

• Povidone-iodinetincture

Instructions

1. Properly perform a blood culture collection.

2. Demonstrate competency by demonstrating the procedure for collecting a blood culture satisfactorily for the instructor while adhering to aseptic technique. All steps must be completed as listed on the Competency Checklist.

• Aerobicbloodculturebottle

• Anaerobicbloodculturebottle

• Safetyneedle

• Disposableadapter

• 232gauzepad

• Bandages

• Sharpscontainer

• Biohazardwastecontainer

Performance Standard

Collect a blood culture with accuracy. Maximum time to complete assignment: 10 minutes.

Procedure

Record in the comments section any problems encountered while performing

the procedure.

You Must: S U Comments

1. Greet and identify the patient. Ask the patient to state his or her name. Use two identiﬁers to verify patient identity.

2. Identify yourself and explain the procedure.

3. Verify the lab tests ordered against the requisition.

4. Wash your hands and don personal protective equipment.

5. Apply the tourniquet, identify the puncture site, and remove the tourniquet.

6. Vigorously scrub the site with alcohol and allow to air dry.

7. Vigorously scrub the site with povidone-iodine and allow to air dry.

8. Assemble the equipment.

9. Cleanse the tops of the blood culture bottles.

10. Reapply the tourniquet without contaminating the site.

11. Perform the venipuncture.

12. Inoculate each bottle in the correct order and mix the samples.

13. Release the tourniquet, remove the needle, activate the safety device, and apply pressure to the site with gauze.

14. Label the blood culture bottles correctly.

15. Remove povidone-iodine from the patient’s arm and apply a bandage.

16. Discard used materials and supplies appropriately.

17. Thank the patient.

18. Remove personal protective equipment and wash your hands.

S 5 Satisfactory U 5 Unsatisfactory

Performance Standard Met Comments

________ Yes ________ No Evaluator ________ Date _____

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295

COMPETENCY CHECKLIST

Blood Smear Preparation

Performance Standard

Accurately prepare a peripheral blood smear. Maxi-

mum time to complete assignment: 5 minutes. Name ____________________________________ Date __________

Materials and Equipment

• Hand-washingequipment

Instructions

1. Successfullyprepareabloodsmear.

• Gloves

• Cleanglassslides

2. Demonstrate competency by demonstrating the

procedure for preparing a blood smear satisfactorily for the instructor. All steps must be completed as listed on the Competency Checklist.

Procedure

Record in the comments section any problems encountered while performing

the procedure.

S 5 Satisfactory U 5 Unsatisfactory

You Must: S U Comments

1. Wash your hands and put on gloves.

2. Apply a small drop of blood to the correct area of the slide.

3. Place the spreader at the correct angle in front of the blood drop.

4. Pull the spreader back to contact the blood drop.

5. Move the spreader forward in a continuous motion.

6. Repeat steps 2 through 5 to prepare a second slide.

7. Allow the smears to dry.

8. Properly label the smears.

9. Examine the blood smears for quality and acceptability.

10. Remove gloves and wash your hands.

Performance Standard Met Comments

________ Yes ________ No Evaluator ________ Date _____

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APPEN DI X C Competency Checklists http://evolve.elsevier.com/Warekois/phlebotomy

COMPETENCY CHECKLIST

Throat Swab

Performance Standard

Successfully and properly perform a throat swab.

Maximum time to complete assignment: 5 minutes. Name ____________________________________ Date __________

Materials and Equipment

• Hand-washingequipment

Instructions

1. Properly perform a throat swab.

2. Demonstrate competency by demonstrating the

procedure for performing a throat swab satisfactorily for the instructor. All steps must be completed as listed on the Competency Checklist.

• Personalprotectiveequipment

• Tonguedepressor

• Flashlight

• Collectionswab

• Transporttubewithtransportmedia

• Biohazardwastecontainer

Procedure

Record in the comments section any problems encountered while performing

the procedure.

S 5 Satisfactory U 5 Unsatisfactory

You Must: S U Comments

1. Greet and identify the patient. Ask the patient to state his or her name. Use two identiﬁers to verify patient identity.

2. Introduce yourself.

3. Verify the lab tests ordered against the requisition.

4. Explain the procedure to the patient.

5. Wash your hands and don personal protective equipment.

6. Assemble the equipment.

7. Position the patient.

8. Depress the patient’s tongue with a tongue depressor and inspect the back of the throat with the ﬂashlight to locate inﬂamed areas.

9. Quickly touch the tip of the swab to the tonsils and any other inﬂamed areas.

10. Return the swab to the holder.

11. Crush the ampule at the bottom of the holder containing the transport media.

12. Thank the patient.

13. Dispose of used supplies and materials.

14. Remove personal protective equipment and wash your hands.

15. Deliver the specimen to the appropriate department.

Performance Standard Met Comments

________ Yes _________ No Evaluator _________ Date _____

APPENDIX D Common Abbreviations

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297

2-hr PPBS 2-hour postprandial blood sugar µL microliter ABG arterial blood gas ABN Advance Beneﬁciary Notice of Noncoverage ACA American Certiﬁcation Agency for

Healthcare Professionals ACE angiotensin-converting enzyme ACT activated coagulation time ACTH adrenocorticotropic hormone ADH antidiuretic hormone AIDS acquired immunodeﬁciency syndrome ALP alkaline phosphatase ALS amyotrophic lateral sclerosis ALT alanine aminotransferase AMT American Medical Technologists ANA antinuclear antibody aPTT activated partial thromboplastin time ASCLS American Society for Clinical Laboratory

Science ASCP American Society for Clinical Pathology ASPT American Society of Phlebotomy

Technicians AST alternate site testing, aspartate

aminotransferase ATP adenosine triphosphate AV arteriovenous, atrioventricular BBP bloodborne pathogen BC blood culture BMP basic metabolic panel BNP B-type natriuretic peptide BT bleeding time BUN blood urea nitrogen BURPP bilirubin, uric acid, phosphorus,

and potassium C&S culture and sensitivity CAP College of American Pathologists CBC complete blood count CBG capillary blood gas CCU cardiac care unit CDC Centers for Disease Control and Prevention CEUs continuing education units CHD congestive heart disease CHP chemical hygiene plan CK creatine kinase CK-BB creatine kinase-BB CK-MB creatine kinase-MB CK-MM creatine kinase-MM CLIA ‘88 Clinical Laboratory Improvement

Act of 1988 CLS clinical laboratory scientist CLSI Clinical and Laboratory Standards Institute CLT clinical laboratory technician

CMP comprehensive metabolic panel CNA certiﬁed nursing assistant CNS central nervous system COC chain of custody COPD chronic obstructive pulmonary disease CPR cardiopulmonary resuscitation CPT certiﬁed phlebotomy technician CQI continuous quality improvement CSF cerebrospinal ﬂuid CT computed tomography CVC central venous catheter DIC disseminated intravascular coagulation diff differential DNA deoxyribonucleic acid DOB date of birth DOT Department of Transportation DVT deep vein thrombosis EBV Epstein-Barr virus ECG, EKG electrocardiogram EDTA ethylenediaminetetraacetic acid EMLA Eutectic Mixture of Local Anesthetics ENT ear, nose, and throat EP expanded precaution ER, ED emergency room, emergency department ESR erythrocyte sedimentation rate FBS fasting blood sugar (glucose) FDA Food and Drug Administration FDP ﬁbrin degradation product FSH follicle-stimulating hormone FTA-ABS ﬂuorescent treponemal antibody

absorption test FUO fever of unknown origin g/dL grams per deciliter GGT GH growth hormone GHS Globally Harmonized System GTT glucose tolerance test Hb A

HBsAG hepatitis B surface antigen HBV hepatitis B virus hCG human chorionic gonadotropin HCl hydrochloric acid Hct hematocrit HCV hepatitis C virus HDL high-density lipoprotein HEPA high-efﬁciency particulate air Hgb hemoglobin HIPAA Health Insurance Portability

HIV human immunodeﬁciency virus HLA human leukocyte antigen

g-glutamyltransferase

glycated hemoglobin/glycosylated

hemoglobin

and Accountability Act

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APPEN DI X D Common Abbreviations http://evolve.elsevier.com/Warekois/phlebotomy

HMO health maintenance organization HTLV human T-cell lymphotropic virus ICD-9-CM International Classiﬁcation of Diseases,

Ninth Revision, Clinical Modiﬁcation

ICD-10-CM International Classiﬁcation of Diseases,

Tenth Revision, Clinical Modiﬁcation ICU intensive care unit ID identiﬁcation INR international normalized ratio IRDS infant respiratory distress syndrome IRS Internal Revenue Service IV intravenous KOH potassium hydroxide LDL low-density lipoprotein LH luteinizing hormone LIS laboratory information services LPN licensed practical nurse LTC long-term care LTT lactose tolerance test MCH mean corpuscular hemoglobin MCHC mean corpuscular hemoglobin

concentration MCV mean corpuscular volume MHC major histocompatibility complex MI myocardial infarction MIS manager of information services MLS medical laboratory scientist MLT medical laboratory technician MPV mean platelet volume MRI magnetic resonance imaging MRSA methicillin-resistant Staphylococcus aureus MSH melanocyte-stimulating hormone MT medical technologist NAACLS National Accrediting Agency for Clinical

Laboratory Sciences NFPA National Fire Protection Association NHA National Healthcareer Association NIDA National Institute on Drug Abuse NIOSH National Institute for Occupational Safety

and Health NK natural killer NP nasopharyngeal NPA National Phlebotomy Association NSY nursery O&P ova and parasites OGTT oral glucose tolerance test OR operating room OSHA Occupational Safety and Health

Administration PBT phlebotomy technician by AMT PCA patient care assistant

partial pressure of carbon dioxide PCR polymerase chain reaction PCT patient care technician PE protective equipment PET positron emission tomography PFA platelet function assay

PHI protected health information PICC peripherally inserted central catheter PID pelvic inﬂammatory disease PKU phenylketonuria PLT platelets PMN polymorphonuclear PMS premenstrual syndrome

partial pressure of oxygen POCT point-of-care testing POL physician ofﬁce laboratory PPD puriﬁed protein derivative PPE personal protective equipment PPO preferred provider organization PSA prostate-speciﬁc antigen PST plasma separator tube PT prothrombin time PTH parathyroid hormone QA quality assurance QC quality control QNS quantity not sufﬁcient RA rheumatoid arthritis RBC red blood cell RDW red blood cell distribution width RF rheumatoid factor RN registered nurse RPR rapid plasma reagin RPT registered phlebotomy technician RSV respiratory syncytial virus RT respiratory therapist SARS severe acute respiratory syndrome SCID severe combined immune deﬁciency SDS safety data sheet SE sweat electrolytes seg segmented neutrophil SLE systemic lupus erythematosus SPS sodium polyanethole sulfonate SST serum separator tube stat short turnaround time STI sexually transmitted infection T

triiodothyronine

thyroxine TDM therapeutic drug monitoring TIBC total iron-binding capacity TLC tender loving care TnT troponin T t-PA tissue plasminogen activator TQM total quality management TSH thyroid-stimulating hormone TSS toxic shock syndrome URI upper respiratory infection UTI urinary tract infection VAD vascular access device VRE vancomycin-resistant Enterococcus WBC white blood cell WCS winged collection set WIS winged infusion set

APPENDIX E Mock Certiﬁcation Exam

https://t.me/med1917

Pamela B. Primrose and Rachel Houston

1. What is phlebotomy? a. A trained professional in blood drawing b. The legal standards for a person who performs

blood-drawing skills c. The process of drawing blood d. All of the above.

2. What is a phlebotomist? a. A trained professional in blood drawing b. The legal standards for a person who performs

blood-drawing skills c. The process of drawing blood d. All of the above.

3. Which of the following is not part of a phlebotomist’s point-of-care job-related duties? a. Taking blood pressure b. Instructing patients on urine specimen collection c. Performing a tracheostomy d. Performing POC testing

4. All of the following are considered hazards except: a. bending your knees when lifting heavy objects. b. airborne viruses and bacteria. c. handling broken glass when wearing gloves. d. All of the above are hazards.

5. All of the following are true about laboratory safety except: a. you may store food in the laboratory refrig-

erator. b. protect your feet from spills. c. always wear required personal protection

equipment. d. All of the above are correct.

6. As written in the Patient Care Partnership from the American Hospital Association, the patient has the right to: a. high-quality care. b. protection of privacy. c. help with billing claims. d. All of the above.

7. Certication is evidence that: a. the phlebotomist is working in the eld. b. the phlebotomist has demonstrated pro-

ciency in the area of blood drawing. c. the phlebotomist is licensed in the eld. d. the phlebotomist is accredited in the eld.

8. Which of the following is not OSHA-required personal protection equipment? a. Steel-toe shoes b. Goggles c. Chin-length face shield d. Full-length lab coat

9. The Clinical Laboratory Improvement Act of 1988 follows guidelines and standards set by the: a. CLIA ’88. b. CLSI. c. JCAHO. d. CDC.

10. Samples collected from a patient in a nursing home are sent to the: a. POL. b. CDC. c. reference laboratory. d. urgent care center.

11. Quality assurance for laboratory personnel includes all of the following except: a. specimen collection procedures. b. specimen transport processes. c. specimen-processing policies. d. the laboratory supervisor’s home telephone

number.

12. Personal protection equipment must be provided by the: a. CDC. b. OSHA. c. employee. d. employer.

13. Which of the following personal protection equipment must a phlebotomist use when performing a skin puncture or venipuncture? a. Goggles b. Gloves c. A mask d. Caps and booties

14. Under HIPAA, protected health information is dened as: a. information that the patient refuses to dis-

close to the physician. b. any test result. c. any part of a patient’s health information

that is linked to information that identies

the patient. d. information that summarizes the patient’s

insurance coverage.

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APPEN DI X E Mock Certiﬁcation Exam http://evolve.elsevier.com/Warekois/phlebotomy

15. Employers must provide vaccination against _________ free of charge. a. hepatitis A virus b. hepatitis B virus c. hepatitis C virus d. hepatitis delta virus

16. Which of the following would be a reason for rejection of a specimen by the laboratory? a. The patient’s name, date of birth, and the

date and time are written on the label and requisition slip.

b. A specimen containing an additive has been

inverted.

c. An ESR has been collected in a red-topped

tube.

d. All of the above are reasons for rejections.

17. The quality of the test result depends on: a. the type of specimen. b. the source of the specimen. c. the time between collecting the specimen

and analyzing the specimen.

d. whether the sample is going to be analyzed

for glucose or phosphate.

18. The purpose of Total Quality Management is to: a. check machinery with automated procedures. b. ensure that proper laboratory procedures are

being followed.

c. ensure that adequate patient care is being

provided.

d. All of the above.

19. A specimen may be rejected by the laboratory if: a. the tube was not initialed. b. the blood is hemolyzed. c. the tube was not transported properly. d. All of the above.

20. Transport bags have a separate compartment (pouch) for requisitions to: a. safeguard the requisition. b. keep the specimen from getting lost. c. prevent contamination if the specimen

leaks.

d. ensure the requisition goes to central receiv-

ing and the specimen to the processing laboratory.

21. ___________ is the most important rst step in phlebotomy and other testing procedures. a. Proper patient identication b. Proper hand washing c. Proper specimen handling d. Collecting sufcient blood

22. Acceptable method(s) of identifying a patient include: a. ask the patient to give his or her name and

DOB. b. check the patient’s ID band. c. ask the patient to present a photo ID. d. All of the above are acceptable.

23. When an admitted patient is not wearing an ID band, the phlebotomist must: a. ask the patient for a picture ID. b. not draw blood from this patient. c. question the patient and conrm the date of

birth.

d. not draw blood until nursing has placed an

ID band on the patient.

24. What is the proper procedure for a phlebotomist to follow if a physician or member of the clergy is in the patient’s room at the time of draw? a. Ask the physician or clergy member to step

outside.

b. Draw the blood with the physician or clergy

member present.

c. Return at another time if the specimen is not

a stat request.

d. Both a and c.

25. How should the phlebotomist proceed if there is a language barrier with the patient a. use hand gestures to communicate. b. leave the room and let the physician draw. c. draw the blood without consent. d. All of the above.

26. Most tubes containing additives should be inverted: a. once. b. three times. c. ve to eight times. d. tubes containing additives should not be

inverted.

27. The lavender-topped tube contains: a. no additive. b. heparin. c. SPS or ACD. d. EDTA.

28. The green-topped tube contains: a. no additive. b. heparin. c. SPS or ACD. d. EDTA.

29. The yellow-topped tube contains: a. no additive. b. heparin. c. SPS or ACD. d. EDTA.

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301

30. The glass red-topped tube contains: a. no additive. b. heparin. c. SPS or ACD. d. EDTA.

31. Which of the following tubes contain(s) sodium uoride and potassium oxalate? a. Red-topped tube b. Lavender-topped tube c. Gray-topped tube d. All tubes with splash guards

32. Which of the following tubes would hold a glucose specimen for 24 hours? a. Red-topped tube b. Lavender-topped tube c. Gray-topped tube d. All tubes with splash guards

33. In which tube(s) would a phlebotomist collect an erythrocyte sedimentation rate? a. Red-topped tube b. Lavender-topped tube c. Gray-topped tube d. All tubes with splash guards

34. Blood for serology testing should be drawn in a: a. red-topped tube. b. lavender-topped tube. c. gray-topped tube. d. all tubes with splash guards.

35. Which of the following tubes yield(s) a serum specimen? a. Red-topped tube b. Lavender-topped tube c. Gray-topped tube d. All of the above.

36. Coagulation studies should be drawn in a light blue tube containing which of the following additives? a. Clot activator b. Sodium citrate c. EDTA d. SPS

37. A blood donation given by a patient for use during his or her surgical procedure is called: a. an autologous donation. b. a cryoprecipitated donation. c. a Willebrand’s collection. d. None of the above.

38. Why should a glass red-topped tube be drawn before a green-topped tube? a. Additives in the red-topped tube will not

interfere with the tests performed on the green-topped tube.

b. Red-topped tubes are always the rst tube

drawn.

c. Since there are no additives in the red-

topped tube, it cannot contaminate the greentopped tube.

d. Green-topped tubes are always the last tube

drawn.

39. Which of the following is false for blood culture collection? a. The culture must be collected in the red- and

marbled-topped tube.

b. The area must be prepped with iodine or

another antibacterial agent before the draw.

c. A tourniquet is not used for blood culture

collection.

d. Both a and c are false for blood culture

collection.

40. Which of the following is correct for arterial blood gas collection? a. ABG must be collected in a red- and marbled-

topped tube.

b. The area must be prepped with iodine before

the draw. c. A tourniquet is used in the collection. d. Both b and c are correct.

41. A heparinized needle and syringe are necessary in the collection of: a. blood culture. b. ESR. c. ABG. d. heparin levels.

42. A Hemogard top: a. is a plastic top that ts over the stopper. b. is only used on the lavender-topped tube. c. is used to reduce aerosol and splattering of

blood.

d. Both a and c.

43. Cold agglutinin test must be maintained at a temperature of: a. 37° F. b. 32° C. c. 32° F. d. 37° C.

44. Chilling a specimen will: a. speed up the metabolic process. b. maintain the stability of the specimen during

transport. c. prevent problems in tubes containing EDTA. d. facilitate processing.

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