Phlebotomy, In Plain English

Welcome To Phlebotomy

Phlebotomy is drawing blood for testing. The job is as much about people, privacy and getting the right patient as it is about the needle.

What To Know

• The word comes from Greek: phlebo = vein, tomy = cut.
• Two ways to get blood: venipuncture (needle into a vein) and skin puncture (a finger or heel stick for a small amount).
• Blood is drawn to diagnose illness, check medicine levels, for donation, to remove extra blood, and for research.
• Old history worth knowing: bloodletting, cupping and leeches. Barbers once did it, which is where the red and white barber pole comes from.
• The vacuum tube system used today was invented in 1949.
• Look the part: scrubs or lab coat, closed-toe shoes, short clean nails, no artificial nails, hair tied back, no strong scents.
• About 55% of communication is body language: face, eye contact, posture.
• If the patient does not speak your language, use a language interpreter, not a family member.

Meeting A Patient, In Order

1. Introduce yourself.
2. Check who they are with two identifiers: full name and date of birth. They say it, you do not say it for them.
3. In a hospital, also check the ID wristband. No wristband? Tell the nurse before doing anything.
4. Explain what you are about to do.
5. Get their consent.
6. Begin.

Consent And Privacy

• Walking into the building is not consent. They have to agree.
• A patient can change their mind at any time, even mid-draw. You stop.
• HIPAA (1996) protects patient health information in every form. No talking about patients in halls, lifts or break rooms. No screens left open. Labelled samples left out count as a violation.
• Patients have rights: to know the procedure, ask questions, refuse, keep things private, and get a copy of their records.

Words To Know

Assault

Harming someone, or threatening to.

Battery

Touching someone without their consent.

Libel

A false, harmful statement in writing.

Slander

A false, harmful statement said out loud.

Negligence

Failing to give proper care, like mixing up or not labelling a sample.

PHI

Protected health information: results, diagnoses, medicines, address, phone.

Ethics

Doing what is right, even past what the law demands.

Systems Of The Body

Blood is the delivery truck, vessels are the roads and the heart is the pump. Know the route, what blood is made of, and which three arm veins to use.

The Heart

• About the size of a fist. Pumps roughly 5 litres a minute.
• Three layers, inside to outside: endocardium, myocardium (the muscle), epicardium.
• Four rooms: right atrium, right ventricle, left atrium, left ventricle.
• The right side sends blood to the lungs. The left side sends it to the body.

The Route Blood Takes

1. Used blood comes back from the body through the vena cava into the right atrium.
2. Through the tricuspid valve into the right ventricle.
3. Out through the pulmonary artery to the lungs, where it drops carbon dioxide and picks up oxygen.
4. Back through the pulmonary veins into the left atrium.
5. Through the mitral valve into the left ventricle.
6. Out through the aorta to the whole body.

Vessels And Blood

• Arteries carry blood away from the heart. Veins carry it back. Capillaries are the tiny ones where the swap happens.
• Blood is about 55% plasma (the liquid, mostly water) and 45% cells.
• Red cells carry oxygen using hemoglobin. White cells fight infection. Platelets make clots.
• The thin layer of white cells and platelets in a spun tube is the buffy coat.
• Normal blood pH is 7.35 to 7.45. Lower is acidosis, higher is alkalosis.

The Three Arm Veins, In Order Of Choice

1. Median cubital — the middle of the inner elbow. Big, steady, first choice.
2. Cephalic — thumb side. Often the best one on larger patients.
3. Basilic — pinky side. Last choice, because an artery and nerves sit close by.

• If the arm will not work, the back of the hand is next. Neck, groin and foot need a provider's say-so.

Blood Types And Donation

• Four groups: A, B, AB, O, each either Rh positive or negative.
• O negative gives to anyone. AB positive can take from anyone.
• The wrong match makes blood clump (agglutination), which can kill. That is why blood is crossmatched first.
• A donation is about a pint. Donors must be 18 to 67, weigh at least 110 lb, with hemoglobin of at least 12.5 and hematocrit of at least 38%.

Words To Know

Erythrocyte

Red blood cell.

Leukocyte

White blood cell.

Thrombocyte

Platelet.

Anemia

Too few red cells.

Polycythemia Vera

Too many red cells.

Hemochromatosis

Too much iron stored in the body.

Leukopenia / Leukocytosis

Too few white cells / too many.

Antecubital Fossa

The inside of the elbow.

Homeostasis

The body keeping itself in balance.

Lab And Workplace Safety

Treat all blood as if it could infect you. Know who makes the rules, what to wear, and exactly what to do after a needle stick or a spill.

Who Makes The Rules

• OSHA — the federal agency for worker safety. It enforces.
• CLSI — writes the lab standards used worldwide.
• CLIA '88 — federal rules for accurate lab testing. Simple, low-risk tests are called CLIA-waived.
• NIOSH — the research agency for safer workplaces.
• The Needlestick Safety and Prevention Act (2000) is why needles have safety caps.
• The most common reason OSHA inspects a workplace is a complaint from an employee.

Lab Rules

• No eating, drinking, gum or makeup. Nothing goes in your mouth.
• No food in the lab fridge.
• Protective gear comes off before you leave the lab.
• No latex. Use nitrile or vinyl gloves.
• Never tear the fingertip off a glove to feel a vein better. It breaks OSHA rules.
• Wipe down surfaces and equipment after every use and every patient.
• Write down the lab fridge temperature every day.

After A Needle Stick, Cut Or Splash

1. Wash with soap and running water for at least 15 minutes. Eyes get flushed at the eyewash station for 15 minutes.
2. Report it to your supervisor right away.
3. Fill in the exposure report form.

Blood Spills

• Gloves on, use the spill kit.
• Bleach mix: 1 part bleach to 10 parts water, left on for 10 minutes.

Protective Gear

• Putting it on: gown, mask, goggles or face shield, gloves.
• Taking it off: gloves, goggles or face shield, gown, mask.
• Gloves are the most important piece and stay on for the whole procedure.

Sharps And Waste

• The sharps container is for sharps only: needles, lancets, glass slides, tubes, syringes.
• Gauze, wipes and gloves go in the biohazard bag, not the sharps bin.
• Close the container when it is two-thirds to three-quarters full.
• Never recap a needle. Click the safety cap on straight after use.
• Broken glass is picked up with tongs or a broom, never hands. Pieces too big for the sharps bin go in a tough, leakproof cardboard box.
• An overflowing sharps bin gets reported to the supervisor straight away.

Hepatitis B

• The employer must offer the vaccine free within 10 days of you starting.
• Three shots: the first, one a month later, one six months after the first.
• It can survive in dried blood for up to 7 days.

Words To Know

Biohazard

Anything that can harm you through exposure.

Bloodborne Pathogen

A germ carried in blood: hepatitis B, hepatitis C, HIV.

SDS

Safety data sheet. One for every chemical.

Percutaneous

Through the skin.

Quality Assurance

The overall plan and policies.

Quality Control

The actual checks done under that plan.

The Venipuncture Process

The whole draw, start to finish. The exam loves the numbers: how high the tourniquet, how long, what angle, how many turns.

The Draw, Step By Step

1. Check the order from the provider.
2. Introduce yourself, confirm the patient with name and date of birth, get consent.
3. Gather supplies and check expiry dates. Ask about allergies and fainting.
4. Seat or lie the patient down. Clean your hands in front of them. Gloves on.
5. Tourniquet 3 to 4 inches above the site. It stays on 1 minute at most.
6. Feel for the vein. You want bouncy, big and straight. Patient makes a fist and holds it. No pumping.
7. Clean with alcohol and let it air dry. No fanning, no blowing.
8. Hold the skin tight 1 to 2 inches below the site.
9. Needle in, bevel up, at 15 to 30 degrees. A butterfly goes in at 5 to 10 degrees.
10. Fill the tubes in the right order. Turn each one gently straight away.
11. Tourniquet off once blood is flowing.
12. Hold gauze over the site without pressing, pull the needle out at the same angle, click the safety cap, then press.
13. Needle and holder go straight in the sharps bin.
14. Label the tubes in front of the patient: name, date, time, your initials.
15. Bandage once bleeding stops. Thank them. Deliver the samples.

Needles

• The bigger the gauge number, the thinner the needle.
• Normal draws use 21, 22 or 23 gauge.
• Three ways to draw: straight needle (most common), butterfly (small or fragile veins, children, older patients), syringe (fragile veins that collapse, or when only a small exact amount may be taken).
• Big needles, 14 to 18 gauge, are for blood donation and IVs.
• Look at the needle tip before using it. A bent or blunt tip hurts the patient. Swap it.

Types Of Consent

• Expressed — they say yes. Needed for a blood draw.
• Informed — signed, after the risks are explained.
• Implied — they hold out their arm, or it is an emergency and they cannot answer.
• Parental — for children.

Words To Know

Aseptic Technique

Working in a way that keeps germs out.

Winged Infusion Set

The proper name for a butterfly needle.

Bevel

The slanted tip of the needle.

Gauge

How wide the needle is.

Lumen

The hollow inside of the needle.

Flash

The first bit of blood you see, proving you are in the vein.

Invert

Gently tip the tube upside down and back to mix it.

Hemoconcentration

Blood gets too concentrated because the tourniquet stayed on too long.

Requisition

The form saying which tests to run.

Palpate

To feel with your fingers.

Small Things That Get Tested

Making Difficult Draws Less Difficult

Some veins are hard to find and some patients faint. This chapter is the list of what to avoid, what to change, and what to do when it goes wrong.

Tricks For Hard Veins

• Warm the site with a warm compress.
• Let the arm hang down so gravity fills the veins.
• Offer water, unless they are about to have surgery.
• Ask where draws have worked before. Patients usually know.
• Feel with your fingers before you trust your eyes.

Where Not To Draw

• Mastectomy side — draw from the opposite arm. If both sides, ask the doctor.
• Arm with an IV — use the other arm. If you must use it, draw below the IV.
• Bruises, burns, scars, rashes, infections, swelling — pick another spot.
• Tattoos — fine if healed over a year. Avoid fresh ones.
• Ports, PICC lines, fistulas, grafts — phlebotomists do not draw from these at all.

Different Patients

• Older patients — thin skin and fragile veins. Gentle tourniquet, small butterfly.
• Larger patients — the cephalic vein is often easiest to find.
• Scared of needles — lie them down, keep supplies out of sight, keep talking.
• Sleeping patients — never draw. Wake them gently first.
• Aggressive or unsteady patients — never alone. Bring help.

If They Faint Mid-Draw

1. Stop. Take the needle out and click the safety cap.
2. Keep them from falling.
3. Call for help.
4. Cool cloth on the forehead or neck.
5. Stay with them until they recover, then write it up.

Other Things That Go Wrong

• Hematoma — a swelling bruise forms. It is the most common problem. Stop the draw, press, use ice.
• Missed vein — pull back slightly, feel again, redirect gently. Still nothing or it hurts? Take it out and try another site.
• Tiny red dots under the tourniquet — it is too tight. Take it off and try the other arm, looser.
• A hissing sound — the needle tip has slipped out of the skin and the tube sucked in air. Cap it, bin it, start again with new gear.
• A slight vibration in the needle — it is touching a valve inside the vein. Reposition slightly.
• Dizzy or sick before you start — keep them where they are, seated or lying. Do not walk them anywhere.
• They fainted last time — do the draw with them lying down, even if they feel fine.
• Seizure — stop, call for help, ease them to the floor, clear the space.
• Severe allergic reaction — stop and call for help immediately.

Words To Know

Syncope

Fainting.

Hematoma

Blood pooled under the skin.

Petechiae

Tiny red or purple dots on the skin.

Edema

Swelling from trapped fluid.

Lymphedema

Swelling after lymph nodes are removed.

Anaphylaxis

A severe, life-threatening allergic reaction.

Fistula

A permanent surgical join between an artery and a vein, for dialysis.

Graft

A temporary man-made tube joining an artery and a vein.

Geriatric / Pediatric / Bariatric

Care for older people / children / people with obesity.

Children And Capillary Draws

Small patients have small veins and very little blood to spare. Often a finger stick or heel stick is enough, and there are strict rules about where and how deep.

Drawing From Children

• Never say it will not hurt. Be honest, in simple words.
• Let them hold a toy. A parent holds them on their lap.
• Use a small butterfly and small tubes.
• Take no more than 1% to 5% of a baby's blood in 24 hours. Too many draws can cause anemia.
• Bandages are a choking risk for under-2s.

Finger Stick

• For adults and children over 2.
• Use the middle or ring finger of the hand they do not write with.
• Aim for the fleshy side of the tip, not the centre or the very end.
• Not the thumb (it has a pulse), not the index finger (too tough), not the pinky (bone too close).
• Cut across the fingerprint lines so the blood forms a bead.

Heel Stick

• For babies under 2.
• Only the inner or outer edge of the bottom of the heel. Never the middle, the arch, or the back.
• Never deeper than 2.0 mm. For premature babies, 0.85 mm. Going deeper can infect the bone.

Capillary Collection, In Order

1. Warm the site. Clean your hands, gloves on.
2. Clean with alcohol and let it dry.
3. Press the lancet firmly on the skin and fire it.
4. Wipe away the first drop with gauze.
5. Collect. Do not squeeze hard, it bursts the cells.
6. Lancet in the sharps bin. Label. Process.

Newborn Screening

• Done in the first 1 to 3 days of life, using drops of blood on a card.
• Fill each circle completely. Only the blood drop touches the card, never the skin. No smearing or layering.
• Checks for bilirubin, PKU, underactive thyroid, cystic fibrosis, sickle cell, G6PD deficiency and galactosemia (cannot digest milk sugar).
• Bilirubin samples must be kept away from light.

How Bleeding Stops, In Four Steps

1. The vessel tightens.
2. Platelets clump into a plug.
3. A proper clot forms.
4. Once healed, the clot dissolves.

Words To Know

Neonate

A newborn in the first 4 weeks.

Lancet

The small blade used for a skin puncture.

Plantar Surface

The bottom of the foot.

Bilirubin

Yellow pigment from broken-down red cells.

Jaundice

Yellow skin and eyes from too much bilirubin.

Hemolysis

Red cells bursting, which ruins the sample.

Hemostasis

The body stopping a bleed.

Fibrin

The protein threads that form a clot.

Iatrogenic Anemia

Anemia caused by taking too much blood for tests.

Osteomyelitis

Bone infection.

POCT

A test done right beside the patient.

Tubes And Order Of Draw

The most tested chapter. Each tube colour has something different inside it, so tubes must be filled in a set order or one will spoil the next.

The Order, And What Each Tube Is For

Tube Rules That Get Tested

• Blood cultures always go first. Two bottles: the aerobic (with air) first, anaerobic second.
• Blood cultures need a stronger skin cleaner than alcohol alone, so chlorhexidine is used. Collect them before antibiotics are started.
• Light blue must be filled all the way. With a butterfly, fill a throwaway tube first to clear the air out of the tubing.
• Red and gold must stand upright to clot for about 30 minutes before spinning.
• Light green needs no clotting time, so it is the fast one for urgent tests.
• Ammonia goes on ice straight away.
• Never spin a CBC.
• Lactic acid is drawn without a tourniquet, in a gray tube, and goes on ice.
• BNP (a heart failure test) goes in a lavender tube.
• Blood alcohol — never clean the skin with alcohol.
• Cap colours vary by maker. Trust the label, not the colour.
• Check the expiry date on every tube. The lab rejects expired ones.

Numbers Worth Knowing

• Sodium 135–145. Potassium 3.5–5.2.
• Fasting glucose 70–100.
• Hemoglobin: men 13.2–17.2, women 12.1–16.1.
• Hematocrit: men 40–54%, women 36–48%.
• INR 0.8–1.5.

Words To Know

Anticoagulant

Something that stops blood clotting.

Aerobic / Anaerobic

Needs oxygen / lives without it.

Aliquot

To pour part of a sample into another tube.

Centrifuge

A machine that spins tubes to separate the parts.

CBC

Complete blood count.

Differential

The share of each of the five white cell types.

Hematocrit

The share of blood that is red cells.

C&S

Culture and sensitivity: find the germ, then find the antibiotic that kills it.

STAT

Do it right now.

WNL

Within normal limits.

SST / PST

Serum separator tube / plasma separator tube.

Hypo- / Hyper-

Too low / too high. Hypokalemia is low potassium.

Laboratory Equipment

The machines you will touch: the centrifuge, rapid test devices, vein finders and the microscope. Mostly it is about balance, cleaning and keeping records.

The Centrifuge

• Spins tubes fast so the heavy parts sink.
• Serum tubes must clot fully first. Plasma tubes can spin right away.
• Balance it. Tubes of the same size and fill go directly opposite each other. Use a water-filled tube if you have an odd number.
• If it shakes or sounds wrong: stop it, unplug it, check the balance, then tag it out of service and report it.

Rapid Test Devices

• Used at the bedside for things like glucose, cholesterol, pregnancy and clotting time.
• Run a quality check on every new box of strips and write it down, with the lot number and expiry.
• If a result shows on screen, tell the provider, not the patient.

Vein Viewer

• A light that shows veins on the skin. Helpful, but feeling with your fingers still comes first.

Microscope

• Never touch the lenses. Clean with lens paper only.
• Carry it with two hands: one on the arm, one under the base.
• Light off and cover on when done.

Making A Blood Smear

1. Use a well-mixed lavender tube.
2. Put one small drop near the end of a glass slide.
3. Hold a second slide at 30 to 45 degrees, back it into the drop, then push forward in one smooth motion.
4. Let it air dry.
5. Label the frosted end in pencil.

Words To Know

Calibration

Adjusting a machine against a known standard so it reads right.

Blood Smear

A drop of blood spread thin on a glass slide.

Feathered Edge

The thin, faded end of a good smear, where cells sit one layer deep.

Lot Number

The batch number printed on a box of supplies.

Processing And Errors

Most lab mistakes happen before the sample is ever tested. This chapter covers timing, temperature, and the long list of ways a good draw gets ruined.

Timing

• STAT — collect now, ahead of everything else.
• Fasting — water only for about 12 hours. Used for glucose and cholesterol.
• NPO — nothing by mouth at all, not even water.
• Peak — the highest drug level, drawn after the dose.
• Trough — the lowest drug level, drawn about 15 minutes before the next dose.
• Always write the exact collection time. If you do not know when the last dose was, ask the nurse.
• It is your job to check the patient followed the rules, like fasting. Ask when they last ate or drank before you draw.

What The Serum Looks Like

• Clear yellow — good.
• Pink or red (hemolyzed) — cells burst. A collection or handling mistake. The lab will reject it.
• Cloudy or milky (lipemic) — fat in the blood. The patient may not have fasted.
• Dark yellow, brown or green (icteric) — high bilirubin. Not your fault.

Special Handling

• Keep from light — bilirubin, vitamins B6, B12 and K. Wrap in foil or use an amber tube.
• Keep warm (body temperature) — cold agglutinin, cryoglobulin.
• Keep on ice — ammonia.
• Freeze — once only. Never thaw and refreeze.
• Most other samples sit in the fridge until pickup.

Mistakes Before The Draw

• Wrong patient — the most serious error there is.
• Wrong time, patient did not fast, site not cleaned properly.

Mistakes During The Draw

• Tourniquet on too long.
• Needle too small (bursts cells) or too big (collapses the vein).
• Wrong order of draw, wrong tube, or not enough blood.

Mistakes After The Draw

• Mislabelled, or not labelled.
• Tube not turned, or shaken instead of turned gently.
• Spun before it finished clotting. This leaves a thick jelly lump on top, called a fibrin clot.
• Samples left for after-hours pickup go in a locked, temperature-controlled box.
• Left in light or at the wrong temperature.

Words To Know

Pre-Analytical

Everything that happens before the sample is tested.

QNS

Quantity not sufficient. Not enough blood in the tube.

Diurnal

Changes through the day, like cortisol.

Turbid

Cloudy.

Stasis

Blood flow slowed or stopped.

PO

By mouth.

Lab Test Directory

The lookup that says which tube, how much, and how to handle every test.

Infection Control

Germs need six things in a row to spread. Break any one and the infection stops. Clean hands break more links than anything else.

The Chain Of Infection

1. The germ itself.
2. Reservoir — where it lives.
3. Way out — how it leaves.
4. How it travels.
5. Way in — how it enters the next person.
6. Someone who can catch it.

How Germs Travel

• Airborne — tiny particles that hang in the air. TB, measles, chickenpox, COVID-19.
• Droplet — bigger drops from a cough or sneeze that fall within about 6 feet. Flu, colds, strep.
• Contact — touching the person, or touching something they touched. MRSA, C. diff, lice.
• Through broken skin — a needle stick. Hepatitis B and C, HIV.
• Vector — insects and animals. Lyme disease, malaria.
• Vehicle — bad food, water or blood. Salmonella, E. coli.

What To Wear For Each

• Contact — gloves and gown.
• Droplet — surgical mask.
• Airborne — N95 mask, and the patient is in a special ventilated room.
• Follow the sign on the door.

Hand Washing

• Wet, soap, scrub every part, rinse from the wrists down, dry with a paper towel, and use that towel to turn off the tap.
• Sanitiser before and after gloves.

Lab Departments

• Chemistry — the biggest. Organs and body chemistry.
• Hematology — blood cells.
• Coagulation — clotting.
• Blood Bank — typing and transfusions.
• Microbiology — finds the germs.
• Urinalysis — urine.
• Surgical Pathology — tissue samples.

Words To Know

Pathogen

A germ that causes disease.

Fomite

An object that carries germs: a doorknob, a pen, a handrail.

HAI / Nosocomial

An infection caught in a healthcare setting.

MRSA

A staph germ that many antibiotics cannot kill.

C. Diff

A gut germ that causes severe diarrhoea.

Communicable

Spreads from person to person.

Parenteral

Any way in other than the gut, like a needle stick.

Accession Number

The lab's own tracking number for a sample.

Biopsy

A small piece of tissue taken for testing.

Non-Blood Specimens

Urine, stool, swabs and more. Many are collected by the patient at home, so clear instructions and correct labelling matter most.

The Basics

• Be kind and matter-of-fact. These can be awkward for patients.
• Give a full kit, say the instructions out loud, and hand over a printed copy.
• Label straight away: name, date of birth, date, time, your initials, and where the sample came from (for example, "throat").

Urine: How It Is Collected

• Random — any time. The everyday one.
• Clean catch midstream — clean first, start, then catch the middle part. Best for avoiding contamination.
• First morning — the most concentrated. Best for pregnancy tests.
• 24-hour — starts after the first morning trip to the toilet, then every drop is collected. Kept in the fridge. When they hand it in, ask whether it was kept cold.
• After a meal — collected 2 hours after eating.

Urine: The Tests

• Urinalysis has three parts: how it looks, a chemical dipstick, and a look under the microscope.
• Urine culture confirms an infection and which antibiotic works.
• Drug screen needs a strict paper trail. The cup has a thermometer to prove the sample is fresh.

Stool

• Hidden blood test — screens for colon cancer. Three samples on three days.
• Parasite test — several samples over several days. It must be in the lab's own container, which has a preservative in it. A container from home is not accepted. Give them a new one.
• C. diff — very contagious. No preservative in the container.

Swabs And Others

• Throat — back of the throat while they say "Ah". Do not touch the tongue, teeth or cheeks. Tests for strep.
• Nasal — just inside the nostril.
• Nasopharyngeal — deeper, to the back of the nose. Flu, COVID, RSV.
• Cheek — inside of the cheek, for DNA.
• Sputum — a deep cough from the lungs, first thing in the morning. Tests for TB.
• Breath test — for a stomach germ. No food, drink, smoking or gum for an hour before.
• Semen — kept at body temperature and delivered within 60 minutes.

Words To Know

Void

To empty the bladder.

Postprandial

After a meal.

Buccal

The inside of the cheek.

Sputum

Mucus coughed up from the lungs.

Guaiac

The chemical that shows hidden blood in stool.

H. Pylori

A germ that lives in the stomach lining.

Chain Of Custody

The paper trail showing who handled a legal sample, and when.

Viability

Whether the sample is still good to test.

Forensic

Used for legal cases.

Advanced Procedures

Special jobs that go past a normal draw. Some you only assist with, but you still need to know the rules.

Arterial Blood Gas

• Blood from an artery, to see how well the lungs are working. Measures oxygen, carbon dioxide and pH.
• Usually taken from the radial artery, on the thumb side of the wrist.
• Done by doctors, nurses and respiratory therapists. Phlebotomists usually assist.
• The sample must not touch air, goes on ice, and is tested within 15 minutes.
• Needle at 45 degrees. Hold pressure yourself for 3 to 5 minutes afterwards.

The Modified Allen Test

1. Patient makes a tight fist.
2. Press on both wrist arteries for about 10 seconds.
3. Patient opens the hand. The palm looks pale.
4. Let go of the pinky side only.
5. Colour back within 5 to 15 seconds means the hand has a good back-up blood supply. If not, use another site.

Glucose Tolerance Test

• Shows how the body handles sugar. Used to find diabetes, including the kind that appears in pregnancy.
• Patient fasts 8 to 10 hours. Water only. No gum, mints or smoking.

1. Draw the fasting sample first.
2. Patient drinks the whole sugar drink within 5 minutes.
3. Start the timer when they finish.
4. They stay seated. No food or drink.
5. Draw at the set times, such as 1 hour and 2 hours.
6. Label every tube with its time.

Blood Alcohol Test

• Never clean the skin with alcohol. Use an alcohol-free cleanser such as iodine.
• Goes in a gray tube.
• Legal cases need the full paper trail.

Treatments Using The Patient's Own Blood

• PRP — blood is spun to concentrate the platelets, then injected back to help healing. Stays liquid. Light blue tubes. Only a provider injects it.
• PRF — the same idea with nothing added, so it sets into a soft gel. Red tubes, spun immediately. Common in dental surgery.

Therapeutic Phlebotomy

• Taking out about 500 mL of blood as the treatment itself.
• For too much iron (hemochromatosis) or too many red cells (polycythemia vera).
• Needs a doctor's order and signed consent.
• The blood is thrown away. It is not donated.

Words To Know

Autologous

Coming from the same person.

Collateral Circulation

A back-up blood route from nearby vessels.

Contraindication

A reason a procedure is unsafe for this patient.

Perfusion

Blood flowing through tissue.

Radial / Ulnar Artery

Thumb side of the wrist / pinky side.

ETOH

Alcohol.

Emergencies And Wellness

What to do in a fire, and basic first aid for the emergencies you might see at work. Lots of short memory words here.

Hospital Codes

• Code Red — fire or smoke.
• Code Blue — medical emergency, heart or breathing has stopped.
• Code Orange — hazardous spill.
• Code Gray — security.
• Codes can differ from one facility to another.

Fire

• A fire needs three things: fuel, oxygen and heat. Remove one and it goes out.
• Never use water on an electrical or grease fire.
• Use the stairs, never the lift.

Fire Types

• A — ordinary things: wood, paper, plastic.
• B — flammable liquids: petrol, oil, paint.
• C — electrical.
• D — metals.
• K — cooking oil and grease.

The Hazard Diamond

• Blue — health. Red — fire. Yellow — reactivity. White — special hazards.
• Each is scored 0 (safe) to 4 (extreme).

Adult CPR

1. Tap and shout. No response, no breathing, no pulse: call 911 and start.
2. Heel of one hand on the centre of the chest, other hand on top.
3. Push hard and fast: 100 to 120 a minute, about 2 inches deep.
4. If trained, 2 breaths after every 30 pushes. If not, pushes only.
5. Use the defibrillator as soon as it arrives and follow its voice.
6. Keep going until help takes over.

First Aid

• Choking — 5 back blows, then 5 belly thrusts. Repeat. If they pass out, start CPR.
• Heavy bleeding — firm, direct pressure. Raise the arm or leg above the heart.
• Shock — pale, clammy, fast weak pulse. Lay them flat, raise the feet about 12 inches, cover with a blanket.
• Heart attack — chest pain spreading to the jaw or left arm, sweating, short of breath. Call for help, sit or lie them down.
• Stroke — confusion, slurred speech, weakness on one side. Call for help. No food or water.

Burns

• First degree — red, top layer only. Cool water, never ice.
• Second degree — blisters. Cool water and a clean non-stick dressing. No creams.
• Third degree — all layers, and it may not hurt. Call for help. Do not pull off stuck clothing.

Words To Know

AED

The portable machine that shocks the heart back into rhythm.

BLS

Basic life support.

Cardiac Arrest

The heart suddenly stops pumping.

Myocardial Infarction

Heart attack.

CVA

Stroke.

TIA

A mini or warning stroke that passes, usually in under an hour.

Cyanotic

Bluish skin from lack of oxygen.

Hemorrhage

Heavy bleeding.

Supine

Lying flat on the back.

Recovery Position

Lying on the side so the airway stays clear.

DNR

Do not resuscitate. No CPR for this patient.

Good Samaritan Act

Legal protection for helping in good faith at an emergency.

Administrative Duties

The desk side of the job: the lab computer system, privacy, phone calls, shipping, and a little insurance and coding.

The Lab Computer System

• Called the LIS. It holds orders, results and patient details, and prints the barcode labels.
• In hospitals you scan the wristband. A match proves the label belongs to that patient.
• If the name or birth date the patient gives does not match the form, stop and fix it before drawing.
• Check for duplicate orders before you draw.
• A patient cannot just ask for an extra test. It needs a provider's order and a diagnosis code.

Records

• The medical record is a legal document. If it is not written down, it is treated as if it never happened.
• Every note needs the date, time, what was done, and who did it.
• Never delete a mistake. Add a new entry marked "Entered in Error" with the correction.

Privacy

• Your own login, never shared.
• The system records who opened every record, and when.
• Looking up a record out of curiosity breaks HIPAA, even for a friend or neighbour. It can cost you the job.
• Only share information with people the patient has approved in writing. That includes husbands, wives and family.

Urgent Results

• A critical value (also called a panic value) is a dangerously abnormal result. Report it to the provider straight away.
• Use read-back: the other person repeats it back to you to confirm they heard it right.
• Write down who you told, and the date and time.

Shipping Samples

• Each shipment needs a waybill: the document listing what is inside, where from, where to, and tracking.
• Samples go in a biohazard bag with something absorbent, then inside a second leakproof container.
• No label, no test. The lab rejects it.

Insurance And Coding

• Third-party payer — whoever pays on the patient's behalf: an insurer, Medicare, Medicaid.
• Self-pay — the patient pays directly.
• ABN — a form Medicare patients sign saying they will pay if Medicare does not cover the test.
• CPT codes say what was done. Five digits. A routine blood draw is 36415.
• ICD-10 codes say why: the diagnosis. They start with a letter. A lab order cannot be entered without one.

Words To Know

LIS

Laboratory information system. The lab's computer system.

EMR

A patient's digital chart within one facility.

EHR

A digital record shared across many facilities.

Turnaround Time

How long from collection to result.

Sentinel Event

A serious, unexpected event that harms or kills a patient.

Security Breach

Someone seeing or releasing protected information without permission.

Waybill

The shipping document for a package.

Quick Reference

The useful parts of the appendices, in short form. Handy for last-minute revision.

Which Tube For Which Test

• Gold — most chemistry: liver, kidney, electrolytes, cholesterol, thyroid, pregnancy hormone, troponin (heart damage), vitamin B12 and D.
• Lavender — the blood count and its parts, A1c, sed rate, sickle cell screen, BNP.
• Light blue — every clotting test: PT, INR, aPTT, D-dimer. Always filled to the top.
• Pink — blood type, crossmatch, antibody screen. Never spun.
• Gray — glucose and lactic acid.
• Royal blue — metals and poisons: arsenic, copper, zinc, selenium.
• Tan — lead.

The Rarer Tubes

• Clear — nothing inside. Throwaway tube only.
• Orange — a fast clot activator, for urgent serum tests.
• White — EDTA with gel, for DNA-type testing.
• Yellow — two kinds: one for blood cultures, one for the blood bank.

Glucose Tests

• All of them use a gray tube.
• After-meal test — no fasting, no sugar drink. One draw, 1 or 2 hours after eating.
• Tolerance test — 8-hour fast, a 75 gram drink, then a fasting draw plus one draw every hour. A 2-hour test is 3 samples. A 3-hour test is 4.
• Pregnancy, first check — no fasting, 50 gram drink, one draw at 1 hour.
• Pregnancy, full test — 8-hour fast, 100 gram drink, 4 draws over 3 hours.

How Much Blood

• Normal draw: 2 to 30 mL. Child: 2 to 4 mL.
• Donation: 450 to 500 mL. Therapeutic: 500 mL.

Who Can Receive Whose Blood

• O negative can be given to anyone.
• AB positive can receive from anyone.
• A negative patient can only receive negative blood. A positive patient can receive either.
• Type O patients can only receive type O.

Moving An Infectious Patient

• Keep moves to a minimum.
• Airborne or droplet: the patient wears a mask.
• Contact: the infected area is covered.

Body Directions

Anterior / Posterior

Front / back.

Superior / Inferior

Toward the head / toward the feet.

Medial / Lateral

Toward the middle of the body / toward the side.

Dorsal

The back surface, as in the back of the hand.

Building Blocks Of Medical Words

Hem- / Hemat-

Blood.

Phleb- / Ven-

Vein.

Cardi-

Heart.

Hepat-

Liver.

Ren- / Nephr-

Kidney.

Derm- / Cutane-

Skin.

Erythr- / Leuk-

Red / white.

Cyan-

Blue.

Gluc- / Glyc-

Sugar.

Thromb-

Clot.

Hyper- / Hypo-

Too much / too little.

Brady- / Tachy-

Slow / fast.

A- / An-

Without.

Anti-

Against.

-Itis

Inflammation.

-Emia

A blood condition.

-Cyte

Cell.

-Lysis

Breaking down.

-Ectomy

Surgical removal.

-Tomy

Cutting into.

-Logy

The study of.

Chart Shorthand

STAT

Immediately.

NPO

Nothing by mouth.

PO

By mouth.

PRN

As needed.

a.c. / p.c.

Before meals / after meals.

q

Every. "q.h." is every hour.

Dx / Hx

Diagnosis / history.

c/o

Complains of.

d/c

Discontinue or discharge.

VS

Vital signs.