Routine Blood Collections — All Questions

Which tube color contains EDTA as its additive and is commonly used for complete blood count (CBC) testing?

A phlebotomist is preparing to collect blood from a patient with small, fragile veins in the hand. Which collection device is most appropriate for this situation?

What is the primary purpose of an adapter (hub) in the evacuated tube system?

While assembling supplies for a routine venipuncture, a phlebotomist notices that a needle package is partially open but the needle appears intact. What should the phlebotomist do?

Which needle gauge is most commonly used for routine venipuncture in adult patients with normal-sized veins?

A phlebotomist needs to collect a specimen for coagulation testing (PT/INR). Which tube should the phlebotomist select?

A phlebotomist is preparing to collect multiple tubes from a patient who has small, rolling veins and orders for a CBC, basic metabolic panel, and glucose. The phlebotomist considers using a syringe rather than the evacuated tube system. Which factor best supports this decision?

What additive is found in gray top evacuated tubes?

A phlebotomist selects a lavender top tube from the supply and notices the expiration date was two weeks ago. The tube appears visually normal. What is the correct action?

Which component of the evacuated tube system creates the vacuum that draws blood into the collection tube?

A phlebotomist is collecting blood from a pediatric patient using a 23-gauge winged infusion set. Compared to a 21-gauge needle, what is a potential concern with using the smaller gauge?

What type of additive is contained in a green top evacuated tube?

A phlebotomist is asked to draw a stat basic metabolic panel (BMP) from an elderly patient with thin, visible but fragile veins in the antecubital area. The available needles are 21-gauge and 22-gauge multisample needles. Which is the best choice and why?

Gold top (SST) evacuated tubes contain which of the following?

A phlebotomist is setting up for a blood draw and realizes the evacuated tube holder has visible cracks along the barrel. What should the phlebotomist do?

A multi-sample needle used in the evacuated tube system has two sharpened ends. What is the purpose of the shorter, rubber-sleeved end?

A phlebotomist has orders to draw a CBC, comprehensive metabolic panel, and PT/INR from a patient who is severely dehydrated with difficult venous access. The phlebotomist decides to use a winged infusion set connected to an evacuated tube holder. Which consideration is most important when using this setup for the light blue coagulation tube?

A phlebotomist needs to collect a blood specimen for a fasting glucose test. Which evacuated tube should be selected?

As needle gauge number increases (for example, from 21-gauge to 23-gauge), what happens to the needle bore size?

During a morning supply check, a phlebotomist finds that a box of evacuated tubes was left on a windowsill overnight in direct sunlight. The tubes are not expired and appear normal. What is the correct action?

What is the recommended angle of needle insertion for routine venipuncture?

A phlebotomist palpates the antecubital area and feels a structure that bounces back when pressed. A nearby structure feels pulsating. Which structure should the phlebotomist select for venipuncture?

When performing venipuncture, what is the standard antiseptic agent used to cleanse the collection site?

After cleansing the venipuncture site with alcohol, a phlebotomist notices the patient’s skin is still visibly wet. What should the phlebotomist do before inserting the needle?

How should the phlebotomist anchor the vein during venipuncture?

A phlebotomist is assessing the antecubital area and identifies the median cubital, cephalic, and basilic veins. The median cubital vein is clearly visible and well anchored. Which vein should the phlebotomist select as the first choice?

During a venipuncture, a phlebotomist inserts the needle and pushes an evacuated tube onto the internal needle, but no blood flows into the tube. The phlebotomist can feel that the needle is in tissue. What is the most appropriate first action?

After completing a venipuncture, what is the correct sequence for removing the needle?

A phlebotomist is drawing blood from a patient whose right arm has an IV running in the antecubital area. The patient’s left arm has a well-healed mastectomy scar. The patient states the doctor previously approved blood draws from the left arm. What should the phlebotomist do?

A phlebotomist is preparing to draw blood from a patient who reports an allergy to latex and adhesive tape. Which antiseptic application method should the phlebotomist avoid?

When assessing the skin at a potential venipuncture site, which finding would require the phlebotomist to select a different site?

A phlebotomist inserts the needle for venipuncture and sees a flash of blood in the tubing of the winged infusion set. What does this indicate?

A phlebotomist is attempting to draw blood from a patient with veins that roll easily during palpation. The phlebotomist has applied the tourniquet and identified the median cubital vein but cannot stabilize it. What is the best technique to address this?

During venipuncture, the needle bevel should face which direction upon insertion?

A phlebotomist completes a venipuncture and withdraws the needle. The phlebotomist notices that the needle safety device did not fully engage after the first attempt. What should the phlebotomist do?

A phlebotomist palpates a patient’s antecubital area and identifies a structure that is firm, cord-like, and does not bounce or refill when pressed. There is no pulse. What does this finding most likely indicate?

When cleansing a venipuncture site with an alcohol prep pad, what is the correct technique?

According to CLSI standards, which tube is drawn first in the standard venipuncture order of draw?

A phlebotomist has orders to collect a CBC, PT/INR, and a comprehensive metabolic panel. The tubes needed are lavender, light blue, and gold (SST). In what order should these tubes be drawn?

How many times should a lavender (EDTA) tube be gently inverted after collection to ensure proper mixing?

A phlebotomist accidentally draws a green (heparin) tube before a light blue (citrate) tube. What is the primary concern with this error?

In the CLSI standard order of draw, which tube color is drawn immediately after blood culture bottles?

A phlebotomist collects blood in a light blue (citrate) tube and notices the tube is only three-quarters full. The phlebotomist has additional tubes to draw. What should the phlebotomist do about the underfilled blue tube?

A phlebotomist has orders for blood cultures, PT/INR, CBC, BMP, and glucose. The tubes needed are: blood culture bottles, light blue, lavender, gold (SST), and gray. What is the correct order of draw for all five tubes?

What is the primary reason for gently inverting evacuated tubes containing additives after collection?

A phlebotomist is drawing a single light blue (citrate) tube from a patient using a butterfly set. No other tubes are ordered. What should the phlebotomist do to ensure accurate coagulation results?

How many times should a light blue (sodium citrate) tube be gently inverted after filling?

A phlebotomist draws tubes in the following order: lavender, light blue, gold (SST), gray. Upon review, the laboratory rejects the light blue tube. What is the most likely reason for rejection?

A phlebotomist collects a gold (SST) tube and notices the blood volume appears adequate, but forgets to invert the tube. Twenty minutes later, the phlebotomist realizes the error. What is the likely consequence?

In the CLSI standard venipuncture order of draw, where does the green (heparin) tube fall?

A phlebotomist uses a syringe to collect blood from a patient with difficult veins. After the draw, the phlebotomist needs to transfer blood into a light blue tube and a lavender tube. In what order should the tubes be filled?

What can happen if an evacuated tube containing an anticoagulant additive is shaken vigorously instead of gently inverted?

A new phlebotomist asks why the gray (fluoride/oxalate) tube is drawn last in the standard order of draw. What is the best explanation?

A phlebotomist draws a green (heparin) tube and immediately places it in the tube rack without inverting it. The specimen is sent to the lab, where it is rejected. What is the most likely reason for rejection?

What is the correct CLSI standard order of draw for venipuncture?

How far above the intended venipuncture site should a tourniquet be placed?

What is the maximum recommended time a tourniquet should remain on a patient’s arm during venipuncture?

A phlebotomist applies the tourniquet and begins palpating for a vein. After one minute and 15 seconds, the phlebotomist still has not identified a suitable vein. What is the correct action?

A phlebotomist notices that after applying the tourniquet, the patient’s hand is turning blue and the patient reports tingling in the fingers. What should the phlebotomist do?

What is hemoconcentration, and how does it relate to tourniquet application?

A phlebotomist is collecting blood from a patient receiving chemotherapy who has very fragile veins. The phlebotomist applies a tourniquet and the patient winces, reporting pain at the tourniquet site. The phlebotomist sees a small bruise forming under the tourniquet. What is the best action?

A phlebotomist is collecting blood for a potassium level. The tourniquet has been on for approximately 90 seconds while the phlebotomist struggled to find a vein. The phlebotomist successfully enters a vein and fills the tube. What concern should the phlebotomist have about this specimen?

When should the tourniquet be released during a routine venipuncture?

A phlebotomist applies a tourniquet and asks the patient to make a fist. The patient begins pumping the fist open and closed repeatedly. What should the phlebotomist instruct the patient to do?

A phlebotomist applies a tourniquet to a patient’s arm and cannot locate any veins in the antecubital area by palpation or sight. Which technique may help make veins more prominent?

A properly applied tourniquet should impede which type of blood flow?

A phlebotomist is collecting blood from a patient with a latex allergy. The standard tourniquets in the draw station are made of latex. What should the phlebotomist do?

A phlebotomist releases the tourniquet after one minute, waits two minutes, and reapplies it. After another minute of palpation with the tourniquet on, the phlebotomist still cannot find a suitable vein. What is the next appropriate step?

If the tourniquet needs to be reapplied after the one-minute time limit, how long should the phlebotomist wait before reapplying?

During a routine draw, a phlebotomist inserts the needle and obtains blood flow. However, the phlebotomist realizes the tourniquet was never released and the last tube is now almost full. The tourniquet has been on for approximately 90 seconds. What should the phlebotomist do?

A phlebotomist is collecting specimens from an obese patient. Standard tourniquets do not fit around the patient’s upper arm. What is the best alternative?

Which of the following is a sign that a tourniquet has been applied correctly?

A phlebotomist is preparing to draw blood from a patient who has an IV running in the left hand. The tourniquet needs to be applied to the right arm. The patient has an AV fistula in the upper right arm for dialysis. Where should the phlebotomist apply the tourniquet?

A phlebotomist collects three tubes of blood over two minutes. The tourniquet was applied at the start and never released during the entire collection. Which laboratory result is most likely to be affected by this error?

During a blood draw, a patient suddenly becomes pale, starts sweating, and says they feel dizzy. What should the phlebotomist do first?

What is the most common complication of venipuncture?

A phlebotomist successfully enters a vein and fills the first tube, but when the second tube is pushed onto the needle, blood flow stops. What should the phlebotomist try first?

While performing a venipuncture, the patient begins to experience a seizure. What is the phlebotomist’s first priority?

Petechiae appearing on a patient’s arm below the tourniquet site indicate which of the following?

During a draw, a phlebotomist notices swelling forming rapidly around the needle insertion site. The patient reports increasing pain. What is happening, and what should the phlebotomist do?

Which symptom during venipuncture requires the phlebotomist to discontinue the draw immediately?

A phlebotomist finishes a draw and the patient reports feeling nauseated. The patient’s face is flushed and sweaty. What should the phlebotomist do?

A phlebotomist inserts the needle and obtains a flash of blood, but then the blood flow becomes very slow and the blood appears bright red and pulsating. What has most likely occurred?

A patient faints during a blood draw and slides from the chair. The phlebotomist has already removed the needle. What should the phlebotomist do next?

After a venipuncture, when is it appropriate to apply a cold pack to the puncture site?

A phlebotomist attempts to draw blood from the median cubital vein but obtains no blood. After one gentle redirection attempt, there is still no blood flow. What should the phlebotomist do?

Diaphoresis during venipuncture refers to which symptom?

A phlebotomist is drawing blood from a patient on warfarin (a blood thinner). After the draw, the phlebotomist applies pressure for the standard time and removes the gauze, but the site is still bleeding. What should the phlebotomist do?

During a venipuncture, the evacuated tube fills very slowly and the blood appears darker than expected. The phlebotomist suspects a partially collapsed vein. What is the best corrective action?

How many venipuncture attempts should a single phlebotomist make on one patient before seeking assistance from another phlebotomist?

A patient tells the phlebotomist that they have a history of fainting during blood draws. What proactive measures should the phlebotomist take before beginning the draw?

A phlebotomist draws blood from a patient and notices the specimen in the tube appears cherry red rather than the typical dark venous color. The draw was from the antecubital area. What should the phlebotomist suspect?

What is syncope?

For an infant younger than 12 months, what is the preferred site for capillary (dermal) puncture?

A phlebotomist is preparing to perform a capillary collection on a 2-year-old child. Which site is most appropriate for this patient?

Why should the first drop of blood be wiped away during a capillary collection?

A phlebotomist is performing a heel stick on a newborn. Before puncturing, the phlebotomist wraps the infant’s heel in a warm, moist cloth for three minutes. What is the purpose of this warming step?

Which area of the infant’s heel should be avoided when performing a heel stick?

What is the maximum recommended depth for a heel puncture lancet on a newborn?

A phlebotomist performs a finger stick on an adult patient but has difficulty collecting enough blood. The blood flow slows after the first microcollection tube is partially filled. What technique can help improve blood flow?

A phlebotomist needs to collect a capillary blood gas specimen from an infant. The phlebotomist warms the heel and performs the puncture, then collects blood into a heparinized capillary tube. Which of the following is most critical during this collection?

Which finger is most commonly recommended for capillary puncture in adults?

A phlebotomist is about to perform a finger stick on an adult patient who is a guitar player and requests that the phlebotomist avoid the fingertips of the left hand. Which approach is correct?

The lancet puncture for a finger stick should be made across which part of the fingerprint?

A phlebotomist is performing a capillary glucose test on a patient. After cleaning the site with alcohol and puncturing, the phlebotomist wipes the first drop and then directly touches the test strip to the second drop. The result shows a much lower glucose than expected. What may have caused this?

A phlebotomist collects capillary blood from an infant’s heel and notices the specimen appears watery and lighter in color than expected. The phlebotomist squeezed the heel firmly to obtain sufficient blood. What is the most likely cause of this specimen appearance?

What type of collection device is specifically designed for capillary (dermal) puncture specimens?

A phlebotomist performs a capillary heel stick on an infant and needs to collect both an EDTA specimen and a serum chemistry specimen. Why must the EDTA microcollection tube be filled before the serum tube?

Which of the following is an advantage of using an automated retractable lancet for capillary puncture?

A phlebotomist is collecting a capillary specimen and notices that the blood is forming small droplets that do not coalesce into a large enough drop to fill the microcollection tube. What should the phlebotomist try?

A phlebotomist needs to collect a capillary specimen from a patient with poor peripheral circulation in both hands due to Raynaud’s phenomenon. The fingers appear pale and cool. What is the most important preparatory step?

After removing the needle from a venipuncture site, what should the phlebotomist immediately apply to the puncture site?