AMCA PTC cheat sheet

CLIA '88 classifies phlebotomy as a waived or moderate-complexity test depending on the specific procedure; personnel requirements vary by test complexity.

Informed consent must include the purpose, risks, benefits, and alternatives; it must be documented before the procedure.

HIPAA Privacy Rule protects individually identifiable health information; disclosure requires patient authorization or a legal exception.

OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) mandates an exposure control plan, HBV vaccination offer, and post-exposure evaluation.

The Patient's Bill of Rights includes the right to refuse treatment, informed consent, and confidentiality.

Chain of custody requires documenting each person who handles a specimen, including date, time, and purpose.

Standard of care is defined by what a reasonably prudent health care professional with similar training would do in similar circumstances.

A phlebotomist must never perform a procedure outside their scope of practice; scope is defined by state law and employer policy.

Hand hygiene is the single most effective infection control measure; use soap and water for visibly soiled hands, alcohol-based rub otherwise.

Standard precautions apply to all patients regardless of diagnosis; treat all blood and body fluids as potentially infectious.

PPE includes gloves, gown, mask, and eye protection; remove gloves without touching the exterior and perform hand hygiene immediately after.

Sharps containers must be puncture-resistant, leak-proof, labeled with the biohazard symbol, and replaced when three-quarters full.

Needlestick injuries require immediate washing with soap and water, reporting, and post-exposure prophylaxis evaluation within hours.

Transmission-based precautions: contact (direct/indirect), droplet (>5 µm, require mask), airborne (<5 µm, require N95 respirator and negative-pressure room).

Disinfectants must have EPA registration and appropriate contact time; bleach is effective against HBV and HIV at 1:10 dilution.

Fire safety uses the RACE acronym: Rescue, Alarm, Contain, Extinguish/Evacuate.

Use two independent identifiers: full name and date of birth, or full name and medical record number; never use room number or bed location.

Ask the patient to state their name and date of birth; do not read the information to the patient and ask for confirmation.

Verify identification against the requisition and the patient's armband before any specimen collection.

For unconscious or confused patients, verify identity through a family member, caregiver, or identification band.

Label specimens at the bedside immediately after collection with patient name, ID number, date, time, and collector's initials.

Mislabeled specimens must be rejected; never relabel a tube that has already left the patient's side.

Newborn identification uses two identifiers: mother's name and the infant's assigned ID number, plus footprint or band.

Assess for contraindications: mastectomy, dialysis fistula, IV infusion, edema, hematoma, scarring, or infection at the site.

Preferred venipuncture site is the median cubital vein, followed by cephalic and basilic veins.

Clean the site with 70% isopropyl alcohol in concentric circles from center outward; allow to air dry for 30 seconds.

Apply the tourniquet 3–4 inches above the venipuncture site for no longer than 1 minute; release before removing the needle.

The antecubital fossa is the first choice; if unavailable, consider the dorsal hand or wrist veins.

Avoid the basilic vein if possible due to proximity to the brachial artery and median nerve.

For capillary collection, warm the site to increase blood flow and wipe away the first drop of blood.

Assess patient for latex allergy; use latex-free tourniquets and gloves when indicated.

Gauge number is inversely related to needle diameter: 21G is larger than 23G; use 21G for routine venipuncture, 23G for small veins.

Evacuated tubes use color-coded stoppers: light blue (citrate), red/gold (serum), lavender (EDTA), green (heparin), gray (oxalate/fluoride).

Order of draw for evacuated tubes: blood culture, light blue, red/gold, green, lavender, gray.

Butterfly needles (winged infusion sets) are used for small or fragile veins; the tubing adds dead space that must be accounted for.

Syringes are used for fragile veins or when vacuum may collapse the vein; transfer blood to tubes immediately.

Tourniquets should be single-use or disinfected between patients; never reuse on multiple patients.

Check expiration dates on all tubes, needles, and collection devices before use.

Lancets for capillary puncture: use safety lancets with retractable blades; discard in sharps container after single use.

Venipuncture procedure: identify patient, assemble equipment, apply tourniquet, cleanse site, perform puncture at 15–30° angle, collect tubes, release tourniquet, withdraw needle, apply pressure.

For capillary puncture, use the middle or ring finger; avoid the thumb, index finger, and fifth finger in adults; use the heel in infants.

Order of draw for capillary tubes: EDTA, heparin, serum, fluoride.

Blood cultures: collect before antibiotics, cleanse site with chlorhexidine or iodine, inoculate aerobic and anaerobic bottles.

For coagulation tests (PT/INR, aPTT), fill light blue tubes to the fill line; underfilled tubes are rejected.

Urine collection: midstream clean-catch; instruct patient to cleanse, void first portion, collect midstream, and cap.

Stool collection: collect in a clean container, avoid contamination with urine or water; deliver within 1 hour or refrigerate.

Sputum collection: obtain early morning specimen, instruct patient to cough deeply, and collect in a sterile container.

Centrifuge serum tubes at 1000–1200 × g for 10–15 minutes; separate serum within 2 hours of collection.

Transport specimens at appropriate temperature: room temperature, refrigerated (2–8°C), or frozen (-20°C) per test requirements.

Avoid hemolysis by not shaking tubes, using appropriate needle gauge, and avoiding excessive suction.

Label all specimens with two patient identifiers, date, time, and collector's initials; unlabeled specimens are rejected.

Biohazard transport requires leak-proof secondary containers and absorbent material; label with biohazard symbol.

Timed specimens (e.g., 24-hour urine) must be collected over the exact time period and kept refrigerated during collection.

Specimens for blood gases must be transported on ice and analyzed within 15–30 minutes.

Chain of custody specimens must be sealed, labeled, and documented at each transfer; maintain a secure log.