AMT CMLA cheat sheet

Venipuncture order of draw: blood culture → light blue (citrate) → serum/clot activator (red, gold/SST) → green (heparin) → lavender (EDTA) → gray (fluoride/oxalate).

Light blue citrate tubes must be filled to the indicated line; the required blood-to-additive ratio is 9:1, and underfilled tubes are rejected because clotting times falsely prolong.

Tourniquet application is limited to 1 minute or less; prolonged stasis causes hemoconcentration and falsely elevates potassium, total protein, and lipid values.

Let antiseptic (alcohol, chlorhexidine) dry completely before puncture; residual antiseptic causes hemolysis, pain, and possible dilution of the sample.

Lavender EDTA tubes are inverted 8-10 times; tubes are never shaken, which causes hemolysis and platelet clumping.

Skin puncture order of draw begins with EDTA (lavender), then other additive tubes, then non-additive serum tubes; the first drop is wiped away when tissue fluid contamination would alter results.

Infant heel puncture is made on the medial or lateral plantar surface to a depth of 2.0 mm or less; the center and posterior curvature of the heel are avoided to prevent bone injury.

Blood gas, ammonia, and lactic acid specimens are transported on ice and delivered immediately; bilirubin is protected from light; most serum/plasma analytes are transported at room temperature.

Specimens are rejected when unlabeled or mislabeled, collected in the wrong tube, underfilled, grossly hemolyzed, clotted when anticoagulated, or outside stated stability limits.

Serum tubes clot at room temperature for about 30 minutes before centrifugation; incomplete clotting leaves fibrin that clogs probes and produces erroneous results.

Centrifuge tubes are loaded in opposing pairs of equal weight and count; an unbalanced rotor causes vibration, poor separation, tube breakage, and aerosol release.

Typical serum/plasma separation is 10-15 minutes at approximately 1000-1300 x g at room temperature; gel separator tubes form a barrier between serum and cells.

Heparinized and EDTA plasma tubes may be centrifuged immediately after collection; EDTA plasma is avoided for potassium and calcium measurement because the chelator alters results.

Storage ranges: refrigerated 2-8 °C; frozen -20 °C or lower; ultracold -70 °C for labile analytes such as catecholamines and certain hormones.

Each aliquot is labeled with two patient identifiers, specimen type, date and time of aliquoting, and storage conditions; unlabeled aliquots are discarded.

Hemolysis, icterus, and lipemia (HIL index) interfere with spectrophotometric and immunoassay methods; results above the manufacturer's threshold are reviewed before reporting.

Grossly hemolyzed specimens falsely elevate potassium, LDH, and AST, and hemoglobin interferes with many colorimetric chemistry assays.

High-risk manipulations that generate aerosols are performed in a biological safety cabinet, and tubes are opened carefully to avoid sprays and droplet dispersal.

CLIA-waived tests are FDA-cleared as simple with low risk of an erroneous result; the testing site still needs a current CLIA Certificate of Waiver.

Waived testing requires following the manufacturer's instructions exactly, including specimen type, storage, timing, and documented QC.

Point-of-care glucose meters use control solutions at manufacturer-specified levels, commonly two levels on each day patient testing is performed.

The CLIA certificate, package insert, and training/competency records must be available at the testing site for inspection.

Urine reagent strips are read within the manufacturer's stated window per pad; reading too early or too late produces falsely low or high results.

Rapid antigen strep tests are less sensitive than culture; a negative result in a child may require culture confirmation per facility policy.

Urine hCG tests typically detect about 25 mIU/mL; first-morning urine is most concentrated, and very early pregnancy may give a false negative.

Capillary specimens are obtained from the side of the fingertip, avoiding fingers that are edematous, cyanotic, or poorly perfused.

All point-of-care results are documented in the patient record, and critical values are reported immediately to the responsible caregiver with read-back.

OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) requires an exposure control plan, free hepatitis B vaccination offered within 10 working days of assignment, PPE, and engineering controls.

Safety Data Sheets follow a 16-section format covering hazards, composition, first aid, firefighting, handling, exposure controls, stability, and toxicology.

Gloves are never washed or reused and PPE is removed before leaving the laboratory; hands are washed after glove removal.

Needles are never recapped by hand; sharps containers are replaced when three-quarters full and closed before disposal as regulated medical waste.

Emergency eyewash stations must be reachable within 10 seconds of travel, and chemical splashes are flushed for at least 15 minutes.

Fire extinguisher classes: A for ordinary combustibles, B for flammable liquids and solvents, C for electrical, K for cooking oils; use the PASS technique.

CLIA regulates laboratory testing through Certificates of Waiver, Compliance, and Accreditation, with biennial inspections and required quality assessment activities.

HIPAA permits disclosure of only the minimum necessary protected health information and requires safeguards for paper and electronic records.

After a sharps injury: wash the site with soap and water, report immediately, and obtain source patient evaluation for HIV, HBV, and HCV per protocol.

Patient identity is verified with two identifiers, such as full name plus date of birth or medical record number; room or bed number is never an identifier.

Specimen labels are completed at the bedside and checked against the patient's armband before the needle is removed.

Informed consent requires that the patient receive an explanation of the procedure, its risks and benefits, and alternatives, and voluntarily agree.

For a patient with a history of syncope, draw with the patient supine or reclined and observe for pallor, diaphoresis, and dizziness.

Limited English proficiency requires a qualified medical interpreter; family members, and especially children, are not appropriate interpreters.

Teach-back, in which the patient restates instructions in their own words, confirms comprehension better than yes/no questioning.

Protected health information is not discussed in elevators, waiting rooms, or other public areas; minimum necessary disclosure applies.

Documentation is objective, timely, and accurate; errors are corrected with a single line, initials, and date so the original entry remains legible.

Professional boundaries include respecting patient autonomy, avoiding personal relationships, and recognizing when to escalate a complaint through service recovery.