AMT RPT cheat sheet

Standard precautions apply to every patient regardless of diagnosis: hand hygiene before and after contact, gloves for blood or body-fluid contact, and additional PPE when splash or spray is anticipated.

Hand hygiene is the single most effective way to break the chain of infection: soap and water for at least 20 seconds, or alcohol-based rub with 20-30 seconds of friction until dry.

Gloves are not a substitute for hand hygiene; perform hand hygiene immediately after glove removal and never wear the same gloves between patients.

Use safety-engineered sharps devices and activate the safety mechanism immediately after use; needles must never be bent, broken, sheared, or recapped by hand.

Used needles and lancets go directly into a rigid, puncture-resistant, leak-proof, labeled sharps container that is replaced when three-quarters full.

Bloodborne pathogen exposure: wash the site with soap and water, flush mucous membranes with water, report immediately, and complete the post-exposure evaluation, which may include HIV prophylaxis and hepatitis B follow-up.

Biohazard labels are required on containers, bags, and equipment holding blood or other potentially infectious material; red bags and red containers are considered to meet the labeling requirement.

Spill cleanup sequence: absorb with disposable towels, decontaminate with an EPA-registered tuberculocidal disinfectant or 1:10 bleach dilution, allow contact time, then discard as biohazardous waste.

Transmission-based precautions: airborne diseases such as tuberculosis, varicella, and measles require an N95 respirator; droplet diseases require a surgical mask; contact precautions require gown, gloves, and dedicated equipment.

Two identifiers are required before every collection: full name plus a second unique identifier such as date of birth or medical record number; room number, bed number, and diagnosis are never acceptable identifiers.

Inpatients are identified from the wristband, which is compared with the requisition; outpatients state their name and date of birth, which the collector compares with the order.

The requisition is verified for tests ordered, fasting status, timing, and any medication holds before the needle is uncapped.

Basal-state specimens are drawn after 8-12 hours of fasting and about 30 minutes of rest; fasting beyond 24 hours increases hemoconcentration, bilirubin, and falsely elevates some analytes.

Tourniquet application longer than 1 minute produces hemoconcentration and falsely increases potassium, lactate, protein, and bilirubin; the tourniquet is released as soon as blood flow begins.

Procedure explanation includes purpose, expected sensation, and duration; an informed, cooperative patient is less likely to move, hyperventilate, or faint during the draw.

Positioning: seat the patient with the arm supported, or place the patient supine with legs elevated when there is a history of syncope; a standing patient is never bled if fainting risk exists.

During the draw the patient opens and closes the fist gently; vigorous fist pumping raises potassium and lactate and increases hemolysis.

Refusal is a patient right: document the refusal in the record, notify the ordering provider, and never collect a specimen against the patient's expressed will.

CLSI order of draw for evacuated tube systems: blood culture, sodium citrate (light blue), serum tube with or without clot activator or gel (red, gold, tiger top), heparin (green), EDTA (lavender), glycolytic inhibitor (gray).

Gauge selection: 21G for routine adult venipuncture, 22-23G for small or fragile veins, and 23-25G winged sets for pediatric and hand veins; smaller gauges increase hemolysis risk.

Needle insertion is bevel up at 15-30 degrees; once blood flows, the angle is lowered toward parallel and the needle advanced slightly to keep the bevel within the lumen without puncturing the posterior wall.

Capillary order of draw: blood gas tubes first if collected, then EDTA (lavender), then other additive tubes such as heparin and fluoride/oxalate, then serum tubes; the first drop is discarded.

Dermal puncture site for adults is the side of the third or fourth fingertip, perpendicular to the ridges; the thumb, index finger, fifth finger, and fingertips of the dominant hand are avoided.

Infant heel stick: puncture the lateral or medial plantar surface of the heel; the central heel, toes, and previously punctured areas are avoided because of the underlying bone and risk of osteochondritis.

Heel stick lancet depth must not exceed 2 mm in newborns and infants because the calcaneus lies close to the skin surface.

Warm the dermal puncture site for 3-5 minutes at no more than 42 degrees Celsius to increase arterial flow and improve blood yield; no tourniquet is used for capillary collection.

Syringe or winged-set collection is indicated for fragile, small, or sclerosed veins; blood is transferred to tubes with a transfer device rather than by pushing through a needle, which causes hemolysis.

Tubes are labeled at the patient's side immediately after collection with full name, second identifier, date, time of collection, and collector initials; pre-labeling before collection is prohibited.

An unlabeled tube is rejected and must be recollected; labels may never be applied to blood drawn from a different patient or applied away from the bedside.

Inversion counts for additive tubes: EDTA and heparin 8-10 times, sodium citrate 3-4 times, serum tubes 5 times; inversions are gentle, and shaking causes hemolysis while under-mixing causes microclots.

Sodium citrate (light blue) tubes require a 9:1 blood-to-anticoagulant ratio and must be filled to the indicated mark plus or minus 10 percent; underfilled citrate tubes are rejected because coagulation times are falsely prolonged.

A discard tube is drawn first when coagulation testing uses a winged set, because the tubing dead space would otherwise cause the citrate tube to be underfilled.

Serum and heparin chemistry tubes are centrifuged within 2 hours of collection and the serum or plasma separated from cells to prevent analyte shifts from ongoing cell metabolism.

Transport conditions: routine tubes at room temperature; ammonia, blood gases, and lactate on ice; cryoglobulins and cold agglutinins kept at 37 degrees Celsius; bilirubin and vitamins protected from light.

Blood culture bottles are transported at room temperature, never refrigerated or placed in an incubator at the collection site, and STAT specimens are delivered immediately.

Chain of custody for forensic, DOT, or legal specimens requires tamper-evident seals and documented date, time, and signature at every handoff; an unbroken chain is required for admissibility.

Rejection criteria include gross hemolysis, insufficient volume, wrong tube or additive, incomplete labeling, clotted specimens, and excessive transport delay.

Scope of practice: a phlebotomy technician collects, labels, handles, processes, and transports specimens but does not interpret results, order tests, or select tube types outside the written order.

Standard of care is the degree of care and skill a reasonably competent phlebotomist would exercise under similar circumstances; practice below that level supports a negligence claim.

Negligence requires four elements: duty owed to the patient, breach of that duty, causation, and damages.

Consent may be implied for routine venipuncture when the patient extends the arm, but the patient must be told the purpose, procedure, and risks and may withdraw consent at any time.

Battery is unauthorized touching without consent, such as drawing blood after a patient has clearly refused; assault is the threat of such touching.

Confidentiality: protected health information may be disclosed only for treatment, payment, or operations; discussing results in hallways, elevators, or waiting rooms violates HIPAA privacy rules.

Mandatory reporting duties include suspected child abuse, elder abuse, and neglect, plus reportable communicable diseases as defined by state law; reporting does not require patient permission.

Documentation is objective, accurate, and timely; errors are corrected with a single line, initials, date, and reason so the original entry remains legible, never obliterated or covered with correction fluid.

Needlestick injuries are recorded on an incident report and in the OSHA sharps injury log, which records the device type, location, and circumstances.

Quality control evaluates the analytic test system with control materials; quality assurance covers the entire process from order entry through reporting and includes QC as a subset.

Controls are run at the start of each shift and after reagent or lot changes; patient results are not reported until control values fall within established limits.

Westgard multirule application: 1-2s is a warning rule, while 1-3s, 2-2s, R4s, 4-1s, and 10x are rejection rules that require corrective action before reporting.

Proficiency testing is required under CLIA for moderate- and high-complexity testing; results are compared with peer laboratories to evaluate accuracy and are not shared between testing personnel.

Phlebotomy quality indicators include hemolysis rate, specimen rejection rate, blood culture contamination rate, turnaround time, patient satisfaction scores, and needlestick injury counts.

Blood culture contamination rates should remain at or below 3 percent; higher rates increase unnecessary antibiotic use, length of stay, and cost while confusing true bacteremia with skin flora.

A delta check compares the current result with the patient's previous result to detect specimen mix-ups, labeling errors, or genuine rapid analyte change.

Root-cause analysis identifies underlying system causes of an error rather than blaming an individual, and the resulting corrective action is documented and monitored for effectiveness.

Turnaround time is measured from order or collection to result reporting; each preanalytic step, including transport delay, adds to total TAT.