NCCT NCPT cheat sheet

Antiseptic order: cleanse with 70% isopropyl alcohol and let air-dry completely before puncture; do not fan or blot.

Order of draw for evacuated tubes: blood culture, sodium citrate (light blue), serum (red/gold), heparin (green), EDTA (lavender), glycolytic (gray).

Capillary puncture site selection: lateral or medial plantar heel in infants; the central heel pad and fingers of newborns are avoided.

Wipe away the first drop of capillary blood; free-flowing blood is used to avoid tissue-fluid dilution and hemolysis.

Sodium citrate tubes require a 9:1 blood-to-anticoagulant ratio; underfilled tubes give falsely prolonged coagulation results.

Tourniquet application is limited to about 1 minute; prolonged stasis causes hemoconcentration and falsely elevated potassium and protein.

EDTA tubes are inverted 8-10 times; coagulation tubes 3-4 times; gentle inversion prevents hemolysis and clot formation.

Needle gauge and length: 21-23 gauge for routine adult venipuncture; smaller gauges increase hemolysis risk.

Blood culture bottles are collected first and filled before other tubes to reduce contamination.

Serum and plasma separation: centrifuge within 2 hours of collection when possible; deliver separated serum/plasma promptly.

Serum separator tubes are centrifuged after clotting (about 30 minutes at room temperature) to form a stable barrier.

Light protection is required for bilirubin and other photosensitive analytes; wrap specimens in foil or amber transport.

Ammonia and blood gases require immediate processing and ice or rapid transport per laboratory protocol.

Cryoglobulin and cold agglutinin specimens require collection and transport at 37 degrees C.

Specimen rejection criteria include unlabeled tubes, wrong tube type, gross hemolysis, clotted anticoagulated blood, and insufficient volume.

Refrigerated storage is inappropriate for whole blood and most coagulation specimens; follow each analyte's stability limits.

Chain-of-custody specimens (e.g., forensic or legal) must remain sealed with documented signatures at every transfer.

Two patient identifiers (full name and date of birth) are verified verbally and matched to the requisition before collection.

Informed consent must be obtained before venipuncture; refusal is documented and respected.

Standard precautions: gloves for all blood contact; hand hygiene before and after every patient interaction.

Needle safety: activate the safety device immediately after use and dispose in a puncture-resistant sharps container at point of use.

Syncope precautions: collect with the patient seated or supine and observe for pallor, diaphoresis, and dizziness.

Protected health information is shared only on a need-to-know basis; discussions occur in private areas.

Communication barriers are addressed with interpreter services, plain language, and confirmation of understanding.

Evacuated tube system components: multi-sample needle, holder, and tube with premeasured vacuum and additive.

Butterfly (winged) sets use a 21-23 gauge needle with tubing; used for fragile or small veins and pediatric patients.

Syringe and needle transfer is used when vacuum draw is contraindicated or veins are fragile; transfer to tubes without force.

Additive color code: light blue = sodium citrate; lavender = EDTA; green = heparin; gray = sodium fluoride/oxalate; red = no additive.

Tourniquet should be nonlatex when latex allergy exists; apply 3-4 inches above the puncture site.

Sharps containers are replaced when three-quarters full; never recap needles manually.

Lancets are single-use and selected by depth for the patient's skin thickness and specimen volume needs.

Skin antisepsis for blood cultures uses chlorhexidine gluconate or iodine; allow full drying time before puncture.

Sterile technique: do not touch the needle shaft or the puncture site after cleansing.

Documentation includes patient identifiers, date and time, collector identity, site, tube types, and any complications.

Label tubes at the bedside immediately after collection, never before, to prevent mislabeling.

Note specimen conditions such as hemolysis or short draw on the requisition or in the record.

Document patient education provided, consent, and any adverse events such as hematoma or syncope.

Record chain-of-custody transfers with signatures, dates, and times when applicable.

Venipuncture site preference: median cubital vein first, then cephalic, then basilic; avoid the basilic region near the brachial artery and nerve.

Avoid sites with hematoma, scarring, infection, edema, or an active IV line; draw below an IV site only per protocol.

Capillary collection order: EDTA (lavender) first, then other additive tubes, then non-additive tubes.

Hemolysis prevention: avoid excessive negative pressure, small-bore needles, and vigorous shaking of tubes.

Blood culture collection requires cleansing the bottle septum with alcohol before needle entry.

Micro-collection devices use a scoop or capillary tube and must be labeled with the same identifiers as venous samples.

Specimen stability varies by analyte; potassium and lactate rise with delay, while glucose falls without fluoride.

Transport temperature categories: ambient, refrigerated, frozen, and 37 degrees C; each analyte specifies its requirement.

Centrifugation speed and time are set per tube type; balanced loads prevent sample damage.

Do not centrifuge tubes with separators before clot formation; incomplete clotting causes fibrin interference.

Specimens for coagulation testing should be transported promptly and not refrigerated if platelet-poor plasma is needed.

Labeling errors are never corrected by relabeling an unlabeled tube; a new specimen must be collected.

Needle gauge increases as the number decreases: 18 gauge is larger than 23 gauge.

Multi-sample needles have a beveled patient end and a non-beveled rubber-sleeve end for tube puncture.

Tube vacuum determines draw volume; partial draws occur with expired tubes, high altitude, or collapsed veins.

Order of draw for capillary tubes differs from evacuated tubes; additive tubes are filled before non-additive.

Safety-engineered devices must be used per OSHA bloodborne pathogen requirements.

Glucose tubes contain sodium fluoride to inhibit glycolysis and potassium oxalate as an anticoagulant.

EDTA binds calcium to prevent clotting; excess EDTA can falsely lower calcium and elevate potassium.

Fall and injury prevention: keep the patient seated during and briefly after collection; ambulate only when stable.

Allergy history is checked before using latex, iodine, or adhesive products.

Needlestick exposure: wash the site with soap and water, report immediately, and follow post-exposure protocol.

Confidentiality includes not discussing results in public areas and securing requisitions and labels.

Effective communication uses the patient's preferred language, avoids jargon, and confirms understanding.

Documented refusal or inability to obtain a specimen is reported to the ordering provider.

Hand hygiene is performed before and after glove use; gloves do not replace handwashing.

Cleanse the venipuncture site with a circular motion from the center outward and allow it to dry.

Do not palpate the cleansed site unless wearing sterile gloves or after re-cleansing.

Document the exact time of collection, especially for timed or therapeutic drug monitoring specimens.

Record the specimen source and any deviations from protocol in the patient record.

Use only approved, unexpired antiseptics and check expiration dates on collection supplies.

Verify that labels match the requisition and patient identifiers before releasing the specimen.

Blood collection sets: evacuated tube system, butterfly set, syringe and needle, and capillary lancet.

Tourniquet material should be disposable or decontaminated between patients.

Tube additives: clot activators in serum tubes, heparin in green tubes, and citrate in light blue tubes.

Needle disposal containers must be rigid, leak-proof, and closable.

Gauze and bandage application after needle removal should include pressure without bending the arm.

Select the smallest needle that allows adequate flow to reduce hemolysis and patient discomfort.

If a vein is missed, release the tourniquet, withdraw the needle, apply pressure, and select another site.

Never probe with the needle to relocate a vein; probing increases hematoma and nerve injury risk.

For capillary collection, warm the site to increase blood flow; avoid squeezing the puncture site.

Blood culture volume matters: collect the recommended volume per bottle to improve sensitivity.

Label micro-collection tubes with patient identifiers and time immediately after collection.

Do not draw above an IV line or from an arm with a dialysis fistula or on the side of a mastectomy without provider approval.

Serum vs plasma: serum lacks fibrinogen; plasma retains clotting factors and requires an anticoagulant tube.

Specimens for ammonia should be placed on ice and processed rapidly.

Grossly lipemic or hemolyzed specimens may require rejection or a comment per laboratory policy.

Store specimens according to analyte stability; some require freezing at -20 degrees C or lower.

Accurate documentation of processing time supports result interpretation.

Specimens for microbiology are transported in appropriate media and not refrigerated unless specified.

Verify patient identity with two identifiers before labeling and before any procedure.

Maintain privacy with curtains or a closed door during collection.

Explain the procedure, expected sensations, and aftercare to reduce anxiety and improve cooperation.

Report and document adverse events such as hematoma, syncope, or arterial puncture.

Use standard precautions with all patients regardless of diagnosis.

HIPAA-style confidentiality applies to verbal, written, and electronic information.

Sterile technique is required for blood culture collection and any invasive site preparation.

Antiseptic must be allowed to dry to achieve full antimicrobial effect.

Document the antiseptic used and the site when required by policy.

A properly labeled specimen includes patient name, unique identifier, date, time, and collector.

Errors in labeling are documented and reported; unlabeled specimens are discarded per policy.

Records are legible, timely, and accurate; corrections follow facility policy.

Order of draw prevents additive carryover that can alter test results.

Do not use a tube past its expiration date; vacuum loss causes short draws.

Coagulation specimens must be filled to the indicated line and mixed gently.

Capillary blood gas specimens require heparinized tubes and immediate analysis.

Use the appropriate lancet depth for the patient's age and skin.

Venipuncture in infants is limited to specified sites and requires provider order per policy.

Specimen rejection protects patient safety and should be documented with the reason.

Centrifuge tubes with the stopper on unless the protocol states otherwise.

Avoid repeated freeze-thaw cycles; aliquot specimens for multiple tests.

Transport specimens in leak-proof secondary containers.

Maintain temperature logs for refrigerators and freezers used for specimen storage.

Timed specimens require exact collection times documented on the requisition.

Butterfly needles reduce trauma to fragile veins and allow flexible tubing for small veins.

Syringe transfer requires removing the needle before transferring blood to avoid hemolysis.

The evacuated tube holder should be held steady to prevent needle movement in the vein.

Tourniquet width and tightness affect venous distention and hemoconcentration.

Use appropriate tube size for the patient's vein and required blood volume.

Inspect supplies for damage and expiration before use.

Identify patients with similar names carefully using a second identifier.

Explain confidentiality and obtain consent before releasing information.

Use interpreter services rather than family members when possible.

Recognize and respond to signs of anxiety, needle phobia, or syncope.

Follow exposure control plans and report all needlesticks.

Respect patient autonomy and the right to refuse.

Clean gloves are used for routine venipuncture; sterile gloves for sterile procedures.

Change gloves between patients and when contaminated.

Dispose of contaminated supplies in appropriate biohazard waste.

Document the patient's response and any education provided.

Ensure requisitions and labels are legible and complete.

Follow facility policy for correcting documentation errors.

Select the appropriate vein by palpation, not just visualization.

Release the tourniquet as soon as blood flow is established.

Remove the needle and apply pressure with gauze; do not bend the arm.

Inspect the site for hematoma before bandaging.

For capillary collection, avoid the fingertips of infants and the heel center.

Collect specimens in the correct order to avoid contamination.

Centrifuge according to tube manufacturer instructions.

Separate serum or plasma promptly to avoid analyte degradation.

Protect light-sensitive specimens from light during processing and transport.

Maintain appropriate temperature during transport.

Document any processing delays.

Reject specimens that do not meet stability requirements.

Select needle gauge based on vein size and required blood volume.

Use safety devices to prevent needlesticks.

Check tube additive and expiration before use.

Use appropriate collection containers for micro-samples.

Dispose of sharps immediately after use.

Use nonlatex tourniquets for latex-allergic patients.

Confirm patient identity before every procedure.

Maintain privacy during collection.

Explain the procedure and aftercare.

Report adverse events promptly.

Follow standard precautions.

Protect patient information.

Use sterile technique for blood cultures.

Allow antiseptic to dry.

Label specimens at the bedside.

Document collection details.

Report labeling errors.

Keep records accurate and legible.

Follow order of draw.

Do not use expired tubes.

Fill coagulation tubes to the line.

Mix tubes gently.

Use appropriate lancet depth.

Follow policy for infant venipuncture.

Document rejection reasons.

Centrifuge correctly.

Avoid freeze-thaw cycles.

Use leak-proof transport containers.

Maintain temperature logs.

Document exact collection times.

Butterfly needles for fragile veins.

Remove needle before syringe transfer.

Hold the holder steady.

Tourniquet affects hemoconcentration.

Use appropriate tube size.

Inspect supplies before use.

Use two identifiers.

Obtain consent.

Use interpreter services.

Recognize syncope signs.

Report needlesticks.

Respect refusal.

Use clean gloves for routine venipuncture.

Change gloves when contaminated.

Dispose of biohazard waste properly.

Document patient response.

Ensure labels are complete.

Follow error-correction policy.

Palpate veins.

Release tourniquet early.

Apply pressure after needle removal.

Inspect for hematoma.

Avoid infant fingertips.

Follow order of draw.

Follow centrifuge instructions.

Separate serum promptly.

Protect light-sensitive specimens.

Maintain transport temperature.

Document delays.

Reject unstable specimens.