Phlebotomy

Step-by-Step Procedure

Procedure: Blood pressure measurement (relevant to phlebotomy).

Technique: Seated, arm at heart level, cuff on bare upper arm, inflate 30mmHg above palpated systolic, deflate 2-3mmHg/sec, Korotkoff sounds: first=systolic, disappear=diastolic

Normal values: Normal: under 120/under 80. Elevated: 120-129/under 80. Stage 1 HTN: 130-139 or 80-89. Stage 2: 140+ or 90+.

Exam Focus Areas

On the Medical Assistant, Ptcb exam(s), questions about phlebotomy typically test:

1. Medical terminology, abbreviations, and coding systems
2. Correct procedure technique and documentation requirements
3. Patient education and communication techniques
4. Normal and abnormal laboratory values and their clinical significance

Overview

Drawing blood via venipuncture or capillary puncture following proper order of draw. Technique, tube colors, and order of draw tested on MA and PTCB exams.

Clinical connection: Pulse technique involves Radial (most common), count 60 sec if irregular. Apical: left MCL, 5th ICS, count 60 sec. Pulse defi.

Regulatory Context

Regulatory context for phlebotomy includes federal and state requirements. Healthcare facilities must comply with CMS Conditions of Participation, state licensure requirements, and accreditation standards (Joint Commission or AAAHC). Non-compliance can result in citations, fines, or loss of Medicare/Medicaid reimbursement.

Calculation Methods

Reference values and calculations for phlebotomy. BMP normal ranges:

• Glucose: 70-100 mg/dL (fasting)
• BUN: 7-20 mg/dL
• Creatinine: 0.7-1.3 mg/dL
• Sodium: 136-145 mEq/L
• Potassium: 3.5-5.0 mEq/L
• CO2: 23-29 mEq/L
• Calcium: 8.5-10.5 mg/dL

Common Errors

Medical assistants must avoid these errors related to phlebotomy:

• Hemolysis: redraw, often caused by vigorous mixing or small-gauge needle
• Syncope: lower head, apply cool compress, do not leave unattended
• Nerve injury: remove needle immediately if patient reports shooting pain
• Failing to verify patient identity using two identifiers before any procedure