NCCT Patient Identification and Preparation 2 — Questions and Answers
Question 1: What is the minimum number of patient identifiers required before performing venipuncture?
- One (patient's name)
- Two (such as name and date of birth) (Correct answer)
- Three (name, DOB, and room number)
- Four identifiers from the wristband
Correct answer: Two (such as name and date of birth)
At least two independent patient identifiers (such as full name and date of birth) must be verified before any specimen collection to prevent misidentification.
The Joint Commission's National Patient Safety Goal NPSG.01.01.01 requires the use of at least two patient identifiers whenever providing care, treatment, or services. Acceptable identifiers include full name, date of birth, medical record number, Social Security number, or a photo ID. Room number is NOT an acceptable identifier because patients may be moved.
Question 2: A patient refuses to have their blood drawn. What should the phlebotomist do?
- Draw the blood anyway as ordered by the physician
- Document the refusal and notify the nurse or physician (Correct answer)
- Ask a coworker to draw the patient instead
- Leave and come back when the patient is asleep
Correct answer: Document the refusal and notify the nurse or physician
Patients have the right to refuse any medical procedure. The phlebotomist must document the refusal and notify the ordering physician or nurse.
Every competent adult patient has the legal right to refuse medical treatment, including blood draws (informed consent/informed refusal). The phlebotomist should explain the importance of the test, listen to the patient's concerns, and attempt to address them calmly. If the patient still refuses, the phlebotomist must respect their decision, document the refusal, and notify the ordering physician and/or nurse.
Question 3: Which of the following patients requires a fasting specimen?
- CBC patient
- Blood culture patient
- Lipid panel patient (Correct answer)
- Blood type patient
Correct answer: Lipid panel patient
Lipid panel testing requires the patient to fast for 9-12 hours because recent food intake significantly affects triglyceride and LDL cholesterol levels.
Fasting (9-12 hours with only water permitted) is required for lipid panel testing because dietary fat enters the bloodstream as chylomicrons, which significantly elevate triglyceride levels. Since LDL cholesterol is typically calculated using the Friedewald equation, elevated triglycerides cause an inaccurate LDL calculation.
Question 4: When should a phlebotomist apply and remove a patient's identification band?
- Only a nurse can apply or remove identification bands
- The phlebotomist can apply bands but must verify them with the nurse
- Phlebotomists should never touch identification bands
- Phlebotomists may apply bands in emergency situations following facility protocol (Correct answer)
Correct answer: Phlebotomists may apply bands in emergency situations following facility protocol
In emergency situations where unidentified patients arrive, phlebotomists may apply temporary identification following their facility's specific emergency protocol.
In emergency departments, unidentified patients (unconscious, trauma, John/Jane Doe) receive temporary identification per facility protocol. Some facilities allow phlebotomists to apply temporary ID bands with a unique emergency number. In routine settings, identification bands are typically applied by nursing or registration staff.
Question 5: What is the proper procedure when the patient's wristband information does not match the requisition?
- Draw the blood and note the discrepancy on the tube
- Do not draw blood; resolve the discrepancy with nursing staff first (Correct answer)
- Use the requisition information since it came from the physician
- Ask the patient which information is correct and proceed
Correct answer: Do not draw blood; resolve the discrepancy with nursing staff first
Any discrepancy between the wristband and the requisition must be resolved before blood is drawn. The phlebotomist should not proceed and must notify nursing staff.
A discrepancy between the wristband and requisition represents a potential patient identification error that could lead to wrong patient blood draw, the most serious preanalytical error. The phlebotomist must stop the procedure, inform the nurse, and the discrepancy must be investigated and corrected before any specimen is collected.
Question 6: How long should a tourniquet remain on the arm before it must be released during venipuncture?
- 30 seconds
- 1 minute (Correct answer)
- 2 minutes
- 5 minutes
Correct answer: 1 minute
A tourniquet should not remain on the arm for more than 1 minute because prolonged application causes hemoconcentration and alters test results.
CLSI guidelines recommend that tourniquet time not exceed 1 minute. After 1 minute of venous stasis, hemoconcentration begins as plasma water and small molecules filter out of the vasculature into surrounding tissue, while larger molecules (proteins, lipids, cells, enzymes) remain in the blood. This directly affects results for total protein, cholesterol, iron, calcium, cell counts, and other analytes.
NCCT Patient Identification and Preparation 2
What is the minimum number of patient identifiers required before performing venipuncture?