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AMCA PTC Phlebotomy Cheat Sheet

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Professionalism + Compliance

  • 18% of exam
  • Laws and Agencies Legal and Ethical Terms Chain of Custody AMCA PTC Exam Logistics OSHA vs CLIA

Patient ID + Site Prep

  • 17% of exam
  • Patient ID Rules Antecubital Veins Sites to Avoid Pre-Analytical Variables Site Picker Tourniquet Rule

Infection Control + Safety

  • 16% of exam
  • Standard Precautions and PPE Sharps and Exposure Response Precaution Picker PPE Sequence

Equipment Selection + Maintenance

  • 10% of exam
  • Additive Mechanisms Tube to Test Map Inversions Per Tube Needle Gauges and Devices Tube Picker by Test

Blood + Non-Blood Collection

  • 29% of exam
  • CLSI Order of Draw Complications and Response Hemolysis Causes Special Collections Capillary and Dermal Puncture Complication Response

Specimen Processing + Transport

  • 10% of exam
  • Serum, Plasma, Whole Blood Specimen Rejection Criteria Transport and Storage Rules Reject or Accept Handling Picker

Quick Facts

  • Credential AMCA PTC
  • Full name Phlebotomy Technician Certification
  • Scored items 100 multiple-choice
  • Time 2 hours
  • Passmark 70 or 74 correct
  • Format Online or paper
  • Proctoring Live remote available
  • Biggest domain Collection, 29%
  • Valid 2 years
  • Accreditation NCCA accredited

OSHA vs CLIA PR

OSHA

  • Worker safety
  • Bloodborne pathogens
  • PPE and sharps

CLIA

  • Test quality
  • Lab certification
  • Personnel standards
  • Employee vs test quality

Laws and Agencies PR

  • OSHA Worker safety enforcement
  • 29 CFR 1910.1030 Bloodborne Pathogens Standard
  • CLIA Laboratory testing quality
  • HIPAA Protected health information privacy
  • Minimum necessary Share only what's needed
  • CDC Recommends, does not enforce
  • CLSI Order of draw standards
  • NCCA Accredits the PTC credential
  • Exposure Control Plan Written, reviewed annually
  • Sharps injury log Employer must maintain

Assault vs Battery PR

Assault

  • Threat only
  • No contact made
  • Patient fears harm

Battery

  • Actual contact
  • Drawing after refusal
  • Unauthorized touching
  • Threat vs touch

Legal and Ethical Terms PR

  • Assault Threatening to draw
  • Battery Drawing without consent
  • Negligence Below reasonable standard of care
  • Malpractice Professional negligence
  • Respondeat superior Employer liable for employee
  • Expressed consent Spoken or written permission
  • Implied consent Patient offers the arm
  • Refusal Document, notify the nurse
  • Scope of practice Never interpret results
  • Chart correction Single line, initial, date

Chain of Custody PR

  • When required Forensic, drug, paternity testing
  • Identity check Photo ID required
  • Seal Tamper-evident, donor witnesses
  • Documentation Every handler signs, dates
  • Unbroken record Collection through final testing
  • Legal alcohol prep Non-alcohol antiseptic only
  • Broken chain Result inadmissible in court

AMCA PTC Exam Logistics PR

  • Scored items 100 multiple-choice questions
  • Pilot items Unscored, no score effect
  • Passmark Varies by exam form
  • Forms C, D 74 correct required
  • Forms E, F 70 correct required
  • Retake waits 30 days, then 60
  • Attempt limit Three within one year
  • Recertification 10 CE credits, 2 years
  • Reinstatement Within one year, $25
  • AMCA recommends 30 venipunctures, 10 capillaries
  • Louisiana rule 100 venipunctures, 25 capillaries

Vein Order PA

  • Median cubital, cephalic, basilic last
  • Median cubital: safest Cephalic: rolls more Basilic: median nerve Basilic: brachial artery

Site Picker PA

  • Routine adult draw → Median cubital ( Least nerve risk )
  • Median cubital unusable → Cephalic ( Anchor well, rolls )
  • Both unavailable → Basilic last ( Nerve, artery nearby )
  • Arm veins unusable → Dorsal hand ( 23G butterfly )
  • Mastectomy one side → Opposite arm ( No approval needed )
  • IV in one arm → Other arm ( Always preferred )
  • Only IV arm available → Draw below IV ( Discard 5 mL )
  • Infant under 1 → Heel stick ( Never a finger )
  • Foot or ankle → Provider approval ( Clot risk )

Antecubital Veins PA

  • Median cubital First choice, well anchored
  • Cephalic Second choice, thumb side
  • Basilic Last resort, highest risk
  • Median nerve Lies near basilic vein
  • Brachial artery Deep to basilic vein
  • Dorsal hand Butterfly, shallow angle
  • Vein feel Bouncy, spongy, no pulse
  • Artery feel Pulsing, thick walled
  • Tendon feel Hard, does not bounce

Tourniquet Rule PA

  • One minute on, 3-4 inches above
  • Over 1 minute: hemoconcentration Release once blood flows No fist pumping Never over a wound

Sites to Avoid PA

  • Edema Tissue fluid dilutes specimen
  • Hematoma Draw below or elsewhere
  • Scars, burns Poor flow, painful
  • Sclerosed veins Hard, cord-like, no return
  • Mastectomy side Lymphostasis, needs provider approval
  • Dialysis fistula Never without provider approval
  • Above an IV Always draw below
  • Foot, ankle Provider approval, clot risk
  • Tattoo, rash Infection and dye interference

Patient ID Rules PA

  • Two identifiers Full name, date of birth
  • Active identification Patient states and spells
  • Never ask Are you Mr. Diaz?
  • Armband Must match the requisition
  • Never accept Room or bed number
  • No ID band Nurse must attach first
  • Unconscious patient Nurse or relative identifies
  • Any mismatch Stop, do not draw
  • Introduce yourself State role, explain procedure

Pre-Analytical Variables PA

  • Fasting 8-12 hours, water only
  • Basal state Morning, rested, fasting
  • Tourniquet limit 1 minute maximum
  • Tourniquet placement 3-4 inches above site
  • Hemoconcentration Raises protein, potassium, calcium
  • Fist pumping Falsely raises potassium
  • Alcohol dry time 30 seconds, air dry
  • Posture Standing raises protein, cholesterol
  • Diurnal rhythm Cortisol, iron peak morning
  • Timed test Collect at ordered hour

PPE Sequence IN

  • Gown, mask, goggles, gloves; reverse off
  • On: gloves last Off: gloves first Doff dirtiest first Hand hygiene after

Standard vs Transmission-Based IN

Standard

  • Every patient, always
  • Assume all infectious
  • Hand hygiene, gloves

Transmission-based

  • Known or suspected organism
  • Contact, droplet, airborne
  • Added to Standard
  • Always vs in addition

Precaution Picker IN

  • MRSA or C. difficile → Contact precautions ( Gown, gloves )
  • Influenza or pertussis → Droplet precautions ( Surgical mask )
  • Tuberculosis or measles → Airborne precautions ( Fit-tested N95 )
  • Immunocompromised patient → Protective isolation ( Shield the patient )
  • Hands visibly soiled → Soap and water ( 20 seconds )
  • Hands not soiled → Alcohol rub ( Routine choice )

Standard Precautions and PPE IN

  • Standard Precautions All patients, all fluids
  • Only exception Sweat is not infectious
  • Donning order Gown, mask, goggles, gloves
  • Doffing order Gloves, goggles, gown, mask
  • Alcohol rub Routine, hands not soiled
  • Soap and water Visible soil, C. difficile
  • Wash duration At least 20 seconds
  • Contact precautions Gown and gloves
  • Droplet precautions Surgical mask, 3-6 feet
  • Airborne precautions Fit-tested N95, negative pressure

Sharps and Exposure Response IN

  • Never recap Activate safety device one-handed
  • Sharps container Rigid, at point of use
  • Replace when Two-thirds to three-quarters full
  • Needlestick first Wash with soap, water
  • Eye or mucosa Flush with water, saline
  • Needlestick second Report supervisor immediately
  • Needlestick third Incident report, baseline testing
  • HIV prophylaxis Within hours, under 72
  • Hepatitis B vaccine Free, within 10 working days
  • Blood spill 1:10 bleach, full contact time

Inversion Counts EQ

  • Blue 3-4, serum 5, rest 8-10
  • Culture: 8-10 Light blue: 3-4 Red, gold: 5 Green, lavender, gray: 8-10 Glass red: none

EDTA vs Citrate EQ

EDTA

  • Binds calcium tightly
  • CBC, ESR, HbA1c
  • Lavender, 8-10 inversions

Citrate

  • Binds calcium reversibly
  • PT INR, aPTT
  • Light blue, exact fill
  • Cell counts vs coagulation

Tube Picker by Test EQ

  • CBC or HbA1c → Lavender EDTA ( 8-10 inversions )
  • PT INR or aPTT → Light blue citrate ( Fill to line )
  • Serum chemistry panel → Gold SST ( 5 inversions )
  • Type and crossmatch → Pink EDTA ( No gel )
  • STAT potassium → Green heparin ( No clot wait )
  • Glucose or alcohol → Gray fluoride ( Antiglycolytic )
  • Suspected sepsis → Culture bottles ( Two sites )
  • Lead level → Royal blue ( Trace element free )
  • Westergren ESR → Black citrate ( Or lavender EDTA )

Additive Mechanisms EQ

  • SPS Anticoagulant, inhibits complement
  • Sodium citrate Binds calcium reversibly
  • Clot activator Silica speeds clotting
  • Separator gel Barrier between serum, cells
  • Heparin Activates antithrombin, blocks thrombin
  • EDTA Chelates calcium, preserves cells
  • Sodium fluoride Antiglycolytic, preserves glucose
  • Potassium oxalate Anticoagulant paired with fluoride
  • ACD Citrate dextrose, DNA testing

Plain Red vs Gold SST EQ

Plain red

  • No gel
  • Blood bank, serology
  • Yields serum

Gold SST

  • Clot activator, gel
  • Chemistry panels
  • Not for blood bank
  • Gel blocks blood bank

Tube to Test Map EQ

  • Yellow SPS Blood cultures
  • Light blue PT INR, aPTT, D-dimer
  • Plain red Serology, blood bank
  • Gold SST Serum chemistry panels
  • Green heparin Ammonia, lactate, STAT chemistry
  • Lavender EDTA CBC, ESR, HbA1c
  • Pink EDTA Type and screen
  • Gray Glucose, lactate, blood alcohol
  • Royal blue Lead, zinc, copper
  • Black Westergren ESR

Inversions Per Tube EQ

  • Culture bottles 8-10 inversions
  • Light blue 3-4 inversions
  • Red, clot activator 5 inversions
  • Gold SST 5 inversions
  • Green heparin 8-10 inversions
  • Lavender EDTA 8-10 inversions
  • Gray fluoride 8-10 inversions
  • Glass plain red No mixing needed
  • Technique Gentle, end-over-end
  • Too few Microclots, platelet clumping

Needle Gauges and Devices EQ

  • Higher gauge Smaller bore
  • 16-18G Blood donation, apheresis
  • 21G Routine venipuncture standard
  • 22G Small or fragile veins
  • 23G butterfly Hand veins, pediatrics
  • ETS holder Single use, discard attached
  • Syringe draw Fragile veins, controlled pull
  • Transfer device Syringe to tube safely
  • Bevel angle Up, 30 degrees maximum
  • Lancet depth 2.0 mm maximum

Equipment Quality Control EQ

  • Needle check Inspect bevel for burrs
  • Expired tube Lost vacuum, weak additive
  • Short draw Wrong blood to additive
  • Centrifuge Documented calibration schedule
  • Point-of-care meter Run controls each shift
  • Antiseptic choice Alcohol routine, chlorhexidine cultures

Order of Draw CO

  • Better Learn Real Good, Great Lab Guys
  • B: blood culture L: light blue R: red G: gold G: green L: lavender G: gray

Hematoma vs Nerve Injury CO

Hematoma

  • Site swells
  • Blood leaks out
  • Pressure and elevate

Nerve injury

  • Shooting electric pain
  • Tingling, numbness
  • Remove, never restick
  • Swelling vs shooting pain

Complication Response CO

  • Patient feels faint → Stop, lay flat ( Never leave alone )
  • Site swells → Release, remove needle ( Hematoma )
  • Shooting electric pain → Remove immediately ( Nerve, report )
  • Bright pulsing blood → Remove, press firmly ( Arterial nick )
  • Bleeding will not stop → Pressure, notify nurse ( Elevate arm )
  • Seizure begins → Remove needle, protect ( Call for help )
  • Two failed sticks → Hand off ( Never probe )
  • Patient vomits → Stop, position safely ( Call the nurse )

CLSI Order of Draw CO

  • Blood culture Yellow SPS, sterile first 1
  • Light blue Sodium citrate, coagulation 2
  • Red, gold Serum, clot activator, gel 3
  • Green Heparin, plasma chemistry 4
  • Lavender, pink EDTA, whole blood 5
  • Gray Fluoride oxalate, glucose 6
  • Royal blue Follows its own additive
  • Discard tube Butterfly before light blue
  • Why it matters Additive carryover skews results

Stop Signals CO

  • Shooting pain or pulsing blood: stop now
  • Electric pain: nerve Bright pulsing: artery Swelling: hematoma Pale, sweaty: syncope

Venipuncture vs Capillary CO

Venipuncture

  • Pure venous blood
  • Large volumes
  • CLSI order of draw

Capillary

  • Mixed arterial, venous, tissue
  • Small volumes
  • Blood gas drawn first
  • Volume decides method

Carryover Errors CO

  • EDTA into chemistry Potassium high, calcium low
  • Clot activator into blue Shortens PT and aPTT
  • Fluoride into chemistry Sodium high, enzymes inhibited
  • Heparin into lavender Distorts cell staining
  • Non-sterile before culture Contaminates the culture bottle
  • Underfilled citrate Falsely prolonged PT
  • Overfilled citrate Falsely shortened PT

Puncture Depth Limits CO

  • Finger and heel: 2.0 mm maximum
  • Heel: medial or lateral Never the posterior curve No finger under 1 Warm to 42 C

Complications and Response CO

  • Syncope Stop, lower head, stay
  • Hematoma Remove needle, pressure, elevate
  • Nerve injury Shooting pain, stop immediately
  • Arterial nick Bright pulsing, press 5 minutes
  • Petechiae Warns of prolonged bleeding
  • Seizure Remove needle, protect patient
  • Excessive bleeding Hold pressure, notify nurse
  • Iatrogenic anemia Blood loss from overdrawing
  • Latex reaction Switch to latex-free supplies
  • Two-stick rule Stop, ask another phlebotomist

Hemolysis Causes CO

  • Wet alcohol Lyses cells on entry
  • Bore too small Shears red cells
  • Shaking tubes Invert gently instead
  • Forced syringe transfer Use a transfer device
  • Milking a finger Squeezing lyses, adds fluid
  • Underfilled additive tube Excess additive lyses cells
  • Traumatic draw Probing damages cells
  • Falsely raises Potassium, LD, AST, magnesium

Special Collections CO

  • Blood cultures Two sets, two sites
  • Culture skin prep Chlorhexidine, let dry fully
  • Infants under 2 months Povidone-iodine instead
  • Bottle tops Wipe with 70% alcohol
  • Adult volume 8-10 mL per bottle
  • Butterfly set Aerobic bottle first
  • Syringe collection Anaerobic bottle first
  • GTT timing Start when drink finished
  • Trough level Just before next dose
  • Peak level After dose, drug specific
  • Legal alcohol Non-alcohol prep, full tube
  • Newborn screen Fill circles, air dry

Capillary and Dermal Puncture CO

  • Adult site Middle or ring finger
  • Finger depth 2.0 mm maximum
  • Direction Across the fingerprint lines
  • First drop Wipe away, tissue fluid
  • Infant site Medial or lateral heel
  • Heel depth 2.0 mm maximum
  • Never puncture Posterior curve, arch, calcaneus
  • Bone contact risk Osteomyelitis
  • No finger stick Under 1 year old
  • Warming 42 C, 3-5 minutes
  • Capillary fill order Blood gas, EDTA, others, serum

Non-Blood Specimens CO

  • Clean-catch urine Cleanse, void, collect midstream
  • 24-hour urine Discard first, keep last
  • Throat culture Tonsils and posterior pharynx
  • Throat swab avoid Tongue, cheeks, lips
  • Sputum Deep cough, first morning
  • Stool, semen Patient collects, instruct clearly

Serum vs Plasma PR

Serum

  • Clotted tube
  • No fibrinogen
  • Red or gold

Plasma

  • Anticoagulated tube
  • Contains fibrinogen
  • Green or lavender
  • Clot means serum

Reject or Accept PR

  • Tube has no label → Reject, recollect ( Never relabel )
  • Serum looks pink → Reject, hemolyzed ( Potassium falsely high )
  • Serum looks milky → Note lipemia ( Check fasting status )
  • Clots in lavender → Reject, recollect ( CBC invalid )
  • Light blue underfilled → Reject, recollect ( Ratio wrong )
  • Tube past expiration → Reject, recollect ( Vacuum lost )
  • Ammonia at room temp → Reject, recollect ( Needed on ice )

Serum, Plasma, Whole Blood PR

  • Serum Clotted tube, no fibrinogen
  • Plasma Anticoagulated, contains fibrinogen
  • Whole blood EDTA, cells intact
  • SST clot time About 30 minutes
  • Plain red clot time Up to 60 minutes
  • Spin time About 10 minutes
  • Separation limit Within 2 hours
  • Balance rule Equal tubes, opposite positions
  • Gel tubes Never re-spin

Hemolysis vs Lipemia PR

Hemolysis

  • Pink or red
  • Red cells ruptured
  • Potassium falsely high

Lipemia

  • Milky, cloudy
  • High triglycerides
  • Patient did not fast
  • Broken cells vs fat

Handling Picker PR

  • Ammonia or lactate → Ice slurry ( Deliver immediately )
  • Cold agglutinins → 37 C carrier ( Warm until separated )
  • Bilirubin or B12 → Amber tube, foil ( Light sensitive )
  • Potassium sample → Room temperature ( Never refrigerate )
  • Serum chemistry → Clot, then spin ( About 30 minutes )
  • Blood smear needed → Make within 1 hour ( From EDTA )

Specimen Rejection Criteria PR

  • Unlabeled tube Never relabel, recollect
  • Mislabeled tube Recollect, file incident report
  • Hemolyzed Pink or red serum
  • Clotted EDTA Microclots void the CBC
  • QNS Quantity not sufficient
  • Wrong tube Additive interferes with test
  • Expired tube Short draw, wrong ratio
  • Delayed transport Stability window missed
  • IV contamination Diluted, glucose falsely high

Transport and Storage Rules PR

  • Chilled on ice Ammonia, lactate, blood gases
  • Warm at 37 C Cold agglutinins, cryoglobulins
  • Light protected Bilirubin, B12, folate
  • Never refrigerate Potassium leaks from cells
  • Room temperature Most routine chemistry
  • Blood smear Make within 1 hour
  • Labeling moment At bedside, after collection
  • Label contents Name, ID, date, time
  • Transport bag Biohazard, requisition outside pocket

Common Traps

Serum vs plasma

  • Serum has no fibrinogen ≠ Plasma keeps fibrinogen

EDTA vs citrate

  • EDTA binds calcium irreversibly ≠ Citrate binds calcium reversibly

Hemolysis vs lipemia

  • Hemolysis looks red ≠ Lipemia looks milky

Gauge vs bore

  • Higher gauge, smaller bore ≠ Lower gauge, larger bore

Hematoma vs nerve

  • Hematoma swells up ≠ Nerve injury shoots

OSHA vs CLIA

  • OSHA protects the worker ≠ CLIA governs test quality

Standard vs transmission-based

  • Standard applies always ≠ Transmission-based is added

Gold vs pink tube

  • Gold for chemistry ≠ Pink for blood bank

Fasting vs basal state

  • Fasting is 8-12 hours ≠ Basal adds morning rest

Assault vs battery

  • Assault is the threat ≠ Battery is the contact

Chill vs refrigerate

  • Ammonia rides on ice ≠ Potassium never gets cold

Aerobic vs anaerobic first

  • Butterfly: aerobic first ≠ Syringe: anaerobic first

Last Minute

  • 1. Culture first, gray tube last
  • 2. Middle: red, gold, green, lavender
  • 3. Light blue needs an exact fill
  • 4. Butterfly plus citrate: discard tube first
  • 5. EDTA = CBC; citrate = PT
  • 6. Gold = chemistry; pink = blood bank
  • 7. Blue 3-4; serum 5; rest 8-10
  • 8. Median cubital first; basilic last
  • 9. Tourniquet off within 1 minute
  • 10. Let alcohol dry 30 seconds
  • 11. Two identifiers: name and birthdate
  • 12. Label at bedside, never before
  • 13. Shooting pain = stop and remove
  • 14. Pulsing bright blood = artery
  • 15. Never recap; activate the safety device
  • 16. Needlestick: wash, report, document
  • 17. Hemolysis falsely raises potassium
  • 18. Separate serum within 2 hours
  • 19. Ammonia on ice; potassium never cold
  • 20. Heel and finger: 2.0 mm max
  • 21. Passmark varies: 70 or 74

AMCA PTC Phlebotomy Technician

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