Phlebotomy Mnemonics: 12 Memory Tricks for the NHA CPT Exam

Order of draw (venipuncture)

“Stop Light Red Stay Put Green Light Go”

1. SSterile: blood culture bottles
2. LLight blue: sodium citrate (coagulation)
3. RRed: serum tube, plastic with clot activator or glass plain
4. SSST: gold or red/gray gel serum tube
5. PPST: light green lithium heparin with gel
6. GGreen: sodium or lithium heparin
7. LLavender: EDTA (pink and pearl tops too)
8. GGray: sodium fluoride/potassium oxalate

Use it when: When a stem lists several ordered tests and asks which tube is filled first, next or last, or asks why a coag, calcium, potassium or glucose result is wrong.

Careful: This is the CLSI order (GP41, now republished as PRE02), with citrate before every serum tube. Old charts that put a glass red tube ahead of light blue are outdated. Royal blue tubes go in the slot that matches their additive. If a winged set is used and light blue is the first tube, draw a discard tube first so the air in the tubing does not underfill the citrate tube.

Order of draw (capillary)

“Get Lavender Out Soon”

1. GGases: capillary blood gas first, if ordered
2. LLavender: EDTA microtube next
3. OOther additive microtubes: heparin, fluoride
4. SSerum microtubes last

Use it when: When a fingerstick or heel-stick item asks which microtube is filled first, or why a capillary CBC shows clumped platelets.

Careful: It runs almost backwards from venipuncture. EDTA comes early because platelets start clumping at the puncture site, and serum tubes come last because clotting does no harm there. Carrying the venipuncture order into a capillary question is the trap. Wipe away the first drop of blood.

Tube inversions

“Blue 3-4, Red and Gold 5, the rest 8-10”

Light blue citrate tubes get 3-4 gentle inversions. Plastic red (clot activator) and gold SST tubes get 5. Light green PST, green heparin, lavender EDTA and gray fluoride tubes get 8-10. A glass red tube with no additive needs none. One inversion is a full turn upside down and back.

Use it when: When an item asks how many times to invert a tube, or why a CBC came back with microclots.

Careful: These are BD Vacutainer figures; other brands publish slightly different counts, so follow the manufacturer in practice. Never shake a tube: vigorous mixing hemolyzes the sample. Underinverted EDTA and citrate tubes form clots that invalidate the result.

Antecubital vein choice

“My Cat Bites”

1. MMedian cubital: first choice, well anchored, least painful
2. CCephalic: second choice, on the thumb side, harder to anchor
3. BBasilic: last resort, near the brachial artery and median nerve

Use it when: When a stem asks which vein to try first, or which vein carries the most risk of nerve injury or arterial puncture.

Careful: This is the H-shaped vein pattern. In the M-shaped pattern the first choice is the median vein. If no antecubital vein is suitable, hand veins are the next option; leg, ankle and foot veins need provider permission under most facility policies. Never probe blindly for the basilic vein.

Sites to avoid

“HIT FEMS”

1. HHematoma: use the other arm or draw below it
2. IIV infusion: use the other arm
3. TTattoos: choose another site when possible
4. FFistula, graft or shunt: never draw from that arm
5. EEdema: tissue fluid dilutes the specimen
6. MMastectomy side: only with the provider's permission
7. SScars and burns: hard to penetrate, poor circulation

Use it when: When a stem describes the patient's arms and asks where you may or may not draw.

Careful: Two of these are not absolute bans. The mastectomy side needs the provider's input, not an automatic no. Below an IV is allowed if the nurse stops the infusion for at least 2 minutes and the IV is noted on the requisition; drawing above an IV is never acceptable.

Blood culture bottle order

“Air goes to Aerobic”

With a winged (butterfly) set, inoculate the aerobic bottle first, so the air in the tubing goes into the bottle that tolerates oxygen. With a syringe, fill the anaerobic bottle first. Either way, culture bottles come before every other tube.

Use it when: When an item names the collection device and asks which bottle is filled first.

Careful: The rule flips with the device, and the stem tells you which device was used. Disinfect the bottle tops separately from the skin, and fill to the marked volume: underfilling lowers the chance of detecting bacteria. Chlorhexidine is the usual skin prep, but many facilities substitute another antiseptic for infants under 2 months.

Blood alcohol (legal) draws

“No alcohol for alcohol”

Clean the site with a non-alcohol antiseptic, such as soap and water or povidone-iodine, as your policy specifies. Fill the gray-top tube completely, leave it unopened, and keep the chain of custody intact at every hand-off.

Use it when: When a stem describes a legal or forensic alcohol draw and asks about site prep, tube choice or handling.

Careful: An alcohol pad is the distractor because it is routine everywhere else. Do not open the tube or leave headspace, because ethanol is volatile. On a forensic draw, a missing signature or unsealed specimen breaks the chain of custody even if the draw itself was perfect.

Specimens that go on ice

“Ice the GALA PArty”

1. GGastrin
2. AAmmonia
3. LLactic acid (lactate)
4. AArterial blood gas, only if analysis is delayed and the syringe is glass
5. PPTH (parathyroid hormone)
6. AACTH

Use it when: When an item asks which specimen must be chilled immediately, or why an ammonia or lactate result is falsely high.

Careful: Use an ice-water slurry so the whole tube cools, not loose ice. A blood gas in a plastic syringe stays at room temperature and is analyzed within 30 minutes. Never chill a potassium specimen: cold drives potassium out of the cells and falsely raises the result.

Specimens to protect from light

“Keep the B's in the dark”

Light breaks down Bilirubin, Beta-carotene and the B vitamins (B6, B12, folate), and also vitamin A and porphyrins. Collect into an amber tube or wrap the tube in foil right after the draw.

Use it when: When a stem asks how to handle a bilirubin, vitamin or porphyrin specimen after collection.

Careful: Vitamin A and porphyrins are on the list even though they do not start with B. Newborn bilirubin is the version most often tested: phototherapy lights are turned off during the heel stick, and the specimen is shielded right away.

Specimens kept at body temperature

“The three cold-hating C's”

1. CCold agglutinins
2. CCryoglobulins
3. CCryofibrinogen

Use it when: When an item asks which specimen needs a prewarmed tube or a 37 degree C heat block.

Careful: These are the opposite of the ice list. Prewarm the tube, keep the specimen at 37 degrees C until the serum or plasma is separated, and never refrigerate it first, or the proteins being measured come out of solution and the result is falsely low.

Fire response

“RACE, then PASS”

1. RRescue anyone in immediate danger
2. AAlarm: pull the alarm and call
3. CContain: close doors and windows
4. EExtinguish if small and safe, otherwise Evacuate
5. PPull the pin
6. AAim at the base of the fire
7. SSqueeze the handle
8. SSweep side to side

Use it when: When an item asks what to do first when a fire starts, or how to use an extinguisher.

Careful: RACE is the order of the whole response; PASS is only the extinguisher technique. Match the extinguisher to the fire: Class C or ABC for electrical equipment, never water. Aim at the base, not the flames.

Needlestick or blood exposure

“Wash, Report, Get evaluated”

Wash a needlestick or cut with soap and water, and flush splashes to the eyes, nose or mouth with water. Report it to your supervisor immediately and document it. Get a medical evaluation right away so post-exposure prophylaxis can start if it is needed.

Use it when: When a stem describes a needlestick, splash or blood spill and asks for the first or next step.

Careful: Do not squeeze the wound or pour bleach on it; CDC says there is no evidence that helps and caustic agents are not recommended. HIV post-exposure prophylaxis should start as soon as possible and is not recommended beyond 72 hours. Under the OSHA Bloodborne Pathogens Standard, the employer provides the evaluation and follow-up at no cost.