NHA Phlebotomy-Technician Exam Syllabus

Tasks

1A. Adhere to regulations regarding workplace safety
(e.g., OSHA, NIOSH).
1B. Adhere to regulations regarding operational
standards (e.g., The Joint Commission, Clinical
and Laboratory Standards Institute, and CDC).
1C. Adhere to HIPAA regulations regarding Protected
Health Information (PHI).
1D. Adhere to scope of practice and comply with
ethical standards applicable to the practice of
phlebotomy.
1E. Perform quality control for laboratory equipment
(e.g., maintain logs for equipment inspection,
reporting and troubleshooting of equipment issues,
and refrigerator/freezer temperature monitoring).
1F. Perform quality control (e.g., machine calibration,
test controls, storage controls) for point-of-care
(POC) and CLIA-waived tests.
1G. Identify and dispose of sharps and biohazards
according to bloodborne pathogens standard (e.g.,
good glass slides, BD Vacutainer plastic urine
transfer system).
1H. Follow exposure control plans in the event of
occupational exposure (e.g., needle sticks, blood
spills, or eye contamination).
1I. Follow transmission-based precautions (e.g.,
airborne, droplet, contact, COVID precautions, and
distancing).
1J. Follow standard precautions regarding personal
protective equipment (e.g., gloves, gowns, masks,
respirators, and eye protection).
1K. Follow hygiene guidelines and infection control
techniques to prevent the spread of infections.
1L. Recognize and respond to emergencies that arise
(e.g., perform CPR, respond to codes).
1M. Initiate first aid when necessary (e.g., wound care,
manage excessive bleeding).
1N. Comply with documentation and reporting
requirements (e.g., patient-related incidents,
charting guidelines). 

Knowledge of: 

k24. Resources and regulations regarding workplace
safety (e.g., Occupational Safety and Health
Administration, National Institute for Occupational
Safety and Health, and Centers for Disease
Control and Prevention)
k25. Operational standards (e.g., The Joint
Commission, Clinical and Laboratory Standards
Institute, and the College of American
Pathologists)
k26. Ethical standards applicable to the practice of
phlebotomy (e.g., NHA code of ethics)
k27. Manufacturer recommendations for laboratory
equipment (e.g., routine maintenance and
calibration)
k28. Quality control and assurance procedures (e.g.,
maintaining logs, checking reference ranges, and
troubleshooting)
k29. Guidelines related to CLIA-waived and point-ofcare (POC) tests
k30. Requirements for sharps disposal
k31. Bloodborne Pathogens Standard
k32. Requirements related to biohazards (e.g.,
cleaning blood and bodily fluids, disinfection, and
disposal)
k33. Exposure control protocols (e.g., eye washing,
hand washing, showers, notification
requirements, needle stick protocols and
reporting)
k34. Transmission based precautions (e.g., airborne,
droplet, and contact)
k35. Hand hygiene guidelines
k36. Personal protective equipment (e.g., gloves,
donning and doffing equipment, goggles or face
shields)
k37. First aid for phlebotomy-related issues (e.g.,
excessive bleeding, falls, fainting/syncope, and
hypo and hyperglycemia)
k38. Cardio-pulmonary resuscitation (CPR) guidelines
k39. Reporting requirements and processes

Tasks

2A. Demonstrate respect for diversity, cultural
sensitivity and competence, and empathy.
2B. Communicate effectively with patients, colleagues,
and other healthcare professionals.
2C. Obtain, review, and verify the order or requisition
form (e.g., STAT or routine orders, timed draws).
2D. Introduce yourself to the patient and provide
information such as name, title, and department.
2E. Positively identify the patient based on specific
identifiers while following HIPAA guidelines.
2F. Receive implied, informed, or expressed consent
from the patient.
2G. Obtain permission from legal guardian if unable to
obtain verbal or expressed consent (e.g., children,
patients with dementia or mental disabilities).
2H. Confirm insurance coverage and review orders
and requisitions.
2I. Collect copayments and perform documentation
and billing practices according to established
protocol.
2J. Create new patient account in system and assist
patients with registration.
2K. Verify patient compliance with testing
requirements (e.g., fasting, medication, basal
state) and proceed accordingly.
2L. Interview patients to identify special considerations
that may impact collections (e.g., allergies,
medical history, and history of fainting) and
proceed accordingly.
2M. Explain the phlebotomy procedure to be performed
to the patient.
2N. Position the patient to maximize comfort and
safety and optimize specimen collection.
2O. Determine site for venipuncture collection, based
on established Clinical and Laboratory Standards
Institute standards, to minimize patient risk and
optimize outcome.
2P. Instruct patients on collection of non-blood
specimens (e.g., stool, urine, semen, and sputum).
2Q. Ensure all pertinent information has been entered
into the electronic medical record/electronic health
record (EMR/EHR).

Knowledge of: 

k40. Patient interviewing techniques (e.g., open-ended
questions and empathetic listening)
k41. Patient identifiers required for verification
k42. Requisition form field requirements (e.g., patient
demographics, physician information, diagnosis
code, tests ordered, and test priority)
k43. Components required for informed, expressed, or
implied consent
k44. Coding systems (e.g., ICD-10-CM)
k45. Timing requirements of draws (e.g., high and low
levels, STAT, routines, and time of day)
k46. Testing requirements (e.g., fasting, medication,
basal state)
k47. Collection tube color matches to laboratory test
(e.g., blue stopper for coagulation)
k48. Variables that may impact collections (e.g.,
allergies, medications, recent surgeries, and
history of fainting)
k49. Special considerations that may impact
collections (e.g., age, physical and mental
condition, presence of fistulas)
k50. Non-blood specimen collection procedures
k51. Minimum and maximum blood volume
requirements
k52. Patient positioning
k53. Site selection criteria 

Tasks 

3A. Select and assemble equipment (e.g., evacuated
tube system, needle, syringe, winged collection
set) needed for blood collection(s).
3B. Verify quality of equipment (e.g., sterility,
expiration date, and manufacturer’s defects).
3C. Adapt collection techniques for patients with
special needs (e.g., burns, dementia, or bleeding
disorders)
3D. Adapt collection based on instructions provided by
analyzer (e.g., minimum blood volume tubes).
3E. Follow standard tourniquet (constricting band)
application and removal procedures.
3F. Select final site through observation and palpation,
for specimen collection.
3G. Apply antiseptic agent to blood collection site.
3H. Anchor vein below venipuncture site.
3I. Insert needle from venipuncture device into site.
3J. Follow order of draw when performing
venipuncture.
3K. Ensure patient safety throughout the collection by
identifying problematic patient signs and
symptoms and discontinue draw if needed.
3L. Recognize and respond to potential complications
resulting from procedure (e.g., lack of blood flow,
hematoma, petechiae, or nerve pain).
3M. Remove venipuncture device and engage safety
feature.
3N. Mix additives in evacuated tubes according to
manufacturer guidelines (e.g. inversion).
3O. Perform dermal puncture for capillary collection.
3P. Follow order of draw when performing capillary
collection.
3Q. Perform post-procedural patient care (e.g.,
acknowledge bleeding has stopped, bandage, and
hydration).
3R. Label all specimens. 

Knowledge of:

k54. Blood collection devices
k55. Considerations for device selection (e.g., current
health status, stated history, vein size, requisition
requirements)
k56. Needle gauge sizes and lengths
k57. Evacuated tubes required for lab testing (colors,
additives and preservatives)
k58. Equipment quality control checks (e.g., inspection
of needles, check for cracks in tubes, and check
expiration dates)
k59. Order of draw, angle of tube insertion, fill
level/ratios, and number of tube inversions
k60. Standard tourniquet (constricting band)
application procedures
k61. Palpation techniques
k62. Skin integrity, venous sufficiency, and any contraindications
k63. Types of antiseptic agents and methods of
application
k64. Techniques for anchoring the vein
k65. Angle of needle insertion and withdrawal
k66. Use of needle safety devices (e.g., retractable or
sheath)
k67. Adjustments for establishing blood flow (e.g.,
redirection, increase or decrease needle angle,
and tube change)
k68. Complications and signs and symptoms arising
during routine blood collection (e.g., syncope,
diaphoresis, nausea, seizures)
k69. Responses to complications (e.g., cold packs,
discontinuation of venipuncture)
k70. Procedural steps when removing tourniquet
(constricting band), tubes, and needle
k71. Dermal puncture procedures for capillary
collection
k72. Order of draw for capillary collection
k73. Bandaging procedures and considerations (e.g.,
allergies, skin types, patient age and condition)
k74. Post-procedural complications and precautions

Tasks 

4A. Perform blood culture collections.
4B. Assist other healthcare professionals with
specimen collection (e.g., pediatric or geriatric,
non-tunneled and tunneled lines).
4C. Obtain information and collect blood samples for
metabolic syndromes (e.g., PKU or galactosemia).
4D. Perform phlebotomy for blood donations.
4E. Calculate or look up volume requirements in
patients who are at higher risk (e.g., pediatric, or
geriatric) to avoid illness caused by the collection.
4F. Perform or process non-blood specimen collection
(e.g., throat cultures, nasal swab, wound cultures).
4G. Perform point of care testing (e.g., hemoglobin and
hematocrit levels, blood glucose screening, urine
pregnancy testing, and urinalysis)
4H. Perform tolerance tests (e.g., gestational glucose,
lactose, or 2-hour post-prandial glucose)
4I. Prepare site for blood alcohol testing.
4J. Collect specimens or samples for drug screening.

Knowledge of: 

k75. Techniques, locations, and skin preparation for
blood culture collections
k76. Equipment needed for blood culture collections
(e.g., needle type, hub/adaptor, and bottle type)
k77. Volume requirements for blood culture collections
k78. Order of draw for blood culture collections
k79. Blood culture bottle preparation procedures
k80. Equipment and transfer procedures needed when
assisting other healthcare professionals with
specimen collection
k81. Techniques to collect blood on filter paper
k82. Standards for blood donation (e.g., check
hemoglobin and hematocrit levels, weight, and
complete patient screening)
k83. Calculation techniques and sources of information
for pediatric volume requirements
k84. Equipment and techniques for performing and
processing non-blood specimen collection (e.g.,
collection methods, and processing times)
k85. Skin preparation for blood alcohol level collection
k86. Specimen collection requirements for drug
screening.

Tasks

5A. Prepare specimens (e.g., centrifuging, aliquoting,
freezing or refrigeration) for testing or transport.
5B. Maintain integrity of specimens based on handling
requirements (e.g., temperature, light, or time).
5C. Adhere to chain of custody guidelines when
required (e.g., forensic studies or blood alcohol).
5D. Follow clinical research laboratory protocols (e.g.,
tube processing, obtain correct specimen bag, air
waybill, and packaging).
5E. Coordinate communication between nonlaboratory personnel for processing and collection.
5F. Input and retrieve specimen data using available
lab information system.
5G. Recognize and report critical values for point-ofcare and CLIA-waived testing.
5H. Ensure that laboratory results are distributed to
ordering providers and medical record is updated.
5I. Contact patient for re-collection as needed.

Knowledge of: 

k87. Centrifuging procedures, techniques, and
equipment
k88. Aliquoting procedures and techniques
k89. Handling, storage, transportation, and disposal
requirements for specimens (e.g., biohazard
bags/containers, viability and preservation 
guidelines, and clinical research specimen
protocols and lab destination)
k90. Laboratory requirements (e.g., CLIA regulations,
environmental requirements and conditions,
machine calibration, and blood volumes)
k91. Chain of custody guidelines
k92. Internal and external databases
k93. Critical values for point-of-care and CLIA waived
testing
k94. Basic protocols to distribute laboratory results 

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