Special Procedures Skills Drill SKILLS DRILL 11-1: REQUISITION ACTIVITY At the same time and from where? Forearm? Explain. Any Hospital USA 1123 West Physician Drive Any Town USA Laboratory Test Requisition PATIENT INFORMATION Name Smith Identification Number 09365784 Birth Date 06/21/75 Referring Physician: Hurst Matson Date to be Collected 05/20/15 Time to be Collected STA Special Instruction: need to start antibiotics ASAP TEST(S) REQUIRED NH4 – Ammonia Gluc – glucose Bn – Bilirubin total & direct Hgb – hemoglobin BMP – basic metabolic panel Lact – lactic acid/lactate BUN – Blood urea nitrogen Pit. CL – platelet count PT – prothrombin time Lytes – electrolytes CBC – complete blood count Chol – cholesterol uCeer esnd pde – Udd T&S – type and screen urine Ogue ypods eod – VSd Other Hand cultures X2 ESR – erythrocyte sedimentation rate EtOH – alcohol D-dimer
The Correct Answer and Explanation is:
Correct Answer:
The blood samples for the listed laboratory tests should be drawn at the same time and from the forearm, ideally from a clean venipuncture site, such as the median cubital vein in the antecubital fossa. This is appropriate unless otherwise contraindicated, such as the presence of infection, scarring, or other medical restrictions.
Explanation):
In this requisition activity, multiple laboratory tests have been ordered simultaneously for a patient, with a clear clinical urgency (“need to start antibiotics ASAP”). It is critical to understand that these tests are intended to provide a comprehensive diagnostic overview to guide immediate treatment decisions. Therefore, timely and accurate specimen collection is essential.
All the listed tests—ranging from routine chemistry panels (like BMP and glucose) to hematology (CBC, Hgb, platelet count), coagulation studies (PT, D-dimer), liver function tests (bilirubin), infection markers (lactic acid, ESR, blood cultures), and others—can typically be collected during a single venipuncture session. This reduces patient discomfort, minimizes risk of contamination, and ensures consistent test results by avoiding variations caused by different collection times.
The forearm, specifically the antecubital area, is the most common and preferred site for venipuncture. The veins in this area are usually accessible, visible, and allow for multiple tubes of blood to be drawn efficiently. This site also reduces the likelihood of complications compared to more distal or central veins.
For some specific tests:
- Ammonia (NH4) and lactic acid require that the blood be placed on ice immediately and processed quickly to preserve analyte integrity.
- Blood cultures (hand cultures X2) should be collected using aseptic technique from two separate sites (ideally both hands or different arms), but still as close in time as possible.
- Urine test and type & screen are separate from venipuncture and will require a urine specimen and a properly labeled blood sample for T&S.
In conclusion, drawing all venous blood specimens from the forearm at the same time maximizes efficiency, reduces patient risk, and supports rapid diagnosis and treatment.
