We or rather the class managed to complete all their studies. The last test resulted in better grades and a definite increase in their confidence.

There were no failures, but there were some close calls. They all passed, some with higher grades than they expected.

For the final exam, they had all day to complete it. With it consisting of two parts, it was realistic for them to leave after completing the first part and coming back after lunch for part two.

I began marking the first part, while they worked on the second part. It was pleasant to see that everyone had answered the diagrams correctly. The questions proved to be more challenging and I was seeing the grades drop.

The plan was the same as with the mid-term exam, They, would have a long weekend and didn't have to return to class until Tuesday morning. I, as well, would have a long weekend of grading the exam.

I wished them all a great weekend when they were done. There was no rushing by anyone, and they all finished within minutes of both each other and the finish of the day.

Although, there were no more chapters that required testing, I did ask everyone to read the last two chapters of their book, that covered specimen collection and some of the equipment used in various tests.

Every student was aware that, in order to fully pass and get their certificate, they had to complete the practice part of the class that would be a full month. Then they had a three-month clinical component. These two portions would simply be marked as satisfactory or not satisfactory.

Tuesday would be a day of excitement for everyone.

We spent the entire day examining the different supplies that they would be using. The variety of specimen tubes for blood, the containers for urine and stool and most importantly the use of gloves and face shields. We discussed what information was needed on label, such as full name, MD name, date of birth, date and time of specimen and their initials.

I reminded them that in class, instead of their full name, their assigned code would be used. They were to come up to the desk, one at a time, for their code. It was simple, we were using their social security number. They were instructed to write their own ID information on the tube and the 'tech' would enter the rest.

I only opened five syringes with their needles, the vacutainers and their needles needed, butterfly needles for the tiny veins. And I demonstrated safe recapping techniques, but I reminded them that under normal working circumstances, they would never recap a needle. Only here would we do so as they inspected them. I then passed them out to the first person in each row with instructions to check them out and then pass them back. I stressed that all needles were to be capped before passing to the next person.

Although I showed them the tourniquet, I advised them we would learn to apply them tomorrow.
The next day, we discussed the use of tourniquets and they took turns applying and removing them. After about thirty minutes of this practice, I had them then find a vein that they could use if they were drawing blood. I did caution them to only leave the tourniquet on for a few minutes and suggested that the 'patients' squeeze their hand open and closed a few times. I had each student find about five veins. And encouraged 'patients' to alternate arms.

When they were done with the vein search, I had them try to find veins on the same people without a tourniquet. It was almost impossible, and I explained that by using a tourniquet they were really restricting most of the blood flow that was attempting to return to the heart.
I had each of them apply a tourniquet to another student's wrist and investigate the veins on the back of their hands.

"Ma-am, mine roll around a lot, what do we do if that happens?" Betty asked.

"That is a great observation Betty. A large part of the population has roller veins. There is a trick to prevent this. I want to give your hand a rest, so I will explain the set up for a blood draw, then I will have you come up and with groups of five I will show you the trick involved. Now I have to warn you that if one has rolling veins in their hands, it usually means they have them everywhere. And most people who have rollers and know so will tell you, in hopes they only need one stick. The rule of thumb is you get two sticks and then it is time to get someone more experienced. That applies to nurses in the hospital and starting IVs as well. Fair enough?"
They all nodded.

I used the desk to lay out the printed order, the required specimen tubes, the vacutainer, one of the vacutainer needles that I had opened as well as an unopened one, a syringe just in case, a tourniquet, an alcohol swab, an unopened square of gauze, a strip of tape and gloves. I also explained that some clinics or labs used a bandaide or stretchable wrap instead of tape.

I had them each answer the reason for each item, then we discussed the various colored tubes and what tests could be done with the blood. Most importantly, I stressed that the tubes should be rotated slightly but not shaken.

"Why are there different colored rubber stoppers on the tubes? Is that something to do with the test?" asked Melonie.

"You are absolutely correct, you have managed to ask a great question but also answered it. Well done. Each clinical lab area has specific guidelines for drawing and handling specimens, so you will adhere to those rules while you are on clinical rotation as well as when you are employed. Basically, the order in which you draw your specimens are all the same. I will not give you a guideline printout because each lab has their own cue cards."

Several heads nodded in acknowledgment.

"If you have among your orders, blood cultures they are always without question drawn first and you use a marble or tiger striped tube. However, if there are no blood cultures, it is usual protocol to draw a waste tube which is discarded. Then the order is as follows-for pre-surgical test a gold, not yellow or red & gray top, red top is used for infectious diseases, donors and drug use. An orange or grey & yellow if there is a concern about clotting activity and is considered a STAT order. What does STAT mean? Yes, Andrea."

"To be done immediately, if not sooner." She replied.

"Correct. Lavender or pink ones are used for CBC, another abbreviation you should know. William?"

"Complete blood count, which compares the amount of red blood cells, white blood cells and platelets."

"Good answer. Next if ordered is the light blue which is used for platelets and coagulation or clotting. Green is for plasma levels but there is also light green or a green with grey that is an enhanced green one because they have a specific gel. Grey is used for glucose or blood sugar levels. Some of the rarer ones are dark blue if the doctor is looking for trace metals in the blood, light yellow is used for blood bank testing, DNA and paternity, tan is when the doctor suspects lead in the blood."

I paused briefly, and Andrea raised her hand. I nodded.

"Will we be expected to know all the tube differences before we start clinical?"

"Absolutely not, you will find there are poster guidelines over each collection site as well as elsewhere throughout the labs. I only know them all because of the years I have worked. Way back when I started, the RNs were responsible for starting IVs, doing lab draws and changing sterile dressings. LPNs were because of licensing not allowed to be as productive as they are now and there were no aides on the floors. So, we not only had to know everything, but we did everything as well."

Several students had looks of surprise and there were a few 'wows'.

"Now I would like each of you to come up, in a single file and pick up what you would need if you were doing three separate lab draws. I will write the three orders on the board. Remember it is three different people. And do not open anything, you are just learning to get organized. When you are finished collecting, set up your desk as if it were three trays. When this is done I will have Betty come up, so I can show you the trick in handling rolling veins. There are baskets to collect your items in. Okay, let's get started.

They were quicker than I expected.

Betty came forward and after placing the tourniquet on her wrist, her veins popped up almost immediately. I showed the class what was considered a rolling vein. Several felt they would never be able to get blood. I then, put a little tension or pulling back on the skin just below where the needle would go, and the vein no longer rolled. The others did but not that one.

I let Betty go back to her seat and advised them all that I would walk around to check their three potential trays, if there were concerns I would tape them on the shoulder and they would have a chance to make a correction.