Basic Review Ch. 7

Why must you use the correct tube? Who establishes the order of draw?

for accurate test results, and to prevent cross-contamination of additives. The Clinical Laboratory Standards Institute (CLSI) establishes the order of draw.

What 2 important details must you verify on the tube before drawing?

additive, expiration date

What is EDTA and its tube top colors?

an anticoagulant that binds calcium permanently, lavender and pink

Which tube colors and additives prevent coagulation?

light blue (sodium citrate), light/dark green (heparins), lavender/pink (K2 EDTA), gray (sodium fluoride/potassium oxalate)

Which tubes can be used as discard tubes?

Tubes without additives

A tube without an additive needs its plasma to be sent for laboratory testing. What do you do?

Centrifuge the tube, aliquot the plasma into a transfer tube.

You are manually labeling the tubes after a draw, where do you label them and what do you label them with?

in the presence of the patient, the patient’s full name, DOB, date/time of draw, and your initials.

What is the basic reason for a blood test?

to detect disease, track treatment progress, and evaluate organ function

Write out the meanings of mEq/L, mg/dL, and µmol/L

Miliequivalent per liter, Milligrams per deciliter, Micromoles per liter

What is plasma and serum and the difference between them?

They are the liquid portion of blood, plasma is from anticoagulated blood and serum is from coagulated blood.

If a small volume of a blood culture is needed, what kind of tube may you use instead of bottles? What color is it?

Sodium Polyanthenol Sulfonate (SPS), yellow-top.

What is SPS and what does it do?

Sodium Polyanthenol Sulfonate, an anticoagulant that preserves microorganisms and prevents clotting by binding to calcium.

List the order of draw

Blood Cultures, Light Blue, Red, Gold/SST, Light Green, Dark Green, Lavender, Pink, Grey

What is the memory tool for order of draw?

Be Careful, Light is Red. Stop! Go on Green. Look, Please Go!

Why are blood cultures first? How much blood do you need for how many bottles in one draw?

to prevent contamination, 8-10 mL for 2 bottles

In a blood culture, what are the different bottles labeled and what do they contain?

aerobic, anaerobic, nutrient broth

What is bacteria in the blood called?

Bacteremia

A doctor ordered a STAT BCx2. What does this mean? How would you draw them? How would you label these BC bottles differently?

STAT means collect immediately. means 2 sets of BC. draw both sets at different sites to detect bacteremia in the body. Label them with the location of the body you drew from.

When cleansing the skin in preparation for a Blood Culture, what do you do? What else should you cleanse?

First, use an isopropyl alcohol wipe, then a stronger cleanser, such as ChloraPrep (Chlorhexidine). Also cleanse both uncapped bottles with separate alcohol wipes.

In pediatric BCs, how much mL do the bottles need?

1-3 mL

What temperature can BCx bottles be at for x hours?

room temperature, four

What is the light blue-top additive, and what does it do?

Sodium Citrate. reversibly binds to calcium to prevent clotting.

How much should you fill the Light Blue tube and what special steps should you take for it with a winged infusion set?

completely. Use a discard tube to ensure the tubing is filled with blood before filling this tube.

List the light blue tube additive, common tests and their full names

sodium citrate. Prothrombin Time (PT), and International Normalized Ratio (INR). Partial Thromboplastin Time (PTT), and Activated Partial Thromboplastin Time (aPTT). D-Dimer

What are the PT/INR tests? Which tube is used for it?

Prothrombin Time, measures the extrinsic length it takes for blood to clot. International Normalized Ratio alongside the PT, measures clotting factors in blood. Light Blue Top

What are the PTT and aPTT tests and which tube is used for them?

Partial Thromboplastin Time measures intrinsic length of clotting time. aPTT is the same except with more sensitive results. light blue tube

What is the D-Dimer test? Which tube is drawn for it?

rules out the presence of a blood clot. light blue tube

What are commonly prescribed anticoagulants?

Coumadin (warfarin), Heparin, and Eliquis (apixaban)

What is TDM? (include common drugs and tube needed)

Therapeutic Drug Monitoring, monitors drugs such as digoxin, dilantin, and lithium. Red top-tube.

What is SST and which colors can it be?

serum separator tube, gold, marble top, tiger top.

What is silica and thixotropic gel? What tube has both of these?

a rapid clot activator; forms a barrier between serum and packed cells after centrifugation which preserves it for a week. Gold/SST.

What is the most common blood test panel, what can it detect, and which tube do you use for it? (include add.) What is important about processing this specific test? How much should that tube be filled?

Complete Blood Count (CBC) measures RBCs, WBCs, platelets, hemoglobin, and hematocrit. It can detect anemia and infections. Lavender top K2 EDTA tube, it should not be centrifuged, at least 2/3 filled

Name what evaluation can be ordered along with a CBC and name the cells it measures. Which is the most common cell?

a differential (diff), it measures the five types of white blood cells, which are, monocytes, lymphocytes, neutrophils, basophils, eosinophils. Neutrophils are most common.

Name the common tests for a Lavender top tube and its additive

CBC. Hemoglobin and Hematocrit (H&H) hemoglobin (Hgb) transports oxygen and carbon dioxide throughout the body, and hematocrit (Hct) is the percentage of red blood cells in a sample. Hemoglobin A1c (HbA1c) reflects average blood glucose levels over past 2-3 months. K2 EDTA.

What is Ammonia testing? What are high ammonia levels associated with? Which tube would you use? (include add.)

What color tube could some labs request it to be drawn with? (include add.)

Ammonia tests liver functions. High levels are associated with liver disease and is life threatening. Dark green sodium heparin tube.
Lavender K2 EDTA tube.

What is FUO and which test and tube is commonly drawn for it?

Fever of Unknown Origin, C&S with blood culture

Which tube is used for coagulation studies? (and additive)

Light blue, sodium citrate

When waiting for a tube to clot, what do you do?

Allow it to clot upright for 30-60 minutes, centrifuge as needed

What does the Standard Electrolyte Panel check (include element signs), which tube does it belong to (include add.) and what other test does that tube commonly include?

It checks Sodium (NA+), Potassium (K+), Chloride (Cl-), and Carbon Dioxide (CO2). It is the light green lithium heparin tube, it also tests hCG (Human Chloronic Gonadotropin)

What tubes are in the exact same order as each other?

Lavender and Pink

What is crossmatching and which tube does it require? (include add.)

determines blood compatibility between donors and recipients to ensure safe transfusion. Pink K2 EDTA tube.

What is sodium fluoride and which tube is it an additive in?

a preservative that maintains sample stability for up to three days. grey top tube

What is potassium oxalate and which tube is it an additive in? How much should that tube be filled?

an anticoagulant that binds to calcium. grey top tube, fill it completely.

where else can the Grey Top glucose test be included?

metabolic panel with an SST

What special way do you process a lactic acid? Which tube do you use?

Promptly on ice. Grey top

What is a BAC/ETOH and which tube do you use?

Blood Alcohol Concentration/Ethanol, measures alcohol content in blood, grey top tube (sometimes SST or green)

What are supplementary tubes and what color is their tops?

tubes for trace element analysis, royal blue

What are trace elements?

minerals needed by the body in very small amounts to support biological function.

What are the two royal blue top types?

red stripe and lavender stripe

What mineral and element does the Royal Blue with Red Stripe Top test for?

Selenium and Copper

What trace elements does the Royal Blue with Lavender Stripe top test for?

Zinc, arsenic, and lead