Collection of Blood and Non-Blood Specimens

Blood specimensdraws, CLSI order of draw

Sterile Tube (blood cultures) - Yellow top, Coagulation Tube - Light Blue top, Serum Tube, Red top (glass or plastic) tube

Blood specimensdraws, CLSI order of draw

SST (Serum Separator Tubes) - Speckled Red/Gray, Tiger top, or Gold BD Hemoguard, PST (Plasma Separator Tubes) - Light Green or Dark Green top

Blood specimensdraws, CLSI order of draw

EDTA Tube - Lavender top, Glycolytic Inhibitor Tube - Gray top

Syncope

Sudden fainting can occur during specimen collection

Hematoma

This occurs when blood is leaking into the surrounding tissues, can be caused by advancing the needle too far or at the wrong angle, causing it to go through the vein

Petechiae

These are small, red, smooth, hemorrhagic spots appearing on a patient's skin, which indicates that minute amounts of blood have leaked in the skin epithelium

Petechiae

Petechiae can be caused by applying the tourniquet too tight

Excessive bleeding

Coagulation times may vary if the patient is on a blood thinner. Be sure to apply appropriate pressure for a longer period for patients taking anticoagulants

Hemoconcentration

A decrease in the plasma volume with an increased concentration of cells and molecules may be caused by prolonged tourniquet application

Hemolysis

This occurs when RBC's are lysed; hemoglobin is released and serum, which is normally straw colored, becomes tinged with pink or red

Collapsed vein

Too strong of a vacuum on a small vein may cause the vein to collapse.

Lack of blood flow

A lack of adequate blood flow can be attributed to several factors. Blood will not flow if a defective evacuated tube without proper vacuum is used

Pediatric patients, Psychological needs

It is important to always calm pediatric patients, explain procedures, and involve the parents whenever possible

Geriatric patients, Physical Changes

Reduction in the collagen and elasticity in the skin of geriatric patients can lead to easy bruising longer coagulation times.

Geriatric patient Considerations

Such as hearing loss, visual impairment, Parkinson's disease, arthritis, or dementi

Guidelines for collecting specimens from geriatric patients

Be sure to identify the patient using his/her ID brace

Guidelines for collecting specimens from geriatric patients

Using a dermal puncture, when possible, will reduce blood loss and bruising.

Guidelines for collecting specimens from geriatric patients

Apply the tourniquet more loosely and over clothing, if possible, to prevent bruising or collapsing of the vein.

Guidelines for collecting specimens from geriatric patients

Massage the area to promote blood flow when locating veins, and ensure veins are anchored securely so they do not roll

Patients with VADs

Only specially trained personnel may perform blood collection from vascular access devices (VADs).

Patients with IVs

It is advisable to draw blood from the opposite arm for patients who have IVs

Collect specimens for POC testing (e.g., glucose, UA, HCG

Urinalysis, Hemoglobin (Hgb), Heatocrit (HCT), Coagulation (ACT, PT, APTT)

The following are variables that would cause a specimen to be rejected:

Improper labeling or identification, Hemolysis, Expired tubes, Using the improper tube for the testing being ordered

The following are variables that would cause a specimen to be rejected

Clotting in anticoagulated specimens, Contaminated specimens, Insufficient volume of specimen for testing

The following are variables that would cause a specimen to be rejected

Inadequately filled tube, incorrect specimen collection time for timed specimens, improper handling, delayed delivery to Lab

Stool Specimens

Stool or fecal specimens are collected to test for bacterial or viral intestinal infections. They may also be used to screen for occult blood, indicative of colorectal cancer.

Semen Specimens

Semen specimens are used in fertility testing, to determine the effectiveness of a vasectomy, or for forensic analysis as part of a rape kit.

Cerebrospinal Fluid Specimens

Cerebrospinal fluid, referred to as CSF, is fluid that circulates in the brain and spinal cord. Testing of this fluid is used to diagnose infections of the central nervous system, such as meningitis.

Amniotic Fluid Specimens

Amniotic fluid is found surrounding the fetus in the amniotic sac in pregnant women. These specimens are collected through a special procedure known as an amniocentesis, which may only be performed by a physician.

Throat Culture

Most commonly, these samples are used in Strep tests, which can be performed as either a rapid strep test (POC test) or as a standard bacterial culture in the laboratory.

Nasal Swab

Nasopharyngeal (NP) secretions can be cultured to detect the presence of microorganisms that cause diseases such as diphtheria, influenza, meningitis, pertussis (whooping cough), and pneumonia.

Guidelines for accurate specimen labeling

Patient's full name, Patient's ID number (if applicable), Time and date of collection, Phlebotomist's initials.

Vital Signs

Blood Pressure: normal BP is less than 120 (Diastolic) and less than 80 (systolic), Breathing 12 - 18 breaths per minute.

Vital Signs

Pulse 60 - 80 beats per minute at rest, Temperature 97.8 - 99.1 degrees Fahrenheit.

Temperature sites

Rectal 98.6F to 100.6F, Oral 97.6F to 99.6F, Axillary 96.6F to 98.6F, Tympanic Membrane 98.6F.

Febrile

Presence of fever.

Afebrile

Absence of fever.

Fever

Elevated body temperature beyond normal range.

Intermittent

Fluctuating fever that returns to or below baseline then rises again.

Remittent

Fluctuating fever that remains elevated; it does not return to baseline temperature.

Continuous

A fever that remains constant above the baseline; it does not fluctuate.

Pyrexia

When a patient has an oral temperature of 100.8.

Hyperpyrexia

When a patient presents with an oral temperature of 104°F or higher.

Oral temperatures are not taken from the following patients

Infants and children less than 6 years old, patients who have had surgery or a facial, neck, or mouth injury, those receiving oxygen.

Oral temperatures are not taken from the following patients

Those with nasogastric tubes, patients with convulsive seizures, hemiplegic patients, patients with altered mental status

Pulse

The normal adult pulse rate ranges between 60 and 100 beats per minute

Respiration

The normal range for adults is 12 to 20 per minute.

Apnea

This is a temporary complete absence of breathing which may be a result of a reduction in the stimuli to the respiratory centers of the brain.

Tachypnea

This is a respiration rate of greater than 40/min. It is transient in the newborn and maybe caused by the hysteria in the adult.

Bradypnea

Decrease in number of respirations. This occurs during sleep. It may also be due to certain diseases.

Blood Pressure

The measurement consists of two components: the highest (systole) and lowest (diastole) amount of pressure exerted during the cardiac cycle.