Tube Colors and Anticoagulants

Each tube color is color coded according to the anticoagulant/additive within the tube.

Evacuated Tubes

-Anticoagulant is *Sodium Citrate* -> binds with Ca to prevent blood from clotting.

Light Blue Top Tubes

May be glass or non-additive tubes or plastic with or without a clot activator... These tubes yield Serum.

Red Top Tubes

A type of SST that contains a thixotropic gel and clot activator... blood clots faster and separates serum from the blood.

Black and Red Top Tube

A type of SST that contains thixotropic gel at the bottom of tube and a clot activator.

Gold Top Tubes

Contains the anticoagulant *Heparin* (combined with ammonium, sodium or lithium) -> inactivates thrombin.

Green Top Tubes

Contains the anticoagulant *EDTA* or *Ethylene-Diamine-Tetra-Acetic acid* -> binds with Ca to prevent blood clots.

Purple Top Tubes

Contains *Sodium Fluoride* which is a weak anticoagulant and a preservative for Glucose.

Gray Top Tubes

Top Tube used for coagulation studies (PT, PTT)

Light Blue Top Tubes

May be used for drug testing, chemistry tests.

Red Top Tubes

Used for tests requiring plasma for general chemistry tests (electrolytes, BMP, CMP)

Green Top Tubes

Tube used for hematology (CBC & differential)

Purple or Lavender Top Tubes

Used for Glucose analysis & Blood alcohol levels.

Gray Top Tubes

To protect all employees working in labs who may be exposed to hazardous chemicals.

Hazard Communication Standard

Used for all hazardous chemicals, requires product to display the chemical name, hazardous ingredients, physical data, fire/explosion data, health hazard data, PPE, first-aid procedure, & permissible exposure limits.

Material Safety Data Sheets (MSDS)

Any specimen or reagent of biological origin that is potentially harmful to your health.

Biohazard

-Airborne

-Ingestion

-Nonintact Skin

-Percutaneous (most common)

-Permucosal

5 most common Biohazards

Greatest concern for CLS - any infectious microorganism present in blood or other body fluids and tissues.

-Hep. B

-Hep C

-HIV

Bloodborne Pathogens

(OSHA) requires labs to develop, implement, and comply with a plan that ensures the protective safety of lab staff to potential infectious bloodborne pathogens - manage and handle medical waste in a safe and effective manner.

Occupational Exposure Control Plan

Minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient.

-All patient specimens should be handles as potentially infectious.

CDC's Standard Precautions

-Hand Hygiene

-PPE

-Use of appropriate engineering controls

-Use of appropriate work practices

CDC's Standard Precautions

Anything within your normal environment that can cause harm... this includes electrical safety, fire hazards, and any equipment with moving parts.

Physical Hazards

The incision of a vein for blood collection.

Phlebotomy

The accuracy of the lab test begins with the quality of the specimen received by the lab.

-Quality depends on how a specimen was collected, transported and processed.

-more than 2/3 of errors are caused by pre-analytical errors.

Quality Assessment (phlebotomy)

-Always check at least 2 patient identifiers (Biggest error)

-Requisition form

-ID Band

-Specimen Label

Quality Assurance (Phlebotomy)

Fasting state, Postprandial Specimen, Medications, Activity/Exercise, Circadian/diurnal variations.

Blood Collection Variables

The fluid portion of blood that remains after coagulation.

Serum

The liquid portion of blood that results after it has been treated with an anticoagulant.

Plasma

Blood pooling at the venipuncture site... will cause falsely elevated results for glucose, potassium, RBC, WBC, and platelets... decreases in plasma volume (caused by leaving tourniquet on too long - longer than a minute)

Hemoconcentration

Collection of blood beneath the skin... caused by failure to apply pressure to the venipuncture.

Hematoma

Light blue, Plain red (no additive), Plastic Red (clot activator), Gold/Red-Gray (SST), Green, Lavender, Gray.

Order of Draw

-Cephalic vein

-Median Cubital

-Basilic vein

Three veins typically used

Results when RBC are lysed... can be caused by using to small or too large of a needle, performing blood collection before the alcohol has dried at collection site, shaking tube vigorously rather than gently inverting tubes.

Hemolysis

Can cause a transient elevation in WBC counts (e.g., newborn crying violently)

Stress

Effects glucose levels or if the patient has eaten a fatty substance, triglycerides levels effected.

Nonfasting

Short term exercise may effect enzymes associated with muscles and WBC count.

Exercise

Cortisol and RBC count are higher in the morning and lower in the afternoon.

Diurnal Rhythms

Patient may have swelling caused by lymph accumulation in the tissues on the side of surgery because of lymph node removal, may make the patient more prone to infections.

Mastectomy

The arm with the IV line should not be used for venipuncture because specimen will be diluted with IV fluid.

-Draw below IV line to obtain blood.

-Nurse should shut off IV for two minutes.

Intravenous Therapy (IV)

Designed to stop the spread of microorganisms via direct contact (gloves & gowns required - Used for patients with C. Diff Infections)

Contact Precautions

Design to provide protection from extremely tiny airborne bacteria (respiratory protection is recommended - used for patients with TB)

Airborne Precautions

Design to provide protection from droplets that may be expelled during coughing or sneezing (face mask protection - use for patients with influenza)

Droplet Precautions

Capillary blood is a mixture of arterial, venous and capillary blood (more closely resembles arterial blood than venous blood)

Capillary Collection

The process whereby the body retains blood within the vascular system (stoppage of blood flow) - Involves a complex interaction among the BV's, platelets, plasma coagulation factors and the fibrinolytic system.

Hemostasis

Measures the extrinsic pathway of the coagulation system; used to monitor patients on Coumadin Therapy.

Prothrombin Time (PT)

Measures the intrinsic pathway of the coagulation system; used to monitor patients on Heparin therapy.

Partial Thromboplastin Time (PTT)

The department responsible for the determination & measurement of chemical metabolites in the body.

Clinical Chemistry