AMCA: equipment selection and maintenance

yellow test tube

blood culture and sterile specimens,

ACD solution - additive used is sodium polyanethol sulfonate

blue test tube

commonly used for coagulation tests (PT, PTT, fibrinogen)

red tube top

no additive required, chemistry testing, blood bank testing, thixotropic gel can be added

green tube top

additive used is sodium heparin or lithium heparin, which is a natural anticoagulant that inhibits thrombin. commonly used for routine chemistry testing

lavender tube top

additive used is ethylenediaminetetraacetic acid (EDTA). additive binds the calcium needed for clot formation. commonly used for hematology testing (CBC, reticulocyte count, erythrocyte sedimentation)

gray tube top

additives used are sodium fluoride, a preservative that inhibits glycolic action, and potassium oxalate, an anticoagulant that binds calcium. commonly used for glucose tolerance and lactic acid measurement

royal blue or tan tube top

used to collect samples for nutritional studies, therapeutic drug monitoring, and toxicology. also used for testing aluminum, copper, arsenic, calcium, etc.

tan topped is used for lead testing and contains EDTA

anticoagulants

prevents blood from clotting

clot activator

promotes coagulation. thrombin directly increases clotting and is therefore used for stat serum chemistries or for patients taking anticoagulants

polymer gel (or thixotropic gel)

is used to separate plasma and serum

type of antiseptic

the ___ used in specimen collection is determined by the tests being ordered

isopropyl alcohol

the most common antiseptic used for cleaning a puncture site

iodine

when drawing sample for blood cultures, ___ is used to prevent contamination of the sample by skin flora

site selection

the __ from which a specimen is collected may cause interference as well

hematomas

test results may be altered cause blood drawn from a ___ not as fresh as venous blood

iv sites

when possible, avoid drawing blood from an arm that has __ in place. if no alternate site is available, be sure to perform specimen collection from a site that is distal to (or below) the __

specimen collection

__ in the correct tubes and following the proper order of draw will help to prevent contamination or interference

tourniquet application

typing a tourniquet too tightly can result in hemoconcentration, or an increase in the proportion of cells to plasma

select proper antiseptic agents for the test

before routine venipuncture selection, the patient’s skin is cleaned with antiseptic to prevent contamination by normal skin flora

needles - parts of a multi-sample needle

bevel, shaft, threaded hub, rubber sleeve over needle

parts of a syringe system

bevel, shaft, hub, graduated barrel, plunger

proper capillary equipment & site

capillary puncture is also known as skin puncture, microcapillary stick, or finger stick

proper capillary equipment & site

skin is punctured with lancet. this is used to obtain small amount of blood

proper capillary equipment & site

use alcohol for disinfectant not iodine (as it leaves residue and affect the rest result). using a circular motion from the inside out

capillary equipment & site - equipment

gauze, bandages, prep pads, clay sealer tray, glass slides, gloves, lancets, micro collection containers, microhematocrit tubes, spring loaded puncture device

site selection

first choice of site middle or ring finger, second choice of site index/pointer and thumb. do not use the pinky finger due to thinner tissue. patient’s non-dominant hand

midstream clean-catch urine collection

requisition form, sterile urine container with label, sterile antiseptic towelettes

midstream clean-catch urine collection

written instructions for cleansing and voiding

24-hour (timed) urine sample collection

requisition form, 24 hour urine sample container with lid. label container with ice, if required. preservative, if required.

urine drug sample collection

requisition form, gloves, bluing agent (dye), sample container, chain of custody form, temperature strip

throat culture swab

requisition form, tongue depressor, collection swab in a sterile tube containing transport media. flashlight

nasopharyngeal swab

requisition form, sterile mini tip dacron polyester or rayon tipped swab, transport medium (saline), ice slurry

quality control on equipment

expiration dates on tubes and needles, equipment check for POCT testing, preventive maintenance on centrifuges, routine cleaning of all surfaces