Blood Collection Equipment, Additives, and Order of Draw

blood-drawing station

is a dedicated area of a

medical laboratory or clinic equipped for

performing phlebotomy procedures on patients,

primarily outpatients sent by their physicians for

laboratory testing

phlebotomy chair

should be

comfortable for the patient and

have adjustable armrests to

achieve proper positioning of

either arm

HANDHELD CARRIERS

come in a variety of styles and sizes designed

to be easily carried by the phlebotomist and to

contain enough equipment for numerous blood

draws. They are convenient for “stat” or

emergency situations or when relatively few

patients need blood work

PHLEBOTOMY CARTS

have swivel wheels, which glide the carts

smoothly and quietly down hospital hallways

and in and out of elevators. They normally

have several shelves to carry adequate

supplies for obtaining blood specimens from

many patients

Carts

are commonly used for early-morning

hospital rounds

Centers for Disease Control/ Healthcare

Infection Control Practices Advisory

Committee

(CDC/HICPAC

Occupational Safety and

Health Administration

(OSHA

gloves

) Bloodborne

Pathogen Standard require the wearing of

Nonsterile, disposable latex, nitrile, neoprene,

polyethylene, and vinyl examination glove

are acceptable for most phlebotomy

procedures

Food and Drug Administration

(FDA)

ANTISEPTICS

- substances used to prevent sepsis

70% isopropyl

alcohol (isopropanol)

The antiseptic most commonly used for

routine blood collection is

povidone–iodine :

for blood culture collection

blood gas collection

Prep pads

7% ethyl alcohol, 70% Isopropyl, Benzalkonium chloride, Chlorhexidine gluconate, Hydrogen peroxide, Povidone-iodine, Tincture of iodine

Antiseptics used in Blood Collection

DISINFECTANTS

are chemical substances or

solutions regulated by the

Environmental Protection

Agency (EPA) that are used to

remove or kill microorganisms

on surfaces and instruments

Corrosive and are (______)

NOT SAFE ON

HUMAN SKIN

EPA-registered sodium

hypochlorite

CDC & HICPAC Guidelines for

Environmental Infection Control

in Healthcare Facilities: use of (_____________) is prefered

1:100 dilution

is

recommended for

decontaminating surfaces after

cleaning up blood or other body

fluid spills in patient-care

settings.

1:10 dilution

: large amounts of

blood or other body fluid spill

10

At least (__) minutes of contact

time is required for disinfectants

to be effective

detergent-containing wipes

If hands are heavily contaminated with

organic material and hand-washing

facilities are not available, it is

recommended that hands be cleaned

with

HAND SANITIZERS

routine decontamination of hands as a

substitute for hand washing provided that

the hands are not visibly soiled

Adhesive bandages

are used to cover a

blood collection site after the bleeding

has stopped

- Paper, cloth, or knitted tape placed

over a folded gauze square can also be

used.

NEEDLE & SHARPS DISPOSAL

CONTAINERS

Used needles, lancets, and other

sharp objects must be disposed

of immediately in special

containers referred to as

“sharps” containers

- All must be clearly marked with

a biohazard symbol and be rigid,

puncture-resistant, leakproof,

and disposable and have locking

lids to seal the contents when

filled to the appropriate volum

Biohazard bags

are leakproof plastic

bags that are commonly used to

transport blood and other specimens

from the collection site to the

laboratory

25- by 75-mm (1- by3-in.) (glass microscope slides)

Precleaned (____________) (______________) are

used to make blood films for

hematology determinations.

PEN

indelible (permanent) nonsmear

ink to label tubes and record

other patient information

WATCH

needed to accurately determine

specimen collection times and

time certain tests

VEIN-LOCATING DEVICES

These devices typically shine high-

intensity LED or infrared red light

through the patient’s

subcutaneous tissue to highlight

veins

TORNIQUET

is a device that is applied or tied

around a patient’s arm prior to

venipuncture to restrict blood

flow

- inflates the veins, making them

larger and easier to find, and

stretches the vein walls so they

are thinner and easier to pierce

with a needle.

needles

are sterile,

disposable, and designed for a

single use only

Multisample needles

are

commonly enclosed in sealed

twist-off shields or covers

Hypodermic needles and

butterfly needle

are typically

sealed in sterile pull-apart

packages

Needle gauge

is indicated by a

number that is related to the

diameter of the lumen. A

needle’s diameter and gauge

have an inverse (opposite)

relationship; that is, the higher

the gauge number, the smaller

the actual diameter of the

needle

(1-1.5 inch) (1 & 1.5) (½ to ¾ long)

LENGTH

Multisample needles: (____)

- Syringe: (_____) are most

commonly used for

venipuncture

- Butterfly: (_____)

Safety features

must provide

immediate permanent

containment and be activated

using one hand, which must stay

behind the needle at all times

Resheathing devices

cover the

needle after use; blunting

devices; and equipment with

devices that retract the needle

after use

EVACUATED TUBE SYSTEM

It is a closed system in which the

patient’s blood flows through a

needle inserted into a vein and then

directly into a collection tube

without being exposed to the air or

outside contaminants

- The system allows numerous tubes

to be collected with a single

venipuncture.

MULTISAMPLE NEEDLES

- they allow multiple tubes of

blood to be collected during

a single venipuncture.

- It is covered by a sleeve that

retracts as the needle goes

through the tube stopper so

that blood can flow into the

tube.

- Upon removal, it slides back

to prevent leakage of blood.

TUBE HOLDERS

- a clear, plastic, disposable

cylinder with a small threaded

opening at one end where the

needle is screwed into it and a

large opening at the other end

where the collection tube is

placed.

vacuum

Evacuated tubes fill with blood automatically because there is a

Partial draw or “short draw

is not

acceptable because there is a significant

blood to anticoagulant ratio. If not

followed correctly, will compromise the

result of an analyte

Additive

Is any substance placed within a tube other

than the tube stopper

(_______) have one or more specific functions,

such as PREVENTING CLOTTING or PRESERVING

CERTAIN BLOOD COMPONENTS. Blood collected in

additive tubes may or may not clot, depending on

the additive type

NONADDITIVE TUBES

Most are used for clearing or discard

purposes only

• Yields

serum

STOPPERS

• Are typically made of rubber

• Protects the analyst from aerosol formation

• Rigidity of the plastic also prevents removal of th

4 and 25℃

Tubes are handled to be properly and stored

between (_____) (_____) loss of vacuum

(SYRINGE SYSTEM) (hypodermic needle and a sterile

plastic syringe with a Luer-lock

tip)

is sometimes

used for patients with small or

difficult veins.

- This system consists of a sterile

syringe needle called a

(______________) (a special tip that allows the

needle to attach more securely

than a slip tip)

2, 5, 10 ml

come in sterile pull-apart

packages and are available in

various sizes or volumes

Barrel

a cylinder with graduated

markings in either milliliters or cubic

centimeters

Plunger

a rod-like device that fits

tightly into the barrel

• SYRINGE TRANSFER DEVICE

- allows the safe transfer of blood into

the tubes without using the syringe

needle or removing the tube stopper

- Reduces the chance of accidental

needlesticks & confines any aerosol

WINGED INFUSION SET/BUTTERFLY

Tool for collecting blood from small or

difficult veins such as hand veins and

veins of elderly & pediatric as it allows

much more flexibility & precision than

a needle and syringe

COMBINATION SYSTEMS

Is a complete system for blood

collection in which the blood

collection tube and collection

apparatus are combined in a

single unit.

• Safety devices are available to

contain the needle immediately

after use

Powdered additive

: lightly tapped

prior to use to settle the additive

to the bottom of the tube.

Chelating (binding) or

precipitating calcium

so it is

unavailable to the

coagulation process

(di-potassium or liquid) (tri-potassium salt)

Commonly available as a powdered

(K2EDTA):

(K3EDTA):

1.5mg/ml of blood

Optimal concentration for EDTA:

(Complete blood count) (Liquid EDTA) (Excess EDTA)

(_____________________):

• It preserves cell morphology

• Inhibits platelet aggregation

• Spray-dried EDTA

(____________________):

• Causes dilution and results in lower

hemoglobin values, RBC & WBC counts,

platelet counts, & HC

(__________________):

• Results when tubes are underfilled, can

cause RBCs to shrink

(PINK) (WHITE) (ROYAL BLUE)

: spray-dried K2EDTA

: EDTA & gel

: K2EDTA

(chelating calcium) (3.2% (0.109M or 0.105M) (9:1)

Citrate Prevents coagulation by:(_______)

concentrations:(______)

• LIGHT BLUE:

• Contain a (___) ratio of blood to

anticoagulant

• Preserves labile coagulation factors

(Factor V & Factor VIII)

• Helps stabilize the p

4:1

BLACK:

• Westergren Erythrocyte

Sedimentation Rate

• Blood to anticoagulant ratio of (______)

(INHIBITING THROMBIN formation) (15-30 U/mLof blood)

Heparin

• Prevents clotting by:

• Optimal concentration:

Heparin

Often used for STAT chemistry tests and

in other response situations when a

fast TAT for chemistry tests is needed.

• Osmotic fragility test, blood gas analysis

PRECIPITATING CALCIUM

OXALATES

• Prevent coagulation by

Potassium Oxalate

Commonly added to tubes

containing glucose preservatives

to provide plasma for glucose

testing.

hemolysis

Fill the tubes to the volume

stated on the tube because

excess oxalate causes

Acid Citrate Dextrose (ACD

• Acid citrate: anticoagulant, with

little effect on cells & platelets

• Dextrose: an RBC nutrient &

preservative by maintaining RBC

viability

Immunohematology tests: DNA

testing, Human leukocyte

antigen phenotyping

Citrate Phosphate Dextrose

(CPD)

• Citrate: anticoagulant

• Phosphate: stabilizes pH

• Dextrose: energ

SODIUM POLYANETHOL SULFONATE

Blood culture:

a. reduces the action of complement

b. slows down phagocytosis

c. reduces the activity of antibiotic

BINDING

CALCIUM

SODIUM POLYANETHOL SULFONATE

• Prevents coagulation by

Antiglycolytic Agents

• Sodium Fluoride

• Lithium iodoacetate

Clot Activators

A substance that enhance

coagulation in tubes used to

collect serum specimens.

Silica :

provide more surface for

platelet activation

- SSTs & plastic red-top tubes

- 15 to 30 minutes

Thrombin

blood clots w/in 5

minutes

Thixotropic Gel Separator

An inert synthetic substance

initially contained at the bottom

of certain blood collection tubes.

- The physical separation prevents

the cells from continuing to

metabolize substances such as

glucose in the serum/plasma

(serum-separator tubes) (rapid serum tubes) (plasma

separator tubes) (plasma-preparation tubes)

• Mottled red/gray rubber stoppers:

(________)

• Orange: (________), also

contain thrombin

• Light-green plastic or mottled

gray/green stoppers: (____________)

• EDTA gel-barrier tubes with pearl-

colored stoppers: (__________)

CARRYOVER/ CROSS-CONTAMINATION

• Is the transfer of additive from one tube to

the next

• Occurs when blood in an additive tube

touches the needle during ETS blood

collection or when blood is transferred from

a syringe into ETS tubes.