Venipuncture

Types of Blood

Whole blood, Plasma, Serum

Uses both the liquid portion of the blood called plasma and the cellular components (red blood cells, white blood cells, and platelets).

Whole blood

It is normally a clear to slightly hazy, pale yellow fluid that separates from the cells when blood in an anticoagulant tube is centrifuged.

Plasma

The liquid portion of clotted blood

Serum

Clear, pale yellow fluid (nonfasting serum can be cloudy to lipids)

Serum

Major differrence between plasma and serum?

Serum does not contain fibrinogen

Serum samples should be allowed to completely clot for how long?

30 minutes

This blood is required for STAT and other tests requiring a fast turnaround time (TAT)

Plasma

This requires blood collection into a vessel containing an anticoagulant

Whole blood

Blood collected from the patient’s vein

Venipuncture

What kind of blood do you get from venipuncture?

Deoxygenated blood

The commonly used veins for venipuncture are located on the

Antecubital Fossa

Name the two sites you can get blood from when the antecubital veins are not accessible

Dorsal Venous Arch, Metacarpal Plexus

Venipuncture’s 1st choice of vein

Median cubital vein

Venipuncture’s 2nd choice of vein

Cephalic vein

Venipuncture’s 3rd choice of vein

Basilic

3 Blood Collection System

Syringe System, Evacuated Tube System, Winged Infusion Set

Used for patients with small or difficult veins

Syringe System

Gauge range of syringe system

Gauge 21 to 23

Length of syringe

1-1.5 inches

Made of pliable rubber or a strip with Velcro

Tourniquet

Tourniquet must be applied to a patient’s arm ______ venipuncture.

during

Tourniquet must not be left on longer than _______.

1 minute

refers to the order in which tubes are collected during a multiple-tube draw or are filled from a syringe

Order of draw

Order of Draw

Blood culture (yellow), Citrate (blue), Red, Heparin (green), EDTA (purple), Sodium Fluoride (gray)

Meaning of SPS

Sodium Polyanethol Sulfonate

Aids in bacterial recovery by inhibiting complement, phagocytes, and certain antibiotics

Yellow SPS

It has 0.025% Sodium Polyanethol Sulfonate (SPS)

Yellow SPS

This is used in microbiology test

Yellow SPS

It preserves the labile coagulation factors

Light blue top

It has 0.105 M or 0.219 M (3.2% or 3.8% respectively) sodium citrate

Light blue top

Light blue top, Blood:AC ratio

9:1

Types of Serum Separator Tubes

Red-gray top tubes, Gold top tubes, Red top tubes (plastic)

Types of Serum Tubes

Red-top tubes (glass)

Types of Rapid Plasma Tubes

Orange-top tubes

Types of Plasma Separator Tubes

light green

Types of Plasma Tube

Green-top tubes, Lavender-top tubes

Types of Antiglycolytic Tube

Gray-top tubes

Types of Special tubes

Pink-top tubes, White-top tubes, Royal blue-top tubes, Yellow-top tubes, Tan-top tubes, Black-top tubes

This both has Thixotropic Gel and is used for Clinical Chemistry

Red-gray top tubes, Gold top tubes

Contains silica particles, requires 5 inversions, and is use for Chemistry, Immunology, Blood Banking

Red top tubes (plastic)

Has non additive tube, required no inversions, used in chemistry, immunology, blood banking

Red top tubes (glass)

It contains thrombin, needs 5 minutes clotting time, required for STAT, and used in Clinical Chemistry.

Orange top tubes

This has an additive: Lithium heparin or Sodium heparin with Gel separator. Used in the department of chemistry

Light green

Contains lithium/sodium heparin without the gel. Used in chemistry

Green top tubes

Contains EDTA

Lavender top tubes

EDTA stands for

Ethylenediaminetetraacetic acid

Contains K2EDTA, K3EDTA and is used for Hematology and Clinical Chemistry

Lavender top tubes

Contains Sodium Fluoride, Potassium Oxalate, and is used for Clinical Chemistry

Gray top tubes

The Sodium Fluoride in gray top tubes serves as a?

Antiglycolytic Agent

The Potassium Oxalate in gray top tubes serves as?

Anticoagulant

In which part of Clinical Chemistry do we use gray top tubes?

Glucose, Lactate, Alcohol

This is spray died K2EDTA and used for Blood banking and Molecular Diagnostics

Pink top tube

This contains Ethylenediamenetetraacetic acid with gel and is used for Molecular Diagnostics

White top tubes

This contains K2EDTA or Sodium Heparin and used in Toxicology: Trace element

Royal blue top

This contains Acid Citrate Dextrose and is used in Blood bank, HLA phenotyping, and paternity testing

Yellow top tubes

Its glass contains heparin while the plastic contains K2EDTA, and is both use for Lead Testing

Tan top tubes

It contains buffered sodium citrate and is used for Westergren ESR

Black top tubes

What is the Blood:AC ratio of black top tubes?

4:1

___ to ___ of all the laboratory errors occur prior to analysis

46% - 68%

Two types of Specimen Handling

Routine Handling, Special Handling

Mixing tubes by inversion is what type of specimen handling?

Routine handling

Additive tubes require ___ to ___ gentle inversions

3-10

Inversions of tubes prevents?

Hemolysis

Some specimen will precipitate or agglutinate if allowed to cool ______ body temperature.

below

Specimens should be transported ___ or ____ the normal body temperature of ____.

at, near, 37C

Doing this to the specimen slows down metabolic processes and protects analytes

Chilling

Blood specimens that require chilling should be completely immersed in a slurry of crushed __________ and either tested immediately or refrigerated upon arrival in the laboratory.

ice and water

Bilirubin decreases up to ____ after 1 hr of light exposure.

50%

Transporting specimens is an important component of processing; accounts _____________

1/3 of TAT

Agitation and rough handling causes

hemolysis, platelet activation, and affect coagulation tests

CLSI and OSHA mandates the use of leak proof __________________.

Specimen transport bag

All specimens arrived at the laboratory within ____ of collection

45 minutes

These specimens should be centrifuged and separated within _____ of arrival in the lab.

1 hr

According the CLSI guidline, they set the maximum time limit for separating the serum from the cells at ______. This prevents metabolic processes like, _______.

2 hrs, glycolysis

Amount of hemolysis that can be seen visually (Visual hemolysis)

≥ 30 mg/dL Hgb

causes a slight dilutional effect on the analytes present in serum or plasma

Severe hemolysis

Average amount of Bilirubin

25.2 mg/L (430 mmol/L)

An icteric specimen which can interfer with the measurement of total protein, albumin, cholesterol and glucose.

Bilirubin

It scatters light and eventually blocks transmission of light

Lipemia

Lipemia happens when serum triglyceride exceeds _____

4.6 mmol/L (400 mg/dL)

Rate for centrifugfation

1000-2000 relative centrifugal force for 10 minutes

Re-centrifugation causes

Pseudohyperkalemia

Hemolysis and aerosol infection

Rimming

May cause lysis and slight elevation in LD and K+

Excessive centrifugation

• incomplete barrier formation (gel tubes)

• cell contamination of the specimen

Insufficient centrifugation

Excessive centrifugation happens at what RCF

>3000

Insufficient centrifugation happens at what RCF

<1000 or <10

If a four-hour delay is expected, store the sample at

4-8C

Samples may be frozen at _____ and stored for longer periods without deleterious effects on the results.

-20C

refers to the resting metabolic state of the body early in the morning after fasting for approximately 12 hrs.

Basal state

In a high protein diet, what analyte is affected?

Ammonia, urea, uric acid

In a caffeine diet, which analyte is affected?

Cortisol, ACTH, Glucose

In a carbohydrates diet, which analyte is affected?

Glucose

In an excessive drinking of water, which analyte is affected?

Hemoglobin and Electrolytes

In a fats and oils diet, which analyte is affected?

Cholesterol & Triglyceride

In a meat and vegetables diet, which analyte is affected?

FOBT

They recommends that lipid profiles be collected in a consistent manner after the patient has been either lying down or sitting quietly for a minimum of 5 minutes.

National Cholesterol Education Program

In Postural Changes, we can get false increased of what enzymes from SUPINE TO SITTING

Enzymes, calcium, albumin

In Postural Changes, we can get false increased of what enzymes from SITTING TO SUPINE

Proteins and lipids