PHB 151 Nov. 3 -Order of Draw and Sticking to Draw

Introduction

• Discussed blood sample collection and analysis in various situations.

Blood Sample Collection Tubes (By Order of Draw)

• Types of Tubes:

  • Microbiology- Yellow Top Tubes or commercially prepared bottles

  • has Sodium polyanethol sulfonate (SPS)

  • If not collecting for blood cultures, don’t draw at all

  • Light Blue Top Tubes

  • has Sodium Citrate -chelating (binding) calcium

  • Red Top Tubes

  • has no anti-coagulant, but may contain clot activator

  • This does not have to be filled to the line

  • Can collect serum with this

  • Only used for chemistry

  • Can be used for Serology/Immunology tests

  • Must let it sit for 30 min. before spinning

  • some may have tubes with Serum Separators

  • Gold Top Tubes

  • No anti-coagulants but may contain clot activator (thrombin or silica grains)

  • Used for Serology/Immunology, and Chemistry tests

  • not used for blood bank

  • May contain gel separators

• Green Top Tubes:

  • Contains heparin- could be lithium, sodium, or ammonium heparin

  • May contain gel-plasma separator tube

  • Used for Chemistry tests; mainly BMP, CMP, Mg, Fe, Lipid Profile and Uric Acid test

  • BMP tests using this tube: Na, K, Cl, CO2, Glucose, BUN, and Creatinine

  • CMP tests using this tube: BMP, ALT, AST, Ca, Phos, TBil, TP, and Albumin

• Purple Top Tubes: 

• Key Anticoagulants:

  • Potassium Oxalate:

  • Commonly used anticoagulant.

  • Anticoagulants and their Function:

  • They prevent coagulation, impacting subsequent analyses.

• Other Considerations:

  • Follow manufacturer guidelines on which trace metals can be collected using specified tubes.

Dialysis Considerations

• Discussed unique needs for dialysis patients:

  • Dialysate components:

  • Mention of aluminum as a component in certain dialysates.

  • Addition of buffers like citrate and dextrose for nourishment during testing.

Organ Transplant Testing

• Collection Process:

  • Blood samples typically drawn from organ donors, which can be:

  • Live donors: Individuals voluntarily donating organs.

  • Cadaver donors: Individuals declared brain dead planned to donate organs post-life support.

• The importance of DNA extraction in organ transplantation and its relevance to genetic testing services like 23andme and ancestry.com.

Test Procedures

• Emphasis on the importance of referring to test procedures and guidelines for accurate results.

• Example: Knowledge of anticoagulants' interaction with test results is essential.

Key Laboratory Concepts

• Flow Cytometry:

  • Use of CD4 and CD8 in specific blood tests.

• Importance of Ratio:

  • A 9:1 ratio of anticoagulant to blood was mentioned.

Safety and Disinfectants

• Disinfectant Recommendations:

  • Preferred disinfectant is a 10% solution of bleach (Floorsox).

  • Suitable for cleaning surfaces, particularly bathrooms and kitchens.

  • Caution:

  • Not to be used on skin or in contact with patients directly.

• Hand Sanitizers:

  • Intended solely for skin, avoid using harsh disinfectants on patients.

Phlebotomy Techniques

• Needle Handling:

  • Importance of proper technique and safety measures in using needles and collection tubes.

• Type of Needles:

  • Importance of using evacuated tube systems appropriately.

• Practical Tips and Skills:

  • Requires practice for mastering blood collection methods.

Blood Cultures and Avoiding Contamination

• First Collection Protocol:

  • Emphasize collecting blood cultures in a specified order to avoid contamination, using:

  • Light red, gray, green and other color-coded tubes.

  • Importance of preventing crossover and cross-contamination between different tube types.

Additional Observations and Mindset

• Acknowledgment of challenges and confusions associated with different blood collection protocols and safety measures.

• Practice is essential for mastery in phlebotomy, highlighting the complexity of the procedure and the need for learning with varied techniques.