chapter 8 venipuncture equipment. copyright © 2008 by saunders, an imprint of elsevier inc. all...

Chapter 8Chapter 8

Venipuncture EquipmentVenipuncture Equipment

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2

Learning ObjectivesLearning Objectives

List the equipment that should be available List the equipment that should be available for venipuncture.for venipuncture.

Describe the purpose of a tourniquet; list Describe the purpose of a tourniquet; list types that may be used to locate a vein.types that may be used to locate a vein.

Differentiate between an antiseptic and a Differentiate between an antiseptic and a disinfectant. List those that may be used for disinfectant. List those that may be used for blood collection.blood collection.



Locate the bevel, shaft, hub, and point of a Locate the bevel, shaft, hub, and point of a needle. Describe safety features that may be needle. Describe safety features that may be included.included.

Define gauge.Define gauge. Name the parts of a syringe, and describe Name the parts of a syringe, and describe

how the syringe system differs from the how the syringe system differs from the evacuated tube system.evacuated tube system.



Explain when a syringe system or winged Explain when a syringe system or winged infusion set (butterfly) is used in blood infusion set (butterfly) is used in blood collection.collection.

Describe the proper use of the tube holder Describe the proper use of the tube holder (needle adapter).(needle adapter).

Differentiate whole blood, serum, and plasma. Differentiate whole blood, serum, and plasma. List at least one use for each. List at least one use for each.

Describe at least nine additives, including Describe at least nine additives, including their mode of action and uses.their mode of action and uses.



List at least 10 different colors for tube List at least 10 different colors for tube stoppers. Identify the additives(s) in each, stoppers. Identify the additives(s) in each, and state one use for each.and state one use for each.

State the correct order in which various types State the correct order in which various types of tubes should be collected.of tubes should be collected.

Describe the proper disposal of a used Describe the proper disposal of a used needle.needle.


Phlebotomy EquipmentPhlebotomy Equipment

Equipment needed includes: needles, tubes, Equipment needed includes: needles, tubes, sharps disposal container, needle holders, sharps disposal container, needle holders, syringes, winged infusion sets, pens, gloves, syringes, winged infusion sets, pens, gloves, tourniquets, antiseptic, gauze, and bandages.tourniquets, antiseptic, gauze, and bandages.

Phlebotomists will carry equipment in a tray Phlebotomists will carry equipment in a tray or a cart to draw blood on inpatients. Never or a cart to draw blood on inpatients. Never place the tray on a patient’s bed.place the tray on a patient’s bed.

Outpatients will come to a drawing station Outpatients will come to a drawing station and use a phlebotomy chair with a locking and use a phlebotomy chair with a locking armrest.armrest.


Phlebotomy EquipmentPhlebotomy Equipment


TourniquetTourniquet

A tourniquet is the most common way to A tourniquet is the most common way to locate a vein.locate a vein.

A tourniquet prevents venous blood flow A tourniquet prevents venous blood flow which causes the veins to bulge.which causes the veins to bulge.

A tourniquet may be latex or nonlatex.A tourniquet may be latex or nonlatex. A tourniquet may be used only once and A tourniquet may be used only once and

disposed of or cleaned before use on another disposed of or cleaned before use on another patient. Follow your facility’s policy regarding patient. Follow your facility’s policy regarding tourniquet reuse.tourniquet reuse.


The Puncture SiteThe Puncture Site

Use 70% isopropyl alcohol, an antiseptic, to Use 70% isopropyl alcohol, an antiseptic, to cleanse the skin before a venipuncture. cleanse the skin before a venipuncture.

Alcohol left to dry on the arm is bacteriostatic.Alcohol left to dry on the arm is bacteriostatic. Disinfectants are used on work surfaces to kill Disinfectants are used on work surfaces to kill

microorganisms and are not safe for use on microorganisms and are not safe for use on the skin.the skin.

For allergic patients, use iodine, chlorhexidine For allergic patients, use iodine, chlorhexidine gluconate or benzalkonium chloride.gluconate or benzalkonium chloride.

Apply a 2 in. by 2 in. gauze square to apply Apply a 2 in. by 2 in. gauze square to apply pressure to the puncture site after needle pressure to the puncture site after needle removal.removal.


NeedlesNeedles

All needles have a point, bevel, and shaft.All needles have a point, bevel, and shaft. The shaft can differ in length and gauge.The shaft can differ in length and gauge. The gauge describes the diameter or lumen of The gauge describes the diameter or lumen of

the needle. the needle. The larger the gauge number, the smaller the The larger the gauge number, the smaller the

lumen of the needle.lumen of the needle. You will learn to pick the correct gauge You will learn to pick the correct gauge

depending on the patient’s veins.depending on the patient’s veins. For adults use a 20 to 21 gauge; for children or For adults use a 20 to 21 gauge; for children or

adults with small veins use a 22 to 23 gauge.adults with small veins use a 22 to 23 gauge.


Parts of a NeedleParts of a Needle


Multisample NeedlesMultisample Needles This needle is double-ended This needle is double-ended

with one tip used on the with one tip used on the patient’s arm and the second patient’s arm and the second end used to pierce tube stopper.end used to pierce tube stopper.

There is a retractable rubber There is a retractable rubber sleeve that covers the second sleeve that covers the second tip when tubes are changed to tip when tubes are changed to prevent blood from leaking into prevent blood from leaking into the holder.the holder.


Syringes and Syringe NeedlesSyringes and Syringe Needles

A syringe has a plunger, a barrel A syringe has a plunger, a barrel and a syringe needle (Figure 8-4, and a syringe needle (Figure 8-4, p. 117).p. 117).

Syringes are used on small, fragile Syringes are used on small, fragile veins to control the pull of vacuum veins to control the pull of vacuum on the veins.on the veins.


Syringes and Syringe NeedlesSyringes and Syringe Needles

You will see a flash of blood in the hub of the You will see a flash of blood in the hub of the needle when you are in the vein.needle when you are in the vein.

Blood must be transferred to evacuated Blood must be transferred to evacuated tubes.tubes.


Winged Infusion Sets (Butterflies)Winged Infusion Sets (Butterflies)

Butterflies are used on pediatric Butterflies are used on pediatric or elderly patients for small veins or elderly patients for small veins such as in the hand.such as in the hand.

The butterfly has a ½ to ¾ inch, The butterfly has a ½ to ¾ inch, 23 gauge needle with wings and 23 gauge needle with wings and plastic tubing.plastic tubing.

The syringe or tube holder can be The syringe or tube holder can be attached at the end.attached at the end. From Bonewit-West K: Clinical Procedures for

Medical Assistants, 6th ed. Philadelphia, Saunders, 2004.


Needle SafetyNeedle Safety

OSHA and the Needle Safety and Prevention OSHA and the Needle Safety and Prevention Act requires the use of safety devices when Act requires the use of safety devices when collecting and transferring blood.collecting and transferring blood.

There are many kinds of safety needles and There are many kinds of safety needles and safety holders available for use.safety holders available for use.


Evacuated Tube System (ETS)Evacuated Tube System (ETS)

The ETS uses a multisample needle, an The ETS uses a multisample needle, an evacuated tube and an adapter.evacuated tube and an adapter.

The needle and holder are used once and The needle and holder are used once and then disposed of “intact” into a sharps then disposed of “intact” into a sharps container.container.

It is best to use tubes, holders, and needles It is best to use tubes, holders, and needles from the same manufacturer for best fit.from the same manufacturer for best fit.


Evacuated Tube SystemEvacuated Tube System


Evacuated Collection TubesEvacuated Collection Tubes

Tubes are color coded and come in assorted Tubes are color coded and come in assorted sizes in either plastic or glass.sizes in either plastic or glass.

The tube size selected depends on the The tube size selected depends on the patient, his vein size and the amount of blood patient, his vein size and the amount of blood needed.needed.

Each tube contains an “additive” or chemical Each tube contains an “additive” or chemical added to the tube to prevent or promote added to the tube to prevent or promote changes in the blood sample.changes in the blood sample.


Types of Blood SpecimensTypes of Blood Specimens

Whole bloodWhole blood is mixed with an anticoagulant to is mixed with an anticoagulant to prevent clotting and is for hematology cell prevent clotting and is for hematology cell counts.counts.

SerumSerum is the fluid portion of blood after is the fluid portion of blood after clotting and is used for chemistry testing such clotting and is used for chemistry testing such as glucose.as glucose.

PlasmaPlasma is the fluid portion of blood containing is the fluid portion of blood containing an anticoagulant and is used for stat an anticoagulant and is used for stat chemistry testing.chemistry testing.


Tube AdditivesTube Additives

Any tube with an additive must be inverted 5 Any tube with an additive must be inverted 5 to 8 times after collection.to 8 times after collection.

Tube additives are identified by the stopper Tube additives are identified by the stopper color.color.

Many tubes are coated with silicone to Many tubes are coated with silicone to prevent blood from sticking to the sides.prevent blood from sticking to the sides.

Only the red glass tube contains NO Only the red glass tube contains NO additives.additives.


AnticoagulantsAnticoagulants

Anticoagulants prevent blood from clotting.Anticoagulants prevent blood from clotting. The choice of anticoagulant varies with the The choice of anticoagulant varies with the

test being done.test being done. Different anticoagulants work in different ways Different anticoagulants work in different ways

to prevent clotting and yield plasma:to prevent clotting and yield plasma: - EDTA, citrate and oxalate bind calcium. - EDTA, citrate and oxalate bind calcium. - heparin inhibits conversion of prothrombin to - heparin inhibits conversion of prothrombin to

thrombin.thrombin.


Antiglycolytic AgentsAntiglycolytic Agents

Sodium fluoride is an additive in the gray Sodium fluoride is an additive in the gray stopper tube used for glucose.stopper tube used for glucose.

Sodium fluoride inhibits glycolysis, or Sodium fluoride inhibits glycolysis, or metabolism of glucose, for accurate testing.metabolism of glucose, for accurate testing.

Lithium iodoacetate is an acceptable Lithium iodoacetate is an acceptable alternative also available in the gray stopper alternative also available in the gray stopper tube for glucose testing.tube for glucose testing.


Clot ActivatorsClot Activators

Thrombin is an additive that promotes Thrombin is an additive that promotes coagulation.coagulation.

Glass or silica promote clotting by providing Glass or silica promote clotting by providing more surface area for platelet activation.more surface area for platelet activation.

Tubes with clot activators must be inverted to Tubes with clot activators must be inverted to allow blood to come into contact with the allow blood to come into contact with the activator.activator.


Thixotropic GelThixotropic Gel

An inert, synthetic substance with a density An inert, synthetic substance with a density between that of cells and plasma or serum.between that of cells and plasma or serum.

When a blood tube with gel is centrifuged, When a blood tube with gel is centrifuged, spun at high speed, the gel becomes liquid spun at high speed, the gel becomes liquid and forms a layer upon hardening between and forms a layer upon hardening between the cellular and liquid layer.the cellular and liquid layer.

Example: SST (Serum Separation Tube)Example: SST (Serum Separation Tube)


Color Coded Tube StoppersColor Coded Tube Stoppers

Tube:Tube: Red (glass) Red (glass)

Allow 30 min. to clot.Allow 30 min. to clot. Additive: NoneAdditive: None Specimen: SerumSpecimen: Serum Tests:Tests: Chemistry (glucose) Chemistry (glucose)

Serology (rubella)Serology (rubella)

Blood Bank (group and Rh)Blood Bank (group and Rh)



Tube:Tube: Red (plastic) Red (plastic) Additive: Clot ActivatorAdditive: Clot Activator Specimen: SerumSpecimen: Serum Tests:Tests: Chemistry (glucose) Chemistry (glucose)

Serology (rubella)Serology (rubella)

NOTE: Do not use for Blood Bank testing.NOTE: Do not use for Blood Bank testing.



Tube:Tube: Light Blue Light Blue Additive: Sodium citrate (anticoagulant)Additive: Sodium citrate (anticoagulant) Specimen: PlasmaSpecimen: Plasma Tests:Tests: Coagulation tests Coagulation tests

PT (prothrombin time)PT (prothrombin time)NOTE: Tube must be filled to its correct level to NOTE: Tube must be filled to its correct level to

maintain a 9:1 ratio of blood to anticoagulant.maintain a 9:1 ratio of blood to anticoagulant.



Tube:Tube: Lavender Lavender Additive: KAdditive: K22 or K or K33 EDTA (anticoagulant) EDTA (anticoagulant) Specimen: Whole bloodSpecimen: Whole blood Tests:Tests: CBC (complete blood count) CBC (complete blood count)

Hgb (hemoglobin)Hgb (hemoglobin)



Tube:Tube: Pearl Pearl Additive: KAdditive: K22 EDTA plus gel EDTA plus gel Specimen: PlasmaSpecimen: Plasma Tests:Tests: Viral Loading Viral Loading



Tube:Tube: Gold Hemogard Gold HemogardTM TM Closure Closure Red/Gray Stopper Red/Gray Stopper

Additive: Clot activator/ thixotropic gelAdditive: Clot activator/ thixotropic gel Specimen: SerumSpecimen: Serum Tests:Tests: Chemistry (glucose, BUN) Chemistry (glucose, BUN)

Both tubes referred to as SSTs for serum Both tubes referred to as SSTs for serum separation tube.separation tube.



Tube:Tube: GrayGrayAdditive: sodium fluoride or iodoacetate to Additive: sodium fluoride or iodoacetate to

preserve glucose; may be preserve glucose; may be combined with potassium combined with potassium

oxalate oxalate or heparin (anticoagulants).or heparin (anticoagulants). Specimen: Specimen: Serum or plasmaSerum or plasma Tests:Tests: Fasting blood sugar/alcohol Fasting blood sugar/alcohol

levelslevels



Tube:Tube: Black Black Additive: Additive: Sodium citrate (anticoagulant) Sodium citrate (anticoagulant) Specimen: Whole bloodSpecimen: Whole blood Tests:Tests: ESR (erythrocyte sedimentation ESR (erythrocyte sedimentation

rate) rate)NOTE: Tube must be filled to its correct level to NOTE: Tube must be filled to its correct level to

maintain a 4:1 ratio of blood to anticoagulant.maintain a 4:1 ratio of blood to anticoagulant.



Tube:Tube: Green Green Additive: Heparin (anticoagulant)Additive: Heparin (anticoagulant) Specimen: PlasmaSpecimen: Plasma Tests:Tests: Stat chemistry tests – glucose, Stat chemistry tests – glucose,

electrolytes, ammonia. electrolytes, ammonia.



Tube:Tube: Light green or green/gray stopper Light green or green/gray stopper Additive: Heparin/thixotropic gelAdditive: Heparin/thixotropic gel Specimen: PlasmaSpecimen: Plasma Tests:Tests: Stat chemistry tests – glucose, Stat chemistry tests – glucose,

potassium, BUN. potassium, BUN.

This tube is referred to as a PST or plasma This tube is referred to as a PST or plasma separation tube.separation tube.



Tube:Tube: Orange or yellow/gray stopper Orange or yellow/gray stopper Additive: Thrombin (clot activator)Additive: Thrombin (clot activator) Specimen: serumSpecimen: serum Tests:Tests: Chemistry tests when serum is Chemistry tests when serum is

required on patients on required on patients on anticoagulant anticoagulant

therapy.therapy.

This tube will clot the blood in 5 minutes.This tube will clot the blood in 5 minutes.



Tube:Tube: Royal blue Royal blue Additive: Heparin/EDTA or noneAdditive: Heparin/EDTA or none Specimen: Plasma or serumSpecimen: Plasma or serum Tests:Tests: Toxicology trace metals, lead Toxicology trace metals, lead

This tube is specially cleaned and has special This tube is specially cleaned and has special stoppers to prevent specimen contamination.stoppers to prevent specimen contamination.



Tube:Tube: Tan Tan Additive: HeparinAdditive: Heparin Specimen: PlasmaSpecimen: Plasma Tests:Tests: Lead Lead

Tube is formulated to contain less than Tube is formulated to contain less than 0.1microgram/mL (ppm) of lead.0.1microgram/mL (ppm) of lead.



Tube:Tube: Yellow (Sterile) Yellow (Sterile) Additive: SPS (sodium polyethanol Additive: SPS (sodium polyethanol

sulfonate) to inhibit sulfonate) to inhibit complement complement and phagocytosis and phagocytosis and keep blood and keep blood from clotting. from clotting.

Specimen: Whole bloodSpecimen: Whole blood Tests:Tests: Blood culture to recover Blood culture to recover

organisms that cause organisms that cause blood blood infection. infection.



Tube:Tube: Yellow (Nonsterile) Yellow (Nonsterile) Additive: ACD (acid citrate dextrose)Additive: ACD (acid citrate dextrose) Specimen: Whole bloodSpecimen: Whole blood Tests:Tests: Paternity testing, tissue typing Paternity testing, tissue typing

The dextrose nourishes and preserves RBCs The dextrose nourishes and preserves RBCs and the citrate is an anticoagulant.and the citrate is an anticoagulant.



Tube:Tube: Pink Pink Additive: KAdditive: K22 EDTA EDTA Specimen: Whole blood or plasmaSpecimen: Whole blood or plasma Tests:Tests: Blood bank compatibility testing Blood bank compatibility testing

and antibody screening. and antibody screening.

This tube, similar to the lavender, meets This tube, similar to the lavender, meets labeling standards for Blood Bank.labeling standards for Blood Bank.


Order of DrawOrder of Draw

1. 1. Blood culture tubesBlood culture tubes yellow sterile yellow sterile to to prevent cross contamination from other prevent cross contamination from other tubes.tubes.

2. 2. Lt. Blue tubesLt. Blue tubes for coagulation tests to for coagulation tests to prevent contamination from other additives prevent contamination from other additives that can interfere with testing.that can interfere with testing.

3. 3. Red, glass or plastic, gold, red-gray, SSTRed, glass or plastic, gold, red-gray, SST which, except for red-glass, contain clot which, except for red-glass, contain clot activators that could interfere with other activators that could interfere with other samples for testing.samples for testing.


Order of DrawOrder of Draw

4. 4. Green or Lt. green tubesGreen or Lt. green tubes because the because the heparin will not interfere with EDTA tubes.heparin will not interfere with EDTA tubes.

5. 5. Lavender tubesLavender tubes with EDTA which can affect with EDTA which can affect calcium and potassium levels if drawn calcium and potassium levels if drawn before other tubes.before other tubes.

6. 6. Gray tubeGray tube is last to avoid contamination of is last to avoid contamination of tubes for electrolyte and enzyme testing.tubes for electrolyte and enzyme testing.

All other colors are typically drawn after these.All other colors are typically drawn after these.


Needle DisposalNeedle Disposal

Activate the needle safety device immediately Activate the needle safety device immediately after removing the needle from the arm.after removing the needle from the arm.

Dispose of the needle and tube holder intact Dispose of the needle and tube holder intact into a closable, sealable, puncture resistant, into a closable, sealable, puncture resistant, leakproof container clearly marked for leakproof container clearly marked for biohazard disposal.biohazard disposal.

chapter 8 venipuncture equipment. copyright © 2008 by saunders, an imprint of elsevier inc. all...

Documents

imprint of elsevier

used needle

phlebotomy equipment

proper use

tourniquet list types

venipuncture equipment

learning objectives

puncture site use