Blood Collection: A Short Course, 2nd edition

UNIT 2 VENIPUNCTURE

EQUIPMENTMarjorie Schaub Di Lorenzo, MT(ASCP)SHSusan King Strasinger, DA, MT(ASCP)

Differentiate between an evacuated tube system, syringe, and a winged blood collection set for the collection of blood by venipuncture.

Differentiate among the various needle sizes as to length, gauge, and purpose.

Discuss methods to safely dispose of contaminated needles.

LEARNING OBJECTIVES

Identify the types of evacuated tubes by color code, and state the anticoagulants and additives present, the mechanism of action, any special characteristics, and the purpose of each.

List the correct order of draw for the various types of blood collection tubes.

LEARNING OBJECTIVES

Discuss the purpose and types of tourniquets.

Name three substances used to cleanse the skin prior to venipuncture.

Discuss the use of gloves, gauze, and bandages when performing venipuncture.

Describe the quality control of venipuncture equipment.

LEARNING OBJECTIVES

SelectionConvenience to collection area

EQUIPMENT ORGANIZATION

PHLEBOTOMY TRAYS

Equipment transport Placement Disinfection

MOBILE PHLEBOTOMY WORKSTATIONS

OUTPATIENT DRAWING STATIONS

Evacuated tube system Syringe system Winged blood collection set

VENIPUNCTURE METHODS

EVACUATED TUBE SYSTEMS

Eliminate transfer of blood

Minimize exposure to blood

Three-part system

Sterile, disposable Standard gauge, 20–22

21-22 gauge standard with evacuated tubes Length, 1 or 1.5 inches 23 gauge with ¾” length may be used

Children/persons with small veins

NEEDLES

Avoid Most have eliminated 20-gauge needles

Patients on blood thinner = hematomas Use of 25-gauge needles

Needle in vein longer Tube fills more slowly–microclots form Hemolysis occurs more frequently

NEEDLES

NEEDLE DESCRIPTIONS

StructureBarbed needles

NEEDLE INSPECTION

NEVER RECAP A NEEDLE ONCE THE SHIELD HAS

BEEN REMOVED.

ShieldsBlunting devicesRetracting devices

SAFETY NEEDLES

SAFETY GLIDE BLOOD COLLECTION SYSTEM

BD VACUTAINER ECLIPSE NEEDLE

VENIPUNCTURE NEEDLE-PRO

BLUNTING NEEDLES

HOLDER DESCRIPTION

Tube advancementTube removalLoss of vacuum

TUBE HOLDER PROCEDURE

TYPES OF HOLDERS

Venipuncture Needle-Pro, Vanish-Point, and BD holders

BECOME THOROUGHLY FAMILIAR WITH THE

OPERATION OF YOUR NEEDLE SAFETY SYSTEM

BEFORE PERFORMING BLOOD COLLECTION.

NEEDLE DISPOSAL SYSTEMS

Puncture-resistant containers• Rigid, leakproof,

biohazard labeling

Syringes with needles attached Winged blood collection sets Adapters with needles attached Safety shields activated

DIRECT DISPOSAL

COLLECTION TUBES

Rubber stoppersHemogard closuresColor-coding• Identifies the type of anticoagulant/additive

DESCRIPTION

STOPPER DESIGN

Premeasured vacuum• Desired volume• Partial fill tubes

Color-coded Types of anticoagulant• Liquid• Powder• Spray-coated

Mixing

METHODOLOGY

DO NOT TRANSFER BLOOD

BETWEEN TUBES CONTAINING DIFFERENT ANTICOAGULANTS OR

ADDITIVES.

EDTA is the anticoagulant Specimen is whole blood Primary test is the CBC• Maintains cellular integrity• Inhibits platelet clumping• Does not interfere with routine staining procedures

CLSI recommends spray-dried K2EDTA for hematology tests

Do not use for coagulation tests

LAVENDER TUBES

K2EDTA is the anticoagulant Specimen is whole blood Designated tube for blood bank tests Special label required by the AABB

PINK TUBES

K2EDTA is the anticoagulant with gel Plasma preparation tube (PPT) Specimen is plasma Used for molecular diagnostic tests

WHITE TUBES

Sodium citrate is the anticoagulant Specimen is plasma Primarily used for coagulation tests• Preserves coagulation factors

Ratio of blood to liquid Na citrate = 9:1• Make adjustments for high and low HCTs

LIGHT BLUE TUBES

INCOMPLETELY FILLED LIGHT-BLUE TUBES ARE

REJECTED BY THE LABORATORY.

OVERMIXING LIGHT BLUE TUBES CAN ACTIVATE

PLATELETS AND PRODUCE ERRONEOUS

COAGULATION TEST RESULTS.

Specimen is plasma Used for fibrin degradation products Additives are thrombin and soybean trypsin

inhibitor

SPECIAL BLUE TUBES

Sodium citrate is the anticoagulant Blood to liquid anticoagulant is 4:1 Specimen is whole blood Used for Westergren sedimentation rates Specially designed tubes

BLACK TUBES

Heparin is the anticoagulant Specimen is plasma Chemistry tests Avoid anticoagulant interference with

particular tests (Na, NH4, Li) Heparin interferes with differential staining

GREEN TUBES

Plasma separator tubes (PSTs) Lithium heparin is the anticoagulant Additive is separation gel Specimen is plasma Separates plasma from cells Ideal for potassium tests and other

chemistry tests

LIGHT GREEN/GREEN BLACK TUBES

Potassium oxalate or Na2EDTA may be the anticoagulant

Antiglycolytic agent, sodium fluoride, is the additive

Specimen may be plasma or serum Used for glucose and blood alcohol levels Sodium fluoride interferes with some enzyme

tests Potassium oxalate distorts RBC morphology

GRAY TUBES

Plain with clot activator, sodium heparin, or K2EDTA

Specimen may be serum or plasma Specially formulated rubber stoppers Chemically clean tubes Used for trace elements, toxicology,

and nutrients

ROYAL BLUE TUBES

K2EDTA is the anticoagulantSpecimen in plasmaContain less than 0.01 µg/mL lead

Used for lead testing

TAN TUBES

Blood bank• Acid citrate dextrose (ACD)

Preserves red blood cellsMicrobiology• Sodium polyanetholsulfonate (SPS)• Blood cultures

Aids microorganism recovery

YELLOW TUBES

Thrombin is the additiveSpecimen is serumUsed for STAT serum chemistry tests

ORANGE/YELLOW GRAY TUBES

GOLD/RED-GRAY (SST) TUBES

Additives Silica clot activator Thixotropic separation gel

Specimen is serum Allow to clot for 30 minutes Used for chemistry tests Do not use for blood bank or

some immunology/serology tests

CENTRIFUGATION OF INCOMPLETELY CLOTTED SST TUBES CAN PRODUCE

A NONINTACT GEL BARRIER AND POSSIBLY

CELLULAR CONTAMINATION OF

SERUM.

Silica clot activator is the additive

Specimen is serumUsed for serology, chemistry, and blood bank testing

RED PLASTIC TUBES

No anticoagulants or additives Specimen is serum Allow to clot for 60 minutes Used for chemistry, serology, and blood bank

testing

RED GLASS TUBES

No additives or anticoagulants Used as a discard tube

CLEAR/RED-LIGHT GRAY TUBES

Prevents specimen contamination by:• Tissue thromboplastin• Anticoagulants• Additives• Microorganisms

ORDER OF DRAW

Tissue thromboplastin affecting coagulation tests

Transfer of EDTA to a tube for calcium testing

Transfer of Na citrate or K oxalate to a tube for electrolyte testing

EXAMPLES

CLSI-RECOMMENDED ORDER OF DRAW

Blood culture Light-blue Red/gray, gold, red plastic or glass Light green PST, green Lavender, pink, white Gray Yellow/gray, orange

Used for small, fragile veinsSuction pressure on vein can be controlled

Coordinate syringe size with volume of blood required

SYRINGES

SYRINGE DESCRIPTION

SYRINGE-TO-EVACUATED TUBE TRANSFER

Blood transfer device

CLSI recommends the same order of draw for both evacuated tube system and filling tubes from a syringe.

CLSI-RECOMMENDED SYRINGE ORDER OF DRAW

WINGED BLOOD COLLECTION SETS

IV fluid infusion Very small adult

veins Pediatric specimens

WINGED BLOOD COLLECTION SETS

WINGED BLOOD COLLECTION SETS

PUNCTURE GUARD WINGED BLOOD COLLECTION SET

COMBINATION SYSTEMS

Blood collection tube and collection device are combined in one unit Blood collected by either

evacuated tube or syringe technique

Use regular needles or winged blood collection needles

TOURNIQUETS

TYPES OF TOURNIQUETS

Flat latex strips Velcro/buckle

closures Rubber tubing Blood pressure

cuffs Disposable

nonlatex strips

Assists in vein location Impedes venous but not arterial blood

TOURNIQUET PURPOSE

Venoscope II, Neonatal Transilluminator, and Transillumination Vein Locator Uses high-intensity LED lights Shines through patient’s subcutaneous tissue Absorbs light Highlights vein

Vena-Vue–uses liquid crystal thermography Vein Entry Indicator Device (VEID)–sensor

technology

VEIN-LOCATING DEVICES

VENOSCOPE

GLOVES

OSHA mandated Latex versus nonlatex Powdered versus

nonpowdered

ANTISEPTICS

70% isopropyl alcohol• Routine venipuncture

Iodine/chlorhexidine gluconate • Blood cultures• Arterial punctures

GAUZE/BANDAGES

2 x 2 gauze pads• Apply pressure to

puncture site Bandages/tape• Apply after bleeding stops• Remove within 1 hour• Latex-free

Self-adhesive gauze

ADDITIONAL SUPPLIES

Pen Biohazard bags Hand sanitizers

Needles• Disposable• Tightly sealed for sterility• Visual examination

EQUIPMENT QUALITY CONTROL

Lot numbersExpiration date• Ensures stability of:

Vacuum Anticoagulants Additives

EVACUATED TUBES QUALITY CONTROL

Short draws• Excessive dilution by liquid anticoagulant

• Underfilled sodium citrate tubes cause a falsely lengthened aPTT result

• Distortion of cellular structures• Underfilled EDTA tubes cause red blood cell

shrinkageAvoid manual filling of additive tubes

POSSIBLE ERRORS