VENIPUNCTURE EQUIPMENTS

MULTISAMPLE NEEDLES
PHLEBOTOMY EQUIPMENT
 Are collection equipment which includes the
needles and tubes that allow to collect patient’s
blood, plus materials to ensure that a vein can be
located, the puncture site is sterile, and the
samples is labelled and transported correctly.
 Proper handling of phlebotomy equipment is of
the utmost importance for the safety of both the
phlebotomist and the patient.
 A double ended needle. One tip of the needle
penetrates the patient’s skin, and the second
pierces the rubber cap of an evacuated collection
tube.
SAFETY SYRINGES AND NEEDLES
 Is used for patients with fragile or small veins,
when the vacuum of the collection tube is likely
to collapsed the vein.

ORGANIZATION OF EQUIPMENTS WINGED INFUSION SET OR BUTTERFLY

 An important key to successful blood collection  Is used for venepuncture on small veins, such as
is making sure that all the required equipment is those in the hand, elderly, pediatric patient.
conveniently present in the collection area.  Has plastic wings attached to the needle and
includes two types of systems.
LOCATING THE VEIN
NEEDLE SAFETY
TOURNIQUET  Is used to reduce the number of sharp injuries.
 Prevents venous blood flow out of the arm,
causing the vein to bulge. NEEDLE ADAPTERS
 Most frequently used:  Is used to ensure a firm, stable connection
o Flat Latex or Vinyl Strips between the multi-sample needle and the
o Snap evacuated tube.
o Blood Pressure Cuffs
LANCETS
CLEANING THE PUNCTURE SITE  Are small cutting instruments designed to
control the depth of the dermal puncture.
ANTISEPTICS
 Agent used to clean living tissues EVACUATED COLLECTION TUBES
 Contain a premeasured vacuum and are most
DISINFECTANTS widely used system in blood collection
 Agent used to clean a surface other than living  These tubes are sterile and contain additives.
tissues  Variety of sizes and colors and are made of glass
or plastics.
 70% Isopropyl Alcohol – most commonly used
antiseptic TUBE ADDITIVES
 Benzalkonium Chloride, Chlorhexidine  Additives include anticoagulants to
Gluconate and Povidone-Iodine – alternative o prevent clotting,
disinfectants if the patient is allergic to isopropyl o clot activator to promote it
alcohol o thixotropic gel to separate components
o preservatives and inhibitors of cellular
PROTECTING THE PUNCTURE SITE reactions to maintain the integrity of
the specimen.
GAUZE PAD  Many tubes are coated inside with silicone, to
 A loosely woven cotton fabric used to cover a prevent blood from adhering to the wall of the
puncture site when applying pressure tube and to slow down the cooling process.
immediately upon completion of the procedure.
 ANTICOAGULANT
NEEDLES o Prevent blood from clotting.
 Inserted into a vein that allows blood to flow out  EDTA
into an evacuated tube or syringe. (Ethylenediaminetetraacetic
 Composed of a hub, the shaft, and the bevel. acid),
  SPS(sodium polyanethol
sulfonate),
 Sodium citrate,
 sodium oxalate,
 heparin
 CLOT ACTIVATOR
o Promote coagulation. Thrombin directly
increase clotting.
o inert substances are glass or silica,
siliceous earth, clay, and celite.
 THIXOTROPIC GEL
o An inert, synthetic substance whose
density is in between that of cells and
that of blood serum plasma.
o Thixo “Related to touch” and refers to
gel’s ability to liquefy when shaken.
TUBES ADDITIVE/COLOR CODED TOPS
NEEDLE DISPOSAL CONTAINER
 A used needle is considered biohazard waste
and must be treated as such.
 Dispose the needle and activate the needle
safety device.
 needles must be placed in a clearly marked
puncture-resistant biohazard container.
ROUTINE VENIPUNCTURE
REQUISITIONS
 The form the phlebotomist used to determine
what type of sample to collect from the patient.
o Patient Demographic (Age, Sex, etc.)
o Physician’s name
o Test name
o Test status
o Hospital ID number, room and bed
number.
BASIC BLOOD COLLECTION
1. Greet and properly identify the patient
2. Select and assemble the appropriate equipment
3. Use aseptic technique and Standard precaution
during venepuncture and specimen collection
4. Provide post-puncture patient care
5. Adhere to specimen labelling equipment
GREETING THE PATIENT
 A phlebotomist’s demeanor instills confidence
and trust in the patient, which can effectively
ease patient apprehension about the
procedure.
ASSEMBLING THE VENIPUNCTURE EQUIPMENT
 Line up the venepuncture equipment needed
for the procedure near the patient by having
the phlebotomy cart or tray placed next to the
patient’s bed.
 The needle must not touch anything to
prevent contamination, otherwise, raw
needle must be use.
PATIENT POSITIONING
 The patient’s position is another critical factor
for a successful venipuncture. When
identification is completed, the patient must be
positioned conveniently and safely for the
procedure.
APPLYING THE TOURNIQUET
 When tourniquet is applied, the flow of venous
blood is slowed, which increases pressure in the
veins, making them more visible and palpable.
 Applied to the arm 3 to 4 inches above the
puncture site
SELECTING THE PUNCTURE SITE
 The most common area to perform a
venipuncture is the antecubital area of the arm.
  Patients generally have prominent veins on the DERMAL PUNCTURE
dominant arm.
 Palpate the vein using the tip of the index DERMAL/CAPILLARY PUNCTURE
finger. Select a vein that is large.  The preferred blood collection technique for
infants (heel) and very small children (finger)
SELECTING THE PUNCTURE SITE o Infants/Children
(Don’ts in selecting a puncture site) o Geriatric Patients (elderly)
1. Do not pump the fist because this can cause o Oncology patients (cancer patients)
hemaconcentration – increased concentration o Severely burned patients
of cells and solids in the blood usually resulting o Obese patients
from loss of fluid to the tissues . o At risk venous thrombosis
2. DO NOT select a vein that moves easily or roll o IV therapy
from side to side. o Capillary specimen only
3. AVOID a vein that exhibits sclerosis, or feels  The blood specimen obtained during dermal
hard and cordlike. puncture is a mixture of capillary blood, venous
4. Avoid paralyzed limbs and sites with shunts.
blood, arterial blood, and interstitial fluid.
5. Do not use the anterior side of the wrist
Example:
6. Ankle veins are not used for venipuncture
o Capillary (glucose, haemoglobin)
7. Never select an arm that is edematous – An
accumulation of an excessive amount of watery o Venous (potassium, calcium, total
fluid in cells, tissues, or body cavities. protein)
8. Do not perform venipuncture above IV site DISADVANTAGE
(contamination)  Hematoma
9. Avoid the arm on the side of mastectomy –  Contamination
removal of the whole breast.  Micro clot formation
a. Lymphostasis – Obstruction of the
normal flow of lymph. DERMAL PUNCTURE PREPARATION
1. Acquire and examine the requisition slip
CLEANSING THE VENIPUNCTURE SITE 2. Greet and identify the patient
 Prevents microbial contamination of the 3. Explain the procedure
specimen and the patient’s venepuncture site. 4. Verify and dietary restriction
 70% alcohol – recommended antiseptic 5. Wash your hands
 Cleanse the site using concentric circles. 6. Put on gloves

PERFORMING THE VENIPUNCTURE SELECTING THE SITE FOR DERMAL PUNCTURE

VERIFY THE PUNCTURE SITE
 Inserting the needle into the skin at 15- to 30
degree angle.
 collecting the specimen. It is important to hold
the puncture assembly steady during the entire
tube filling method.
 Removing the needle. Remove the tourniquet
prior.
 Remove the last tube from the holder. Gently
place the – directly in the site
 Apply gentle pressure to the site
 3 – 8 mins or until bleeding stops.
AFTER VENIPUNCTURE
 DISPOSING THE EQUIPMENT
 LABELLING THE SPECIMEN
 APPLY THE BANDAGE
 The skin should be warm, pink, free from scars,
cuts, rashes, or bruises.
 SITES TO CONSIDER:
o Regions of middle finger and ring finger
in adults and children
o Medial or lateral regions of the plantar
surface of the heel of the infant.
SELECTING THE SITE FOR DERMAL PUNCTURE
(DON’T’S)
1. Do not use the thumb, pinkie or pointer finger
they are poor choices because the area is often
too thick and calloused.
2. Do not use the end or tip of the finger
3. Never perform on an infant who has begun to
walk because of the potential for pain at the
site.
 4. Do not use the arch of the foot, the back of the
heel, or the plantar area of the foot.
5. Do not puncture from the area of the calcaneus
or heel bone; it can cause osteochondritis or
osteomyelitis.
PERFORMING A DERMAL PUNCTURE
 Clean the finger with an alcohol pad and allow
to dry.
 The finger should be heel in such a way that the
skin is stretched tightly
 For finger puncture, the cut is made across the
fingerprint lines
 The puncture depth could be 1.5 to 2.00 mm.
 Premature babies is 0.65 to 0.85 mm
COLLECTING THE CAPILLARY SPECIMEN
 Wipe away the first drop of blood
 The second drop is collected by touching the
open end of the micro collection container to
the drop of blood. The container will fill by
gravity or capillary action.
 Capillary tubes are typically collected
horizontally using a capillary action and require
very little blood
 Gently squeeze and release the site periodically,
allowing for capillary refill.
 Gently tap the container on a hard surface to
mix the blood.
COLLECTING THE CAPILLARY SPECIMEN (DON’TS)
 Do not “milk” the finger. It will contaminate the
specimen with interstitial fluid.
 Do not scrape the collection container against
the skin because it will cause the blood to
hemolyze or clot
 Do not underfill or overfill the container
AFTER THE DERMAL PUNCTURE
 Mix the specimen
 Dispose of the contaminated safety lancet in the
sharps container
 Label the micro containers and observe any
specimen handling instruction
 Check the site of puncture and apply a bandage.
WINGED INFUSION SET (BUTTERFLY
METHOD)
 When suitable vein cannot be found in the
antecubital fossa
o Hand, foot, leg
 Collection from the leg and foot usually requires
the physician’s permission
 Veins at the back of the hand is recommended.
VEINS AT THE BACK OF THE HAND
 Small and fragile
 Use smaller gauge needle and tube or syringe is
advised
o Basillic vein, cephalic vein, dorsal
metacarpal vein.
WINGED INFUSION SET (BUTTERFLIES)
 Used for the infusion of IV fluids and for
performing venipuncture from very small or
fragile veins of children and geriatrics
population.
 Needles are usually 21 or 23 guage with
lengths of ½ ti ¾ inch.
 Plastic attachments to the needle that resemble
butterfly wings are used for holding the needle
during insertion
 The flexible needle can be attached to an IV set
up, syringe, and evacuated tube holder.
PROCEDURE
1. Support the hand on the bed or drawing chair
armrest and have the patient make a fist.
2. Apply the tourniquet 3-4 inches above the wrist
bone.
3. Palpate the top of the hand or wrist. Select a
vein that is large and straight and that can be
easily anchored.
4. Release the tourniquet, have the patient relax
the fist, and clean the site with 70% isopropyl
alcohol in concentric circles and allow it to dry.
5. Anchor the vein by placing the thumb of the
non-dominant hand below the knuckles and
pulling the skin taut.
o Having the patient make a fist may be
helpful.
o Grasp the needle between the thumb
and index finger by holding the back of
the needle or by folding the wings
together.
6. Pull back on the plunger of the syringe slowly VENIPUNCTURE COMPLICATIONS
and smoothly with the non-dominant hand to
collect blood. Do not pull back on the syringe IDENTIFICATION
plunger if blood does not appear.  You can’t access the patient without any
o When using an evacuated tube holder, identification
o TEMPORARY IDENTIFICATION
insert the tubes in the correct order of
 Requisition form
draw.
 Location
7. Cover the puncture site with gauze, remove the
 Identification of the patient
needle smoothly or activate the safety device
on needles designated to be retracted while the COMMUNICATION BARRIER
needle is in the vein.  Language
8. Remove the winged blood collection set form  When the patient is still sleeping or unconscious
the syringe and discard it in the sharps
container. SITE SELECTION
9. Label the tubes and confirm identification with  Veins that are small
the patient. o Massage. Bending of arm, etc.
10. Examine the puncture site and apply a bandage. o Proceed to alternative sites
11. Remove gloves and wash hands.  Hematoma, Scars, Bruise

SITE CLEANING
 Allergic reaction to alcohol
o Povidone-iodine (betadine)
 Blood culture collection and arterial puncture
(Contamination)
 Blood Alcohol Testing – test that alcohol should
not be used for cleaning the puncture site.
Note: Only doctor, nurses, and medical
technologists are allowed to do the procedure.

TOURNIQUET APPLICATION
 HEMOCONCENTRATION – increases ammonia,
bilirubin, calcium, enzymes, iron, lactic acid,
lipids, potassium, proteins, red blood cells.
o Fluid goes to the tissues
o Hemoglobin increases – 3%
o Pumping
 Petechiae – are small, non-raised red spots.
 Tourniquet applied too tightly – the patient
complains of pinching or numbing of the arm.
 Latex allergy
 Ischemia – anoxia; lack of oxygen supply
 Nerve Injury/Neuropaxia – loss of nerve
function
 Rhabdomyolysis – destruction of muscles.

DURING COLLECTION
 CHANGES IN PATIENT’S STATUS
o Nausea and vomiting
o Syncope – fainting
o Seizure
o Pain
 HEMATOMA – leakage of blood within tissues
- old blood.
  LACK OF BLOOD FLOW TESTS AFFECTED BY PATIENT POSITION
o Defective evacuated tubes Cells counts Haemoglobin or
o Improperly positioned needle haematocrit
 Bevel is stuck to the vein wall Protein Albumin
 Needle is not advanced far Bilirubin Calcium
enough into the vein Enzymes Triglycerides
 Needle has passed through Cholesterol
both sides of the vein
 Vein was missed completely
o Blown out vein – for the term bbq 4. ANTICOAGULANT REFLUX
o Probing – cross stitch
o Reposition – push and pull LONG TERM COMPLICATIONS ASSOCIATED WITH
VENIPUNCTURE
COMPLETING THE PROCEDURE  ANEMIA – Iatrogenic anemia
 Collapsed vein o Decrease of RBC
 Inadvertent puncture of the artery o Cause of treatment
 Failure to collect on the first.  HEMATOMA
o Do it only twice, asap. o Failure to remove tourniquet
 Patient’s request – let him/her sign the request o Applying inadequate pressure
 Prolonged bleeding o Bending the arm
o Excessing probing
FACTORS THAT AFFECT SAMPLE INTEGRITY o Failure to insert the needle enough into
1. HEMOLYSIS the vein
 Using too small needle in respect to vein o Inserting the needle through the vein
size o Selecting a needle too large
 Using a needle smaller than 23 gauge o Using veins that are small
 Using a needle with large vacuum tube o Puncturing brachial artery
 Too much agitation of blood
 Vigorously mixing or shaking tubes  COMPARTMENT SYNDROME
 Blood frothing, from a needle improperly
 NERVE DAMAGE
attached to a syringe
 INFECTION
 Failing to allow blood to run down the side
of the tube
REMEDIES TO MAKE VEIN PROMINENT
 Forcing blood from a syringe into vacuum
 Massage the puncture site
 Blood flow is slow
 Warm wash cloth <42 degree Celsius
 NOT ACCEPTED
 Light exercise
 Tapping the puncture site
TEST AFFECTED BY HEMOLYSIS
 Cleansing it with an alcohol
Seriously Moderately Slightly
 Twisting the wrist
affected affected affected
Potassium CBC Phosphorus
INFORMATIONS
LD Serum iron Total protein  Patient’s full name
AST ALT Albumin  Age
Thyroxine Magnesium  Gender
Calcium  Date and time
ACP  Phlebotomist’s initial
 Test name
2. BLOOD DRAWN FROM HEMATOMA – OLD o FBS – Fasting Blood Sugar
BLOOD o CREA - Creatinine
o SUA - Serum Uric Acid
3. PATIENT POSITION o TRI - Triglyceride
o CHOL – Cholesterol
o BUN – Blood Urea Nitrogen
 ARTERIAL PUNCTURE
DELIVERING SAMPLES AT A TIMELY MANNER
 Stability of analysis CLSI – Clinical and Laboratory Standards Institute
 Accurate results
 Immediate diagnosis and treatment 5 PURPOSES OF TRAINING
 1. Supervision
ETS VS. SYRINGE 2. To correct puncture procedure
EVACUATED TUBE SYRINGE 3. Precaution/ensure safety procedure
SYSTEM 4. Complications
Multiple collection Back flow 5. Sample handling
Faster way of collecting Controlled pressure
COMPOSITION OF ARTERIAL BLOOD
Closed system – reduce Cheaper
 Rich in oxygen and electrolytes
the risk of exposure of
 Uniform in composition throughout the body
blood
 Ideal for managing oxygen, electrolytes, and
Prevent exposure of Less painful
acid-base balance
Ammonia and Carbon
 Often used for testing Arterial Blood Gas (ABG),
Dioxide
ammonia, and lactic acid.
Reduce hemolysis (no Change the needle
transferring of blood will gauge for smaller and
DISEASES THAT RECOMMENDS AP
happen) thinner vein
 COPD (Chronic obstructive pulmonary
Calibrated tubes Can be maneuvered
disorder)
(additives)
 Lung cancer
Simpler and safer (safety Recommended for
 Diabetic coma
device) children and geriatrics
 Schoch
Storage efficient
 Respiratory distress in fetus
 Respiratory diseases

ARTERIAL BLOOD GASES

 Determines the concentrations of oxygen and
carbon dioxide in the blood and measures the
pH
 Measures the gas exchange ability of the lungs
and the buffering capacity of the blood.

EQUIPMENT FOR ARTERIAL PUNCTURE

- GAS IMPERMEABLE PLASTIC SYRINGE

 HEPARINIZED SYRINGED AND NEEDLE

o Pre-treated with heparin to prevent
coagulation
o Glass or gas impermeable plastic
 Plastic is safer
o 1-5 mL
o 21 or 22 gauge, 1 to ½ inch long
o Brachial and radial arteries, 1inch.
o Femoral arteries 1 ½ inches

 ANTISEPTIC
o Both alcohol and povidone-iodine or
chlorhexidine
 Stringent cleansing
  ANTESTHETIC o Poor collateral circulation – MOD Allen’s
o 0.5 mL of lidocaine, a local anaesthetic test
is injected. o Difficult site to keep aseptic
o Near the groin
 SAFETY EQUIPMENT
o Need fluid resistant gown, face ALTERNATIVE SITES IN ADULT
protection, gloves  Dorsalis Pedis Artery
 LUER TIP  Umbilical artery (babies)
o Plastic tip that covers the syringe top  Scalp artery (babies)
after removing needle.
 Prevents alteration of the ARTERIAL PUNCTURE COMPLICATIONS
sample
Arteriospasm The spontaneous
 OTHER EQUIPMENT constriction of an
o Transport container artery in response to
o Crushed ice pain
o Ice and water Nerve damage Cause by an
 If there is a delay. To prevent inadvertent contact
any other metabolism or with the nerve
oxygen Hematoma Resulting from
o Gauze pads inadequate pressure on
o Pressure bandages the site. This is more
o Thermometer likely in elderly patients
whose artery walls are
SITE SELECTION not as elastic.
 Large enough to accept 25 gauge needle Hematoma – near the
 Located near the skin surface so that deep basillic vein
puncture is not required Thrombosis Clot formation within
 In an area where injury to surrounding tissues the artery (bleeding
will not be critical disorders)
 Located in an area where other arteries are Haemorrhage More likely in patients
present to supply blood in case the puncture who have coagulation
artery is damaged disorders or receiving
anticoagulant therapy.
 RADIAL ARTERY (ideal site) (delay in healing)
o Supplying the hand, the artery of choice Infection From skin contaminant
o Smaller than brachial and femoral Vasovagal reaction Result in sudden loss of
artery, good collateral circulation, and consciousness.
accessible
o Ulnar artery provides collateral SAMPLING ERROR
circulation to the hand  Using too much heparin
o ADVANTAGE – SMALL SIZE  Using too little heparin
 BRACHIAL ARTERY  Insufficient mixing
 More dangerous because it has  Allowing air bubbles to enter the syringe
lots of tissues on the area  Using improper plastic syringe
o Very large, it is easy to palpate and  Using improper anticoagulant
puncture o O.05 mL = 1mL of blood
o It is very deep and is close to median o Alteration
nerve  Puncturing of vein instead of artery
o Lies in soft tissue and is more difficult to o Artery = bright red
compress.  Exposing the specimen to the atmosphere after
 FEMORAL ARTERY collection
o Largest artery used, useful when cardiac
output is low
EFFECTS OF ERRORS ON ABG RESULT BLOOD COLLECTION IN SPECIAL
TECHNICAL ERROR EFFECT POPULATION
AIR BUBBLES PRESENT Atmospheric oxygen enters
the sample, and CO2 from PEDIATRIC PATIENTS
the sample enters the air
bubbles  PHYSIOLOGIC DISORDERS
TOO MUCH HEPARIN pH is lowered  Children have a lower total blood
TOO LITTLE The presence of clots that volume
HEPARIN/INADEQUATE will interfere with the  Removal of more than 10% of total
MIXING analyser
blood volume can cause cardiac arrest
DELAYED ANALYSIS WBC and platelets in the
sample continue their
 Repeated withdrawal of even smaller
metabolism, utilizing oxygen amounts can cause anemia
and producing CO2  Removal of 3% or less is the preferred
Venous rather than the Falsely decreased PO2 and maximum
arterial sample increased PCO2 (p = partial)
 Dermal puncture is the most common
pediatric collection procedure
SPECIMEN REJECTION  Children differ in their levels of
 Inadequate volume understanding, ability to cooperate, and
 Clotting anxiety about medical condition
 Improper label  Needles represent pain, and their fear
 Wrong syringe of pain often makes collection
 Air bubbles challenging
 Delayed delivery to the lab  Prolonged crying effects WBC and the
 Failure to ice the specimen pH level of blood.

 Pressure applied must be EXTRA MINIMIZE CHILD’S ANXIETY

 30-45 DEGREE ANGLE 1. Prepare the materials ahead of time
2. If possible, perform the procedure in a
room that is not the child’s hospital
room
3. Be friendly, cheerful, and empathetic.
Use of soothing tone voice.
4. Explain what will you do appropriate for
the child’s age
5. Do not say that it will not hurt
6. Give the child choices whenever
possible
7. Use the shortest possible needle for the
procedure
8. Distract the child just before the actual
stick
9. Tell the child how much longer it will be
10. Afterward, praise the child, offer him a
small reward

 INVOLVEMENT OF PARENTS AND SIBLINGS

 IDENTIFICATION OF NEWBORNS
 Identification bracelet, hospital ID
number

 SUPPLIES
 Use shorter needles, smaller guage.
Butterfly needles and pediatric tube
 Rewards such as stickers or small toys
  ANAESTHETICS
 Topical anaesthetic cream
 IMMOBILIZATION OF INFANTS
 this ensure their safety during the draw.
Wrapping new born in a receiving
blanket is usually sufficient
 patient either seated on the lap or lying
down
 the assistant may support the arm from
behind, at the bend in the elbow
GERIATRICS PATIENTS
 collection from geriatric patients presents
both physical and physiologic challenges
 they feel less in control pf their medical
situations and some may feel apprehensive
of the procedure
 a little extra TLC goes a long way to this
population
 PHYSICAL CHANGES
o Aging often results in gradual hearing
loss
o Failing eyesight
o Sense of taste, smell, and feeling are
also affected
o Muscles weakness unable to make fist
o Memory loss, inability to remember
when he or she last eaten
 BLOOD COLLECTION CONSIDERATIONS
o Identifying the patient
o Limiting blood loss and bruising
o Applying the tourniquet
o Locating the vein
o Performing venepuncture
 DISEASE STATE
o A patient with Alzheimer’s disease may
be confused or combative
o Stroke patient may have paralysis
o Patient in coma
o Arthritic patients may be in pain, unable
to strengthened arm
o Older patients may have tremors
PATIENT’S REQUIRING BLOOD DRAWS FOR EXTENDED
PERIODS OF TIME
 Frequent blood drawing often caused the most
commonly sites to become damaged
 Veins become hardened and difficult to
penetrate with the needle, the skin develop scar
tissue
 Minimize the damage by frequently rotating the
sites form which you draw
 Use alternative sites; forearm, underside of the
arm, wrist or fingers.
SPECIAL EQUIPMENTS USED IN THE INTENSIVE CARE
UNIT (ICU) AND EMERGENCY ROOM (ER)
 VASCULAR ACCESS DEVICES
o Peripherally Inserted Central Catheter
(PICC)
o Arterial Line
o Heparin or saline lock
o External AV shunt
o Arteriovenous shunt
 DRAWING FROM VAD
o Never use a syringe larger than 20ml
o VADs are often periodically flushed with
heparin to keep the line open.
Therefore, discard at least the 5ml. for
coagulation, discard the first 10ml
o Order of draw should be blood cultures,
anticoagulated tubes, and then clotted
tubes
 WORKING WITH INTRAVENOUSE LINES (IV)
o Have the nurse turn off the IV drip for
less than 2 minutes before the draw
o Apply tourniquet distal to the IV
insertion site
o Select a vein distal to the IV insertion
site, and in different vein
o Discard the first 5ml blood because it
will contaminate with the IV fluid
 SPECIAL COLLECTIONS  Is used to test for DM. it compares the
fasting glucose level with level 2 hours
Sweeping schedule – warding after consuming glucose.
 ORAL GLUCOSE TOLERANCE
COLLECTION PRIORITIES  Is used to diagnose DM and gestation
 ROUTINE SAMPLE diabetes (for pregnant women)
 Are collected early in the morning or  4 times extraction
throughout the day  EPINEPHRINE TOLERANCE TEST
 ASAP SAMPLE  Determine patient ability to mobilize
 The response time for the collection of glycogen from the liver
the test sample
 STAT SAMPLE  LACTOSE TOLERANCE TEST
 Sample is collected, analysed, and  Determine whether the lactose-
results reported immediately digesting enzyme lactase is present in
FACTORS the gut
 Age
 Altitude – Different normal values DIURNAL VARIATION
because of the place  Refers to the normal daily fluctuations in body
 Dehydration chemistry related to hormonal cycles, sleep-
 Environment wakes cycles and other regular patterns of
 Gender change
 Pregnancy o HORMONES
 Stress  The time is very important
 Diet  Cortisol
 Diurnal variation  Testosterone
 Drugs  Estradiol
 Exercise  Progesterone
 Body position  Serum iron
 Smoking  Glucose
 White blood cells
FASTING SPECIMEN AND THE BASAL STATE
Nothing per orem (NPO) SPECIAL HANDLING PROCEDURES
- Patients (surgery)  COLD AGGLUTININS (False (+))
- Hours of fasting depends on the doctor  Are antibodies often formed in
- Collapsed vein response to infection cause by
Mycoplasma pneumoniae
 FASTING SPECIMEN  The antibodies react with rbc
 Patient must refrain from eating and temperature below body temperature
drinking (except water) for 12 hours.  Prewarm a plain red-topped tube in a
 BASAL STATE 37◦C for 3o minutes. Keep the specimen
 Patient must refrain from eating, warm heel warmer pack or in an
drinking (except water) and exercise for incubator. Deliver soon in the
12 hours. laboratory
 Cyrofibrinogen and cryoglobulin are
TIMED SPECIMEN two proteins that precipitate when cold.
 Are taken to determine changes in the level of  CHILLED SPECIMEN
some substance of interest over time.  Chilling is used to prevent chemical
 Medication levels changes that could alter results
 Changes in the patient condition  The sample is placed in crushed ice or in
 Normal diurnal variation of blood levels an ice water mixture
at different times of the day  The temperature should be 1◦C to 5◦C
 2 HOUR POSTPRANDIAL TEST  Sample should be transported to the lab
for testing within 5 minutes of
collection.
  TESTS
 Arterial blood gas (if indicated)
 Ammonia
 Lactic acid
 Pyruvate
 Glucagon
 Gastrin
 Adrenocorticotropic hormone
 Parathyroid hormone
 LIGHT SENSITIVE SPECIMEN
 Exposure to light can break down or
alter certain blood constituents
 Wrap the tube in aluminium foil
immediately after collection. An
amber colored microtube can be
used.
 BLOOD CONSTITUENTS THAT ARE
LIGHT SENSITIVE
 BILIRUBIN
 BETA-CAROTENE
 VITAMIN A
 VITAMIN B6
 PORPHYRINS
 TIME-SENSITIVE SPECIMENS
 Unstable and volatile analytes
 Test be performed rapidly after the
sample taken
 BLOOD CONSTITUENTS THAT ARE
TIME SENSITIVE
 Ammonia
 Lactate
 Platelet aggregation
 Brain natriuretic peptide
 Prostatic acid phosphatase
 ACTH
 Aldolase
 LEGAL AND FORENSIC SPECIMENS
 Evidence in legal proceedings,
including alcohol and drug testing,
DNA analysis, or paternity testing
 Such samples must be handled with
special procedures designed to
prevent tampering misidentification
or interference with the test result
 Chain of custody
 Trace the sample
SPECIAL HANDLING
“ACCURATE RESULTS”
“ACCURATE DIAGNOSIS”
GENERAL GUIDELINES FOR SPECIMEN TRANSPORT
 Tubes with additives should be inverted gently
and completely 5 to 10 times
o Right tubes
o Mix properly
 Specimen must be correctly labelled
 Use leak-resistant bag for transport
 Use of crush-resistant containers with
absorbent material
 Tubes should remain upright during transport
TIME CONSTRAINTS
QUALITY CREED – doing right things right, all the
time, every time
 Quality test results depends on the time
between collection and analysis
 Delayed processing may lead to glycolysis
o Glucose
 Gray top – anticoagulant
agent
 24 hours at room
temperature
 48 hours at 2-8◦C
o Phosphorus
o Aldosterone
o Enzyme
 Samples should be delivered in the lab
within 45 minutes of being drawn
 No more that 2 hours should pass between
collection and separation of cells from
serum
o EDTA (CBC)
 24 hours distortion of cells
 Make a blood smear within
an hour
 Preserved the # of
cell but not the
morphology
TEMPERATURE CONSIDERATIONS
 Temperature can cause hemolysis
 Keeping specimen warm at 37◦C during
transport and handling are cold agglutinins
 Keeping specimen cool during transport
handling are blood gases and lactic acid
PROTECTING SPECIMENS FROM LIGHT
 Light exposure can breakdown light
sensitive analytes
 Samples are collected in amber colored
microtubes, wrapped in aluminium foil, or
placed in a brown envelope, or heavy paper
bag.
o Blood constituents that are light
sensitive
 Bilirubin
 Byproduct of rbc
 Beta-carotene
 Vitamin a
 Vitamin B6
 Porphyrins
TRANSPORTING SAMPLES IN LABORATORY
 Samples are carried by phlebotomist or another
lab member
 Samples may be dropped off at designated
areas
 Use of logbook at the drop off and pick up area.
 Patient’s name
 Specimen type
 Date and time of delivery
 Name of the person depositing it
 Pneumatic tube system, in which samples are
carried in sealed container within a network of
tubes.
PROCESSING
Chyle / chylomicros – fats, serum, mucoid. White thing
that sometimes appear at the tubes
 SAFETY
 OHSHA requires PPE during sample
processing
 CENTRAL PROCESSING
 An area devoted to cataloguing and
sorting sample
 Sample are logged with date and time
of arrival, and accession number (a
unique identifying number)
 Samples are also labelled with bar codes
that are read by electronic reader and
stores in the computer system.
 CLOTTING
 Specimen must be clotted before
centrifugation
 Incompletely clotted samples continue
to clot after serum separation
 Plasma specimens, can be centrifuged
immediately
 Complete clotting may take 30 to 45
minutes at room temperature
 Patients on anticoagulants have longer
clotting time
 Samples with clot activators clot more
rapidly at 15 minutes
 CENTRIFUGING
 Spins the sample at a very high speed,
separating components based on
density
 The stopper should remain on the
sample to prevent contamination
 Principle of centrifugation involves
samples must be balanced by another
of equal weight
 The lid of the centrifuge must be closed
and secured during operation, and it
must be closed until the rotor stops.
 REMOVING THE STOPPER
 Major risk of stopper removal is
formation of aerosol
 Careful stopper removal reduces the
risk of aerosol stopper
 Place a 4- by 4-inch of gauze over the
top, and pull the stopper straight up
 Hemogard top, is aplastic top that fits
over the stopper to reduce aerosol
formation and splattering
 PREPARING ALIQUOTS
 Tubes into which aliquots are placed
should be labelled before filling and
capped before delivery.
 Aliquot is removed with the use of
disposable pipetting system.
 Aliquots – FOR SEPARATION
SPECIMEN REJECTION
 Improper of inadequate identification
 Hemolysis
 Incorrect tube for the test ordered
 Tubes used past their expiration date
 Inadequate ratio of blood to additive
 Insufficient volume of testing
 Specimen at a wrong time
 Improper handling
 Contaminated specimen
 SPECIAL NONBLOOD COLLECTION
PROCEDURE
 Provides valuable information about patient’s
health or diseases state
 It requires strict adherence to protocol as it is
for blood collection
 It includes urine, feces, semen, and body fluids
 Special handling procedure are needed to
maintain sterility, preserve specimen integrity
and chain of custody.
URINE SPECIMEN
 TYPES OF URINE SPECIMEN
 Random specimen
 First morning specimen
 Ideal for urinalysis
 Concentrated specimen
 Best for pregnancy test
 Timed specimen
 It is good when you want to do
a quantitative analysis on the
specimen or certain substances
( e.g. creatinine, urea, etc.)
 COLLECTION PROCEDURE
 Midstream clean catch
 Middle of urinating
 Pediatric collection
 Cellophane-like with adhesive
 Catheter collection
 Sterile urine
 Invasive procedure
 Suprapubic aspiration
 Inject directly to the bladder
 Urea detects infection and abnormalities
FECAL SPECIMEN
 Determine the presence of ava / parasite
 Screen colorectal cancer
 Fats, fibers
 TYPES OF FECAL SPECIMEN
 Random specimen
 Occult blood specimen
 “hidden blood”
 Seventy-two hours stool specimen
 Steatorrhea - the excretion of
abnormal quantities of fat with
the feces owing to reduced
absorption of fat by the
intestine. (Malabsorption of
fats)
 COLLECTION PROCEDURE
 Patient is provided a container and
instruct to defecate on it
 Container must be tightly sealed
 Specimen must be at room temperature
or refrigerated (most common) until
delivery at the lab
 If delayed, transfer to vials containing
preservative
 Pea sized
 Formalin – most common preservative
 Routine – drop of Saline solution
SEMEN SPECIMENS
 Fertility test
 Sperm count
 Forensic studies
 Evaluate post vasectomy procedures
 Spermatozoa (testis) 5%
 Acid – 20-30% - Seminal fluid, fructose
 Bulbourethral gland 5% - neutralization of
semen.
 COLLECTION PROCEDURE
 Avoid ejaculation for 3 days before
collection
 Immotile sperm
 increase
 Time collection is recorded
 Volume of semen is IMPORTANT
 Sample must be kept close to body
temperature and delivered to the lab
within 30 mins.
 Polyurethane condom is used in
collection
 Sterile glass container/beaker
 Volume affects fertility
CEREBROSPINAL FLUID SPECIMEN
 CNS Disorders
 Lumbar top L1-L%
 COLLECTION PROCEDURE
 CSF collection is done only by a
physician
 Three tubes are collected
 Culture / microbiology
 Chemistry
 hematology
 Must be handled in STAT collections
NASOPHARYNGAL SPECIMEN
 Respiratory infection

 COLLECTION PROCEDURE
 Specimen is collected using a cotton or
Dacron tipped sterile wire
 The swab is passed carefully through
the nostril to reach the back of the
nasopharynx
 The swab is placed in either transport
media or growth media