BLOOD COLLECTION EQUIPMENT AND - not always done in the Philippines

SUPPLIES • nonsterile, disposable latex, nitrile,

neoprene, polyethylene, and vinyl are
BLOOD DRAWING STATION acceptable
- dedicated area for blood drawing • GOOD FIT IS ESSENTIAL
- equipped for performing phlebotomy • special glove liners may be used if gloves
procedures cause allergies or dematitis
• primarily outpatients • barrier hand creams help prevent skin
- components of a blood drawing station irritation gloves
include: • GLOVES WITH POWDER ARE NOT
1. Table for supplies RECOMMENDED
• usually near the phlebotomy chair
2. Special chair or Phlebotomy Chair ANTISEPTICS
• comfortable - PREVENTS SEPSIS
• has adjustable armrests - safe on human skin
- prevents the patient from falling if he/ - used to clean the site prior to blood
she faints collection
3. Bed or reclining chair - most commonly used for routine blood
collection is 70% isopropyl alcohol
EQUIPMENT CARRIERS • for bacterial cultures blood collection
1. Handheld Carriers sterilize skin by alcohol, betadine, then
• carriers or trays alcohol again
• convenient
• easily carried DISINFECTANTS
• contains enough equipment for - remove or kill microorganisms on surfaces
numerous blood draws and instruments
- should be replenished with materials - corrosive
2. Phlebotomy Carts - not safe on human skin
• stainless steel or strong synthetic - SODIUM HYPOCHLORITE PRODUCTS IS
material PREFERRED
• swivel wheels • generic 5.25% sodium hypochlorite or
• several shelves to carry adequate household bleach may be used
supplies • 1:100 dilution for decontaminating
• commonly used for early-morning • 1:10 dilution for spills of blood or other
hospital phlebotomy rounds body fluids
• disadvantage • 10 MINUTES CONTACT TIME
- bulky - lets the disinfectant work
- potential source of nosocomial
infection HAND SANITIZERS
• cannot be strelized always - alcohol based hand sanitizers
- substitute for hand washing provided that
GLOVES AND GLOVE LINERS the hands are not visibly soiled
- required by CDC/HICPAC and OSHA when
performing phlebotomy
- new pair must be used for each patient and
removed when the procedure is completed

©Janielle Jarabata
GAUZE PADS/ COTTON BALLS VENIPUNCTURE EQUIPMENT
- clean 2 by 2 inch gauze pads folded in
fourths VEIN-LOCATING DEVICES
- use of cotton balls to hold pressure is not - TRANSILLUMINATION means to inspect an
recommended organ by passing light through its walls
• fibers of the cotton balls may go to the - shine high-intensity LED or infrared red light
open wound through the patient’s subcutaneous tissue
to highlight veins
BANDAGES
- used to cover a blood collection site after TOURNIQUET
the bleeding HAS STOPPED - device applied or tied around a patient’s
- paper, cloth or knitted tape placed over arm to restrict blood flow
folded gauze can be used - should restrict venous flow to inflate veins
- SHOULD NOT BE USED FOR ARTERIAL
NEEDLES AND SHARPS DISPOSAL BLOOD COLLECTION
CONTAINERS - has 2 types
- used needles, lancets, and other sharps 1. stretchable disposable straps
objects must be disposed immediately in 2. snap on tourniquet
sharps containers - hard to use
- red (easy identification) — most common - may hurt the patient if lock is released
- must be clearly marked with a biohazard fast
symbol
- puncture-resistant, leak proof and NEEDLES
disposable - sterile, disposable and designed for SINGLE
USE ONLY
BIOHAZARD BAGS - types:
- used to transport blood and other • Multisample Needle
specimens from the collection site to the • Hypodermic Needle
laboratory • Winged Infusion/Butterfly
- marked with a biohazard label
- help protect the collector and others from PARTS OF A NEEDLE
biohazard contamination 1. Bevel
- end that pierces the vein
SLIDES 2. Shaft
- precleaned 25 b 75 mm (1 by 3 in.) - long cylindrical portion
- used to make blood films for hematology 3. Hub
determinations - end that attached to the blood
• plain collection device
• with frosted area 4. Lumen
- frosted area is for labels - internal space of the needle

PEN
- permanent or non-smear ink

WATCH
- sweep second hand or timer

©Janielle Jarabata
COMMON VENIPUNCTURE NEEDLE 23 butterfly used on veins
GAUGES WITH NEEDLE TYPE AND TYPICAL of infants and
USE children and
on difficult or
hand veins of
GAUGE NEEDLE TYPE TYPICAL USE
adults
15 - 17 special needle collection of
attached to donor units, GAUGE
collection bag blood - defines the DIAMETER OF THE LUMEN
donation,
- HIGHER GAUGE NUMBER = SMALLER
therapeutic
DIAMETER OF NEEDLE
phlebotomy
- APPROPRIATE RANGE FOR PHLEBOTOMY
18 hypodermic used as • 20 to 23
transfer • 21 most common
needle rather - needles COLOR CODED BY GAUGE
than for blood
collection
• yellow for 20 gauge
• green for 21 gauge
20 multisample used when • black for 22 gauge
and large volume
hypodermic tubes are LENGTH
collected or - VENIPUNTURE NEEDLES
large volume • 1 or 1.5 in. long
syringes are - BUTTERFLY NEEDLE
used on
patients with
• 1/2 to 3/4 in. long
normal size
SAFETY FEATURES
veins
- resheathing devices
21 multisample standard • resheath — returning the cap of the
and venipuncture needle
hypodermic needle for - blunting devices
patients with
• blunting — makes the needle less sharp
normal veins - retraction devices
or for syringe
blood culture • the needle goes inside the barrel
collection
EVACUATED TUBE SYSTEM
22 multisample used for older - closed system where blood flows through a
and children and needle inserted into a vein directly into a
hypodermic adults with collection tube
small veins or - prevents bloods’ exposure to air or outside
for syringe contaminants
draws on
- allows numerous tubes to be collected in a
difficult veins
single venipuncture
- basic components
1. special blood-drawing needle
2. tube holder
3. evacuated tubes

©Janielle Jarabata
 • produces accurate results with the
MULTISAMPLE NEEDLES amount of blood it takes to fill the tube to
- allows multiple tubes of blood to be the capacity or vol. indicated
collected in a singe venipuncture - stopper color of additive tubes
- double pointed • light blue, red. black, gold, green, gray,
- have threaded parts that screws into the light green, green, lavander, pink, orange,
holder yellow, tan
- tube end of needle has retractable sleeve to
prevent leakage NONADDITIVE TUBES
- available with or without safety features - very few tubes are additive free
• if no safety feature : use with safety - most nonadditive plastic tubes are used for
holder discard purposes only
- stopper color of nonadditive tubes
TUBE HOLDERS • red, light gray and royal blue
- with and without safety features
• if no safety feature : use with safety STOPPERS
needle - made of rubber
- some covered by a plastic shield
NEEDLE AND HOLDER UNITS
- needle and tube-holder devices are COLOR CODING
permanently attached - tube stoppers are color-coded
- identifies type of additive placed in tube
EVACUATED TUBES
- used with ETS and syringe method EXPIRATION DATES
- available in different sizes and volumes - reliability of additives and tube vacuum
• range 1.8 to 15 mL until an expiration date
- tube selection is based on the following • printed on label
• age of patient - tubes must be handled properly sored
• amount of blood needed for the test between 4 and 25 celsius
• size and condition of the patient’s vein • improper handling or storage may affect
• available in plastic and glass additive integrity and tube vacuum
- plastic tubes for safety reasons
COMMON STOPPERS COLORS, ADDITIVES
VACUUM AND DEPARTMENTS
- evacuated tubes have vacuum
• fills them automatically STOPPER ADDITIVE DEPARTMENT
- artificially created by pulling air from the COLOR
tube
light blue sodium coagulation
ADDITIVE TUBES citrate
- prevents clotting red none chemistry,
- preserves certain blood components blood bank,
- amount of additive is calibrated by the serology/
manufacturer immunology

red clot activator chemistry

©Janielle Jarabata
red/light gray none NA (discard SYRINGE SYSTEM
tube) - used for patients with small or difficult veins
- hypodermic needle
red/black
clot activator chemistry
gold
and gel - sterile plastic syringe with a luer-lock tip
red/gold separator
SYRINGE NEEDLES
green/gray
lithium chemistry - gauges 21 to 23
light green heparin and
gel - 1 to 1.5 in lengths
separator - must have a resheathing feature
green - lithium chemistry SYRINGES
heparin

- sodium - sterile pull-apart packages

heparin
- various sizes or volumes
- ammoniu - most common volumes
m heparin • 2, 5, and 10 mL
lavander EDTA hematology - syringe volume is selected accd to:
• size
pink EDTA blood bank • condition of patient’s vein
- big or small
gray - sodium chemistry
flouride • amount of blood to be collected
and
potassium PARTS
oxalate
- barrel
- sodium • cylinder with graduated
flouride markings
and EDTA

- sodium
- either mL or cc
flouride - plunger
• rod-like device
orange
thrombin chemistry
gray/yellow
• fights tight into barrel
royal blue - none
chemistry
- EDTA

- sodium
heparin

tan EDTA

yellow sodium microbiology

polyethanol
sulfonate

yellow acid citrate blood bank/

dextrose immunohematol
ogy

©Janielle Jarabata
SYRINGE TRANSFER DEVICE
- blood collected in syringe must be
transferred to an ETS tube
- in the past, blood was transferred by poking
the syringe needle through the tube stopper
or by removing the tube stopper and
ejecting blood from syringe to tube
• NOW UNSAFE
- allows safe transfer of blood unto tubes
without using the syringe needle or
removing the tube stopper
WINGED INFUSION SET
- AKA butterfly
- effect for small or difficult veins
• hands, elderly, pediatric
- allows more flexibility and precision than a
needle and syringe
- consists of:
• 1/2 to 3/4 in. stainless steel needle
• 23 or 25 gauge
• 5 to 12 in length of tubing
• luer attachment for syringe or a
multisample luer adapter (ETS)
• plastic extensions (butterfly wings) allow
easier manipulation for shallow angel of
needle insertion
• safety devices required to prevent
needlesticks
COMBINATION SYSTEMS
- complete system for blood collection
- blood collection tube and collection
apparatus are combines in a single unit
- specimen can be collected by evac. tube or
syringe system technique
- available with regular or butterfly style
needles
- safety devices are available
BLOOD COLLECTION ADDITIVES
- different types of additives and each has
specific functions
- type of additive depends on the test
ordered
©Janielle Jarabata
- additives can be in liquid, spray-dried and
powder form
• tube with powder additive should be
lightly tapped
- settles additive at the bottom of the
tube
• additive tube must be gently inverted 3
to 10 times IMMEDIATELY after collection
- mixes the additive with the specimen
ANTCOAGULANTS
- substances that prevent blood from clotting
- 2 methods of preventing clotting
1. chelating (binding) or precipitating
calcium
2. inhibiting the formation of thrombin
- if a test requires whole blood or plasma
tube must contain anticoagulant
- anticoagulant specimen must be mixed
IMMEDIATELY after collection to prevent
microclot formation
• gently mixing is essential to prevent
hemolysis
- different types of anticoagulants (most
common)
• ethylenediaminetetraacetic acid
• citrates
• heparin
• oxalates
EDTA
- ethylenediaminetetraacetic acid
• powdered di-potassium (K2)
• liquid tri-potassium
- aka Versene
- prevents coagulation
- must be mixed immediately after
collection
• prevents platelet clumping and
microclot formation
- invert 8-10 times
- provides whole blood specimens for
hematology tests and blood bank
CITRATES SPECIAL USE ANTI-COAGULANTS
- prevents coagulation by binding or
ACID CITRATE DEXTROSE
chelating calcium - immunohematology tests
- most common citrate: sodium citrate • DNA testing and human leukocyte
- light blue stopper antigen phenotyping
- immediate mixing after collection • acid citrate
- prevents coagulation bu binding
• prevents activiation of coagulation calcium
process and microclot formation • dextrose
- invert 3 to 4 times - acts as an RBC nutrient and
- 9:1 ratio of blood to anticoagulant preservative by maintaining RBC
viability
HEPARIN • ACD
- prevents clotting by inhibiting thrombin - yellow tops
formation - inversion: 8
- heparinized plasma is often used for chem.
tests CITRATE PHOSPHATE DEXTROSE
- three types of heparin - used in collecting units of blood for
• ammonium transfusion
• lithium • citrate
- least interference in chemistry test - prevents clotting by binding chelating
- most widely used coagulant calcium
• sodium heparin • phosphate
- must be mixed immediately upon collection - stablizes pH
• prevent clot formation and fibrin • dextrose
generation - provides cells energy
- invert 5 to 10 times - helps keep cells alive
- gentle mixing to avoid hemolysis
- hemolyzed specimens are unsuitable SODIUM POLYETHANOL SULFONATE
for chem. tests - prevents coagulation by binding calcium
- used for blood culture collection
OXALATES - SPS tubes
- prevents coagulation by precipitating • yellow stoppers
calcium - inversion: 8
- potassium oxalate (most widely used)
- glucose preservatives (antiglycolytic
agents) ANTIGLYCOLYTIC AGENTS
- must be mixed immediately after collection - substance that prevents glycolysis
• prevent clot formation and fibrin • breakdown of glucose by blood cells
generation - sodium flouride (most common)
- invert 8-10 times • preserve glucose for up to 3 days
• inhibits bacterial growrh
• used with potassium oxalate for rapid
response
- anticoagulant

©Janielle Jarabata
 • if glycolysis is not prevented glucose 2. blue-top coagulation tube
concentration in a blood specimen 3. serum tube with or without clot
decreases at a rate of 10mg/dL per activator, with or without gel
hour 4. heparin tube with or without plasma
• gray stoppers separator
• inversion: 5 to 10 5. EDTA tube
6. glycolytic inhibitor tube
CLOT ACTIVATORS
- substances that enhances coagulation in
serum specimen tubes
- types:
• substances that provide more surface
for platelet activation
- Glass (silica) particles
• clot activators in serum0separator
tubes
• plastic red top
• blood to clot (15 to 30 mins)
- Inert clays like Celite
• clotting factors such as thrombin
- clots within 5 mins
• inversion: 5
THIXOTROPIC GEL SEPARATOR
- has density between cells and serum or
plasma
- when centrifuged, gel moves between cells NOTE
and the serum or plasma - filling tubes in the wrong order can lead to
- prevents cells from continuing to interference in testing from cross
metabolize substances contamination of the specimen by additive
carryover, tissue thromboplastin or
TRACE ELEMENT-FREE TUBES microorganisms
- royal blue stoppers - special sequence is intended to minimize
- tubes made of materials free of trace these problems
element contamination
- used for trace element tests, toxicology CARRYOVER/CROSS-CONTAMINATION
studies and nutrient determinations - transfer of one additive to the next
- occurs when:
ORDER OF DRAW • blood in additive tube touches the needle
- order in which tubes are collected during a during ETS blood collection
multiple-tube draw or are filled from a • blood is transferred from syringe to ETS
syringe tube
- CLSI recommends the following order of - order of draw eliminates confusion by
draw for both ETS collection and in filling presenting sequence of collection that
tubes from a syringe results in the least amount of interference
1. Sterile tube (blood culture) should carryover occur

©Janielle Jarabata
ORDER OF DRAW, STOPPER COLORS, AND
RATIONALE FOR COLLECTION ORDER

TISSUE THROMBOPLASTIN
CONTAMINATION
- tissue thromboplastin
• present in tissue fluid
- activates the extrinsic coagulation
pathway
- can interfere with coagulation tests
- for coagulation tests (other than PT or PTT)
• draw a few milliliters of blood into a
nonadditive tube or another coagulation
tube before the coagulation specimen is
collected.

MICROBIAL CONTAMINATION
- site cleaning is most important
- microorganisms found on skin can
contaminate blood specimens
- blood culture tubes or bottles are sterile
and are collected first in the order of draw,
when sterility of the site is optimal and to
prevent microbial contamination of the
needle

©Janielle Jarabata