Phleb Notes

CIRCULATORY SYSTEM
MLS 1A Lecture
University of San Agustin
LEARNING OUTCOMES
1. Describe the heart and its structure; Discuss its function and
significance for the body.
2. Compare and contrast between an artery and a vein;

Describe their structure and functions; Identify major veins
and arteries of the body.
HEART
• Roughly the size of your fist
• Found in the thoracic cavity

• Mediastinum region
• Composed of cardiac muscle
• Pumps blood for circulation

CARDIAC CYCLE
• All events associated with one
heartbeat
• Alternating contraction
between the atria and
ventricles
• Force blood from areas of high
pressure to low pressure
• Systole phase (contraction) and
diastole (relaxation)
BLOOD CIRCULATION
• Systemic circulation
• Pumped from the left side of the heart
• Oxygen-rich RBCs from lungs
• Ejects blood into aorta for transport to body
• Pulmonary circulation
• Pumped from the right side of the heart
• Deoxygenated RBCs returning from circulation
• Ejects blood from right ventricle into pulmonary trunk to lungs
BLOOD VESSELS
ARTERY VEIN
• Carry oxygenated blood from • Carry deoxygenated blood to
heart heart
• Bright red in color • Dark red in color
• Elastic, thick walls expand • Less elastic & thin walls
• No valves • Valves present
• Pulse present • No pulse
BLOOD VESSELS
BLOOD VESSELS
• Structural layers
• Tunica interna / intima
• Direct contact with blood during
blood flow
• Tunica media
• Smooth muscle layer
• Regulates diameter of the lumen
• Tunica externa
• Elastic and collagen fibers
• Nerves and self vessels
• Anchors the vessel on tissues
ARTERIES
VEINS
VEINS
REFERENCES
1. Hoeltke, L.B. (2018). Cengage Learning.
2. Tortora, G.J., Derrickson, B. (2009). John Wiley & Sons,

(Asia) Pte Ltd.
BLOOD
MLS 1A Lecture
LEARNING OUTCOMES
1. Describe the blood; Identify the different components of the
blood and discuss their functions.
2. Identify the types of cells present in the blood and discuss

their functions for the body.
3. Compare and contrast between the plasma and serum;

Describe their appearance and composition.
BLOOD
• Adult (150 lbs / 68 kgs) has
approx. 5 liters of blood
• 45% are formed elements / cells
• 55% fluid (plasma in circulation
w/ fibrinogen)
• Anticoagulant prevents blood

from clotting
HEMATOPOIESIS
• Formation of blood cells
• Bone marrow as primary

source of blood cells
• Red marrow
• Key locations
• Iliac crest
• Sternum
• Ribs
HEMATOPOIESIS
BLOOD CELLS
RED BLOOD CELL
• Contains hemoglobin
• Gives red color of blood
• Primary function is transport of oxygen
• Antigens found on plasma membrane determines blood type

• Sugar molecules
WHITE BLOOD CELLS
1. Neutrophil 2. Eosinophil
• Primary function for • Responds in allergic
phagocytosis reactions
• Eliminates bacteria • Parasitic infections
WHITE BLOOD CELLS
3. Basophil 4. Lymphocyte
• Responds to allergic • Regulates immune
reactions response
• Inflammatory processes
WHITE BLOOD CELLS
5. Monocyte 6. Platelets
• Phagocytosis • Hemostasis
• Involvement in immune • Blood clotting
response
• Macrophage (tissue
phagocytes)
BLOOD
• When blood is removed from
the body, blood will clot
• Fluid portion becomes serum
• Clot (formed elements bound w/
fibrin)
• Clotting process
• Blood with no anticoagulant
• Utilization of calcium
• Prothrombin converts to thrombin
• Fibrinogen converts to fibrin
• Clot forms with serum extraction
REFERENCES
1. Hoeltke, L.B. (2018). Cengage Learning.
2. Tortora, G.J., Derrickson, B. (2009). John Wiley & Sons,

(Asia) Pte Ltd.
BLOOD COLLECTION
EQUIPMENT
MLS 1A Laboratory
SYRINGE
•Instrument used in blood
collection
• Needle attached on one end
• Pull plunger to create vacuum
for blood aspiration
•Varies in size and capacity

NEEDLES
EVACUATION TUBE SYSTEM
BUTTERFLY NEEDLE SET

PHLEBOTOMY
OPEN SYSTEM CLOSED SYSTEM

• Syringe method • Evacuated tube method
TOURNIQUET ALCOHOL & IODINE
• Slows down blood flow • Disinfect with alcohol
• Veins more visible and easier to • Kills microbes present
feel
• Iodine as antiseptic
• Application should not exceed • Prevents growth of microbes
2 minutes
• Hemoconcentration • Apply using circular motion
• Inside moving outside
Objectives
1. Define the key terms and abbreviations listed at the
beginning of this chapter.
2. State the primary reason for performing arterial
punctures and identify the personnel who may be
Chapter 14: Arterial Puncture required to perform them.
Procedures 3. Explain the purpose of collecting arterial blood gas
(ABG) specimens and identify and describe commonly
measured ABG parameters.
4. Identify the sites that can be used for arterial puncture,
the criteria used for selection of the site, and the
advantages and disadvantages of each site.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Objectives (cont’d) Objectives (cont’d)

5. List equipment and supplies needed for arterial 8. Describe the procedure for collecting radial arterial
puncture. blood gases and the role of the phlebotomist in other
site collections.
6. Identify typical required and supplemental requisition
information and describe patient assessment and 9. List hazards and complications of arterial puncture,
preparation procedures, including the administration of identify sampling errors that may affect the integrity of
local anesthetic, prior to performing arterial blood an arterial sample, and describe the criteria for
gases. specimen rejection.
7. Explain the purpose of the modified Allen test, describe
how it is performed, define what constitutes a positive
or negative result, and give the procedure to follow for
either result.
1
Overview: Video (Arterial blood gas sampling) ABGs
• Disadvantages of Arterial Puncture • Used in diagnosis & management of respiratory disorders
– Technically difficult • Provide valuable info. about patient’s:
– Potentially more painful & hazardous than venipuncture – Oxygenation
– Thus, not normally used for routine blood tests – Ventilation
• Reason for Arterial Puncture – Acid-base balance
– To obtain blood for arterial blood gas (ABG) tests • Used in management of electrolyte & acid-base balance
– Arterial blood: in patients w. diabetes & other metabolic disorders
• Best specimen for evaluating respiratory function • Specimens are sensitive to effects of preanalytical errors
• Has high oxygen content & consistency of composition
Commonly Measured ABG Analytes Personnel Who Perform Arterial Puncture

Analyte Normal Description • Nurses
Range
pH 7.35– A measure of acidity or alkalinity of • Medical technologists & technicians
7.45 blood (acidosis or alkalosis)
PaO2 80–100 Partial pressure of O2 dissolved in • Respiratory therapists-Most of the time
mm Hg arterial blood
• Emergency medical technicians
PaCO2 35–45 Partial pressure of CO2 dissolved in
mm Hg arterial blood • Level II phlebotomists
HCO2 22–26 A measure of bicarbonate in blood
mEq/L
O2 sat 97%– Percent O2 bound to hemoglobin
100%
Base -2–+2 A calculation of nonrespiratory part
excess mEq/L of acid-base balance
2
Site-Selection Criteria Arterial Puncture Sites
• Presence of collateral circulation • The Radial Artery
– Blood supply from more than one artery (Allen Test) – Advantages
• Artery accessibility & size • Good collateral circulation (radial & ulnar arteries)
• Easy to palpate (close to surface of skin)
• Type of tissue surrounding puncture site
• Less chance of hematoma formation after collection
– Low risk of injuring adjacent structures or tissue during puncture
– Disadvantages
– Ability to fix or secure artery to prevent rolling
• Requires considerable skill to puncture it successfully due to
– Adequate pressure can be applied to artery after collection small size
– Absence of inflammation, irritation, edema, hematoma, lesion, • Difficult to locate on patients with hypovolemia or low cardiac
wound, AV shunt in close proximity, or recent arterial puncture output
Arterial Puncture Sites (cont’d) Arterial Puncture Sites (cont’d)

• The Brachial Artery • The Femoral Artery
– Advantages – Largest artery used for arterial puncture
• Large & relatively easy to palpate & puncture – Located superficially in groin, lateral to pubis bone
• Sometimes the preferred artery for a large volume of blood – Performed primarily by physicians & specially trained
emergency room personnel
• Adequate collateral circulation (but not as good as radial)
– Generally used only in emergency situations or when no other
– Disadvantages site is available
• Deeper & can be harder to palpate than radial artery
• Lies close to basilic vein; risk of mistakenly puncturing it
• Lies close to median nerve; risk of pain & nerve damage
• Increased risk of hematoma formation
3
Arterial Puncture Sites (cont’d) Arterial Puncture Sites (cont’d)
• The Femoral Artery • Arteries of the leg
– Advantages
• Large & easily palpated & punctured
• Sometimes, only site where arterial sampling is possible
– Disadvantages
• Poor collateral circulation
• Lies close to femoral vein; risk of mistakenly puncturing it
• Increased risk of infection due to location & pubic hair
• Risk of dislodging plaque buildup from inner artery walls
• Requires extended monitoring for hematoma formation
Arterial Puncture Sites (cont’d) ABG Specimen Collection

• Other Sites • Test Requisition
– In infants: – Info. concerning conditions at time of collection is needed:
• Scalp • Current body temperature
• Umbilical arteries • Respiratory rate
– In adults: • Ventilation status
• Dorsalis pedis arteries • *Fraction of inspired oxygen (FIO2)
• *Prescribed flow rate in liters per minute
4
ABG Specimen Collection (cont’d) ABG Specimen Collection (cont’d)
• Equipment and Supplies • Equipment & Supplies – 2- by 2-in. gauze squares
– Personal protective equipment – Antiseptic – Self-adhering gauze

bandage
• Fluid-resistant lab coat, gown, or apron – Local anesthetic (optional)
– ID & labeling materials
• Gloves – Sharp, short-bevel
hypodermic needle – Puncture-resistant sharps
• Face protection container
– 1- to 5-mL self-filling
syringe
– Luer-tip normal or bubble
removal cap
– Coolant

• ABG equipment • Patient Preparation
– Identification & explanation of procedures
– Patient preparation & assessment
– Steady state
– Modified Allen test
– Administration of local anesthetic (optional)
5
• Modified Allen test procedure • Left: using middle & index fingers to apply pressure to
1. Have patient make a tight fist
patient’s wrist. Middle: patient opens hand. Right:
positive result—hand flushes pink within 15 seconds.
2. Compress patient’s radial & ulnar arteries at same time
3. Maintaining pressure, have patient open hand slowly
4. Lower patient’s hand & release pressure on ulnar artery only
5. Assess results: +hand flushes pink; -hand does not flush pink
6. Record results on requisition

• Preparing and Administering Local Anesthetic • Preparing and Administering Local Anesthetic
1. Verify absence of allergy to anesthetic or its derivatives 8. Insert needle into skin at site at angle of 10 degrees
2. Sanitize hands & don gloves 9. Pull back slightly on plunger
3. Attach needle to syringe 10. Slowly expel contents into skin, forming a raised wheal
4. Clean stopper of anesthetic bottle w. alcohol wipe 11. Wait 1 to 2 min. before proceeding w. arterial puncture
5. Insert needle through bottle stopper & withdraw anesthetic 12. Note anesthetic application on requisition
6. Carefully replace needle cap & put syringe in horizontal position
7. Clean & air-dry site
6
• Radial ABG Procedure • Assess collateral circulation
1. Review & accession test request
2. Approach, identify, & prepare patient
3. Check for sensitivities to latex & other substances
4. Access steady state, verify collection requirements, & record info
5. Sanitize hands & don gloves
6. Assess collateral circulation
7. Position arm & ask patient to extend wrist
8. Locate radial artery & clean site

• Radial ABG Procedure • Insert needle at a 30- to 45-degree angle, slowly direct
9. Administer local anesthetic (optional)
it toward pulse, & stop when a flash of blood appears
10. Prepare equipment & clean gloved nondominant finger
11. Pick up equipment & uncap & inspect needle
12. Relocate radial artery & warn patient of imminent puncture
13. Insert needle at a 30- to 45-degree angle, slowly direct it toward
pulse, & stop when a flash of blood appears
14. Allow syringe to fill to proper level
15. Place gauze, remove needle, activate safety feature, & apply
pressure
7
• Radial ABG Procedure • Expel air bubbles, cap syringe, mix, & label specimen
16. Remove & discard syringe
17. Expel air bubbles, cap syringe, mix, & label specimen
18. Check patient’s arm & apply bandage
19. Dispose of used & contaminated materials, remove gloves, &
sanitize hands
20. Thank patient & transport specimen to lab ASAP
Hazards and Complications of Arterial Chapter 13 & 14 Test information: 68 total questions
Puncture and Sampling Errors
• Know:
Fecal fat test
• All key terms
• Hazards & Complications • Sampling Errors Pleural, pericardial, peritoneal
• How do you insure no compromise in pt
– Arteriospasm – Air bubbles care Electrolytes in PST
• Most analyzed non-blood fluid Commonly measured ABG parameters
– Artery damage – Delay in analysis
• What do non blood-body fluid consist of
Collateral circulation
– Discomfort – Improper mixing • What do you do if delay in transporting to
lab Abducted
– Infection – Improper syringe
• From Chap 12: pre-analytical, most Arteriospasms
– Numbness – Obtaining venous blood by common cause of hemolysis, routine
mistake specimens should arrive in lab within 45 Allen test
– Thrombus formation min of collection, STAT, cholesterol & uric
acid test least likely to require special Steady state
– Use of improper
– Vasovagal response anticoagulant
handling), homocystine & renin (study
What causes erroneous ABG values
question #10), QNS, centrifuge
“balanced”, Aliquot, know study
– Use of too much or too questions.
Know all study questions from both
little heparin chapters
8
Chapter 9
Dermal/Capillary
Puncture
© 2016 McGraw-Hill Education. All Rights Reserved.

9-2
Learning Outcomes
When you finish this chapter, you will be able to:
9.1 Explain why dermal/capillary puncture is used instead of routine

venipuncture for some patients.
9.2 Select an appropriate site for dermal puncture and identify the equipment
needed.
9.3 Carry out the procedure for performing a dermal puncture.
9.4 Apply the procedure for collecting a capillary specimen.

9-3
NAACLS Competencies
5.00 Demonstrate knowledge of collection equipment, various types of
additives used, special precautions necessary, and substances that can
interfere in clinical analysis of blood constituents.
5.5 List and select the types of equipment needed to collect blood by
venipuncture and capillary (dermal) puncture.
5.6 Identify special precautions necessary during blood collections by

6.00 Follow standard operating procedures to collect specimens.
6.1 Identify potential sites for venipuncture and capillary (dermal) puncture.
6.2 Differentiate between sterile and antiseptic techniques.

9-4
NAACLS Competencies
6.3 Describe and demonstrate the steps in the preparation of a puncture site.
6.4 List the effects of tourniquet, hand squeezing, and heating pads on
specimens collected by venipuncture and capillary (dermal) puncture.
6.6 Describe and perform correct procedure for capillary (dermal) collection
methods.
6.7 Describe the limitations and precautions of alternate collection sites for
6.10 List the steps necessary to perform a venipuncture and a capillary

(dermal) puncture in order.
6.12 Demonstrate a successful capillary (dermal) puncture following standard

operating procedures.

9-5
Key Terms
• calcaneus
• interstitial fluid
• osteomyelitis
• palmar
• plantar

9-6
9.1 Dermal/Capillary Puncture
• Preferred method for young patients
• Infants
• Very small children
• May also be used for other patients
• Obese
• Elderly
• Severely burned

9-7
9.2 Preparing for Dermal

Puncture
Competency Check 9-1:
Dermal Puncture Preparation
1. Acquire and examine the requisition slip.

2. Greet and identify the patient.
3. Explain the procedure.
4. Verify any dietary restrictions.
5. Wash your hands.
6. Put on gloves.

9-8
Selecting a Dermal Puncture Site

9-9
Assembling Dermal Puncture Equipment

9-10
9.3 Performing a Dermal

Puncture
Planning the Dermal Puncture
• Examine the fingers
• Choose a finger for

the puncture
• Plan to cut across

the fingerprint

9-11
Performing the Puncture
• Clean the site with alcohol
• Allow to dry completely
• Hold the finger to stretch skin tightly
• Puncture the finger

9-12
9.4 Collecting the Capillary

Specimen
Wipe away first Apply steady Collect specimen

drop pressure

9-13
Complications of Dermal Puncture
• Infection
• Osteochondritis
• Osteomyelitis

9-14
Minimum and Maximum Blood Volumes
• Collecting the correct volume is

important
• Enough for tests to be performed
• Do not exceed maximum allowed

for day or over short time
• Most containers are marked with

acceptable minimum and maximum
fill levels

9-15
After the Dermal Puncture
• Place used lancet in sharps container
• Label the microcontainers
• Check patient’s finger and apply bandage if necessary
• Collect and dispose of supplies appropriately
• Thank and dismiss the patient
• Remove gloves
• Transport specimen to the laboratory

9-16
Chapter Summary
• Capillary/dermal puncture is used for blood collection from
infants, small children, and adults in whom veins may be
difficult to find, such as elderly patients, obese patients, or
severely burned patients.
• Dermal puncture procedures include a series of detailed
steps that must be performed safely and accurately.
• Properly identify patients and prepare them for blood
collection by explaining the procedure and positioning
them in a supported seated or lying position.
• Select an age-appropriate site on the fingers or the heel of
the foot.

9-17
Chapter Summary
•
(cont.)
Equipment needed for dermal puncture is the same as that
used for venipuncture with the exception of the puncture
device and the collection containers.
• Properly cleanse the puncture site using an alcohol prep
pad or other appropriate antiseptic; wipe in a circular
motion from the center outward. Be sure the site is dry
before collecting blood.
• It is essential to follow aseptic technique and Standard
Precautions and to collect the specimen in the appropriate
microcontainers.

9-18
Chapter Summary
•
(cont.)
Complications of dermal puncture include infection,
osteochondritis, and osteomyelitis.
• It is important to draw the correct amount of blood—no
less than the minimum and no more than the maximum
amount. Drawing less than needed for tests requires an
additional puncture; drawing too much may result in
exsanguination, especially in infants and small children.
• After the puncture is complete, dispose of the
contaminated safety lancet, label the microcontainers,
check the puncture site, apply a bandage if indicated and
appropriate, dispose of used supplies, clean the area, and
thank and dismiss the patient.
Objectives
1. Define the key terms and abbreviations listed at the
beginning of the chapter.
2. Describe nonblood specimen labeling and handling.
3. Name and describe the various urine tests, specimen
Chapter 13: Nonblood Specimens types, and collection and handling methods.
and Tests
4. Identify and describe the types of nonblood specimens
other than urine and explain why these specimens are
tested.
Nonblood Specimen Labeling and

Objectives (cont’d) Handling
5. Describe collection and handling procedures for • Should be labeled with same ID info. as blood specimens
nonblood specimens other than urine.
• Labeling should include type &/or source of specimen
6. Identify tests performed on various nonblood specimens
other than urine. • Label should be applied to container, not lid, as lid is
removed for testing
• Familiarity w. handling requirements is needed to protect
integrity of specimen & ensure accurate test results
• All body substances are potentially infectious
• Standard precautions must be observed in handling them
1
Nonblood Body-Fluid Specimens: liquid or
semi-liquid substances Nonblood Body-Fluid Specimens (cont’d)
• Urine • Urine
– Most frequently analyzed nonblood body fluid – Accurate results depend on:
– Readily available, easy to collect, & inexpensive to test • Collection method
– Its analysis can aid in: • Container used (some are sterile)
• Providing info. on many of body’s major metabolic functions • Specimen transportation & handling
• Monitoring wellness • Timeliness of testing
• Diagnosis & treatment of urinary tract infections – Roles in collection
• Detection & monitoring of metabolic disease • Inpatient collection typically handled by nurses
• Determining effectiveness or complications of therapy • Outpatient collection often handled by phlebotomists
• Must explain procedure w/o embarrassing patient
Nonblood Body-Fluid Specimens (cont’d) Nonblood Body-Fluid Specimens (cont’d)

• Common Urine Tests • Common Urine Tests
– Routine urinalysis (UA) – Culture & sensitivity
• Most commonly requested urine test • Ordered for patients w. symptoms of urinary tract infection
• Screens for urinary & systemic disorders • Place measured portion of urine on special nutrient medium
that encourages growth of microorganisms
• Ordered as part of a physical or during hospitalization
• Incubate for 18 to 24 hrs
• Includes physical, chemical, & microscopic analysis
• Check it for growth
• Avoid contamination by using midstream collection
• Identify any microorganisms that grow
• Collect in clear, dry, chemically clean containers
• If microorganism is identified, sensitivity test is performed to
• May be kept at room temp. for up to 2 hrs or refrigerated determine which antibiotics will be effective
• Requires midstream clean-catch collection in sterile container
2
• Urine specimens collected in sterile containers for C&S • Common Urine Tests
testing – Urine cytology studies
• For detecting cancer, cytomegalovirus, & other diseases
• Cells from lining of urinary tract are shed into urine
• A smear containing these cells is prepared from urinary
sediment or filtrate
• Smear is stained by PAP method & examined under
microscope for abnormal cells
• Fresh clean-catch specimen is required
• Examine specimen ASAP after collection or preserve in alcohol

• Common Urine Tests • Common Urine Tests
– Urine drug screening – Urine glucose & ketone testing
• Performed to detect: • To screen for diabetes & monitor glucose & ketone levels in
diabetics
• Illicit use of recreational drugs
– Urine pregnancy testing
• Use of anabolic steroids to enhance performance in sports
• Tests for HCG, a hormone appearing in urine after conception
• Unwarranted use of prescription drugs
• First morning specimen is preferred due to higher
• Used to monitor therapeutic drug use to minimize withdrawal concentration
symptoms & confirm a diagnosis of drug overdose
– Other urine tests
• Tests are performed in groups based on drug classifications
• Electrophoresis, heavy metals (copper & lead), myoglobin
• Random sample in chemically clean, covered container clearance, creatinine clearance, & porphyrins
3
• Types of Urine Specimens • 24-Hour Urine Collection Procedure
– Random: collected at any time 1. Void into toilet as usual on waking
– First morning/8-hour: collected on waking after 8 hrs sleep 2. Note time & date on label, place on container, begin timing
– Fasting: second specimen voided after fasting (glucose 3. Collect all urine voided for next 24 hrs
monitoring)
4. Refrigerate specimen throughout collection period (if required)
– Timed: collected at specific times
5. Collect urine before anticipated bowel movement, not after
• Tolerance test (glucose)
6. Drink normal amount of fluid unless instructed otherwise
• 2-hour postprandial (2 hrs after meal)
7. Void one last time at end of 24 hrs. Keep last void
• 24-hour (collection & pooling of all urine voided in 24 hrs)
8. Seal container, place in cooler, transport to lab ASAP
• Double-voided (empty bladder, wait specified time, then
collect specimen)

• Urine Collection Methods • Amniotic Fluid
– Regular voided: patient voids into clean container – Clear fluid that fills membrane surrounding & cushioning fetus
– Midstream: patient voids into toilet first, then container – Collected after 15 weeks gestation
– Midstream clean-catch: requires special cleaning of genital – Obtained by physician in transabdominal amniocentesis
area before collection. Used to detect UTI
– Needle is inserted into mother’s abdominal wall into uterus
– Catheterized: collected from sterile catheter inserted through
urethra into bladder – About 10 mL of fluid from amniotic sac is aspirated
– Suprapubic aspiration: collected by inserting needle directly – Analyzed to detect genetic disorders & problems in fetal
into bladder & aspirating development
– Pediatric: collected in plastic bag, for children not potty trained – Must be collected in sterile container, protected from light, &
delivered to lab ASAP
4
• Cerebrospinal Fluid • Gastric Fluid/Gastric Analysis
– Clear, colorless liquid that surrounds brain & spinal cord – Examines stomach contents for abnormal substances
– Specimens are obtained by physician via lumbar puncture – Measures gastric acid concentration to evaluate production
– Used to diagnose: – Basal gastric analysis (phlebotomist only assists)
• Meningitis • Tube is passed through mouth & throat (or nose & throat)
into stomach after fasting
• Brain abscess
• Sample of gastric fluid is aspirated
• CNS cancer
• Sample is tested to determine acidity prior to stimulation
• Multiple sclerosis
• Stimulant is administered by IV
– Routine tests: cell counts, chloride, glucose, & total protein
• Several more samples are collected at timed intervals

• *Nasopharyngeal Secretions
– From nasal cavity & pharynx • Saliva
– Cultured to detect presence of microorganisms causing: – Fluid secreted by glands in mouth
– Used to monitor hormone levels & detect alcohol & drug abuse
• Diphtheria
– Can be collected quickly & easily in a noninvasive manner
• Meningitis
• Semen
• Pertussis (whooping cough)
• Most commonly used for post-vasectomy patients
• Pneumonia – Sperm-containing fluid discharged during male ejaculation
– Collected using sterile Dacron or cotton-tipped flexible wire swab – Analyzed to assess fertility or effectiveness of sterilization
– Swab is inserted into nose & passed into nasopharynx – Examined for forensic reasons in criminal sexual investigations
– It is rotated, removed, placed in sterile container, labeled, sent – Collected in sterile containers, kept warm, & protected from light
5
• Serous Fluid • Sputum
– Found between double-layered membranes enclosing – Mucous or phlegm ejected from trachea, bronchi, & lungs
pleural, pericardial, & peritoneal cavities
– Collected for diagnosis or monitoring of lower respiratory tract
– Allows membranes to slide past one another w. minimal friction infections (tuberculosis)
– Can be aspirated for testing purposes by physician – First morning specimens are preferred (larger volume)
– *Types of serous fluid should be indicated on label: – Collect at least 1 hr after a meal to avoid gagging or vomiting
• Pleural fluid (lungs) – Patient removes dentures & gargles w. water
• Peritoneal fluid (abdominal cavity) – Patient takes 3 or 4 deep breaths & then coughs forcefully,
expelling sputum into container
• Pericardial fluid (heart)

• A sputum specimen container • Sweat (not done in all hospitals)
– Analyzed for chloride content in diagnosis of cystic fibrosis
– Sweat chloride test
• Pilocarpine (sweat-stimulating drug) is transported into skin
by electrical stimulation (iontophoresis)
• Sweat is collected, weighed, & analyzed for chloride content
– Also used to detect illicit drug use; collected via skin patches
6
Nonblood Body-Fluid Specimens (cont’d) Other Nonblood Specimens
• Synovial Fluid • *Buccal (Cheek) Swabs
– Clear, pale-yellow, viscous fluid that lubricates movable joints – Less invasive, painless alternative to blood collection for
obtaining cells for DNA analysis
– Normally occurs in small amounts
– Phlebotomist gently massages mouth on inside of cheek w. swab
– Increases when inflammation is present
– DNA is extracted from cells on swab
– Can be tested to identify or differentiate arthritis, gout, & other
inflammatory conditions • Bone Marrow
– Typically collected in 3 tubes: – Aspirated & examined to detect & identify blood diseases
• EDTA/heparin: for cell counts, ID of crystals, smear prep. – Physician inserts large-gauge needle into bone marrow in hip
• Sterile: culture & sensitivity bone or sternum
• Nonadditive: macroscopic appearance, chemistry, & – 1.0 to 1.5 mL of specimen is aspirated using syringe
immunology tests & to observe clot formation
Other Nonblood Specimens (cont’d)

• Feces (Stool)
• *Breath Samples
• Clostridium Diffcile (C Diff): frequently found in hospitalized patients
– C-urea breath test and is implicated as a causative agent in hospital acquired diarrhea.
Extremely contagious.
• Used to detect H. pylori (bacteria that damages stomach
lining) • Occult blood can not be seen by the naked eye
– Hydrogen breath test – Useful in evaluation of gastrointestinal disorders
• Helps identify problems w. digestion of lactose & fructose – Stool specimens can be:
• Thought to be most accurate lactose tolerance test • Evaluated for presence of intestinal parasites & their eggs
• Also used to detect bacterial overgrowth in small intestine • Checked for fat & urobilinogen content
• Cultured to detect presence of pathogenic bacteria & viruses
• Tested for presence of occult blood using stool test
7
Other Nonblood Specimens (cont’d) Other Nonblood Specimens (cont’d)
• Hair • A throat swab and transport tube
– Collected for trace & heavy metal analysis & detection of drugs
– Easy to obtain & cannot easily be altered or tampered with
– Shows evidence of chronic rather than recent drug use
• Throat Swabs
– Collected to aid in diagnosis of strep infections
– Nurses collect from inpatients, phlebotomists from outpatients
– Collected with sterile polyester-tipped swab in covered transport
tube containing transport medium
Other Nonblood Specimens (cont’d) Other Nonblood Specimens (cont’d)

• Throat Culture Specimen Collection • Throat Culture Specimen Collection
1. Wash hands & don gloves (may wear mask & goggles) 9. Place swab in transport tube, embed in medium, secure cover
2. Open container & remove swab 10. Label specimen
3. Stand back or to side of patient 11. Remove gloves & sanitize hands
4. Instruct patient to tilt head back & open mouth wide 12. Arrange transport or deliver to lab ASAP
5. Direct light onto back of throat (flashlight)
6. Depress tongue w. tongue depressor, have patient say “ah”
7. Swab tonsils, back of throat, inflamed areas; avoid lips, tongue
8. Maintain tongue depressor position while removing swab
8
• Tissue Specimens • Chapter 13 & 14 information at the end of Chap 14 slides
– Biopsy: removal of tissue sample for examination
– Most arrive at lab in formalin or other solution & only need to be
accessioned & sent to proper department
– Some, however, may not be in proper solution
– Phlebotomist should check procedure manual to determine
proper handling for any unfamiliar specimen
– Improper handling can ruin a specimen
9
Objectives
1. Define the key terms and abbreviations at the beginning
of this chapter.
2. Explain the principle behind each special collection
procedure, identify the steps involved, and list any
Chapter 11: Special Collections special supplies or equipment required.
and Point-of-Care Testing 3. Describe patient identification and specimen labeling
procedures required for blood bank tests and identify
the types of specimens typically required.
4. Describe sterile technique in blood culture collection,
explain why it is important, and list the reasons why a
physician might order blood cultures.
Objectives (cont’d) Special Procedures

5. List examples of coagulation specimens and describe • Blood Bank Specimens
how to properly collect and handle them. – Specimen requirements
• Lavender- or pink-top EDTA tubes
6. Describe chain-of-custody procedures and identify the
tests that may require them. • Non additive glass red-top maybe used
– Identification & labeling requirements
7. Explain the importance of timing; identify the role of
• Patient’s full name
drug half-life, providing names of drugs as examples;
and describe peak, trough, and therapeutic levels in • Patient’s hospital ID# or SS#
therapeutic drug monitoring. • Patient’s date of birth
• Date & time of collection
8. Define point-of-care testing (POCT), explain the
principle behind the POCT examples listed in this • Phlebotomist’s initials
chapter, and identify any special equipment required.
1
Special Procedures (cont’d) Special Procedures (cont’d)
• Blood Bank Specimens • A phlebotomist compares a labeled blood bank tube with
– Special identification systems
a blood bank ID bracelet
• ID bracelet w. self-carbon adhesive label for specimen
• Blood ID-band with linear bar-coded BBID #’s
• Siemens Patient Identification Check-Blood Administration
• Type, Screen, and Cross-Match

– Blood type (ABO) & Rh factor (+ or -) & screen
– Cross-match to determine compatibility between patient & donor

• Blood Donor Collection • Blood Donor Collection
– General – Lookback program
• Collected for transfusions, not diagnostic testing • All blood components of unit must be traceable to donor
• Collected in “units” from volunteers • Requires notification to all blood recipients when a donor is
shown to be positive for a transmissible disease
• Requires special training & skills
– Autologous donation
– Donor eligibility
• Person donates blood for his/her own use (e.g., for elective
• Between ages 17 & 66 years surgeries)
• Weight at least 110 lbs – Cell salvaging
• Physical exam & medical history required • Patient’s blood can be salvaged, washed, & reinfused
• Written permission from donor required • Salvaged blood must be tested for residual free hemoglobin
2
• Blood Cultures • Blood Cultures: Video (Blood Cultures)
– General
– Skin antisepsis: Most important part of collecting
• Determine presence & extent of infection
• Purpose
• Identify type of organism responsible & best antibiotic to use
• Destroy skin microorganisms
• Should be ordered on basis of patient having a condition in which
bloodstream invasion is possible & presence of fever • Prevent misinterpretation of microorganism as pathogenic
– Specimen requirements
• Acceptable antiseptics
• 2 blood culture sets
• chlorhexidine gluconate
• Drawn 30 to 60 min. apart (unless patient in critical condition)
• Tincture of iodine or povidine
• Collected in special bottles, one aerobic & one anaerobic
• Requires 30- to 60-second friction scrub

• Blood Cultures • Performing friction scrub, removing flip-off cap, &
– Collection procedure
cleansing culture bottle stopper
1. Follow normal ID protocol; explain collection procedure
2. Identify venipuncture site & release tourniquet
3. Aseptically select & assemble equipment
4. Perform friction scrub
5. Allow site to dry
6. Remove flip-off cap & inspect bottle for visible defects
7. Cleanse culture bottle stoppers while site is drying
3
Special Procedures (cont’d)
• Blood Cultures Special Procedures (cont’d)
– Collection procedure
• Performing venipuncture & inoculating medium
8. Mark min. & max. fill on culture bottles
9. Reapply tourniquet & perform venipuncture
10. Inoculate medium as required
11. Invert bottle several times
12. Clean patient’s skin if applicable
13. Label specimen containers with required ID info which
includes name, DOB, time collected, indicate where it was
drawn from (RH, RA, LH, LA)
14. Dispose of used & contaminated materials

• Blood Cultures • Blood Cultures
– Collection procedure – Media inoculation methods
15. Thank the patient, remove gloves, & sanitize hands • Direct inoculation
16. Transport specimens to lab ASAP • Collect specimen directly into blood culture medium
• Use butterfly & specially designed holder
• Syringe inoculation
• Transfer blood to bottles after draw is completed
• Safety transfer device is required
4
• Blood Cultures • Antimicrobial Neutralization Products
– Intermediate collection tube – Purpose
• Sometimes used in place of blood culture bottle • Removes or neutralizes antimicrobials/antibiotics from blood
• Yellow-top SPS tube is acceptable • Prevents antimicrobials from inhibiting growth of
microorganisms.
• Use is discouraged, however, because:
• Final concentration of SPS is increased
• Presents another opportunity for contamination
• Increased exposure risk to lab staff
Special Procedures (cont’d)

• Coagulation Specimens Special Procedures (cont’d)
– A “clear” or discard tube is required for coagulation tubes (PT/PTT)
drawn with butterfly because of the tubing. Some places require a
discard tube each time a blue top is drawn. Top of pg 372
• 2-Hour Postprandial Glucose
– Sodium citrate tubes must be filled until vacuum is exhausted. If not – Glucose in diabetics is significantly increased 2 hrs after meal
filled completely they will be rejected. Must be 9:1 ratio of blood to
anticoagulant. – Excellent screening test for diabetes
– Never pour 2 partially filled tubes together • Glucose Tolerance Test (GTT)
– Cooling on ice during transport may be required – Used to diagnose problems of carbohydrate metabolism
– When drawing from an indwelling catheter: A draw & discard 10 mL
must be drawn by the RN. – Monitors patient’s tolerance to high levels of glucose
– Hyperglycemia: increased blood glucose level
– Hypoglycemia: decreased blood glucose level
5
• Glucose Tolerance Test (GTT) • Glucose Tolerance Test (GTT)
– GTT preparation – GTT procedure
• Patient must: 1. Follow normal ID protocol & explain collection procedure;
advise of fasting requirements
• Fast at least 12 hrs but not more than 16 hrs before test
2. Draw fasting specimen & check for glucose
• Drink water during fast & test
3. Ask patient to collect fasting urine specimen (if needed)
• Do not smoke or chew gum
4. Give patient determined dose of glucose beverage
5. Remind patient to finish beverage within 5 min.
6. Note time patient finishes, start timing, calculate collection
times

• Glucose Tolerance Test (GTT) • Lactose Tolerance Test
– GTT procedure – Determines lack of enzyme that converts lactose into
glucose/galactose
7. Give a copy of collection times to patient (not necessary, pt
does not leave area) – Performed in same manner as 2-hr GTT, only w. lactose
8. Collect blood & urine specimens at computed times • Paternity/Parentage Testing
9. Label all specimens with collection times, intervals, patient – Excludes possibility of paternity rather than proves it
ID
– Requires a chain-of-custody protocol & specific ID procedures
10. Deliver or send specimens to lab ASAP
– Mother, child, & alleged father are all tested
– Blood samples are preferred, but cheek swabs are increasing
– Blood sample testing includes ABO & Rh typing
6
• Therapeutic Drug Monitoring • Toxicology Specimens
– Establishes & maintains drug dosage at therapeutic level – General
– Such as blood thinners, seizure meds etc • Toxicology: scientific study of toxins (poisons)
• Concerned with detection of toxins & treatment of effects
– Avoids drug toxicity
– Forensic blood alcohol (ethanol) specimens
– Typically used for drugs with therapeutic ranges
• Often requested by law enforcement officials
• Therapeutic Phlebotomy: Video (Hemochromatosis) • Used to determine levels in breath, urine, or blood
– Withdrawal of large volume of blood to treat (500ml) • Specimen collection must follow chain of custody
• Polycythemia: Body’s over production of RBCs • Forensic toxicology is concerned with legal consequences of
toxin exposure.
• Hemochromatosis: Excess iron deposits in tissues

• Toxicology Specimens • Toxicology Specimens
– Clinical blood alcohol (ethanol) specimens – Drug screening
• Normally ordered by physician for treatment purposes • Required by many healthcare organizations, sports
associations, & major companies
• Chain of custody not required, but follow standard protocol
• May be random, pre employment, post accident
• Required in connection to on-the-job injury, employee
insurance programs, & employee drug screening • May detect a specific drug or screen for up to 30 drugs
• Skin preparation: don’t use alcohol-based disinfectant • Typically performed on urine rather than blood
• Specimen requirements: gray-top sodium fluoride tube; • Chain of custody is required
fill tube until vacuum is exhausted & don’t remove stopper
7
– Drug screening • Trace Elements
• Patient preparation requirements – Tests for aluminum, arsenic, copper, lead, iron, & zinc
• Explain test purpose & procedure – Measured in small amounts
• Advise patient of his or her legal rights – Traces of them in glass, plastic, or stopper material can leach
• Obtain a witnessed, signed consent form into specimen
• Specimen collection requirements – Special trace element–free tubes must be used (royal blue &
contain EDTA, heparin, or no additive)
• Special area for urine collection
• Proctor present at time of collection
• Split sample may be required
• Specimen must be labeled, sealed, & placed in a clocked
container
Point-of-Care Testing Point-of-Care Testing (cont’d)

• General • Quality and Safety in POCT
– Brings lab testing to location of patient – Waived vs. non-waived quality control checks
– Made possible by development of small, portable testing devices – Electronic quality control (EQC) built into POC instruments
– Offers convenience to patient & short turnaround time – Specimen collection & handling not checked by EQC
– Requires carrying out quality-control & maintenance procedures – Daily external liquid QC for noninstrumented POCT
necessary to ensure that results are accurate
– POC instruments become possible fomites for disease
• Disinfect with 10% bleach
• Reduce cross-contamination between patients
8
Point-of-Care Testing (cont’d) Point-of-Care Testing (cont’d)
• Coagulation Monitoring by POCT • Coagulation Monitoring by POCT
– Coagulation tests that are monitored: Done in physician – POCT instruments
office, to monitor pt blood thinner (warfarin)
• Cascade POC —ACT, APTT, PT/INR
• Prothrombin time (PT) & international normalized ratio (INR)
• CoaguChek XS Plus —PT/INR
• Activated partial thromboplastin time (APTT or PTT)
• GEM Premier 4000 —ACT, APTT, PT/INR
• Activated clotting time (ACT)
• i-STAT —ACT, PT/INR
• Platelet function
• Verify Now —platelet function

• Bleeding-Time Test Procedure • Bleeding-Time Test Procedure
1. ID patient & sanitize hands 9. Inflate blood pressure cuff to 40 mm Hg
2. Determine patient use of aspirin in past 2 weeks & describe risks 10. Remove safety clip & place puncture device on forearm
3. Support patient’s arm on steady surface 11. Depress trigger & start timer; discard in sharps container
4. Select area on inner lateral surface of forearm 12. Blot blood flow at 30 seconds w. filter paper
5. Place blood pressure cuff around arm 13. Stop timer when blood no longer stains filter paper
6. Clean selected area with alcohol & allow to air-dry 14. Remove blood pressure cuff, clean & bandage arm
7. Put on gloves & prepare equipment 15. Record time to nearest 30 seconds
8. Remove puncture device from package, keeping blade sterile 16. Dispose of used & contaminated supplies; thank patient
9
• Place puncture device firmly on lateral aspect of forearm • Arterial Blood Gases and Chemistry Panels
– Arterial blood gases measured
• pH
• Partial pressure of carbon dioxide
• Oxygen saturation
• Partial pressure of oxygen

• Arterial Blood Gases and Chemistry Panels • Multiple-Test-Panel Monitoring by POCT
– Electrolytes measured – Commonly ordered stat tests such as blood gases, electrolytes,
& hemoglobin
• Sodium
– Instruments with a menu of several different tests:
• Potassium
• GEM Premier
• Chloride
• i-STAT
• Bicarbonate ion
• NOVA Stat Profile Analyzer
• Ionized calcium
• ABL 80 Flex
10
Chapter 10/11 test info:
Point-of-Care Testing (cont’d) • Know what disqualifies a site for
capillary puncture
• Spiral patterns on finger tips
• Small tubes used to collect capillary
• What are the skin puncture supplies specimens
• Other Tests Performed by – Hematocrit:
• When are capillary specimens
• Osteomyelitis, Osteochondritis
POCT – Hemoglobin A1C: Done normally done on adults
in some physicians office • Hemoconcentration
– Cardiac troponin T & I • Hypoglycemia
• Maximum depth of capillary
– Lipid testing – Lactate puncture • Measures packed cell volume
– B-type natriuretic peptide – Occult blood: Microscopic • Additional fluids found in capillary • Newborn/neonatal screening
blood in stool specimens
• GTT
– C-reactive protein • What angle used in routine blood
– Pregnancy testing • Therapeutic drug monitoring
– Glucose: Most common smear
– Skin tests • Skin asepsis
• Most common POCT
– Glycosylated hemoglobin • Cold agglutinins
– Strep testing • What is collected when doing
1st
capillary puncture? • Type & screen
– Urinalysis
Cont.
• Feathered
• Capillary blood more resembles
what
• 43 multiple choice
• Know study questions
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
11
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
PowerPoint ® Presentation to Accompany
Booth, Wallace, and Fitzgerald
Chapter 5 1
Specimen Processing
Chapter 5 2
Objectives
Upon completion of this chapter, you should be able to:
• List requirements for special specimen handling

procedures.
• Describe the technique required for collecting

blood cultures.
• List the steps for Unopette® collection.
• Describe the procedure for performing a

microhematocrit.
Chapter 5 3
Objectives cont’d
• Explain the collection process and procedure for
making a peripheral blood smear.
• Discuss common point-of-care and CLIA waived

tests.
• Explain the procedure for urine specimen

collection and reagent testing.
• Identify safety requirements for operating a

centrifuge.
Chapter 5 4
Special Handling Procedures

In addition to blood collection, some specimens require
special handling either before or after the blood is
collected.
Common Tests Requiring Special Handling Procedures
Blood
Legal Specimens
Cultures
Chilled and
Cold Agglutinins
Light-Sensitive
Chapter 5 5
Blood Cultures
• Requested on patients
with a high fever
• Purpose is to isolate
microorganisms from the
patient’s blood that may
be causing the fever
• Strict aseptic technique
is required for the
Blood culture bottles
collection of the blood are larger than normal
specimen venipuncture tubes
Chapter 5 6
Blood Cultures Part 2

• Blood culture bottles • Blood cultures are
contain culture media, usually ordered STAT
which enhances the • Collected in sets of two
growth of the or three
microorganisms
• Each set is collected
• Septicemia is the presence from different sites at
of microorganisms in the different time intervals
blood with symptoms that
can result in death
One sample will be incubated as an anaerobic specimen and

the other as an aerobic specimen
Chapter 5 7

• Blood cultures seek to identify
the agent(s) responsible for
the patient’s illness
Common Pathogen Classifications
• Bacteria • Protozoa
• Fungi • Viruses
Chapter 5 8
Blood Culture Volume

Blood Culture Volume
• The exact amount indicated by the

manufacturer must be collected.
• Usually 8 to 10 mL per bottle or tube is
sufficient for an adult. Lesser amounts are
drawn on infants and children.
• The correct amount is needed to increase
the chance of bacterial growth.
Chapter 5 9

The collection of blood cultures is essentially the same as for
routine venipuncture, except:
• Special site
cleansing
• Amount of • Specimen transfer

blood needed
Chapter 5 10
Site Cleaning Procedure

Blood Culture Site Cleaning Procedure
Correct cleaning of the site is the most
important part of collecting blood cultures
Steps to Correct Cleaning

1. Release the tourniquet after
site is selected
2. Clean first with 70% to 95% alcohol, chlorhexidine
gluconate, or benzalkonium chloride using
concentric circles, from the center working
outward
3. Do not allow the strokes to go back toward the
center area
Chapter 5 11
Site Cleaning Procedure Cont’d

Steps to Correct Cleaning (cont’d)
4. Allow the site to air dry

5. Repeat cleansing using a 2% iodine
swab or applicator if using alcohol
6. Allow iodine to dry and do not retouch
the area
If the patient is allergic to iodine, use another

cleanser.
Chapter 5 12
Blood Culture Specimen

Transfer
Collecting Blood Culture Specimens
• If using a syringe, be sure to have a syringe that can

hold at least 20 mL. Attach the syringe to a transfer
device and fill anaerobic bottles first.
If a butterfly setup is used, the aerobic sample is drawn first so

that air from the butterfly tubing is cleared before the
anaerobic culture sample is drawn.
Chapter 5 13
• Establishing a chain of custody is required for

medicolegal issues. Without proper proof of custody,
the specimen will be considered invalid.
• A chain of custody form must be completed

correctly, and multiple copies are used as a safeguard
system.
These specimens must be correctly identified and under

the uninterrupted control of authorized personnel to
ensure their validity.
Chapter 5 14
Cold Agglutinins
• Testing for cold agglutinins or antibodies
is done for patients suspected of having
atypical pneumonia.
• Atypical pneumonia is caused by the

microorganism Mycoplasma
pneumoniae.
• People infected with Mycoplasma

pneumoniae produce autoantibodies.
Chapter 5 15
Cold Agglutinins Part 2

Normal body temperatures range from 97.6F to 99.6F. At
temperatures lower than normal body temperature, cold
agglutinins attach to red blood cells and cause clumping.
Specimen Collection
• Use red-topped tubes • Keep the sample at

that do not contain 98.6F until the serum
additives can be separated from
• Collection tubes must be the cells
prewarmed • Serum must be separated
from cells within 1 hour
Chapter 5 16
• Some specimens must be chilled or covered

immediately after collecting.
Chilled Specimens Light-Sensitive

Specimens
•Arterial blood gases
•Bilirubin
•Ammonia
•Lactic acid
Chapter 5 17
Apply Your Knowledge Part 2

Which of the following best describes the correct
cleansing procedure for blood culture collection?
A. Clean the arm starting a distance from the site and clean
toward the selected site
B. Use linear strokes to clean up and down the arm until the
entire arm is cleansed
C. Clean the site starting in the center and working outward
Answer: C. Clean the site starting in the

center and working outward GREAT!
Chapter 5 18

James is suspected of having atypical pneumonia.
Which of the following tests will most likely be ordered?
A. Arterial blood gases
B. Cold agglutinin BRAVO!
C. Bilirubin
Answer: B. Cold agglutinin tests for atypical pneumonia

caused by Mycoplasma pneumoniae
Chapter 5 19
Unopette Procedure
A Unopette®, manufactured by Becton-Dickinson, is
a prepackaged microcollection device.
• Disposable
• Consists of a plastic reservoir containing a
premeasured volume of reagent
Common Tests Performed with a Unopette

• White blood cell count • Platelet count
• Red blood cell count • Hemoglobin
• RBC fragility
Chapter 5 20
Unopette Procedure Part 2

Each test requires a specific Unopette that has a
different premeasured volume of reagent inside.
• Specific pipettes accompany each Unopette.
• Pipettes are self-filling, thin-walled, glass capillary
tubes attached to a plastic holder.
• Use a dermal puncture specimen to fill the pipette.
• Wipe the pipette after it fills with blood, but do
not touch the end of the pipette with gauze.
• Gently invert to mix the sample with the reagent.
• Label Unopette and transport to lab.
Chapter 5 21
Apply Your Knowledge
Which tests can be performed with the

Unopette microcollection device?
ANSWER: WBC count, RBC count, RBC

fragility, platelet count and hemoglobin
Good Job!
Chapter 5 22
Measuring Microhematocrit
• Microhematocrit tubes are used
for measuring hematocrit or
packed cell volume
• They have a thin red band

around the end of the tube
• These tubes are coated with

sodium heparin
• Blood flows freely into these

tubes because of capillary
action
Chapter 5 23
Measuring Microhematocrit Part

2
• Fill two capillary tubes 3/4 full
• Seal the end that was not used
to collect the specimen by
embedding the clean end into a
clay sealant (if the tube
requires it)
• Place in a separate tube for
labeling and transporting to the
laboratory
• Place in centrifuge machine
according to procedure
NOTE: The values of the two microhematocrits should

match within 2 percent.
Chapter 5 24

True or False: Microhematocrit tubes are coated with
an anticoagulant.
Hey, remember! An
anticoagulant prevents
blood from clotting.
Great!
Answer: True
Chapter 5 25
Peripheral Blood Smear

A blood smear is for the microscopic examination of blood.
• Venous or capillary blood may be

used to prepare a blood smear.
• The complete blood count (CBC)
differential test is done with a blood
smear.
• Blood smears are also used to
diagnose malaria, anemia, and
leukemia.
Chapter 5 26
Peripheral Blood Smear Part 2

Blood Smear Procedure
• Fresh drops of blood are

obtained, usually following
dermal puncture
• Wipe away the first drop of
blood • The blood smear should
• Place 1 drop of blood about be smooth in appearance
1/2 inch from the frosted with no irregularities,
end of one glass slide streaks, or holes and a
• Hold the spreader slide at a feathered edge
30 to 35o angle and spread • The wedge method is the
blood toward the opposite most common technique
end of the slide for making blood smears
Chapter 5 27

Blood smears are used to diagnose which of
the following diseases?
A. Malaria
B. Leukemia
C. Anemia
D. All of the above
E. None of the above
Bravo!
ANSWER: D. All of the above

Chapter 5 28
Point-of-Care Testing
• Near-patient testing
• Designed to reduce hospital cost and reduce
turnaround time for blood test results
• Instruments are portable, internally calibrated, and
easy to use
• Point-of-Care testing (POCT) is usually performed by
phlebotomists, nurses, technicians, or medical
assistants
• Dermal puncture usually done because a small blood
specimen is needed
• Each instrument must be calibrated and requires
quality control checks
Chapter 5 29
Point-of-Care Testing Part 2

• Bicarbonate
• Ionized calcium
Common Point-of-Care Tests • Cholesterol
• Glucose • Blood ketones
• Hemoglobin • Urine dipstick
• Sodium • PT and PTT
• Potassium • Chloride
Chapter 5 • Blood gases 30

• Often requires blood from a dermal

puncture.
• POCT is done at various facilities.
• If a clinical lab is not available, only

CLIA waived testing can be performed.
• CLIA waived tests are those that are

cleared for home use.
Chapter 5 31
Before the Test

• Confirm test orders
• Establish a procedure for patient ID
• Give patient pre-test instructions
• Collect specimens according to package
directions
• Label specimens appropriately
• Never use expired kits
Chapter 5 32
During the Test

• Perform quality control testing
• Correct any problems
• Establish a policy for frequency of control
testing
• Carefully follow all test-timing
recommendations
• Interpret test results using product inserts as
a guide
• Record test results according to office policy
Chapter 5 33
After the Test
• Report results in a timely manner

• Follow package insert for follow-up
• Follow OSHA regulations for disposing of
biohazardous waste
• Participate in quality assurance assessment
programs
Chapter 5 34
Which of the following tests cannot be performed

with POCT?
A. Glucose
B. Hemoglobin Good Job!
C. Blood culture
D. Cholesterol
Answer: C. Blood cultures require a larger amount of blood

and have to grow in culture media.
Chapter 5 35
• Used to evaluated substances found in

urine
• Consist of the physical component,
chemical component, and the
microscopic component
• First morning urine is best used for
testing
• Chain of custody must be established
for drug and alcohol testing
• Should be refrigerated if not tested
within 1 hour
Chapter 5 36
Obtaining Urine Specimens

• For a Female:
• Separate the skin folds and wipe front to
back three times
• Keep the skin folds apart and collect a
midstream urine in the cup
• Once ¾ full, place the lid on the cup
• Label the specimen
• For a Male:
• Use 2 towelettes to clean the head of the penis
• If uncircumcised, keep foreskin retracted while patient urinates
and collect a midstream urine in the cup
• Once ¾ full, place the lid on the cup
• Label the specimen
Chapter 5 37
Urine Specimen Testing
The Urine Dipstick

• Uses reagent strips to test urine for a number of substances
• Keep strips in a cool dry area
• Never remove them from the container until ready to test
• Examine the strips for discoloration
• Check the expiration date
• Always run a control sample when opening a new supply
• Write the date opened
Follow the manufacturer’s directions for accurate results

Chapter 5 38
Which is the best urine specimen for testing?
ANSWER: The first morning urine
GREAT!
Chapter 5 39
Centrifuge Operation
Centrifuging is the spinning down or separating of cells from
the liquid portion of the blood.
• Specimens also require aliquoting (dividing specimens

into separate containers)
• Aliquoting for most laboratory tests requiring serum or
plasma must be done within two hours or less
What happens if • Test results could be altered

the specimen is
not separated in
time?
• If the RBCs are left in contact
with the serum, the glucose
level would be decreased
Chapter 5 40
Centrifuge
Types of Centrifuges
Operation Part 2
• Refrigerated
• Floor models
• Tabletop models
The speed of rotation

and the radius of the
rotor head determine the
relative centrifugal force
of a centrifuge, which is
Most laboratory specimens are
expressed in gravity (g).
centrifuged at 750 to 1000 g for
15 minutes
Chapter 5 41
Centrifuge Operation Part 3

• Place tubes of equal
size and volume
directly across from
each other so the
machine will be
balanced
• Never open the lid
until the centrifuge
After centrifugation, always machine has come to
be sure the transfer tube is a complete stop
properly labeled before you
begin to aliquot a specimen
Chapter 5 42
Within what time frame should specimens be

centrifuged for tests that require serum or
plasma?
ANSWER: Within 2 hours

GREAT!
Chapter 5 43
CHAPTER SUMMARY
• Specimens may require special handling or
collection in order to be accurate.
• Blood cultures must be drawn under strict
aseptic technique to prevent false results.
• When using a Unopette, collect the specimen
with the pipette and mix the specimen carefully.
• To perform a microhematocrit, obtain blood in a
capillary tube and centrifuge. The separated
cells can be used to determine the patient’s
hematocrit.
Chapter 5 44
CHAPTER SUMMARY (cont’d)

• Peripheral blood smears require a drop of blood
on a slide. The blood is spread across the slide
using a spreader slide.
• Point-of-care tests are obtained and tested
immediately at the point of care or near the
patient. CLIA waived tests pose a minimal risk to
the patient.
• A urine specimen can be collected and a
reagent strip may be used to determine the
concentration of a substance.
• When using a centrifuge, make sure the load is
balanced.
Chapter 5 45
END OF CHAPTER 5
Choose a job you love and you will

never have to work a day in your life.
-- Confucius
Chapter 5 46

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CIRCULATORY SYSTEM

2. Compare and contrast between an artery and a vein;

• Found in the thoracic cavity

• Composed of cardiac muscle

• Pumps blood for circulation

2. Tortora, G.J., Derrickson, B. (2009). John Wiley & Sons,

2. Identify the types of cells present in the blood and discuss

3. Compare and contrast between the plasma and serum;

• Anticoagulant prevents blood

• Bone marrow as primary

• Primary function is transport of oxygen

• Antigens found on plasma membrane determines blood type

2. Tortora, G.J., Derrickson, B. (2009). John Wiley & Sons,

•Varies in size and capacity

BUTTERFLY NEEDLE SET

OPEN SYSTEM CLOSED SYSTEM

Objectives (cont’d) Objectives (cont’d)

Commonly Measured ABG Analytes Personnel Who Perform Arterial Puncture

Arterial Puncture Sites (cont’d) Arterial Puncture Sites (cont’d)

Arterial Puncture Sites (cont’d) ABG Specimen Collection

– Personal protective equipment – Antiseptic – Self-adhering gauze

ABG Specimen Collection (cont’d) ABG Specimen Collection (cont’d)

ABG Specimen Collection (cont’d) ABG Specimen Collection (cont’d)

ABG Specimen Collection (cont’d) ABG Specimen Collection (cont’d)

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9.1 Explain why dermal/capillary puncture is used instead of routine

9.3 Carry out the procedure for performing a dermal puncture.

9.4 Apply the procedure for collecting a capillary specimen.

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5.6 Identify special precautions necessary during blood collections by

6.00 Follow standard operating procedures to collect specimens.

6.2 Differentiate between sterile and antiseptic techniques.

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6.10 List the steps necessary to perform a venipuncture and a capillary

6.12 Demonstrate a successful capillary (dermal) puncture following standard

© 2016 McGraw-Hill Education. All Rights Reserved.

© 2016 McGraw-Hill Education. All Rights Reserved.

9.1 Dermal/Capillary Puncture

• Preferred method for young patients

• Very small children

• May also be used for other patients

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9.2 Preparing for Dermal

1. Acquire and examine the requisition slip.

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Selecting a Dermal Puncture Site

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Assembling Dermal Puncture Equipment

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9.3 Performing a Dermal

• Examine the fingers

• Choose a finger for

• Plan to cut across

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Performing the Puncture

• Clean the site with alcohol

• Allow to dry completely

• Hold the finger to stretch skin tightly

• Puncture the finger

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9.4 Collecting the Capillary

Wipe away first Apply steady Collect specimen

© 2016 McGraw-Hill Education. All Rights Reserved.