LESSON 6
conditions.
OVERVIEW OF PRE-ANALYTICAL
PHASE OF TESTING
The pre-analytical testing phase includes
procedures such as laboratory handling
and identification which takes place prior
to any laboratory testing. It is in this phase
where proper control measures are placed
to avoid subsequent issues. This starts
when the doctor's order is given and ends
when the laboratory testing has officially
commenced.
During this phase, aside from the ability
to draw blood from the patient, the
phlebotomist should also possess the skill
of being able to identify factors that affect
the process and address the same as
needed.
The laboratory test is used by physicians
to diagnose and monitor the presence of a
disease. The physicians compare the
results to a reference range or reference
interval. This range shows the high and
low limits of result values as compared to
healthy individuals. Several factors are
considered as part of the reference interval
study or the interpretation of the data
obtained.
In phlebotomy, the basal state is ideal in
establishing reference range since it
represents the condition of the metabolism
of the body early in the morning or after
approximately 12 hours of fasting. This
can be influenced by age, gender and
conditions of the body.
PROBLEM AREAS AND
TROUBLESHOOTING IN THE SITE
SELECTION
Listed are problem areas to considered
when selecting the venipuncture site and
the phlebotomist should be aware of these
so he could choose an alternative site, or
perform the procedure under special
This maybe created for hemodialysis
Burns, Scars, & Tattoos - a site which has
burns, scars or tattoos is not
recommended because veins in the area
may be difficult to examine and blood
circulation maybe impaired. Burns may be
too painful to touch and tattoos may also
be susceptible to infection due to the dyes
used that may interfere with the process.
Damaged Veins -aside from encountering
difficulty in puncturing the site when
veins are damaged another problem is the
possibility of getting inaccurate results.
Veins could be Sclerosed or hardened or
Thrombosed or clotted.
Edema - which is also known as Oedema,
is an abnormal swelling caused by
accumulation of fluid in the tissues. The
tissues become fragile, making the task of
locating the veins harder. This condition
maybe due to reactions from medications,
pregnancy, infections and other medical
problems. cephalic or cubital vein.
VASCULAR ACCESS SITES AND
DEVICES
There are cases when a patient needs a
patient require the use of Vascular Access
Devices (VADs) for blood sampling,
infusing medication, central venous
pressure readings and blood transfusion.
The choice of vascular access sites is
based on the needs of the patient, the
purpose and length of time it needs to
remain in the body. Listed are vascular
access sites and devices used in
phlebotomy:
Arterial Line
To obtain samples for arterial blood gas
and laboratory studies, critically ill
patients require arterial lines where a thin
catheter is inserted into an artery. This
also used to monitor blood pressure
continuously. Neither tourniquet nor
venipuncture are allowed in the arm with
an arterial line.
Arteriovenous Shunt or Fistula
An arteriovenous shunt or fistula is a
passageway created thru surgery which is
usually in the arms with the intention of
connecting the artery and a vein directly.
treatment or pathological process such as
erosion of arterial aneurysm.
Blood Sampling Device
A blood sampling device is used to avoid
the use of needle sticks, reduce infections,
and reduce wastage from line draws. The
device collects blood from the arterial or
central venous catheter where it is
connected.
Heparin or Saline Lock
The heparin or saline lock, which is
commonly called a "hep-lock," is an
intravenous (IV) catheter attached to a
stopcock or cap with diaphragm. The
basic function is to provide access for
administering medicine or drawing blood
from the patient. This is threaded in the
peripheral vein which is in the lower arm
above the wrist for up to 48 hours. It is
usually flushed with herapin or saline (to
prevent clogging) and capped for future
use.
 Intravenous (IV) Sites
An IV line is a thin plastic tube or catheter
inserted into a vein in the forearm to inject
a volume of fluids into the bloodstream.
The phlebotomist should avoid collecting
blood from the arm with IV because the
blood collected could be contaminated
with IV fluid. If blood collection is
necessary, collection site should be below
the IV. Take note that collection of blood
from known previously IV sites should be
avoided for 24 to 48 hours.
Central Vascular Access Devices
(CVADs)
The Central Vascular Access Devices
(CVADs) is also known as indwelling
lines which is a tubing inserted to the
main vein or artery used for blood
collection, monitoring the patient's
pressures and administering medications
and fluids.
There are three (3) types of CVADs
which include the Central Venous catheter
lines, implanted port, and peripherally
inserted central catheter.
CENTRAL VENOUS CATHETER is
also known as a central line inserted into
the large vein (subclavian) and advanced
into superior vena cava.
IMPLANTED PORT is a surgically
implanted disk-shaped chamber attached
into the indwelling line. This is usually
placed on the upper chest just below the
collarbone.
PERIPHERALLY INSERTED
CENTRAL CATHETER (PICC) is a
flexible tube
inserted into the veins of extremities and
the centralveins
HANDLING PATIENT
COMPLICATIONS ASSOCIATED
WITH BLOOD COLLECTION
Allergies to Equipment and Supplies
When the patient has adhesive allergy, a
gauze should be placed over the site and
should be removed after fifteen minutes.
The alternative is to ask the patient to
apply pressure for five minutes. For
Antiseptic allergy, simply use a different
antiseptic. And for latex allergy, look for
a sign to indicate the allergy and use a
non-latex alternative for gloves,
tourniquet and bandages.
Excessive Bleeding
When a patient is on aspirin or
anticoagulant, the bleeding may take a
longer time. The pressure should be
applied to the site until the bleeding stops.
The attention of the authorized personnel
should be called when the bleeding
continues after five minutes.
Fainting
Fainting is a temporary loss of
consciousness which is caused by the
insufficient flow of blood to the brain. If
the patient is prone to fainting during
venipuncture, they are asked to lie down
during the procedure.
Nausea and Vomiting
When the patient feels nauseous and has
the tendency to vomit, the phlebotomist
has to discontinue the procedure until the
patient feels better or until the feeling
subsides. An emesis basin or wastebasket
should be provided, and a cold damp
washcloth should be applied in the
forehead.
Pain
The patient should be warned before the
needle insertion, and the phlebotomist
should avoid redirection of the needle. If
the patient complains of extreme pain or
numbness, remove the needle and apply
ice to the site because this could indicate
nerve involvement. The phlebotomist
needs to document the incident if the
condition persists.
Petechiae
This condition involves the appearance of
small red or purple spots that look like
rashes, which appears on the arm when
tourniquet is applied.
Seizures/Convulsion
When seizures or convulsions occur, the
blood draw should be discontinued
immediately. Hold pressure over the site
but make sure that movement is not
restricted, the mouth is free from any
obstruction and the patient is protected
from self-injury. Call the attention of the
first-aid personnel.
AVOIDING AND HANDLING
PROCEDURAL ERROR RISKS AND
FAILURE TO DRAW BLOOD
Hematoma Formation
The phlebotomist should hold pressure on
the site immediately after discontinuing
the draw. A cold compress or ice pack
maybe offered to help address the
swelling. Factors that trigger Hematoma
are:
Excessive or blind probing
Inadvertent arterial puncture
Size of the vein - too small
The needle penetration - all through the
vein
Needle is not completely inserted
Tourniquet is still on when the needle was
removed
Pressure - not adequate
Latrogenic Anemia
This results from blood loss due to blood
draw. It is important to ensure to collect
only the required specimen volume
because if 10% of the blood volume is
removed at once from the body, the
patients could face a threat.
Inadvertent Arterial Puncture
This happens when blood is filling up the
tube rapidly and there is a rapid formation
of hematoma on the site.
Infection
Infection can be avoided by making sure
that tapes or bandages are not opened
ahead of time, needles are not preloaded
into the tube holders, insertion site of the
needle is not touched after sterilization,
cap is removed just before venipuncture,
and patients are advised to keep the
bandage on the site for at least 15 minutes
Nerve Injury
Nerve injuries happens when there is
improper site selection, rapid needle
insertion, excessive redirection of the
needle and blind probing. If the initial
attempt is not successful, the phlebotomist
should try to redirect the needle by using a
slightly forward or backward movement.
The next step is to remove the needle and
look for an alternative site.
Reflux of Anticoagulant
To avoid blood that has already been
drawn to flow back into the vein from the
collection tube, which may cause adverse
reaction because of the presence of tube
additives, make sure to keep the arm of
the patient in a downward position and the
tube just below the venipuncture sites.
Vein Damage
Damaging the vein could be avoided by
following the proper technique and
avoiding blind probing.
TROUBLESHOOTING FAILED
VENIPUNCTURE Venipuncture attempts
could fail due to improper seating of the
tube and failure of the needle to go
through the stopper. The phlebotomist
must be aware and must take measures to
ensure that the proper procedures are
followed. The needle position is critical to
the success of the venipuncture. The
phlebotomist should ensure that the
following does not happen:
Needle not inserted far enough
Bevel partially out of skin
Bevel partially into vein
Bevel partially through vein
Bevel completely through vein
Bevel against vein wall
Needle beside vein
Undetermined position
Collapsed Vein
The collapsed veins usually occur when
conditions are less than ideal, which leads
to the veins being blocked, resulting to
insufficient blood flow. This happens
when there is a strong pressure in the
vacuum of the tube or plunger, the
tourniquet is too close to the site or it is
too tight, or when the tourniquet was
removed during the draw.
Tube Vacuum
To avoid failure due to loss of vacuum,
the phlebotomist should make sure that
the bevel is not partially out of skin and
the tube itself is not damaged.
SPECIMEN QUALITY
Hemoconcentration is a decrease in the
fluid content or plasma volume which is
usually caused by tourniquet that
stagnates the normal flow of blood,
leading to the increase in concentration of
red blood cells and other nonfilterable
large molecules.
Hemolysis, which is also called
haemolysis, refers to the rupture pes of the
red blood cells. The hemoglobin is then
released to the surrounding fluid.  which holds blood specimen collected in
Partially Filled Tubes, or short draw,
happens when the phlebotomist pulls a
tube before reaching the required volume
which may lead to the incorrect blood-to-
additive ratio.
Specimen Contamination means that the
specimen is compromised due to incorrect
handling, which includes allowing
alcohol, powder or other materials into the
sample. Getting glove powder or
perspiration into films and specimens,
using the wrong antiseptic, or simply not
following the proper antiseptic procedure
could interfere with the results.
Wrong or Expired Collection Tube should
not be used because the manufacturer
could not warrant the quality of the seal
and pressure after the expiration date
declared in the tube.
LESSON 7
TYPE OF EQUIPMENT FOR
CAPILLARY COLLECTION
Capillary puncture or skin puncture is a
method that uses a lancet to make a small
incision in the capillary bed in the skin to
obtain a small volume of blood specimen.
The following are the equipment used for
capillary collection:
Lancet/Incision Devices - sterile, sharp
instrument that are intended for one-time
use only. It is designed for use in making
cuts in the skin for finger or heel
puncture.
Laser Lancet - a type of lancet that
produces a small hole in the skin by
vaporizing water in the skin. This
eliminates the risks of sharp injuries
because cauterizing the skin is not
necessary. There are 2 types that are used
in capillary puncture: finger puncture
lancet and heel puncture lancet.
Microcollection Containers - also known
as microtube, is a small plastic tube used
the capillary puncture. These have
markings on the side that show the
minimum and maximum fill levels and at
times comes with a narrow capillary tube.
Microhematocrit Tubes and Sealants -
narrow bore tube that could be made of
plastic or glass typically used for
hematocrit determinations. This can hold
50 to 75 mL and filled by capillary action.
One end is sealed with sealants made of
clay or plastic.
Microscope Slides - used for blood films
for hematology determinations
Warming devices - used to increase the
blood flow seven-fold by warming the
puncture site.
Capillary Blood Gas Equipment (CBG) -
special equipment used for collecting
capillary blood gas specimen (CBG)
which contains CBG collection tubes,
stirrers, magnet and plastic caps.
COMPOSITION OF CAPILLARY
BLOOD SPECIMEN, THE TEST AND
REFERENCE VALUE
The Capillary blood specimen is a mixture
of different blood and fluids which
include the following: arterial blood,
venous blood, capillary blood, interstitial
fluid and intracellular fluid.
Arterial Blood is the bright red blood
found in the pulmonary vein, left chamber
of the heart and the arteries. It is the
oxygenated blood in the circulatory
system.
Venous Blood is the blood that travels
from the peripheral veins passing through
the venous system then through the right
chamber of the heart. This is dark red in
color because it is deoxygenated.
Capillary Blood is preferred specimen for
infants, young children, elderly patients
and patients with severe burns. It is
extracted from the venules and arterioles
found in the capillary bed. Interstitial
Fluid fills the spaces around the cells and
these are filtered from the blood
capillaries and drained away as lymph.
Intracellular Fluid is found inside the
cells. They facilitate movement of fluid in
the membrane and they block the entrance
of unwanted materials.
The capillary reference values may vary
from the venous values. The concentration
of the glucose in the blood is higher,
while the Total Protein (TP), Calcium
(Ca2+), and potassium (K+)
concentrations are lower.
INDICATION SOF PERFORMING
CAPILLARY PUNCTURE ON
ADULTS, CHILDREN, AND INFANTS
Capillary specimen could be a good
alternative to venipuncture for adults and
older children under the following
circumstances:
veins are fragile and not accessible
because of scars, burns, etc.;
veins are reserved for another procedure
such as chemotherapy;
clotting tendencies,
extreme fear of needles and
veins will be used for POCT such as
glucose monitoring.
This is also the preferred method for
infants and young children because of the
following reasons: (1) health risks such as
anemia, and cardiac arrest; (2) requires
only a small volume of blood; (3)
venipuncture could damage veins and
tissues surrounding the site; (4)
puncturing could result to hemorrhage,
thrombosis, gangrene, and infection; (5)
risk of injury because of the restraint
needed in venipuncture; and (6) capillary
blood is the preferred specimen.
Capillary Puncture should not be used for
erythrocyte sedimentation rate methods,
blood cultures, studies that need plasma
specimen, and have large volume
specimen requirement.
ORDER OF DRAW FOR COLLECTING
CAPILLARY SPECIMEN
Order of Draw refers to the specific
sequence with which blood must be drawn
and collected in tubes to avoid cross
contamination of additives between the
tubes. The Order of Draw should be
Blood gas specimens (CBGs), EDTA
specimens, other additive specimen and
serum specimen.
PROCEDURE FOR SELECTING THE
PUNCTURE SITE AND COLLECTING
CAPILLARY SPECIMEN FROM
ADULTS, INFANT AND CHILDREN
Capillary Puncture steps
Step 1: Review & accession test request
Step 2: Approach, identify, & prepare
patientStep 3: Verify diet restrictions &
latex sensitivity
Step 4: Sanitize hands & put on gloves
Step 5: Position Patient
During finger puncture, the patient's arm
should be placed in a firm surface. His
arms should be extended, and his palms
are facing up.
When the patient is a young child, he
should be placed in the lap of his
guardian. While infants, the infant heel
puncture should be performed with the
baby in a supine position and his foot not
lower than his torso.
During finger puncture, the patient's arm
should be placed in a firm surface. His
arms should be extended, and his palms
are facing up.
When the patient is a young child, he
should be placed in the lap of his
guardian. While infants, the infant heel
puncture should be performed with the
baby in a supine position and his foot not
lower than his torso.
Step 6: Select the Puncture/Incision Site
As a general criterion, the skin of the
incision site should be pink, normal in
color, and warm. The selected area should
be free from scars, cuts, bruises, rashes,
cyanosis, edema, or infection.
When the patient is an adult or an older
child the palmar surface of the distal, end
segment of the middle finger or ring
finger of the non-dominant hand should
be used. The center or the fleshy portion
of the finger should be used.
For infants, the incision site should be less
than 2.0 mm deep and to avoid bone
damage the incision the recommended site
should be in the plantar surface of the
heel, or on the median or lateral edge.
Step 7: Warm Site if Applicable
Warming the incision site increases the
blood circulation in the area for up to
seven times. Using a warm washcloth or
towel, warm the site for 3 to 5 minutes.
Warming is usually done when the
specimen is for pH or blood gas specimen
collection and also recommended for heel
sticks.
Step 8: Clean and Air-Dry Site
The incision site should be clean and
sanitized using antiseptic or 70%
isopropyl alcohol.
Step 9: Prepare Equipment
Make sure that the phlebotomist is
wearing gloves before arranging the
sterilized collection device and placing
them in an area that is easy to reach.
Packages should be open in front of the
patient.
Step 10: Puncture the Site and Discard
Lancet
When doing the finger puncture, the
phlebotomist should hold the finger
between the thumb and index finger of the
non-dominant hand. He should then place
the lancet flat against the central fleshy
part of the incision site.
For heel puncture, he should hold the foot
gently but firmly and proceed to
encircling the heel with the use of the
index finger near the arch, the thumb
should be placed in the bottom, and the
rest of the fingers around the top portion
of the foot. Then the lancet is positioned
in the medial or lateral plantar of the heel.
Step 11: Wipe Away the first blood drop
because they may be contaminated with
excess tissue fluid.
Step 12: Fill and Mix Tubes/Containers in
Order of Draw
The phlebotomist should prioritize the
collection of slides, platelet counts, and
other hematology specimens to avoid
clumping and clotting. The anticoagulant
containers should be next followed by
serum specimens. Do not forget to touch
collection device to drop of blood.
Step 13: Place gauze and apply pressure.
Keep the incision site elevated.
Step 14: Label Specimen and Observe
Special Handling Instructions
Step 15: Check the Site and Apply
Bandage
Step 16: Dispose of Used and
Contaminated Materials
Step 17: Thank Patient, Remove Gloves,
and Sanitize Hands
Step 18: Transport Specimen to the Lab
ROUTINE AND THICK BLOOD
SMEARS
Routine blood film/smear preparation is a
blood test that is used to check
abnormalities in the blood cells. A small
drop of blood is placed near the frosted
end of the glass side. Another slide is used
to spread the blood in a thin film over the
slide. It is then air-dried and stained.
Thick blood smear preparation is used to
determine if the patient has malaria which
is diagnosed by its presence in the
peripheral blood smear. The procedure
starts by placing a large drop of blood in PATIENT IDENTIFICATION, TYPES
the center of the slide. The blood drop is OF SPECIMEN, LABELING
spread until it is about the size of a dime, PROCEDURES REQUIRED FOR
using a cover slip or another slide. This BLOOD BANK TESTS
should be air-dried for at least 2 hours
before staining. The Blood bank specimen is important in
determining which blood product can be
COLLECTION OF SPECIMEN FOR safely used for blood transfusion. Blood
CAPILLARY GAS, NEONATAL banks use a lavender-top or pink-top
BILIRUBIN, AND NEWBORN Ethylenediaminetetraacetic acid (EDTA)
SCREENING TESTS AND ITS tube or a red-top non additive glass as an
CLINICAL SIGNIFICANCE alternative.
Capillary blood gas specimen by heel Blood banks follow a strict identification
puncture which is recommended for and labeling procedure to ensure that there
infants and small children. The blood are no errors which could lead to
samples are collected on the same site as incompatible blood product that can cause
routine capillary puncture specimens. fatal reaction to the recipient of the blood.
The following information must be
Neonatal bilirubin collection is used to included:
help determine any liver disorder in
infants. This is collected with a heel stick.
Newborn/neonatal screening is done as Full name including middle initial
part of the routine check for infants to
determine inborn disorders such as Hospital ID Number
phenylketonuria, hypothyroidism and
Social Security Number for outpatients
galactosemia, and cystic fibrosis. 
Date of Birth
LESSON 8
Date & time of collection
PRINCIPLE BEHIND SPECIAL
COLLECTION PROCEDURES,
Initials of the phlebotomist.
SPECIAL SUPPLIES OR EQUIPMENT
Note: Room number and bed number
Special collection procedures are non-
is optional.
routine laboratory test that may not only
involve additional preparation and
procedure but may require other specimen
such as urine or feces. These can be
applied for special cases such as blood
donation.
Blood banks can use special identification
systems such as ID bracelet (self-carbon
adhesive for specimen), Blood ID band
(linear bar-code), and Siemens Patient
Identification check-blood administration.
Blood banks make tests in the lab to
ensure that the donated blood are safe for
blood transfusion. This includes typing
the blood for transfusion and screening for
infectious diseases. The blood type (ABO)
and Rh factor (+ or -) are determined.
There are cases when there is a need to
conduct a cross-match test to eliminate
blood related compatibility issues that
may arise between the patient and the
donor. The plasma or serum from the
patient is mixed the RBC of the donor to
check the compatibility.
PROPER DONOR IDENTIFICATION,
BLOOD UNITS LABELING AND POST
HANDLING PROCEDURES
Blood donor collection is done mainly for
the purposes of blood transfusion. Blood
is donated by volunteers in units.
Phlebotomists involved in donor
collection should have undergone a
special training to acquire these special
skills and should have excellent
venipuncture skills.
Blood donors should be 17 to 66 years of
age, with a minimum weight of 110 lbs.
They must have completed the physical
exam and declared their medical history.
Their medical history is recorded, and a
brief examination is conducted prior to the
collection. All donor information are
confidential and a written permission
must be submitted by the donor for
documentation purposes since all blood
components of a unit must be traceable as
part of the look back program.
The unit of blood can be separated into
RBCs, plasma and platelets but these
should still be traceable to the donor.
Under the lookback program, blood
recipients needs be notified when the
donor was diagnosed positive for
transmittable disease. The blood
components are then verified and
retrieved.
There are also cases when there is an
autologous donation where the patient
donates blood for his use especially for
elective surgeries. This eliminates risks
associated with blood transfusion. After
securing a written permission from the
physician, blood can be collected within a
minimum of 72 hours from the surgery
schedule.
Another special scenario is cell salvaging
where the blood of the patient is salvaged
(during surgical procedure), washed and
re-infused after testing for residual free
hemoglobin. The salvaged blood needs to
be tested prior to reinfusion because a
high free hemoglobin level means that too
many red cells were destroyed during the
salvage process and reinfusion is not
recommended because it will result to
renal dysfunction.
STERILE TECHNIQUE IN BLOOD
CULTURE COLLECTION
A blood culture is a test that checks the
blood for pathogens for patients who have
a fever of unknown origin (FUO). The test
determines the presence of bacteria in the
blood that causes bacteremia or presence
of microorganism and toxins in the blood
that causes septicemia.
The physician orders this test only if there
is a probability of bloodstream invasion.
Since the test identifies the responsible
organism and the extent of and infection
can be determined, the best antibiotic
could be prescribed.
For optimum results, the collection
should have 2-4 blood culture sets placed
in special bottles, one aerobic (with air)
and one anaerobic (without air), that were
drawn 30 to 60 minutes apart.
Skin antisepsis is crucial in the blood
collection procedure because it prevents
the contamination by microbial flora in
the skin which can be introduced in blood
culture bottles and affect the results.
The sterile technique varies per laboratory
but the following antiseptics can be used
to sterilize the site: betadine swab sticks,
chloroprep, PVP ampule, Frepp/Sepp II,
and Benzalkonium chloride. To minimize
the risk, friction rub of the collection sites
are performed for about 30 to 60 seconds
using tincture of iodine, chlorhexidine
gluconate, and a povidine/70% ethyl
alcohol combination. Any detected
microorganism in the laboratory should be
reported so that the physician could
evaluate if it is clinically significant.
BLOOD CULTURE COLLECTION
PROCEDURE
It is important to note that blood culture
collection takes first priority in the order
of draw to prevent contamination. Below
are the steps followed when doing blood
culture collection:
The patient should be properly identified
and the collection procedure should be
explained clearly.
Select the venipuncture site and release
the tourniquet within 60 seconds.
Assemble the equipment and make sure to
follow proper aseptic technique.
Perform the friction rub for about 60
seconds.
Wait for 30 seconds to allow the site to
dry.
Open the culture bottle by removing the
flip-off cap while checking the same for
defects. Bottle should draw at least 8cc
and should be in date.
Clean the bottle stopper while waiting for
the site to dry.
Check the fill lines on the bottle to
determine the minimum and maximum
level of the bottle.
Tourniquet should be reapplied and
perform the venipuncture. Make sure that
the site is not touched.
Inoculate the medium.
To mix the blood with the medium, invert
the bottle a couple of times.
If iodine is used in the arm, the patient's
skin should be cleaned.
Observe proper labeling procedures.
Make sure to include information about
the site where the blood was collected.
Discard used and contaminated materials
properly.
Courteously thank the patient. Remove
the gloves and decontaminate the hands
with hand sanitizer.
Transport the specimen promptly to the
laboratory for analysis and processing.
Media Inoculation Methods
There are three ways to inoculate the
medium: (1) directly into the bottle
(during collection), (2) collected in a
syringe (after collection), and (3) through
an intermediate collection tube (in the
laboratory).
In direct inoculation, a butterfly and
specially designed holder is used. The
holder is connected to the Luer connector
of the butterfly collection set. The aerobic
vial is filled first and each container is
mixed after removal from the holder. The
needle is removed after completing the
collection and the safety device is
activated as pressure is applied over the
site.
When using the syringe method, blood is
transferred to the culture bottles after
completing the draw using a safety
transfer device which is activated as soon
as the needle is removed from the site.
Attach the safety transfer device to the
syringe. Push the bottle into the device
until it reaches the stopper. The blood will
be drawn from the syringe filling the
vacuum in the container. The bottle
should be placed in a solid surface or in a
rack.
Intermediate Collection Tube is
performed in the laboratory rather than the
patient's bedside. Although this is not
recommended because the sodium
polyaethol sulfonate (SFS) in collection
tubes increase concentration when added
to the blood culture bottles. Moreover,
the transfer of blood increases the risk of
contamination and exposure of laboratory
staff. However, if it could not be avoided,
the yellow-top SFS tube is acceptable for
collection purposes.
COAGULATION SPECIMEN AND ITS
PROPER COLLECTION AND
HANDLING
A physician requests coagulation tests to
assess the blood clotting functions
especially if the patient has an
unexplained bleeding. This test could be
prothrombin time (PT), activated partial
thromboplastin time (aPTT), and
thrombin time (TT) which is a close
approximation of the hemostatic system.
The integrity of the blood specimen
during collection and transportation has a
direct effect on the test result, thus,
special care should be taken to ensure that
it is done properly.
If only the coagulation specimen is drawn,
draw a "clear" tube with 1-2 mL which is
discarded prior to collection. The blood
specimen is then collected using a light
blue top with 3.2% citrate tube with the
correct (9:1) blood to coagulant ratio.
To ensure proper mixing, invert the tubes
gently 3 to 4 times immediately after
collection.
Coagulation sample is collected second
when an evacuated tube system is used.
For draws using indwelling catheter, the
line should be flushed with 5 mL of
saline. The 5 mL which is equivalent to
six dead space volumes of catheter is
discarded.
The concentration of the sodium citrate
should be adjusted for patients with above
55% hematocritt values.
The collected specimen should be
transported to the laboratory immediately.
Should the specimen be unable to reach
the laboratory within four hours, it should
be centrifuged and the plasma frozen.
2-hour Postprandrial Glucose
This blood test is done to check if the
patient is suffering from diabetes and
other metabolic problems. The 2-hour PP
test is also used to monitor insulin
therapy. The principles of 2-hour PP
specimen collection are:
A high-carbohydrate diet was introduced
2 to 3 earlier.
The patient should fast at least 10 hours
prior to the test.
Fasting glucose specimen maybe be
collected before the start of the procedure.
A special breakfast containing an
equivalent of 100g glucose or a glucose
beverage will be given on the day of the
test.
Blood glucose specimen will then be
collected 2 hours after the meal.
Glucose Tolerance Test
A patient who could be suffering from
carbohydrate metabolism problems is
subjected to the glucose tolerance test
(GTT) which is also called oral glucose
tolerance test (OGTT) to evaluate the
ability of the body to metabolize glucose
by measuring the tolerance level to high
glucose level. Insulin response to a
measured dose of glucose is recorded by
specimen collection at given intervals.
The GTT length is 1 hour for gestational
diabetes while it is 3 hours for other
evaluations. The method of collection
should also be consistent be it
venipuncture or skin puncture.
GTT Procedure
Before the procedure the patient must eat
balanced meal containing approximately
150 grams of carbohydrates for 3 days
and must fast for 12 to 16 hours before the
scheduled test. Drinking water is allowed
to avoid dehydration and because urine
specimen is also collected as part of the
test. The steps in the GTT procedure are
as follows:
Begin with the normal identification
protocol. Explain the procedure and
advise the patient that only water is
allowed during the whole test period.
The fasting specimen is drawn and the
glucose level is checked and should be
over 200 mg/dL for the test to proceed.
The patient should collect a fasting urine
specimen if ordered.
The patient is given the glucose beverage
dose. Adult dose is 75g while children are
given 1g per kilogram of weight. For
gestational diabetes the dose should be
between 50 to 75g.
The beverage should be ingested within 5
minutes.
Record the time when the drink was
finished then start timing the test which is
collected within 30 minutes, 1 hour, 2
hours and so forth.
A copy of the collection time is provided
to the patient.
If applicable the collection time for other
specimen such as urine should coincide
with the computed collection time.
The exact time collected and the time
interval should be written in the label
along with patient identification
information.
Transport the specimen immediately or
within 2 hours for accurate results.
Lactose Tolerance Test
A lactose tolerance test  measures the
ability of the body to process lactose and
determines if the patient lacks mucosal
lactase which is an enzyme that converts
lactose into glucose or galactose.
Gastrointestinal distress and diarrhea
follows after ingestion of milk or food
containing lactose for those who lack the
lactase enzyme.
This test is similar to the procedure of the
GTT but the difference is that lactose is
substituted for glucose. The principles for
the lactose tolerance testing include:
It is recommended that a 2-hour GTT test
be administered at least a day before the
lactose tolerance test.
Equal amount of lactose is substituted to
glucose but the test will be performed
following the manner of GTT.
Glucose specimen is drawn at the same
time as the previous GTT procedure.
The GTT curve and the glucose curve will
be similar if the patient has mucosal
lactase.
Patients with slow gastric emptying,
Crohn's disease and cystic fibrosis could
show false-positive results.
Paternity/Parentage Testing
Parentage testing or paternity testing is
performed to exclude the possibility of
paternity of a particular child. Before the
advent of DNA parenting testing, testing
for parentage involves ABO and Rh
typing, and basic red cell antigen testing.
Should the result does not exclude alleged
parent further test is performed which
include extended red cell antigens, red
cell enzymes, serum proteins testing,
white cell enzymes, white cells antigen,
and human leukocyte antigen (HLA).
DNA paternity testing is the most
advanced technology to date. The test
uses the genetic fingerprinting or DNA
profiling to establish parentage by
providing genetic proof. Polymerase chain
reaction (PCR) and restriction fragment
length polymorphism (RFLP) are two
other methods used today although the
older techniques still exist.
The principles of DNA paternity testing
are:
All involved parties need to submit a
government issued photo identification
along with the completed Chain of
Custody form. The photos of all tested
parties are also taken.
The Buccal samples as collected by using
a swab that was rubbed inside the cheek
and the loose cheek cells adhere to the
swab.
Sealed and tamper-evident package are
used to hold the specimen during
transportation to the laboratory.
The test results are ready after 48 hours
which are usually sent via mail. 
CHAIN OF CUSTODY PROCEDURES
IN DRUG TESTING 
Toxicology Specimens
because toxicology test involves
collection of blood, hair, urine and other
substances from the body for the purpose
of determining the presence of toxins
which could be in very small amounts.
Forensics Specimens
Toxicology specimen are ordered by the
law enforcement department for legal or
forensic purposes. The most common
specimen are breath and blood for
alcohol. Others request urine for drug
screening, blood specimen for drugs and
DNA analysis. For forensic specimen,
there is a need to track the specimen from
the time of collection until the time that
the results are released using a special
protocol called chain of custody.
Important information about the collection
of the specimen is recorded in this form
which includes type of specimen, the
phlebotomist who made the collection, the
technician who processed the specimen,
details of the collection (time, date and
place) and the signature of specimen
owner. The collection and packaging is
done in the presence of a witness which is
usually a law enforcer and the person
responsible in collecting the specimen for
legal reasons could be summoned to
appear before the 7court as witness.

If the patient is lactose intolerant, the A phlebotomist plays a role in both

result will yield a "flat" curve where clinical toxicology (detection of toxins
glucose levels just slightly rise over the and treatment) and forensic toxicology
fasting level. (legal consequences of toxin exposure)
TIMING, ROLE OF DRUG HALF-LIFE,
NAMES OF DRUGS, ITS PEAK,
TROUGH, AND THERAPEUTIC
LEVELS IN DRUG MONITORING
Therapeutic Drug Monitoring
The Therapeutic drug monitoring (TDM)
measures drug levels at designated
intervals so that the appropriate dosage
can be established and maintained for the
patient thus avoiding toxicity. Drugs that
are monitored usually have a narrow
range between the amounts with which it
has optimal effect to the amount that
triggers side effects.
TDM begins with prescription of the
initial dosage appropriate for the patient's
clinical condition. The amount in the
bloodstream is expected to rise, eventually
reach peak (maximum) which screens
drug toxicity, and gradually fall to a
trough or minimum level which ensures
that the levels within therapeutic range.
The timing of collection is important for
aminoglycoside drugs (amikacin,
gentamicin, and tobramycin) which have
short half-lives but it is not critical for
phenobarbital and digoxin.
Appropriate concentrations should be
given to optimize the clinical outcomes
while considering the drug dosage, history
of dosage given, the recorded response of
the patient and desired outcome.
Therapeutic Phlebotomy
Therapeutic phlebotomy is performed by
drawing a large volume of blood from the
patient about 500 mL as part of the
treatment procedure for polycythemia and
hemochromatosis.
Polycythemia is the overproduction of red
blood cells which is harmful to the
patient. A hematocrit test is used to check
the RBC level and removal of blood is
done when level exceeds a certain level
with the goal of returning the levels to
normal range.
Hemochromatosis is characterized by
excess iron deposits in the tissues which
could be due to problems with iron
metabolism as a result of multiple blood
transfusions or excessive intake of iron.
The procedure is done by periodic
removal of single units of blood which
will gradually deplete the excess iron in
the body.
Blood Alcohol (Ethanol) Specimens
Blood alcohol (ethanol [ETOH]) tests are
usually ordered for purposes related to
treatment but could also be for industrial
or job-related purposes such as insurance
claims or programs and employee drug
screening. The law enforcement
department orders blood alcohol
concentration (BAC) for individuals
involved in traffic related accidents. The
ETOH test for treatment purposes do not
require the chain of custody to be
accomplished but the results of such tests
can become evidence in court. However,
BAC for industrial and legal samples
should follow the chain-of-custody
protocol.
The ETOH specimen collection uses
aqueous povidone-iodine and aqueous
benzalkonium chloride (BZK). Avoid
using isopropyl alcohol and tincture of
iodine as antiseptic because these might
affect the results. Just use plain soap and
water if the abovementioned antiseptic or
their alternative is not available. Use gray-
top sodium fluoride glass tubes for
specimen collection. These tubes could be
with anticoagulant but it depends on the
need of the required specimen for a
specific test. The tubes are filled until the
vacuum is exhausted. The tube stopper
should remain in place at all times
because alcohol could evaporate.
Drug Screening
Companies, healthcare organizations and
sports associations subject their potential
employee to drug screening as part of
their pre-employment requirement. The
company or organization could also run a
random screening without prior notice.
The specimen used is urine instead of
blood. The chain of custody protocol is
strictly implemented since legal
implications are involved.
Patient preparation requirements
-The purpose and procedure should be
explained to the patient.
-The patient should be advised about his
legal rights.
-There should be a witness present when
the form is signed.
Specimen collection requirements
A special area should be designated for
the purpose of urine collection.
During the collection, a proctor is present
to ensure that the specimen came from the
correct person.
Split sample may be used for parallel
testing.
Proper labeling should be followed to
establish a chain of custody.
Protect the specimen from tampering.
After collection it should be sealed in a
lock container and sent to the laboratory
immediately. Documentation should be
handled carefully.
Trace Elements
Trace elements tests for presence of
aluminum, arsenic, copper, lead, iron, and
zinc. They are collected in small amounts
and must use special element-free tubes
colored royal blue, since traces of these
elements in the glass, plastic or stopper
could trickle into the specimen will affect
the accuracy of the result. The type of
additive, if any, is indicated in the label.
(red - no additive, lavender - EDTA, and
green-heparin). To avoid contamination,
change the transfer device before filing
the tube.
PRINCIPLE OF THE DIFFERENT
POINT-OF-CARE TESTING (POCT)
The Point-of-Care Testing (POCT) is any
analytical test that is done outside the
centralized laboratory and near the site
where the patient receives treatment.
POCT has been called by different names,
such as alternate site testing (AST),
bedside, near-patient testing, remote
testing, satellite testing, and rapid
diagnostics. The testing ranges from a
simple procedure as a dipstick,
glucometer which is handheld, and up to
automated molecular test using analyzers
and imaging systems that are portable.
These tests are not only convenient, but it
also shortens the turnaround time (TAT).
Quality and Safety in POCT
Quality Control (QC) and maintenance
procedures should be followed during the
conduct of POCT to maintain the
accuracy of the results. The processes
should yield results that are no different if
the test has been performed in the
centralized or main laboratory which
poses a challenge to the phlebotomist.
However, waived test are becoming more
prevalent and these test does not need to
be of the same level as non-waived test.
For this reason, Quality Control
procedures are in place for strict
compliance.
In the effort to continuously improve the
healthcare service provided to the
patients, manufacturers have enhanced
their instruments to include electronic
QCs (EQCs) which can detect specimen
related problems. Internal checks are also
in place to check the functionality status
of the instrument. These enhancements
have greatly helped ease the regulatory
requirements for POCT. For non-
instrumented tests, daily external liquid
QC checks make sure that there is
adherence to use of required techniques
and the gnerated results are accurate.
Another challenge is that POC
instruments, such a handheld analyzers,
may help in the transmission of infection
in the facility. Several manufacturers
recommended disinfecting the instrument
using 10% bleach to reduce the risk of
cross contamination between patients.
Coagulation Monitoring by POCT
Warfarin and heparin therapy can be
evaluated using a Coagulation POCT
analyzer. The common coagulation tests
checked are Prothrombin time (PT) &
international normalized ratio (INR),
Activated partial thromboplastin time
(APTT or PTT), Activated clotting time
(ACT), and Platelet function. Listed are
the available POCT instruments available:
Cascade POC —ACT, APTT, PT/INR
CoaguChek XS Plus —PT/INR
GEM Premier 4000 —ACT, APTT,
PT/INR
i-STAT —ACT, PT/INR
Verify Now —platelet function
Bleeding Time
Bleeding time (BT) test is a non-
instrumented test ordered by the physician
to evaluate the capillaries for platelet plug
formation which is indicative of disorder
in the platelet function or problems in
capillary integrity. This test is also used
for pre-surgical screening and detection of
problems involving hemostasis. Although
platelet function assays (coagulation test)
has been mostly ordered in place of BT, it
is still requested in some occasion.
Execution of the proper technique is
important to get an accurate result.
The following steps in BT should be
followed:
The patient should be identified properly.
Proper hand hygiene should be followed.
Ask the patient if he has taken aspirin or
any salicylate-containing drug within a
period of the past two weeks because it
can prolong bleeding time which will
influence the result. Inform the patient
that although the incision is small,
scarring could still occur.
Place the arm on a steady surface for
support.
The site should be in the volar lateral of
the forearm and 5 cm distal to the
antecubital area. Shave the area when
necessary and make sure that the area
does not have surface veins, scars, bruises
or edema.
A blood pressure cuff is placed around the
arm.
Use alcohol to clean the selected area with
alcohol. Allow the site to air-dry.
The phlebotomist should put on gloves &
prepare equipment to be used while
waiting for the site to dry.
Open the puncture device package and
keep blade sterile.
The blood pressure cuff should be inflated
to 40 mm Hg.
The safety clip must be removed quickly
and positioned on the forearm
The trigger should be depressed while
simultaneously starting the timer. The
blade will then retract. Remove the device
from the arm and discard sharps properly.
A filter paper should be used to blot the
blood flow for 30 seconds. Wick the
blood without touching the wound.
Stop the timer when bleeding stops and no
longer stains the filter paper. The test is
stopped if bleeding persists beyond 15
minutes.
The blood pressure cuff is removed. Clean
the arm and bandage the arm. Advise the
patient to keep the site dry and bandage
should be intact for the next 24 hours.
The bleeding time is recorded and
rounded to the nearest 30 seconds.
Normal results are between 2 to 8
minutes.
Follow proper disposal of used &
contaminated supplies. Thank patient
before you leave.
Arterial Blood Gases and Electrolytes
Many healthcare institutions have
supported the use of POCT for arterial
blood gases (ABGs) and electrolytes in
selected settings such as the emergency
department, pulmonary unit and neonatal
intensive care unit. It has been said that
these panels of test are more expensive
than traditional pre-analytic and analytic
procedures performed in a typical
laboratory but it has greatly improved the
turnaround time for the of test for patients
in emergency situations which in turn
reduces the time of waiting for the
physician's medical diagnosis and
prescription.

Arterial Blood Gases
The arterial blood gas (ABG) test
measures the level of oxygen, carbon
dioxide and acid-base (pH) in the patient's
blood which gives the physician an idea
about the status of the function of your
lungs, heart and kidneys. ABGs measured
by POCT methods include potential
hydrogen (pH), partial pressure of carbon
dioxide (PCO2), partial pressure of
oxygen (PO2), and oxygen saturation
(SO2).
pH refers to the concentration of hydrogen
ions in a solution. The arterial pH test
checks the balance of the acid-base level
which shows the metabolic and
respiratory status of the patient.
Normal range is from 7.35 to 7.45 only.
The PCO2 is an indicator on how well air
is exchanged between the blood and
lungs. The test shows the measure of
pressure exerted by dissolved CO2 in the
blood plasma in proportion to the PO2 in
the alveoli. Hypoventilation is when the
PCO2 level increased to an abnormal
level while hyperventilation is when it
decreases. On the other hand, PO2 is
representative of the pressure exerted by
the dissolved O2 and the ability of the
lungs to diffuse oxygen through the
alveoli which is usually used to measure
the effectiveness of an oxygen therapy.
SO2 is used to evaluate the oxygenation
status of the patient. It measures the
percentage of the binding sites of the
hemoglobin that is occupied by oxygen in
the blood. A normal person exhibits 98%
oxygen saturation.
Electrolytes
The electrolytes in the body mainly aid in
moving nutrients in the body and removes
wastes in the cells of the body. The POCT
uses electrolyte panels to determine the
blood level of sodium (Na+), potassium
(K+, chloride (Cl-), bicarbonate ion
(HCO3), and ionized calcium (iCa2+).
Sodium helps keep the normal balance of
fluids in the body and also plays a role in
transmitting nerve impulses. An elevated
level of sodium is called Hypernatremia
while reduced level is known as
hyponatremia. Potassium is an electrolyte
that helps in nerve conduction and muscle
function. It also regulates the acid-base
balance and keeps the blood pressure in
check. We call increased blood potassium
hyperkalemia while the decreased level is
called hypokalemia. Chloride maintains
the integrity of the cells by helping in
keeping the balance in osmotic pressure as
well as the acid-base and water balance of
the body. Bicarbonate ion helps transport
carbon dioxide to the lungs and it also
helps with the regulation of blood pH.
When there is a decrease in H+ ions and
increase in blood pH or hypoventilation,
that patient might suffer from acidosis.
When the condition is reversed or there is
hyperventilation, the condition could lead
to alkalosis. Ionized calcium comprise
about 45% of the blood calcium and they
help in the muscular function, cardiac
function, blood clotting, and nerve
transmission function of the body.
LESSON 9
STEPS INVOLVED IN PROCESSING
AND HANDLING DIFFERENT TYPES
OF SPECIMENS
The result of a test is compromised when
the proper collection procedures, storage,
processing, and transporting protocol
were not followed in the preanalytical
phase. Studies show that approximately
48% to 68% of laboratory result failures
are due to prior to analysis phase
mishandling or error. The phlebotomist
should be responsible enough to follow all
the appropriate steps required for each test
that he is scheduled to perform.
Routine Handling
A phlebotomist should have the
knowledge and skills to perform routine
venipuncture and he should also be
careful in mixing tubes and preparing
specimen for transport to the laboratory.
He should adhere to time limits set for
delivery of specimen to the laboratory
except for cases such as emergency
specimen or other conditions mentioned
in the time limit exception within the
chapter.
Mixing tubes by inversion
Some tests require gentle inversion of the
specimen tube to evenly distribute
additive. The number of inversion
depends on the type of additive but it is
usually between 3 to 10 inversions.
Special Handling
There are cases when temperature and
light affects the analytes for a blood
specimen with which special care when
handling them is needed to protect the
condition and quality of the specimen
collected.
 Body temperature
Specimen that precipitate or agglutinate if
allowed to cool below body temperature
should be transported at near body
temperature which is 37˚C. The tubes
should also be pre-warmed at 37˚C and
portable heat blocks are used during
transport which could hold the
temperature for 15 minutes from removal
from the incubator. A heel warmer can be
used for specimen that can withstand a
temperature slightly higher than 37˚C.
Examples: Cold agglutinin,
cyrofibrinogen, and cyroglobulins
Chilled specimens
Chilling slows the metabolic process
which could affect the results for some
specimen. It should be completely
submerged in crushed ice and water slurry
during transport and immediately tested or
refrigerated if needed.
Examples: Adrenocorticotropic hormone
(ACTH), acetone, Angiotensin-converting
enzyme (ACE), ammonia,
catecholamines, free fatty acids, gastrin,
glucagon, homocysteine, lactic acid,
parathyroid hormone (PTH), ph/blood gas
(if indicated), pyruvate, renin
Light-sensitive specimens
There are cases when exposure to light
could affect the result of a specimen, like
bilirubin. The phlebotomist should wrap
the tube with aluminum foil or use light-
blocking amber-colored container.
Examples: Bilirubin, Carotene, Red cell
folate, serum folate, Vitamin B2, Vitamin
B6, Vitamin B12, Vitamin C, urine
porphyrins, and urine porphobilinogen
CRITERIA FOR SPECIMEN
REJECTION
The collected specimen is transported to
the central processing or triage for
screening and prioritizing. The specimen
are (1) identified, (2) logged or
accessioned, (3) sorted by department and
type of processing, and (4) evaluated for
specimen suitability which is necessary
for accurate reasons.
The specimen is rejected if it did not meet
a specific criterion such as:
Specimen is not identified properly.
It has inadequate volume to complete the
test.
Hemolysis
The use of wrong tube for collection.
Outdated tube
Improper handling (improper mixing)
Contaminated specimen
Insufficient specimen or "Quality Not
Sufficient" (QNS)
Incorrect collection time
Exposure to light
Did not follow testing time limits
Delay or error in processing
TIME CONSTRAINTS AND
EXCEPTIONS FOR DELIVERY AND
PROCESSING OF SPECIMENS  to blood and other potentially infectious
Delivery time limits
The specimen should be transported to the
laboratory immediately after collection.
Routine blood specimen is expected to
reach the laboratory within 45 minutes.
For specimen that needs centrifugation, it
should be done in 1 hour. However,
hematology specimen with EDTA which
are placed in tubes with lavender or
purple stopper should not be centrifuged.
Time Limit Exceptions
The delivery time limit has some
exception such as specimen that are
marked as "STAT" or "emergency", it
takes priority over all other specimen in
terms of transportation, processing and
testing. Aside from this, listed below are
other exceptions to the time limit rule:
Blood smear from EDTA specimen -
prepared 1 hour from collection
EDTA specimen for CBC - analyzed
within 6 hours but are stable 24 hours
from collected if stored in room
temperature.
EDTA specimen for erythrocyte
sedimentation rate (ESR) determination -
tested 4 hours (room temperature) and 12
hours (refrigerated).
EDTA specimen for reticulocyte counts -
stable for 6 hours (room temperature) and
72 hours if refrigerated.
Glucose test drawn in sodium fluoride
tubes - stable for 24 hours (room
temperature) but stable for up to 48 hours
when refrigerated at 2°C to 8°C.
Prothrombin time (PT) - stable for 24
hours and partial thromboplastin time
(PTT) should analyzed within 4 hours
from collection.
OSHA-REQUIRED PROTECTIVE
EQUIPMENT WORN WHEN
PROCESSING SPECIMEN
When processing specimen in the
laboratory, the health worker is exposed
materials. For this reason, health care
institutions should comply with the
appropriate protective equipment required
by the Occupational Safety and Health
Administration (OSHA) which includes
wearing gloves to prevent contact with
blood, laboratory gown, laboratory coats,
and masks.
CENTRIFUGATION
A centrifuge is a apparatus that is used to
separate cells, plasma or serum of blood
specimen which is achieved by spinning
the blood tubes inside the vessel at a high
speed such that the centrifugal force will
cause the separation of specimens.
It is important to leave the stoppers on the
tube before and during centrifugation to
avoid contamination, evaporation, aerosol
formation, and pH changes which will
affect the accuracy of the results. Take
note that the tubes should be balanced in a
centrifuge, meaning tubes of the same size
and volume of specimen should be placed
opposite one another. A centrifuge should
not be repeated. 
The plasma specimen collected in tubes
with anticoagulants should be centrifuged
immediately and without any delay. On
the other hand, serum specimen needs to
be completely clotted prior to
centrifugation. Normally, complete
clotting takes around 30 to 60 minutes at
room temperature.
Although there are machines that tests
sample specimens directly through the
stopper, most of the test needs the stopper
to be removed to obtain the serum or
plasma. Removal can be done using
removal devices or robotics but if there is
a need to remove the stopper manually, a
face shield or splash shield should be used
to protect the technician from any risk of
contamination. A gauze or tissue is used
to cover the stopper to catch drops of
blood that may leak or to catch aerosol
that maybe released during the process.
The tube stoppers should be removed by
pulling it straight up and off the tube.
ALIQUOT PREPARATION
An aliquot of specimen refers to a portion
of a sample specimen taken for chemical
analysis or testing. This is prepared when
multiple tests are ordered on a single
specimen. The preparation is done by
transferring a portion of the specimen into
one or more tubes that are labeled with the
same information as the original specimen
tube using a disposable transfer pipettes.
Do not put specimen with different
anticoagulants in the same aliquot tube.
Make sure to cover the tube as soon as it
is filled.