MODULE 4.
BLOOD COLLECTION EQUIPMENT, • An equipment carrier makes the
ADDITIVES, AND ORDER OF DRAW
-Introduction-
Phlebotomists are responsible for collecting blood
specimen for testing in the laboratory. It is imperative that
they are knowledgeable about the pieces of different
equipment, devices, and supplies used for the different
methods of drawing blood so they could prepare them
appropriately. Selecting the correct tools and using them
properly during the testing procedure does not only ensure
safe collection but also guarantee accurate results.
-objectives-
Upon completion of this module, you should be able to:
1. discuss the use of equipment and supplies needed to
collect blood by venipuncture;
2. distinguish between antiseptics and disinfectants and
cite examples of each;
3. identify appropriate phlebotomy needles by length,
gauge, and any associated color coding;
4. illustrate how the evacuated tube system (ETS) and
syringe system components work, and when they are
used;
5. enumerate the general categories of additive used in
blood collection;
6. describe the color coding used in identifying additives
in blood collection tubes; and
7. explain the "order of draw” followed in blood collection
using multiple tubes.
Definition of terms
Term Definition (Meriam Webster Dictionary)
Equipment - the set of articles or physical resources
serving to equip a person or thing
-discussion-
. "sharps containers” are used as receptacle for
PART 1. EQUIPMENT AND SUPPLIES USED IN
VENIPUNCTURE
I. General Blood Collection Equipment and Supplies
There are general blood collection equipment and supplies
that are commonly used by the phlebotomist regardless of
the collection method. These should be calibrated and
maintained on a regular basis for the safety of the patient
and health worker during blood collection.
• The blood-drawing station is primarily used for the
outpatient department and typically has a table for
supplies, a comfortable chair for the patient to sit on
during the procedure, and a bed or padded table for
the heelstick procedure for infants and young children.
• The phlebotomy chair should be comfortable and with
an adjustable arm rest.
collection portable. A hand-held
phlebotomy equipment is used
for "stat" cases and a phlebotomy
cart is usually utilized for early-
morning phlebotomy rounds. The
carts are left in the hallway to Figure 4.1 Tackle box
avoid nosocomial infection.
• A new pair of gloves and glove liners should be used
when performing blood collection. Gloves should
have a good fit. The gloves that are approved to be
used during phlebotomy are: (1) non-sterile, (2)
disposable latex, (3) nitrile, (4) neoprene, (5)
polyethylene, and (6) vinyl. It is best if the
phlebotomist uses liners when his/her skin is prone
to allergies and dermatitis.
• Antiseptics are used to prevent sepsis, which is the
presence of harmful bacteria that typically enters the
human body through a wound or a break in the skin.
• Disinfectants, which are used in killing
microorganisms on surfaces and instruments, should
be handled with care because they could be harmful
to the skin.
• The use of hand sanitizer or wall-mounted hand
sanitizer dispenser is recommended as a substitute
for hand washing except when the hands are visibly
soiled.
• Gauze pads are clean 2x2-inch gauze folded in
fourths. They can be used to hold pressure after
blood collection instead of cotton balls, since they
have fluid-proof backing that prevents contamination.
• Bandages can be used on the blood collection site
once the bleeding has stopped. Other materials such
as paper, cloth, or knitted tape can also be used over
folded gauze.
• 1x3-inch glass microscope slides for blood films are
used in hematology determinations.
• A pen with non-smear ink is recommended to be
used when labeling specimens.
• A watch with timer can be used to determine
collection times and to time tests.
• Sharp’s disposal containers, commonly called
needles, syringes, lancets, and other sharp objects.
• Biohazard bags are used to transport blood and other
specimens to the laboratory. These are leak-proof
bags marked with biohazard logo. An outside pocket
is used to hold requisitions and other documentation.
Figure 4.2 Sharp container Figure 4.3 Biohazard bags
II. Venipuncture Equipment
Aside from the general collection tools discussed
previously, there are pieces of equipment that are used for
venipuncture purposes only. They are as follows:
 1. Vein-locating devices are IV. Phlebotomy Needles
transillumination portable devices There are three types of phlebotomy needles used in
that use infrared light to help evacuated tube system or syringe system. These are:
health professionals locate and
assess veins for safe venous 1. The multi-sample needles are used in the evacuated
access. tube system (ETS) and are equipped with safety
Figure 4.1 Vein-locator features. Color-coded needles that do not have
2. Tourniquet is a constricting device applied to a safety features must be used with tube holders that
patient's arm prior to venipuncture with the aim of have safety features.
inflating the veins by restricting venous blood for a
period of time. This device comes in different sizes and
is intended for single use only.

Figure 4.5 Multi-sample needles

2. A hypodermic needle is used in the syringe system

Figure 4.2 Tourniquet and comes with different gauges and lengths for
different types of usage.
3. Needles are used for withdrawing blood samples.
These are sterile and for single use only. The 3 types
of needles used in venipuncture are multi-sample,
hypodermic, and winged infusion.
4. Needle gauge is classified according to the diameter
of the lumen. The higher the number, the smaller the
Figure 4.6 Hypodermic needles (syringe)
actual needle diameter. The appropriate gauge used
should be 20 to 23, but a 21-needle gauge is the most
3. A winged infusion set (butterfly) is used for difficult
commonly used. The length of the needle in
veins such as those of pediatric or elderly. patients
venipuncture is 1 to 1.5
because it is more flexible than the needle or syringe.
inches. The needles come
It is composed of ½ to ¾ inch stainless needles, 23
with color-coded caps and
to 25 gauge, with 5- to 12-inch tubing. It has a Luer
hubs for easy identification.
attachment for syringes or multi-sampler Luer
They are equipped with safety
adapter for ETS. The wings or the plastic extensions
features such as resheathing,
facilitate the easy manipulation of the shallow angle
blunting, and retraction
needle insertion.
devices. Figure 4.3 Needle Gauge

5. Evacuated tube system (ETS) is a closed collection

system composed of multi-sample needle, tube holder,
and evacuated tubes, which prevents exposure to
contaminants. One end of the needle is pierced
through the vein and the other end is in the stopper of
the evacuated tube allowing the blood to flow into the
tube. This allows numerous tubes to be collected in a
Figure 4.7 Winged infusion set (butterfly)
single venipuncture.
V. Syringe System and Evacuated Tube System (ETS)
III. Antiseptics and Disinfectants used in Venipuncture Components
The disinfectants preferred to be used in venipuncture are
Environmental Protection Agency (EPA)-registered sodium 1. Syringe System
hypochlorite with 1:100 dilution. For spills clean-up The syringe system is used as an alternative method when
procedures, the 10% dilution is used. The contact time drawing blood from patients with small or difficult veins. It is
required is 10 minutes. a traditional collection procedure that uses a syringe to
draw blood from the patient and the collected specimen is
There are different antiseptics that are used in blood transferred into tubes. The components of this system
collection. The use of alcohol-based include:
preparations is becoming popular because
• a syringe needle that
many patients have allergies when exposed
has a resheating
to povidone-iodine. The following are
feature, and
antiseptics that are used in blood collection:
• a syringe that is
70% ethyl alcohol, 70% isopropyl alcohol,
divided into a
benzalkonium chloride, chlorhexidine
graduated barrel and
gluconate, hydrogen peroxide, povidone-
plunger
iodine; and tincture iodine. Figure 4.9 Syringe
Figure 4.4 Alcohol

MODULE 4 – BLOOD COLLECTION EQUIPMENT, ADDITIVES, AND ORDER OF DRAW 2

When drawing blood, the plunger is pulled back slowly,
thus, creating a vacuum that causes the barrel to fill with
blood. It uses a hypodermic needle and sterile plastic
syringe with Luer lock tip. Syringes that are commonly used
in phlebotomy are 2 ml, 5 mL, and 10 mL. The blood
collected by the syringe should be transferred into tubes
using a syringe transfer device which is. attached to the hub
of the syringe after the syringe draw is completed. Syringe
transfer devices facilitate the transfer of blood into tube;
without stopper removal or the use of a syringe.
2. Evacuated Tube System
Evacuated tube system (ETS) is a closed collection system
that is considered the most efficient system for collecting
blood samples. The procedure involves piercing one end of
the double-pointed needle into the vein and the other end
in the stopper of the evacuated tube allows the blood to flow
into the tube. This method enables numerous tubes to be
collected in a single venipuncture.
Figure 4.10 ETS Parts
The system is
composed of
multi-sample
needles, tube
holders, and
evacuated tubes
that prevent the
exposure of the
specimen to
contaminants.
The ETS
needles are
threaded in the middle and the bevel point on each end. The
threaded portion is then attached to a tube holder with the
sleeve that retracts when the needle goes through the tube
stopper. The sleeve slides back once the tube is removed
to prevent leakage. The tube holders can accommodate
different-sized tubes. Should it lack safety features, the
phlebotomist must make sure that the needle used has a
safety feature. The needle and the tube-holder device are
permanently attached as a unit or come pre-assembled.
Evacuated tubes are color-coded tubes filled with
predetermined volume of blood by vacuum. They are used
in both the ETS and syringe method and can be an additive
or non-additive tube. They are available in different sizes
and volumes and can be made of glass or plastic. The
usage depends on, factors which include the age of the
patient, size and condition of the vein, and the volume of
blood that is needed.
PART 2. CATEGORIES OF ADDITIVES USED IN
BLOOD COLLECTION
The blood collection tube may contain one or more
additives depending on. the test ordered by the physician.
They can be in liquid, spray--dried, or powdered form and
each additive has a specific function. The tube should be
gently inverted 3 to 10 times after the collection to mix the
additive with the specimen. Listed are the categories of
additives used in blood collection:
MODULE 4 – BLOOD COLLECTION EQUIPMENT, ADDITIVES, AND ORDER OF DRAW 3
• Anticoagulants - commonly called blood thinners,
are chemical substances that prevent blot clots. The
two methods are by precipitation of calcium or by
preventing thrombin formation. The different ·types
of, anticoagulants are ethylenediaiminetetraacetic
acid (EDTA), citrates, heparin, and oxalates.
• Special-use anticoagulants – include acid citrate
dextrose, citrate phosphate dextrose, and sodium
polyanethol.
• Antiglycolytic agents - are substances that prevent
the breakdown of glucose by blood cells or
glycolysis. The most common is sodium fluoride
which preserves glucose and prevents growth of
bacteria. It is usually used with potassium oxalate for
rapid response.
• Clot activators - enhance coagulation in serum
specimen tubes. There are two types of activators:
clotting factors such as thrombin, and substances
that provide more surface for platelet activation such
as glass (silica) particles and inert clays (celite).
• Thixotropic gel separator - inhibits cells from
metabolizing substances and moves between cells
and serum, or plasma when centrifuged.
• Trace element-free tubes - are made of materials
that are free of trace element contamination. They
have royal-blue stoppers and are used for a variety
of purposes such as trace element tests, toxicology
studies, and nutrient determination.
I. Color Coding in Identifying Additives in Blood
Collection Tubes
An additive is any substance that is placed within the tube
and can be used in ETS tubes to prevent clotting and to
preserve the components. The amount in the tubes is
calibrated by the manufacturer. Blood collection stoppers
have color-coded caps 'depending on the additives that
they contain. Listed are the cap colors and their additives.
(Table 4.1)
Table 4.1 Color Coding for Tube Caps
Cap Color Specification
RED No additive
ORANGE Coagulant
YELLOW Coagulant and Separation Gel
GREEN Heparin Sodium
LIGHT Heparin Lithium
GREEN
PURPLE EDTA Coagulant
LIGHT BLUE Sodium Citrate 1:9
BLACK Sodium Citrate 1:4
GREY Potassium Oxalate Monohydrate and
Sodium Flouride
II. Order of Draw
Order of draw refers to the specific order that must be
followed by a phlebotomist when collecting blood samples
to prevent any cross-contamination, especially when
dealing with multiple collection tubes. Not following the
prescribed sequence affects the test results due to cross-
contamination.
 Prepared by:

Ruth Abigail S. Contante, RMT, LPT

Instructor

Student assessment question 1:

Suppose you did not follow the order of draw; do you
think there would be an effect with regards to the
accuracy and precision of the results? Support your
answer. (10 pts)

Student assessment question 1:

Differentiate the following in a tabular form:
1. Syringe System
2. Evacuated Tube System
3. Winged infusion set
After the table, choose one venipuncture technique that
you think would best suit you and would you learn
easily. (40 pts)

-SUMMARY-
Proper specimen collection and handling is a critical part of
obtaining a valid laboratory result. Specimens must be
collected in the appropriate collection container, kit or
device, correctly labeled and transported promptly to the
laboratory. The phlebotomist should follow essential
safeguards to ensure accurate testing and to provide quality
patient care.

-reference-
• Learning Guide for Principles of Medical
Laboratory Sciences 2
Copyright 2020 by C&E Publishing Inc.,
Bernard U. Ebuen, Nini F. Lim, Edliberto P.
Manahan, Jose Jurel M. Nuevo, Maria Luisa R.
Olano, and Aileen C. Patron

MODULE 4 – BLOOD COLLECTION EQUIPMENT, ADDITIVES, AND ORDER OF DRAW 4