PRINCIPLES OF MEDICAL LABORATORY SCIENCE 2

[TRANS] LESSON 4: BLOOD COLLECTION EQUIPMENT, ADDITIVES, AND ORDER OF DRAW

1. Vein-locating devices: transillumination portable devices
that use infrared light to locate veins
OUTLINE 2. Tourniquet: constricting device applied to patient’s arm
I General Blood Collection Equipment & Supplies prior to venipuncture
II Venipuncture Equipment  Inflates veins by restricting venous blood
A Antiseptics and Disinfectants
flow
III Phlebotomy Needles
IV Syringe System and Evacuated Tube System (ETS) 3. Needles: for withdrawing blood
Components  Multi-sample, hypodermic, winged infusion
V Categories of Additives Used in Blood Collection 4. Needle gauge: according to diameter of lumen
VI Order of Draw  Higher the number = smaller needle
diameter
 21 gauge: commonly used
GENERAL BLOOD COLLECTION EQUIPMENT  Length: 1-1.5 inches
AND SUPPLIES  With color coded caps and equipped with
safety features: resheating, blunting, and
Table 1. Equipment & Supplies retraction devices
Equipment Use 5. Evacuated tube system (ETS): closed collection system
Blood- For outpatient department  Multi-sample, adapter, evacuated tubes
drawing - With bed or padded table for heelstick : allows blood to flow directly to the tube
station procedure
- For “stat” cases ANTISEPTICS & DISINFECTANTS
Equipment - Early morning phlebotomy rounds  Environmental and Protection Agency (EPA) registered
carrier - Left in the hallway to avoid nosocomial  Sodium hypochlorite with 1:100 dilution – “chlorox:
infection o 1 is to 10
1. Non-sterile o 100 ml: 10ml = hypochlorite (?)
2. Disposable latex  For spills: 10% dilution is used
3. Nitrile o Contact time: 10 mins
Gloves 4. Neoprene  Antiseptics:
5. Polyethylene o 70% ethyl alcohol
6. Vinyl o 70% isopropyl alcohol
7. Liners (if prone to allergies)  because of its properties; water acts a
- Prevents sepsis denature/catalyst to penetrate the walls of
Antiseptics
- Applied onto skin of patient the bacteria; helps in penetration in killing
Disinfectants - Sanitizes instruments and materials the bacteria
- Clean 2x2 inch gauze folded in fourths o Benzalkonium chloride
- Hold pressure after blood coll o Chlorhexidine gluconate: for larger surfaces
Gauze pads
- Has fluid proof backing
o Hydrogen peroxide
**Cotton - can remove platelets on area
o Povidone-iodine: for alcohol test
Can be used once bleeding has stopped
o Tincture iodine
Bandages - Paper, cloth, knitted tape can be used
over folded gauze
1x3 inch PHLEBOTOMY NEEDLES
glass For blood films in hematology  Multi-sample needles: used in ETS; equipped w/ safety
microscope determination features
slides o Color-coded needles that do not have safety
Pen with non features must be used with tube holders that have
Ball point pen for labelling specimens safety features
smear ink
Watch with  Hypodermic needle: used in syringe system; different
Monitor collection time and to time tests gauges and lengths
timer
Sharps  Winged infusion set (butterfly): for difficult veins,
Receptacle for needles, syringes, lancets pediatric or elderly patients; more flexible
disposal
and other sharp objects  Wings: for easy manipulation of shallow
containers
To transport blood and other specimens to angle insertion
the lab o ½ to ¾ inch stainless needles
Biohazard o 23 to 25 gauge
- Leak-proof
bags
- Outide pocket for requisitons and other o 5 to 12 inch tubing
documentations o Luer attachment for syringes
o Multi-sampler luer adapter for ETS
VENIPUNCTURE EQUIPMENT
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PRINCIPLES OF MEDICAL LABORATORY
SYRINGE SYSTEM & EVACUATED TUBE SYSTEM
COMPONENTS

 SCIENCE
Enhance coagulation in serum specimen tubes
2 types of activators: clotting 2
factors (thrombin) and
substances that provide more surface for platelet
SYRINGE SYSTEM activation (silica and inert clays [celite] )
 Alternative method when drawing blood with small or
difficult veins; THIXOTROPIC GEL SEPARATOR
 Transferred to tubes using a syringe transfer device which  From metabolizing subs.
is attached to the hub of the syringe  Moves between cells, serum or plasma when centrifuged
 Syringe transfer device: w/o stopper removal TRACE ELEMENT FREE TUBES
 Traditional method
 Royal blue stoppers
o syringe needle w/ resheating feature o Trace element tests, toxicology studies, nutrient
o syringe divided into graduated barrel and plunger
determination
 Plunger is pulled back slowly = vacuum
 Uses hypodermic needle and sterile plastic syringe w/ COLOR CODING IN IDENTIFYING ADDITIVES IN
Luer lock tip BLOOD COLLECTION TUBES
o common syringes: 2ml, 5ml, 10ml
 Additive: placed in tube to prevent clotting and to
preserve components
EVACUATED TUBE SYSTEM
 Considered most efficient system Table No. Color Coding for Tube Caps
 Piercing one end of the double-pointed needle into the Cap Color Specification
vein and other end into the stopper of the evacuated tube Red No additive
to allow the flow of blood into the tube Orange Coagulant
 Numerous tubes in single venipuncture Yellow Coagulant & Separation Gel
Green Heparin Sodium
EVACUATED TUBE Light green Heparin Lithium
 Prevents exposure of specimen to contaminants Purple EDTA Coagulant
 Color coded tubes filled with predetermined volume of Light blue Sodium Citrate 1:9
blood by vacuum Black Sodium Citrate 1:4
 Used in both ETS and syringe method Potassium Oxalate Monohydrate and
Grey
 Can be additive or non-additive Sodium Fluoride
 Different sizes and volume; glass or plastic
 Usage depends on: age, size and condition of vein, ORDER OF DRAW
volume of blood needed  Order that must be followed when collecting blood
samples to prevent cross contamination, especially when
 Threaded portion: attached to tube holder w/ the sleeve dealing with multiple collection tubes
that retracts when the needle goes through the tube
stopper
o Sleeve: slides back once tube is removed to
prevent leakage

CATEGORIES OF ADDITIVES USED IN BLOOD

COLLECTION
 Tube should be inverted 3-10 times after collection

ANTICOAGULANTS
 “blood thinners”, prevent blood clots
 2 methods: precipitation of calcium or by preventing
thrombin formation
 Types: Ethylenediaminetetraacetic acid (EDTA), Citrate,
Heparin, Oxalates

SPECIAL USE ANTICOAGULANTS

 Acid citrate dextrose
 Citrate phosphate dextrose
 Sodium polyanethol

ANTIGLYCOLYTIC AGENTS **If butterfly is used: citrate tube is first

 Prevent breakdown of glucose by blood cells or glycolysis
 Sodium fluoride: most common; preserves glucose and
prevents growth of bacteria
o Usually with potassium oxalate for rapid
REFERENCES
response

CLOT ACTIVATORS Notes from the discussion by Prof. Amy Puaso

De La Salle Medical and Health Sciences Institute

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