Drawing blood samples for serum total cholesterol, HDL cholesterol and plasma glucose, HbA1c and DNA extraction

Based on EHES Manual, Part B. Fieldwork Procedures, 2nd edition (2016) Available at: http://urn.fi/URN:ISBN:978-952-302-701-5 These slides can be used freely, translated and adapted to national use (e.g. concerning the equipment). However, it is important to keep in mind that no changes should be made to the measurement techniques, which need to be standardized.

Equipment Blood sampling vacuum tubes Needle for vacuum tubes Needle holder/adapter Needle disposal container Stasis Disinfection solution, swabs, gauze pads, skin tape Disposable gloves

Blood collection tubes Serum evacuated tubes containing gel or plain serum tubes (red cap) For lipids Fluoride-citrate plasma tube (grey cap) For glucose EDTA plasma tubes (violet cap) For HbA1c

Exclusion criteria Blood samples are not taken, if participant Has a chronic illness which restricts taking blood samples Has anemia (Hb below 10 g/l) Doubts about the blood volume to be taken Refuses

Preparing for the blood collection Ask and record length of time from the last meal in full hours Participant rests 10-15 minutes Use gloves or disinfect hands

Posture Sitting position, hand downward, palm upwards Before blood collection, ask the participant to remove tight clothes that might constrict the upper arm If participant tells that he/she easily faints, supine posture due to safety of the participant may be needed (this exception needs to be recorded) Take blood from the arm not used for BP measurement usually left arm

Protocol 1/8 Gently tap top of the fluoride citrate plasma tube if it contains granules Release cover from the end of the needle and connect the holder and sample needle Apply tourniquet (if needed) to search a vein Limit the use of the tourniquet to less than one minute at a time

Protocol 2/8 Place the arm in a supported downward position and disinfect the puncture site Remove the protector case from the needle Perform the venipuncture

Protocol 3/8 Collect blood first into the 2 plain serum tubes Press the tube to puncture the stopper and start filling Loosen the tourniquet when the bloodstream runs Support the tube during filling

Protocol 4/8 When the bloodstream stops, take the tube out of the holder Check that the tube is filled to the accurate volume Mix the plain serum tube 5 times by inverting the tube completely top-down immediately after taking the tube out of the holder

Protocol 5/8 Fill the fluoride-citrate plasma tube Immediately after taking the fluoride-citrate tube out of the holder, mix 15 times by inverting the tube completely top-down

Protocol 6/8 Fill the 3 EDTA tubes Mix the plain EDTA tubes 5 times by inverting the tube completely top-down immediately after taking the tube out of the holder Store all tubes in a vertical position until sample handling

Protocol 7/8 Remove the needle from the vein Apply pressure immediately on the puncture site with a gauze pad until bleeding stops

Protocol 8/8 Label the successfully filled tubes according to the sampling chart Discard needles into a needle dispose container and all other materials contaminated with blood into a biological waste container

Recording Deviations from the blood drawing protocol, if any Your initials/personnel code to identify who draw the blood samples

Acknowledgements Slides prepared by: Laura Råman Photographs: Hanna Tolonen Blood sample drawing demonstrations by Saara Vallivaara and a voluntary participant Experiences and feedback from the EHES network have been utilized in the preparation of these slides Funding: Preparation of the slides is part of the activities of the EHES Coordinating Centre which has received funding from the EC/DG SANTÉ in 2009-2012 through SANCO/2008/C2/02-SI2.538318 EHES and Grand Agreement number 2009-23-01, and in 2015-2017 through Grand Agreement number 664691/BRIDGE Health

Disclaimer The views expressed here are those of the authors and they do not represent the Commission’s official position.