Blood Collection Equipment Chapter 6

Venipuncture Equipment Includes: Vacuum tubes and safety-engineered needle collection devices Tourniquet Supplies to cleanse the puncture site Labeling supplies Gloves Special trays to transport blood specimens

Vacuum (Evacuated) Tube System Requires an evacuated tube, a special needle, and a special safety plastic holder (adapter) that covers the needle after blood collection One end of the double-pointed needle enters the vein, the other end pierces the top of the tube, and the vacuum aspirates the blood

Two Criteria used to Describe Vacuum Tube Size External tube diameter and length The maximum amount of specimen to be drawn into the vacuum tube

Additives in Tubes Additives- substances (gels, clotting activators or anti coagulants) that are added in small amounts to tubes to alter the specimen to make it appropriate for analysis EDTA- ethyleneadiamine tetra acetic acid- anti coagulant** Oxalates, citrates and EDTA prevent coagulation by removing calcium and forming insoluble salts**

Tubes and their additives

Tubes Tube tops are color-coded according to the additive Serum, plasma, or whole blood for various assays Many coagulation factors are involved in blood clotting, and coagulation can be prevented by the addition of different types of anticoagulants. These anticoagulants often contain preservatives that can extend the metabolism and life span of the red blood cells (RBCs) after blood collection

Green-Topped Tubes Contain the anticoagulants sodium heparin, ammonium heparin, and lithium heparin. These tubes are used in various laboratory assays requiring plasma or whole blood. Should not be used for collections for blood smears. Used for most chemistry tests (electrolytes) BUN- Blood Urea Nitrogen*** kidney function Creatinine- kidney function Glucose Calcium CK- Creatine kinase-** heart damage

Purple (Lavender)-Topped Tubes Contain EDTA Typically used for CBC(complete blood count)** Hematological procedures Blood-banking procedures Molecular diagnostic testing Under filled purple tops- inaccurate cell counts inaccurate hematocrit

Light Blue–Topped Tubes Contain sodium citrate Many coagulation procedures, such as PT and APTT** are done on blood collected in light blue– topped vacuum tubes. If a light blue–topped tube is under filled, coagulation results will be inaccurate must be filled to the line

Red-Topped, Royal Blue–Topped, Brown-Topped Tubes and Tan-Topped Tubes Red-topped tubes are tubes without anticoagulant for the collection of serum. Royal blue –topped tubes are used to collect samples for nutritional studies, therapeutic drug monitoring, and toxicology. ** Royal blue–topped tube is the trace element tube.

The brown-topped tube contains heparin or no additive and is used for blood lead values. The tan-topped tube is used for lead testing and contains EDTA** Grey topped tubes contain sodium flouride used for glucose and lactic acid has glycolitic inhibitor- prevents glucose breakdown***

Yellow-Topped Tubes Contains sodium polyanethol sulfonate (SPS). Used for blood culture specimen collections in microbiology. Tubes containing ACD additive are use for specialty blood banking

Mottled-Topped, Speckled-Topped, and Gold-Topped Tubes AKA: Serum Separation Tubes These tubes contain a polymer barrier in the bottom of the tube. During centrifugation, the polymer barrier forms a barrier between the serum and blood cells

Pink-Topped Tubes Contain EDTA and are used for blood bank collections Type and Cross for blood transfusions

Black Topped tubes Contains sodium citrate additive Used for testing ESR (sed rate)**

Safety Syringes Used for patients whose veins are too fragile for blood collection with vacuum tubes Hazardous and pose an increased risk of accidental needle sticks Sometimes used for collecting blood from central venous catheter (CVC) lines (RN performed) Consist of a needle, safety cover, hub, barrel, and plunger

Safety Syringes The syringe needle should be shielded after blood collection, removed, and discarded in a sharps disposal container. The BD blood-transfer device is attached to the syringe, and a vacuum tube is inserted into the transfer device. The blood is transferred from the syringe to the tube using the tube’s vacuum

Gauge and Length of a Needle The gauge number indicates the diameter of the needle; the smaller the gauge number, the larger the needle diameter **and higher the flow rate. Larger (16- to 18-gauge) needles are used for collecting donor units of blood (450 mL or less) Smaller (21- and 22-gauge) needles are used for collecting specimens for laboratory assays. (this is typically what you will be using) Color coding of needles indicates gauge size**

There are many manufacturers of venipuncture equipment There are many manufacturers of venipuncture equipment. The type of equipment depends on the facility. Essentially, they are all the same Familiarize yourself with the equipment that your facility uses

Needles Sterilized and packaged by vendors in sealed shields that maintain sterility. Check the tip of each needle for damage. Multiple-sample needles are used with vacuum collection tubes and the holder to allow for multiple tube changes without blood leakage within the plastic holder

The Butterfly Needle (Blood Collection Set) Also called a blood collection set or winged infusion set The most commonly used intravenous device The most common butterfly needle sizes are 21 and 23 gauge and the length of these needles range from ½ to ¾ inches long. These safety needles each have a shield that automatically covers the contaminated needle point upon withdrawal from the patient’s vein Highest rate of needle stick injuries**.

Needle and Other Sharps Disposal Must be discarded in rigid, leak-proof, plastic containers. Each unit is usually orange or red. Disposable as biohazardous waste

Tourniquets Types The pliable strap The Velcro type The blood pressure cuff

Non-latex disposable tourniquets are now available. If the tourniquets used in the health care facility are not disposable, they must be wiped frequently with 70 percent isopropyl alcohol and disinfected with a chlorine bleach dilution of 1:10 if contaminated with blood or other body fluids. Provide a barrier to slow down venous flow

Gloves for Blood Collection Use non-latex gloves Do not use gloves with talcum powder Change gloves after each patients’ blood collection Do not wash, disinfect, or reuse gloves.

Other items needed for blood collection .Antiseptics, Sterile Gauze Pads and Bandages 70% isopropyl alcohol preparation iodine swab sticks or pads** (for blood cultures) are essential for blood collection

Micro collection Equipment Usually, skin puncture blood-collecting techniques are used on infants, because venipuncture is excessively hazardous. For infants, the Clinical Laboratory Standards Institute recommends a penetration depth of less than 2.0 mm on heelsticks to avoid penetrating bone.***

Lancets and Tubes Different facilities use different manufacturers Examples BD Quikheel Lancet BD Genie Lancet Tenderlett Automated Skin Incision Device Monoject Monoletter Safety Lancet Greiner Bio-One Lancets

Microcontainers For dermal sticks two additional equipment is required- -Plastic micro hematocrit capillary tubes -Disposable narrow-bore pipettes that are used for packed red cell volume in microcentrifugation

Micro collection tubes Have colored bands; a red band indicates a heparin-coated tube, and a blue band indicates no anticoagulant Usually color coded according to the established protocol for blood collection vacuum tube tops

Different manufacturers Samplette micro blood collector BD Microtainer tube Microvette capillary blood collection system SAFE-T-FILL capillary blood collection system

Specimen Collection Trays Taken on blood-collecting rounds Made of plastic (preferably latex free) that can be sterilized Includes all necessary collection equipment Prior to rounds- ensure that your tray is fully stocked

Specimen Collection Trays For Home Health Care Providers Carry an enclosed container with the biohazard symbol visible on the outside Lockable, to protect the contents from tampering or accidental contamination With a tight seal to reduce the risk of infection from bloodborne pathogens due to spills or accidents