Methodologies and Regulations in Specimen Collection and Management Module 1: Phlebotomy Equipment Methodologies and Regulations in Specimen Collection and Management Module 1: Phlebotomy Equipment

Module 1: Phlebotomy Equipment Objectives Module 1: Phlebotomy Equipment At the conclusion of this module you will be able to: Define Phlebotomy List types of phlebotomy and identify the equipment used in each type Venipuncture Dermal Puncture Identify the various types of anti-coagulants, additives, tube colors, and order of draw used in the evacuated tube method of blood collection. Suggestion for demonstration purposes: Draw two tubes of blood in front of the participants- one red top and one lavender top Explain you are going to show the difference between Whole blood Anticoagulated blood and plasma Clotted specimen and serum Set a timer for 5 minutes and repeat ~ 4 times (20 minutes) as the timer dings gently show the 2 tubes to the class so they may observe the changes This demonstration will be useful as you proceed through this presentation and the tubes may be referred to as well

Module 1: Phlebotomy Equipment Objectives Module 1: Phlebotomy Equipment At the conclusion of this module you will be able to: Discuss other blood drawing equipment Identify arm veins used in venipuncture Demonstrate the ability to organize all equipment and supplies necessary to perform a venipuncture and dermal puncture Demonstrate proper procedure for collection and transport of Dried Blood Spots (DBS)

Module 1: Phlebotomy Equipment Today’s Agenda Module 1: Phlebotomy Equipment Define Phlebotomy List types of phlebotomy and identify the equipment used in each type Venipuncture Dermal Puncture Identify the various types of anti-coagulants, additives, tube colors, and order of draw used in the evacuated tube method of blood collection. Identify and correctly use other types of blood drawing equipment

Definition of Phlebotomy Module 1: Phlebotomy Equipment Comes from the Greek word: Phlebo-: meaning vein -Tome: meaning incision Phlebotomy is the process of collecting blood from a client by puncturing a vein

Module 1: Phlebotomy Equipment Today’s Agenda Module 1: Phlebotomy Equipment Define Phlebotomy List types of phlebotomy and identify the equipment used in each type Venipuncture Dermal Puncture Identify the various types of anti-coagulants, additives, tube colors, and order of draw used in the evacuated tube method of blood collection. Identify and correctly use other types of blood drawing equipment

Module 1: Phlebotomy Equipment Types of Phlebotomy Module 1: Phlebotomy Equipment Venipuncture: Involves collecting blood by penetrating a vein with a needle and collection apparatus Includes the use of the evacuated tube system, syringe, and winged infusion systems

Module 1: Phlebotomy Equipment Types of Phlebotomy Module 1: Phlebotomy Equipment Dermal (Skin) Puncture: Collecting blood after an incision is made to the skin with a lancet Includes finger puncture and heel puncture Maximum depth should never exceed 2.0 mm

Equipment and Supplies Module 1: Phlebotomy Equipment Gloves Needle Holder Tubes Gauze Alcohol Pad Band Aid Sharps Container Tourniquet

Module 1: Phlebotomy Equipment Gloves Module 1: Phlebotomy Equipment Standard Precautions require the wearing of gloves Gloves provide protection from infection A new pair of gloves must be worn for each client and for each new procedure Types: “A good fit is essential” Nitrile Vinyl Latex Universal precautions to be discussed in Module 2

Module 1: Phlebotomy Equipment Tourniquet Module 1: Phlebotomy Equipment Slow down venous flow without affecting arterial flow Enlarge the vein for easier location and easier penetration Assess the width, direction and depth of veins Should be left on for no longer than one minute Some countries use 3 minutes for the maximum length a tourniquet should be left on. A suggested response is that Phlebotomy Best Practices has shown after 1 minute of tourniquet use there is some degree of hemoconcentration of analytes which will affect the accuracy and reliability of patient test results.

Tourniquet Application Module 1: Phlebotomy Equipment Position the tourniquet 7.5 – 10 cm above the venipuncture site with strip equal on both sides Pull left side over the right side and make an X

Tourniquet Application Module 1: Phlebotomy Equipment With X in place, tuck a loop Have both ends of strip facing up End that is facing up is used for one hand and easy removal

Module 1: Phlebotomy Equipment Needles Module 1: Phlebotomy Equipment Sterile, Disposal and for Single use only Color coded for size or gauge Hollow stainless steel shafts Bevel or slant at the end

Module 1: Phlebotomy Equipment Needle Features Module 1: Phlebotomy Equipment Bevel or slant: Must face up Shaft: Cylindrical portion, length ranges from .65 to 3.80 cm Hub: Attaches the needle to the holder Gauge: The size of the needle, refers to the diameter of the needle

Module 1: Phlebotomy Equipment Needle Size Module 1: Phlebotomy Equipment Needle Size or Gauge Gauge is the diameter of the needle Routine: 21 gauge Children: 23 gauge The larger the number the smaller the needle Colored coded for size Range from 16 – 25 Most common size used is 21g by 3.80 cm

Module 1: Phlebotomy Equipment Multi Sample Needle Module 1: Phlebotomy Equipment Used for multiple samples during a single venipuncture Composed of a double pointed needle The hub screws into the needle holder Open with a twist motion

Module 1: Phlebotomy Equipment Safety Needles Module 1: Phlebotomy Equipment Allows the user’s hand to remain behind the needle Always use a safety needle when available Minimizes exposure to blood borne pathogens

Holder or Barrel (Bulldog) Module 1: Phlebotomy Equipment A plastic tube like device Feet extensions: Used for placement and removal of the evacuated tube Many different kinds: Retract the needle Draw the needle into the barrel

Needle Holder & Adapter Module 1: Phlebotomy Equipment The second pointed needle with rubber sleeve resides in the holder Push the tube directly into the middle of the holder for proper collection Second needle will penetrate top of tube

Antiseptics & Disinfectants Module 1: Phlebotomy Equipment Antiseptic: to prevent sepsis, to inhibit or prevent the growth of bacteria 70% isopropyl alcohol Methylated spirits Iodine Chlorohexidine sulfonate Disinfectant: will kill bacteria, used on surfaces and instruments, not skin Household Bleach 1:10 Jik or Biosite (product labs/clinics use in some countries) Clean up all blood spills on countertops / floors, phlebotomy chairs

Module 1: Phlebotomy Equipment Gauze Pads Module 1: Phlebotomy Equipment Called a 2 X 2 Should be sterile Used for drying the site after cleaning with alcohol Placed on the site after needle removal Cotton balls are not recommended – they can stick to the site and initiate bleeding

Module 1: Phlebotomy Equipment Bandages Module 1: Phlebotomy Equipment Adhesive Band-Aids or Plastics Be careful of latex allergies Should be placed over site after venipuncture Two Point Check Always make sure patient is not bleeding before applying the bandage Be careful when using a plastic or adhesive bandage on children

Module 1: Phlebotomy Equipment Sharps Containers Module 1: Phlebotomy Equipment Marked Biohazard Used for the disposal of used needles, lancets or other sharp objects Needles are not to be recapped, bent or cut All needles and holders are disposed of immediately after use Do not detach needle from holder

Module 1: Phlebotomy Equipment Any questions?

Module 1: Phlebotomy Equipment Knowledge Check 1 Module 1: Phlebotomy Equipment What is the purpose of the tourniquet? What is the maximum time a tourniquet should be on a client’s arm?

Module 1: Phlebotomy Equipment Today’s Agenda Module 1: Phlebotomy Equipment Define Phlebotomy List types of phlebotomy and identify the equipment used in each type Venipuncture Dermal Puncture Identify the various types of anti-coagulants, additives, tube colors, and order of draw used in the evacuated tube method of blood collection. Identify and correctly use other types of blood drawing equipment

Module 1: Phlebotomy Equipment Evacuated Tube System Module 1: Phlebotomy Equipment A closed system which allows blood to go directly from the vein into a stopper tube without blood being exposed to air Allows multiple tubes to be drawn with a single venipuncture Tubes contain a vacuum which is premeasured and guaranteed by the manufacturer until the expiration date stamped on each tube

Module 1: Phlebotomy Equipment Evacuated Tube System Module 1: Phlebotomy Equipment Collection Tubes Types of Specimens Anticoagulants Additives Tube Stoppers Order of Tubes During Blood Draw Inverting and Mixing Tubes

Module 1: Phlebotomy Equipment Collection Tubes Module 1: Phlebotomy Equipment Size varies from 2 mL to 15 mL May or may not contain an additive An additive is a substance that has been added to the tube Types of additives: Anticoagulants Gel separators Clot activators

Module 1: Phlebotomy Equipment Types of Specimens Module 1: Phlebotomy Equipment Whole Blood Cells + Plasma Anticoagulant prevents clotting Mix specimen well Haematology / Full Blood Count CD4 Testing

Module 1: Phlebotomy Equipment Types of Specimens Module 1: Phlebotomy Equipment Plasma Plasma contains fibrinogen Centrifuge whole blood, separate plasma from cells

Module 1: Phlebotomy Equipment Types of Specimens Module 1: Phlebotomy Equipment Serum Allow blood to clot for 20 - 30 minutes Centrifuge 10 – 15 minutes, separate cells from serum Serum does not contain fibrinogen Chemistry Testing

Module 1: Phlebotomy Equipment Any questions?

Module 1: Phlebotomy Equipment Knowledge Check 2 Module 1: Phlebotomy Equipment What is the difference between serum and plasma?

Module 1: Phlebotomy Equipment Anticoagulants Module 1: Phlebotomy Equipment A substance that prevents blood from clotting. Yields a whole blood specimen or when spun a plasma specimen Types: EDTA ethylenediaminetetraacetic acid in a tripotassium or disodium base (Purple) Sodium Citrate (Light Blue) Heparin (Green) Sodium Fluoride/Potassium Oxalate (Gray)

Module 1: Phlebotomy Equipment Anticoagulants Module 1: Phlebotomy Equipment EDTA Ethylenediaminetetraacetic acid in a tripotassium or disodium base (Purple): prevents clotting by binding calcium Used in Hematology for CBC and CD4

Module 1: Phlebotomy Equipment Anticoagulants Module 1: Phlebotomy Equipment Sodium Citrate (Light Blue): prevents clotting by binding the calcium. Used for coagulation workup (PT and APTT) Ratio of 1 part anticoagulant to 9 parts blood is critical for quality specimen and quality test result Must be filled with exact amount of blood – NOT UNDERFILLED or OVERFILLED 1. Suggest a short discussion on how under/overfilling the tube can cause inaccurate PT/APTT test results and can cause harm to the patient. 2. Demonstrate use of a discard tube if drawing only a light blue tube on a patient and using a winged infusion set to collect the blood

Module 1: Phlebotomy Equipment Anticoagulants Module 1: Phlebotomy Equipment Heparin (Green): Three types: ammonium, lithium, and sodium. Prevents clotting by inhibiting thrombin. Used for plasma chemistry testing Use appropriate type of heparin

Module 1: Phlebotomy Equipment Anticoagulants Module 1: Phlebotomy Equipment Potassium or ammonium oxalate (Gray): prevents clotting by binding the calcium. Used in glucose testing Sodium Fluoride (Gray): inhibits the metabolism of glucose by the cells. Used for glucose tolerance testing

Module 1: Phlebotomy Equipment Additives Module 1: Phlebotomy Equipment Clot activator: initiate or enhance coagulation. Can be thrombin, glass or silica particles Gel Separator: forms a barrier between the cells and the serum portion after the blood has been spun Used for Chemistry Testing

Module 1: Phlebotomy Equipment Tube Stoppers Module 1: Phlebotomy Equipment Red/Glass: no additives Red/Plastic: clot activator Red/Gray or marbled: gel separator Green: Heparin (three types) Mint Green: Heparin with gel separator Lavender: EDTA Light Blue: Sodium citrate Gray: potassium oxalate and sodium fluoride Hemogard: plastic stopper with rubber inside. Used for safety

Module 1: Phlebotomy Equipment Colors of Tubes Module 1: Phlebotomy Equipment

Order of Draw with the Evacuated Tube System Module 1: Phlebotomy Equipment Blood Cultures: sterile specimen Light Blue: sodium citrate for coagulation. Tube should be full and well mixed Gel Separator with or without clot activator Glass or Plastic Tubes Green: heparin or plasma chemistry Purple: EDTA for Hematology, CBC, CD4 Gray: oxalate/fluoride, glucose testing

Inverting and Mixing the Tubes Module 1: Phlebotomy Equipment Tubes with additives must be gently mixed Gently invert several times for proper mixing

Module 1: Phlebotomy Equipment Any questions?

Module 1: Phlebotomy Equipment Knowledge Check 3 Module 1: Phlebotomy Equipment What color tube is used to draw the laboratory test CD4? What color tube is used to draw a CBC? TBC = Total Blood Count AKA …..CBC or FBC

Module 1: Phlebotomy Equipment Today’s Agenda Module 1: Phlebotomy Equipment Define Phlebotomy List types of phlebotomy and identify the equipment used in each type Venipuncture Dermal Puncture Identify the various types of anti-coagulants, additives, tube colors, and order of draw used in the evacuated tube method of blood collection. Identify and correctly use other types of blood drawing equipment

Other Blood Drawing Equipment Module 1: Phlebotomy Equipment Syringe Winged Infusion or Butterfly Lancet Micro-collection Warming Devices

Module 1: Phlebotomy Equipment Other Blood Drawing Equipment Module 1: Phlebotomy Equipment Syringe used for fragile veins, you determine the pressure and pull Winged Infusion or Butterfly used for difficult veins, small veins and hand veins. Usually used for elderly clients and children

Module 1: Phlebotomy Equipment Other Blood Drawing Equipment Module 1: Phlebotomy Equipment Lancet: used for skin punctures. Different sizes for different depths. Never to exceed 2.0 mm. in depth

Module 1: Phlebotomy Equipment Micro - Collection Module 1: Phlebotomy Equipment Micro - container: have colored coded stoppers which indicate additives or non - additives Same color coding as the tube system

Module 1: Phlebotomy Equipment Warming Devices Module 1: Phlebotomy Equipment A warming device increases the blood flow as much as seven times Often used for heel punctures on newborns and finger sticks A warming device can be made by warming paper towels Never make it too hot

Module 1: Phlebotomy Equipment Knowledge Check 4 Module 1: Phlebotomy Equipment What is the purpose of an anticoagulant? What is the purpose of the clot activator/gel separator?

Summary Now you can: Define phlebotomy List types of phlebotomy and identify the equipment used in each type Venipuncture Dermal Puncture Identify the various types of anti-coagulants, additives, tube colors, and order of draw used in the evacuated tube method of blood collection.

Summary Now you can: Discuss other blood drawing equipment Identify arm veins used in venipuncture Demonstrate the ability to organize the equipment and supplies necessary to perform venipuncture and dermal puncture Demonstrate proper procedure for collection and transport of Dried Blood Spots (DBS)

Any questions? Thank you! Module 1: Phlebotomy Equipment Any questions? Thank you!