1. Collection of Blood Blood is to be collected only by trained personnel working under the direction of a qualified licensed physician. Blood collection must be by aseptic methods, using a sterile closed system. If more than one skin puncture is needed, a new container and donor set must be used for each additional venipuncture. by Mohammed Abu-basha1

2. Blood Containers Blood must be collected into an FDA-approved container that is pyrogen-free and sterile and contains sufficient anticoagulant for the quantity of blood to be collected. The container label must state the type and amount of anticoagulant and the approximate amount of blood collected. Blood bags may be supplied in packages containing more than one bag. The manufacturer’s directions should be followed for the length of time unused bags may be stored in packages that have been opened. by Mohammed Abu-basha2

3. Is there anything I should do before I donate? Be sure to eat well at your regular mealtimes and drink plenty of fluids.

4. Identification Identification is essential in each step from donor registration to final disposition of each component. Before beginning the collection, the phlebotomist should: 1.Identify the donor record (at least by name) with the donor and ask the donor to state or spell his or her name. 2.Attach numbered labels to the donor record and ensure that it matches the blood collection container, attached bags, and tubes for donor blood samples. Attaching the numbers at the donor chair, rather than during the examination procedures, helps reduce the likelihood of identification errors. 3.Recheck all numbers. by Mohammed Abu-basha4

5. Preparation of the Venipuncture Site B lood should be drawn from a large firm vein in an area (usually the antecubital space) that is free of skin lesions. Both arms must be inspected for evidence of drug use, skin disease, or scarring. A tourniquet or a blood pressure cuff inflated to 40 to 60 mm Hg makes the veins more prominent. Having the donor open and close the hand a few times is also helpful. Once the vein is selected, the pressure device should be released before the skin site is prepared. by Mohammed Abu-basha5

6. There is no way to make the venipuncture site completely aseptic, but surgical cleanliness can be achieved to provide the best assurance of an uncontaminated unit. Several acceptable procedures exist. After the skin has been prepared, it must not be touched again to repalpate the vein. The entire site preparation must be repeated if the cleansed skin is touched. by Mohammed Abu-basha6

7. Principle Iodophor compounds, or other sterilizing compounds, are used to sterilize the venipuncture site before blood collection. Materials 1.Scrub solution: Disposable povidoneiodine scrub 0.75% or disposable povidone-iodine swabstick 10%; available in prepackaged single-use form. 2.Preparation solution: 10% povidoneiodine; available prepackaged single- use form. 3.Sterile gauze. Arm Preparation for Blood Collection (practical) by Mohammed Abu-basha7

8. Procedure 1.Apply tourniquet or blood pressure cuff; identify venipuncture site, then release tourniquet or cuff. 2.Scrub area at least 4 cm (1.5 inches) in all directions from the intended site of venipuncture (ie, 8 cm or 3 inches in diameter) for a minimum of 30 seconds with 0.7% aqueous solution of iodophor compound. Excess foam may be removed, but the arm need not be dry before the next step. by Mohammed Abu-basha8

9. 4.Starting at the intended site of venipuncture and moving outward in a concentric spiral, apply “prep” solution; let stand for 30 seconds or as indicated by manufacturer. 5.Cover the area with dry, sterile gauze until the time of venipuncture. After the skin has been prepared, it must not be touched again. Do not repalpate the vein at the intended venipuncture site. by Mohammed Abu-basha9

10. Notes 1.For donors sensitive to iodine (tincture or povidone preparations), another method (eg, ChloraPrep 2% chlorhexidine and 70% isopropyl alcohol) should be designated by the blood bank physician. 2.For donors sensitive to both iodine and chlorhexidine, a method using only isopropyl alcohol could be considered. by Mohammed Abu-basha10

11. Phlebotomy and Collection of Samples During collection, the blood should be mixed with the anticoagulant. The amount of blood collected should be monitored carefully so that the total, including samples, does not exceed 10.5 mL per kilogram of donor weight per donation. When the appropriate amount has been collected, specimen tubes must be filled. The needle and any blood-contaminated waste must be disposed of safely in accordance with universal precaution guidelines. by Mohammed Abu-basha11

12. The needle must not be recapped unless a safety recapping device is used. Disposal of the needle must be in a puncture-proof container. After collection, there must be verification that the identifiers on the unit, the donor history, and the tubes are the same. Gloves must be available for use during phlebotomy and must be worn by phlebotomists when collecting autologous blood and when individuals are in training. by Mohammed Abu-basha12

13. Principle Blood for transfusion and accompanying samples is obtained from prominent veins on the donor’s arm, usually in the area of the antecubital fossa. Phlebotomy and Collection of Samples for Processing and Compatibility Tests (practical) by Mohammed Abu-basha13

14. Materials 1.Sterile collection bag containing anticoagulant, with integrally attached tubing and needle. 2. Metal clips, hand sealers, Dielectric sealer. 3.Balance system to monitor volume of blood drawn. 4. Sterile gauze and clean instruments (scissors, hemostats, forceps). 5. Test tubes for sample collection. by Mohammed Abu-basha14

15. Procedure 1.Ask donor to confirm his or her identification. 2.Ensure that all labeling on blood container, processing tubes, and donor records is correct. 3.Prepare donor’s arm as described in (previous method). 4.Inspect bag for any defects and discoloration. The anticoagulant and additive solutions should be inspected for particulate contaminants. 5. Position bag below the level of the donor’s arm. A hemostat should be applied to the tubing before the needle is uncapped to prevent air from entering the line. by Mohammed Abu-basha15

16. Tubes for testing Bag O’Blood Remains in a closed system!

17. 6.Reapply tourniquet or inflate blood pressure cuff. Ask the donor to open and close hand until previously selected vein is again prominent. 7. Uncover sterile needle and perform the venipuncture immediately. A clean, skillful venipuncture is essential for collection of a full, clot-free unit. When the needle position is acceptable, tape the tubing to the donor’s arm to hold the needle in place. 8. Release the hemostat. Open the temporary closure between the interior of the bag and the tubing. 9. Ask the donor to open and close hand slowly every 10 to 12 seconds during collection. by Mohammed Abu-basha17

18. 10. Keep the donor under observation throughout the donation process. The donor should never be left unattended during or immediately after donation. 11. Mix blood and anticoagulant gently and periodically (approximately every 45 seconds) during collection. Mixing may be done by hand or by continuous mechanical mixing. 12. Be sure blood flow remains fairly brisk, so that coagulation activity is not triggered. 13. Monitor volume of blood being drawn. One mL of blood weighs at least 1.053 g. A convenient figure to use is 1.06 g/mL. For a 500-mL bag unit, this is 530g (plus the weight of the container and anticoagulant). 18 63 mL anticoagulant in 450 mL bag 70 mL anticoagulant in 500 mL bag