1. CHAPTER 6 Blood Collection Equipment

2. Introduction to Blood Collection Equipment Safety features decrease needle stick injuries. Collection equipment is used for venipuncture, skin puncture, and arterial puncture. Venipuncture Equipment Includes: – Vacuum tubes and safety – Engineered needle collection devices – Tourniquet – Supplies to cleanse the puncture site – Antimicrobial hand gel or foam to wash hands – Labeling supplies – Gloves – Special trays to transport blood specimens

3. Venipuncture Equipment Includes: – Specimen collection tray – Puncture-resistant disposal container – Gauze pads/wraps and bandages 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 collected into the vacuum tube 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.

4. Blood Collection Tubes and Additives Yellow-Topped Tubes, Vacuum Culture Vials, and ACD Tubes – Sterile tubes that contain sodium polyanethol sulfonate (SPS) – Used for blood culture specimen collections in microbiology. – Tubes containing ACD additive are use for specialty blood banking. – Blood can be collected directly into vacuum vials containing culture media Light Blue–Topped Tubes – Contain sodium citrate – Many coagulation procedures, such as PT and PTT, are done on blood collected in light blue – If a light blue–topped tube is under filled, coagulation results will be inaccurate. Serum Separation Tubes (Mottled-Topped, Speckled-Topped, and Gold-Topped Tubes) – These tubes must be gently inverted with the blood to ensure mixing of the clot activator. – 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.

5. Red-Topped Serum Tubes – Red-topped tubes are tubes without anticoagulant or polymer (gel) barrier for the collection of serum. – Thus, the collected blood will clot in the tube. Green-Topped Tubes – Contain the anticoagulants sodium heparin, ammonium heparin, or lithium heparin. – These tubes are used in various laboratory assays requiring plasma or whole blood. – Should not be used for collections for blood smears. Purple (Lavender)-Topped Tubes – Contain EDTA – Hematological procedures – Molecular diagnostic testing

6. Pink-Topped Tubes – Contain EDTA and are used for blood bank collections. Gray-Topped Tubes – Usually contain (1) potassium oxalate and sodium fluoride, (2) sodium fluoride and EDTA, or (3) only sodium fluoride. – Primarily used for glucose (sugar) tests. – Antiglycolytic agent and glycolytic inhibitor are the terms for this tube’s additive because it slows the chemical process of glucose breakdown. Royal Blue–Topped Tubes – Royal blue–topped tubes are used to collect samples for nutritional studies, therapeutic drug monitoring, and toxicology. –is the trace element tube. Tan-Topped Tubes – The tan-topped tube is used for lead testing and contains EDTA. Black-Topped Tubes – A black-topped tube with sodium citrate for blood collections to determine the erythrocyte sedimentation rate (ESR) is available from certain manufacturers.

7. 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 Consist of a needle, safety cover, hub, barrel, and plunger 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

8. Safety Needles/Holders 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. – The BD Eclipse safety–shielding blood needle is attached to a holder. Venipuncture Needle-Pro has a protective holder and provides a single-handed technique. The Vanishpoint blood collection tube holder automatically retracts the needle directly from the patient upon activation. The VACUETTE® QUICKSHIELD Complete PLUS Safety Tube Holder device is used to prevent accidental needle stick injuries during venous blood collection. S-Monovette Blood Collection System – An enclosed multiple-sampling blood collection system. – Collects blood using either an aspiration or vacuum principle of collection. – Each needle has an integral holder that does not require assembly before use and cannot be disassembled.

9. Needles – Sterilized and packaged by vendors in sealed shields that maintain sterility – Check the tip of each needle for damage. – It is important to use needles withholders or syringes that are compatible with the needle to avoid possibility of leaking blood and blood exposure. 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. 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

10. Tourniquets Types – The pliable strap – The Velcro type – The blood pressure cuff Non-latex disposable tourniquets are now available. Many facilities now use disposable tourniquets to help prevent cross-contamination of infections. If the tourniquets used in the healthcare facility are not disposable, they must be wiped frequently with 70% 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. Use proper hand hygiene and change gloves after each patient's blood collection. Do not wash, disinfect, or reuse gloves.

11. Antiseptics, Sterile Gauze Pads, and Bandages These items are needed for blood collection by either venipuncture or microcollection. 70% isopropyl alcohol preparation and iodine swab sticks or pads (for blood cultures) are essential for blood collection. Waterless Antiseptic Agent – Use in home health care and other ambulatory health care environments where soap and water may not be available. – Carry with other blood collection items. – Use before and after blood collection.

12. Microcollection Equipment Usually, skin puncture blood-collecting techniques are used on adults and infants when small amounts of blood can be used for diagnostic lab tests and also if venipuncture is excessively hazardous for a patient. The Clinical Laboratory Standards Institute (CLSI) recommends a penetration depth of less than 2.0 mm on heel sticks to avoid penetrating bone. Micro containers – Plastic micro hematocrit capillary tubes – Disposable narrow-bore pipettes that are used for packed red cell volume in micro centrifugation – Have colored bands; a red band indicates a heparin-coated tube, and a blue band indicates no anticoagulant – Plastic micro collection containers for general laboratory collections – Usually color coded according to the established protocol for blood collection vacuum tube tops

13. Specimen Collection Trays Taken on blood-collecting rounds Made of plastic (preferably latex free)that can be sterilized Includes all necessary collection equipment 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 blood borne pathogens due to spills or accidents