1. Phlebotomy Simplified
Third Edition
Chapter 6
Blood Collection Equipment
Copyright © 2019, 2013, 2008 Pearson Education, Inc. All Rights Reserved

2. Chapter Learning Objectives (1 of 3)
6.1 Describe the latest phlebotomy safety supplies and equipment. 6.2 Identify the various supplies that should be carried on a specimen collection tray when a skin puncture specimen must be collected.

3. Chapter Learning Objectives (2 of 3)
6.3 List the various types of anticoagulants and additives used in blood collection, examples of tests performed on the specimens collected in the tubes containing them, and the color codes for these anticoagulants and additives. 6.4 Identify how anticoagulants may interfere with certain blood analytes.

4. Chapter Learning Objectives (3 of 3)
6.5 Describe the differences between the venipuncture and skin puncture equipment and supplies. 6.6 Identify the types of safety equipment needed to collect blood by venipuncture and skin puncture.

5. Introduction to Blood Collection Equipment (1 of 3)
Safety features decrease needlestick injuries.
Collection equipment is used for venipuncture, skin puncture, and arterial puncture.

6. Introduction to Blood Collection Equipment (2 of 3)
Venipuncture equipment includes:
Vacuum tubes and safety-needle collection devices
Tourniquet
Supplies to cleanse the puncture site

7. Introduction to Blood Collection Equipment (3 of 3)
Venipuncture equipment includes:
Labeling supplies
Gloves
Special trays to transport blood specimens
See Box 6-1: Equipment for Routine Venipuncture

8. Venipuncture Equipment
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.

9. Figure 6-1
Vacuum Tube
Courtesy of Becton, Dickinson and Company

10. Figure 6-2 Vacuum (Evacuated) Tube Holder System and Parts
Courtesy of Becton, Dickinson and Company

11. Blood Collection Tubes and Additives (1 of 20)
Two criteria used to describe vacuum tube size
External tube diameter and length
Maximum amount of specimen to be collected into the vacuum tube
Please see Table 6-1 in the textbook.

12. Blood Collection Tubes and Additives (2 of 20)
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.

13. Blood Collection Tubes and Additives (3 of 20)
These anticoagulants often contain preservatives that can extend the metabolism and life span of the red blood cells (RBCs) after blood collection.

14. Blood Collection Tubes and Additives (4 of 20)
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.
Blood can be collected directly into vacuum vials containing culture media.

15. Blood Collection Tubes and Additives (5 of 20)
Yellow-Topped Tubes, Vacuum Culture Vials, and ACD Tubes
Tubes containing acid citrate dextrose (ACD) additive used for specialty blood banking.

16. Figure 6-4
Collecting Blood for Culture Using the BD BACTEC™ Culture Vial
Courtesy of Becton, Dickinson and Company

17. Blood Collection Tubes and Additives (6 of 20)
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 light blue–topped tube underfilled or overfilled, coagulation results will be inaccurate.

18. Blood Collection Tubes and Additives (7 of 20)
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.

19. Blood Collection Tubes and Additives (8 of 20)
Serum Separation Tubes (Mottled-Topped, Speckled- Topped, and Gold-Topped 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.

20. Figure 6-6 VACUETTE® Serum Tube
Courtesy of Grenier Bio-One, Kremsmünster, Austria

21. Blood Collection Tubes and Additives (9 of 20)
Rapid Serum Tubes (RST)
Orange and gray/yellow vacuum-topped tubes have additive thrombin, which completes clotting of the blood in less than five minutes.
Used for STAT (emergency) laboratory procedures requiring serum specimens.

22. Blood Collection Tubes and Additives (10 of 20)
Red-Topped Serum Tubes
Red-topped tubes are tubes without anticoagulant or polymer (gel) barrier for the collection of serum.
Collected blood will clot in the tube.
After blood is collected in the tube, the clotting process begins and takes at least 30 minutes for fibrin clot to form.

23. Blood Collection Tubes and Additives (11 of 20)
Orange-Topped Tubes
Tubes with orange tops have a thrombin-based clot activator with a gel for serum separation.
This tube is for STAT serum determinations in chemistry.
Blood-clotting time is only five minutes.

24. Blood Collection Tubes and Additives (12 of 20)
Green-Topped Tubes
Contain the anticoagulants sodium heparin and lithium heparin.
These tubes used in various laboratory assays requiring plasma or whole blood.
Should not be used for collections for blood smears.

25. Blood Collection Tubes and Additives (13 of 20)
BD Vacutainer Barricor Tubes
Uses mechanical separator technology that reduces centrifugation time from 10 minutes to 3 minutes.
Reduces cellular contamination by 50 to 65 percent compared to other current plasma gel tubes.

26. Blood Collection Tubes and Additives (14 of 20)
Purple (Lavender)-Topped Tubes
Contain EDTA
Hematological procedures
Molecular diagnostic testing

27. Blood Collection Tubes and Additives (15 of 20)
Pink-Topped Tubes
Contain EDTA.
Used for blood bank collections.

28. Blood Collection Tubes and Additives (16 of 20)
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.

29. Blood Collection Tubes and Additives (17 of 20)
Royal Blue–Topped Tubes and Tan-Topped Tubes
Used to collect samples for nutritional studies, therapeutic drug monitoring, and toxicology.
Royal blue–topped tube is the trace element tube.
Tan-topped tube used for lead testing and contains EDTA.

30. Blood Collection Tubes and Additives (18 of 20)
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.

31. Blood Collection Tubes and Additives (19 of 20)
Molecular Diagnostics Tubes
Special sterile vacuum tubes for molecular diagnostic studies.
Available containing different additives (e.g., sodium citrate, sodium heparin) as required for the different testing procedures.
Manufacturers have different color tops.

32. Blood Collection Tubes and Additives (20 of 20)
Tube Organizer
TIMO™ Tube Management Organizer is an innovative test tube holder that assists with managing the test tubes during the blood collection process.

33. Figure 6-11
TiMO™ Tube Management Organizer
Courtesy of ITL Corp.

34. Safety Syringes (1 of 4)
Used for patients whose veins are too fragile for blood collection with vacuum tubes.
Hazardous and pose an increased risk of accidental needlesticks.

35. Safety Syringes (2 of 4)
Sometimes used for collecting blood from central venous catheter (CVC) lines.
Consist of a needle, safety cover, hub, barrel, and plunger.

36. Figure 6-12
Example of a Safety Syringe

37. Safety Syringes (3 of 4)
The syringe needle should be shielded after blood collection, removed, and discarded in sharps disposal container.
BD blood-transfer device is attached to the syringe, and a vacuum tube is inserted into the transfer device.

38. Safety Syringes (4 of 4)
The blood is transferred from the syringe to the tube using the tube’s vacuum.

39. Figure 6-13 BD SafetyGlide™ Needle and BD Blood Transfer Device
Courtesy of Becton, Dickinson and Company

40. Safety Needles/Holders (1 of 9)
Gauge and Length of a Needle
Gauge number indicates 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).

41. Safety Needles/Holders (2 of 9)
Gauge and Length of a Needle
Smaller (21- and 22-gauge) needles are used for collecting specimens for laboratory assays.
The BD Vacutainer® Eclipse™ safety–shielding blood needle is attached to a holder.

42. Safety Needles/Holders (3 of 9)
Jelco® Venipuncture Needle-Pro® has a protective holder and provides a single-handed technique.
Retractable Technologies VanishPoint® blood collection tube holder automatically retracts needle directly from the patient when end cap is closed after the last tube has been removed.

43. Safety Needles/Holders (4 of 9)
The VACUETTE® QUICKSHIELD Safety Tube Holder device is used to prevent accidental needlestick injuries during venous blood collection.

44. Figure 6-14 BD Eclipse™ Blood Collection Needle Attached to a Holder
Courtesy of Becton, Dickinson and Company

45. Figure 6-15 Vanishpoint Blood Collection Tube Holder
Courtesy of Retractable Technologies, Little Elm, TX

46. Figure 6-16 VACUETTE® QUICKSHIELD Complete PLUS Safety Tube Holder
Courtesy of Greiner Bio-One GmbH, Kremsmünster, Austria

47. Safety Needles/Holders (5 of 9)
S-Monovette Blood Collection System
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.

48. Figure 6-18 Sarstedt S-Monovette® Venous Blood Collection System
Courtesy of Sarstedt, Inc., Newton, NC

49. Safety Needles/Holders (6 of 9)
Check tip of each needle for damage.
It is important to use needles with holders or syringes that are compatible with the needle to avoid possibility of leaking blood and blood exposure.

50. Safety Needles/Holders (7 of 9)
The Butterfly Needle (Blood Collection Set)
Also called a blood collection set or winged infusion set.
Most commonly used intravenous device.

51. Safety Needles/Holders (8 of 9)
The Butterfly Needle (Blood Collection Set)
Most common butterfly needle sizes are 21- and 23- gauge and 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.

52. Figure 6-19
Blood Collection with BD Vacutainer® UltraTouch™ Push Button Blood Collection Set
Courtesy of Becton, Dickinson and Company

53. Figure 6-20 VACUETTE® Safety Blood Collection Set
Courtesy of Greiner Bio-One, Kremsmunster, Austria.

54. For long description, see slide 84: Appendix A
Figure 6-22
Surshield™ Safety Winged Blood Collection Set
Courtesy of Terumo Medical Corp., Somerset, NJ
For long description, see slide 84: Appendix A

55. Safety Needles/Holders (9 of 9)
Needle and Other Sharps Disposal
Must be discarded in rigid, leakproof, plastic containers.
Each unit is usually orange or red.
Disposable as biohazardous waste.

56. Figure 6-23 Sharps Disposal Container with the Required Biohazard Sign
Steve Carroll/Shutterstock

57. Tourniquets (1 of 3) Tourniquet Key to successful venipuncture.
Provides barrier to slow down venous flow.
Used in specimen collection to apply enough pressure to the arm to slow the return of venous blood to the heart.

58. Tourniquets (2 of 3) Types Pliable strap Velcro type
Blood pressure cuff
Seraket with seat-belt design

59. Tourniquets (3 of 3) Nonlatex disposable tourniquets available.
Many facilities use a disposable natural latex tourniquet strap to help prevent cross-contamination.

60. Figure 6-24 BD Vacutainer® Latex-Free Tourniquet
Courtesy of Becton, Dickinson and Company

61. Gloves for Blood Collection
Use nonlatex gloves.
Do not use gloves with powder.

62. Figure 6-25
Use of Gloves

63. Antiseptics, Sterile Gauze Pads, and Bandages (1 of 2)
These items are needed for blood collection by either venipuncture or microcollection.
70 percent isopropyl alcohol preparation and chlorhexidine swab sticks or pads (for blood cultures) are essential for blood collection.

64. Antiseptics, Sterile Gauze Pads, and Bandages (2 of 2)
In home health care and other ambulatory health care environments where soap and water may not be available, a waterless antiseptic agent should be carried with other blood collection items and used before and after blood collection.

65. Microcollection Equipment (1 of 7)
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.

66. Microcollection Equipment (2 of 7)
Lancets and Tubes
Clinical Laboratory Standards Institute recommends a penetration depth of less than 2.0 mm on heelsticks to avoid penetrating bone.

67. Microcollection Equipment (3 of 7)
Lancets and Tubes
BD Quikheel™ infant lancet
BD Quikheel™ preemie lancet

68. Figure 6-26 BD Quikheel™ Lancet
Courtesy of Becton, Dickinson and Company

69. Figure 6-27 BD Microtainer® Contact-Activated Lancet
Courtesy of Becton, Dickinson and Company

70. Figure 6-28 Terumo CAPIJECT® Safety Lancet
Courtesy of Terumo Medical Corp., Somerset, NJ

71. Figure 6-29
Greiner Bio-One MiniCollect® Lancelino Safety Lancets for Microcollection
Courtesy of Greiner Bio-One GmbH, Kremsmünster, Austria

72. Figure 6-30 NeatNick™ Preemie Lancet
Courtesy of Natus Medical Incorporated

73. Microcollection Equipment (4 of 7)
Microcontainers
Plastic microhematocrit capillary tubes.
Disposable narrow-bore pipettes used for packed red cell volume (hematocrit) in microcentrifugation.
Have colored bands; a red band indicates a heparin- coated tube, and a blue band indicates no anticoagulant.

74. Microcollection Equipment (5 of 7)
Microcontainers
Plastic microcollection containers for general laboratory collections.
Usually color coded according to the established protocol for blood collection vacuum tube tops.

75. Figure 6-31 BD Microtainer® Tube
Courtesy of Becton, Dickinson and Company

76. Figure 6-32 SAFE-T-FILL® Capillary Blood Collection Tubes
Courtesy of RAM Scientific, Inc., Needham, MA

77. Microcollection Equipment (6 of 7)
BMP LeukoChek Microdilution™ System
Collection and dilution unit for blood samples.
Disposable, self-filling diluting pipette
Consists of straight, thin-walled, uniform-bore, plastic capillary tube fitted into a plastic holder

78. Microcollection Equipment (7 of 7)
BMP LeukoChek Microdilution™ System
Includes plastic reservoir containing a premeasured volume of buffered ammonium oxalate solution.

79. Specimen Collection Trays (1 of 2)
Taken on blood-collecting rounds
Made of plastic (preferably latex-free) that can be sterilized
Includes all necessary collection equipment

80. Specimen Collection Trays (2 of 2)
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.

81. Figure 6-33 Specimen Collection Tray
Courtesy of MarketLab,

82. Copyright
This work is protected by United States copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the World Wide Web) will destroy the integrity of the work and is not permitted. The work and materials from it should never be made available to students except by instructors using the accompanying text in their classes. All recipients of this work are expected to abide by these restrictions and to honor the intended pedagogical purposes and the needs of other instructors who rely on these materials.

83. Appendix A
Long Description for Figure 6-22 Terumo’s Surshield Safety Winged Needle Set with one handed activation provides a solution with a cost effective, easy to use design. Press shield over the needle until it locks into place. Unique needle locking mechanism helps reduce the risk of needlestick injuries. One handed activation for safety and ease of use. No change in needle insertion technique. Simple, built in safety design is easy to use. Step 1. Flip safety shield toward needle. Remove the needle and apply digital pressure to the site. Step 2. With the wing and shield between your thumb and index finger, press the safety shield against a hard surface such as a bedside table until an audible click is heard. Step 3. Visually confirm activation of the safety feature.
Return to presentation