2. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 3 1 Booth, Wallace, and Fitzgerald PowerPoint Presentation to Accompany PowerPoint ® Presentation to Accompany Chapter 3

3. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 3 2 Equipment for Specimen Collection

4. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 33 Objectives Upon completion of this chapter, you should be able to: List the information required on a requisition form. Describe computer use in phlebotomy. Describe the supplies and general equipment required for phlebotomy. Describe the components of the evacuated tube system. Explain the proper method for needle disposal.

5. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 34 Objectives cont’d Identify the type, explain the mechanism of action, and identify the evacuated tube color associated with each additive. Explain the order of draw for evacuated tubes. List the components of the butterfly infusion and syringe systems. Identify the equipment needed to perform dermal puncture.

6. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 35 Laboratory Requisitions Laboratory requisitions are generated following a physician’s order, which may be verbal or written. Information Included on Requisition Form Patient’s name, DOB, medical record number Ordering physician’s name Date and time test is to be done Type of test ordered Test status (timed, fasting, STAT) Patient’s location (if inpatient) Initials of phlebotomist NOTE: Requisition forms may be handwritten or computer- generated. Click picture for larger view

7. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 36 Sample Electronic Requisition Form Click button to return.

8. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 37 Be sure to determine the correct spelling of a patient’s last name prior to obtaining a blood specimen!! Also, check at least one other patient identifier. The correct spelling of the patient’s name should be on: Requisition form ID band Specimen label John Smith Patient Identification

9. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 38 Apply Your Knowledge True or False: A requisition form must be signed by a physician or other qualified health care practitioner. ANSWER: True Great!

10. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 39 Specimen Collection Equipment Gloves Tourniquet Alcohol prep pads Gauze pads Adhesive bandage Needles Evacuated tube holder or syringe Evacuated tubes Sharps (needle disposal) container Permanent marker, pen, or computer labels

11. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 310 Specimen Collection Equip. - Gloves Gloves Gloves are available in materials such as latex and vinyl. Sterile and non-sterile gloves are available. Powder-free gloves are recommended because the powder can serve as a specimen contaminant. OSHA regulations require that gloves be worn during phlebotomy procedures. Always wash your hands after removing gloves. Be alert to latex allergies (itchy, red hands).

12. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 311 Specimen Collection Equip. - Tourniquet Tourniquet A device that is wrapped around the arm to temporarily stop the flow of venous blood Used to locate a patient’s veins easily Are disposable; may be cleaned for reuse on same patient if not visibly contaminated Never apply a tourniquet for longer than 1 minute at a time Types of Tourniquets Non-latex Latex Blood pressure cuff

13. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 312 Health care workers and patients can be allergic to latex and experience symptoms such as: Itchy, watery eyes Skin rash Chest tightness Shortness of breath Shock Always ask the patient if he or she is allergic to latex!!! Latex Allergies and Phlebotomy

14. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 313 Specimen Collection Equip. – Alcohol Prep Pads Alcohol Prep Pads Prior to needle insertion, the site must be cleaned Alcohol prep pads, bacteriostatic antiseptic, are soaked with 70% isopropyl alcohol Not recommended for the collection of blood alcohol levels or blood glucose Gauze Pads Adhesive Bandage Loosely woven fabric applied to the arm after needle is removed Placed over the puncture site for 3 to 5 minutes to stop the bleeding. Not used on children under 2 years.

15. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 314 Failure to remove the tourniquet following venipuncture can cause temporary or permanent injury to the patient and is an act of negligence!! Remove the Tourniquet

16. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 315 Specimen Collection Equip. - Needles Needles Composed of: -Hub -Shaft -Bevel Vary in length from ¾ to 1½ inches Gauge size varies from 16- gauge (large) to 23-gauge (small) Needles Used by Phlebotomists Multiple-sample needle Hypodermic needle Butterfly (wing-tipped) needle NOTE: The larger the gauge size, the smaller the needle

17. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 316 Needlestick Safety and Prevention Act Developed due to the large number of needlestick injuries Requires needles to have special safety features to protect from accidental puncture Safety feature should be activated as soon as the procedure is complete Make sure you know how to operate the device you are using!!

18. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 317 If you or a co-worker sustain a needlestick injury, you must report it to a supervisor! You are obligated to report hazards from needles you observe in the workplace! Reporting Needlestick Injuries

19. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 318 Specimen Collection Equip. – Evacuated Tube Holder Evacuated Tube Holder Also called barrel or adapter Holds both a needle and a tube for blood collection Should be disposed of after use

20. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 319 Specimen Collection Equip. – Sharps Container Sharps Container Needle disposal containers Protect health care personnel from accidental needlesticks Made of nonpenetrable plastic and are red or bright orange in color with a biohazard label Stores used needles, lancets, and other sharps

21. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 320 Specimen Collection Equip. - Marker Computer Label, Permanent Marker, or Pen Each evacuated tube must be labeled at the time of specimen collection. The following information should be included on the label: Patient’s name and identification number Date and time of collection Collector’s initials (your initials if you collected the specimen)

22. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 321 Specimen Collection Equip. – Evacuated Tubes Evacuated Tubes Contain a premeasured vacuum Most widely used system for blood collection Range in size from 2mL to 15mL and both adult and pediatric sizes are available Fill automatically with blood due to the vacuum

23. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 322 Specimen Collection Equip. – Evacuated Tubes cont’d Evacuated tubes with a plastic splashguard safety device reduce the aerosol mist when the tube stopper is removed during specimen processing. Evacuated Tubes (cont’d) order of draw Multiple tubes may be required for collection of various specimens, and the order in which you use the tubes is important. This is known as the “order of draw.”

24. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 323 Specimen Collection Equip. – Tubes and Anticoagulants Tubes and Anticoagulants Tubes with an anticoagulant prevent the specimen from clotting. It is important that tubes containing an anticoagulant be mixed or inverted several times after drawing to ensure uniform mixing.

25. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 324 Specimen Collection Equip. - Tubes Commonly Used Tubes Red-Topped Glass is recommended for serum testing Does not contain additives Used for most drug tests Plastic red-topped tubes should not be used for blood banking Serum Separator Tube Black and red tube with a speckled look (tiger-topped) Contains a gel and clot activator Blood clots faster and the gel separates the serum from the blood cells

26. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 325 Specimen Collection Equip. – Lavender Topped Lavender-Topped Used frequently for hematology studies (CBC and differential)Used frequently for hematology studies (CBC and differential) Contains the additive EDTA (ethylene- diaminetetraacetic acid)Contains the additive EDTA (ethylene- diaminetetraacetic acid) EDTA is an anticoagulant that binds with calcium to prevent blood from clottingEDTA is an anticoagulant that binds with calcium to prevent blood from clotting EDTA inhibits platelet clumpingEDTA inhibits platelet clumping

27. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 326 Specimen Collection Equip. – Light Blue Topped Light Blue-Topped Used for coagulation studies (PT, APTT, PTT)Used for coagulation studies (PT, APTT, PTT) Primary additive is sodium citrate, which binds with calcium to prevent blood from clottingPrimary additive is sodium citrate, which binds with calcium to prevent blood from clotting This tube must be completely filled in order to maintain the anticoagulant-blood ratioThis tube must be completely filled in order to maintain the anticoagulant-blood ratio NOTE: NOTE: The tube should be inverted to prevent clotting.

28. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 327 Specimen Collection Equip. – Green topped Green-Topped Contains sodium heparin, lithium heparin, or ammonium heparin as the anticoagulant Light green or green-gray tubes are called plasma barrier tubes Used for tests requiring plasma or for general chemistry tests Heparin stops blood from clotting by inactivating thrombin and thromboplastin

29. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 328 Specimen Collection Equip. – Gray topped Gray-Topped Used for glucose analysis and blood alcohol levelsUsed for glucose analysis and blood alcohol levels Contains sodium fluoride or potassium oxalate as an anticoagulant; these additives bind with calcium to stop blood from clottingContains sodium fluoride or potassium oxalate as an anticoagulant; these additives bind with calcium to stop blood from clotting Contains a glycolytic inhibitor that prevents the metabolism of glucose by red blood cellsContains a glycolytic inhibitor that prevents the metabolism of glucose by red blood cells

30. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 329 Specimen Collection Equip. – Yellow topped Yellow-Topped Available with two different additives:Available with two different additives: -Sodium polyanethol sulfonate (SPS), which is used for blood culture collections -Acid citrate dextrose (ACD) which maintains red cell viability NOTE NOTE: It is very important that the correct yellow-topped tube be used because they look alike but have different additives!

31. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 330 Hemolysis of blood samples should be avoided at all costs. A hemolyzed sample will produce erroneous results for most laboratory tests. Always make sure to select the appropriate tube size and needle to prevent hemolysis. Hemolysis

32. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 331 Order of Draw Sterile Specimens Blood Culture Tubes Coagulation Tubes Light Blue SST Gold or Red/Black Multiple Tubes Using a Vacuum Tube System Serum Red Green Light Green Lavender Gray

33. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 332 Butterfly Infusion Set with Syringe System Used to collect blood from people with small, fragile veins, such as the elderly and children Provides greater control with non- stable patients This system is completely sterile. This picture shows an adapter that can be used with the evacuated system.

34. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 333 Apply Your Knowledge Jenny is about to collect blood from a two-day-old infant while you observe her. She asks, “Since this is a newborn, will I have to wear gloves”? How will you respond? ANSWER: Yes, according to OSHA, gloves are required when potentially coming in contact with blood or body fluids. GREAT!

35. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 334 Apply Your Knowledge Which tube system is the most widely used for blood collection? ANSWER: Evacuated tube system BRAVO!

36. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 335 Apply Your Knowledge A lavender-topped tube is primarily used for what types of studies? ANSWER: Hematology studies (CBC and differential) GOOD JOB!

37. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 336 Apply Your Knowledge Which color tube is used for glucose analysis and blood alcohol levels? ANSWER: Gray-topped tubes GREAT!

38. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 337 Dermal Puncture Used for blood specimens that require less blood Blood may come from arterioles, venules, and capillaries Obtained mostly from infants and small children under 2 years of age Indications for Adult Dermal Puncture Cases of severe burns Chemotherapy patients Older patients with fragile veins Home glucose monitoring for diabetes

39. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 338 Dermal Puncture Collection Devices and Equipment Safety lancets Gloves Alcohol pads Sterile gauze Sharps disposal container Microspecimen container To prevent puncturing a bone, the puncture depth should not exceed 2.0 mm, especially when performing heel sticks on infants. NOTE: A warm towel or cloth applied to the dermal site will increase blood flow.

40. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 339 Dermal Puncture Microspecimen Containers Microspecimen containers collect samples of less than 1 milliliter. Capillary tubes or microhematocrit tubes are used to collect hematocrit specimens.

41. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 340 Dermal Puncture Microcollection Containers Microcollection containers provide a larger collection volume than capillary tubes. They come with a variety of anticoagulants and use a color-coded system.

42. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 341 Apply Your Knowledge What are the indications for dermal puncture in the adult patient? ANSWER: Severe burns, chemotherapy, older patient with fragile veins, home glucose monitoring GREAT!

43. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 342 Chapter 3 Summary All patient information must be included on the requisition form. All tube labels must include the patient’s name, date, time, and the phlebotomist’s initials. Computer information in phlebotomy are used to maintain patient data and results, receive orders and requisitions, and generate charges. Equipment needed for phlebotomy includes gloves, tourniquet, alcohol pads, gauze, bandage, needles, evacuated tube and holder, sharps container, marker, label, and evacuated tube(s).

44. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 343 Chapter 3 Summary (cont’d) Evacuated tubes are a closed system of collection that allow for multiple tubes to be collected in one venipuncture. Used equipment must be disposed of in a sharps container with a biohazard label. Evacuated tubes come in different colors with different additives. You should be familiar with the tube colors most commonly used at your facility.

45. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 344 Chapter 3 Summary (cont’d) The order of draw for evacuated tubes is blood culture or yellow tube, SST, serum, heparin, PST, EDTA, pink or lavender, and gray. The winged set includes a butterfly needle, small tubing, and a syringe. The syringe set may also be used. Dermal puncture is performed with a safety lancet or puncture device, collection tubes, and the same equipment used for venipuncture.

46. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 3 45 END OF CHAPTER 3 Real success is finding your lifework in the work that you love. --David McCullough