1. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 1 This product was funded by a grant awarded under the President’s Community-Based Job Training Grants as implemented by the U.S. Department of Labor’s Employment & Training Administration. The information contained in this product was created by a grantee organization and does not necessarily reflect the official position of the U.S. Department of Labor. All references to non-governmental companies or organizations, their services, products, or resources are offered for informational purposes and should not be construed as an endorsement by the Department of Labor. This product is copyrighted by the institution that created it and is intended for individual organizational, non- commercial use only.

3. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 3 Test Request Form The test request form (requisition) must contain specific information: – Patient’s name and age or date of birth – A UNIQUE patient identification number – Date and time specimen is to be obtained – Type of test to be collected

4. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 4 Test Request Form (cont.) – An accessioning number – The physician’s name – The department or location work is to be done – Other specific specimen information – ICD9 diagnosis codes

5. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 5 Minimum Requirements to Label a Specimen All specimens should be labeled before you leave the patient. The following is required: – The patient’s first and last names – An identification number, such as date of birth – The collection date – Time the specimen was collected – The initials or name of the person collecting the specimen

6. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 6 Appropriate Venipuncture Site The median cubital vein of the antecubital area of the arm is the preferred vein to use for venipuncture. The secondary site for venipuncture is the top of the hand.

7. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 7 Sites to Avoid Arms with IVs Arms with any indwelling line Edematous arms Arms in casts Cannulas: Central line, Art line, Subclavian line, PICC line, Port-a-Cath, Hep lock, Saline lock Fistulas (dialysis pts) Areas of scarring Side of a mastectomy

8. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 8 Order of Draw When Filling Evacuated Tubes Blood culture bottles or yellow top blood culture tubes (sterile procedure) Coagulation tubes (e.g., light blue top) Serum tube with or without clot activator or gel serum separator (e.g., gold, red top, red/black top, plastic, or glass)

9. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 9 Order of Draw When Filling Evacuated Tubes (cont.) Heparin tube with or without gel separator (e.g., green top) EDTA tube (e.g., lavender top) Oxalate/fluoride, glycolytic inhibitor tube (e.g., gray top)

10. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 10 Order of Draw When Filling Evacuated Tubes If not all the tubes in the order of draw are to be collected, the order is started with the first tube needing collection.

11. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 11

12. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 12 Tubes in the Correct Order of Draw Blood Culture – always first! If no Blood Cultures, then 1. Light Blue (Citrate) (Coag tests) 2. Serum tubes (no anticoagulant) - can be red, tiger top, gold (Chemistry tests, BMP, CMP, lipid, etc.) 3. Green (Heparin) (STAT tests, ammonia, etc) 4. Lavender (EDTA) (Hematology tests, CBC, Sed Rate, Hgb & Hct) 5. Gray (Oxalate) (Glucose levels)

13. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 13 Positioning the Patient for Specimen Collection The patient must be made to feel at ease.

14. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 14 Steps to Performing a Safe Venipuncture Verify any patient restrictions. Assemble supplies. Greet patient. Positively identify patient Tie tourniquet and locate a vein.

15. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 15 Vacutainer, Butterfly, or Syringe Collection Apply tourniquet. Feel for a vein. Clean with alcohol swab in concentric circles.

16. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 16 If using Vacutainer Hold skin taut with the non- dominant hand. Insert needle at a 15-degree angle ALWAYS with the bevel up.

17. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 17 If using Butterfly Hold skin taut with the non- dominant hand. Insert needle at 5 to 10 degree angle.

18. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 18 Butterfly Collection System (cont.) When the needle enters the vein you should see a “flash” of blood.

19. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 19 If using Syringe Hold syringe in dominant hand and insert needle bevel up.

20. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 20 Two Methods to Transfer Blood from a Syringe into a Tube

21. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 21 Vacutainer or Butterfly Remove hand from holding skin taut. Insert tubes into holder in the correct order of draw.

22. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 22 Evacuated Tube System Collection Fill tubes until the vacuum is exhausted to ensure the proper blood to anticoagulant ratio. Remove tube from holder.

23. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 23 Butterfly Collection System Insert vacutainer tubes onto holder that is now at end of butterfly tubing

24. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 24 Vacutainer or Butterfly Always release tourniquet first!! Remove the needle from the arm. Apply pressure to site.

25. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 25 ALL SYSTEMS Activate the safety shield on needle. Properly labeled specimens Check site, bandage if needed

26. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 26 Patient Reactions to Blood Collection Pain Nerve damage Syncope (fainting) Nausea Hematoma Continued bleeding (Any of these complications or mis- identifications can become legal issues for healthcare facilities and employees that have not followed proper procedure.)

27. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 27 Patient Blood Visual Abnormalities From left to right: – Normal serum – Hemolyzed serum (know reasons) – Icteric serum – Lipemic serum

28. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 28 Techniques to Enhance a Vein and Recover a Failed Venipuncture Retie the tourniquet. Use a blood pressure cuff as a tourniquet. NO! Massage the arm. Lower the patient’s arm.

29. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 29 Techniques to Enhance a Vein and Recover a Failed Venipuncture (cont.) Warm the venipuncture location. Reseat the tube in the holder. Use a different tube. Place you finger above the venipuncture site and stretch the vein slightly.

30. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 30 Intravenous and Indwelling Lines Blood collected above a line will result in inaccurate results because of IV fluid contamination. To avoid contamination, the phlebotomist must draw below the IV in the hand or a fingerstick. Best strategy is to choose alternate site for venipuncture.

31. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED. 31 Priority Now ASAP Timed STAT