Blood Sample Colection

Considerations in Blood Collection

1. The “X” indicates stopper colors that may be drawn. IF MORE THAN ONE

STOPPER COLOR IS INDICATED CHECK

WITH YOUR CLINICAL FACILITY FOR PROPER TUBE.

2. More than one test can be done on a tube. For example if a CBC and Retic count

are ordered BOTH can be done on the same

tube of blood.

3. The order of the draw MUST be followed to prevent additive carry over which

will severely compromise the results of

laboratory tests sterile blood cultures, light blue, red, purple, green, gray. IF

ONLY A LIGHT BLUE NEEDS

COLLECTING AND YOU ARE USING A BUTTERFLY A DISCARD

TUBE MUST BE DRAWN SO THAT TUBE

WILL NOT BE UNDERFILLED.

4. Correct Specimen Volume:

a. All blood collection tubes need to be filled to the correct volume this will ensure

the proper amount of blood for the

amount of additive in the tube (blood to additive ratio).

b. For example, if a 5 mL draw heparin tube is only filled with 3 mL of blood, the

heparin concentration is erroneously

high and may potentially interfere with some chemistry analytes.

c. Expiration dates should also be checked on the evacuated tubes.

d. Expired tubes should not be used, as they may have a decreased vacuum, as well

as potential changes in any additives

in the tubes.

e. Light blue and black tubes MUST be completely filled. These tubes require a

specific blood to additive ratio, failure

to completely fill WILL cause the sample to be REJECTED as accurate results

CANNOT be obtained..

5. Tourniquet Application and Time

a. The tourniquet should be applied approximately three to four inches above the

venipuncture site. The tourniquet

should be on the arm no longer than one minute.

b. A good rule of thumb to determine the one-minute tourniquet time is to remove

the tourniquet when blood starts to

flow into the first tube of blood being drawn.

c. Prolonged tourniquet time can lead to an false increase in various chemistry

analytes, including serum protein,

potassium, total protein, aspartate aminotransferase (AST), total lipids, cholesterol,

iron and lactic acid due to

hemoconcentration of blood at the puncture site.

6. Maintain microtainers and vacuum tubes in an upright, vertical position. This is

done to for two purposes:

a. Promote clot formation, if required and

b. Reduce possibility of hemolysis.

7. Each lab department will establish their own guidelines for rejection of samples

for the laboratory taking into consideration

the following factors:

a. Discrepancy between specimen and lab requisition, mislabeled samples

CANNOT be accepted.

b. Failure to write date, time and/or initials of phlebotomist - NEVER LABEL

SOMEONE ELSE’S TUBES, your initials

verify that YOU collected the sample. If any lawsuit is filed based on the results

from the tubes the person whose

initials appear on the tube WILL BE THE ONE SUED.

c. Unlabeled tubes -DO NOT BEG TO COME AND LABEL TUBE, once tube

leaves bedside the legal chain of custody

has been broken and the tube MAY NOT BE LABELED OR CORRECTED.

d. Hemolyzed specimens - usually do to IMPROPER COLLECTION

TECHNIQUE, too small of a needle, drawing from

a line, pulling too hard on the plunger of the syringe - HEMOLYSIS

ADVERSELY AFFECTS LABORATORY

RESULTS AND CANNOT BE USED.

e. Wrong tube collected.

f. Outdated supplies used.

g. Contaminated specimens.

h. Quantity Not Sufficieint (QNS)-inadequate volume

i. Anticoagulated samples that are clotted- GENTLY mix as soon as the tube is

filled, transfer blood from a syringe

IMMEDIATELY, do not lay it down and do other things.

j. Improper transport

i. time-some samples must be tested or separated IMMEDIATELY after collection

ii. temperature-some samples MUST be kept cool or warm after collection

iii. light exposure-some samples MUST be protected from the light to prevent false

decrease in analyte.

k. Timed sample drawn at wrong time

8. Many tests require special handling requirements. Refer to the following chart.

Handling Tests ordered

Chilled samples

$ place in ice slurry

IMMEDIATELY upon

collection, failure to do so will

result in REJECTION of blood

sample.

$ Some tests require collection vial

to be chilled prior to collecting.

$ If not chilled the results of the

test will be invalid and patient

may not be properly treated.

$ blood gases,

$ gastrin,

$ ammonia,

$ renin

$ angiotenson

$ lactic acid,

$ catecholamine,

$ parathyroid hormone,

$ ACTH

$ glucagon.

Warmed samples- samples which require

warming that are submitted at room

temperature MUST be rejected

$ cold agglutinins and

$ cryoglobulin.

Protect from light -

$ Failure to protect from light will

result in falsely decreased

values

$ Collect in amber tube to protect

from light.

$ If amber tube unavailable place

in box, wrap on foil

$ bilirubin,

$ vitamin B12,

$ carotene,

$ folate

$ urine samples for porphyrin

determina

tion.

Test Yellow Lt. Blue Red Green Lavender Gray Black Tan Royal

Blue

Blood Culture X

Coagulation Tests

Prothrombin Time (PT) X

Partial Thromboplastin Time (PTT) X

Thrombin Time (TT) X

Fibrinogen X

Fibrin degradation products (FDP) X

Activated clotting time (ACT) X

D-dimer X

Cryofibrinogen - Whole blood must be drawn in a prewarmed

(37C) syringe and kept at 37C. Immediately after

collection, transfer blood to pre-warmed (37C) 3.5 mL

(sodium citrate) light blue top tube. Keep at 37C until

separated from cells.

X

Factor Assays

X


Blue

Hematology

Complete Blood Count (CBC) X

Hemoglobin X

Hematocrit X

White blood cell (WBC) count X

Red blood cell (RBC) X

Platelet Count X

Differential X

Erythrocyte Sedimentation Rate (ESR) X

Reticulocyte (Retic) Count X X

Hemoglobin A1C X

Eosinophil count X

Sickle cell test X

Chemistry

Glucose Levels X

Blood Alcohol Levels X

Lactate X

Bicarbonate X

Comprehensive Metabolic Panel (CMP) Old name Chem 12, SMA 12, SMA 20,

SMAC Include the following tests.

Glucose level, electrolyte and fluid balance, kidney function, and liver function.

http://www.labtestsonline.org/understanding/analytes/cmp/cmp.html

$ Glucose X X

$ Calcium X X

$ Albumin X X

$ Total Protein X X

Electrolytes

* Sodium

* Potassium

* CO2 (carbon dioxide, bicarbonate)

* Chloride

X X

$ Blood Urea Nitrogen (BUN) X X

$ Creatinine X X

$ ALP (alkaline phosphatase) X X

$ ALT X X

$ AST X X


Blue

$ Total Bilirubin-Protect specimen from light. X X

Basic Metabolic Panel Old Name Chem 7, SMA 7 Include the following tests:

glucose level, electrolyte and fluid balance, and

kidney function.

http://www.labtestsonline.org/understanding/analytes/bmp/bmp.html

$ Glucose X X

$ Calcium X X

Electrolytes

* Sodium

* Potassium

* CO2 (carbon dioxide, bicarbonate)

* Chloride

X X

$ Blood Urea Nitrogen (BUN) X X

$ Creatinine X X

Other Chemistry Tests

Uric Acid X X

Lactate Dehydrogenase (LD or LDH) X X

Gamma-Glutamyltransferase (GGT or GGTP) X X

Amylase X X

Triglycerides X X

Cholesterol X X

Low Density Lipids (LDL) X X

High Density Lipids (HDL) X X

Iron X X

Total Iron Binding Capacity (TIBC) X X

Creatine Kinase (CK) X X

LD Isoenzyme Panel X X

Albumin X X

Digoxin-Collect 5-7 hours after administration of last dose. X

Dilantin -Collect immediately prior to next dose. X X

Vancomycin X X

Gentamycin X

Phenobarbital X X

Theophylline X

Lithium X X

Theophylline X X

Tobramycin X X X


Blue

Cyclosporin - Draw just prior to morning dose for trough

level or two hours post dose.

X X

Hemoglobin Electrophoresis X

Lead

ACTH - *PLACE IN ICE SLUSH* X

ADH X

Alcohol- Prepare venipuncture site with betadine or soap

and water.

X X X X

Aldosterone - Patient must be in upright position (sitting or

standing) for 30 minutes prior to blood draw.

X X

Aluminum Red

Ammonia -*PLACE IN ICE SLUSH* X X

Arsenic Lav

Lead X Lav

B Type Natriuretic Peptide (BNP) X

Carotene (FASTING) X X

Glucagon -*PLACE IN ICE SLUSH* X

Catecholamines-*PLACE IN ICE SLUSH* Because

venipuncture stress elevates catecholamine levels, for truly

basal levels, samples should be collected a minimum of 30

minutes after resting with the patient supine. Patient

preparation: 12-14 hour fast prior to collection.

X

Carcinoembryonic Antigen (CEA) X

Ceruloplasmin X

Chromium Red

Cold Agglutinin (KEEP WARM) - NO Gel X

Copper Lav

Zinc-Do not let specimen come in contact with glass, metal

or rubber.

Lav

Manganese X Lav

Platinum Red

Selenium Lav

Cortisol - Optimal blood collection times to evaluate

diurnal variation are 8:00 AM or 4:00 PM

X

Cryoglobulin - Keep Warm -The accuracy of this test is

greatly compromised if blood is at < 37 degrees during 90

minute period after collection.

X


Blue

Renin Activity-Cannot test patients that have received

radioisotopes within the past 48 hours. Renin levels are

affected by high sodium diet. Patient should be in upright

(sitting or standing) or supine position for 30 minutes prior

to blood draw. Patient's posture during blood draw (upright

or supine) should be noted. Stability: No more than 4 hours

on cells at ambient temperature; NEVER refrigerate.

X

Estrogen X X

Angiotensin X

Folate, Serum X

Folate, RBC X X

Follicle Stimulating Hormone (FSH) X

Progesterone X X

Testosterone

T3 Triiodothyronine X X

T4 Thyroxine X X

thyroglobulin X X

Thyroid Antibodies X

Parathyroid Hormone *PLACE IN ICE SLUSH* X

Thyroid Stimulating Hormone (TSH) X X X

Gastrin-10 hour fast and no radioactive isotopes therapy 48

hours prior to collection.

X

HBsAb (Hepatitis B Surface Antibody) X X

HBsAg (Hepatitis B Surface Antigen) X X

HCG X X

HCV Antibody (Hepatitis C Antibody) X X

Herpesvirus 6 Human IgG & IgM Abs X X X X

HIV 1 & 2 Antibody Screen X X X X X

HIV Viral Load White

Ketones X X

Lipase X X

Magnesium X X

Myoglobin, Serum X X

Osmolality X X

Phosphorus X X

Porphorins - Protect specimen from light. X X


Blue

Porphobilinogen - Protect specimen from light. X

Serotonin-patient should avoid avocados, bananas,

eggplant, pineapple, plums, tomatoes or walnuts for a 48

hour period prior to collection.

X

Serology

C-Reactive Protein X X

Cytomegalovirus CMV X

Epstein Barr Virus (EBV) X

Lyme Antibodies, IgG, IgM X

Rheumatoid Factor X

RPR X X

Rubella X

Streptozyme X

Mono test X

Blood Bank - Tube drawn will depend on clinical site, some sites have special

armband

ABO/D Type (ABO/Rh) X Pink

Type and Screen (Indirect Coombs Test) X Pink

Crossmatch X Pink

Direct Coombs Test or Direct Antiglobulin Test (DAT) X

Elution X

Kleihauer Betke Stain X

References

1. http://uh.edu/admin/hc/Blood_Chem.html

2. http://www.webmd.com/hw/lab_tests/tu6207.asp

3. Activated Clotting Time http://enw.org/Research-ACT.htm

4. Phlebotomy Services

http://som.ucdavis.edu/departments/pathology/clinical/phlebotomy_services

ORDER OF DRAW IS

INCORRECT

5. Test Directory - Excellent reference for looking up tests by alphabetical order

http://referencelab.clevelandclinic.org/DBSearch/Search.htm

6. ARUP Guide to Clinical Laboratory Testing Excellent reference for looking up

tests by alphabetical order

http://www.aruplab.com/testing/lab_testing.jsp

7. Pre-Analytical Considerations in Blood Collection

http://www.columbia.edu/itc/hs/medical/selective/AdvClinicalPathology/2005/lect

ure/PreAnalyticalLectureColor_Fink.pdf

8. Preanalytical Variables in the Chemistry Laboratory

http://www.bd.com/vacutainer/labnotes/Volume15Number1/

9. BLOOD COLLECTION: ROUTINE VENIPUNCTURE AND SPECIMEN

HANDLING

http://medlib.med.utah.edu/WebPath/TUTORIAL/PHLEB/PHLEB.html

GENERAL BLOOD COLLECTION

TUBE REQUIREMENTS

TEST

TUBE

TEST

TUBE

TEST

TUBE

TEST

TUBE

ABO Type *** Pink Cortisol R or Y HCG screen & quant R or Y PSA Y, R (only)

Acid Phosphatase R or Y FDP or D-dimer B HIV (signed consent) R or Y PT,

APTT (PTC & PTV) B

AFP R or Y C-Reactive Protein (CRP) R or Y IgG, IgM, IgA, IgE R or Y

Progesterone R or Y

Albumin LG or Y Ca19, Ca 125 R or Y Iron Profile (Fe, TIBC, %sat) LG or Y

Rast or Allergy R or Y

Alcohol (!use non-alcohol wipe) R or G Crossmatch*** R & L Lactic Acid G

Reticulocyte Count L

Alkaline Phosphatase R, LG or Y Cytomegelovirus (CMV) R or Y Lead L

Rheumatoid Arthritis R or Y

Ammonia L (on ice) Drug Levels* - all types R or LG LDH LG or Y RPR R

Amylase LG or Y Drug Screen R Legionella Y or R Rubella Screen R or Y

ANA R Electrolytes R, LG or Y Lipase LG or Y Sed Rate (ESR)

L

Anticardiolipin Ab R or Y Epstein Barr Ab R or Y

Lipid Profile or Coro

(Chol, Trig, HDL, LDL) LG or Y Serum Electrophoresis (SPEP)

R or Y

ASO R Ferritin R, LG or Y Lithium R or Y

Serum Immunoelectrophoresis

(SIEP)

R or Y

Bilirubin (Total & Direct) R, LG or Y Fibrinogen Levels B Liver Profile LG or Y

SGOT (AST) or SGPT (ALT) LG or Y

BUN, Creatinine

R, LG or Y

Folate (Folic Acid)

Y or R

Lupus Type Anticoagulant*

LTA

3B & R or Y

(pediatric tubes

6B)

BNP

L

Calcium R, LG or Y

Comprehensive Metabolic Panel –

CMP or General Chem R, LG or Y Lyme (Progressive) R or Y TSH, T3, T4

R or Y

Carboxyhemoglobin LG/Do not spin GGT R, LG or Y Magnesium LG or Y Free

T4 R or Y

Cardiac Enzyme Profile

(CK,CKMB,Troponin) LG Glucose LG, G or Y Mononucleosis Screen R Total

Protein

LG or Y

CBC L Glycohemoglobin (HbA1C) L Osmolality R, LG or Y Testosterone R or Y

CEA R or Y Hemoglobin & Hematocrit (H&H) L Phosphorus LG or Y Troponin I

LG

Cholesterol, Triglycerides LG or Y Hemoglobin Electrophoresis L Platelet Count

L Type and Screen*** Pink

CD4/CD8****

Rm Temp/Same Day/Before 2:30

1 10ml GR and

I L

Heparin Assay (XA) Freeze/Deliver

to Lab within 1 hour

B (on ice)

OB Panel

2L,2R,2Y

Uric Acid

LG or Y

Cold Agglutinin (keep warm)

R

Hepatitis Profiles – All

R or Y

Basic Metabolic Panel - BMP or

Profile 7 (consists of: BUN, CR,

CA,Glu,Lytes and Bicarb)

LG, Y

Vitamin B-12

Y or R

CODES AND ORDER OF THE DRAW

B - Light BlueTop (Tube must be full!)

R - Red-Top Tube

Y – Yellow Top Tube (Corvac)**

LG – Light Green Top Tube

GR – Green Top Tube

L – Lavender or Pink Top Tube

G – Grey Top Tube

*Refer to lab manual for special instructions.

**Can substitute Red Top for Yellow Top.

***Date, Time, User’s Initials on tubes and #13 BB Slip

****Obtain tube from Lab

Documents

Blood Sample Colection