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Chapter 6Chapter 6
Venipuncture Equipment Includes:
• Vacuum tubes and safety-engineered needle collection devices
• Tourniquet• Supplies to cleanse the puncture
site Labeling supplies• Gloves• Special trays to transport blood
specimens
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 drawn into the vacuum tube
Additives in Tubes
• Additives- substances (gels, clotting activators or anti coagulants) that are added in small amounts to tubes to alter the specimen to make it appropriate for analysis
• EDTA- ethyleneadiamine tetra acetic acid- anti coagulant**
• Oxalates, citrates and EDTA prevent coagulation by removing calcium and forming insoluble salts**
Tubes and their additives
• 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
Green-Topped Tubes
• Contain the anticoagulants sodium heparin, ammonium heparin, and lithium heparin.
• These tubes are used in various laboratory assays requiring plasma or whole blood.
• Should not be used for collections for blood smears. • Used for most chemistry tests (electrolytes)• BUN- Blood Urea Nitrogen*** kidney function• Creatinine- kidney function• Glucose• Calcium• CK- Creatine kinase-** heart damage
Purple (Lavender)-Topped Tubes
• Contain EDTA• Typically used for CBC(complete
blood count)** • Hematological procedures• Blood-banking procedures • Molecular diagnostic testing• Under filled purple tops- inaccurate cell counts inaccurate hematocrit
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 a light blue–topped tube is under filled,
coagulation results will be inaccurate must be filled to the line
Red-Topped, Royal Blue–Topped, Brown-Topped Tubes and Tan-
Topped Tubes
• Red-topped tubes are tubes without anticoagulant for the collection of serum.
• Royal blue –topped tubes are used to collect samples for nutritional studiesnutritional studies, therapeutic drug monitoring, and toxicology. **
• Royal blue–topped tube is the trace element tube.
• The brown-topped tube contains heparin or no additive and is used for blood lead values.
• The tan-topped tube is used for lead testing and
contains EDTA**
•Grey topped tubes contain sodium flouride used for glucose and lactic acid
has glycolitic inhibitor- prevents glucose breakdown***
Yellow-Topped Tubes
• Contains sodium polyanethol sulfonate (SPS).
• Used for blood culture specimen collections in microbiology.
• Tubes containing ACD additive are use for specialty blood banking
Mottled-Topped, Speckled-Topped, and Gold-Topped Tubes
• AKA: Serum Separation 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
Pink-Topped Tubes
• Contain EDTA and are used for blood bank collections
• Type and Cross for blood transfusions
Black Topped tubes
• Contains sodium citrate additive
• Used for testing ESR (sed rate)**
• 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 (RN performed)
• Consist of a needle, safety cover, hub, barrel, and
plunger
Safety Syringes
• 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
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. (this is typically what you will be using)
• Color coding of needles indicates gauge size**
• There are many manufacturers of venipuncture equipment. The type of equipment depends on the facility.
• Essentially, they are all the same
• Familiarize yourself with the equipment that your facility uses
• Sterilized and packaged by vendors in sealed shields that maintain sterility.
• Check the tip of each needle for damage.
• Multiple-sample needles are used with vacuum collection tubes and the holder to allow for multiple tube changes without blood leakage within the plastic holder
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
• Highest rate of needle stick injuries**.
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
Tourniquets
Types • The pliable strap• The Velcro type • The blood pressure cuff
• Non-latex disposable tourniquets are now available.
• If the tourniquets used in the health care facility are not disposable, they must be wiped frequently with 70 percent 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
• Change gloves after each patients’ blood collection
• Do not wash, disinfect, or reuse gloves.
Other items needed for blood collection
• .Antiseptics, Sterile Gauze Pads and Bandages
• 70% isopropyl alcohol preparation
• iodine swab sticks or pads** (for blood cultures) are essential for blood collection
Micro collection Equipment
• Usually, skin puncture blood-collecting techniques are used on infants, because venipuncture is excessively hazardous.
• For infants, the Clinical Laboratory Standards Institute recommends a penetration depth of less than 2.0 mm on heelsticks to avoid penetrating bone.***
Lancets and Tubes
• Different facilities use different manufacturers
Examples• BD Quikheel Lancet• BD Genie Lancet • Tenderlett Automated Skin Incision Device• Monoject Monoletter Safety Lancet • Greiner Bio-One Lancets
Microcontainers
• For dermal sticks two additional equipment is required-
-Plastic micro hematocrit capillary tubes
-Disposable narrow-bore pipettes that are
used for packed red cell volume in microcentrifugation
Micro collection tubes
• Have colored bands; a red band indicates a heparin-coated tube, and a blue band indicates no anticoagulant
• Usually color coded according to the established protocol for blood collection vacuum tube tops
Different manufacturers
• Samplette micro blood collector • BD Microtainer tube • Microvette capillary blood collection system • SAFE-T-FILL capillary blood collection system
Specimen Collection Trays
• Taken on blood-collecting rounds
• Made of plastic (preferably latex free) that can be sterilized
• Includes all necessary collection equipment
• Prior to rounds- ensure that your tray is fully stocked
Specimen Collection Trays
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