portable transillumination devices

Blood Collection Equipment, Additives, and Order of Draw Flashcards by Kyla Mae

3 methods of blood collection

venipuncture
capillary puncture/skin puncture
arterial puncture

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phlebotomy section/area
where phlebotomy procedures are performed
typically contains
- table for supplies
- special chair
- bed or reclining chair
- bed or padded table

blood drawing station

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comfortable
have adjustable armrests

phlebotomy chairs

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make blood collection equipment portable
handheld carriers
phlebotomy carts

equipment carriers

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easily carried
contain enough equipment for numerous blood draw
“stat” or emergence situations

handheld carriers

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gliding carts made up of steel or synthetic material
shelves carrying adequate supplies for many patients
not in the room, hallway only, nosocomial infection

phlebotomy carts

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one for each patient
non-sterile, disposable latex, nitrile, neoprene, polyethylene, and vinyl
special gloves
barrier hand creams
key point: decontamination of hands after removal is essential

gloves and glove liners

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substances that is used to prevent sepsis
prevent or inhibit growth and development of microorganism but doesn’t kill them
used to clean site prior to blood collection
70% ethyl/isopropyl alcohol, benzalkonium chloride, chlorhexidine gluconate, hydrogen peroxide, povidone iodine (0.1% - 1% available iodine), tincture of iodine

antiseptics

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chemical substances used to remove or kill microorganisms on surface and instruments
sodium hypochlorite (household bleach

disinfectants

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dilution ratio for nonporous surface

1:100

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dilution ratio for large amount of blood or other body fluid contamination

1:10

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How many minutes of contact time is for disinfectants?

10 minutes

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routine decontamination: alcohol based sanitizers
detergent containing wipes for visible soiled hand and there’s no hand washing facilities

hand sanitizers

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1 x 1 in
hold pressure over the site following blood collection procedure
use of cotton balls to hold pressure is not recommended

gauze pads

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used to cover a blood collection site after the bleeding has stopped
paper, cloth, knitted tape
caution: adhesive _____ should not be used on babies younger than 2 of age because of aspiration and suffocation

bandages

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where you play needles, lancets, and other sharp objects
with biohazard symbol
rigid, puncture resistant, leak proof, and disposable and have locking lids
caution: should not be overfilled because it creates dangers of sharps injury or other biohazard exposure

needles and sharps disposal containers

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leakproof plastic bags
transporting blood and other specimens from collection site to the laboratory
biohazard label and outside pocket

biohazard bags

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3 ways to perform venipuncture

syringe method
butterfly infusion method
vacutainer/ETS method

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General equipment/materials needed:

cotton/gauze pad, tourniquet, 70% ethyl alcohol, needle disposal container

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equipment/materials needed for syringe method

syringe, needles, transfer device, tubes

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equipment/materials needed for evacuated tube method

tube holder, needles, evacuated tubes

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equipment/materials needed for butterfly system

winged infusion set

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Vein locating device

portable transillumination devices

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Principle of transillumination devices in vein location

hemoglobin in the blood within the veins absorbs light, causing the vein to stand out as dark lines

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* to constrict flow of blood, makes the vein more prominent * flat strip, non-latex made material * can be reused? * 3 - 4 inches below puncture site (7.5 - 10 cm) * not longer than 1 minute * blood pressure cuff (sphygmomanometer) - for obese, pediatric, geriatric

torniquet

Materials for syringe method

needle, syringe, transfer devices

* single sample needle * sterile and disposable * color coding for needles indicates the gauge

needle

The larger the gauge number, the _______ the needle bore and length`

smaller

20 - 21 g is commonly used for?

blood collection

23 g is used for?

children

21 - 23, and 25 is used for?

blood infusion/needle

gauge 20 color

yellow

gauge 21 color

green

gauge 22 color

black

gauge 23 color

blue

gauge 25 color

orange

gauge 26 color

brown

Needle lengths?

* 1 or 1.5 inch * 1/2 to 3/4 in - butterfly needle

Gauge and use: 27

PPD skin test

Gauge and use: intramuscular injections

Gauge and use: butterfly or syringe collection

Gauge and use: syringe or ETS collection

22 - 20

Gauge and use: Ivs or blood donation

18 and 16

* safety cap * fishing out * barrel that slides over the needle * device that slides over the needle after use

syringe method

* glass or plastic * "breathing the syringe" * the large the syringe, the greater the amount of vacuum obtained" * fragile, thin, or "rolly" veins that tend to collapse

syringe

When collecting blood using syringe, add the ________ of blood needed to fill the tubes to ensure that the syringe is capable of drawing the total volume

total volume

A transfer device must be _____ when tubes are being filled in order to prevent blood in the tube from touching the needle in the transfer device

vertical

* short needle with a thin tube with attached plastic wings * used for infants and children, and patients with fragile veins (cancer patients) * could be connected to syringe or evacuated tubes * 21- or 23- gauge * 1/2 or 3/4 in * safety devices - sleeves that slide over the needle * 5 - 12 in rubber tubing

butterfly method/system

Materials needed for ETS

* multi-sample needle/double-pointed needle * tube holder/needle adapter/plastic holder * evacuated tubes

* both ends are sharp * the tube end has a rubber cover to prevent leakage between tubes * 20, 21, 22 (21, and 22) * length: 1 to 1.5 in * bevel (facing upward)

multi-sample needle set/double pointed needle

* help place and remove tubes * has an indentation about 1/4 inch * grasp the same way of holding the barrel of syringe

tube holder/needle adapter

* Sodalime, borosilicate glass or plastic * tubes are indicate by color of rubber stopper (color-coded) * with different additives or anti-coagulant present * has vacuum inside * has expiration date * sterile * different diameters: 10, 13, 16 mm

Evacuated tube system

* pulling air from the tube * draw exact volume of blood indicated * loss of it: fail to properly fill with blood

Vacuum

Do tubes fill blood all the way to the stopper?

* improper storage * opening the tube * dropping the tube * needle bevel partially out of skin

causes of premature loss of vacuum

* preserve a specific blood constituent * used to improve sample quality or accelerate sample processing * aid in the separation of serum from cell

Tube additives

* additive that interrupts the process of coagulation

Anticoagulants

Anticoagulant additives are?

EDTA, citrate, heparin, oxalates

Additive that prevents glycolysis

Anti-glycolytic

example of anti-glycolytic additive?

sodium fluoride

example of clot activator additive

thixotropic gel separators

Actions of anticoagulants

* chelates or precipitates calcium * inhibits thrombin activity

* Range of Mix or # of inversion for anticoagulant: _____ * EDTA and Heparin: ___ * Citrate: ___

* 3 - 8 x * 8x * 3 - 4x

Anticoagulants with special use

* acid citrate dextrose - DNA testing, HLA typing, transplant compatibility * citrate phosphate dextrose * sodium polyanethol sulfonate (SPS)

* action: chelates calcium * uses hematology test (CBC) and blood bank * Key point: excess causes RBC to shrink and change CBC results

Ethylenediaminetetraacetic acid (EDTA)

2 forms of EDTA

* Versene * sequestrene

Forms of EDTA

* 2 forms: Versene and Sequestrene -> Dipotassium EDTA (K2 EDTA) -> Tripotassium EDTA (K3 EDTA) - Sequestrene -> Disodium EDTA (Na2 EDTA) - Versene

What color is the stopper for EDTA?

Purple

What color is the stopper for citrate?

Light blue

* action: combines calcium in a non-ionized form * Concentration: 3.2 - 3.8 g/dL in a ration of 1 part of anticoagulant to 9 parts of blood (1:9) * 8x inversion * uses: coagulation studies

Citrate

Other variations of citrate tube

* 3.8% or 0.129 M trisodium citrate * 3.2% or 0.109 M buffered sodium citrate

Sodium citrate in ____ stoppers are used for erythrocyte sedimentation rate

black

Fill lines of blood in light blue stopper?

Max, mid, min.

Color of stopper with heparin additive

green

* aka Mucoitin Polysulfuric acid * ideal universal anticoagulant * naturally occurring anticoagulant * action: acts as antithrombin and antithromboplastin * Available in: -> Sodium, lithium, potassium, and ammonium salts -> lithium heparin (dry powder)

heparin

* Uses: BGA, Chemistry test (STAT request eg electrolytes), situation that needs a fast turn around time

Heparin

__________ is preferred over serum for potassium tests since RBC releases potassium as blood clots

Heparinized plasma

* Action: combines with calcium to form an insoluble salt * temperature sensitive anticoagulant * uses: hematology (CBC, Hgb, and Hct) * available in: -> ammonium oxalate: swells the cells -> potassium oxalate: shrinks the cells -> double balance oxalate (2:3)

Oxalates

What is the color of the stopper of a tube of oxalate additive?

black

* action: forming weakly associated calcium components; inhibits the glycolytic enzyme enolase * weak anticoagulant * available in: Sodium flouride * concentration: 10mg/mL of blood (2mg/mL fluoride) * without any antiglycolytic agent, glucose decreases approximately 100mg/ml or 10mg/dL per hour

Fluoride

Color of tube with fluoride additive?

gray

* for blood culture collection * microbiology section * action: anti-coagulant, anti-complementary, anti-phagocytic, neutralizes aminoglycoside (antibiotic) * Disadvantage: inhibits (Gardnerella, Neiserria, strptobaccilus, peptostrptoco)

Sodium polyanethol sulfonate)

* Gold top * designed to help isolate/separate the serum to cell composition * with thixotropic polymer gel (specific gravity of 1.04; serves as physical barrier or gel separator)

Serum separator tube

* white top * in order to draw: after SST or before heparinized tube

plasma separator tube

Additive: None Specimen/Clinical use: Serum/chemistry and serology

Red (glass)

Additive: clot activator Specimen/Clinical use: serum/chemistry and serology

red (plastic/hemogard)

Additive: K3 EDTA in liquid form Specimen/Clinical use: Plasma/hematology

Lavender (glass)

Additive: K2 EDTA/spray dried Specimen/Clinical use: plasma/hematology

Lavender (plastic)

Additive: Spray dried K2 EDTA Specimen/Clinical use: Plasma/blood bank

Pink

Additive: EDTA and gel Specimen/Clinical use: Plasma/molecular diagnostic

White

Additive: sodium citrate Specimen/Clinical use: plasma/coagulation studies

light blue

Additive: sodium heparin, Na2 EDTA Specimen/Clinical use: Plasma/chemistry, toxicology, TDM

Royal blue

Additive: lithium heparin, sodium heparin Specimen/Clinical use: plasma/chemistry

green

Additive: sodium fluoride, lithium iodoacetate Specimen/Clinical use: plasma/glucose testing

gray

Additive: sodium polyanethol sulfonate (SPS), acid citrate dextrose Specimen/Clinical use: serum/microbiology culture (SPS), HLA typing (ACD)

Yellow

* Additive: clot activator and gel separator * Specimen/Clinical use: Serum/chemistry

Red/black, gold

Additive: sodium heparin Specimen/Clinical use: plasma/lead testing

tan (glass)

Additive: K2 EDTA Specimen/Clinical use: Plasma/lead testing

Tan (plastic)

Additive: thrombin Specimen/Clinical use: serum/chemistry

orange

* Additive free tubes * mostly for clearing and discard purposes * yields serum sample

nonadditive tubes

Order of draw: (section) - (color) Sterile blood culture tubes -

yellow

Order of draw: (section) - (color) coagulation tubes -

light blue

Order of draw: (section) - (color) serum tube/plain tube -

red

Order of draw: (section) - (color) heparin tube -

green

Order of draw: (section) - (color) EDTA tube -

lavender/purple

Order of draw: (section) - (color) anti-glycolytic tube/fluoride -

gray

If SST or PST is available or needed, after 3rd tube or before heparinized tube:

* "**S**top, **Light** is **R**ed, **Green** **L**ight, **G**o" * "**S**top, **Light** is **R**ed, **S**tay **P**ut. **Green** **L**ight, **G**o"

Order in which tubes are collected during multiple draw or are filled from a syringe

1. Sterile blood culture tubes - yellow 2. Coagulation tubes - light blue 3. serum tube/play tube - red 4. heparin tube - green 5. EDTA tube - lavender/purple 6. Antiglycolytic tube/fluoride - gray

* transfer of additive from one tube to the next * occurs when: -> blood in additive tube touches the needle during ETS blood collection -> when blood is transferred from a syringe into ETS tube

Carry over/cross contamination

* complete system for blood collection * blood collection tube and collection apparatus combined in a single unit * ether ETS or Syringe technique

Combination system

* aka capillary puncture or micro sampling or micro collection

skin puncture

length of lancet

1.75 mm

Depth of incision of lancet: * infants and children: * adults:

* infants and children: <2.0 mm * adults: <2.5 mm

Distance of lancet from skin surface to bone or cartilage

1.5 - 2.4 mm

A fingerstick to obtain blood is preferred for children older than ____ year old

Before blood collection, wipe the ____ drop of blood using cotton or gauze

first

Cut orientation for skin puncture?

across fingertips

During blood collection, ___________ the site to prevent hemolysis and excess tissue fluid

Do not milk

Filling of ______ should be done rapidly

capillary tube

In skin puncture, Prevent the induction of ______

air bubbles

Person who can benefit from this method of collection (skin puncture) (4)

* pediatric patients - sample volume limited * obese patients * chemotherapeutic patients * burn patients

Order of filling micro sampling tubes?

*blood gas specimen * EDTA specimen * other additive specimens *serum specimens

* Stop point * disadvantage: -> blade is exposed after use -> anxiety of the patient

Non-retractable lancets

* 2 types: -> automatically punctures the skin -> phleb pushes the blade * plastic device hides the blade in a plastic holder

retractable lancets

* Holds all the equipment necessary for proper sample collection * biohazard symbol is needed to meet OSHA blood borne standard precautions * Always prevent contamination -> Place a towel before placing the tray on the bed of the patient -> get the towel after

sample collection trays or carts

Blood Collection Equipment, Additives, and Order of Draw Flashcards

(126 cards)