Methods of Blood Collection
Trays should be totally emptied and disinfected on a WEEKLY basis Needle Disposal Systems
Needles should be: Rigid
Sterile Puncture-resistant
Disposable Leakproof
Used once only With Biohazard symbol
Usually color red (some are yellow)
Needle size varies by:
1. Length
- for routine venipuncture: 1-inch and EVACUATED TUBES (Vacutainers)
1.5-inch Tube used for blood collection
2. Gauge (diameter of the bore) Contains a premeasured amount of vacuum
- gauge 18 (blood transfusion)
- gauge 21 (routine venipuncture) Anticoagulants: revent clotting by:
- gauge 25-27 (subcutaneous Binding calcium(EDTA, citrate, oxalate)
puncture) Inhibiting thrombin in the coagulation cascade (heparin)
- gauge 16 (blood donation)
SYRINGES: often preferred over an evacuated tube system when 1. Lavender (purple top)
drawing blood from patients with small or fragile veins Ethylenediaminetetraacetic acid (EDTA)
Advantages: Two forms:
Blood will appear in the hub Liquid tripotassium EDTA
Control of the suction pressure on the vein Spray-coated dipotassium EDTA
K2 EDTA: anticoagulant of choice for CBC
WINGED BLOOD COLLECTION SET: or “butterflies” are used for Inversion: 8 times
the infusion of IV fluids May be used for:
- for performing venipuncture from very small or fragile veins often Immunohematology testing
Blood donor screening
seen in children and in the geriatric population
Effects of short draw:
Shrinkage of RBCs
TOURNIQUET Decreased, hematocrit, RBC indices, and ESR
Constrict flow of blood in arm
Make veins more prominent
Rubber or elastic strip 1 inch wide by 15-18 inches long
Blood pressure cuff may be used instead
2. Pink top 9. Royal blue top
Contains gray-coated K2 EDTA Used for toxicology, trace metal, and nutritional analyses
Used specifically for blood bank in some facilities Contains spray-coated silica clot activator for serum or K2 EDTA
or sodium heparin
3. White top
Contains spray-coated K2EDTA and a separation gel 10. Tan tube
Called as plasma preparation tube (PPT) Available for lead determinations
Primarily used for molecular diagnostics Are certified to contain 0.1 ug/mL of lead
Contains K2 EDTA
4. Light blue top
Contains 3.2% sodium citrate 11. Yellow top
For coagulation studies Two different purposes:
Blood anticoagulant (9:1) Cellular studies; HLA phenotyping
DNA and paternity testing (ACD):
5. Black top Prevents clotting by binding calcium
3.8% sodium citrate Dextrose preserves the RBCs
For Westergren sedimentation rate Blood culture (SPS)
Blood:anticoagulant ratio (4:1) Binds calcium
Aids in the recovery of microorganisms by inhibiting the action of
6. Green top complement, phagocytosis, and certain antibiotics
Contain heparin combined with sodium, lithium, or ammonium ion
Used for chemistry tests (stat tests) 12. Orange top
Lithium heparin: shown to produce the least interference Contains a thrombin-based medical clotting agent and separation
gel
7. Light green top Rapid serum tubes (RSTs)
Contains lithium heparin and a separation gel Inversion: 5 times
Plasma separator tubes (PSTs) Ideal for stat serum chemistry
Well-suited for potassium determinations
13. Gold top
8. Gray top Contains a clot activator and separation gel
All gray stopper tubes contain sodium fluoride Serum separator tubes (SSTs)
May contain anticoagulant (potassium oxalate or Na2 EDTA) Used for most chemistry tests
For determination of blood alcohol levels
14. Red top
Referred to as clot or plain tubes
Contains no anticoagulant or additives
ORDER OF DRAW
Blood Culture Tube or Vial
Citrated Tube
Serum Tubes or with/without Clot Activator/Gel Separator
Heparin Tube
EDTA Tube
Glycolytic Tube
Solutions for Skin Antisepsis
Most common: 70% isopropyl alcohol
Scrubbed for 30-60 seconds in a back-and-forth motion SKIN PUNCTURE: Is the technique of choice to obtain a blood
creating a friction on the skin specimen from newborns and pediatric patients. In adults, this
Air-dry
procedure may be used in patients:
Two-step Cleansing
Who are severely burned
For collection of specimens for blood culture:
Whose veins are being reserved
1. 70% isopropyl alcohol
Extremely obese
2. 1-10% povidone iodine pads/ tincture of iodine/
Elderly patients
chlorhexidine compounds
Scrub for 30-60 seconds
Collection Sites for Skin Puncture
Infants (under 1 year): Lateral or medial plantar surface of the heel
Children older than 1 yr and adults: Palmar surface of the distal
portion of the third or fourth finger on the nondominant hand
The puncture should be perpendicular to the fingerprint
Sites that should NOT be punctured:
Swollen
Bruised
Infected
Has been punctured
Edematous
Patients who are dehydrated and have poor peripheral circulation
SPECIMEN HANDLING
Reasons for Specimen Rejection
Test order requisition and the tube identification do not match
Tube is unlabeled, or the labeling, including patient identification
number is incorrect
Specimen is hemolyzed
Specimen was collected at the wrong time
Specimen was collected in the wrong tube
Specimen was clotted, and the test requires whole blood or plasma
Specimen was contaminated with intravenous fluid
CAPILLARY TUBES Specimen is lipemic
Are available with or without heparin
(NOTE: OSHA recommends the use of plastic tubes or Mylar-coated glass Cold Agglutinins
tubes to avoid injury by broken glass and exposure to bloodborne Samples must be kept warm until the serum can be separated from
pathogens) the cells
Samples are collected in tubes that have been warmed in an incubator
MICROCOLLECTION TUBES at 37 degree Celsius for 30 minutes and that contain no additives or
Are available with or without additives gels that could interfere with the test
Should be labeled with the same information as required for evacuated
tubes Chilled Samples
(NOTE: EDTA microcollection tube should be filled first) Inhibit metabolic processes
For adequate chilling, the sample must be placed in either crushed
ice or a mixture of ice and water, or in a uniform ice block at the
bedside
RED N/A
Photosensitive Analytes
Artificial light or sunlight may affect some analytes K3EDTA CBC
LAVANDER
Must be wrapped in aluminum foil or use an amber-colored container K2EDTA BB
Legal or Forensic Samples
Blood
Documentation of sample handling, called the Chain of Custody, is PINK K2EDTA
Bank
essential
Tests most frequently requested are alcohol and drug levels, and DNA
analysis PPT
K2EDTA + Molecular (Plasma
WHITE
seperation gel diagnostic Preparation
Blood Alcohol Samples tube)
The site of venipuncture should be cleansed:
With soap and water
3.2% Sodium Coagulatio
A nonalcoholic antiseptic solution such as benzalkonium chloride LIGHT BLUE
Citrate n Studies
(Zephiran Chloride)
Westergen
ADDITIVES/ 3.8% Sodium Sedimentation
TUBES ANTICOAGULANT
USE Others BLACK
Citrate rate
ESR
Lead
TAN K2EDTA
determination Heparin (combined with Chemistry
GREEN Na, Li, Ammonium ion) test (STAT)
ACD (Blood bag)
YELLOW SPS (Blood culture)
Lithium Potassium PST
LIGHT (Plasma
Heparin+seperation determinati
GREEN gel
Seperation
ons tube)
RST
Clot Activator STAT serum
ORANGE (Thrombin) (CHEMISTRY)
(Rapid Serum
tube)
Na Fluoride (Additive) Blood alcohol
GRAY Potassium Oxalate levels
(Anticoagulant) determination
SST
Clot Activator CHEMISTRY
GOLD + Seperation gel test
(Serum
Separation tube)
Toxicology, CC,
K2EDTA or Sodium Trace metal,
ROYAL BLUE Heparin multiple
analysis
