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