Lesson 4 |BLOOD COLLECTION EQUIPMENT ADDITIVES ORDER OF DRAW

• Venipuncture

  • collect blood using the patient’s vein
• Capillary Puncture or Skin Puncture

  • blood is not coming from the skin, but rather on the capillaries—combination of the blood coming from veins and the arteries
• Arterial

  • collection of blood from the artery of the patient; should not be done by a phlebotomist or a medical technology as it is only done by RTs and physicians
• Blood drawing station

  • Primarily used for the outpatient department and typically has a table for supplies, a comfortable chair for the patient to sit on during the procedure, and a bed or padded table for the heel stick procedure for infants and young children
• Phlebotomy chairs

  • Should be comfortable and with an adjustable armrest
• Equipment carrier

  Makes the collection portable.

  A hand-held phlebotomy equipment is used for “stat” cases and a phlebotomy cart is usually utilized for early-morning phlebotomy rounds.

  The carts are left in the hallways to avoid nosocomial infection
• Handheld carriers (Tackle box)

  • Easily Carried
  • Contains enough equipment for numerous blood draw
  • “Stat” or emergency situations
• Phlebotomy cart

  • Gliding carts made up of steel or synthetic material
  • Shelves carrying adequate supplies
• Decontamination of hands after glove removal is essential
• Gloves and glove liners

  Should be used when performing blood collection.

  Gloves should have a good fit.

  The gloves that are approved to be used during phlebotomy.

  Non-sterile, disposable latex, nitrile, neoprene, polyethylene, and vinyl.

  It is best if the phlebotomist uses liners when his/her skin is prone to allergies and dermatitis
• Antiseptics

  Used to prevent sepsis, which is the presence of harmful bacteria that typically enters the human body through a wound or a break in the skin

  Substances that is use to prevent sepsis

  PREVENT or INHIBIT growth and development if Microorganism BUT DOESN’T KILL THEM

  Used to clean site prior to blood collection
• Disinfectants

  Used in killing microorganism on surfaces and instrument, should be handled with care because they could be harmful to the skin

  Chemical substances used to remove or kill microorganisms on surface and instruments
• SODIUM HYPOCHLORITE (Household Bleach)

  • 1:100 dilution for nonporous surface
  • 1:10 dilution for large amount of blood or other body fluid contamination

  10 minutes contact time
• Hand sanitizer or wall-mounted hand sanitizer

  Recommended as a substitute for hand washing except when the hands are visibly soiled.

  Routine decontamination: Alcohol based sanitizers

  Detergent containing wipes for visibly soiled hand and there’s no hand washing facilities
• Gauze pads

  Clean 2x2 inch gauze folded in fourths.

  They can be used to hold pressure after blood collection instead of cotton balls, since they have fluid proof backing that prevents contamination

  Use Of Cotton Balls To Hold Pressure Is Not Recommended

  Cotton tend to stick on the site of puncture, can reinstated bleeding
• Bandages

  • Used on the blood collection site once the bleeding has stopped. Other materials such as paper, coth, or knitted tape can also be used over folded gauze.
  • Caution: Adhesive bandages should not be used on babies younger than 2 years of age because of aspiration and suffocation
• 1-3 inch glass microscope slide

  ● For blood films and are used in hematology determinations
• Pen with non smear ink

  ● Recommended to used when labeling specimens
• A watch with timer

  ● Used to determine collection tome and to time tests.
• Sharps disposal containers

  ● Commonly called “sharps containers” are used as receptacle for needles, syringes, lancets, and other sharp objects

  ● With Biohazard Symbol

  ● Rigid, puncture resistant, leak proof and disposable and have locking lids

  ● CAUTION: It should not be overfilled because it creates dangers of sharps injury or other biohazard exposure
• Biohazard bags

  ● Used to transport blood and other specimens to the laboratory.

  ● These are leak-proof bags marked with biohazard logos.

  ● Outside pocket is used to hold requisitions and other documentation.
• Vein locating devices

  ● Are transillumination portable devices that use infrared light to help health professionals locate and assess veins for safe venous access.

  ● Inspecting organ by passing light through its walls

  ● Principle : Hemoglobin in the blood within the veins absorbs the light causing the vein to stand out as dark lines
• Tourniquet

  ● A constriction device applied to a patient’s arm prior to venipuncture with the aim of inflating the veins by restricting venous blood for a period of time.

  ● This device comes in different sizes and intended for single use only

  ● Its purpose is to constrict the flow of blood and makes the vein more prominent

  ● Flat strip, non-latex made material

  ● 3 to 4 inches above the puncture site (7.5-10 cm)

  ● Not longer than 1 minute
• Needles

  • Single sample needle, Sterile and disposable
  • Used for withdrawing blood samples.
  • 20-21 g commonly used, 21 and 22 used for blood collection
  • 23 g used for children
  • 21-23 and 25 used for butterfly infusion/need
  • These are sterile and for single use only. The 3 types of needles used in venipuncture are Multi-sample, hypodermic, and winged infusion.
  • Color coding for needles indicates the gauge
• Butterfly method/system

  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 to 3⁄4 inches

  Safety device- sleeves that slides over the needle

  5-12 inches rubber tubing
• Evacuated tube system - ETS (Multi-sample needle, tube holder, and evacuated tubes)

  A closed collection system composed of multi-sample need, tube holder, and evacuated tubes, which prevents exposure to contaminants.

  One end of the needle is pierced through the vein and the other end is in the stopper of the evacuated tube allowing the blood to flow into the tube.

  This allows numerous tubes to be collected in a single venipuncture
• • The disinfectants preferred to be used in venipuncture are the Environmental protection agency (EPA) registered sodium hypochlorite with 1:100 dilution.
  • For spills clean up procedure, the 10% dilution is used. The contact time required is 10 minutes
• Hypodermic

  Used in the syringe system and comes with different gauges and lengths for different types of usage.
• Multi sample

  • Used in the evacuated tube system (ETS) and are equipped with safety features. Color coded needles that do not have safety features must be used with tube holders that have safety features.
• Winged-Infusion

  Used for difficult veins such as those of pediatric or geriatric patients because it is more flexible than the needle or syringe.
• Self re-sheathing needles

  • After the device is used, the user slides the sleeve forward over the needle where it locks in place and provides a guard around the used needle
• Syringe with retractable needles

  • After the needle is used, an extra push on the plunger retracts the needle into the syringe, removing removing the hazard of needle exposure
• Blunt tipped blood drawing needles

  • After blood is drawn, a push on the collection tube moves the blunt tip needle forward through the needle and past the sharp needle point.
• Winged steel needle

  • After placement, the third wing is rotated to flat position, which blunts the needle point before it is removed from the patient
• Re-sheathing disposable scalpels

  • Single-use disposable scalpels have a shield that is advanced forward over the blade after used, containing and removing the hazard.
• Add on” Safety feature

  • Hinged or sliding shields attached to phlebotomy needles, winged steel needles, and blood gas needles, acts as an “”add on” safety feature.
• Retracting finger prick lancets

  • This single use lancet retracts automatically after use, containing and removing the hazard.
• Anticoagulants,

  commonly called blood thinners, are chemical substances that prevent blood clots. The two methods are by precipitation of calcium or by preventing thrombin formation.

  The different types of anticoagulants are ethylenediaminetetraacetic acid (EDTA), citrates, heparin, and oxalates.
• ETHYLENEDIAMINETETRAACETIC ACID (EDTA)

  • Against coagulation of blood

  Actions:

  • Chelates or precipitates Calcium
  • Inhibits thrombin activity

  Inversion - 8 times
• CITRATE

  Action: Combines calcium in a non-ionized form

  Available in:

  • 3.8% or 0.129M Trisodium citrate
  • 3.2% or 0.109M Buffered Sodium Citrate

  Concentration: 3.2-3.8g/dL in a ratio of 1 part of anticoagulant to 9 parts of blood (1:9)

  Inversion: 3 to 4 times