ETS

• Evacuated Tube System (ETS) is preferred for blood collection as it is direct, efficient, relatively safe, and allows for the collection of multiple tubes easily
• Equipment needed for venipuncture using ETS:

  • Tourniquet
  • Gloves
  • Antiseptic pad
  • ETS needle
  • Tube holder and tubes
  • Gauze pads
  • Sharps container
  • Permanent ink pen
  • Bandage
• Two-way/multi-sample needle components:

  • Bevel: slanted opening of the needle
  • Needle shaft: ranges from 1 to 1 ½ inches
  • Threaded hub: screws into needle holder
  • Rubber sheath: rubber cover that prevents blood leakage
• Evacuated tubes:

  • Sealed with a partial vacuum inside by rubber stoppers
  • Vacuum is artificially created by pulling air from the tube
  • The amount of vacuum is precisely measured by the manufacturer to draw the exact volume of blood indicated on the label
• Evacuated tube additives:

  • Different blood tests require different types of blood specimens
  • Most tubes have an additive, usually an anticoagulant, to prevent clotting of the blood sample
  • The color of the stopper on each tube indicates the type of additive it contains
• Evacuated tubes & additives:

  1. Red Top:

  • Additive: No additive or clot activator
  • Tests: Routine blood chemistry, serology tests, blood bank procedure
• Evacuated tubes & additives:

  2. Gold Top:

  • Additive: Gel separator or clot activator
  • Tests: Routine blood chemistry, diagnostic testing of serum for infectious diseases, HLA typing
• Evacuated tubes & additives:

  3. Light Blue Top:

  • Additive: Sodium citrate – removes calcium
  • Tests: Prothrombin time, APTT, D-dimer, fibrinogen
• Evacuated tubes & additives:

  4. Green Top:

  • Additive: Heparin – inhibits thrombin formation
  • Tests: Arterial blood gas, therapeutic drug monitoring, electrolyte analysis
• Evacuated tubes & additives:

  5. Purple/Lavender Top:

  • Additive: Ethylene diamine tetraacetic acid (EDTA) – removes calcium
  • Tests: Complete blood count, erythrocyte sedimentation rate, peripheral blood smear, reticulocyte count, HbA1C
• Evacuated tubes & additives:

  6. Black Top:

  • Additive: Buffered sodium citrate
  • Tests: Erythrocyte sedimentation rate, coagulation studies
• Evacuated tubes & additives:

  7. Grey Top:

  • Additive: Potassium oxalate – precipitates calcium or sodium fluoride – inhibits glycolysis
  • Tests: Glucose determination, Gamma-glutamyl transferase (GGT), blood alcohol level
• Evacuated tubes & additives:

  8. Brown/Tan Top:

  • Additive: Sodium heparin – inactivates thrombin and thromboplastin
  • Test: Serum lead determination
• Evacuated tubes & additives:

  9. Yellow Top:

  • Additive: Sodium polyanethol sulfonate (SPS) or acid citrate dextrose (ACD)
  • Tests: SPS, blood culture specimen, ACD, blood bank studies, HLA phenotyping
• Evacuated tubes & additives:

  10. Light Green Top:

  • Additive: Lithium heparin or gel separator
  • Test: Routine chemistry tests
• Order of draw for venipuncture procedure:

  1. Review and accession test request

  2. Greet and reassure the patient

  3. Identify the patient

  4. Verify patient information and conditions
• Venipuncture procedure steps:

  5. Select correct tubes and equipment

  6. Wash hands and apply gloves

  7. Position the patient's arm

  8. Apply the tourniquet

  9. Clean the site with alcohol

  10. Assemble the equipment
• Venipuncture procedure steps:

  11. Insert the tube into the holder

  12. Reapply the tourniquet

  13. Remove the needle cap

  14. Anchor the vein

  15. Insert the needle into the vein
• Venipuncture procedure steps:

  16. Advance the tube onto the needle

  17. Release the tourniquet

  18. Remove the tube when blood flow stops

  19. Invert anticoagulated tubes promptly
• Venipuncture procedure steps:

  20. Cover the puncture site with gauze

  21. Activate the safety device

  22. Dispose of the needle/holder assembly

  23. Label the tubes and verify identification

  24. Examine the puncture site and apply a bandage
• Venipuncture procedure steps:

  25. Prepare the sample for transportation

  26. Dispose of used supplies

  Sites to avoid for venipuncture:

  • Scarred or inflamed skin
  • Arms with IV fluids
  • Edematous arms
  • Arterial puncture
  • Fistula
  • Hand veins
• Common blood tests affected by additives:

  • Citrate affects alkaline phosphatase, calcium, phosphorous
  • EDTA affects alkaline phosphatase, calcium, creatine kinase, partial thromboplastin, protime, potassium, sodium, serum iron
  • Heparin affects acid phosphatase, calcium, partial thromboplastin, protime, sodium, lithium
  • Oxalates affect acid phosphatase, alkaline phosphatase, amylase, calcium, LDH, potassium, protime, RBC morphology
  • Silica gel/clot activators affect partial thromboplastin, protime
  • Sodium fluoride affects sodium, blood urea nitrogen