FINALS ANACHEM

• Venipuncture


  The act of obtaining a blood sample from a vein using a needle attached to a syringe or a stoppered evacuated tube

  
• Venipuncture is the most common way to collect blood specimens

  
• Major veins for Venipuncture

  • Median Cubital Vein
  • Cephalic Vein
  • Basilic Vein
  • Veins on the back of the hand and wrist
  • Underside of the wrist
  • Leg
  • Ankle
  • Foot Veins

  
• Serum


  Normally a clear, pale yellow fluid, non-fasting serum can be cloudy due to lipids, separated from clotted blood by centrifugation

  
• Plasma


  Normally a clear to slightly hazy, pale yellow fluid, separates from the cells when blood in an anticoagulated tube is centrifuged, contains fibrinogen

  
• Whole Blood


  Consists both cells and plasma, must be collected in an anticoagulant tube to keep it from clotting, used for most hematology tests and many point of care tests

  
• Evacuated Tube System (ETS)


  • Preferred method because blood is collected directly from the vein into a tube, minimizing the risk of specimen contamination and exposure to blood
• Needle and Syringe


  • Discouraged by CLSI due to safety and specimen quality issues, sometimes used in small, fragile or damaged veins

  
• Butterfly Set


  • Can be used with the ETS or a syringe, often used to draw blood from infants and children, hand veins, and other difficult-draw situations

  
• Tourniquet


  Restricts venous flow but not arterial flow, must not be left on longer than 1 minute
• Needle Gauge


  The gauge of the needle is inversely related to the size of the needle, the larger the gauge number, the smaller the needle bore and length
• Needle Specifications


  • 21-gauge needle - considered the standard for venipuncture
  • 23-gauge needle - used for children
  • 23 or 25 gauge is used for winged infusion set (butterfly)
  • 23-gauge butterfly - most commonly used for small difficult veins
  • 25-gauge - used by specially trained personnel to collect blood from scalp or other tiny/small veins of premature infants and other neonate

  
• Evacuated Tube System


  Has 3 basic components: Multi-sample Needle, Tube Holder, Evacuated Tubes
• Syringe System


  Includes a plastic syringe, a needle and a transfer device

  
• Butterfly System


  23 gauge is the most commonly used for phlebotomy
• General Blood Collection Equipment and Supplies

  • Blood-drawing station (adult, child/infants)
  • Phlebotomy chair
  • Equipment carrier
  • Gloves (Non-sterile, disposable latex, nitrile, neoprene, polyethylene, and vinyl)
  • Antiseptics
  • Disinfectants
  • Hand sanitizer
  • Gauze pads
  • Bandages
  • Glass microscope slides
  • Permanent marker
  • Watch/Timer
  • Sharps disposal containers
  • Biohazard bags

  
• Venipuncture Equipment


  • Vein-locating devices
  • Tourniquet
  • Needles
  • Evacuated tube system
• Anticoagulants


  • EDTA, citrates, heparin, and oxalates
  • Acid citrate dextrose, citrate phosphate dextrose, and sodium polyanethol sulfonate (SPS)
  • Potassium oxalate and sodium fluoride
• Tube Additives


  • Clot activators (Silica or celite)
  • Thixotropic gel separator
  • Trace element-free tubes
• Red Top Tube


  No additive in glass tube, clot activator in plastic/Hemogard tube, used for routine blood chemistry, serology tests, and blood bank procedures
• Gold Top Tube


  Clot activator, gel separator, used for routine blood chemistry and diagnostic testing of serum for infectious disease, HLA typing
• Light Blue Top Tube


  Buffered sodium citrate, chelates/binds calcium, used for plasma/coagulation tests like prothrombin time, APTT, D-dimer, fibrinogen
• Black Top Tube


  Sodium citrate, forms calcium salts to remove calcium, used for erythrocyte sedimentation rate
• Green Top Tube


  Sodium/lithium heparin, inhibits thrombin formation, used for plasma/chemistry tests like arterial blood gas, therapeutic drug monitoring, electrolyte analysis
• Purple/Lavender Top Tube


  Ethylene diamine tetra acetic acid, chelates/binds calcium, used for complete blood count, erythrocyte sedimentation rate, peripheral blood smear, reticulocyte count, HbA1c
• Gray Top Tube


  Potassium oxalate (anticoagulant), sodium fluoride (antiglycolytic agent), used for glucose determination, GGT, blood alcohol level
• Brown/Tan Top Tube


  Glass - sodium heparin, inactivates thrombin and thromboplastin, Plastic - K2 EDTA, chelates/binds calcium, used for serum lead determination
• Yellow Top Tube


  Sterile - sodium polyanethol sulfonate (SPS) for blood culture, acid citrate dextrose additives (ACD) for WBC preservative, blood bank studies, HLA phenotyping, paternity testing
• Blood Culture Bottle


  Sodium polyanethol sulfonate (SPS) to minimize microbial contamination
• Other Tubes


  • Pink - Spray Dried K2 EDTA, chelates/binds calcium, used for blood bank and molecular diagnostics
  • White - EDTA and gel, chelates/binds calcium, used for plasma/molecular diagnostics
  • Light Green/Black - Lithium heparin and gel, inhibits thrombin formation, used for plasma/chemistry
  • Royal Blue - Sodium heparin, K2 EDTA, inhibits thrombin formation, binds calcium, used for plasma/chemistry/toxicology
• Order of Draw


  • Blood culture
  • Coagulation tubes
  • Glass non-additive tubes
  • Serum separator
  • Heparin tubes
  • EDTA tubes
  • Plasma preparation tubes

  
• The order of draw is important to prevent contamination and carry-over problems
• Color Coding in Identifying Additives in Blood Collection Tubes

  • Red - Silicone coated (glass) - no additive, Silicone coated (plastic) - clot activator
  • Gold - Clot activator and gel for serum separation
  • Light Green - Lithium heparin and gel for plasma separation
  • Orange - Thrombin based clot activator with gel for serum separation
  • Royal Blue - Clot activator, K2EDTA
  • Green - Sodium heparin, Lithium heparin
  • Gray - Potassium oxalate and Sodium fluoride, Sodium fluoride/Na2 EDTA, Sodium fluoride (serum tube)
  • Tan - K2EDTA (plastic)
  • Yellow - Sodium Polyanethol sulfonate (SPS), Acid Citrate Dextrose (ACD)
  • Lavender - Liquid K3 EDTA (glass), Spray-coated EDTA K2 EDTA (plastic)
  • White - K2EDTA and gel for plasma separation
  • Pink - Spray coated K2 EDTA (plastic)
  • Light Blue - Buffered sodium citrate

  
• The tube stopper color and additives are used to identify the tests that can be performed in the laboratory
• Tube colors and additives

  • Gray tube: Potassium oxalate and Sodium fluoride
  • Gray tube: Sodium fluoride/Na2 EDTA
  • Gray tube: Sodium fluoride (serum tube)
  • Tan tube: K2EDTA (plastic)
  • Yellow tube: Sodium Polyanethol sulfonate (SPS)- 0.025%
  • Yellow tube: Acid Citrate Dextrose (ACD)
  • Lavender tube: Liquid K3 EDTA (glass)
  • Lavender tube: Spray-coated EDTA K2 EDTA (plastic)
  • White tube: K 2 E D T A and gel for plasma separation (PST)
  • Pink tube: Spray coated K2 EDTA (plastic)
  • Light Blue tube: Buffered sodium citrate
  • Light Blue tube: CTAD (Citrate, Theophylline, Adenosine, Dipyridamole)
  • Red/Light Gray tube: None (plastic)
• Gray tube


  For glucose determination/glycolytic testing
• Tan tube


  For Lead determinations
• Yellow tube


  • Blood culture specimen collections in microbiology
  • Blood bank studies, HLA phenotyping, DNA and paternity testing

  
• Lavender tube


  Whole blood hematology tests (e.g. Complete blood count, Platelet count, Reticulocyte count, ESR, Hemoglobin A1c)
• K2EDTA


  Routine blood banking tests, donor screening