Module 6

• What are the 4 main components Evacuated Tube System?

  • Multisample Needle
  • Evacuated Tube
  • Tube Holders - hub
  • Needle and holder units
• Appropriate site can vary depending on

  patient
• Primary vein for venipuncture:

  • Median cubital vein of antecubital area of

  arm
• Second choice:

  • Basilic, cephalic, or median veins

  • Cephalic is preferred second site
• Least preferred site

  • Basilic vein

  • Use with caution

  • Brachial artery and major nerves are along

  this vein
• Alternative sites:

  • hand veins

  • wrist in line with the thumb

  • ankle or foot
• • Areas with damaged veins

  • Edematous or swollen, tender or painful extremities

  • Areas with hematoma

  • Extensive scars from burns or surgery

  • Arm with tattoo

  • Arms on the side of modified radical mastectomy

  • Extremities with intravenous (IV) line, arterio-

  venous (AV) fistula or vascular graft, and

  transfusion line
• Request form before blood collection shall include

  a Full name of the patient with the middle

  name

  b. Age and Sex

  c. Date of birth

  d. Working impression or clinical diagnosis

  e. Indicate as OP if out-patient;indicate the

  room/bed number if in-patient

  f. Test requested

  g. Name of the requestor/physician

  h. Date and time of blood specimen

  collection
• 2. Greet and properly identify the patient. Verify

  dietary restrictions, if there are any, and check for

  any sensitivity to latex.
• 3. Reassure and position the patient.
• 4. Assemble all equipment needed. a. For

  evacuated tube system (ETS), attach the two-way

  needle to the adaptor and prepare the evacuated

  tubes
• 5. Apply the tourniquet three (3) to four (4) inches

  above the puncture site. Ensure that the tourniquet

  is placed for no longer than one (1) minute.

  6. Sanitize hands and put on the gloves.

  7. Locate and select an appropriate venipuncture

  site.
• 8. Disinfect the venipuncture site with 70%

  isopropyl alcohol using the aseptic technique

  (concentric circle from inner to outer). Allow skin

  to air dry.

  9. Examine and assemble the puncture

  equipment.

  10. Perform the venipuncture. Place the thumb of

  the non dominant hand 1 to 2 inches below the

  puncture site to anchor the vein. Ensure that the

  needle is inserted bevel up with a 15 to 30

  degree angle from the site, or depending on the

  depth of the vein.
• 11. Collect blood in the tubes following the

  correct order of draw.

  ✓ If not all tubes in order of draw are to be

  collected, order is started with first tube

  needing collection

  ✓ Fill tubes until vacuum is exhausted to

  ensure proper blood-to-anticoagulant ratio

  ✓ Remove tube from holder
• 12. Release the tourniquet and withdraw the needle.

  13. Properly dispose all the infectious and

  biohazardous waste.

  14. Remove and dispose the gloves. Sanitize hands.
• 15. Label the tubes with the correct information

  • Name of the patient
  • Age and gender
  • Date of Birth
  • Initials of the phlebotomist
  • Date and time of specimen collection

  Note: Pre-labelling is strictly prohibited.

  
  

  16. Transport the specimen to the laboratory
• 
  

  ✓ Retie tourniquet

  ✓ Use blood pressure cuff as tourniquet

  ✓ Massage the arm. Do not slap the arm.

  ✓ Lower patient’s arm

  ✓ Warm venipuncture location

  ✓ Reseat tube in holder

  ✓ Use different tube

  ✓ Place your finger below venipuncture site and stretch vein slightly

  ✓ Rotate needle one-quarter to one-half turn

  ✓ Pull back or advance needle slightly
• Sample Preparation and Transportation

  1. Specimen Transport Bags
  2. Pneumatic Tube System
  3. Absorbent Wrap
• Federal Aviation Administration (FAA)

  • Regulates the shipment of etiological agents.
• Centers for Disease Control and Prevention

  • References indicate that specimen shipments in

  the United States and internationally are

  regulated under the following:

  1. HazardousMaterialsRegulations(USA)

  2. Dangerous Goods Regulation (International)
• According to the International Air Transport

  Association (IATA) Dangerous Goods

  Regulations (DGR):

  • Biological substance , Category A - Capable of causing permanent disability, life- threatening or fatal disease in otherwise healthy humans or animals

  • Biological substance ,Category B - infectious substance that does not meet the criteria for inclusion in Category A.