Safety Preanalitycal

F Alvi Satriyadi – BD PAS

RSUD dr R Soetijono
16 Okt 2019
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BD COMPLETE PRE ANALITYCAL SYSTEM
( Venous, Capillary and Arterial )
Blood Collection System

© 2016 BD. BD, the BD Logo and all other trademarks are property of Becton, Dickinson and Company. By Alvi Satriyadi
© 2016 BD. BD, the BD Logo and all other trademarks are property of Becton, Dickinson and Company.
 3-4

BD Vacutainer program
In Service Training
May I Help You ( With Himpunan Kimia Klinik Indonesia)
Persiapan Akreditasi :

Confidential—For Internal Use Only

Preanalytical Systems
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 Changing…..

Need to No need to transfer

transfer

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 Do Safe With BD

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 Pelaksana Medis
• Dokter
• Perawat / Bidan
• Analis / Sertifikasi

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 More Safety

• Support pelaksanaan kesehatan dan

keselamatan kerja ( K3 ) yang pada akhirnya
meningkatkan efisiensi dan juga
produktivitas kerja
• Worker Safety ↔ Patient Safety
• Mengurangi Needle Stick Injury

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 FAKTA DI LAPANGAN

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© 2016 BD. BD, the BD Logo and all other trademarks are property of Becton, Dickinson and Company.
© 2016 BD. BD, the BD Logo and all other trademarks are property of Becton, Dickinson and Company.
 SAMPLE

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 NEEDLE

• Multi Sample Needle :

• Jarum BD Vacutainer ® dapat digunakan untuk beberapa
sampel tabung. BD Vacutainer ® jarum memiliki low-angle
desain bevel canggih dan mempunyai tingkat gesekan
rendah, sangat lembut dan halus saat masuk vena.
• Kontrol kualitas Laser individu mempertahankan tingkat
kualitas tertinggi.
BD Vacutainer ® jarum yang tersedia dengan jarum
pengukur 20, 21 atau 22.

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 MULTI SAMPLE NEEDLE

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 NEEDLE

• Flashback Needle :
• Flashback needle BD Vacutainer ® Flashback metupakan
multi-sampel jarum yang menyediakan konfirmasi instan
penempatan jarum, melalui kilas balik visual yang unik.
• Flashback needle BD Vacutainer ® dapat digunakan dalam
kasus di mana
vena sulit untuk ditemukan. Hal ini juga memudahkan
personil dalam pengambilan sampel sistem tertutup (
Closed System )

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 FLASHBACK NEEDLE

© 2016 BD. BD, the BD Logo and all other trademarks are property of Becton, Dickinson and Company.
 ECLIPSE NEEDLE

• Eclipse Flashback Needle :

• Eclipse Flashback needle BD Vacutainer ® dengan
pengaman jarum meningkatkan keamanan petugas
phlebotomy dan pasien dari Needle Stick Injury
• Futuristik Flashback Needle, new material in Needle

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 NEEDLE
• Luer Adapter :
• BD Vacutainer ® Luer adapter adalah perangkat steril dengan
katup multi-sampling dan dirancang untuk menghubungkan
dengan IV kateter atau jarum suntik untuk pengumpulan darah
dengan tabung BD Vacutainer ®.

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 NEEDLE

• Wingset Collection Needle :

• Mempunyai kunci jarum ireversibel yaitu
teknologi unik memungkinkan penarikan jarum ke dalam
perangkat, memberikan perlindungan terhadap resiko
tertusuk jarum suntik / Needlestick injury

• Available at 21 / 23 / 25 Gauge

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 NEEDLE
• Wingset Collection Needle :
• Selain digunakan untuk pemeriksaan darah rutin juga
dapat digunakan sekaligus untuk pengambilan sampel
kultur darah
• Mengurangi NSI dan pengambilan sampel maksimum

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 HOLDER
• Standard
• Pronto Quick Release

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 Types of Vacutainer® Tubes
• Serum – with or without Gel
• Heparinized Plasma – with or
without Gel
• Citrate
• Fluoride
• EDTA
• Others

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 Sodium Citrate tube Full
Draw
• Plastic (2 layers) with very few head space or
4.5ml glass tube
• Contains buffered sod. Citrate:
– binding calcium & inhibiting coagulation
pathways
– Ratio of anticoagulant to blood 1 : 9
– 0.105M/ 3.2% solution
– 0.129M/ 3.8% solution
• For coagulation studies
– PT, aPTT, INR
– Factor Assays, Fibrinogen Assays, Platelet
Counts
 CLSI recommends 0.105M to 0.109M citrate
solution

Invert
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 Sodium Citrate tube Full
Draw
– Centrifuged for 10 minutes at 1500
rcf to achieve platelet poor plasma
(CLSI recommended)
– Don’t placing the tourniquet for
longer than 1 minute because can
lead to changes in the
concentration of coagulation
protein in the plasma as well as
platelet activation which can result
in erroneous coagulation result.

Invert
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 CLSI (NCCLS) recommends
3.13% to 3.2% citrate solution

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© 2016 BD. BD, the BD Logo and all other trademarks are property of Becton, Dickinson and Company.
 The Anti – coagulant ACD

ACD Tube ( Acid Citrate Dextrose )

• For Platelet-Rich Plasma (PRP)
• digunakan untuk konservasi eritrosit.
• ACD ada dua bentuk: Solusi A (8,5ml)
dan B (6ml) , masing-masing dengan
rasio anticoagulant bebeda.

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 Selection of specimen bottles

Serum Plus tube (RED closure)

• Coated with micronized silica (clot
activator)
• For a wide array of chemistry,
immunology & serology tests
• invert for 5 times for tubes (Silica
Activator well mixed with blood)
• Centrifuged for 10 minutes 1300 rcf
• Remain in upright position
for one hour to allow clotting

Invert
5 times
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 SST / SST II tube
(Serum Separation Tube)
• Contains an inert Polymer Gel &
Micronised Silica Clot Activator
• For wide array of Chemical Tests
• Follow “ 5:30:10” rule for complete blood
clot form before centrifugation and better Gel
Separation
Gel Separator
•10 mins centrifugation using swing head
centrifuge
• Best Performance at around 25oC
• Improved Gel Stability and Quality
 Suitable for TDM & Hormonal
Invert 5
Monitoring (esp. for SSTII) times
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 GEL TUBES - Advantages
• Allow use of primary tube on analyzer(s)
• Allow storage of sample in primary tube
• Minimize Turnaround Time (TAT)
• Eliminate cost of secondary (aliquot) tubes
• Eliminate labour cost associated with aliquoting
• Minimize labeling errors
• Reduce waste
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 Automation / Core Lab

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 Plasma tubes

• Contains Lithium Heparin (sometimes

Na+ Heparin or NH4+ Heparin)
• Plasma Separation for immediate
analysis, esp. in Emergency Lab of ICU
for urgent electrolytes (Na+ & K+)
• Type of Heparin anticoagulant used
depends on type of assay & analytical
method.
• Invert 8 times, centrifuge and remove
plasma from cells for testing

Invert
8 times
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 PST / PST II tubes
(Plasma separation tube)

• Plasma tube with separating gel for clinical

chemistry
• Contains Lithium heparin as anticoagulant -
by inhibition of thrombin activity in blood
coagulation pathway
• Analysis of common chemistry analytes
• Invert 8 times and centrifuge immediately
• Can be used as primary tube &
no separation of Plasma required
• Centrifuged for 10 minutes 1000-1300RCF Invert
8 times
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 EDTA tubes
• Coated / Uncoated interior – for Spray-Dried /
Liquid Anticoagulant
• EDTA (Ethylene Diamine Tetraacetic Acid)  Binds
Calcium in Blood and inhibits Coagulation
Pathway
• K2 EDTA- spray dried
• K3 EDTA – liquid or spray-dried
• 7.5% solution (2-3 ml draw)
• 15% solution (3.5-10ml draw)

• For Complete Blood Picture , ESR

Invert
• Invert 8 times 8 times
• CLSI recommends K2EDTA
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 Facts about K2EDTA and K3EDTA
• K3EDTA causes initial shrinkage of red cells (typically 2 to 3%)
• Apart from RBC volume changes, EDTA (all types) also
induces degenerative changes in other cell types (leucocytes
and platelets)
• RBC volume changes leads to errors in manual haematocrit,
and mean red cell volume (MCV) values in specimens tested
on automated haematology analysers  lead to errors in red
cell indicies derived from these (eg mean cell haemoglobin
concentration - MCHC)
• MCV and MCHC are useful for classification of anaemia
• RBC shrinkage  misinterpreted by inexperienced
microscopists

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 Sodium Fluoride
• Plasma tubes with glycolytic inhibitor
• Mainly for Glucose determination
• Stabilize glucose in plasma
– Potassium oxalate/Sod. Fluoride
(for at least 48 hours)
**must mix these tubes properly
because Oxalate has poor
solubility, improper mixing will
form fibrins easily.
Overfill the tube (by syringe) with
poor mixing results in Fibrin
formation that blocks the
instrument probe.
 Sodium Fluoride / Na2EDTA tubes Invert
are also available 8 times
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 Cell and Biomarker Tube
• PAXgene® Blood RNA System
• PreAnalytiX, pengembangan antara
QIAGEN dan BD.
• Tabung PAXgene® RNA memastikan:
• Stabilisasi cepat RNA intraseluler
dalam darah lengkap.
• Hasil RNA
• Kualitas RNA
• Stabilisasi miRNA

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 Cell and Biomarker Tube
• PAXgene® ccf DNA System
• PreAnalytiX, pengembangan antara
QIAGEN dan BD.
• Untuk Pemeriksaan EFGR ( Epidermal
Growth Factor Receptor )
• Mutasi EFGR penanda kanker Paru
• Formulasi EDTA yang segera
menstabilkan intraseluler DNA
• Memastikan kecukupan kuantitas dan
kualitas DNA untuk uji diagnostik
molekuler yang membutuhkan DNA
dari seluruh darah.

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 SAMPEL DARAH KAPILER

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 JENIS LANCET

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 COUNT – ACT LANCET
Lancet otomatis pengambilan sampel jari
dengan desain ergonomis

LANCET CONT-ACT
PURPLE : Low
Flow, 30G x 1,5
mm depth

LANCET CONT-ACT
PINK : Medium
Flow, 21G x 1,8
mm depth

LANCET CONT-ACT
BLUE : 1,5 mm x
2,0 mm depth

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 QUIKHEEL Lancet ™
Lancet otomatis generasi safety yang di desain ergonomis dan
mempunyai nyeri minimal untuk pengambilan darah di tumit
pada bayi

PINK : 0,85
mm x 1,75
mm depth
TEAL : 1,00
mm x 2,50
mm depth
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MICROTAINER BLOOD COLLECTION
TUBES
Tabung penampung darah kapiler berkualitas yang
memaksimalkan pencampuran / mixing

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Arterial Blood Gas Preset ™

Spuit pengambilan sampel darah arteri yang sudah

dilengkapi dengan Dry Heparin
50 Unit per ml NO Dilution

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 How Much Heparin?
The IFCC recommends 50 IU/ml
 BD 3ml syringes contain approximately
80 units
To achieve 50 units per ml these should be
filled to 1.6ml
 BD 1ml syringes contain approximately
30 units
To achieve 50 units per ml these should be
filled to 0.6ml

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 Lokasi Pengambilan Darah Arteri
• Arteri Radialis
• Arteri Brachialis
• Arteri Femoralis

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 Allen Test
• Pasien diminta untuk mengepalkan tangan
• Beri tekanan pada arteri radial dan ulnary
sampai aliran darah distal tersumbat
• Dengan tetap menekan arteri tersebut, pasien
diminta membuka dan menutup tangannya
secara perlahan. Tangan harus kelihatan
memucat
• Lepaskan tekanan pada arteri ulnary. Apabila
dalam 15 detik tangan kembali berwarna
merah berarti positif (aliran arteri lancer) dan
dapat dilakukan pengambilan sampel pada
arteri radialis tersebut.
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© 2016 BD. BD, the BD Logo and all other trademarks are property of Becton, Dickinson and Company.
 Alvi BD Vacutainer
081329546352

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