Special Blood Collection

TOPICS FOR MIDTERM
Special Blood Collection

Point of Care Testing (POCT)
Introduction to Hematology
Introduction to Immuno-Serology
Introduction to Blood Banking
Toxic and Abuse Substances
I. Collection Priorities
II. Fasting Samples
III. Timed Samples
IV. Blood Cultures
V. Blood Collection From Central Venous Catheters
VI. Special Sample Handling Procedures
VII. Special Patient Populations
Collection Priorities
 Use to diagnose and monitor a patient’s condition.

 Routine samples are usually collected early in the
Routine morning.
Samples  Can be collected throughout the day during scheduled
“sweeps” (collection times) on the floors or from
outpatients.
 “As Soon As Possible.”

ASAP  The response time for the collection of this test sample is
Samples determined by each hospital or clinic and may vary by
laboratory tests.
 The sample is to be collected, analyzed, and results
reported immediately.
 Stat tests have the highest priority and are usually
Stat Samples ordered from the emergency department or for a
critically ill patient whose treatment will be
determined by the laboratory result.
Fasting Samples
FASTING PATIENT. Abstinence from food and liquids (except

water) for a specified period.
A patient who is NPO (nothing by mouth) PATIENT is not

allowed to have food or water because of possible
complications with anesthesia during surgery or certain
medical conditions.
Timed Samples
Glucose Tolerance Tests

Lactose Tolerance Test
Diurnal Variation
Therapeutic Drug Monitoring
 Originally these included the 2-HOUR POSTPRANDIAL (PP)

GLUCOSE TEST and the Classic GLUCOSE TOLERANCE TEST (GTT).
 The 2-HOUR PP GLUCOSE compared a patient’s fasting glucose level with
the glucose level 2 hours after eating a meal with a high carbohydrate
content.
 The Classic GTT required patients to drink a standard glucose load and
return for testing on an hourly basis up to 6 hours in length.
 Currently statistics and methods developed by the American Diabetes
Association (ADA) and the World Health Organization (WHO) have
standardized and shortened the methods used for the diagnosis of
hyperglycemia.
 These methods include the 2-hour oral glucose tolerance test (OGTT) for
diabetes mellitus and the 1-step and 2-step methods for diagnosing
gestational diabetes.
 Phlebotomists need to be aware of the variation in these procedures.
 Requirements for GTT:

(1) Ambulatory, Fasting: 8-12 hours.
(2) Unrestricted diet of 150g CHO/day for 3 days.
(3) Smoking, chewing tobacco, alcohol, sugarless gum, and
vigorous exercise should be avoided before and during
the test.
(4) 75 g = adult (WHO Standard): 100 g = pregnant
GTT Procedure
EQUIPMENT:
Requisition form FLAVORED GLUCOSE SOLUTION
Gloves Tourniquet
Alcohol pads Evacuated tube holder and needles
Evacuated tubes 2 × 2 gauze
Sharps container Indelible pen
Bandage Biohazard bag
GTT Procedure
Step 1. Identify the patient and explain the procedure.

Step 2. Confirm that the patient has fasted for 12 hours and not more
than 16 hours.
Step 3. Draw a fasting glucose sample. The fasting blood sample is
tested before continuing the procedure to determine whether
the patient can safely be given a large amount of glucose.
GTT Procedure
Step 4. Ask the patient to drink the appropriate flavored glucose
solution within 5 minutes. Small adults and children may have
adjusted amounts based on 1 g of glucose per kilogram of
weight.
Step 5. Timing for the remaining collection times begins when the
patient finishes drinking the glucose solution . Outpatients are
given a copy of the schedule and instructed to continue
fasting, to drink water & to remain in the drawing station area.
GTT Procedure
GTT Procedure
Step 6. Collect remaining samples at the scheduled times. Timing of
sample collection is critical, because test results are related to
the scheduled times; any discrepancies should be noted on
the requisition.
Step 7. The type of evacuated tubes used for blood collection must
be consistent. Blood samples that will not be tested until the
end of the sequence should be collected in gray stopper tubes.
Consistency of VENIPUNCTURE or dermal puncture must also
be maintained.
GTT Procedure
Step 8. Corresponding labels containing routinely required
information and sample order in the test sequence, such as 1-
hour, 2-hour, and 3-hour are placed on the blood samples.
Step 9. During scheduled sample collections, phlebotomists should
also observe patients for any changes in their condition, such
as dizziness, which might indicate a reaction to the glucose,
and should report any changes to a supervisor.
GTT Procedure
Step 10. Some patients may not be able to tolerate the glucose
solution, and if vomiting occurs, the time of the vomiting must
be reported to a supervisor and the health-care provider
contacted for a decision concerning whether to continue the
test.
Step 11. Transport samples to the laboratory immediately. Samples
not collected in gray stopper tubes must be centrifuged or
tested within 2 hours of collection for reliable results.
2-Hour Oral Glucose Tolerance Test
 The OGTT is now the recommended method for the diagnosis of
diabetes mellitus.
 The procedure requires the collection of a fasting glucose sample, having
the patient drink a 75-g glucose solution within 5 minutes and return for
an additional glucose test in 2 hours.
 A result equal to or greater than 200 mg/dL is considered indicative of
diabetes mellitus.
One- and Two-Step Method for Gestational Diabetes
 The one-step method utilizes the same procedure as the diagnostic

OGTT used to diagnose diabetes mellitus.
 A value equal to or less than 140mg/dL is considered normal.

One- and Two-Step Method for Gestational Diabetes
 The two-step method requires the patient to receive two tests. First a 50-g
glucose challenge load is administered to the fasting patient and blood
collected and tested at 1-hour post ingestion.
 The second test is administered on a different day and consists of either a
75-g OGTT or a 100-g 3-hour OGTT based on institutional protocol and
health-care provider preferences.
 A value of 155 mg/dL in the 2-hour 75-g test is considered normal and a
value of 140 mg/dL is considered normal in the 3-hour 100-g test.
Lactose Tolerance Test
 A lactose tolerance test evaluates a patient’s ability to digest lactose, a
milk sugar.
 Lactose intolerance can be diagnosed by a lactose tolerance test. The
patient is asked to drink a standardized amount of lactose solution based
on body weight in place of the glucose.
 A blood collection schedule is similar to a 2-hour GTT.
 Glucose levels will raise no more than 20 mg/dL from the fasting
sample result if the patient is lactose intolerant.
Diurnal Variation
 Substances and cell counts primarily affected by diurnal variation are
corticosteroids, hormones, serum iron, glucose, and white blood cell
counts, particularly eosinophils.
 Phlebotomists are often requested to draw samples for these tests at
specific times, usually corresponding to the peak diurnal level.
 Certain variations can be substantial.
 I.E. Plasma cortisol levels drawn between 08:00 and 10:00 will be twice as
high as levels drawn at 16:00.
 To ensure patient safety and
medication effectiveness, the blood
levels of many therapeutic drugs are
monitored.
 The most beneficial levels are those
drawn before the next dosage is given
(TROUGH LEVEL) and shortly after the
medication is given (PEAK LEVEL).
 TROUGH LEVELS are collected immediately before the drug is to be given and
represent the lowest level in the blood and ensure the drug is in the
therapeutic (effective) range.
 The time for collecting PEAK LEVELS varies with the medication and the
method of administration (30 minutes after IV, 1 hour after intramuscular, or
1 to 2 hours after oral dosage) ensures that the drug is not at a toxic level.
 Therapeutic drug monitoring collections are often coordinated with the
pharmacy, laboratory, and nursing staff.
NOTE:
Collection of blood in gel serum separator tubes has caused

FALSELY LOW LEVELS for certain medications. RED STOPPER
TUBES are recommended for Therapeutic Drug Monitoring and
samples should be transported in an upright position.
Blood Cultures
 STRICT ASEPTIC TECHNIQUE required and the need to collect multiple
samples in special containers.
 A positive blood culture could be from skin contamination and not from
an actual patient infection in the blood.
 Blood cultures are requested on patients when symptoms of fever
(Fever of Unknown Origin (FUO)) and chills indicate a possible
infection of the blood by pathogenic microorganisms (septicemia).
Blood Cultures
Factors to consider in Blood Culture:
 Timing of Sample Collection
 Collection Equipment
 Blood Culture Anticoagulation
 Cleansing the Site
 Sample Collection
Blood Cultures
Timing of Sample Collection
 Blood cultures are usually ordered stat or as timed collections.
 Samples are usually collected in sets of two drawn 30 or 60 minutes
apart; however, timing of sample draws varies from institution to
institution, or just before the patient’s temperature reaches its highest
point (spike).
 The concentration of microorganisms fluctuates and is often highest
just before the patient’s temperature spikes.
Blood Cultures
Timing of Sample Collection
NOTE:
 If antibiotics are to be started immediately, the sets are drawn at the
same time from different sites.
 Samples collected from different sites at the same time serve as a
control for possible contamination and must be labeled as to the
collection site, such as right arm antecubital vein, and their number in
the series (#1 or #2).
Blood Cultures
Collection Equipment
 Blood can be drawn directly into bottles containing culture media or
drawn into sterile, yellow stopper evacuated tubes containing the
anticoagulant and sodium polyanethol sulfonate, and transferred to
culture media in the laboratory.
 Blood can be collected in a syringe and aseptically transferred to blood
culture bottles at the bedside using a safety transfer device.
 Occupational Safety and Health Administration (OSHA) regulations do
not allow direct inoculation from the syringe to the bottle.
Blood Cultures
Collection Equipment
 A health-care provider may order blood cultures on a patient who is on
antibiotic therapy, Antimicrobial Removal Devices (ARDs) containing
resin that inactivates antibiotics.
 The Fastidious Antimicrobial Neutralization (FAN) Blood Collection
System uses bottles that contain an activated charcoal that neutralizes
the antibiotic.
 The recommended procedure is to collect one blood culture
from the IV line and a second culture by venipuncture.
Blood Cultures
Blood Culture Anticoagulation
 An anticoagulant must be present in the tube or blood culture bottle
to prevent microorganisms from being trapped within a clot.
 The anticoagulant SODIUM POLYANETHOL SULFONATE is used for

blood cultures.
 Other anticoagulants should not be used because bacterial growth may

be inhibited.
Blood Cultures
Cleansing the Site
 The venipuncture technique for collecting blood cultures follows the

routine procedures, except for the increased aseptic preparation of the
puncture site.
 Antiseptics for disinfecting the blood collection site include 2% iodine
tincture, povidone-iodine, multiple isopropyl alcohol preps, and
chlorhexidine gluconate, and all are equally effective in killing bacteria
on the skin.
Blood Cultures
Cleansing the Site
 Cleansing of the site typically begins with vigorous scrubbing of the site
for 1 minute using isopropyl alcohol.
 The alcohol is followed by scrubbing the site with 2% iodine tincture or povidone-
iodine for another minute starting in the center of the venipuncture site and
progressing outward 3 to 4 inches in concentric circles. Allow the iodine to dry on the
site for at least 30 seconds.
 The venipuncture site is scrubbed for 30 to 60 seconds in a back-and-
forth motion creating a friction on the skin, which is effective in skin
antisepsis.
Blood Cultures
Sample Collection
 Two samples are routinely collected for each blood culture set,
one to be incubated aerobically and the other anaerobically.
 Syringe: ANAEROBIC BOTTLE should be inoculated first.
 Winged Blood Collection Set: AEROBIC BOTTLE is inoculated first.
 Filling bottles directly through an evacuated tube needle and
holder system is not recommended.
Blood Cultures
Sample Collection
NOTE:
 Pediatric blood culture volume requirements are based on the child’s

weight and pediatric bottles are inoculated. Draw 1 mL of blood for
every 5 kg (approximately 10 pounds) of patient weight.
 The sample of a child heavier than 45 kg is treated as that of an adult.
 Draw 1 mL of blood on babies weighing less than 5 kg, and place all of
the blood in one pediatric bottle.
Blood Cultures
Sample Collection
NOTE:
 There should be at least a 1:10 ratio of blood to media.

 ADULT BLOOD CULTURE BOTTLES usually require 8 to 10 mL for each.
 PEDIATRIC BOTTLES require 1 to 3 mL for each.
 Over filling of bottles should be avoided because this may cause false-
positive results with automated systems.
 Under filled blood culture bottles may cause false-negative results.
Blood Cultures
Sample Collection
NOTE:
Failure to follow the proper inoculation procedure for aerobic
and anaerobic samples is most critical for the anaerobic
sample because the addition of air to the anaerobic bottle will
kill any anaerobic organisms present.
Blood Culture Sample Collection
EQUIPMENT:
Requisition Form Gloves Tourniquet
Chlorhexidine gluconate Alcohol pads Blood Culture
Bottles Syringe Hypodermic Needle Blood Transfer Device
Winged Blood Collection Set Tube Holder
2 × 2 Gauze Sharps Container Indelible Pen
Bandage Biohazard bag
Step 1. Obtain and examine the requisition form.
Step 2. Greet the patient and explain the procedure to be
performed.
Step 3. Use two identifiers to correctly identify the patient.
Step 4. Prepare the patient and verify allergies.
Step 5. Select equipment.
Step 6. Wash hands and don gloves.
Step 7. Apply the tourniquet and locate the venipuncture site.
Step 8. Release tourniquet.
Step 9. Sterilize the site using chlorhexidine
gluconate. Creating a friction, rub for 30 to
60 seconds and allow to air dry for at least
30 seconds for antisepsis.
Step 10. Assemble equipment while the
antiseptic is drying. Attach the needle to
the syringe.
Step 11. Remove the plastic cap on the
collection bottle. Confirm the volume of
blood required from the label.
Step 12. Clean the top of the bottles with a

70 percent isopropyl alcohol pad and allow
to dry.
Step 13. Reapply the tourniquet and perform the venipuncture. Do not repalpate
the site without cleansing the palpating finger in the same
manner as the puncture site.
Step 14. Release the tourniquet. Place gauze over the puncture site, remove the
needle, and apply pressure.
Step 15. Activate the safety device or remove the syringe needle with a Point-Lok
device.
Step 16. Attach the transferring device.
Step 17. Inoculate the anaerobic blood
culture bottle first when using a syringe or
second when using a winged blood
collection set.
Step 18. Dispense the correct amount of

blood into bottles. Some institutions
require documenting the amount of blood
dispensed.
Step 19. Mix the blood culture bottles by
gentle inversion eight times.
Step 20. Fill other collection tubes after the

blood culture tubes.
Step 21. Clean the iodine off the arm with alcohol if necessary.
Step 22. Label the samples appropriately and include the site of collection. Verify
Identification with the patient.
Step 23. Dispose of used equipment and supplies in a biohazard container.
Step 24. Check the venipuncture site for bleeding and bandage the patient’s arm.
Step 25. Thank the patient, remove gloves, and wash hands.
Blood Collection From Central Venous Catheters
 Blood samples may be obtained from indwelling lines called central
venous catheters (CVCs).
 This procedure must be performed by specially trained personnel and
physician authorization is required.
 CVCs are a special type of catheter that is inserted by a physician or a
certiﬁed health-care professional either as an internal catheter or
external catheter into a large blood vessel.
 It can be used for administration of fluids, drugs, blood products, and
nutritional solutions and to obtain blood.
 There are numerous types of CVCs and specific procedures must be
followed for flushing the catheters with saline, and possibly heparin to
prevent thrombosis, when blood collection is completed.
 Sterile technique procedures must be strictly adhered to when entering
IV lines, because they provide a direct path for infectious organisms to
enter the patient’s bloodstream.
Special Sample Handling Procedures
Examples of Analytes That May Require Chilling
Samples protected from light
Chain-of-Custody Form
 Chilling samples prevents deterioration of specific analytes such as
ammonia, lactic acid, pyruvate, gastrin, adrenocorticotrophic hormone
(ACTH), renins, catecholamines, and parathyroid hormone.
 Samples should be immediately placed into a crushed ice and water
slurry or uniform ice block after blood collection.
 Exposure to light will destroy bilirubin; beta-carotene; vitamins A, B6, and
B12, and folate; and porphyrins. Wrapping tubes in aluminum foil or
using amber-colored tubes will protect the sample.
 Samples for cold agglutinins are collected in tubes that have been
warmed in a 37°C incubator for 30 minutes and contain no additive or
gel.
 The blood is collected into the warmed tube, returned to the laboratory
as soon as possible, and placed back into the incubator before testing.
 Forensic studies are performed on samples for legal proceedings. The
most common are blood alcohol tests, urine drug tests, and DNA
analysis. Documentation of sample handling, the chain of custody, must
be strictly followed.
 Phlebotomists encounter patients of all ages, which will require
different technical and communication skills appropriate for each age
group.
 Modifications to blood collection techniques and equipment are
necessary to successfully accommodate the challenges of blood
collection for the pediatric and geriatric populations.
 Phlebotomists must develop and increase their knowledge and skills in
working with all age groups of patients while performing blood
collection procedures.
Special Patient Populations: Geriatric Population
Physical Factors Tourniquet Application
Disease States Site Selection
Emotional Factors Blood Collection
Patient Identification Bandages
Equipment Selection
Physical Factors
 Normal aging often results in gradual hearing loss. The phlebotomist may
have to speak louder or repeat instructions while facing the patient. The
phlebotomist must confirm that the patient thoroughly understands the
instruction and identification procedures. Use of nonverbal methods or
paper and pencil to explain the procedure or obtain permission may be
required before performing the venipuncture.
Physical Factors
 Failing eyesight is common in the older patient. The patient may have to be
guided to the blood drawing chair and have help being seated.
 Muscle weakness may cause the patient to drop things or be unable to
make a fist before venipuncture or to hold the gauze after the venipuncture.
 Memory loss may cause the older patient to not remember medications he
or she may have taken that can affect laboratory test results. A patient’s
inability to remember when he or she has last eaten can affect a test
requiring fasting.
Physical Factors
 The epithelium and subcutaneous tissues become thinner, causing veins to
be less stable and harder to anchor. The phlebotomist must firmly anchor
the vein below the site so that the vein does not move when punctured.
Muscles become smaller. The angle of the needle may need to be
decreased for venipuncture.
 Epidermal cell replacement in the aging patient is delayed, increasing the
chance of infection. If the patient already has a weakened immune system,
the patient may not heal as quickly or have the ability to fight bacteria that
can be introduced during venipuncture.
Physical Factors
 Aging veins have decreased collagen and elasticity, making them less
firm, more likely to collapse, more difficult to anchor and puncture, and
more prone to hematoma formation.
 Older patients often feel cold because of the decreased fatty tissue layer,
and warming of the site may be required.
 Arteries and veins often become sclerotic in the older patient, making
them poor sites for venipuncture.
Disease States
 A patient with Alzheimer’s disease may be confused or combative,
which can cause problems with identification and performing the
procedure. Assistance from a family member or the patient’s caretaker
may be necessary to calm the patient and hold the arm steady.
 Stroke patients may have paralysis or speech impairments requiring
assistance in positioning and holding the arm and help with
communication.
Disease States
 Patients in a coma should be treated as if they can hear what is being
said. Assistance will be required when holding the arm.
 Arthritic patients may be in pain or unable to straighten the arm and
may require assistance gently positioning and holding the arm. Using a
winged blood collection set with flexible tubing will allow the
phlebotomist to access veins at awkward angles.
 Older patients may have tremors, as evidenced in Parkinson’s disease,
and may not be able to hold the arm still for the venipuncture procedure.
Emotional Factors
 Patients are often embarrassed by these conditions, which may cause
anxiety or fear of blood collection.
 All of these physical and emotional factors can alter test results, and the
phlebotomist must be sensitive to them. In preparing the patient for
venipuncture, it is important to take more time than usual to assist
and reassure the patient.
 Treat patients with respect and dignity, giving them a sense of control.
Patient Identification
 When identifying older patients without identification bands,
be sure to have them state their names.
 An elderly patient who is confused or who has difficulty
hearing is very likely to answer “yes” to any question.
 When identifying patients, address them by their rightful title
and not by their first name. Always be considerate and thank
the patient.
Equipment Selection
 The vacuum pressure in the collection tube may cause fragile veins to collapse.
 A better choice is a winged blood collection set with a 23-gauge needle attached
to a syringe that will allow the phlebotomist to control the suction pressure on
the vein.
 A small-gauge needle with a syringe also is an option.
 If an evacuated tube system is used, the smallest possible tubes should be filled.
Because of the tendency to develop anemia by older patients, the volume of
blood collected also should be kept to the minimum acceptable amount.
Tourniquet Application
 The tourniquet can be placed over the patient’s sleeve and must not be
applied too tight to avoid injury to the patient or collapsing the vein.
 Gently release the tourniquet after venipuncture without snapping it

against the patient’s skin to avoid bruising the area.
 Blood pressure cuffs can be used for the thin patient with small, hard-
to-find veins.
Site Selection
 The antecubital fossa may not be the best site selection.
 The veins in the hand or forearm may be a better choice.
 Applying heat compresses for 3 to 5 minutes and stimulating the area
with alcohol can make the vein more prominent.
 To avoid bruising the patient, do not tap the vein.
 Other techniques used by phlebotomists to enhance the prominence of
veins include massaging the arm upward from the wrist to the elbow
and briefly hanging the arm down.
Blood Collection
 Elderly patients’ veins “roll” easily; therefore, the skin must be pulled
taut, anchored firmly, and the vein punctured in a quick motion.
 Loose skin can be pulled taut by wrapping your hand around the arm
from behind.
 The angle of the needle may need to be decreased for
venipuncture because the veins are often close to the surface of
the skin.
Bandages
 Older patients may have increased sensitivities to adhesive bandages
and an increased tendency to bruise.
 Therefore, it is preferable to use a self-adhering pressure dressing
bandage (e.g., Coban) because adhesive bandages on the fragile skin
of older patients can actually take off a layer of skin when they are
removed and leave a raw wound susceptible to infection.
Special Patient Populations: Pediatric Population
Patient/Parent Preparation
Techniques for Dealing with Children
Methods of Restraint
Equipment Selection
Pain Interventions
Site Selection
Patient/Parent Preparation
 Pediatric blood collection involves preparing both the child and parent,
using certain restraining procedures, and special equipment.
 Pediatric phlebotomy presents emotional as well technical difficulties
and should be performed by only experienced phlebotomists.
 A negative experience can lead to a child’s life-long fear of needles.
Often, there is only one chance to attempt a venipuncture on a child.
 The phlebotomist must develop interpersonal skills to successfully
gain both the young patients’ and parents’ trust.
 Techniques for dealing with children vary depending on the child’s age.
 It is best to establish guidelines and to be honest with both the patient
and parent.
 Newborns and infants are totally dependent on their parents.
 The phlebotomist should introduce him or herself to the parents and
explain the procedure.
 The parents must identify the child if it is an outpatient setting.
 Hospitalized patients will have an identification band.
Techniques for Dealing with Toddlers
 Toddlers have limited language skills and fear of strangers.
 It is important to talk to the child calmly and maintain eye contact.
 Demonstrate the procedure using toys.
 Allow children to have their comfort toys or blanket and develop
strategies to distract or entertain them.
 Reward the child with praise and stickers.
 Thank the child and parent for their cooperation.
Techniques for Dealing with Older Children
 Older children are more willing to participate.
 Explain the steps of the procedure and demonstrate the equipment.
 Demonstrate and allow the child to touch the tourniquet or other clean
equipment.
 Answer their questions honestly.
 Never tell a child it will not hurt. Explain that “it will hurt a little bit,
but if you hold very still, it will be over quickly.”
 Give the child permission to cry.
Techniques for Dealing with Teenagers
 Teenagers are more independent and often embarrassed to show their
emotions.
 Use adult language with teenagers for identification and explanation of
the procedure.
 Ask them if they have fainted or had any reaction to a previous
venipuncture procedure.
 Encourage them to ask questions about the procedure.
 They may or may not want their parents present.
Note:
Utilizing techniques to calm an infant and reduce crying

times will minimize the pre-examination effect of
transient elevated white blood cell counts.
Methods of Restraint
 Older children can usually sit in a drawing chair by themselves.
 An infant cradle pad facilitates blood collection for infants.
 Never draw blood from a small child without some type of assistance.
 Physical restraint may be required to immobilize the young child and
steady the arm for the venipuncture procedure.
 This can be accomplished by having someone hold the child or by using
a papoose board.
 Either a VERTICAL or HORIZONTAL RESTRAINT will work.
Methods of Restraint: VERTICAL RESTRAINT
 In the vertical position, the parent holds the child in an upright

position on the lap.
 The parent places an arm around the toddler to hold the arm not
being used.
 The other arm holds the child’s venipuncture arm firmly from behind,
at the bend of the elbow, in a downward position.
Methods of Restraint: HORIZONTAL RESTRAINT
 In the horizontal restraint, the child lies down, with the parent on one
side of the bed and the phlebotomist on the opposite side.
 The parent leans over the child holding the near arm and body securely
while reaching over the body to hold the opposite venipuncture arm for
the phlebotomist.
 In some instances, a child may become extremely combative. The
procedure should be discontinued to avoid the risk of injury to the
patient or phlebotomist and the health-care provider notified.
Equipment Selection
 The minimum amount of blood required for laboratory testing
should be collected from infants and small children.
 The amount of blood collected within a 24-hour period must be
monitored owing to the small blood volume in newborns and small
children.
 It is recommended that no more than 3% of a child’s blood volume
be collected at one time and no more than 10% in a month.
Equipment Selection
 To quickly estimate a child’s blood volume, divide the child’s weight in
pounds by 2 to convert to kilograms and multiply the kilograms by 100
to get the estimated blood volume in milliliters.
 When using an evacuated tube system, select the smallest evacuated
pediatric tubes available.
 Evacuated tubes as small as 1.8 mL are available.
 A 23-gauge winged blood collection set needle with a syringe is
recommended because of the small, fragile veins.
Pain Interventions
 A local topical anesthetic, eutectic mixture of local anesthetics (EMLA)
(Abraxis Pharmaceuticals) is ideal for use on an apprehensive child
before venipuncture.
 This emulsion of lidocaine and prilocaine is applied directly to intact
skin and covered with an occlusive dressing.
 EMLA penetrates to a depth of 5 mm through the epidermal and
dermal layer of the skin. It takes 60 minutes to reach its optimal effect
and lasts for 2 or 3 hours.
Pain Interventions
Research has shown that glucose,
dextrose, and sucrose solutions have a
calming effect on infants. When
administered before or during venipuncture
or heelsticks, pain was significantly reduced
as opposed to a topical anesthetic. The
duration of crying was lessened, which
minimized the temporary increase in the
white blood cell counts.
Site Selection
CHILDREN OLDER THAN 2 YEARS: Veins Located in the Antecubital Fossa.
CHILDREN YOUNGER THAN 2 YEARS OF AGE: Dorsal Hand Venipuncture.
Small amount of blood: heel stick puncture, micro sample containers.
Note:
Do not use deep veins.
Site selection and technique is similar to that used for adults can be used for.
Point of Care Testing
 Other Names: Near-patient Testing, Decentralized Testing,
Bedside Testing, Alternate Site Testing
 Analytical testing performed outside the confines of the central
laboratory, usually by non-laboratorian personnel (Nurses,
Respiratory Therapists, etc.)
 Use of portable whole blood glucose meters for the
management of patients.
 is the performance of laboratory tests at the patient’s bedside or
nearby rather than in a central laboratory.
 POCT is particularly beneficial to patient care in the critical care
or intensive care units, operating suites, emergency department,
or neonatal intensive care units.
 Other POCT locations include satellite laboratories, physician
offices, ambulatory clinics, ambulances or helicopters, long-term
care facilities, workplace screenings, health fairs, dialysis centers,
and home settings.
 Factors that have motivated the practice of POCT include the
increased acuteness of inpatient illnesses that require a faster
turnaround time (TAT) of results and the decreased length of
hospital stays that require the increased performance of
procedures and care on an outpatient basis.
Common POCT Associated With Laboratory Departments
Blessed New Year, as we step into 2019, I want to encourage you to
have a confident expectation of good – because the LORD has already
gone ahead of you to prepare the way and provide for very demand
and need. There may be challenges along the way, but His love is
greater and will deliver you from each other! Praying you and
your loved ones will walk in a multiplied measure of peace, joy,
health and good success this year, with the LORD’S protection
and favor on every area of your life. YOUR BEST DAYS ARE
NOT BEHIND YOU, BUT AHEAD OF YOU!
© Joseph Prince

Special Blood Collection

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Special Blood Collection

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TOPICS FOR MIDTERM

Special Blood Collection

 Use to diagnose and monitor a patient’s condition.

 “As Soon As Possible.”

FASTING PATIENT. Abstinence from food and liquids (except

A patient who is NPO (nothing by mouth) PATIENT is not

Glucose Tolerance Tests

 Originally these included the 2-HOUR POSTPRANDIAL (PP)

 Requirements for GTT:

Step 1. Identify the patient and explain the procedure.

 The one-step method utilizes the same procedure as the diagnostic

 A value equal to or less than 140mg/dL is considered normal.

Collection of blood in gel serum separator tubes has caused

 The anticoagulant SODIUM POLYANETHOL SULFONATE is used for

 Other anticoagulants should not be used because bacterial growth may

 The venipuncture technique for collecting blood cultures follows the

 Pediatric blood culture volume requirements are based on the child’s

 There should be at least a 1:10 ratio of blood to media.

Step 12. Clean the top of the bottles with a

Step 18. Dispense the correct amount of

Step 20. Fill other collection tubes after the

 Gently release the tourniquet after venipuncture without snapping it

Utilizing techniques to calm an infant and reduce crying

 In the vertical position, the parent holds the child in an upright

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