3D Paper ETS HOLDER Alternative To Plastic Vacutainer Adapter

OUR LADY OF FATIMA UNIVERSITY 1
3D PAPER ETS HOLDER: ALTERNATIVE TO PLASTIC VACUTAINER
ADAPTER
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1,2,3 1,2,3
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Mavi Rose C. Cernero , John Rey V. Dagoc , L
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1,2,3 1,2,3 1,2,3
Desiree L. Doblon Lorraine E. Espela , Baby Jean L. Marquez , Jann E
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1,2,3
Nicko S. Mendoza E
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College of Medical Laboratory Science
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Research Development and Innovation Center L
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Our Lady of Fatima University L
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Research Adviser B
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In Partial Fulfilment
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of the Requirements for the Degree S
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Bachelor of Science in Medical Laboratory Science (BSMLS) I
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January 2023 E
Chapter 1
THE PROBLEM AND ITS BACKGROUND
1.0. Introduction
Evacuated Tube System (ETS) holder in phlebotomy, is an additional
blood collection equipment used when drawing blood. Often made of C

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translucent polypropylene. It simplifies the process of drawing blood samples
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as it guides the placement of blood collection tubes onto collection needles. It G
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provides protection only from the back end of the phlebotomy needle. The
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laboratory workers, phlebotomists, nurses, and doctors are amongst the F
population that uses this equipment, when drawing blood from a patient. M
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D
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ETS holder is reused in Philippine laboratories which can lead to C
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increased risk of spreading various diseases associated with blood and
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bloodborne pathogens. According to Cheng, V., et al. (2019), a reusable blood- A
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collection tube holder without disinfection between patients can cause a O
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nosocomial HCV infection. Single-use disposable tube holders should be used A
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according to the recommendations by Occupational Safety and Health O
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Administration and World Health Organization (OSHA). Y
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Most often, these are reused because of shortage of medical funds, for
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it is costly when bought in bulk. Removing the needle in order to reuse the E
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ETS holder poses a risk, even if the needle used is a safety-engineered needle. C
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The tube puncturing the back end of the needle is exposed and its rubber
sheath provides little to no protection.
According to Cheng, V., et al. (2019), the use of reusable blood
collection tube holders (RBCTH) in a Hong Kong public hospital is observed
and it presented that a female victim and the male source patient shared a C
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ward with one or more phlebotomists. 34 phlebotomists made 54 visits to this
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ward for all patients between August 6 and August 19, 2017, according to the G
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laboratory’s computerized barcoding system. On August 9, 2017,
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(phlebotomist A) and on August 11, 2017, the same phlebotomist took blood F
from the source patient before taking blood from the female victim M
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(phlebotomist B). Of 29 phlebotomists being interviewed, 28 reported the sole D
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usage of RBCTH kept in the ward’s phlebotomy trolley where the HCV-positive C
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RBCTH was located, including those who gave services on August 9, 2017,
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and August 11, 2017. Because HCV remains infectious for 6 weeks in the A
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environment, individuals were at risk of infection whether the same or O
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different phlebotomists collected blood from the victim before or after the A
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source patient, as long as the HCV-contaminated RBCTH in this phlebotomy O
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trolley was in use. RBCTH could have been the vector; extensive investigation Y
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did not identify any other modes of transmission. The only shared item that
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posed a risk of transmission to the index case patient was a contaminated E
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reusable blood collection tube holder with scarcely perceptible blood that was C
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found to have HCV genotype 6a. Additionally, during their 13 days of co-
hospitalization in the liver transplant ward, 14 episodes of sequential blood
collection from the source patient and the index case patient were recorded on
the computerized time log of the laboratory barcoding system. After each
patient, the tube holders were not cleaned and disinfected. Experiments in
blood collection simulations demonstrated that HCV and technetium isotope
contamination of the sleeved needle's tip can reflux back from the patient side C
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to the side of the vacuum specimen tube.
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Designing an effective, reproducible and biodegradable ETS holder is a
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great alternative in this conventional equipment which are ones made from F
plastics. Making use of recycled materials is also advantageous because they M

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have a low economic value and a minimal negative influence on the D
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environment, such as used and unused white papers, used or unused C
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newspapers and used egg cartons.
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A
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Due to the underlying issues and problems in the present available O
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ETS holders made of plastics, which are made for general laboratory and A
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phlebotomy use, the researchers aim to test the effectiveness of the use of O
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vacutainer adapter made out of 3D paper, as an alternative. To be able to use Y
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it only once in laboratory practices, made from easily reproducible, cheap,
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sturdy materials and be easily discarded after one use, making it beneficial for E
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financial, environmental and safety purposes. C
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1.2. Statement of the Problem
This study aims to test the effectiveness of the use of ETS holder made out of
3D paper, as an alternative to ETS holder made out of plastic.
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This in particular will answer the following: O
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1.1.1 What are the characteristics of the ETS holder made of 3D paper in
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terms of:
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- Thickness:
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- Texture: D
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- Size: A
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1.1.2 What is the hardness test result of the experimental 3D paper ETS L
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holder and the control using a plastic ETS holder? B
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A
1.1.3 What is the fastener test result of the experimental 3D paper ETS holder
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and the control using a plastic ETS holder? R
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1.1.4 What is the biodegradability test result of the experimental 3D paper S

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ETS holder and the control using a plastic ETS holder? I
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1.1.5 What is the usability feedback of the RMTs using the 3D paper ETS C
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holder and the control using a plastic ETS holder?
1.1.6 Is there a significant difference in the hardness test result of the
experimental 3D paper ETS holder and the control using plastic ETS holder?
1.1.7 Is there a significant difference in the fastener test result of the
experimental 3D paper ETS holder and the control using plastic ETS holder?
1.1.8 Is there a significant difference in the biodegradability test result of the C

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experimental 3D paper ETS holder and the control using a plastic ETS L
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holder?
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1.1.9 Is the 3D paper ETS holder effective as an alternative to the plastic ETS O
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holder?
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1.3. Hypothesis L
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H01. There is no significant difference in hardness test result of experimental
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3D paper ETS holder as compared to the control using ETS plastic holder. A
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H02. There is no significant difference in fastener test result of experimental O
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3D paper ETS holder as compared to the control using ETS plastic holder. Y
H03. There is no significant difference in the biodegradability test result of an S

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experimental 3D paper ETS holder as compared to the control using ETS I
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plastic holder.
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1.4. Significance of the Study
The outcome of this study will benefit almost everybody, particularly
the: C
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Clinical Laboratory Scientists. This study will help clinical laboratory G
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scientists use 3D paper ETS holders that will perform the same as plastic ETS
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holders in a budget-friendly way and to prevent cross contamination that will F
be dangerous to the patients and clinical laboratory scientists. M

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Laboratories. Due to low cost materials needed to produce a paper ETS C
A
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holder, it can aid in minimizing financial burden on laboratories, as well as
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value the safety of the patients being handled. A
B
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Students. Due to its inexpensiveness,this study will help medical students A
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with their training that requires the use of ETS holders for multiple laboratory O
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procedures. Y
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Community. Usage of non-toxic materials will benefit the environment by E
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ensuring them a safer environment compared to the plastic ETS method C
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which is a threat to the environment.
Future Researchers. The outcome of this study can serve as a reference for
further studies and contribute to the existing knowledge about the production
of paper ETS holders.
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1.5. Scope and Delimitation of the Study
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This study will only focus on the capability of a paper as a raw G
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material in making a prototype 3D paper ETS holder for evacuated tube
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systems. To test the effectiveness of the 3D paper ETS holder as an alternative F
to plastic ETS holder, three tests will be employed to test its capability, M
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specifically, Hardness test, Fastener test, and Biodegradability test. Other D
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tests will not be employed, and this study will not cover sterility testing which C
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show whether biological parenterals intended for human use contain
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extraneous, viable contaminating microorganisms. This research will also not A
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cover Latex test, a skin test that can help determine if a person’s skin reacts O
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to the latex protein, which should be an unusual component of the common A
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ETS holder. The only process guide of the researchers will be Lietch's O
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technique — the pulping of used white papers, used or unused newspapers Y
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and used egg cartons will be utilized. Other types of paper, specifically
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cardboards, will not be used and other characteristics specifically, the color of E
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the paper will not be observed. We will not be using the papier-mâché C
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technique, and the researchers will only produce ten pieces of the prototype of
the 3D paper ETS holder.
For the compatibility and better grip of the 3D paper ETS holder to a
two way needle, a screw type will be utilized and will undergo torque testing
only, a fastener test. Other types of fastener test, specifically rotational C

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capacity test will not be employed. In Hardness testing, a shore durometer
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hardness testing device will be used. Other types of hardness tests like G
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rockwell hardness tests will not be employed. Biodegradability of the 3D paper
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ETS holder will be observed for 14 days through soil burial only. F
Testing of physical characteristics of the prototype 3D paper ETS M

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holder, specifically its size, thickness, texture, hardness and fastening D
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capability to a two-way needle will be observed by ten randomly selected C
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Registered Medical Technologists (RMT) through performing ETS method of
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venipuncture. The color and transparency of the paper holder will not be A
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observed. Venipuncture procedure will be performed on random volunteers. O
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The RMTs that will test the use of 3D paper ETS holders will rate its A
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characteristics and if it is user-friendly through a questionnaire presented by O
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the researchers that constitutes the Likert Scale format. Other scale formats Y
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will not be used.
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1.6. Definition of Terms C
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3D Printing. Making a physical thing out of a three-dimensional computer
model, usually by applying successively many thin layers of material.
Biodegradability. The capacity of objects to degrade when exposed to
microorganisms with or without oxygen, and as they integrate into their
natural surroundings. C
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Cross Contamination. Process by which bacteria or other microorganisms G
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are unintentionally transferred from one substance or object to another, with
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harmful effects. F
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Evacuated Tube System (ETS). The standard equipment used for routine D
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venipuncture. C
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Fastener. Any of the different devices used for fastening. That can hold two A
B
things or two parts together that occasionally need to be separated O
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A
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Hardness. The capacity of a material to withstand deformation, which is O
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assessed using a common test that gauges the surface resistance to Y
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indentation.
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HCV (Hepatitis C Virus). Hepatitis C is an infection of the liver caused by the
hepatitis C virus (HCV). Hepatitis C is transmitted by contact with infected
blood and body fluids.
Likert scale. It is a one-dimensional scale used by academics to collect
respondents' views and opinions. C

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Nosocomial. A sickness that originated in a hospital. G
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Occupational Safety and Health Administration (OSHA). Administration F
that ensures safe and healthful working conditions for workers by setting and M
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enforcing standards and by providing training, outreach, education and D
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assistance. C
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Phlebotomy. Is the surgical opening or puncture of a vein in order to A
B
withdraw blood or introduce a fluid as part of the procedure of letting blood. O
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A
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Prototype. A first, typical, or preliminary model of something, especially a O
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machine, from which other forms are built or replicated. Y
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RBCTH. Reusable blood collection tube holders. E
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Registered Medical Technologist. In the healthcare industry, medical
technologists or clinical laboratory scientists work as private investigators.
They are expert researchers in conducting experiments to help with disease
diagnosis and therapy.
Translucent Polypropylene. A linear hydrocarbon polymer, which serves C

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both as fiber and plastic.
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Chapter 2
REVIEW OF RELATED LITERATURE
This chapter presents the associated literature and studies that gave
direction to the study. Included also is the conceptual framework that was the C
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basis of this study.
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2.0 Conceptual Framework
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The Conceptual framework serves as the backbone and guidelines for
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identifying the research study's main objectives. According to the E
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International Journal of Higher Education (2018), a conceptual framework is I
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the whole logical orientation and associations of everything that underpins the A
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assumptions, frameworks, strategies, and methods used in the
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implementation of the entire research such as problem investigation, the B
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significance of theories, and methodology. methods, procedures and tools, R
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data analysis and interpretation of findings, recommendations, and the T
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researcher's conclusions. It also serves as a diagram that connects the R
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numerous elements that are crucial to a research study. The framework
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shows the connectivity of the input and output processes in every research
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study. The diagram examines how well processing and performance systems N
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function under the assumption that inputs—raw materials—are turned into E
outputs by internal system processes. The first box shows the materials
needed for the prototype that will initially be gathered and prepared by the
researchers. The primary materials required for the study are shown in the
diagram, namely used papers, a blender, water, and a 3D printer for molding
the ETS holder. These materials are easy to acquire and can be found in the
locality of the researchers.
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The next box shows the process of making the product or prototype O
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from the prepared materials. The researchers will conduct testing for the
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hardness, fastening capability and the biodegradability of the prototype. Data E
results will be gathered at the end of the trial and conclude the effectiveness O
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of the sample product.
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The last box shows the output or outcome of the research study, which D
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is the 3D Paper ETS Holder. C
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2.1 Related Studies and Literatures C
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2.1.1 PHLEBOTOMY A
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According to Srikanth and Lotfollahzadeh (2022),the process of drawing O
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blood with a needle from a patient is known as phlebotomy. This process can A
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be utilized for therapeutic purposes for specific conditions or for laboratory O
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testing as a diagnostic tool to eliminate other possibilities. Phlebotomy is a Y
profession that is closely related to medicine and patient care. It plays a key S
C
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role in enhancing clinical results by acting as a link between the laboratory
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and the patient, diagnosing a variety of disorders, monitoring electrolyte levels C
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regularly to adjust management regimens, and treating patients with specific
conditions. Depending on the patient's overall health or the location where the
blood will be collected, certain blood draw techniques may be forbidden in
certain situations. A tourniquet, a suitable needle, gloves, alcohol wipes, and
the collecting device for blood are the essential tools required for a successful
and safe blood draw. The tourniquet artificially restricts blood flow and
momentarily raises pressure, which makes it easier for the phlebotomist to C

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find the veins. Additionally, studies show that the veins grow and increase
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their surface area immediately after a tightly placed tourniquet, facilitating G
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blood collection. The usage of gloves and alcohol wipes is necessary for
O
sterility. Phlebotomist is a person trained to obtain blood samples primarily F
from venipuncture. A phlebotomist can be carried out by a doctor, nurse, lab M

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technician or anyone willing to claim the medical training. D
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According to the National Journal of Laboratory Medicine (NJLM) 2021, C
A
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Phlebotomy is without a doubt the most underrated and undervalued
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technique in laboratory medicine. In fact, phlebotomy should be regarded as A
B
the "true face of any laboratory," as it provides critical support to medical O
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laboratory services. Although phlebotomy has a significant impact on A
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laboratory services, there is no uniformity or standardization of phlebotomy O
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practice, as significant diversity in phlebotomy techniques is observed from Y
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laboratory to laboratory. The patient is at the center of the entire testing
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process. E
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2.1.1.1Blood

According to Strasinger and Di Lorenzo (2019), the primary fluid used
by the body to circulate nutrients, waste materials, gasses, and hormones is
blood. A typical adult has 5 to 6 liters of blood. Two components make up
blood: formed elements, which are the cells, and plasma, which is a liquid C
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component. Approximately 55% of the blood's total volume is made up of
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plasma. It is a clear straw-colored fluid that is about 91% water and 9% G
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dissolved substances. It serves as a transporter for waste products of
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metabolism as well as plasma proteins, nutrients, minerals, gasses, vitamins, F
hormones, and blood cells. M

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According to Prof. Giuseppe Lippi, Section of Clinical Biochemistry, I
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reliable evidence suggests that the vast majority of preanalytical errors are A
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caused by improper biological sample collection and management procedures.
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Overall, the collection of unsuitable specimens for testing (either due to B
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insufficient sample volume or quality) is by far the most common source of R
A
laboratory errors (i.e., approximately 80-90%). A thorough review of the T
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scientific literature revealed that hemolyzed samples are the most common R
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cause of specimen non-conformity in clinical laboratories (40-70%), followed
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by insufficient or inappropriate sample volume (10-20%), biological samples
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collected in the wrong container (5-15%), and excessive clotting (5-10%). N
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Contamination by infusion fluids (most commonly saline or glucose solutions), E
cross-contamination of blood tube additives, inappropriate sample storage

conditions, or repeated freezing-thawing cycles are fewer common causes of
impaired sample quality (about 3% overall).
Several lines of evidence now confirm that the vast majority of
laboratory medicine errors occur in the extra-analytical phases of total testing
processing, particularly in the preanalytical phase. Most importantly, the

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collection of unsuitable specimens for testing (either due to insufficient O
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volume or quality) is by far the most common source of all laboratory errors,
E
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necessitating the development of immediate strategies for improving blood E
sample quality and managing data potentially generated by measuring O

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unsuitable specimens. According to a thorough review of the scientific
M
literature, hemolyzed samples are the most common cause of specimen E
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nonconformity in clinical laboratories (40-70%), followed by insufficient or I
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inappropriate sample volume (10-20%), biological samples collected in the A
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wrong container (5-15%), and undue clotting (5-10%).Infusion fluid
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A
contamination (most commonly saline or glucose solutions), cross- B
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contamination of blood tube additives, inappropriate sample storage R
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conditions, or repeated freezing-thawing cycles are less common causes of T
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poor sample quality. R
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As a result, this article summarizes the current evidence on the most S

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common types of unsuitable blood samples, along with preliminary
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recommendations on how to prevent or manage these preanalytical C
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nonconformities.
2.1.1.2 Venipuncture
According to Otto (2018), The process of piercing a vein with a needle to
withdraw blood or start an intravenous line for medicine administration is
known as venipuncture. Venipuncture is frequently used to test blood for a
wide range of medical reasons and problems. A phlebotomist, or blood draw
professional, prepares a patient by selecting a vein, placing a tourniquet, or C

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tight band, to reduce blood flow in the targeted vein, and cleaning the skin
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over the vein to prevent infection. She then selects the best venipuncture G
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technique for the patient. The veins in the crook of your arm and the tiny
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veins on the back of your hand are usually used for this reason. The F
phlebotomist drawing blood will clean the underlying area with an antiseptic M
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wipe after identifying the chosen vein. An elastic band placed on your upper D
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arm will help fill the target vein with blood if blood is drawn from the inside of C
A
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your elbow. To take blood during a regular venipuncture, your health care
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practitioner will attach a hollow needle to a syringe, vacuum tube, or vial, A
B
then carefully slide the needle through the skin and into the vein's center, O
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first Blood will be taken from your vein and sent through the needle into the A
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associated receptacle. After extracting the necessary amount of blood for the O
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tests, your clinician will withdraw the needle and apply absorbent material on Y
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the puncture site to help stop any remaining bleeding. When the testing is
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done, the laboratory will send the results to the doctor, who will analyze the E
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results and discuss them with the patient. C
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According to Merrill et al. (2022), One of the most common non-
invasive medical procedures is venipuncture, which is conducted on a regular
basis. Unfortunately, there is always some discomfort for the patient during
blood collection. For patients receiving repeated treatments, such as those in
oncology receiving chemotherapy, this is especially true. Veins become
considerably smaller, brittle, and difficult to anchor for venous access after C
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chemotherapy treatment. Remarkably, two or more tries were needed to
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successfully draw blood from 95% of individuals who reported having G
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difficulty with collections.
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Cancer patients have a special need for safe and effective vascular F
access. It's crucial throughout a cancer patient's journey, from before surgery M
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or chemotherapy even begins, all the way through palliative care and chronic D
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management. Cachexia, advanced age, scarring from frequent IV access, C
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and/or repeated administration of chemotherapeutic medicines are all factors
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that contribute to poor venous access for phlebotomy in oncology patients. A
B
Phlebotomy is known to cause higher pain and discomfort in these individuals O
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because of this. A
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Venipuncture pain is caused by the mechanical forces or traction O
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applied by the needle. Hemolysis could be affected by fluidic shear force Y
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exerted on red blood cells as they travel through a needle of smaller gauge,
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whereas a needle of bigger gauge could raise the flow rate too much. When E
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drawing blood, increasing flow rates might lead to turbulence in the needle C
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and the tube. Fewer painful injections are experienced when needle diameter
is decreased and insertion forces are lowered. However, the smaller inner
diameter and slower tube filling time associated with employing a smaller
gauge needle could reduce blood flow. The UltraTouch Push Button system,
with its 25-gauge needle, has a thinner cannula wall and, thus, a greater
inner diameter, while the outside diameter remains the same. With this
innovation, doctors can use a thinner needle to ease pain and improve venous C
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access, even in the most challenging cases. Laboratory test findings may be
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skewed if blood samples have been hemolyzed, and spectrophotometric G
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interferences may occur if laboratory techniques are used. Because lactate
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dehydrogenase (LDH) is found in larger concentrations in the cells than in the F
plasma, it can be used as a surrogate marker for hemolysis. M

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2.1.1.3 Methods of Venipuncture C
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According A phlebotomist may choose to to Strasinger and Lorenzo
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(2019), use a winged infusion set (butterfly) when drawing blood from infant A
B
and small child antecubital veins or difficult adult veins such as small O
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antecubital veins or wrist and hand veins. In these cases, a butterfly needle is A
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preferable because it is less likely to collapse or "blow" (rupture) the vein. A O
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butterfly can be used in conjunction with either an ETS tube holder or a Y
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syringe. When using a butterfly with an ETS holder, small-volume tubes
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should be used because the vacuum of large tubes may collapse the vein or E
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hemolyze the specimen. C
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The evacuated tube method is the preferred method for obtaining
venipuncture specimens. In fact, blood collection with a needle and syringe
should be avoided for safety reasons, according to CLSI standard H3-A5. Even
so, when the patient has extremely small, fragile, or weak veins, a needle or
butterfly and syringe are sometimes used. An evacuated tube's vacuum
pressure may be too great for such veins, causing them to collapse easily. C
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This is especially true for elderly patients and newborn infants. When using a
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during, the amount of pressure can be reduced slightly more than with a tube G
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by slowly pulling the plunger back. The material, however, may start to clot if
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the syringe fills too slowly, either before enough blood is drawn or before it F
can be transferred to the right tubes. To simply transfer blood from the M
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syringe into the ETS tubes, a specific syringe transfer equipment is needed. D
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2.1.1.4 ETS Method
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Strasinger and Di Lorenzo in their 2019 authored book, stated that the A
B
evacuated tube system is the most popular, effective, and preferred method by O
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the CLSI (Clinical and Laboratory Standard Institute) for collecting blood A
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samples. The patient's blood flows through a needle placed in a vein and into O
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a collection tube without being exposed to the air or other contaminants Y
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because it is a closed system. With the help of the technology, several tubes
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can be gathered with just one venipuncture.Evacuated tube system are E
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available from several manufacturers. Although the design of individual C
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elements may vary slightly by the manufacturer, all ETS have three basic
components: a special blood drawing needle, a tube holder, and various types
of evacuated tube.
According to Wahed (2021), the evacuated-tube system, also known as
the Vacutainer TM (previously the Evacutainer) brand name, was introduced
by Beckton & Dickinson in 1949. A plastic or glass tube that is sealed with a
prefabricated vacuum rubber stop replaces the barrel in such a device C

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because the plunger is absent. An adapter in a tube with the necessary
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component already present can be used to draw blood directly. This is G
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accomplished by the rubber stopper on the evacuated tube being pierced by a
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needle that is in the tube holder. After drawing blood, the rubber stop's F
puncture is sealed once more to prevent the sample from escaping while the M
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tube is detached from the holder. With this technique, switching between D
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many tubes is possible when different additives are required for blood tests C
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without pausing the blood withdrawal. The color code that phlebotomists use
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to pick the right additive. Since the blood sample is still flowing in a closed A
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system, the evacuated tubing system provides the phlebotomist and his O
R
surroundings with superior protection. It even ensures the accuracy of several A
T
laboratory tests to avoid the mechanical stress caused by the dispensing O
R
procedure on the blood components and to guarantee that the tube is filled Y
S
with enough blood to accommodate the necessary addition. The European
C
I
Council Directive on the prevention of acute harm on the healthcare business E
N
is of course required to integrate safety-engineered defensive mechanisms in C
E
medical devices. The two main collecting tools are the piston syringe and the
evacuated tube system. As a fundamental technique, the piston syringe has
been in use since the second half of the 19th century. It has a plunger that
draws blood into a barrel that may be immediately locked with a needle.
Venipuncture techniques have long been associated with discomfort.
Nevertheless, it is the most widely employed method globally. The proficiency
of the phlebotomist and the caliber of the equipment utilized are the two key C
O
L
factors that determine how efficient these approaches are.
L
E
2.1.1.5 Materials used in ETS method G
E
According to McCall (2020), A tube holder is a transparent, plastic,
O
disposable cylinder having a small threaded aperture (also known as a hub) at F
one end, into which the needle is put, and a larger opening at the other end, M
E
into which the collecting tube is inserted. The sidewalls and flanges on the big D
I
end of the tube help with insertion and extraction. C
A
L
Phlebotomy needles are sterile, disposable, and only intended for single
L
use. Multi-sample needles, hypodermic needles, and winged-infusion needles A
B
are all used with both the evacuated tube system and the syringe system. O
R
Multi-sample needles are typically protected by a sealed twist-off shield or A
T
cover. Typically, hypodermic needles and butterflies are packaged in sterile O
R
pull-apart packages. Y
S
Evacuated tubes are used with both the ETS and the syringe method
C
I
of obtaining blood specimens. Evacuate tubes are available from various E
N
manufacturers in a variety of sizes and volumes ranging from 1.8-15ml. Tubes C
E
are selected based on the patient's age, the amount of blood required for the
test, and the size and condition of the patient's vein. Most laboratories keep
several sizes of each type of tube on hand to meet a variety of needs. Tubes
are currently available in plastic and glass. For safety reasons, many
laboratories have switched to plastic tubes. Current applicable regulations
should be obtained from local, state, and federal safety regulatory agencies.
C
O
L
2.1.2 VACUTAINER
L
E
According to Saadet et al. (2021), choosing the appropriate device for G
E
blood collection is a frequent issue in laboratory medicine. This study aimed
O
to compare the hemolysis index, pain intensity, and tube filling rates of blood F
samples drawn with the BD Vacutainer® EclipseNeedle and the BD M

E
Vacutainer Ultra-TouchTM Butterfly Blood Collection Set, both of which are D
I
currently used in laboratories. Immediate sample collection is associated with C
A
L
the majority of problems encountered in the preanalytical phase (particularly
L
hemolysis). Causes of pre-analytical hemolysis include sample collection, A
B
improper transport, extreme temperature, sample handling, delayed O
R
processing, and prolonged storage. Hemolysis can significantly compromise A
T
the accuracy of test results, particularly for potassium (K), aspartate O
R
aminotransferase (AST), lactate dehydrogenase (LDH), phosphorus (P), and Y
S
bilirubin (etc.), necessitating retesting. Retaking the examination can increase
C
I
patient distress, hospital expenses, and labor hours. E
N
In hemolyzed samples, biochemistry test results may not reflect the C
E
clinical condition of the patient, either due to red blood cell contents spilling
into the serum or plasma (changing the plasma concentration of the analytes)
or red blood cell contents interfering with the testing methodology (i.e.,
hemoglobin could discolor a solution and effect spectrophotometric
absorbance measurements at certain wavelengths). In general, K, LDH, and
AST are the analytes most frequently affected by this primary interference
mechanism, as their concentrations rise. Many other analytes can increase or C

O
L
decrease based on the testing methodology; most laboratories examine the
L
E
degree of hemolysis in the sample and have protocols in compliance with the G
E
laboratory manager's instructions (e.g., the hemoglobin (H), icterus (I), and
O
lipaemia (L)/(HIL) index corresponds to the approximate concentration of F
hemoglobin, bilirubin, or lipid present in the sample) to deal with hemolyzed M

E
samples. Hemolyzed samples have a substantial impact on the delivery and D
I
quality of health care. Design flaws or improper use of blood collection devices C
A
L
can compromise the accuracy of laboratory test results. By exerting shear
L
forces across the bloodstream, vascular access devices such as catheters and A
B
needles may induce cell lysis. Components from blood collection tubes, O
R
including stoppers, lubricants, surfactants, and separating gels, can leak into A
T
samples and/or adsorb analytes from the sample; special tube additives can O
R
also alter the stability of analytes. Blood collection sets are a potential source Y
S
of pre-analytical errors in laboratory tests as a result of their interactions with
C
I
blood samples. In order to optimize the preanalytical phase and achieve E
N
consistent results the selection of the blood collection device becomes the C
E
most important factor. While the major preanalytical determinants are
interchangeable, the blood collection method has a substantial impact on the
validity of laboratory test results. The butterfly collection set, which consists
of a small needle attached to the flexible plastic wings and a flexible extension
tube, can be viewed as a reliable alternative to the traditional straight needle
for collecting blood from certain patient groups. In fact, an adapter can be
easily attached so that it can be used with a vacuum system and vacuum C
O
L
needle holder. Blood collection with the butterfly blood collection set can be
L
E
extremely difficult or easier and less painful in newborns, children, small G
E
animals, and patients with small, hard, and atypical venous access. In
O
addition, the use of a butterfly collection set, which is less frightening due to F
the smaller size of the needle, may be appropriate in certain other M

E
circumstances, particularly when approaching nervous or anxious patients. D
I
This system has the added benefit of being simple to use for incompetent C
A
L
laboratory technicians and nurses, as the needle does not need to be held
L
while in the vein. The disadvantages of the butterfly collection sets are their A
B
high price, the increased likelihood of needle damage, and the possibility of O
R
blood leakage as the needle is retracted. There are very few studies on the A
T
optimal blood sample collection methods using catheters. In the study O
R
conducted by Lippi et al., the degree of hemolysis as measured by free plasma Y
S
hemoglobin, LDH, and AST did not appear to be greater with a butterfly
C
I
needle set than with a conventional straight needle set. E
N
In this study, the BD Vacutainer® EclipseTM Blood Collection Needle C
E
was compared to the BD Vacutainer® Ultra-TouchTM Butterfly Blood
Collection Set for the performance of selected serum chemistry analytes and
complete blood count parameters (CBC). In addition, the potential for
hemolysis was evaluated based on comparisons of changes in potassium,
aspartate transaminase, and lactate dehydrogenase concentrations, in
addition to the hemolysis index, pain scale, and visual inspection.
C
O
L
L
2.1.3 PAPER
E
G
Guo and Wen in their 2020 published article, stated that paper's E
omnipresence, low cost, easy production, and process-facilitating structure O

F
have sparked a surge in scientific interest. Paper is widely available and has
M
enormous application potential in areas such as energy harvesting and E
D
storage, biomedicine, and the packing field. Furthermore, mature paper- I
C
making technologies pave the way for paper fabrication. Paper is one of the A
L
four great inventions of ancient China, providing the foundation of material
L
A
technology for the prosperity of ancient Chinese culture. Even in this day and B
O
age of fast changes in technological information, paper continues to play a R
A
significant role in writing, printing, painting, and packing. Paper's invention T
O
ended the convoluted history of old crude papers and tremendously aided the R
Y
spread and development of civilization. Cellulose-based paper is a green and
S
C
sustainable product that has become an essential part of our everyday lives
I
E
due to its numerous applications in the fields of packing, storage, and N
C
information delivery. Papermaking may be traced back to 105 AD. Cai et. E
Paper was made from bark, hemp, and other resources, and papermaking
technology was altered. Bamboo fiber and silk have now been supplanted by
paper-made plant fiber paper with outstanding writability. Cellulose-based
paper is a cost-effective and ecologically beneficial product created from wood,
straw, reed, and waste paper, among other things. Numerous investigations
on raw materials have been conducted in order to make cellulose-based
paper. Green manufacture of colorful superhydrophobic paper from natural C

O
L
cotton cellulose was described by Wen et al. Raw cotton was treated with a
L
E
zinc chloride (ZnCl2) solution to generate a homogeneous slurry in their G
E
investigation. And three types of colored sheets were created utilizing copper
O
stearate (CuSA2), ferric stearate (FeSA3), and zinc stearate (ZnSA2). Non-toxic F
modifiers were utilized in the manufacturing, and the as-prepared paper M

E
demonstrated super hydrophobicity both inside and outside. The cotton-based D
I
cellulose-based paper has water repellency, self-cleaning properties, and C
A
L
mechanical durability. Except for cotton, wood pulp was the most often
L
utilized raw ingredient in the production of paper. Koga et al. created a paper A
B
reactor made of renewable wood pulp with hierarchical micro/nanopores. The O
R
paper reactor was created by combining wood pulp with customized nanoscale A
T
pores in its wall. Micro- and nanoscale pores were formed as a result of the O
R
wood pulp and interlaced nanocellulose networks. Furthermore, discarded Y
S
paper pulp might be converted into fresh recycling paper using deinking,
C
I
bleaching, and other cleaning procedures. In this circumstance, energy E
N
consumption and pollution would be drastically decreased. Si et al. created a C
E
bio-inspired writable multifunctional recycled paper with homogeneous
superhydrophobic properties on the outside and inside. Under heating and
magnetic stirring, they got an aqueous solution of rough cellulose fibers (CF)
pulp. The addition of dopamine (PDA) might give the micro fibrillated cellulose
a strong bonding, increasing the mechanical strength of the paper.
2.1.4 CLINICAL SIGNIFICANCE C
O
L
2.1.4.1 Advantages of a Paper as a Raw Material *in med use if applicable*
L
E
2.1.4.1.1 Promoting sustainable packaging applications in the circular G
E
economy by exploring and advancing molded pulp materials for food products:
O
a review F
According to Itkor, Lee Y., Lee M., Shin, and Singh (2022), Packaging M
E
facilitates the safe handling and distribution of fresh and processed food items D
I
across a variety of supply chains, and it has become an essential component C
A
L
of the food business. However, the rapidly rising use of plastics, particularly
L
single-use plastics, as packaging material results in insufficient waste A
B
management, littering, and, as a result, considerable environmental harm, O
R
mostly affecting marine and freshwater sources. As a result, the use of A
T
plastics for packaging has become a major public problem, as well as a worry O
R
among worldwide governments. Notably, packaging accounts for 26% of total Y
S
worldwide plastic output, with single-use plastics accounting for 50%,
C
I
resulting in contamination that might endure hundreds of years. E
N
This paper gives an overview of how molded pulp products may be used C
E
to improve the sustainability of food packaging applications by emphasizing
manufacturing processes, highlighting aspects of recyclable molded pulp, and
combining circularity with eco-friendly and safe food product packaging. In
this sense, modern conceptions promote the use of molded pulp products in a
dynamic and sustainable way. This strategy includes the design and
manufacture of environmentally friendly packaging, the distribution and
consumption of packaged items, and the collecting and recycling of spent C

O
L
packaging for further usage.
L
E
G
E
2.1.4.2 Disadvantages of Plastic ETS Holder
O
2.1.4.2.1 SARS-CoV-2 Survive longer on Plastic than on Paper F
M
According to Corpet (2021), SARS-CoV-2, the Covid-19 coronavirus, E
D
inactivates significantly more quickly on paper than it does on plastic: three I
C
hours after being placed on paper, no virus can be found. On the other hand, A
L
after being placed on plastic for seven days, the virus can still infect cells. The
L
A
following list of materials—from long to short stability—is generated by B
O
classifying them according to the SARSCoV-2 stability on their surface: R
A
polypropylene (mask), plastic, glass, stainless steel, pig skin, cardboard, T
O
banknote, cotton, wood, paper, tissue, copper. R
Y
In the research mentioned above, the examined objects, the S

C
I
methodologies, and the criteria are not exactly the same. Infectious virus
E
N
decay is also biphasic, with a few viruses remaining on smooth surfaces for an C
E
extended period of time. Depending on the ranking criteria, different lists
might be created. The modifications do not alter what follows, however,
because the variances across these lists are small and primarily concern the
median products (such as cardboard, cotton, and wood).
The substance affects how long other wrapped viruses remain on
surfaces. SARS-CoV-1 and SARS-CoV-2 exhibit extremely similar behaviors .

C
Additionally, compared to paper and tissue, the influenza virus may persist O
L
L
for 24 to 48 hours on plastic and stainless steel.
E
G
E
Practically speaking, these variations indicate that paper sheets and
O
bags should be used in place of plastic to wrap, cover, and transport objects F
in order to lessen the spread of virus via fomites (books, food, furniture). M
E
Similarly, handles and door knobs should be made of copper alloy rather than D
I
stainless steel, as was previously reported. C
A
L
Such variations in survival duration are perplexing from a scientific
L
A
perspective: Why would the virus be "killed" by some materials while being
B
O
"protected" by others? Products that absorb moisture and blot it appear to R
A
render the virus inactive. In contrast, copper appears to protect the virus, as T
O
do smooth and waterproof surfaces. Would a shortage of water cause the R
Y
virus to die? A virus shouldn't require water because it is not metabolically
S
active, making such a straightforward explanation difficult to accept. So how C
I
E
might "dryness" cause a virus to die? This brief review explores available data
N
C
on this issue and proposes a theory explaining why SARS-CoV-2 lives longer E
on plastic than on paper.

2.1.4.2.2 Plastic Waste as Potential Carriers of Pathogens
According to Meng et al. (2021), for the plastic waste as the potential
carriers of pathogens. Globally, plastic trash has created significant
environmental issues. Large plastic waste can entangle creatures and cause
their deaths. Small pieces of big plastics (5 mm, microplastics) can be

C
swallowed by biota and passed up the food chain to higher trophic-level O
L
L
organisms. Due to the prevalence of plastic trash, the effects of both
E
G
macroplastics (5 mm) and microplastics on creatures and human health are a E
developing concern. Once in the environment, bacteria quickly colonize the O

F
surface of plastic. On the surface of plastic in the environment, several
M
microorganisms have been found, including bacteria, fungus, and microalgae. E
D
Both field and lab research has been done on the composition and I
C
mechanisms of biofilm development on plastic surfaces . Pathogenic bacteria A
L
found in biofilms on plastic garbage have become a major problem in the last
L
A
two years. This has significance because plastic garbage may absorb organic B
O
material and biomolecules, which is good for microbe life. Pathogen survival R
A
and gene enrichment may be aided by the enrichment of antibiotic resistance T
O
genes and horizontal gene transfer between microbes on the surface of plastic R
Y
garbage. Less attention has been given to viruses on plastic debris than to
S
C
bacteria. According to Meng et al. recent investigations, several viruses can be
I
E
found on the plastic surfaces of things found in homes, hospitals, schools, N
C
and airports. People are concerned about plastics being possible pathogen E
carriers and contributing to the spread of diseases because of the capacity of
germs to colonize plastic's surface and the prevalence of plastic garbage.
2.1.1.6 Plastic ETS holder
As per Erson & Ilanbey, (2022) hemolysis is one of the most common
problems seen in laboratories that causes delays in diagnosis, treatment, and

C
hospitalization of the patients. This study aids to determine the most O
L
L
appropriate method in phlebotomy and device to reduce the hemolysis of
E
G
blood samples especially during emergencies. Erroneous laboratory test E
results occur in the preanalytical phase. The hemolysis is more commonly O

F
observed in the emergency department than in any other specimens.
M
Therefore, most of the laboratories reject the hemolyzed sample and request E
D
for another specimen that may cause delays in diagnosis, hospitalization and I
C
treatment of the patient. In obtaining the sample, a syringe is used that may A
L
pose needle sticks injuries and blood contamination that increases hemolysis
L
A
in transferring the blood from the syringe to the vacutainer tubes. There are B
O
blood drawing devices that was developed by (Sarstedt, Nümbrecht, Germany) R
A
which is called as S-Monovette tubing and the Luer-Lock access device by T
O
(Becton Dickinson, NJ) that is believed to be reduce the hemolysis of the blood R
Y
sample in performing the phlebotomy from IV catheters.
S
C
The hemolysis of the blood sample is a prevalent condition in
I
E
emergency departments that leads to false results, delayed diagnosis and N
C
repetitive blood draws from the patient. Drawing blood through the use of a E
syringe increases the hemolysis rate. In this study, it will determine the
effectiveness and reliability of the results by comparing the regular syringe
from the use of the evacuated tube system. The result of this study shows
that the use of the evacuated tube system reduced the hemolysis of the blood
sample and avoided the delayed diagnosis and laboratory results.
According to Derg (2021), experience in Reducing Hemolysis in the
Emergency Laboratory, the primary cause of the high prevalence of hemolysis C

O
L
in EDs is the use of injectors to take blood from newly placed IV catheters.
L
E
Several approaches have been developed in attempt to reduce hemolysis, G
E
particularly in the preanalytic phase. One such approach is to use a Luer-
O
Lock adapter with a holder, which includes a lock mechanism and usually F
limits transmission. A Luer-Lock adapter with a holder enables blood M

E
collection from an IV catheter, allowing for direct specimen draw from the D
I
catheter to the evacuated tube. The Luer-one-piece Lok's transfer mechanism C
A
L
provides a secure connection that allows for adequate blood flow and the
L
highest quality sample. It also reduces the risk of blood exposure and needle A
B
stick injuries when the specimen is transferred from the syringe to evacuated O
R
tubes. A
T
According to the article from the Journal of Laboratory and Precision O
R
Medicine (2019), there is evidence that the HOLDEX® single-use holder Y
S
(Greiner Bio-One GmbH, Kremsmuenster, Austria) may be useful in reducing
C
I
the risk of false hemolysis during blood drawing. This encouraging evidence E
N
has been attributed to the device's specific conformation, which is C
E
characterized by the presence of an eccentric luer on the top, which may
effectively reduce the pressure differential between the evacuated blood tube
and the vein, especially when blood is drawn through catheters. Greiner
BioOne has recently developed a new type of holder (VACUETTE® SAFELINK,
Greiner BioOne GmbH, Kremsmuenster, Austria), which is intended to allow
for more efficient and practical handling, as well as easier and faster blood
drawing when used in conjunction with blood sampling devices that include a C
O
L
standardized female luer lock adapter. Unlike the HOLDEX® single-use
L
E
holder, which has an integrated luer needle with an off-center luer slip G
E
connector, the luer lock mechanism in VACUETTE® SAFELINK is centered at
O
the top of the holder. However, the device still has a small chamber that F
allows seeing the flash of vein penetration and also has the effect of M
E
decelerating blood flow prior to entering the tube, potentially reducing the risk D
I
of spurious hemolysis during blood drawing and ultimately In compliance C
A
L
with recent EFLM recommendations, we undertook a comparative research to
L
determine whether VACUETTE® SAFELINK can provide equivalent sample A
B
quality as the HOLDEX® single-use holder. O
R
A
T
O
R
2.2 RELATED STUDIES Y
S
2.2.1 3D PRINTING
C
I
According to the article entitled An Overview on 3D Printing E
N
Technology: Technological, Materials, and Applications by Lee,Ramlan,& C
E
Shahrubudina(2019) by gradually adding materials, digital fabrication
technology—also known as 3D printing or additive manufacturing—creates
tangible items from a geometric representation. A rapidly developing
technology is 3D printing. The use of 3D printing is very common these days.
In the fields of agricultural, healthcare, the automotive, locomotive, and
aviation sectors, 3D printing technology is increasingly employed for mass
modification and fabrication of any kinds of opensource designs. Layer by C

O
L
layer, material can be deposited to create an object using 3D printing
L
E
technology and a computer-aided design (CAD) model. The overview of the G
E
various 3D printing technologies, applications of the technology, and
O
materials utilized in the manufacturing business are all covered in this article. F
M
E
2.2.1.1 An Overview on 3D Printing Technology: Technological, Materials, and D
I
Applications C
A
L
Models can be produced using 3D printing technology for visualization,
L
instruction, and communication in addition to producing 3D skin, bones, A
B
cartilage, organs, replacement tissues, medications, and pharmaceuticals. O
R
The landscape for 3D printing in the manufacturing industry is diverse. A
T
The public, commercial, and governmental sectors can benefit from O
R
technology adoption in the 3D printing manufacturing industries, which is Y
S
now taking place. The development of methods to hasten the use of 3D
C
I
printing technology must therefore continue. By learning more about the E
N
technology, businesses and the government will be better positioned to C
E
establish the infrastructure for 3D printing. To give a broad overview of the
various 3D printing methods, the manufacturing industry's materials, and
lastly the applications of 3D printing technology It will be feasible to do future
study on the various 3D printing technologies and the best materials for each
type of machine.
2.2.1.2 Development of a Biodegradable Subcutaneous Implant for Prolonged C

O
L
Drug Delivery Using 3D Printing
L
E
According to Stewart et. al (2020), the three dimensional (3D) printing G
E
is a flexible technique, which has been subject to increasing interest in the
O
past few years, especially in the area of medical devices. F
An implanted medicine delivery system has a significant potential for M

E
personalization and becomes increasingly likely as a result of the rising D
I
demand for 3D printing technologies. The high degree of controllability and C
A
L
flexibility of 3D printing would enable the creation of customized dose forms
L
with a release profile created specifically to match each patient's unique needs A
B
and the condition that has to be treated. O
R
Furthermore, as the technology is utilized more frequently, some of the A
T
drawbacks of 3D printing—like its high cost and speed—are getting better. O
R
The use of 3D printing to study more advanced (implantable) drug delivery Y
S
systems could usher in a new era of illness therapies.
C
I
E
N
2.2.2 3D PAPER C
E
2.2.2.1 Lietch's Method
Using 3D molds, Leitch's method allows cardboard, newspaper, plain
white paper, or egg carton packaging to be molded into a thick new material.
This final substance is rigid, biodegradable, and pliable into almost any three-
dimensional shape.
Leitch (2018), stated that his material is much stronger than existing
C
paper-based substitutions for plastic and can have more intricate designs. O
L
L
Leitch's method involves compressing wet paper pulp and a water-soluble
E
G
binding substance in a 3D printed mold. The pulp is formed by blending E
shredded plain white paper, cardboard, or newspaper with a binding agent — O

F
commonly rice paste — and water into a homogeneous mixture. This pulp is
M
then placed in a 3D printed mold, which is compressed with a vice, clamp, or E
D
other pressing device to remove the majority of the water, leaving only the I
C
binder to keep the paper fibers together. A
L
L
2.2.2.2 Pulping
A
B
O
Many different types of paper can be used to make paper pulp at home. R
A
This includes newspapers (although the newsprint will give a gray look to the T
O
paper), uncoated junk mail, tissue, construction paper, or even clean toilet R
Y
paper. Some types of cards and card stock can also be recycled this way.
S
C
In making paper pulp, you must first prepare the papers that will be I
E
N
used. The paper must be torn to small pieces. In a mixing bowl, put the small
C
E
pieces of paper as well as the water, leave to soak; within a couple of hours or
overnight. Soaking helps to break down the paper to make pulp. The second
step is to use the blender to pulp the wet paper mix. The paper pulp mixture
should be blended until all of the pieces are dissolved and there is only one
mass of paper pulp remaining. Squeeze the pulp to drain out the extra water
after the paper has been properly pulped. Third, is to press the paper pulp
into the mold. Line the plastic container lid with plastic wrap or parchment C
O
L
paper. This makes it easier to produce the paper. Begin squeezing the paper
L
E
pulp into the mold; continue pressing the paper pulp firmly into the mold to G
E
ensure even distribution. The fourth step is to fully remove the water from
O
paper. To remove the water, press firmly on the paper pulp with a towel. The F
firmer you press; the more water is drained and the end outcome becomes M
E
more stable. Place the paper in a warm, dry place to dry completely. The last D
I
step is finishing the paper. When the paper has dried completely, it can be cut C
A
L
and decorated as desired. The surface of the handmade paper is rough and
L
not fully flat, but this emphasizes the handmade aspect of the paper and A
B
emphasizes that no two pieces will be exactly alike (Pullen, 2020). O
R
A
2.2.2.3 Paper to 3D structure: Generation of Cost-Effective Paper-Based Tissue T
O
Models through Matrix-Assisted Sacrificial 3D Printing R
Y
According to Bei et al., (2019), bacterial cellulose has a number of
S
C
appealing properties due to the combination of cellulose and nanoscale
I
E
(diameter 20-60 nm), including its natural origin, moderate biosynthesis N
C
process, good biocompatibility, and cost-effectiveness. Furthermore, after E
simple drying, bacterial cellulose nanofibers can be easily processed into

three-dimensional (3D) intertwined structures and form stable paper devices.
These benefits make it suitable for the fabrication of organ-on-a-chip devices
via matrix-assisted sacrificial 3D printing. It is able to successfully fabricate
various microchannel structures embedded in bulk bacterial cellulose
hydrogels and keep their integrity after drying. These paper-based devices
with hollow microchannels could be rehydrated and populated with relevant C

O
L
cells to form vascularized tissue models, which was surprising. In order to
L
E
build a 3D paper-based vascularized breast tumor model, we seeded human G
E
umbilical vein endothelial cells (HUVECs) into the microchannels to obtain
O
vasculature and inoculated the MCF-7 cells onto the surrounding matrix of F
the paper device. The results showed that the microchannels were perfusable, M
E
and that both HUVECs and MCF-7 cells proliferated well. This research could D
I
lead to a new strategy for creating simple and low-cost in vitro tissue models, C
A
L
which could have applications in drug screening and personalized medicine.
L
A
B
2.2.3 PAPER STRAW O
R
As stated by Gutierrez, Royals, Jameel, Venditti and Pal., (2019) due to A
T
the constant demands and rapid changes in the environment, the government O
R
policies and regulations decided to rule out a plan on how to avoid and Y
S
minimize the use of plastic straws and other single-use plastic products.
C
I
There are rising concerns about its quality, tensile strength and stability in E
N
using plastic straws when having contact with fluids. This study will aid in C
E
the evaluation of the performance and chemical properties of commercially
available plastic straw. There are different factors that are needed to consider
in making plastic straws, its physical, mechanical and characteristic
components nowadays to focus and point out the real problem in using
plastic straws. Though there are different options or alternatives to utilize
instead of plastic, it can be made out of metal, glass or silicon.
Still, paper straw is the best option for a disposable straw to use in C
O
L
drinking beverages instead of plastic. But, the paper straws are still not
L
E
durable enough and cost more than the plastic straws. Moreover, the G
E
researchers observed from the result that the paper straws absorbed liquid at
O
around 30% weight of the straw after a 30-minute exposure from the liquid. F
The paper straws lose their mechanical and physical integrity once they come M
E
in contact with the fluid. An increased temperature causes lower compressive D
I
strengths and higher liquid uptake in the paper straws. This research study C
A
L
provides methods and processes in testing the paper straws and defines the
L
current limitations of the paper straws as compared to the relative straws. A
B
The researcher will also investigate a single-use paper straw as compared to O
R
regular plastic straws to identify which property needs improvement to A
T
become as tensile and has compressive strength similar to a plastic straw. O
R
Y
S
2.2.4 TESTS REQUIRED TO BE PERFORMED
C
I
2.2.4.1 Hardness Test E
N
Denton and Vian in their 2018 article, in engineering technology C
E
education, the development of new effective laboratory experiences to extend
and reinforce knowledge from lectures is critical. This paper will focus on a set
of hardness testing labs. Hardness testing is a common mechanical property
test. Based on the hardness test type, measures indent penetration or other
surface characteristics of materials The laboratory procedures and testing
specimens adhere to materials testing standards. Polymer specimens are
tested for Shore Durometer hardness in an introductory materials course for C

O
L
the manufacturing and mechanical engineering technology degree programs
L
E
at Purdue University's campuses. The final hardness test results are directly G
E
affected by the quality and manufacture of the specimens. To help students
O
understand this polymer property and the significance of the specimens' F
respective manufacturing processes, samples of the same material and size M

E
but produced using different methods were evaluated. Polymer specimen D
I
design, processing, testing, and analysis were all tasks assigned to students. C
A
L
For several polymer materials, sample production approaches and hardness
L
values corresponding to each process are discussed. Student understanding A
B
of variability and interest in experimental research will be investigated. O
R
This hardness testing laboratory project's initial offering met its goals of A
T
increasing student awareness of the variability in hardness properties due to O
R
manufacturing and improving their observation and understanding of Y
S
experimental research. This project was combined with a similar tensile
C
I
testing effort in order to strengthen student recognition of process-based E
N
effects on material properties and provide more experimental research C
E
practice. The instructors intend to return to the project with more guided
analysis of the process-based and location-based variability in the hopes that
this slight shift in research focus will yield more intriguing results for future
students.
2.2.4.2 Fastener Test
C
Hyung et.al in their 2021 article, noted that screw-type fasteners are O
L
L
extensively used to join wood members or wood and steel connectors because
E
G
they can withstand withdrawal or shearing stresses. The withdrawal E
resistances of screw-type fasteners were assessed in this study, and the O

F
impacts of lead-hole size, relative grain direction (tangential, radial, and cross-
M
sections) of the wood component, screw diameter, screw type, and species E
D
were examined. Domestic larch and imported spruce were employed, as well I
C
as three screw-type fasteners, domestic lag screws (diameters 9.46, 7.79, and A
L
6.27 mm), domestic tapping screw (diameter, 6.3 mm), and foreign Sherpa
L
A
screw (diameter, 8.0 mm). To evaluate the influence of lead-hole size, lead B
O
holes with sizes equivalent to 68.7%, 70.8%, and 74.0% of the lag screw's R
A
shank diameter were predrilled. Although there was no significant difference T
O
in withdrawal resistance depending on the lead-hole sizes used in this study, R
Y
the lead hole corresponding to 74% of the shank diameter was chosen for this
S
C
study because smaller lead holes required more rotational force for
I
E
installation, which may cause damage in the screw neck. The withdrawal N
C
resistances of lag screws put on the tangential and radial surfaces were E
comparable to each other and larger than those positioned on the cross-
sectional surface. The withdrawal resistance rose correspondingly as the lag
screw diameter grew from 6.27 mm to 9.46 mm. The withdrawal resistance of
the tapping screw with a diameter of 6.3 mm was nearly 1.6 times greater
than that of the lag screw with a similar diameter of 6.27 mm, while the
withdrawal resistance of the Sherpa screw with a diameter of 8.0 mm was
approximately 1.4 times greater than that of the lag screw with a similar C
O
L
diameter of 7.79 mm.
L
E
G
Despite recent studies on small-size dowel-type fasteners such as nails E
and screws in Korea, research on the structural behavior of big-size dowel- O

F
type fasteners like bolts or lag screws, which are commonly employed in heavy
M
wood construction, is lacking. Lag screws are one of the most prevalent E
D
fasteners used in modern-style timber structures to join wood members or I
C
wood members with steel connectors. To prevent wood cleavage during the A
L
installation of the lag screw, the lead hole should be pre-drilled. The shank
L
A
portion of the lag screw must have a diameter equal to the shank diameter, B
O
and the threaded portion must have a diameter corresponding to 70% to 80% R
A
of the shank diameter to wood with specific gravity (G) > 0.6, 60% to 70% for T
O
wood with G 0.5, and 40% to 60% for wood with G 0.5, and a depth equal to R
Y
the length of the threaded portion. Lag screws with bigger diameters must use
S
C
the higher percentile in each range.
I
E
N
C
E
2.2.4.3 Biodegradability Test
Zhao et al. (2019) Since the devices are employed in environments of
body fluids such as blood and urine, they are usually single-use in order to
prevent infection with viruses and bacteria. Unfortunately, nearly all the
commercially available devices are made of non-biodegradable polymers such
as polyvinyl chloride, polypropylene (PP), and thermoplastic elastomer.
Moreover, disposal of these plastics needs incineration to reduce biological C

O
L
contamination risk, which has an undesirable environmental impact
L
E
Polylactic acid (PLA) and polybutylene adipate-co-terephthalate (PBAT) are G
E
among the most important biodegradable polyesters which have been
O
produced commercially at large scale. F
In general, terminal sterilization is required to eradicate microbiological M

E
life from biomaterials and single-use, disposable medical equipment. However, D
I
polymer-based medical devices may undergo physicochemical changes after C
A
L
sterilization, limiting their clinical applicability. Various sterilization
L
procedures for biomedical purposes have been developed so far. Although A
B
ethylene oxide (EtO) is a highly effective sterilizing technology that may be O
R
used on almost any material, leftover ethylene oxide may cause toxicity and A
T
chemical interactions with polymer matrices. O
R
There are different kinds of sterilization processes. First is electron Y
S
beam irradiation (EB) is a radiation sterilization with a high effectiveness
C
I
owing to the shorter processing time, but it is inappropriate for thick items E
N
due to the machine-accelerated electrons' lower penetrating capacity. Second C
E
is saturated steam (SS) sterilization is a chemical-free method, therefore no
residue is left on the product. Because of the high-temperature water vapor,
SS is not suggested for thermolabile and hydrolytically sensitive polymers.
Third is hydrogen peroxide gas plasma (HPGP) is an ionization sterilization
technique that operates at low temperatures. Polar groups may arise as a
result of this.
The literature has thoroughly evaluated the appropriateness of various C

O
L
sterilization procedures for certain polymers. For example, Xie et al. (2018),
L
E
revealed that SS treatment at 121 °C had no effect on the pore structure of G
E
stereocomplex PLA scaffolds due to the development of stereocomplex
O
crystallites. Wach et al. demonstrated that EB radiation may be utilized to F
manufacture PLA components using fused deposition modeling. According to M

E
Grémare et al.(2017), printed PLA scaffolds did not exhibit any cytotoxicity D
I
following sterilization. Valente et al. looked at the sterilizing techniques C
A
L
(ultraviolet light, EtO, and -radiation) effect on electrospun PLA fiber
L
orientation, implying that both are suitable. Methods of sterilizing PLA A
B
membranes using ultraviolet light and radiation. Savaris et al. (2017) O
R
investigated the physicochemical and thermal changes to commercial PLA A
T
characteristics following multiple sterilizations, implying that EtO, HPGP, EB, O
R
and y-radiation may all be used to sterilize PLA plastic films. Y
S
C
I
E
N
2.3 Justification of the Study C
E
In order to gather quality samples, the complete blood-drawing method
must be precisely standardized and appropriately executed, by mindfully
using currently available suggestions and standards. This also means that the
various materials used to collect blood must meet stringent quality standards.
This study aims to produce a prototype 3D paper ETS holder made of paper
for venipuncture. The researchers aim to be environment friendly and reduce C

O
L
the cost and plastic waste disposal from the laboratory. This will be done by
L
E
utilizing different kinds of used paper and will undergo some procedure G
E
specifically pulping and molding. Several studies have identified the
O
possibilities of the pulped paper to be solid material like plastic. According to F
Didone and Tosello (2019), Molded Fibers Pulps, also known as molded fibers M
E
or molded pulps, are generally made up of biodegradable lignocellulosic fibers D
I
such as recycled paper, newspaper, cardboard, and other natural planted C
A
L
fibers such as some bleached/unbleached chemical pulps and high yield
L
pulps, etc. According to Ortendal (2022), he investigates the method of A
B
molding with paper pulp in an architectural setting. The pulp can be O
R
compressed or molded into solid pieces that can be utilized to design A
T
architectural elements by combining shredded cardboard or paper, water, and O
R
an adhesive agent. According to Didone et al., (2017), molded fibers and pulps Y
S
are widely used as plastic alternatives in handling and packing thousands of
C
I
produced products to provide shipment protection, consumer convenience, E
N
and other economic packaging and environmental benefits. Su et al., (2018), C
E
Molded pulp materials have been widely used in the disposable items market
due to its low cost, biodegradability, and disposability. Clinical health care
goods, such as urine bottles, bedpans, kidney dishes, and bowls, are an
example of a rising sector. When compared to traditional items, single-use,
disposable products are more convenient, less expensive, and can greatly
lower the risk of cross contamination and illness.
C
O
L
L
E
G
E
O
F
M
E
D
I
C
A
L
L
A
B
O
R
A
T
O
Chapter 3 R
Y
RESEARCH METHODOLOGY S
C
I
E
N
C
3.0 Research Design E
This study will employ a mixed research method that follows a
combination of qualitative and quantitative data to assess the effectiveness of
use of 3D paper as an alternative to plastic ETS holders. This will be done
through the collection of relevant information and concepts using the
available literatures as well as relevant numerical data and evidence to
acquire a valid and reliable result. Moreover, this study will use true C
O
L
experimental research design on three tests involving the hardness test,
L
E
fastener test, and biodegradability test. The experimental group treatment of G
E
whole blood samples will be observed by ten randomly selected Registered
O
Medical Technologists (RMT) through performing ETS method of F
venipuncture. Venipuncture procedure will be performed on random M

E
volunteers. The results of the tests will be the basis of the effectiveness of the D
I
use of 3D paper as an alternative to plastic ETS holders. C
A
L
3.1 Locale of the Study
L
A
The experimental research will be conducted at Our Lady of Fatima B
O
University (OLFU) Antipolo Campus. These places were selected for knowing R
A
the efficiency of the said study. Prior to the experimentation, the researchers T
O
will ask permission from the head of Our Lady of Fatima University (OLFU) R
Y
Antipolo Campus to conduct the study. This also involves the participants set
S
C
by the researchers, which will be the Registered Medical Technologist and the
I
E
volunteer patients that will take part in the research tests. The effectiveness of N
C
3D Paper ETS Holder in terms of hardness test, fastener test and E
biodegradability will be performed inside Our Lady of Fatima University
(OLFU) Antipolo Campus.
3.2 Test Sample of Population
Purposive sampling was used by the researchers. Purposive sampling is
a form of a non-probability sampling technique in which the researchers rely C

O
L
on their own judgment when choosing the members of the population to
L
E
participate in their surveys. Ten (10) samples in total will be participating in G
E
testing the 3D paper ETS holder with its three (3) categories: (1) hardness, (2)
O
fasteners, and (3) biodegradability test. Ten (10) Registered Medical F
Technologists from the college of medical technologists in Our Lady of Fatima M

E
University will be subjected to this research. Two different sets of registered D
I
medical technologists will be subjected to this study. There are no other C
A
L
qualifications upon utilizing this testing, only the subjects mentioned above.
L
A
B
3.3 Ethical Consideration O
R
A
This research study will involve human participants; thus, strict ethical T
O
considerations shall be observed. The proposal will be forwarded to the R
Y
Research Ethics Committee of the Research Development and Innovation
S
C
Center of Our Lady of Fatima University - Antipolo Campus for ethical
I
E
evaluation as per the guidelines by World Health Organization (2019). The N
C
following ethical principles will serve as a guide in the conduct of this study: E
Autonomy. The participants will be treated as autonomous, which means
that they have the right to make their own decisions. The researchers will give
a brief explanation of the study and will provide a consent form for other
information needed to help the participants decide on their own without any
inducements and coercion. Participants will be given enough time to ensure
that they fully understand the information given. C

O
L
L
Informed Consent. All the participants will be fully informed of the process of
E
G
the research including the samples that will be collected from them and how it E
will be used. Informed consent forms (ICF) will be given to them which O
F
includes their right to accept or refuse in participating and also their right to
M
their information and to withdraw at any time without penalty. This will be E
D
seen as the contract between the researchers and the participants. The ICF I
C
that will be given to the participants will be based on the template for clinical A
L
studies provided by the WHO Research Ethics Review Committee. The ICF will
L
A
include a brief explanation of the objectives of the research, the type of B
O
intervention to be conducted by the researchers, the possible risks and R
A
benefits of voluntary participation, a statement of protecting the participant’s T
O
confidentiality, and contact information of the researchers. Most importantly, R
Y
the ICF will require the personal information and signature of the participant,
S
C
certificate of consent and the names and signature of the researchers.
I
E
N
Privacy and Confidentiality. All the participants in this study will be C
E
protected from disclosure of any identifiable health information. The medical
procedures and medically important data will be strictly confidential to the
participant, researchers, and the medical professionals involved. The identity
of the participants will also be protected, in accordance with Republic Act No.
10173 or otherwise known as the Data Privacy Act. The information obtained
from the patients, including the ICF, will be used only throughout the
duration of this research and written documents indicating any information of C

O
L
the participants shall be destroyed after this undertaking.
L
E
G
Anonymity. All participants’ identities will remain anonymous and the E
researchers will make sure that their identities will not be traced back to O
F
them. The names of the participants will not be included in the study, but
M
instead, the names will be replaced by identifiers: V1, V2, V3, V4, V5, V6, V7, E
D
V8, V9, and V10. Only the feedback from the RMTs that conducted the ETS I
C
venipuncture method using 3D paper ETS holder to sample volunteers will be A
L
obtained. No other records about the participants’ information that will aid in
L
A
their identification will be included in the study. B
O
R
Non-maleficence. The procedures that will be performed will not result in A
T
harm to the participants involved in this study. Participants will be of O
R
considerable importance to the researchers, thus, prioritizing their welfare by Y
not subjecting them to unnecessary risks. It will be ensured that blood S

C
I
collection will be performed by a certified and well-trained personnel to
E
N
minimize the possible injuries that might arise during the procedure and to C
E
limit the venipuncture by two (2) times only; per individual volunteer. The
participants’ participation will provide the researchers the necessary data in
answering the research problem; however, there are no perceived benefits and
incentives to the participants.
3.4 Materials and Methods
The ETS holder is a clear, plastic, disposable cylinder with a tiny

C
threaded aperture (also known as a hub) at one end for inserting the needle O
L
L
and a larger hole at the other end for inserting the collecting tube McCall
E
G
(2020). The researchers will make a few changes in this study: the product E
will be manufactured by hand utilizing used papers with the help of a 3D O

F
molder. In preparation of the prototype, Construct a design of (a.) ETS holder
M
molder with Automatic Computer-Aided Design (AutoCAD) software, based on E
D
the structures and specific measurements of existing ETS plastic holders. I
C
Send the 3D molder model to a (b.) 3D printer, convert to standard triangle A
L
language (STL) format then proceed to the formation or printing of the ETS
L
A
holder molder. The molding requires a substance to be put inside the mold. B
O
Researchers will make this substance by utilizing Leitch’s method. Manually R
A
or using cutting tools, (c.) used paper, newspaper, and egg cartons must be T
O
either cut or shredded into small pieces. Mix the small pieces of paper with a R
Y
certain amount of (d.) water. Incorporate this mixture with (e.) rice paste
S
C
which will serve as the binding agent. Then use a (f.) blender to grind or break
I
E
the materials down until the desired consistency is achieved. Decant the N
C
liquid or filter out the solid substance from the mixture. Leitch’s method E
involves stuffing the cavity of the printed ETS holder mold with the filtered
pulp. The pulp within the molder is then compressed using a vice, clamp, and
other pressing equipment to eliminate superfluous water, leaving just the
binder to hold the paper fibers together. Allow the mold to sit in the pressing
mechanism for 24 hours to allow the paper pulp mixture to fully take shape.
After 24 hours, disassemble the pressing tool then let the slightly damp
molded ETS paper holder dry out more while keeping it in the molder. After C
O
L
another one or two days, the molded ETS paper holder can be taken out.
L
E
Place it on a dry flat surface to avoid warping and to dry out the excess G
E
moisture for another 2-4 hours. Trim off the flashing of the fully dried ETS
O
paper holder, and then smoothen it out with high-grit sandpaper for a more F
defined form and shape. M

E
Testing of the prototype 3D paper holder will be observed by ten D
I
randomly selected Registered Medical Technologists (RMT) through performing C
A
L
ETS method of venipuncture. Venipuncture procedure will be performed on
L
random volunteers. The RMTs that will test the use of 3D paper ETS holders A
B
will rate its characteristics and if it is user-friendly through a questionnaire O
R
presented by the researchers that constitutes the Likert Scale format. A
T
Visual characteristics of the prototype 3D paper ETS holder, specifically its O
R
size, thickness and texture, will be rated by choosing very poor, poor, Y
S
acceptable, good and very good. Hardness quality will be rated also through a
C
I
survey by choosing very poor, poor, acceptable, good and very good. Same E
N
rating choices with the testing of the fastening capability to a two-way needle C
E
of the 3D paper holder.
C
O
L
L
E
G
E
O
F
M
E
Figure 2. Step-by-Step Procedure Based on Grounded Protocol D
I
C
A
3.5 Collection of Data L
L
A
After verifying the methods to be used in the study, the researchers will B
O
gather information to acknowledge the intent of the research. The first step is R
A
T
to collect papers that will be needed to be pulped. The second step is to tear
O
R
the papers into small pieces, and soak them in water overnight, and proceed Y
to put the soaked paper into a blender. Transfer the mixture into a mixing S
C
bowl, then add rice paste, then proceed to compressing the paper mixture into I
E
the 3D paper mold. After the prototype is made, the third step is to test the N
C
effectiveness based on hardness, fastening capability and biodegradability E
that will be observed under 14 days. The final prototype will be tested by ten
(10) RMTs, to ten (10) volunteers.Data to be collected during this observation
will be based on the 3D Paper ETS holder’s thickness, texture, and size.
Hardness test, fastener test and biodegradability test will be observed and
recorded. Blood will be drawn from ten (10) volunteers by selected RMTs to
compare 3D Paper ETS holders to plastic ones. The average processing time to C
O
L
draw blood is 5 to ten minutes per individual. Data to be generated from the
L
E
Likert-scale format questionnaires answered by the RMTs will be the basis in G
E
determining if the 3D Paper Ets holder will be an effective substitute for the
O
plastic paper ETS holder. All of the data to be gathered will be analyzed using F
various statistical tools. M

E
D
I
3.6 Data Analysis C
A
L
The ETS holder that will be created as a result of the process of data
L
collection will be tested using one way anova followed by a post-hoc test, and A
B
paired t-test. To determine the hardness, and fastening capability of the ETS O
R
holder we will utilize the torque test and shore durometer hardness test, in A
T
determining the biodegradability, it will be observed for 14 days in soil burial. O
R
These will be performed by ten (10) Registered Medical Technologists (RMT) Y
S
who will evaluate the hardness, fastening capability, and biodegradability of
C
I
the ETS holder made of paper pulp. Mixed data approach is measured in the E
N
rate of the participants' experience through the use of a questionnaire in likert C
E
scale, and it will also be analyzed statistically and used to determine the
significant difference between utilizing the ETS holder made up of paper and
utilizing the ETS holder made up of plastic by utilizing t-test and
questionnaires that will be helpful in determining the overall experience of
participants.
C
O
L
L
E
G
E
O
F
M
E
D
I
C
A
L
L
A
B
O
R
REFERENCES A
T
Books O
R
Y
S
Ruth McCall( 2020. )Phlebotomy Essential
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https://books.google.com.ph/books? E
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hl=tl&lr=&id=CDzpDwAAQBAJ&oi=fnd&pg=PP1&dq=phlebotomy+essent C
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ials&ots=kT96o_kdkR&sig=gkBwQ6OKQwyYqjOsf9eiRbB8XKg&redir_e
sc=y#v=onepage&q=phlebotomy%20essentials&f=false
Srikanth K. and Lotfollahzadeh S. (2022). Phlebotomy
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Strasinger S. and Di Lorenzo M. (2019). Phlebotomy textbook 4th Edition
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https://books.google.com.ph/books? G
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hl=tl&lr=&id=eJWNDwAAQBAJ&oi=fnd&pg=PR1&dq=phlebotomy+essen
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tials&ots=1oup9YJmc1&sig=iCCNH8C- F
YI5DoOMkN4b7gzYWVaI&redir_esc=y#v=onepage&q=phlebotomy M
E
%20essentials&f=false D
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Journals
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Cheng, Feng, Xia Cao, Hongbin Li, Tingting Liu, Xin Xie, Di Huang, Sushila B
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Maharjan, et al. (2019) “Generation of Cost-Effective Paper-Based R
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Tissue Models through Matrix-Assisted Sacrificial 3D Printing.” Nano T
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Letters 19, no. 6 (June 12, 2019): R
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3603–11.https://doi.org/10.1021/acs.nanolett.9b00583.
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Cheng et al., “Generation of Cost-Effective Paper-Based Tissue Models
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Corpet, D. E. (2021) “Why Does SARS-CoV-2 Survive Longer on Plastic
than on Paper?” Medical Hypotheses 146 110429.
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Ersoy, S., & Ilanbey, B. (2022). A Single-Center Prospective Study of the
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Effects of Different Methods of Phlebotomy in the Emergency E
Department on Blood Sample Hemolysis Rates. Journal of Emergency O

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Nursing.
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Grémare A. et al. (2018). Characterization of printed PLA scaffolds for bone I
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tissue engineeringJ. Biomed. Mater. Res. Part A, 106A (2018), pp. A
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887-894. https://onlinelibrary.wiley.com/doi/10.1002/jbm.a.36289
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Gutierrez, J. N., Royals, A. W., Jameel, H., Venditti, R. A., & Pal, L. (2019). R
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Evaluation of paper straws versus plastic straws: Development of a T
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methodology for testing and understanding challenges for paper R
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straws. BioResources, 14(4), 8345-8363.
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https://bioresources.cnr.ncsu.edu/resources/evaluation-of-paper-st
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raws-versus-plastic-straws-development-of-a-methodology-for-testi N
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ng-and-understanding-challenges-for-paper-straws/ E
Kader, Saadet, Kirmit, Adnan, Akdağ, Turan and Tekindal, Mustafa Agah.
"Evaluation of BD Vacutainer Eclipse and BD Vacutainer Ultra-Touch
butterfly blood collecting sets in laboratory testing" Turkish Journal of
Biochemistry, vol. 46, no. 6, 2021, pp. 685-691.
https://doi.org/10.1515/tjb-2020-0626
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M. Savaris, V. dos Santos, R.N. Brandalise (2016). Influence of different
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sterilization processes on the properties of commercial poly(lactic acid) G
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Mater. Sci. Eng. C, 69 (2016), pp. 661-667
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https://www.sciencedirect.com/science/article/pii/S09284931163070 F
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National Journal Laboratory Medicine (2021) C
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Purdue University, (2018)“Hardness Comparison of Polymer T
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Specimens Produced with Different Processes. R
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Saleyman E. and Bilal I. (2023). A Single-Center Prospective Study of the N
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3D Paper ETS HOLDER Alternative To Plastic Vacutainer Adapter

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3D Paper ETS HOLDER Alternative To Plastic Vacutainer Adapter

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OUR LADY OF FATIMA UNIVERSITY 1

3D PAPER ETS HOLDER: ALTERNATIVE TO PLASTIC VACUTAINER

THE PROBLEM AND ITS BACKGROUND

Evacuated Tube System (ETS) holder in phlebotomy, is an additional

blood collection equipment used when drawing blood. Often made of C

sheath provides little to no protection.

According to Cheng, V., et al. (2019), the use of reusable blood

collection tube holders (RBCTH) in a Hong Kong public hospital is observed

hospitalization in the liver transplant ward, 14 episodes of sequential blood

blood collection simulations demonstrated that HCV and technetium isotope

plastics. Making use of recycled materials is also advantageous because they M

1.2. Statement of the Problem

3D paper, as an alternative to ETS holder made out of plastic.

1.1.4 What is the biodegradability test result of the experimental 3D paper S

1.1.6 Is there a significant difference in the hardness test result of the

1.1.7 Is there a significant difference in the fastener test result of the

1.1.8 Is there a significant difference in the biodegradability test result of the C

H03. There is no significant difference in the biodegradability test result of an S

1.4. Significance of the Study

The outcome of this study will benefit almost everybody, particularly

be dangerous to the patients and clinical laboratory scientists. M

of paper ETS holders.

the 3D paper ETS holder.

only, a fastener test. Other types of fastener test, specifically rotational C

Testing of physical characteristics of the prototype 3D paper ETS M

3D Printing. Making a physical thing out of a three-dimensional computer

model, usually by applying successively many thin layers of material.

Biodegradability. The capacity of objects to degrade when exposed to

microorganisms with or without oxygen, and as they integrate into their

HCV (Hepatitis C Virus). Hepatitis C is an infection of the liver caused by the

hepatitis C virus (HCV). Hepatitis C is transmitted by contact with infected

blood and body fluids.

Likert scale. It is a one-dimensional scale used by academics to collect

respondents' views and opinions. C

Registered Medical Technologist. In the healthcare industry, medical

technologists or clinical laboratory scientists work as private investigators.

They are expert researchers in conducting experiments to help with disease

diagnosis and therapy.

Translucent Polypropylene. A linear hydrocarbon polymer, which serves C

REVIEW OF RELATED LITERATURE

locality of the researchers.

blood will be collected, certain blood draw techniques may be forbidden in

certain situations. A tourniquet, a suitable needle, gloves, alcohol wipes, and

momentarily raises pressure, which makes it easier for the phlebotomist to C

from venipuncture. A phlebotomist can be carried out by a doctor, nurse, lab M

According to Strasinger and Di Lorenzo (2019), the primary fluid used

by the body to circulate nutrients, waste materials, gasses, and hormones is

blood. A typical adult has 5 to 6 liters of blood. Two components make up

hormones, and blood cells. M

cross-contamination of blood tube additives, inappropriate sample storage

conditions, or repeated freezing-thawing cycles are fewer common causes of

impaired sample quality (about 3% overall).

Several lines of evidence now confirm that the vast majority of

laboratory medicine errors occur in the extra-analytical phases of total testing

processing, particularly in the preanalytical phase. Most importantly, the

sample quality and managing data potentially generated by measuring O

As a result, this article summarizes the current evidence on the most S

According to Otto (2018), The process of piercing a vein with a needle to

withdraw blood or start an intravenous line for medicine administration is

known as venipuncture. Venipuncture is frequently used to test blood for a

wide range of medical reasons and problems. A phlebotomist, or blood draw

professional, prepares a patient by selecting a vein, placing a tourniquet, or C

According to Merrill et al. (2022), One of the most common non-