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Full Chapter Phlebotomy Notes Pocket Guide To Blood Collection 2Nd Edition Marjorie Schaub Di Lorenzo Susan King Strasinger PDF
Full Chapter Phlebotomy Notes Pocket Guide To Blood Collection 2Nd Edition Marjorie Schaub Di Lorenzo Susan King Strasinger PDF
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2nd Edition
Phlebotomy
Notes
Pocket Guide to Blood Collection
Printed in China
All of the photographs and several of the illustrations included in this product are
adapted from Strasinger, SK and Di Lorenzo, MS: The Phlebotomy Textbook, ed. 4.
FA Davis, 2019, Philadelphia, with permission.
As new scientific information becomes available through basic and clinical research,
recommended treatments and drug therapies undergo changes. The author(s) and
publisher have done everything possible to make this book accurate, up to date, and
in accord with accepted standards at the time of publication. The author(s), editors,
and publisher are not responsible for errors or omissions or for consequences from
application of the book, and make no warranty, expressed or implied, in regard to
the contents of the book. Any practice described in this book should be applied by
the reader in accordance with professional standards of care used in regard to the
unique circumstances that may apply in each situation. The reader is advised always
to check product information (package inserts) for changes and new information
regarding dose and contraindications before administering any drug. Caution is
especially urged when using new or infrequently ordered drugs.
HIPAA compliant
OSHA compliant
Needles
Needle size varies by length and gauge and is indicated by color-
coded caps. Gauge refers to the needle’s diameter: the lower the
number, the larger the needle.
Standard Sizes
■ Routine venipuncture: 21- or 22-gauge with 1- or 1.5-inch
length
■ Children and patients with small veins: 22- or 23-gauge with
3
/4-inch length
ALERT: Use of a 25-gauge needle is not recommended because
the needle must remain in the vein longer, increasing the likelihood
of hemolysis and clotting.
EQUIP
EQUIP
2
3
EQUIP
EQUIP
Holders
Holders are available with and without safety features.
Assembly
■ Screw the stopper-puncturing end of the ETS needle into the
holder.
■ Advance the blood collection tube on to the
stopper-puncturing needle up to the tube advancement
mark.
■ Fully advance the tube to the end of the holder when the
needle is in the vein.
Needle
Tube advancement
mark
Rubber sleeve
Holder
Assembled
system
4
5
NEEDLE AND SHARPS
DISPOSAL CONTAINERS
Dispose of used needles, lancets, and other sharp objects in sharps
disposal containers. Containers must be:
■ Labeled “biohazard”
■ Rigid, puncture-resistant, and leakproof
■ Equipped with locking lids
Seal the container when the appropriate volume “fill” line is
reached.
ALERT: Do not overfill a sharps container.
ALERT: Never recap a needle under any circumstance.
EQUIP
EQUIP
Collection Tubes
Evacuated tubes are labeled with:
■ Type of anticoagulant or other additive indicated by the
color-coded stopper
■ Draw volume
■ Expiration date
■ Lot number
Additives
Anticoagulants
Tests requiring whole blood or plasma are collected in tubes
containing an anticoagulant to prevent clotting of the specimen by:
■ Binding or chelating calcium
■ EDTA
■ Citrates
■ Oxalates
■ Inhibiting thrombin
■ Heparin
6
7
Antiglycolytic
■ Sodium fluoride: Preserves glucose and inhibits bacterial
growth
Clot Activators
■ Silica: Increases platelet activation
■ Thrombin: Promotes clotting
Polymer Barrier Gel
■ Forms a barrier between the cells and serum or plasma after
centrifugation
ALERT: For anticoagulants and additives to be totally effective,
specimens must be thoroughly mixed three to eight times
immediately after collection.
= 1 inversion
EQUIP
BD Vacutainer Venous Blood Collection Tube Guide
EQUIP
8
(glass)
Red Red • Clot activator, 5 Blood clotting time, glass:
silicone coated 60 minutes.
(plastic) Blood clotting time, plastic:
30 minutes.
EQUIP
• Clot activator 5 For trace-element,
Royal (plastic serum) toxicology, and
Blue nutritional-chemistry
• K2EDTA (plastic) 8 determinations.
(serum tube)
10
dextrose
EQUIP
• Buffered sodium citrate 3–4 For coagulation
Light Light 0.105 M (≈3.2%) glass determinations.
Blue Blue 0.109 M (3.2%) plastic
• Citrate, theophylline, 3–4
adenosine,
Light dipyridamole (CTAD)
Clear
Blue
12
the proper anticoagu-
lant-to-blood ratio.*
For complete clotting, 30
Chemistry
Immunochemistry minutes minimum clotting
Clot Activator 5–10 time is required. Incomplete
Immunohematology
Viral Markers or delayed mixing may result
in delayed clotting.
For complete clotting, 30
Chemistry minutes minimum clotting
Clot Activator 5–10 time is required. Incomplete
w/Gel Immunochemistry
TDMs or delayed mixing may result
in delayed clotting.
*CLSI H3-A6 Procedures for the Collection of Diagnostic Blood
Specimens by Venipuncture; Approved Standard – 6th Edition
Cap Number of Testing
Color Additive Inversions Disciplines Comments
EQUIP
Lithium Heparin
Lithium Heparin 5–10 Chemistry
w/Gel Immunochemistry
Sodium Heparin
Hematology
K 3EDTA Immunohematology
8–10
K 2EDTA Molecular Diagnostics
Viral Markers
Sodium
Fluoride/
5–10 Chemistry
Potassium
Oxalate
14
Courtesy and © Grenier Bio-One. Adapted with permission.
15
CLSI Recommended Order of Draw
Fill tubes in the following order to prevent invalid test results
caused by contamination of the specimen by microorganisms,
tissue thromboplastin, and additive carryover.
Lavender EDTA
Pink EDTA
Tan EDTA
5
Royal blue EDTA
White PPT Gel separator
with EDTA
Potassium oxalate
6 Gray
Sodium fluoride
7 Yellow ACD
EQUIP
EQUIP
16
17
Common Tests Affected by
Additive Carryover
Continued
EQUIP
EQUIP
Continued
18
19
Additive Possible Compromised Test
• Calcium
• Cholesterol
• CK-MB
• Copper
• Creatine kinase (CK)
• Creatinine
• Gamma-GT
• Glucose
• High-density lipoprotein (HDL) cholesterol
• Iron
• Phosphorus
• Sodium
• Triglycerides
• Uric acid
Sodium • Acid phosphatase
fluoride • Alanine aminotransferase (ALT)
• Alkaline phosphatase
• Amylase
• Aspartate aminotransferase (AST)
• Bilirubin
• BUN
• Cholesterol
• Cholinesterase
• CK-MB
• Copper
• Creatine kinase (CK)
• Creatinine
• Gamma-GT
• HDL cholesterol
• LDH
• Sodium
• Triglycerides
• Uric acid
EQUIP
EQUIP
Syringe System
Barrel
Luer-Lok tip (graduated in mL) Plunger
20
21
ALERT: Hold the syringe, blood transfer device, and tube in a
vertical position to prevent additive carryover.
ALERT: Do not push the plunger to force blood into the tube.
Allow the vacuum in the evacuated tube to draw the correct amount
of blood into the tube.
Syringe
Transfer
device
Evacuated
tube
EQUIP
EQUIP
Uses
■ Small, fragile veins
■ Pediatric patients
■ Elderly patients
■ Lower needle insertion angle
ALERT: Observe your facility’s policy for routine use of winged
blood collection sets.
“Butterfly wings”
Tubing
Syringe
ETS
holder
Additional Equipment
■ Tourniquets
■ Gloves
■ Antiseptics
■ 70% isopropyl alcohol (for routine blood collection)
■ Chlorhexidine gluconate or iodine (for procedures
requiring additional sterility, such as blood cultures)
22
23
■ 2-inch × 2-inch gauze
■ Bandages
■ Pen
■ Slides
■ Biohazard transport bags
■ Hand sanitizers
EQUIP
EQUIP
Equipment Notes
Workplace 1 Policies
Workplace 2 Policies
24
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