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Venipuncture Equipment Unit 2
- 1. Blood Collection: A Short Course, 2nd edition UNIT 2 VENIPUNCTURE EQUIPMENT Marjorie Schaub Di Lorenzo, MT(ASCP)SH Susan King Strasinger, DA, MT(ASCP)
- 2. ∗ Differentiate between an evacuated tube system, syringe, and a winged blood collection set for the collection of blood by venipuncture. ∗ Differentiate among the various needle sizes as to length, gauge, and purpose. ∗ Discuss methods to safely dispose of contaminated needles. LEARNING OBJECTIVES
- 3. ∗ Identify the types of evacuated tubes by color code, and state the anticoagulants and additives present, the mechanism of action, any special characteristics, and the purpose of each. ∗ List the correct order of draw for the various types of blood collection tubes. LEARNING OBJECTIVES
- 4. ∗ Discuss the purpose and types of tourniquets. ∗ Name three substances used to cleanse the skin prior to venipuncture. ∗ Discuss the use of gloves, gauze, and bandages when performing venipuncture. ∗ Describe the quality control of venipuncture equipment. LEARNING OBJECTIVES
- 5. ∗Selection ∗Convenience to collection area EQUIPMENT ORGANIZATION
- 6. PHLEBOTOMY TRAYS ∗ Equipment transport ∗ Placement ∗ Disinfection
- 9. ∗ Evacuated tube system ∗ Syringe system ∗ Winged blood collection set VENIPUNCTURE METHODS
- 10. EVACUATED TUBE SYSTEMS ∗ Eliminate transfer of blood ∗ Minimize exposure to blood ∗ Three-part system
- 11. ∗ Sterile, disposable ∗ Standard gauge, 20–22 ∗ 21-22 gauge standard with evacuated tubes ∗ Length, 1 or 1.5 inches ∗ 23 gauge with ¾” length may be used ∗ Children/persons with small veins NEEDLES
- 12. ∗ Avoid ∗ Most have eliminated 20-gauge needles ∗ Patients on blood thinner = hematomas ∗ Use of 25-gauge needles ∗ Needle in vein longer ∗ Tube fills more slowly–microclots form ∗ Hemolysis occurs more frequently NEEDLES
- 15. NEVER RECAP A NEEDLE ONCE THE SHIELD HAS BEEN REMOVED.
- 17. SAFETY GLIDE BLOOD COLLECTION SYSTEM
- 18. BD VACUTAINER ECLIPSE NEEDLE
- 20. BLUNTING NEEDLES
- 22. ∗Tube advancement ∗Tube removal ∗Loss of vacuum TUBE HOLDER PROCEDURE
- 23. TYPES OF HOLDERS ∗ Venipuncture Needle- Pro, Vanish-Point, and BD holders
- 24. BECOME THOROUGHLY FAMILIAR WITH THE OPERATION OF YOUR NEEDLE SAFETY SYSTEM BEFORE PERFORMING BLOOD COLLECTION.
- 25. NEEDLE DISPOSAL SYSTEMS ∗Puncture- resistant containers • Rigid, leakproof, biohazard labeling
- 26. ∗ Syringes with needles attached ∗ Winged blood collection sets ∗ Adapters with needles attached ∗ Safety shields activated DIRECT DISPOSAL
- 27. COLLECTION TUBES
- 28. ∗Rubber stoppers ∗Hemogard closures ∗Color-coding • Identifies the type of anticoagulant/additive DESCRIPTION
- 29. STOPPER DESIGN
- 30. ∗ Premeasured vacuum • Desired volume • Partial fill tubes ∗ Color-coded ∗ Types of anticoagulant • Liquid • Powder • Spray-coated ∗ Mixing METHODOLOGY
- 31. DO NOT TRANSFER BLOOD BETWEEN TUBES CONTAINING DIFFERENT ANTICOAGULANTS OR ADDITIVES.
- 32. ∗ EDTA is the anticoagulant ∗ Specimen is whole blood ∗ Primary test is the CBC • Maintains cellular integrity • Inhibits platelet clumping • Does not interfere with routine staining procedures ∗ CLSI recommends spray-dried K2EDTA for hematology tests ∗ Do not use for coagulation tests LAVENDER TUBES
- 33. ∗ K2EDTA is the anticoagulant ∗ Specimen is whole blood ∗ Designated tube for blood bank tests ∗ Special label required by the AABB PINK TUBES
- 34. ∗ K2EDTA is the anticoagulant with gel ∗ Plasma preparation tube (PPT) ∗ Specimen is plasma ∗ Used for molecular diagnostic tests WHITE TUBES
- 35. ∗ Sodium citrate is the anticoagulant ∗ Specimen is plasma ∗ Primarily used for coagulation tests • Preserves coagulation factors ∗ Ratio of blood to liquid Na citrate = 9:1 • Make adjustments for high and low HCTs LIGHT BLUE TUBES
- 36. INCOMPLETELY FILLED LIGHT-BLUE TUBES ARE REJECTED BY THE LABORATORY.
- 37. OVERMIXING LIGHT BLUE TUBES CAN ACTIVATE PLATELETS AND PRODUCE ERRONEOUS COAGULATION TEST RESULTS.
- 38. ∗ Specimen is plasma ∗ Used for fibrin degradation products ∗ Additives are thrombin and soybean trypsin inhibitor SPECIAL BLUE TUBES
- 39. ∗ Sodium citrate is the anticoagulant ∗ Blood to liquid anticoagulant is 4:1 ∗ Specimen is whole blood ∗ Used for Westergren sedimentation rates ∗ Specially designed tubes BLACK TUBES
- 40. ∗ Heparin is the anticoagulant ∗ Specimen is plasma ∗ Chemistry tests ∗ Avoid anticoagulant interference with particular tests (Na, NH4, Li) ∗ Heparin interferes with differential staining GREEN TUBES
- 41. ∗ Plasma separator tubes (PSTs) ∗ Lithium heparin is the anticoagulant ∗ Additive is separation gel ∗ Specimen is plasma ∗ Separates plasma from cells ∗ Ideal for potassium tests and other chemistry tests LIGHT GREEN/GREEN BLACK TUBES
- 42. ∗ Potassium oxalate or Na2EDTA may be the anticoagulant ∗ Antiglycolytic agent, sodium fluoride, is the additive ∗ Specimen may be plasma or serum ∗ Used for glucose and blood alcohol levels ∗ Sodium fluoride interferes with some enzyme tests ∗ Potassium oxalate distorts RBC morphology GRAY TUBES
- 43. ∗ Plain with clot activator, sodium heparin, or K2EDTA ∗ Specimen may be serum or plasma ∗ Specially formulated rubber stoppers ∗ Chemically clean tubes ∗ Used for trace elements, toxicology, and nutrients ROYAL BLUE TUBES
- 44. ∗K2EDTA is the anticoagulant ∗Specimen in plasma ∗Contain less than 0.01 µg/mL lead ∗Used for lead testing TAN TUBES
- 45. ∗Blood bank • Acid citrate dextrose (ACD) ∗ Preserves red blood cells ∗Microbiology • Sodium polyanetholsulfonate (SPS) • Blood cultures ∗ Aids microorganism recovery YELLOW TUBES
- 46. ∗Thrombin is the additive ∗Specimen is serum ∗Used for STAT serum chemistry tests ORANGE/YELLOW GRAY TUBES
- 47. GOLD/RED-GRAY (SST) TUBES ∗ Additives ∗ Silica clot activator ∗ Thixotropic separation gel ∗ Specimen is serum ∗ Allow to clot for 30 minutes ∗ Used for chemistry tests ∗ Do not use for blood bank or some immunology/serology tests
- 48. CENTRIFUGATION OF INCOMPLETELY CLOTTED SST TUBES CAN PRODUCE A NONINTACT GEL BARRIER AND POSSIBLY CELLULAR CONTAMINATION OF SERUM.
- 49. ∗Silica clot activator is the additive ∗Specimen is serum ∗Used for serology, chemistry, and blood bank testing RED PLASTIC TUBES
- 50. ∗ No anticoagulants or additives ∗ Specimen is serum ∗ Allow to clot for 60 minutes ∗ Used for chemistry, serology, and blood bank testing RED GLASS TUBES
- 51. ∗ No additives or anticoagulants ∗ Used as a discard tube CLEAR/RED-LIGHT GRAY TUBES
- 53. ∗Prevents specimen contamination by: • Tissue thromboplastin • Anticoagulants • Additives • Microorganisms ORDER OF DRAW
- 54. ∗Tissue thromboplastin affecting coagulation tests ∗Transfer of EDTA to a tube for calcium testing ∗Transfer of Na citrate or K oxalate to a tube for electrolyte testing EXAMPLES
- 56. CLSI-RECOMMENDED ORDER OF DRAW ∗ Blood culture ∗ Light-blue ∗ Red/gray, gold, red plastic or glass ∗ Light green PST, green ∗ Lavender, pink, white ∗ Gray ∗ Yellow/gray, orange
- 57. ∗Used for small, fragile veins ∗Suction pressure on vein can be controlled ∗Coordinate syringe size with volume of blood required SYRINGES
- 59. SYRINGE-TO-EVACUATED TUBE TRANSFER ∗ Blood transfer device
- 60. ∗ CLSI recommends the same order of draw for both evacuated tube system and filling tubes from a syringe. CLSI-RECOMMENDED SYRINGE ORDER OF DRAW
- 61. WINGED BLOOD COLLECTION SETS ∗ IV fluid infusion ∗ Very small adult veins ∗ Pediatric specimens
- 62. WINGED BLOOD COLLECTION SETS
- 63. WINGED BLOOD COLLECTION SETS
- 64. PUNCTURE GUARD WINGED BLOOD COLLECTION SET
- 65. COMBINATION SYSTEMS ∗ Blood collection tube and collection device are combined in one unit ∗ Blood collected by either evacuated tube or syringe technique ∗ Use regular needles or winged blood collection needles
- 66. TOURNIQUETS
- 67. TYPES OF TOURNIQUETS ∗ Flat latex strips ∗ Velcro/buckle closures ∗ Rubber tubing ∗ Blood pressure cuffs ∗ Disposable nonlatex strips
- 68. ∗ Assists in vein location ∗ Impedes venous but not arterial blood TOURNIQUET PURPOSE
- 69. ∗ Venoscope II, Neonatal Transilluminator, and Transillumination Vein Locator ∗ Uses high-intensity LED lights ∗ Shines through patient’s subcutaneous tissue ∗ Absorbs light ∗ Highlights vein ∗ Vena-Vue–uses liquid crystal thermography ∗ Vein Entry Indicator Device (VEID)–sensor technology VEIN-LOCATING DEVICES
- 70. VENOSCOPE
- 71. GLOVES ∗ OSHA mandated ∗ Latex versus nonlatex ∗ Powdered versus nonpowdered
- 72. ANTISEPTICS ∗ 70% isopropyl alcohol • Routine venipuncture ∗ Iodine/chlorhexidine gluconate • Blood cultures • Arterial punctures
- 73. GAUZE/BANDAGES ∗ 2 x 2 gauze pads • Apply pressure to puncture site ∗ Bandages/tape • Apply after bleeding stops • Remove within 1 hour • Latex-free ∗ Self-adhesive gauze
- 74. ADDITIONAL SUPPLIES ∗ Pen ∗ Biohazard bags ∗ Hand sanitizers
- 75. ∗Needles • Disposable • Tightly sealed for sterility • Visual examination EQUIPMENT QUALITY CONTROL
- 76. ∗Lot numbers ∗Expiration date • Ensures stability of: ∗ Vacuum ∗ Anticoagulants ∗ Additives EVACUATED TUBES QUALITY CONTROL
- 77. ∗Short draws • Excessive dilution by liquid anticoagulant • Underfilled sodium citrate tubes cause a falsely lengthened aPTT result • Distortion of cellular structures • Underfilled EDTA tubes cause red blood cell shrinkage ∗Avoid manual filling of additive tubes POSSIBLE ERRORS