Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Chapter 3
PowerPoint ® Presentation to Accompany
Booth, Wallace, and Fitzgerald
Chapter 3
1
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Equipment for
Specimen Collection
Chapter 3
2
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Objectives
Upon completion of this chapter, you should be able to:
• List the information required on a requisition form.
• Describe computer use in phlebotomy.
• Describe the supplies and general equipment
required for phlebotomy.
• Describe the components of the evacuated tube
system.
• Explain the proper method for needle disposal.
Chapter 3
3
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Objectives cont’d
• Identify the type, explain the mechanism of
action, and identify the evacuated tube color
associated with each additive.
• Explain the order of draw for evacuated tubes.
• List the components of the butterfly infusion and
syringe systems.
• Identify the equipment needed to perform dermal
puncture.
Chapter 3
4
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Laboratory Requisitions
Laboratory requisitions are generated following a physician’s
order, which may be verbal or written.
Information Included on Requisition Form
•Patient’s name, DOB, medical record number
•Ordering physician’s name
•Date and time test is to be done
•Type of test ordered
•Test status (timed, fasting, STAT)
•Patient’s location (if inpatient)
•Initials of phlebotomist
NOTE: Requisition forms may be
handwritten or computergenerated.
Chapter 3
Click picture for larger view
5
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Patient Identification
Be sure to determine the
correct spelling of a patient’s
last name prior to obtaining a
blood specimen!! Also, check
at least one other patient
identifier.
The correct spelling of the
patient’s name should be on:
John Smith
• Requisition form
• ID band
• Specimen label
Chapter 3
7
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Apply Your Knowledge
True or False:
A requisition form must be signed by a
physician or other qualified health care
practitioner.
ANSWER: True
Great!
Chapter 3
8
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Specimen Collection Equipment
• Gloves
•
•
•
•
•
•
Tourniquet
Alcohol prep pads
Gauze pads
Adhesive bandage
Needles
Evacuated tube
holder or syringe
• Evacuated tubes
• Sharps (needle
disposal) container
• Permanent marker,
pen, or computer
labels
Chapter 3
9
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Specimen Collection Equip. Gloves
Gloves
• Gloves are available in materials such as
latex and vinyl.
• Sterile and non-sterile gloves are available.
• Powder-free gloves are recommended
because the powder can serve as a
specimen contaminant.
• OSHA regulations require that gloves be
worn during phlebotomy procedures.
• Always wash your hands after removing
gloves.
• Be alert to latex allergies (itchy, red hands).
Chapter 3
10
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Specimen Collection Equip. Tourniquet
Tourniquet
• A device that is wrapped around
the arm to temporarily stop the
flow of venous blood
• Used to locate a patient’s veins
easily
• Are disposable; may be cleaned for
reuse on same patient if not visibly
contaminated
Types of Tourniquets
• Never apply a tourniquet for
longer than 1 minute at a time
• Non-latex
• Latex
• Blood pressure cuff
Chapter 3
11
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Latex Allergies and Phlebotomy
Health care workers and patients can be allergic to
latex and experience symptoms such as:
•
•
•
•
Itchy, watery eyes
Skin rash
Chest tightness
Shortness of
breath
• Shock
Always ask the patient if he or she is allergic to latex!!!
Chapter 3
12
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Specimen Collection Equip. –
Alcohol
Prep Pads
Alcohol Prep
Pads
• Prior to needle insertion, the site must be cleaned
• Alcohol prep pads, bacteriostatic antiseptic, are soaked
with 70% isopropyl alcohol
• Not recommended for the collection of blood alcohol
levels or blood glucose
Adhesive Bandage
Gauze Pads
• Loosely woven fabric
applied to the arm after
needle is removed
Chapter 3
• Placed over the
puncture site for 3
to 5 minutes to stop
the bleeding.
• Not used on children
under 2 years.
13
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Remove the Tourniquet
Failure to remove the
tourniquet following
venipuncture can cause
temporary or permanent
injury to the patient and is
an act of negligence!!
Chapter 3
14
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Specimen Collection Equip. Needles
Needles
• Composed of:
- Hub
- Shaft
- Bevel
• Vary in length from ¾ to
1½ inches
• Gauge size varies from 16gauge (large) to 23-gauge
(small)
Needles Used by Phlebotomists
• Multiple-sample needle
• Hypodermic needle
• Butterfly (wing-tipped) needle
NOTE: The larger the gauge size, the smaller the needle
Chapter 3
15
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Needlestick Safety and Prevention Act
• Developed due to the large number
of needlestick injuries
• Requires needles to have special
safety features to protect from
accidental puncture
• Safety feature should be activated
as soon as the procedure is
complete
Make sure you know how to operate the device you are using!!
Chapter 3
16
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Reporting Needlestick Injuries
• If you or a co-worker sustain a
needlestick injury, you must
report it
to a supervisor!
• You are obligated to report
hazards from needles you
observe in the workplace!
Chapter 3
17
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Specimen Collection Equip. –
Evacuated
Tube Holder
Evacuated
Tube Holder
• Also called barrel or
adapter
• Holds both a needle
and a tube for blood
collection
• Should be disposed of
after use
Chapter 3
18
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Specimen Collection Equip. –
Sharps
Container
Sharps
Container
• Needle disposal containers
• Protect health care
personnel from accidental
needlesticks
• Made of nonpenetrable
plastic and are red or bright
orange in color with a
biohazard label
• Stores used needles,
lancets, and other sharps
Chapter 3
19
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Specimen Collection Equip. Computer Label, Permanent Marker, or Pen
Marker
Each evacuated tube must be labeled at the time of
specimen collection.
The following information should be included on the label:
• Patient’s name and identification number
• Date and time of collection
• Collector’s initials (your initials if you collected the specimen)
Chapter 3
20
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Specimen Collection Equip. –
Evacuated Tubes Tubes
Evacuated
• Contain a premeasured vacuum
• Most widely used system for blood collection
• Range in size from 2mL to 15mL and both adult and
pediatric sizes are available
• Fill automatically with blood due to the vacuum
Chapter 3
21
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Specimen Collection Equip. –
Evacuated
Tubes
cont’d
Evacuated Tubes (cont’d)
Evacuated tubes with a plastic splashguard safety device
reduce the aerosol mist when the tube stopper is
removed during specimen processing.
Multiple tubes may be required for collection of various
specimens, and the order in which you use the tubes is
important. This is known as the “order of draw.”
Chapter 3
22
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Specimen Collection Equip. –
Tubes
and Anticoagulants
Tubes and
Anticoagulants
Tubes with an anticoagulant prevent the specimen from
clotting.
• It is important that
tubes containing an
anticoagulant be mixed
or inverted several
times after drawing to
ensure uniform mixing.
Chapter 3
23
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Specimen Collection Equip. Tubes Commonly Used Tubes
Red-Topped
Serum Separator Tube
• Glass is recommended
for serum testing
• Does not contain
additives
• Used for most drug
tests
• Plastic red-topped
tubes should not be
used for blood banking
• Black and red tube
with a speckled look
(tiger-topped)
• Contains a gel and
clot activator
• Blood clots faster
and the gel
separates the serum
from the blood cells
Chapter 3
24
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Specimen Collection Equip. –
Lavender Topped
Lavender-Topped
• Used frequently for hematology studies
(CBC and differential)
• Contains the additive EDTA (ethylenediaminetetraacetic acid)
• EDTA is an anticoagulant that binds with
calcium to prevent blood from clotting
• EDTA inhibits platelet clumping
Chapter 3
25
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Specimen Collection Equip. –
Light Blue Topped
Light Blue-Topped
• Used for coagulation studies (PT, APTT, PTT)
• Primary additive is sodium citrate, which binds
with calcium to prevent blood from clotting
• This tube must be completely filled in order to
maintain the anticoagulant-blood ratio
NOTE: The tube should be inverted to prevent clotting.
Chapter 3
26
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Specimen Collection Equip. –
Green toppedGreen-Topped
• Contains sodium heparin, lithium heparin, or
ammonium heparin as the anticoagulant
• Light green or green-gray tubes are called plasma
barrier tubes
• Used for tests requiring plasma or for general
chemistry tests
• Heparin stops blood from clotting by inactivating
thrombin and thromboplastin
Chapter 3
27
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Specimen Collection Equip. –
Gray topped
Gray-Topped
• Used for glucose analysis and blood alcohol levels
• Contains sodium fluoride or potassium oxalate as
an anticoagulant; these additives bind with calcium
to stop blood from clotting
• Contains a glycolytic inhibitor that prevents the
metabolism of glucose by red blood cells
Chapter 3
28
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Specimen Collection Equip. –
Yellow toppedYellow-Topped
• Available with two different additives:
- Sodium polyanethol sulfonate (SPS),
which is used for blood culture
collections
- Acid citrate dextrose (ACD) which
maintains red cell viability
NOTE: It is very important that the correct yellow-topped
tube be used because they look alike but have different
additives!
Chapter 3
29
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Hemolysis
Hemolysis of blood samples
should be avoided at all costs.
A hemolyzed sample will
produce erroneous results for
most laboratory tests.
Always make sure to select the appropriate
tube size and needle to prevent hemolysis.
Chapter 3
30
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Multiple Tubes Using a
Vacuum Tube System
Order of Draw
Sterile
Specimens
Coagulation
Tubes
Light Blue
Blood Culture Tubes
SST
Serum
Green
Gold or Red/Black
Light Green
Red
Lavender
Gray
Chapter 3
31
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Butterfly Infusion Set with
Syringe System
• Used to collect blood from people
with small, fragile veins, such as the
elderly and children
• Provides greater control with nonstable patients
• This system is completely sterile.
• This picture shows an adapter that
can be used with the evacuated
system.
Chapter 3
32
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Apply Your Knowledge
Jenny is about to collect blood from a two-day-old
infant while you observe her. She asks, “Since this is
a newborn, will I have to wear gloves”? How will you
respond?
ANSWER:
Yes, according to OSHA, gloves are required
when potentially coming in contact with blood or body fluids.
GREAT!
Chapter 3
33
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Apply Your Knowledge
Which tube system is the most widely
used for blood collection?
ANSWER: Evacuated tube system
BRAVO!
Chapter 3
34
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Apply Your Knowledge
A lavender-topped tube is primarily used
for what types of studies?
ANSWER: Hematology studies (CBC and
differential)
GOOD JOB!
Chapter 3
35
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Apply Your Knowledge
Which color tube is used for glucose
analysis and blood alcohol levels?
ANSWER: Gray-topped tubes
GREAT!
Chapter 3
36
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Dermal Puncture
• Used for blood specimens that require less blood
• Blood may come from arterioles, venules, and capillaries
• Obtained mostly from infants and small children under
2 years of age
Indications for Adult Dermal Puncture
• Cases of severe burns
• Chemotherapy patients
• Older patients with fragile veins
• Home glucose monitoring for diabetes
Chapter 3
37
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Dermal Puncture
Collection Devices and Equipment
•
•
•
•
•
•
Safety lancets
Gloves
Alcohol pads
Sterile gauze
Sharps disposal container
Microspecimen container
To prevent puncturing a bone, the puncture depth should not
exceed 2.0 mm, especially when performing heel sticks on
infants.
NOTE: A warm towel or cloth applied to the dermal site will
increase blood flow.
Chapter 3
38
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Dermal Puncture
Microspecimen Containers
• Microspecimen containers
collect samples of less
than 1 milliliter.
• Capillary tubes or
microhematocrit tubes
are used to collect
hematocrit specimens.
Chapter 3
39
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Dermal Puncture
Microcollection Containers
• Microcollection
containers provide a
larger collection volume
than capillary tubes.
• They come with a
variety of anticoagulants
and use a color-coded
system.
Chapter 3
40
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Apply Your Knowledge
What are the indications for dermal
puncture in the adult patient?
ANSWER: Severe burns, chemotherapy,
older patient with fragile veins, home
glucose monitoring
GREAT!
Chapter 3
41
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Chapter 3 Summary

All patient information must be included on the requisition
form.

All tube labels must include the patient’s name, date, time,
and the phlebotomist’s initials.

Computer information in phlebotomy are used to maintain
patient data and results, receive orders and requisitions,
and generate charges.

Equipment needed for phlebotomy includes gloves,
tourniquet, alcohol pads, gauze, bandage, needles,
evacuated tube and holder, sharps container, marker,
label, and evacuated tube(s).
Chapter 3
42
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Chapter 3 Summary (cont’d)

Evacuated tubes are a closed system of collection that
allow for multiple tubes to be collected in one
venipuncture.

Used equipment must be disposed of in a sharps
container with a biohazard label.

Evacuated tubes come in different colors with different
additives. You should be familiar with the tube colors
most commonly used at your facility.
Chapter 3
43
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
Chapter 3 Summary (cont’d)

The order of draw for evacuated tubes is blood culture or
yellow tube, SST, serum, heparin, PST, EDTA, pink or
lavender, and gray.

The winged set includes a butterfly needle, small tubing,
and a syringe. The syringe set may also be used.

Dermal puncture is performed with a safety lancet or
puncture device, collection tubes, and the same
equipment used for venipuncture.
Chapter 3
44
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
END OF CHAPTER 3
Real success is finding your
lifework in the work that you love.
--David McCullough
Chapter 3
45