Basic Principles of
Phlebotomy
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2
Phlebotomy Video
3
Blood Composition:
Formed elements (~45%)
– RBC
– WBC
– Platelets
Fluid component (~55%)
– Water (~92%)
– Protein (~7%)
– etc
4
Blood Collection Tubes:
• Contain a vacuum
• Used with
Vacutainer and
Syringe systems
• Stoppers universal
color coded: indicates contents
• Have an expiration date
5
Safety: Engineering Controls
• PPE
• Sharps containers
• Safer medical devices
6
Safer Medical Devices:
7
Equipment:
1. PPE: gloves, lab coat, mask
2. Cleaning agent
– Alcohol pads: routine
– Povidone iodine: blood culture collection and
blood gases
– Soap and water: alcohol testing, allergies
3. Cotton balls, gauze
8
Equipment:
4. Bandage, tape (use caution with children)
5. Sharps container:
– Discard needles,
lancets
– Biohazard marking
– Puncture resistant
– NEVER recap, bend
break needles
9
Equipment:
6. Tourniquets:
–
–
–
–
Slows venous blood flow down
Causes veins to become more prominent
NEVER leave on for >1 minute
AVOID rigorous fist clenching or hand
pumping (potassium, lactic acid, LD)
– Latex allergy
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Tying on the Tourniquet:
11
Equipment:
7. Needles
–
–
–
NEVER reuse a needle
NEVER use if shield is broken
NEVER recap, cut, bend or break
–
Drop immediately into sharps container after
venipuncture
–
Size of needle is indicated by gauge:
•
•
Larger gauge number indicates smaller needle diameter
21, 23 gauge needles routinely used for phlebotomy
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Needles:
Used with syringe system
Used with vacutainer system13
Multi-sample Needle:
14
Butterfly Needle:
15
Butterfly Needle:
• Most often used with
syringe
• Expensive, thus not used
for routine draws
• Used for small, fragile
veins
• Increased risk of needle
stick injury
16
Equipment:
8. Tube holder/
vacutainer adapter
– Threaded
– Flanges
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Equipment:
9. Syringe
10. Black
water proof
pen
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Syringe Safety Device:
19
Labeling Blood Collection Tubes:
•
Black indelible marker (water proof)
– Never pencil
– Legal document
– Print legibly
•
Required information: 5 items
–
–
–
–
–
Patient name
Identification number
Date of draw (mm,dd,yyyy)
Time of draw (military time)
Phlebotomist initals
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Labeling
Last Name, First Name
Patient ID: 1234-56
June 5, 2005 8:10 AM Initials: SM
21
Vacutainer or Syringe?
• Vacutainer
– Most often used
– Most economical
– Quick
– Least risk of accidental needle stick
• Syringe
– More control
– Reposition easily
– Will see ‘flash’ of blood in syringe hub when
vein successfully entered
22
The Patient:
•
•
•
•
•
Approach
Communication
Empathy
Handling special situations
Patient identification
– Arm band
– Legal document
• Prepare patient for blood draw
– Latex allergy?
23
Great QUESTIONS TO ASK YOUR
PATIENT
• Have you ever had blood drawn before?
• Have you had problems during a
venipuncture?
• If yes—
– Did you have pain, bruising or bleeding?
– Did you have chest pain, dizziness,
fainting or nausea?
24
Necessary Equipment for
Venipuncture
Equipment
•
•
•
•
•
PPE
Alcohol swabs
Gauze pads
Tourniquet
Needles- sterile
disposable
• Blood collection tubes
• Pediatric collection
tubes
Equipment
• Winged infusion sets
• Vacutainer
• Lancets
25
Patient Preparation
1. Patient education
1. Do not make it lengthy
2. Tell the steps of the procedure
3. Instruct patient to let you know right away if
they are having pain
4. Explain possible complications
1. Bruising, hematoma, infection, prolonged
bleeding, excessive pain
5. Ask if they have questions
26
Selecting the Site
1.
2.
3.
4.
Begins with hand washing
Must be done before and after procedure
Don gloves
Ask patient to extend arm with palm
facing up
5. Search for a vein using visual
examination and palpation
27
Selecting the Site:
• Antecubital area most
often accessed
– “ the bend of the
arm”
– Preferred site
– There are 3 veins
that are preferred for
blood draw in this
location
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The 3 Preferred Veins
• Medial Cubital
– 1st choice
– In center of AC fossa
– Usually does not move
– In obese patient- not seen by can be palpated
• Cephalic Vein
– 2nd choice
– Located in lateral aspect of AC fossa
– Large vein and can be seen
– *** tends to ROLL and difficult to stabilize
• Brachial Vein
– Last choice
– Located in medial aspect of AC fossa
– ** very close to brachial artery
– Not visible and tends ROLL
30
Examine the Patients AC
FOSSA!!
• If you see a good vein it is time to palpate!
• Touch the vein with you fingers
• Vein should feel
– Soft
– Flexible
– Non- tender
– The vein SHOULD NOT BE HARD,
INFLEXIBLE OF TENDER
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Conditions
• The following conditions cause veins to be unsuitable for
venipuncture
– Sclerosis
• HARD, INFLEXIBLE,NARROW
– Tortuous veins
• TWISTED, TURN EASILY
– Thrombotic veins
• BLOOD CLOT(S) IN THE VEIN
– Fragile veins
• THIN, DARK, CLOSE TO SURFACE, COLLAPSE
EASILY
– Phlebitis
• INFLAMMED BLOOD VESSELS, TENDER TO
TOUCH
32
Complications
• If performed on any of the aforementioned
categories
– Vein will be difficult to access
– Impossible to puncture
– Painful
– Easily damaged
– Blood supply through the vein will be POOR
33
Troubleshooting to Locate a
Vein
• Place the arm below the level of the heart
for several minutes
• Place a warm compress
• *** The best technique is to slow down and
take your time
• Ask someone else to try
• Notify supervisor
• Notify Physician
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Other Veins
•
•
•
•
Hand and wrist veins
Dorsum area of the hand
Easily seen--- *** are more fragile!!
** ROLL easily– superficial,small and
painful
• Short length– difficult to to angle needle
• Vein on underside of wirst
– CLOSE to Artery and Nerves
– Physically challenging to access
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Hand Vein Draw
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NO BLOOD DRAW
•On arm with IVF
•Dialysis Shunt
•Mastectomy side
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Collection Site Problems:
• Intravenous line
– NEVER draw above
an IV
– Draw from other arm
– Draw from hand
on other arm
– Draw below the IV
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Draw Below IV site:
39
Cleaning the SITE
• Invasive procedure
• Scrub with isopropyl alcohol 70%
• Other germicides include- chlorhexidine and
iodine
• Alcohol preferred
– Dries fast
– No residue
– Not highly irritating
– Does not obscure
– Not drying to the skin
40
Proper Venipuncture Technique
•
•
•
•
•
•
•
•
•
Introduce self
Identify the patient
Check laboratory requisition form
Have patient sit or lie down- NEVER STANDING
Assemble equipment – check expiration
Wash hands
Don gloves
Locate vein
Apply tourniquet
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STEPS
•
•
•
•
•
•
Do not touch area after prepping site
Use your fingers to spread the skin & make tight
Uncap and inspect the needle tip
Discard if defective or if sterility was compromised
Insert the needle at 15-30 °angle – BEVEL UP
This angle
– Allow room to work
– Reduces pushing the needle through the vein
– Allow best blood flow
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Needle Position:
43
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Releasing the Tourniquet
• Once the needle has entered the vein and
you have attached the 1st tube to the
infusion set or vacutainer
• RELEASE the tourniquet
• The tourniquet should NOT be left on for
more than 1 minute
45
Complications of Leaving
Tourniquet Applied Too Long
1. Hemolysis
1. Destruction of blood cell
2. Will cause abnormal electrolyte readings
2. Petechiae
1. Very tiny hemorrhages-appear in red and
purple spot on the skin
3. Hemoconcentration
1. Tourniquet application can force fluids out of
cells and leak into blood volume
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Petechiae
47
Attach the Collection Tubes
• After you have successful accessed the vein
• Attach the blood collection tubes to vacutainer or
infusion set
• Tubes will fill in about 5 seconds
• Tubes must be filled in the correct sequence
• Tubes must be handled correction after filling
• At most– if you fill 6 tubes with blood– 30 ml or
cc’s will be the amount of blood removed
48
Order of the DRAW
1.
2.
3.
4.
5.
6.
Blood cultures or sterile specimens
Blue top
Red top
Gold or Green top
Lavender or Purple top
Gray top
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Fill Tubes:
• Use correct order of draw:
– Sterile/Blood cultures-----------SALLY
– Blue------------------------------------BRINGS
– Red-------------------------------------REALLY
– Gold/Green---------------------------GOOD GREASE
»and
– Purple/ Lavender-------------------LEAVES
»the
– Gray------------------------------------GRAVEY
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Inverting the Tubes
• Once filled– tubes must be inverted
• Invert by holding it in your hand and
turning your wrist
• Blue top- 3-4 inversions
• Lavender and Green top- 8-10 inversions
• Serum separator tubes ( SST, red tops)
and serum tubes ( red tops without the
separating gel) 5 inversions
51
Removing the Needle
• Place gauze over the needle
• Quickly remove needle and apply firm
pressure to site
• Always use gauze pad and wear gloves
• Allow patient to apply pressure ( if
possible) so you can invert tubes
• You can place pressure for 30 seconds
and apply adhesive bandage over the
gauzes
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Recheck Draw Site:
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Labeling the Tubes
Immediately:
•
•
•
•
•
In sight of patient
Patient name
Identification number
Date of draw
Time of draw
(military time)
• Your initials
• **This is a critical step
• **Mislabeling can lead to
serious consequences
54
Handling and Transporting
Specimens
•
•
•
•
•
All specimens must be handled correctly
Most have a standard # of inversions
Most can be stored at room temp
**** There are exceptions!!!
Learn the proper transport policy of the
facility
55
Finishing the Procedure
•
•
•
•
Discard the needle in sharps container
NEVER REUSE!!!
NEVER RECAP!!
Remove gloves and wash your hands!!!
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Recheck Draw Site:
57
Reporting Test Results
• There may be occasions in
which you will be asked to
transmit lab results
• The keys to doing this
accurately and correctly are
repetition and confirmation
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After the Venipuncture
•
•
•
•
•
•
•
Check the patient for:
Excessive bleeding
Excessive pain
Lack of sensation
Excessive bruising
Signs of infection
How the patient feels
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Troubleshooting Technical Problems
during Venipuncture
• Most are done quickly and with ease
• What do you do if the blood flow stops?
– *** This occurs when the vacuum is not
enough
– ***Patency of the system has been
compromised
– Try another tube
– check to see if you have released the
tourniquet
– Needle is in too far or not far enough
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•
•
•
•
•
•
•
•
Collection Site Problems:
Complications
Nerve damage
Hematomas
Phlebitis
Petechiae
Thrombus
Physical Reactions
Collection or processing errors
Edematous area
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Collection or Processing
•
•
•
•
•
•
Misidentification of patient
Improper site selection and preparation
Incorrect order of the draw
Under filling of tubes
Failure to invert tubes
Failure to document when a specimen was
obtained and when it was received
• Mislabeling of the specimen
62
Needle Sticks and Contact with
Body Fluids and Secretions
• Good technique and PPE is KEY!!
• If you have contact with skin– WASH
Immediately with soap and water
• EYE contact= Eye wash for 15 minutes
with lukewarm water
• Inhalation of body fluid=leave area and
seek fresh air
• ** Report exposure soon after you finish
basic first aid measures
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Needlesticks
•
•
•
•
•
Milk and wash the area with soap and water
Cover with dressing
Report the incident ASAP
Any break in the skin can be a portal of entry!!
Risk of HIV, Hepatitis B & C
64
First Aid, Medical Emergencies
and the Phlebotomy
You must be prepared to deal with medical
emergencies
•
excessive bleeding- apply direct pressure &
call for help
• Patient faints-call for help – try to prevent patient
injury- check for breathing and pulse
• Know how and when to start CPR
• Know who and what to do quickly
65
Finger and Heel Stick
Phlebotomy
• If blood is needed and venipuncture is
contraindicated
• Heel or finger stick may be used
• These are NOT venipuncture- because
you are not drawing from veins
• You are drawing from capillaries
• There are differences between a HEEL
and FINGER sticks
•
66
Capillary Blood
• Mixture of arterial, venous, capillary blood
and fluid from surrounding tissues
• Fluid from surrounding tissues may
interfere and/or contaminate the specimen
• Warming skin puncture site increases
arterial blood flow to the area
• Reference ranges often differ from venous
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Fingersticks
• Done when only a small amount of blood
is needed
• When venous access is difficult
• Commonly done on children
• Commonly done on adults who need very
frequent blood checks
• Can be used to check for lead,
hemoglobin and other blood components
including blood glucose
68
Fingerstick Procedure
•
•
•
•
•
•
•
Infection control
Assemble equipment
AIDETPosition patient
wash hands
Don gloves
ID site- middle and ring finger
are best
• Use side of the finger
– Avoid cold, cyanotic,
scarred, fingers
• Clean site with alcohol 70%
• Gently massage- milk finger
puncture fingertip with lancet
• Wipe away first drop
• Allow blood to drip into collection
tube
• Cap when filled
• Position and massage site as
needed- careful not to over
milk/massage may damage cells
• Cap filled tube
• Label specimen
• Check patient
• Discard equipment
• Remove glove & wash hands 69
Heelstick Procedure
• Assemble equipment
• Choose correct lancetwill puncture the skin to a
specific depth
– If infant <2.2 lb.
choose lancet which
punctures depth of
0.65mm
• Positon patient
• Apply heel warmer for 35 minutes
• Wash hands and don
gloves
•
Select site
– Best sites are lateral and medial sides
of the heel
– DO NOT USE back of heel
– Clean site
– Puncture skin with lancet
– Use your thumb and fingers to gently
squeeze heel
– Wipe away first drop of blood
– Allow blood to drip into collection tube
– Do not over squeeze
– Cap tube when filled
– Label specimen
– check patient
– discard equipment
– remove gloves & wash hands
70
Recheck Draw Site:
71
SPECIAL COLLECTIONS
• This refers to any collection that is
different from the standard blood draw
• Uses techniques that are a bit more
complicated
• You may be required to perform or assist
in a special collection
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Peripheral Blood Smears
• A peripheral blood smear is a blood
collection that is used most often to
diagnose a hematologic disorder
• The smear is used to examine different
types of white blood cells ---WBCs
• This is call checking the DIFFERENTIAL
• Peripheral blood smears also are used to
detect malarial parasites in the blood
73
Peripheral Blood Smears
• Can be done using capillary or venous
blood
• It can be collect at the bedside or using
blood from an EDTA collection tube
• You will need the following equipment:
– Lens cleaner
– Lens paper
– glass slides
– gloves
– EDTA tube
74
Peripheral Smears
• Take 2 glass slides
• Apply drop of lens cleaner on each slide and use the lens paper to rub
the slides until they are dry
• Invert the EDTA tube 8-10 times
• Open the stopper & use a stick or other pipette to remove a small
amount of blood
• Place a drop of blood 2mm in diameter onto the slide just in front of
frosted area
• Drop of blood should be in the center of the slide & approximately ¼ inch
from the back edge of the slide
• Smear immediately after the blood is applied** a delay will affect the test
• Do this by using the end of the other slide, hold at 30° just in front of the
blood and then pull the slide until it just touches the blood
75
Peripheral Smears
• The blood will begin to spread towards the edge of the
bottom slide
• Wait until the blood has almost reached the edges of the
bottom slide
• Maintain a 30°- push the spreader slide rapidly across
the bottom slide
• Do not press down
• The smear should be across ¾ of the bottom slide
• There should be a smooth appearance and no holes or
lines
• It should have rainbow sheen when reflected in light
• Allow smear to air dry and label correctly
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How to Prepare a Peripheral
Blood Smear Slide
• Peripheral Blood
Slide Preparation
77
Blood Culture Collection
• Obtained to detect the presence of
microorganisms in the blood= bacteremia
• Blood Culture or Blood C & S requires a
specific collection procedure
78
Blood Culture Collection
• Assemble equipment
• Blood Culture Bottles
2( anaerobic & aerobic)
• Tourniquet
• Gloves
• Alcohol 70 % swabs
• Gauze pads
• Chlorhexidine
• Syringe & winged infusion set
•
79
Blood Culture Collection
• Clean top of bottles with alcohol ( NOT with
CHOLORHEXADINE OR IODINE allow to dry for 30
seconds
• Find suitable site and clean with chlorhexidine -------scrubbing firmly a 5 cm area for 30 seconds
• Allow to dry and DO NOT TOUCH the area once prepped
• Perform venipuncture and remove 20 ml of blood using
butterfly device with special BC vacutainer device
• Transfer the blood to the bottles filling the aerobic 1st then
the anaerobic bottle
• Divide blood amounts evenly between the 2 bottles
• *** it is helpful to mark off the fill level on the bottles for
filling accuracy
80
Blood Culture Collection
Procedure
• Blood Culture Collection
Procedure
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Recheck Draw Site:
82
Blood Samples for Inborn Errors
of Metabolism
• Genetic disorders that affect the way the
body metabolizes certain nutrients
• Will affect the enzyme systems
• Diagnosed by blood tests
• 3 common blood tests are:
1. Serum Ammonia
2. Serum Lactate
3. Serum Pyruvate
83
Blood Samples for Inborn Errors
of Metabolism
• Use the standard venipuncture procedure
• DO NOT use a tourniquet or have the patient
make a fist
• Patient should be fasting for the serum pyruvate
level
• These specimens are collected in special tubes
• MUST BE PLACED ON ICE & immediately
transported to the lab for processing
84
Phlebotomy for Blood Donation
• Collecting specimens for blood donation
follow the same principles
• Patient ID
• Patient assessment
• Site preparation
• Vein access
• Infection control
85
Phlebotomy for Blood Donation
• Screening for BLOOD donation includes:
– Age
– weight
– Blood- borne disease exposure
– ** Today guidelines are very specific and extensive
– Maximum amount of blood that is taken is 525 ml
– American Academy of Blood Banks recommendation is
10.5 ML per kg of body weight– assuming a minimum
weight of 110 lb or 50 kg
86
Draw Below IV site:
87
No Needle Movement!
• You must anchor the blood-drawing equipment
on the patient’s arm to minimize chance of injury
88
89
Withdraw Needle:
• First release tourniquet
• Disengage tube
• Place cotton directly over needle, without
pressing down
• Withdraw needle in swift, smooth motion
• Immediately apply pressure to wound
• Do not bend arm
90
You should try again
• Look at alternate site
– Other arm
– Hand
• Use clean needle
• Use fresh syringe if
contaminated
• Only try twice
91
Venipuncture Procedure:
•
•
•
•
•
•
Wash hands
Put on gloves
Identify patient
Latex allergy?
Position arm
Apply tourniquet
92
Venipuncture Procedure:
• Locate vein
• Release
tourniquet
• Cleanse site in
outward rotation
– Allow to air dry
93
94
Mark your spot
95
Venipuncture Procedure:
• Reapply tourniquet
– Do not contaminate
site
• Anchor vein
• Insert needle
• Fill tubes
– Quick mix additive
tubes
• Release tourniquet
• Withdraw needle
96
Venipuncture Procedure:
• Engage safety device
• Dispose of needle
immediately
• Apply pressure to
puncture site
• Label tubes
• Recheck puncture
site
• Thank patient
• Remove gloves,
wash hands
97
Syringe draw
98
Be careful not to:
• Push needle further into vein when
engaging evacuated tube
• Pull needle out of vein when disengaging
tube
• Pull needle out of vein as you pull back on
the plunger
• Pull up or press down when needle in vein
• Forget to mix additive tubes 8-10 times
99
Syringe Safety
Transfer Device
100
Skin Puncture Procedure:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Wash hands
Approaching the patient
Patient identification
Latex allergy?
Bedside manner
Site selection
Cleanse site: DO NOT use providone- idodine
Perform puncture: Wipe away first drop of blood
Label the specimen
101
Skin Puncture:
• Method of choice for infants, children
under 1 year
• Adults
– Scarred
– Fragile veins
– Hardened veins
– Home glucose monitoring (POCT)
– Patients with IV
102
Skin Puncture Procedure:
• Hold finger between your index finger and thumb
• Puncture the finger using a quick, smooth motion
• Wipe away the first drop of blood
103
Skin Puncture Site Selection:
104
Skin Puncture Equipment:
1. PPE
2. Cleaning agent
– Alcohol pads: routine
– Soap and water: alcohol testing, allergies
– DO NOT use providone iodine
3. Cotton balls, gauze
105
Skin Puncture Equipment:
4. Bandage/tape
5. Sharps container
6. Warming device
–
–
Commercial warmer
Warm wet washcloth
106
Skin Puncture Equipment:
7. Lancet
–
Always use
standardized
equipment
–
NEVER use a
surgical blade
107
Skin Puncture Equipment:
8. Micro-specimen
containers
– Capillary tubes
– Microtainers
– Capillary blood gas
tubes
– Micropipet diluting
system
108
Skin Puncture Equipment:
9. Glass slides:
used to prepare
blood smears
109
Skin Puncture Procedure:
• Collect sample
– DO NOT touch collecting device to skin surface
– DO NOT scrape collecting device across skin surface
– DO NOT scoop blood into collecting device
110
Skin Puncture Procedure:
• Order of draw is critical: platelets accumulate at
puncture site causing clot formation
–
–
–
–
Blood smear
EDTA
Heparin
Serum
• Apply pressure to puncture site
• Label specimen in sight of patient (indelible marker)
111
112
113
114
Specimen
Processing Essential
Knowledge
115
Labeling and Transporting
Specimens
• Each facility has a protocol for
transporting specimens
– The time from collection to transport
– Storage requirements for the specimen during
transport
– Most can be transported on room Air
– Some require traveling on ice
116
CLIA Quality Control
• Clinical Laboratory Improvement
Amendments
– Federal regulatory standards for labs that
perform testing of human samples
– CLIA standards stipulate that certain simple,
low risk lab tests may be waived
– There does not have to be any direct routine
oversight of the labs in regards to how they
perform these tests
117
Good Lab Practices
• Include:
– Using recent package insert from the kits
manufacturer
– Doing quality control or calibration on
equipment
– Documenting quality control
– Storing and handling according to
manufacturer
– Provide personnel with training and document
training
– Using OSH regulations that pertain to labs
118
Non-Blood Specimen Collection
Transport
• Include;
–Semen
–Sputum
–Stool
–urine
119
Collection
• All will require a simple collection
• This means the patient is given a cup and
the specimen is placed in the cup
• The only exception is
– Sterile urine
120
•
•
•
•
•
•
•
•
•
Sterile Urine Collection
Wait 2-3 hr. for urine to be in the bladder
wash hands
Men- clean head of penis with sterile wipe
Women- must separate labia and wipe front to
back – use a second wipe to clean area around
the urethra
Void for several seconds
STOP urine stream
Urinate in the sterile cup
DO not touch inside of cup
Seal cup and properly label
121
Pre-Analytical Errors
• Common errors include:
– Insufficient specimen– QNS
– Hemolysis
• The destruction of red blood cells which leads to the
release of hemoglobin from within the red blood cells
into the blood plasma.
– Hemoconcentration
• Decrease in the volume of plasma in relation to the
number of red blood cells; increase in the
concentration of red blood cells in the circulating
blood
– Specimen contamination
– Allergic reactions
122
Chain of Custody
• The process through which specimens must be obtained,
processed and transported for legal purposes
• Refers to the documentation that must be done when
these specimens are obtained, processed and
transported
• Examples;
– Bld ETOH levels
– Test for illicit drug
– Workplace drug testing
– Specimens that may be part of a crime• ie sexual assault
123
Chain of Custody
• The following must be carefully
documented
– When, how and by whom specimen was
collected
– When, how and by whom specimen was
transported
– Who received the specimen and when; where
and how it was stored
– How and when the specimen was processed
– When, by whom and to whom the results
124
were reported
Chain of Custody
• Most labs will have specific forms and a
protocol in place to handle chain of
custody
• Refer to handout for more information on
Chain of Custody
125
Communication and Specimen
Collection and Processing
• Communication during specimen
collection and processing is very important
• Accurate communication is vital
• The best way to ensure accurate
communication is to use repetition and
confirmation
126
Entering and Retrieving
Laboratory Values
• Lab values must be entered correctly
• You must pay special attention to the
values and the units that are used to
report
• You must also have basic knowledge of
normal and abnormal values
• Entering or retrieving values incorrectly
could have serious consequences
127
Reporting Routine and Critical
Values
• When you are reporting routine and critical
lab values --- use repetition and
confirmation
• You must document to whom you report
the values and when
• Doing this especially when you are
reporting critical lab values
128
Summary
• Basic venipuncture
• Proper venipuncture technique
• Proper
– patient ID
– Preparation
– Troubleshooting
– Potential complications
– Finger stick
– Heel stick
– Special collections
– Processing of specimens
129
Tubes and Tests
• Gray top- fbs, gtt, bld etoh, lactic acid
• Lavender top- CBC, H&H, ESR, Sickle
Cell screening
• Light Blue top- PT, PTT, Fibrinogen
Degradation Product FDP,
• Red top- Blood bank, immunohematology
• Red/gray(speckled)- most chemistry tests
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Practice Skills
• The following is a more simply stated order of the
draw. Keep in mind that other, less frequently used
tubes, will be placed in the order below based on the
additive present. MEMORIZE!
• blood cultures
• light blue
• red
• green
• purple
• gray
• Other.
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