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Blood Specimens in Phlebotomy
• Whole Blood- (For the most part) Not Centrifuged
•

Serum- Centrifuged

•

Plasma- Centrifuged

For Serum specimen:
1
...

Tube Additives
1
...
Initiating (starting or activating) the process of coagulation






















3
...
Anticoagulant- Prevent blood from clotting/ Let the blood in
collection tube stay in liquid form
2
...
Silica=absorbs moisture/ Desiccant)
3
...
A
...
B
...
Light Blue - Fully Fill Tube- (9 to 1 ratio/ 9 parts blood to 1
part Sodium citrate)
(3-4 inversions)
Additive: Sodium citrate (anticoagulant)
Specimen: Plasma
Laboratory Uses:Coagulation studies: PT, PTT, and
Fibrinogen
(PT- ProThrombin time)
(PTT- Partial Thromboplastin time)
3
...
Plastic / B
...
)
Additive: Plastic: Clot activators - Glass: No Additive
Specimen: Serum
Laboratory Uses: Chemistry, Serology, Immunology, &
Blood Bank
Plastic: (5 inversions)
Glass: No additive - no inverting
Serology= Study of serum
3
...
Gold / D
...
A
...
B
...
Lavender (8-10 inversions)
Additive: EDTA K2 (Potassium EDTA), EDTA K3
Specimen: Whole Blood
Laboratory Uses: Hematology Studies: Complete Blood
Count(CBC), WBC count, Hemoglobin(iron protein), Hematocrit(%
of Blood), Platelet count, Erythrocytes sedimentation Rate (ESR),
RBC, Reticulocyte, and differential count
Reticulocyte: immature RBC first 24hrs
6
...
Royal Blue (8-10 inversions)
Additive: Sodium or Sodium EDTA or No Additive
Specimen: Plasma or Serum
Laboratory Uses: Chemistry trace elements: Toxicology
trace metals, lead, and nutrition analysis
2
...
Orange (5-6 inversions)
Additive: Thrombin (Clot activator) or Thrombin w/
Gel
Specimen: Serum
Laboratory Uses: STAT Serum Chemistries
4
...
Blood culture tube- Yellow SPS or (sterile)
2
...
Serum- Tube w/o clot activator (Red:Glass) & w/ clot
activator (Red:Plastic), Serum Separator Tube (SST)
4
...
EDTA- Tube w/o gel separator (Lavender, Pink,) & EDTA
tube w/ Plasma Preparation Tubes (PPTs) (White)
6
...
-1min
...

Lanet- Width-2
...
0mm
Middle finger or Ring finger
Dermal puncture order of draw
Lets get Lit, Guys you ready?
Lavender- EDTA
Green- lithium heparin
Light Green- lithium heparin w/gel
Gray- NaF/Na2EDTA
Yellow- Clot activator
Red- No Additive
















Centrifuge machine
Spins and force to separate heavier and lighter particles

Lighter particles are towards the top\ heavior moves to the
bottom
Must be balanced on opposite side
RPM- rotation per minute

Phlebotomy procedures 1
Procedure
1
...
Identify the speed and duration
3
...
Secure rotor lid properly, close centrifuge lid

5
...
When cycle is over rotor has completely stopped spinning
Specimen processing
1
...
Directly centrifuge

Position patient comfortably

•

Check if patient is on medication or dietary restriction

•

Prep- Prepare & disinfect incision site

•

Apply blood pressure cuff




•




Explaining procedure to patient




•




Washing hands & Donning PPE




•




Assemble equipment & supplies




•




ID patient- Full name/ DOB/




•




ID yourself & procedure




•




Greet patient




•







Bleeding time test procedure
• Verify physician's order

•

Position device on palmar surface on forearm

•

Blot Blood in 30sec
...


•

Release tourniquet prior to withdrawing needle

•

Remove needle, apply safety cap if there is one

•

Apply direct pressure on incision site

•

Dispose of sharps and contaminated materials into
appropriate containers

•

Mix tubes (correct number of inversion)




•




With fingers of non-needle carrying hand pull skin taut




•




Reapply tourniquet




•




Connect needle to connection holder, inspect needle (use
appropriate gauge)




•




Disinfect incision site




•




Remove tourniquet- 60sec
...


•

Disinfect incision site

•

Connect needle to connection holder, inspect needle (use
appropriate gauge)

•

Reapply tourniquet

•

With fingers of non-needle carrying hand pull skin taut




•




Dispose of gloves and supplies into containers




•




Remove gloves




•




Package specimen for transport




•




Apply bandaid




•




Check the patient for hemostasis by inspecting the site of
incision




•




Blood collection tubes labeling must be done to facility
standards










•

•

With needle carrying hand insert needle at the appropriate
angle

•

Fill tubes in correct order of draw

•

Remove tourniquet- 60sec
...





•




Fill syringe but pull plunger back slowly




•




insert needle at appropriate angel




•




Pull patient skin taut to anchor skin




•




Reapply tourniquet




•




Connect syringe to needle, inspect needle




•




Disinfect site with alcohol







•

Package specimen for transport

•

Remove gloves

•

Dispose of gloves

•

Wash hands

•

Document

•

Oct
...





•










•

Thrombophlebitis- a blood clot formed within the vein
further causes inflammation, redness, and pain

•

Pain

•

Allergic Response- An allergic response may initiate as a
result of an equipment or supply using during procedure

•

Phlebitis- Inflammation of vein may occur due to injury to
that vein due to venipuncture or due to blood clot formation

•

Syncope (Fainting)- A patient may faint before, during or
after the procedure
...
The symptoms would be sharp tingling




•




Thrombus- injury to a blood vessels leads to clot formation
...
The clot formed in a thumbus
...
The breakdown
causes release of hemoglobin

•

Hemoconcentration- increase in the concentration of
formed elements

•

Vasovagal reaction- A patient experiences fainting as a
result of shock or pain from the needle stick

•

Bone Infection- if a bone is hit with a needle or lancet, it
may cause bone infection and inflammation( osteomyelitis)

•

Inability to draw blood- A phlebotomist may not be able to
draw blood from a patient on the 1st attempt
...
Some facilities allow for a 2nd
draw

•

Compartmental syndrome- This can occur as a result of
excessive bleeding post- phlebotomy procedure
...


structures, such as blood vessels, nerves
and other tissues
...
It would be normally take excess fluid in that part of the
body ( including arm but if the glands are not there, that has
additional bodily fluid and can affect the blood drawn
IV sites
• Must request that it is turned off for 3min
...
Bilirubin, beta carotene, biotin, propheyn, Vitamin
B1,B2,B3, &
...
6 Fahrenheit) incubator Temp
...
, unless chilling is recommended

•

Local, state, and national standards and regulations must be
followed while transporting specimens
















Using appropriate antiseptic




•




Clean site and letting it air dry




•




Avoid using needle if packaging is not intact




•




New Needles




•




Precautions to be considered
• Proper hand hygiene

•

Bandage puncture site

•

Supplies and equipment should be free of any contaminants

•

Avoid reusing supplies when moving from one patient to
another

*Pediatric blood collection
• Neonatal- 0-28 days/ newborn screening procedure/
screenes 50+ conditions/ within 48hrs of birthHypothyroidism, Galactosemia & phenylketonuria (PKU)
•

0-6 months - heel stick

•

6-2yrs- Finger stick

•

2yrs+ - Venipuncture

* Steps Neonatal
1
...
Identify the patient
3
...
Perform heel puncture
5
...
Fill the circle of the filter paper by touching a sufficient drop
of blood to fill the circle completely Don't touch area within

7
...

It is usually order when provider suspects infection in the blood
Blood collection for legal purposes
• Use appropriate blood collection kit, if available
•

Explain procedure and obtain consent prior to performing the
blood collection

•

Must be sealed appropriately according

•

Do not use alcohol for cleaning site
















Blood banks use 16-18 gauge needles
Incident report
Location and name of facility
AM or PM
Type of accident
Witness name(s)
Summary
Take action for patient care



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