Once you have withdrawn the needle from the pa- tient’s arm, it must be handled with extreme care to avoid an accidental needle stick. A used needle is considered biohazardous waste and must be treated as such. Dispose of the needle with the adapter still attached immediately after activating the needle safety device. Needles must be placed in a clearly marked, puncture-resistant biohazard disposal con- tainer (Figure 8-12). Containers must be closable or sealable, puncture resistant, leak-proof, and labeled with the correct biohazard symbol.
You must become familiar with the system in use at your workplace. Practice with a new system before you draw your first sample.
REVIEW FOR CERTIFICATION
The phlebotomist’s tray includes tourniquets for lo- cating veins; antiseptics and disinfectants for clean- ing the puncture site; a variety of needles in different sizes, including multisample needles, syringe nee- dles, and butterfly needles; needle adapters or tube holders; evacuated collection tubes; bandages; and a variety of other materials. The phlebotomist chooses the needle type and size to fit the characteristics of the patient and the test and then uses tubes that con- tain additives appropriate for the tests that have been ordered. A prescribed order of draw is used to mini- mize the effects of contamination among tubes.
FIGURE 8-12 Needle disposal systems reduce the risk of accidental injury while removing the needle. (From Bonewit-West K: Clinical pro- cedures for medical assistants, ed. 7, Philadelphia, 2008, Saunders.) FLASH FORWARD
You will learn about blood culture collections and tubes in Chapter 14.
BI BLIOG R AP HY
Calfee DP, Farr BM: Comparison of four antiseptic preparations for skin in the prevention of contamination of percutaneously drawn blood cultures: A randomized trial, J Clin Microbiol 40:1660–1665, 2002.
Chapman AK, Aucott SW, Milstone AM: Safety of chlorhexidine gluconate used for skin antisepsis in the preterm infant, J Peri- natol 32(1):4–9, 2012.
CLSI: Procedures for the collection of diagnostic blood specimens by venipuncture; Approved standard—sixth edition. CSLI docu- ment GP41-A6 (formerly H03-A6). Wayne, Pa., 2007, Clinical and Laboratory Standards Institute.
CLSI: Tubes and additives for venous and capillary blood specimen collection; Approved standard—Sixth edition. CSLI document
GP39-A6. Wayne, Pa., 2010, Clinical and Laboratory Standards Institute.
College of American Pathologists (CAP). So you’re going to collect a blood specimen, ed. 13, Northfield, Ill., 2010, CAP.
Lippi G, Salvagno GL, Montagnana M, et al: Phlebotomy issues and quality improvement in results of laboratory testing, Clin Lab 52:217–230, 2006.
Medical Safety Product Directory: Advance for Medical Labora- tory Professionals, March 13, 2006.
OSHA: Disposal of Contaminated Needles and Blood Tube Holders Used for Phlebotomy. Safety and Health Information Bulletin, 2013.
Retrieved from https://www.osha.gov/dts/shib/shib101503.html.
Winkelman J, Tanasijevic M: How RBCs move through thixo- tropic gels, Lab Med 30:476–477, 1999.
WHAT WOULD YOU DO?
You should not perform the draw. Although the vacuum might still be good, it might not, and using a defective tube could mean the patient must undergo a second draw, a potentially distressing and even harmful procedure. In the future, be sure to check the expiration on all the tubes when you stock your tray, and never arrive at the draw without extra tubes.
AVOID THAT ERROR!
Maria’s requisition called for a coagulation test, which should be
drawn into a light blue–topped tube, which contains sodium ci- trate. But Maria used a lavender tube, which contains EDTA and
is used for CBCs and sedimentation rate. Unfortunately, she has used the wrong tube and the sample is useless. She must ask the patient for permission to draw another sample.
STUDY QUESTIONS
See answers in Appendix F.
1. Explain the purpose of a tourniquet.
2. What does the gauge of a needle indicate?
3. Describe the consequences of using a needle with a large gauge number.
4. Explain the purpose of the rubber sleeve on the multisample needle.
5. Explain the advantages and disadvantages of the syringe method of drawing blood as opposed to the evacuated system.
6. Blood tubes are evacuated. Explain what this means.
7. Why must unused blood tubes be discarded when they expire?
8. Define SPS and explain what it is used for.
9. If a collection tube contains an anticoagulant, what must you do immediately after collection?
10. Explain the purpose of thixotropic gel in a collection tube.
11. Define glycolysis.
12. Name the three types of blood specimens used for analysis.
Match the collection tube top color to the type of test it is commonly used for:
13. Tan a. blood bank
b. lead analysis
c. glucose tolerance test d. chemistry testing e. sedimentation rate f. ABGs
g. CBC h. trace metals i. coagulation 14. Red or pink
15. Light blue 16. Lavender 17. Gray 18. Black
19. Gold BD Hemogard Closure 20. Green
21. Royal blue
22. Number the following in the correct order of draw using the evacuated method.
_________ light blue _________ lavender _________ green
_________ red, plastic tube _________ yellow, sterile _________ gray
_________ gold BD Hemogard Closure
See answers in Appendix F.
1. Which of the following is not an anticoagulant?
a. Polymer gel b. Sodium heparin c. Sodium citrate d. EDTA
2. The most common antiseptic used in routine venipuncture is
a. povidone–iodine solution.
b. bleach.
c. isopropyl alcohol.
d. chlorhexidine gluconate.
3. How many times may a needle be used before discarding it?
a. 1 b. 2 c. 3 d. No limit
4. Which of the following indicates the largest- sized needle?
a. 20 gauge b. 23 gauge c. 16 gauge d. 21 gauge
5. Complete clotting of a blood sample in a SST (gold or red-gray) tube takes __________ min- utes at room temperature.
a. 10 b. 30 c. 45 d. 60 6. Serum contains
a. fibrinogen.
b. clotting factors.
c. plasma.
d. none of the above.
7. Which color-coded tube does not contain any additives?
a. Red, plastic tube b. Red, glass tube
c. Gold BD Hemogard Closure d. Royal blue
8. EDTA prevents coagulation in blood tubes by a. inactivating thrombin.
b. binding calcium.
c. inactivating thromboplastin.
d. inhibiting glycolysis.
9. Tubes with gray tops are used for a. sedimentation rate tests.
b. glucose tolerance tests.
c. coagulation studies.
d. CBC.
10. Tubes with green tops may contain a. sodium citrate.
b. sodium heparin.
c. sodium oxalate.
d. sodium phosphate.
11. The smaller the gauge number, the a. larger the lumen diameter.
b. longer the needle.
c. shorter the needle.
d. smaller the lumen diameter.
12. The syringe method of draw is useful because a. it allows for control of blood flow.
b. it shows the appearance of blood at the c. it allows for greater flexibility and less hub.
bulk.
d. both a and b above.
CERTIFICATION EXAMINATION PREPARATION
13. The additive sodium citrate is used in blood collection to test for
a. blood alcohol.
b. prothrombin time.
c. lactic acid.
d. lead.
14. The most common gauge used for a routine venipuncture is
a. 16.
b. 21.
c. 25.
d. 23.
15. Blood banks use a __________ gauge needle to collect blood from donors for transfusions.
a. 16- to 18- b. 20- to 22- c. 22- or 23- d. 23- to 25-
16. Blood collection tubes containing an anticoag- ulant should be
a. inverted gently and repeatedly after blood collection.
b. shaken aggressively after blood collection.
c. allowed to sit for 30 minutes before centrifugation.
d. centrifuged immediately.
17. Tubes containing the SPS anticoagulant are used for
a. antibody screen.
b. HLA studies.
c. nutritional analysis.
d. blood culture analysis.
18. Blood collected in lavender-topped tubes is used for which test?
a. FBS b. CBC
c. Stat potassium d. Stat chemistry
19. Blood collected in gray-topped tubes is used for which test?
a. FBS b. CBC
c. Stat potassium d. Stat chemistry
20. Blood collected in light blue–topped tubes is used for which test?
a. Sedimentation rate b. Glucose tolerance c. Toxicology d. Coagulation
128
ABBR EVIATION S
ABN Advance Beneficiary Notice of Noncoverage DOB date of birth
ICD-9-CM International Classification of Diseases, Ninth Revision, Clinical Modification
ICD-10-CM International Classification of Diseases, Tenth Revision, Clinical Modification
ID identification
stat short turnaround time After completing this chapter, you should be able to:
OBJ ECTIVE S
1. List the information that is commonly found on a patient’s test requisition.
2. List, in order, the steps in a routine venipuncture.
3. Discuss the information that must be verified for inpatient identification (ID) before the blood collection procedure.
4. Explain how the ID of outpatients differs from that of inpatients.
5. Describe patient preparation and positioning.
6. Describe how to assemble the evacuated tube system.
7. Explain how to apply a tourniquet, and list three consequences of improper application.
8. List the veins that may be used for blood collec- tion, and give the advantages and disadvantages of each.
9. Explain how to clean the venipuncture site.
10. Describe how to properly insert the needle into the vein.
11. Discuss how the needle should be removed when the last tube of blood has been collected.
12. List the information that must be included on the label of each tube.
13. Describe how venipuncture using a syringe differs from that using the evacuated tube system.
hematoma hemoconcentration
hemolysis palpation
petechiae requisition
KEY TE R M S
Requisitions
Advance Beneficiary Notice of Noncoverage
Patient Identification
Routine Venipuncture
Procedure 9-1: Routine Veni- puncture
Routine Venipuncture With a Syringe Procedure 9-2: Routine Venipunc-
ture With a Syringe Review for Certification
OUTLI N E
R
outine venipuncture is the most common proce- dure a phlebotomist performs. The most impor- tant step in venipuncture is positive identification (ID) of the patient. This is done by matching the informa- tion on the requisition with, for inpatients, the infor- mation on the patient‘s ID band or, for outpatients, theinformation provided by the patient. Although most patients are suitable candidates for drawing blood with evacuated tubes, patients with fragile veins may be better candidates for wing-set (“butterfly”) collec- tion; the blood is transferred to evacuated tubes after the draw if a syringe is used.
CHAPTER 9
Routine Venipuncture
WHAT WOULD YOU DO?
It’s midday at City Center Hospital, and your next draw is for Thomas Phelps in room 322. As you enter room 322, you see the patient sitting up in bed. You greet him. You ask his name, and he replies: “I’m Tommy Phelps.” You then check the ID band on his wrist—the number matches the number on the req- uisition form. When you ask him to state his date of birth, he says, “June 14, 1985”—but the requisition gives the date of birth as July 14, 1985. Can you go ahead and draw?