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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3621_Библиотеки_им_академика_М_И_Перельмана.pdf
AB
Figure - Greiner Bio-One uses (A)
AB
CD
AB
a black ring in tube caps to indicate use
for adult venous blood collections and
(B) a white ring in tube caps to indicate
use for pediatric or difficult venous
blood collections.
©greiner bio-one. Photos by Photo Affairs, Inc./
Steve Rouben
Figure - These Greiner Bio-One
tube caps indicate the presence of
(A) clot activator, (B) clot activator and
separator gel, (C) heparin, and (D)
heparin and separator gel.
©greiner bio-one. Photos by Photo Affairs, Inc./
Steve Rouben
by either syringe aspiration or the vacuum principle (Figure 8-36). S-Monovette®
devices can be used like a syringe to better control vacuum pull or used like
an evacuated tube if the plunger is pulled back and removed before blood collection. The S-Monovette® is color coded to indicate the additive present. The
color codes are similar to those on BD brand tubes. However, the cap on serum
separator tubes is brown. The Microvette® enables blood sampling using either
the capillary action principle or the gravity-flow principle, using the special
rim (Figure 8-37). The Multivette® allows for the collection of both venous and
capillary blood. For venous blood collection, a luer needle is connected to the
capillary tube of the Multivette®, which automatically fills by normal venous
pressure. Capillary blood is collected using the capillary tube (Figure 8-38).
Figure - Sarstedt S-Monovette® closed blood collection
system.
©Sarstedt, Inc.
Chapter Blood Collection Equipment
Figure - Sarstedt Microvette® tubes can be filled by
(A) capillary action or (B) gravity fill.
©Sarstedt, Inc.
Copyright © 2019 by McGraw-Hill Education
Figure - Sarstedt Multivette® can be used for small
samples of venous blood or capillary blood.
©Sarstedt, Inc.
1. How does Becton Dickinson indicate the difference between
full-volume (adult) evacuated tubes and small-volume (pediatric) evacuated tubes? How is the presence of a separator gel in an evacuated tube
indicated?
2. How does Greiner Bio-One indicate the difference between
full-volume (adult) evacuated tubes and small-volume (pediatric)
evacuated tubes? How is the presence of a separator gel in an evacuated tube indicated?
3. What is unique about the venous blood collection system
manufactured by Sarstedt?
Copyright © 2019 by McGraw-Hill Education
Checkpoint
Questions .
Chapter Blood Collection Equipment
Chapter Summary
Learning Outcome Key Concepts/Examples
Related
NAACLS
Competency
. Identify equipment used for both
venipuncture and dermal (capillary)
puncture.
. Identify equipment specific for
venipuncture procedures.
. Identify equipment specific for dermal
(capillary) puncture procedures.
. Identify the various types of additives
and color coding used in blood collection
and explain the reasons for their use.
. Implement the correct order of draw
for venipuncture and dermal (capillary)
puncture procedures.
. Compare blood collection equipment
from various manufacturers.
Common equipment and supplies needed for phlebotomy
include gloves; alcohol prep pads; gauze pads; tissue
warmers; adhesive bandages or tape; sharps container;
permanent marker, pen, or computer labels; specimen
transport bags; and evacuated tubes. Equipment is stored
and transported on a tray or cart.
Phlebotomy equipment specific to venipuncture procedures
includes tourniquets, needles or butterfly assemblies,
evacuated tube holders or syringes, and evacuated tubes.
The winged infusion set (butterfly assembly) includes a
needle that has butterfly wings; short, thin tubing; and a
place to attach a syringe or an evacuated tube holder for
blood collection. The syringe set includes a needle and
syringe, plus a transfer device for adding blood to the
evacuated blood tubes. Evacuated tubes are a closed
system of collection that allows for multiple tubes to be
collected with one venipuncture. Evacuated tubes come
with tops of different colors and with different additives and
are designated for different tests based on their additives.
Phlebotomists should be familiar with the tube color-coding
system used at their facility.
Phlebotomy equipment specific to dermal (capillary)
puncture includes a lancet or puncture device and special
microcollection tubes.
Additives used in blood collection containers are indicated
by the color used in the tube closure. Commonly used
additives and colors are nonadditive (white or clear with red
center, depending on brand), citrate (blue), clot activator
and gel (gold or red with yellow ring, depending on brand),
heparin (green), EDTA (lavender), and potassium oxalate
with fluoride (gray).
The order of the draw using the routine venipuncture
procedure depends on the facility’s policies. An accepted
order of draw may include a nonadditive discard tube
being collected first, followed by citrate tube, SST serum
separator tube, heparin and heparinized plasma separator
tubes, EDTA tube, and last, sodium fluoride/potassium
oxalate tube. Specimens requiring sterile blood collection
procedures (blood cultures) must be drawn first, regardless
of order of draw. Sterile tubes replace the discard tube
in the order of draw using the evacuated tube system.
The order in which blood is collected using evacuated
tube systems is critical for avoiding contamination with
interfering substances.
Several companies manufacture blood collection
equipment. The coding used to indicate additives and draw
volumes vary among manufacturers. Phlebotomists must
become familiar with the equipment used at their facilities.
5.00, 5.5, 5.6
5.5, 5.6
5.5
5.00, 5.1, 5.2
5.3, 5.4, 5.6
5.2
Chapter Blood Collection Equipment
Copyright © 2019 by McGraw-Hill Education
Chapter Review
3.
2.
A: Labeling
Label the parts of the following evacuated tube assembly.
6.
1. 4.
1. [LO 8.2]
2. [LO 8.2]
3. [LO 8.2]
4. [LO 8.2]
5. [LO 8.2]
6. [LO 8.2]
B: Matching
Match each term with its definition.
5.
7. [LO 8.2] anticoagulant
8. [LO 8.2] gauge
9. [LO 8.2] winged infusion set
10. [LO 8.2] evacuated tube
11. [LO 8.2] evacuated tube holder
12. [LO 8.2] safe needle device
a. covers the needle after specimen collection
b. plastic holder for both the needle and the
blood collection tube
c. closed collection tube containing a premea-
sured vacuum
d. agent that prevents blood from clotting
e. also known as a butterfly needle
f. needle diameter or bore
C: Fill in the Blank
Next to each additive listed on the left, write the colors of the tubes containing that additive on the right.
13. [LO 8.4] none
14. [LO 8.4] EDTA
15. [LO 8.4] sodium citrate
Copyright © 2019 by McGraw-Hill Education
16. [LO 8.4] sodium fluoride/potassium oxalate
Chapter Blood Collection Equipment
17. [LO 8.4] heparin (either sodium, lithium, or ammonium)
18. [LO 8.4] clot activator
19. [LO 8.4] thixotropic gel
D: Sequencing
Place the following types of tubes in the correct order of draw (from 1 to 7).
20. [LO 8.5] light blue (coagulation)
21. [LO 8.5] sterile specimens (blood cultures or yellow SPS tube)
22. [LO 8.5] pink or lavender (EDTA)
23. [LO 8.5] gold or red/black (SST)
24. [LO 8.5] red plastic or glass (serum)
25. [LO 8.5] green (heparin)
26. [LO 8.5] gray (fluoride)
E: Case Studies/Critical Thinking
27. [LO 8.4] Your supervisor asks you to collect an EDTA sample on a patient waiting in the outpatient
drawing room. Which tubes contain EDTA? How will you determine which tube to collect?
28. [LO 8.3] You are going to collect blood from an elderly person with fragile veins. What are your options
for blood collection equipment in this case? What other things do you need to consider for your
selection of equipment?
29. [LO 8.2, 8.3] A young child needs blood drawn for coagulation studies prior to going to surgery. What
are your options for blood collection equipment? What are the concerns for order of draw?
30. [LO 8.4] While you are drawing blood on a patient, he asks why there are so many different colors of
tubes. How would you respond to this question?
F: Exam Prep
Choose the best answer for each question.
31. [LO 8.1] The term evacuated tube refers to a
venipuncture collection tube that
a. does not contain a vacuum.
b. contains a vacuum.
c. does not contain an anticoagulant.
d. contains an anticoagulant.
33. [LO 8.1] Needles used with evacuated tube
systems have a (Choose all that apply.)
a. single point.
b. double end.
c. continuous shaft.
d. rubber sleeve.
32. [LO 8.4] The purpose of an anticoagulant in a
blood collection container is to
a. decrease the chance of hemolysis.
b. preserve the life span of red blood cells.
c. prevent blood from clotting.
d. produce serum for testing.
Chapter Blood Collection Equipment
34. [LO 8.2] Syringes are used with which type of
needle? (Choose all that apply.)
a. Butterfly
b. Double-ended
c. Hypodermic
d. Surgical
Copyright © 2019 by McGraw-Hill Education
35. [LO 8.2] When performing a venipuncture on a
patient with small veins, the best size of needle
to use is
a. 19 gauge.
b. 20 gauge.
c. 21 gauge.
d. 22 gauge.
36. [LO 8.1] Gloves are not required while
a. transporting specimens to the lab.
b. performing a venipuncture.
c. performing a dermal (capillary) puncture.
d. cleaning the venipuncture site.
37. [LO 8.3] The depth of a dermal (capillary)
puncture device is controlled during capillary
collection in order to
a. puncture an artery.
b. control excessive clotting.
c. avoid puncturing a bone.
d. avoid bacterial contamination.
38. [LO 8.1] An alcohol prep pad is
a. not an appropriate antiseptic to use in blood
collection.
b. a bacteriostatic preventing contamination of
the puncture site.
c. saturated with a 70% iodine solution.
d. used after the venipuncture to stop bleeding
at the site.
39. [LO 8.4] A plastic red-topped tube contains
a. an anticoagulant.
b. an antiglycolytic agent.
c. a clot activator.
d. no additives.
40. [LO 8.4] A gray-topped tube contains
a. an antiglycolytic agent.
b. a clot activator.
c. no additives.
d. separator gel.
41. [LO 8.4] Blood specimens for coagulation testing
are collected in tubes.
a. citrate
b. EDTA
c. fluoride
d. heparin
Copyright © 2019 by McGraw-Hill Education
42. [LO 8.4] EDTA is the anticoagulant found in
-topped tubes. (Choose all that apply.)
a. lavender
b. pink
c. tan
d. white
43. [LO 8.4] Gel separation barriers are included in
which tubes? (Choose all that apply.)
a. Gold
b. Light blue
c. Light green
d. Tan
44. [LO 8.4] Tubes with a gel separation barrier may
also contain (Choose all that apply.)
a. heparin.
b. EDTA.
c. clot activator.
d. citrate.
45. [LO 8.5] When collecting blood using a butterfly
assembly, which tubes must have a discard tube
drawn prior to their filling? (Choose all that
apply.)
a. Gray
b. Lavender
c. Royal blue
d. Light blue
46. [LO 8.5] If gray, green, and lavender tubes are
needed, the correct order of draw is
a. green, lavender, gray.
b. gray, lavender, green.
c. lavender, gray, green.
d. gray, green, lavender.
47. [LO 8.5] An erroneous coagulation test result
was obtained on a specimen. What may have
happened in the pre-examination phase of
testing to cause this?
a. The blue-topped tube was filled to
capacity.
b. A nonadditive tube was drawn before the
blue-topped tube.
c. The blue-topped tube was underfilled.
d. The blue-topped tube was drawn before the
lavender-topped tube.
Chapter Blood Collection Equipment
48. [LO 8.5] To avoid contamination of sterile
specimens,
a. sterile tubes should be collected first.
b. sterile tubes should be collected last.
c. discard tubes should be collected before ster-
ile tubes.
d. blue-topped tubes should be collected before
sterile tubes.
49. [LO 8.5] Interfering substances that may
contaminate specimens for coagulation
testing may be introduced into specimens
except when
a. nonadditive tubes are collected first.
b. fluoride tubes are collected first.
c. heparin tubes are collected first.
d. clot activator tubes are collected first.
50. [LO 8.6] Which tube would you use to collect a
pediatric coagulation study?
a. Translucent, lavender-topped tube
b. Solid, light-green-topped tube
c. Solid, blue-topped tube
d. Translucent, blue-topped tube
51. [LO 8.6] You have to complete a difficult
microcollection draw. Which of the following
tubes would you most likely use?
a. Greiner Bio-One black ring tube cap
b. Becton Dickinson solid, blue-topped tube
c. Greiner Bio-One white ring tube cap
d. Sarstedt closed blood collection system
52. [LO 8.5] Which tube is drawn first in a sterile
venipuncture?
a. SPS yellow-topped tube
b. Light-blue-topped tube
c. Gray-topped tube
d. Red-topped tube
53. [LO 8.5] If red, yellow, and light blue tubes are
needed, which is the correct order of draw?
a. Yellow, red, light blue
b. Red, yellow, light blue
c. Yellow, light blue, red
d. Light blue, yellow, red
Enhance your learning by completing these exercises and more at
connect.mcgraw-hill.com.
References
Becton Dickinson. (2005). Components of the BC Vacutainer® SST tube. Tech Talk, 4(2). Retrieved January 15, 2011, from www
.bd.com/vacutainer/pdfs/techtalk/TechTalk_November2005_VS7436.pdf
Becton Dickinson. (2006). BD Microtainer™ Contact Activated Lancet. BD Diagnostics Preanalytical Systems website: www
.bd.com/vacutainer/pdfs/vs7573.pdf
Becton Dickinson. (2007). Proper handling of BD Vacutainer® Plus citrate tubes. Tech Talk, 5(1). Retrieved January 15, 2011, from
www.bd.com/vacutainer/pdfs/techtalk/BDVS-TechTalk-9947_D2.pdf
Becton Dickinson. (2008). BC Vacutainer® venous blood collection tube guide. Retrieved January 15, 2011, from www.bd.com/
vacutainer/pdfs/plus_plastic_tubes_wallchart_tubeguide_VS5229.pdf
Clinical and Laboratory Standards Institute. (2007). Procedures for the collection of diagnostic blood specimens by venipuncture;
approved standard (6th ed.) Wayne, PA: Author. CLSI H3-A6. 27(26).
Emst, D. J., & Calam, R. C. (2004, May). NACCLS simplifies the order of draw: A brief history. MLO, May 2004, 26–27.
Greiner Bio-One GmbH. (n.d.). Vacuette® Preanalytics Manual. Greiner Bio-One North America Inc.
Greiner Bio-One GmbH. (2017). Vacuette® Preanalystics Catalog. Retrieved February 2, 2017, from www.gbo.com/fileadmin/user_
upload/Downloads/Product_Catalogue/Catalogue_Preanalytics/English/980042_VACUETTECatalogue_rev08_07_2014_e_
lowres.pdf
National Accrediting Agency for Clinical Laboratory Sciences. (2010). NAACLS entry-level phlebotomist competencies. Rosemont, IL:
Author.
Sarstedt. (n.d.). S-Monovette®: The enclosed blood collection system. Sarstedt, Inc., North Carolina.
Wilson, D. D. (2008). McGraw-Hill manual of laboratory and diagnostic tests. New York, NY: McGraw-Hill.
Copyright © 2019 by McGraw-Hill Education
Chapter Blood Collection Equipment
NAME: __________________________________________________ DATE: ___________________________________________________
COMPETENCY CHECKLIST: ORDER OF DRAW FOR VENIPUNCTURE
Practice Performed
Procedure Steps Yes No Master
Procedure
. Determines whether routine or sterile veni-
puncture is required.
. If sterile venipuncture is required, collects
sterile SPS yellow or blood culture bottles first.
. If sterile venipuncture is not required, and if
the facility requires a discard tube, fills a redtopped or clear discard tube.
. Collects light-blue-topped tube(s), if blood
with citrate additive is required.
. Collects red, royal blue, or orange clot activa-
tor serum tube(s), as required.
. Collects gold or red/black speckled serum
separator tube(s), as required.
. Collects light green or green/black speckled
plasma separator tube(s), as required.
. Collects green heparinized tube(s), as
required.
. Collects lavender, pink, royal blue, tan, or
white EDTA tube(s), as required.
. Collects gray sodium fluoride tube(s), as
required.
COMMENTS: ___________________________________________________________________________________
______________________________________________________________________________________________
SIGNED
EVALUATOR: ________________________________________________________________________________
STUDENT: _________________________________________________________________________________
Copyright © 2019 by McGraw-Hill Education
Chapter Blood Collection Equipment
NAME: __________________________________________________ DATE: ___________________________________________________
COMPETENCY CHECKLIST: ORDER OF DRAW FOR DERMAL CAPILLARY PUNCTURE
Practice Performed
Procedure Steps Yes No Master
Procedure
. Collects lavender or pink EDTA microcollec-
tion tube(s), as required.
. Collects green or light green heparin microcol-
lection tube(s), as required.
. Collects gray sodium fluoride microcollection
tube(s), as required.
. Collects nonadditive (red) or serum separator
(gold microcollection tube[s]), as required.
COMMENTS: ___________________________________________________________________________________
______________________________________________________________________________________________
SIGNED
EVAL UATOR : _________________________________________________________________________________
STUDENT: __________________________________________________________________________________
Design Elements: Life Span Considerations icon (baby holding hand) ©Lerche&Johnson/Shutterstock.com RF; Communicate & Connect icon (patient and doctor)
©Rocketclips, Inc./Shutterstock.com RF; Safety & Infection Control icon (samples in hand) ©motorolka/Shutterstock.com RF.
Chapter Blood Collection Equipment
Copyright © 2019 by McGraw-Hill Education
9
Venipuncture
antecubital fossa
anticoagulant
aseptic
collapsed vein
concentric circles
ecchymosis
edematous
exsanguination
hematoma
essential terms
hemoconcentration
iatrogenic anemia
lymphostasis
palpate
petechiae
sclerosis
syncope
venous reflux
©ftwitty/E+/Getty Images RF
Learning Outcomes
. Summarize the steps necessary
to perform a competent/effective
venipuncture.
. Describe special procedures needed
for venipuncture on difficult-to-draw
veins.
. Describe signs and symptoms of
venipuncture complications.
Related NAACLS Competencies
. Demonstrate knowledge of collection equipment,
various types of additives used, special precautions
necessary, and substances that can interfere in clinical
analysis of blood constituents.
. List and select the types of equipment needed to
collect blood by venipuncture and capillary (dermal)
puncture.
. Identify special precautions necessary during blood
collections by venipuncture and capillary (dermal)
puncture.
. Follow standard operating procedures to collect
specimens.
. Identify potential sites for venipuncture and capillary
(dermal) puncture.
. Differentiate between sterile and antiseptic
techniques.
. Describe and demonstrate the steps in the
preparation of a puncture site.