Can A Phlebotomist Draw From The Foot Or Leg With A Doctor's Order

BLOOD Collection:

ROUTINE VENIPUNCTURE AND SPECIMEN Handling

Objectives for the tutorial:

Depict and perform the venipuncture process including:
1. Appropriate clothing and protective equipment
2. Ensuring the comfort of the patient
3. Proper patient identification procedures.
4. Proper equipment selection and use.
5. Proper labeling procedures and completion of laboratory requisitions.
6. Club of draw for multiple tube phlebotomy.
7. Preferred venous access sites, and factors to consider in site selection, and ability to differentiate between the experience of a vein, tendon and avenue.
8. Patient care following completion of venipuncture.
9. Safety and infection command procedures.
10. Quality assurance bug.
Identify the condiment, additive function, book, and specimen considerations to exist followed for each of the various colour coded tubes.
Listing six areas to be avoided when performing venipuncture and the reasons for the restrictions.
Summarize the bug that may be encountered in accessing a vein, including the procedure to follow when a specimen is not obtained.
List several effects of exercise, posture, and tourniquet application upon laboratory values.

VENIPUNCTURE Process

The venipuncture process is circuitous, requiring both knowledge and skill to perform. Each phlebotomist by and large establishes a routine that is comfortable for her or him.

Phlebotomists are considered to have occupational exposure to blood borne pathogens. The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to preclude contact with blood. Laboratory coats or work smocks are not typically needed as personal protective equipment during routine venipuncture, only an employer must assess the workplace to determine whether sure tasks, workplace situations, or employee skill levels may consequence in an employee's need for laboratory coats or other personal protective equipment to prevent contact with blood. It is an employer'south responsibility to provide, clean, repair, supersede, and/or dispose of personal protective equipment/wearable. As part of presenting a professional person appearance, an institutional dress code may include wearing of a laboratory coat or smock.

Several essential steps are required for every successful collection procedure:

Patient comfort. Is the seating comfortable and has the patient been seated for at to the lowest degree 5 minutes to avert being rushed or confused?
Carry out manus hygiene before and after each patient procedure, before putting on and later removing gloves.
Place the patient using two dissimilar identifiers, request open concluded questions such as, "What is your proper noun?" and "What is your date of birth?"
Assess the patient'south physical disposition (i.e. diet, practise, stress, basal state).
Check the requisition grade for requested tests, patient information, and whatsoever special requirements.
Label the drove tubes at the bedside or drawing area.
Select a suitable site for venipuncture.
Prepare the equipment, the patient and the puncture site.
Perform the venipuncture, collecting the sample(s) in the appropriate container(s).
Recognize complications associated with the phlebotomy procedure.
Assess the need for sample recollection and/or rejection.
Promptly ship the specimens with the requisition to the laboratory.

ORDER FORM / REQUISITION

A requisition course must back-trail each sample submitted to the laboratory. This requisition form must comprise the proper information in order to process the specimen. The essential elements of the requisition form are:

Patient'due south surname, beginning proper name, and middle initial.
Patient'southward ID number.
Patient's engagement of nascence and sex.
Requesting doc's complete name.
Source of specimen. This information must be given when requesting microbiology, cytology, fluid analysis, or other testing where assay and reporting is site specific.
Date and fourth dimension of collection.
Initials of phlebotomist.
Indicating the test(due south) requested.

An example of a uncomplicated requisition form with the essential elements is shown beneath:

LABELING THE SAMPLE

A properly labeled sample is essential so that the results of the test match the patient. The primal elements in labeling are:

Patient's surname, first and middle.
Patient's ID number.
NOTE: Both of the above MUST friction match the aforementioned on the requisition course.
Date, time and initials of the phlebotomist must be on the label of EACH tube.

Automated systems may include labels with bar codes.

Examples of labeled collection tubes are shown below:

EQUIPMENT:

THE Following ARE NEEDED FOR ROUTINE VENIPUNCTURE:

Evacuated Collection Tubes - The tubes are designed to fill with a predetermined volume of blood past vacuum. The safety stoppers are color coded co-ordinate to the additive that the tube contains. Various sizes are available. Blood should NEVER exist poured from one tube to some other since the tubes can have different additives or coatings (meet illustrations at stop).
Needles - The judge number indicates the diameter size: the larger the judge number, the smaller the needle bore. Needles are available for evacuated systems and for utilize with a syringe, single draw or butterfly system.
Holder/Adapter - use with the evacuated drove organisation.
Tourniquet - Wipe off with booze and supercede frequently.
Alcohol Wipes - 70% isopropyl alcohol.
Povidone-iodine wipes/swabs - Used if blood civilisation is to be fatigued.
Gauze sponges - for application on the site from which the needle is withdrawn.
Adhesive bandages / tape - protects the venipuncture site after collection.
Needle disposal unit - needles should NEVER exist broken, bent, or recapped. Needles should be placed in a proper disposal unit IMMEDIATELY later their use.
Gloves - can be made of latex, safe, vinyl, etc.; worn to protect the patient and the phlebotomist.
Syringes - may be used in place of the evacuated drove tube for special circumstances.

ORDER OF Draw

Blood collection tubes must be drawn in a specific order to avoid cantankerous-contamination of additives between tubes. The recommended order of draw for plastic collection tubes is:

Beginning - blood culture canteen or tube (xanthous or yellow-black top)
Second - coagulation tube (light blue peak). If just a routine coagulation assay is the just test ordered, then a single calorie-free blue top tube may be drawn. If there is a business regarding contamination by tissue fluids or thromboplastins, and then 1 may describe a non-additive tube first, and so the lite blue summit tube.
Third - not-additive tube (ruddy top)
Last draw - condiment tubes in this order:
1. SST (ruddy-gray or gold top). Contains a gel separator and clot activator.
2. Sodium heparin (dark light-green top)
3. PST (calorie-free green top). Contains lithium heparin anticoagulant and a gel separator.
4. EDTA (lavander top)
5. ACDA or ACDB (pale yellowish top). Contains acrid citrate dextrose.
6. Oxalate/fluoride (calorie-free gray top)

NOTE:Tubes with additives must be thoroughly mixed. Erroneous test results may exist obtained when the claret is not thoroughly mixed with the additive.

PROCEDURAL Issues

PATIENT RELATIONS AND IDENTIFICATION:

The phlebotomist's role requires a professional person, courteous, and understanding manner in all contacts with the patient. Greet the patient and identify yourself and indicate the process that volition take identify. Effective communication - both exact and nonverbal - is essential.

Proper patient identification MANDATORY. If an inpatient is able to respond, ask for a full proper name and ever check the armband or bracelet for confirmation. Practise NOT DRAW BLOOD IF THE ARMBAND OR BRACELET IS MISSING. For an inpatient the nursing staff tin be contacted to help in identification prior to proceeding.

An outpatient must provide identification other than the verbal statement of a proper name. Using the requisition for reference, ask a patient to provide additional information such every bit a surname or birthdate. A government issued photo identification carte such as a driver's license can aid in resolving identification bug.

If possible, speak with the patient during the process. The patient who is at ease volition exist less focused on the procedure. Always thank the patient and excuse yourself courteously when finished.

PATIENT'S Bill OF RIGHTS:

The Patient'southward Pecker of Rights has been adopted by many hospitals as declared by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The basic patient rights endorsed by the JCAHO follow in condensed form are given below.

The patient has the right to:

Impartial admission to treatment or accommodations that are available or medically indicated, regardless of race, creed, sex, national origin, or sources of payment for care.
Considerate, respectful intendance.
Confidentiality of all communications and other records pertaining to the patient'southward care.
Expect that any word or consultation involving the patient's case will be conducted discretely and that individuals not directly involved in the instance will non be present without patient permission.
Look reasonable safety congruent with the hospital practices and environs.
Know the identity and professional person status of individuals providing service and to know which doctor or other practitioner is primarily responsible for his or her intendance.
Obtain from the practitioner complete and current information nigh diagnosis, treatment, and whatsoever known prognosis, in terms the patient tin can reasonably be expected to understand.
Reasonable informed participation in decisions involving the patient'southward health intendance. The patient shall be informed if the hospital proposes to engage in or perform human experimentation or other research/educational profits affecting his or her intendance or treatment. The patient has the right to turn down participation in such activity.
Consult a specialist at the patient's own request and expense.
Refuse handling to the extent permitted by police.
Regardless of the source of payment, request and receive an itemized and detailed explanation of the full bill for services rendered in the infirmary.
Be informed of the hospital rules and regulations regarding patient comport.

VENIPUNCTURE SITE SELECTION:

Although the larger and fuller median cubital and cephalic veins of the arm are used nigh ofttimes, the basilic vein on the dorsum of the arm or dorsal hand veins are also acceptable for venipuncture. Foot veins are a last resort considering of the higher probability of complications.

Certain areas are to exist avoided when choosing a site:

Extensive scars from burns and surgery - it is difficult to puncture the scar tissue and obtain a specimen.
The upper extremity on the side of a previous mastectomy - test results may exist affected because of lymphedema.
Hematoma - may cause erroneous test results. If another site is non available, collect the specimen distal to the hematoma.
Intravenous therapy (IV) / blood transfusions - fluid may dilute the specimen, so collect from the opposite arm if possible. Otherwise, satisfactory samples may be fatigued below the IV by following these procedures:
- Plough off the 4 for at to the lowest degree two minutes before venipuncture.
- Apply the tourniquet beneath the Iv site. Select a vein other than the one with the 4.
- Perform the venipuncture. Draw 5 ml of blood and discard before cartoon the specimen tubes for testing.
Lines - Drawing from an intravenous line may avert a difficult venipuncture, but introduces problems. The line must be flushed first. When using a syringe inserted into the line, blood must be withdrawn slowly to avoid hemolysis.
Cannula/fistula/heparin lock - hospitals take special policies regarding these devices. In full general, blood should non be drawn from an arm with a fistula or cannula without consulting the attending physician.
Edematous extremities - tissue fluid accumulation alters test results.

Procedure FOR VEIN SELECTION:

Palpate and trace the path of veins with the index finger. Arteries pulsate, are nigh elastic, and have a thick wall. Thrombosed veins lack resilience, feel cord-similar, and ringlet hands.
If superficial veins are not readily credible, y'all tin forcefulness claret into the vein by massaging the arm from wrist to elbow, tap the site with alphabetize and 2nd finger, use a warm, damp washcloth to the site for 5 minutes, or lower the extremity over the bedside to let the veins to fill.

PERFORMANCE OF A VENIPUNCTURE:

Approach the patient in a friendly, calm manner. Provide for their comfort as much every bit possible, and gain the patient's cooperation.
Identify the patient correctly.
Properly fill out advisable requisition forms, indicating the examination(s) ordered.
Verify the patient's condition. Fasting, dietary restrictions, medications, timing, and medical treatment are all of concern and should be noted on the lab requisition.
Check for any allergies to antiseptics, adhesives, or latex past observing for armbands and/or by asking the patient.
Position the patient. The patient should either sit in a chair, lie down or sit up in bed. Hyperextend the patient'due south arm.
Utilise the tourniquet 3-4 inches above the selected puncture site. Do not identify likewise tightly or leave on more than two minutes (and no more than than a infinitesimal to avoid increasing take chances for hemoconcentration). Wait 2 minutes before reapplying the tourniquet.
The patient should make a fist without pumping the paw.
Select the venipuncture site.
Set up the patient'due south arm using an alcohol prep. Cleanse in a round fashion, beginning at the site and working outward. Let to air dry.
Grasp the patient's arm firmly using your thumb to describe the skin taut and ballast the vein. The needle should form a 15 to 30 caste angle with the surface of the arm. Swiftly insert the needle through the skin and into the lumen of the vein. Avoid trauma and excessive probing.
When the terminal tube to exist fatigued is filling, remove the tourniquet.
Remove the needle from the patient's arm using a swift astern movement.
Printing downwardly on the gauze once the needle is out of the arm, applying adequate force per unit area to avoid germination of a hematoma.
Dispose of contaminated materials/supplies in designated containers.
Mix and label all advisable tubes at the patient bedside.
Deliver specimens promptly to the laboratory.

PHLEBOTOMY Procedure ILLUSTRATED:

Patient identification
Filling out the requisition
Equipment
Apply tourniquet and palpate for vein
Sterilize the site
Insert needle
Drawing the specimen
Drawing the specimen
Releasing the tourniquet
Applying pressure level over the vein
Applying bandage
Disposing needle into sharps
labeling the specimens

PERFORMANCE OF A FINGERSTICK:

Follow the procedure as outlined above for greeting and identifying the patient. As always, properly fill out appropriate requisition forms, indicating the test(s) ordered.

Verify the patient'due south status. Fasting, dietary restrictions, medications, timing, and medical treatment are all of business concern and should be noted on the lab requisition.

Position the patient. The patient should either sit in a chair, lie down or sit down upwards in bed. Hyperextend the patient'south arm.

The best locations for fingersticks are the 3rd (center) and quaternary (ring) fingers of the non-dominant hand. Practice not utilise the tip of the finger or the center of the finger. Avoid the side of the finger where there is less soft tissue, where vessels and nerves are located, and where the bone is closer to the surface. The second (alphabetize) finger tends to have thicker, callused peel. The 5th finger tends to accept less soft tissue overlying the bone. Avoid puncturing a finger that is cold or cyanotic, swollen, scarred, or covered with a rash.

Using a sterile lancet, make a skin puncture just off the center of the finger pad. The puncture should be made perpendicular to the ridges of the fingerprint and so that the drop of claret does not run down the ridges.

Wipe away the first drop of blood, which tends to contain excess tissue fluid.

Collect drops of blood into the drove device past gently massaging the finger. Avoid excessive pressure that may squeeze tissue fluid into the drop of claret.

Cap, rotate and invert the collection device to mix the blood collected.

Have the patient hold a small gauze pad over the puncture site for a couple of minutes to terminate the bleeding.

Dispose of contaminated materials/supplies in designated containers.

Characterization all appropriate tubes at the patient bedside.

Deliver specimens promptly to the laboratory.

FINGERSTICK Process ILLUSTRATED:

Equipment

Proper location on finger

Puncture with lancet

Drib of blood

Wipe first drop

Collecting the specimen

Specimen container

ADDITIONAL CONSIDERATIONS:

To foreclose a hematoma:

Puncture simply the uppermost wall of the vein
Remove the tourniquet earlier removing the needle
Employ the major superficial veins
Make sure the needle fully penetrates the upper most wall of the vein. (Partial penetration may allow blood to leak into the soft tissue surrounding the vein by way of the needle bevel)
Use pressure level to the venipuncture site

To prevent hemolysis (which can interfere with many tests):

Mix tubes with anticoagulant additives gently 5-10 times
Avoid cartoon blood from a hematoma
Avoid cartoon the plunger back too forcefully, if using a needle and syringe, or as well modest a needle, and avoid frothing of the sample
Make sure the venipuncture site is dry out
Avert a probing, traumatic venipuncture
Avoid prolonged tourniquet application or fist clenching.

Indwelling Lines or Catheters:

Potential source of exam error
Most lines are flushed with a solution of heparin to reduce the hazard of thrombosis
Discard a sample at least three times the volume of the line before a specimen is obtained for analysis

Hemoconcentration: An increased concentration of larger molecules and formed elements in the blood may be due to several factors:

Prolonged tourniquet application (no more than 1 minute)
Massaging, squeezing, or probing a site
Long-term 4 therapy
Sclerosed or occluded veins

Prolonged Tourniquet Application:

Main effect is hemoconcentration of non-filterable elements (i.due east. proteins). The hydrostatic pressure level causes some water and filterable elements to leave the extracellular space.
Significant increases can exist establish in total poly peptide, aspartate aminotransferase (AST), full lipids, cholesterol, iron
Affects packed jail cell volume and other cellular elements
Hemolysis may occur, with pseudohyperkalemia.

Patient Preparation Factors:

Therapeutic Drug Monitoring: different pharmacologic agents have patterns of assistants, body distribution, metabolism, and elimination that affect the drug concentration as measured in the blood. Many drugs volition have "peak" and "trough" levels that vary co-ordinate to dosage levels and intervals. Check for timing instructions for drawing the advisable samples.
Furnishings of Do: Muscular activity has both transient and longer lasting effects. The creatine kinase (CK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and platelet count may increase.
Stress: May crusade transient elevation in white blood cells (WBC'southward) and elevated adrenal hormone values (cortisol and catecholamines). Anxiety that results in hyperventilation may cause acrid-base imbalances, and increased lactate.
Diurnal Rhythms: Diurnal rhythms are body fluid and analyte fluctuations during the 24-hour interval. For example, serum cortisol levels are highest in early morn but are decreased in the afternoon. Serum iron levels tend to drop during the 24-hour interval. You must check the timing of these variations for the desired collection point.
Posture: Postural changes (supine to sitting etc.) are known to vary lab results of some analytes. Sure larger molecules are not filterable into the tissue, therefore they are more concentrated in the blood. Enzymes, proteins, lipids, iron, and calcium are significantly increased with changes in position.
Other Factors: Age, gender, and pregnancy have an influence on laboratory testing. Normal reference ranges are often noted according to age.

REASONS FOR CANCELING A LABORATORY Test

A test that has been ordered may be cancelled due to bug unrelated to drawing the specimen, and these are the most common causes for cancellations:

Indistinguishable test request
Incorrect test ordered
Examination no longer needed

A test may be cancelled due to a technical problem in the specimen collection process:

Hemolysis of the specimen
Clotted specimen
Quantity of specimen not sufficient
Collection of specimen in incorrect tube
Contaminated specimen
Identification of the specimen is suspect
Delay in transport - specimen too one-time

Prophylactic AND INFECTION Command

Because of contacts with sick patients and their specimens, information technology is important to follow safety and infection command procedures.

PROTECT YOURSELF

Practice universal precautions:
- Wear gloves and a lab coat or gown when handling blood/body fluids.
- Change gloves after each patient or when contaminated.
- Launder easily oft.
- Dispose of items in advisable containers.
Dispose of needles immediately upon removal from the patient'southward vein. Do not bend, break, recap, or resheath needles to avoid accidental needle puncture or splashing of contents.
Clean up any blood spills with a disinfectant such as freshly made 10% bleach.
If you stick yourself with a contaminated needle:
- Remove your gloves and dispose of them properly.
- Squeeze puncture site to promote bleeding.
- Wash the expanse well with soap and h2o.
- Record the patient's proper noun and ID number.
- Follow institution's guidelines regarding treatment and follow-up.
- NOTE: The use of rubber zidovudine post-obit blood exposure to HIV has shown effectiveness (about 79%) in preventing seroconversion

PROTECT THE PATIENT

Place blood collection equipment abroad from patients, peculiarly children and psychiatric patients.
Exercise hygiene for the patient's protection. When wearing gloves, change them betwixt each patient and launder your hands frequently. Always wearable a make clean lab coat or gown.

TROUBLESHOOTING GUIDELINES:

IF AN INCOMPLETE Collection OR NO BLOOD IS OBTAINED:

Modify the position of the needle. Motion information technology frontwards (information technology may not be in the lumen)
or move it backward (information technology may have penetrated too far).
Arrange the angle (the bevel may be confronting the vein wall).
Loosen the tourniquet. It may be obstructing blood catamenia.
Attempt another tube. Use a smaller tube with less vacuum. There may be no vacuum in the tube being used.
Re-ballast the vein. Veins sometimes roll abroad from the point of the needle and puncture site.
Accept the patient make a fist and flex the arm, which helps engorge muscles to fill veins.
Pre-warm the region of the vein to reduce vasoconstriction and increment blood menstruation.
Have the patient drink fluids if dehydrated.

IF BLOOD STOPS FLOWING INTO THE TUBE:

The vein may accept collapsed; resecure the tourniquet to increment venous filling. If this is non successful, remove the needle, accept intendance of the puncture site, and redraw.
The needle may take pulled out of the vein when switching tubes. Hold equipment firmly and place fingers against patient's arm, using the flange for leverage when withdrawing and inserting tubes.

PROBLEMS OTHER THAN AN INCOMPLETE COLLECTION:

A hematoma forms under the skin next to the puncture site - release the tourniquet immediately and withdraw the needle. Apply house force per unit area.

Hematoma germination is a problem in older patients.
The blood is bright red (arterial) rather than venous. Utilize house pressure for more than 5 minutes.

Claret COLLECTION ON BABIES:

The recommended location for blood drove on a newborn baby or babe is the heel. The diagram below indicates in green the proper area to utilize for heel punctures for blood collection:
Prewarming the infant's heel (42 C for 3 to 5 minutes) is important to obtain capillary blood gas samples and warming also greatly increases the flow of blood for collection of other specimens. However, practise not utilize too high a temperature warmer, because baby's skin is sparse and susceptible to thermal injury.
Clean the site to be punctured with an alcohol sponge. Dry the cleaned expanse with a dry cotton sponge. Hold the baby's pes firmly to avert sudden movement.
Using a sterile blood lancet, puncture the side of the heel in the appropriate regions shown above in light-green. Do not use the central portion of the heel considering you lot might injure the underlying bone, which is close to the skin surface. Practice not use a previous puncture site. Make the cutting across the heelprint lines then that a drop of blood can well up and not run down along the lines.
Wipe away the first drop of claret with a piece of clean, dry out cotton wool. Since newborns do not often bleed immediately, use gentle pressure to produce a rounded drib of blood. Practice not use excessive pressure or heavy massaging because the claret may become diluted with tissue fluid.
Fill the capillary tube(due south) or micro collection device(due south) as needed.
When finished, elevate the heel, place a piece of clean, dry cotton on the puncture site, and hold information technology in place until the bleeding has stopped.
Exist certain to dispose of the lancet in the appropriate sharps container. Dispose of contaminated materials in advisable waste receptacles. Remove your gloves and wash your hands.

HEELSTICK Process ILLUSTRATED:

Heelstick on babe

PEDIATRIC PHLEBOTOMY:

Children, particularly nether the age of 10, may experience pain and anxiety during the phlebotomy procedure.
A variety of techniques can exist employed to reduce hurting and anxiety. Constructive methods utilise distraction. These may include listening to music or a story, watching a video, playing with a toy, having a parent provide distraction with talk or touch, using flash cards, and squeezing a rubber ball. (Uman et al, 2013)

Drove TUBES FOR PHLEBOTOMY

Collection tubes tin vary in size for volume of blood drawn, appropriate to the tests ordered with sample size required, and vary in the kind of additive for anticoagulation, separation of plasma, or preservation of analyte. Larger tube sizes typically provide for collection of samples from 6 to 10 mL.
Smaller collection tubes for sample sizes of two mL or less may be appropriate in situations where a smaller corporeality blood should be drawn, as in pediatric patients, or to minimize hemolysis during collection, or to avoid bereft sample book in the drove tube.

Red Peak
ADDITIVE	None
Style OF Activeness	Blood clots, and the serum is separated by centrifugation
USES	Chemistries, Immunology and Serology, Blood Bank (Crossmatch)

Aureate Top
Condiment	None
Fashion OF Activity	Serum separator tube (SST) contains a gel at the bottom to dissever claret from serum on centrifugation
USES	Chemistries, Immunology and Serology

Light Green Acme
Additive	Plasma Separating Tube (PST) with Lithium heparin
Fashion OF ACTION	Anticoagulates with lithium heparin; Plasma is separated with PST gel at the lesser of the tube
USES	Chemistries

Purple Acme
ADDITIVE	EDTA
Way OF ACTION	Forms calcium salts to remove calcium
USES	Hematology (CBC) and Blood Banking concern (Crossmatch); requires full depict - invert eight times to prevent clotting and platelet clumping

Light Blue Top
Condiment	Sodium citrate
MODE OF Activity	Forms calcium salts to remove calcium
USES	Coagulation tests (protime and prothrombin fourth dimension), full draw required

Light-green Top
ADDITIVE	Sodium heparin or lithium heparin
Style OF ACTION	Inactivates thrombin and thromboplastin
USES	For lithium level, apply sodium heparin For ammonia level, use sodium or lithium heparin

Dark Blue Top
Additive	EDTA-
Style OF Activity	Tube is designed to comprise no contaminating metals
USES	Trace element testing (zinc, copper, atomic number 82, mercury) and toxicology

Lite Greyness Top
Additive	Sodium fluoride and potassium oxalate
MODE OF ACTION	Antiglycolytic agent preserves glucose upward to 5 days
USES	Glucoses, requires full draw (may cause hemolysis if short draw)

Yellow Tiptop
ADDITIVE	ACD (acrid-citrate-dextrose)
Way OF Activeness	Complement inactivation
USES	HLA tissue typing, paternity testing, DNA studies

Yellow - Black Summit
Additive	Goop mixture
Style OF ACTION	Preserves viability of microorganisms
USES	Microbiology - aerobes, anaerobes, fungi

Black Top
Additive	Sodium citrate (buffered)
MODE OF Action	Forms calcium salts to remove calcium
USES	Westergren Sedimentation Rate; requires full depict

Orange Top
Condiment	Thrombin
MODE OF ACTION	Quickly clots blood
USES	STAT serum chemistries

Light Brown Superlative
ADDITIVE	Sodium heparin
MODE OF Activeness	Inactivates thrombin and thromboplastin; contains almost no pb
USES	Serum atomic number 82 determination

Pink Peak
ADDITIVE	Potassium EDTA
MODE OF Action	Forms calcium salts
USES	Immunohematology

White Peak
ADDITIVE	Potassium EDTA
Way OF Activeness	Forms calcium salts
USES	Molecular/PCR and bDNA testing

References

Giavarina D, Lippi G. Claret venous sample collection: Recommendations overview and a checklist to improve quality. Clin Biochem. 2017;50(10-11):568-573.

Kiechle FL. So You lot're Going to Collect a Blood Specimen: An Introduction to Phlebotomy, 13th Edition (2010), College of American Pathologists, Northfield, IL.

Dalal BI, Brigden ML. Factitious biochemical measurements resulting from hematologic conditions. Am J Clin Pathol. 2009 Feb;131(ii):195-204.

Lippi 1000, Salvagno GL, Montagnana M, Franchini M, Guidi GC. Phlebotomy issues and quality comeback in results of laboratory testing. Clin Lab. 2006;52(five-half-dozen):217-thirty.

Lippi G, Blanckaert N, Bonini P, Greenish S, Kitchen Southward, Palicka Five, Vassault AJ, Mattiuzzi C, Plebani M. Causes, consequences, detection, and prevention of identification errors in laboratory diagnostics. Clin Chem Lab Med. 2009;47(2):143-53.

Occupational Safety and Health Assistants, United States Department of Labor. https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=25913 and https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf (Accessed Jan x, 2018).

Phelan MP, Reineks EZ, Berriochoa JP, Schold JD, Hustey FM, Chamberlin J, Kovach A. Impact of Use of Smaller Volume, Smaller Vacuum Blood Collection Tubes on Hemolysis in Emergency Department Blood Samples. Am J Clin Pathol. 2017;148(4):330-335.

Uman LS, Birnie KA, Noel Chiliad, et al. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev. 2013 Oct 10;(10):CD005179. doi: 10.1002/14651858.CD005179.pub3.

Valenstein PN, Sirota RL. Identification errors in pathology and laboratory medicine. Clin Lab Med. 2004;24(4):979-96, 7.

World Health Organisation. WHO guidelines on cartoon claret: all-time practices in phlebotomy. https://world wide web.ncbi.nlm.nih.gov/books/NBK138650/pdf/Bookshelf_NBK138650.pdf (Accessed Jan 10, 2018)

And for our furry friends:

Joslin JO. Blood Collection Techniques in Exotic Small Mammals. Journal of Exotic Pet Medicine. 2009;18(2):117-139.

Source: https://webpath.med.utah.edu/TUTORIAL/PHLEB/PHLEB.html

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