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Specimen Collection Manual

ROUTINE BLOOD COLLECTION


Purpose

The Vacutainer System is used to collect blood specimens for diagnostic analysis in the laboratory. This system is comprised of three basic elements:

  1. 1. An evacuated glass or plastic tube containing a premeasured vacuum to provide a controlled prespecified draw.

  2. 2. A holder, which is used to secure the needle during insertion into the tube and venipuncture site.

       

     

  3. 3. A sterile single-use needle.

 

Procedure

PREVENTION OF BACKFLOW
To guard against backflow, the following precautions should be taken when drawing blood with evacuated tubes:

  1. 1. Ask patient to identify himself/herself. The name must match the request form.
    2. Place patient's arm in a downward position during the procedure.
    3. Hold the tube in a vertical position.
    4. Release the tourniquet as soon as a strong flow of blood is obtained.


ORDER OF DRAW
When more than one tube is drawn, special attention should be given to the order in which tubes are filled.

  1. First Draw - Blood culture tubes

  2. Second Draw – Citrate Tube (Light blue)

  3. Third Draw – SST and/or Plain Red top tubes

  4. Fourth Draw – Heparin Tube (Green top)

  5. Fifth Draw – EDTA Tube (Lavender top)

  6. Last Draw – Fluoride (glucose) Tube (Gray top)

 

PREPARATION FOR SPECIMEN COLLECTION
The following materials should be readily accessible before beginning venipuncture.

  1. 1. All necessary tubes
    2. Appropriate needle and holder.
    3. Alcohol swab (plus iodine swab for a sterile specimens)
    4. Dry sterile swab
    5. Bandage


VENIPUNCTURE TECHNIQUE

  1. 1. Open needle package but do not remove needle shield. Thread needle into holder until secure.
    2. Select tubes for draw. Tubes that contain additives should be gently tapped to dislodge any
    additive which may be trapped around the stopper.
    3. Insert tube into holder, but do not puncture the stopper.
    4. Select site for venipuncture by palpation.
    5. Apply tourniquet. Prepare venipuncture site with an appropriate antiseptic. Place the patient's
    arm in a downward position.
    6. Remove needle shield. Perform venipuncture with the arm in a downward position and tube in
    vertical position, stopper uppermost.
    7. Push tube to end of holder, puncturing diaphragm of stopper.
    8. As soon as adequate blood flow is obtained, remove tourniquet.

Note: If at this point there is no blood flow into the tube or if blood flow ceases before adequate sample is obtained, the following steps are suggested to complete satisfactory blood collection. Each successive step should be taken until flow into the tube occurs.

  1. a. Confirm correct positioning of needle cannula in vein.
    b. Remove tube and fully insert a new tube into holder.
    c. Remove tourniquet and needle, and repeat venipuncture.


Single Sample Collection

9. When vacuum is exhausted and blood stops flowing into tube, immediately remove needle from
vein, and apply pressure to puncture with a dry sterile swab. Keeping swab in place, elevate
arm to prevent oozing of blood.
10. Remove the tube of blood from holder. If the tube contains additives, gently invert 8-10 times
to mix. Do not shake.
11. Apply bandage if required.

 

Multiple Sample Collection

9. When vacuum is exhausted and blood flow ceases, immediately remove tube from holder.
10. Place second tube in holder. While blood is flowing into succeeding tubes, gently invert
previously filled tubes containing additives 8-10 times to mix.
11. As soon as blood stops flowing into the last tube to be drawn, remove needle from vein and
apply pressure to puncture site with a dry sterile swab. Keeping swab firmly in place, elevate
arm to prevent oozing of blood.
12. Apply adhesive bandage to site if required.


SPECIMEN LABELING PROCEDURE

  1. 1. Patients last name, first name, DOB and time of draw shall be written on all specimens that you have drawn or collected. You should be verifying the spelling of the patient’s name and their DOB by having them spell it to you as you are writing it on the tube/container.  All specimens shall be labeled in front of the patient after the specimen is collected.  The only specimen that shall be labeled prior to collection is a urine container.
  2. 2. When labeling with the 4medica label, the label should be under the patient’s name on the tube. Line the 4medical label up with the label on the tube (far left).  On the 5ml tubes there will be an over lap at the bottom, this is okay.
  3. 3. All tubes of blood, urine specimens, stool specimens (in urine container) should be labeled with a 4medica label if a 4medica test requisition was generated.

NOTE:  Do not put 4medica labels on Thin Preps, Sure Paths, Culture swabs, stool O&P bottles and
biopsy bottles.  These specimen types are too small for a label to fit on properly.

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