Blood Collection

Equipment
Blood Collection Equipment
• Gloves
– Non-sterile
– Disposable latex
– Nitrile
– Neoprene
– Polyethylene
– Vinyl examination gloves
Blood Collection Equipment
• Antiseptics
– are substances used to prevent sepsis
(microorganisms or their toxic products within
the bloodstream)
– prevent or inhibit the growth and development
of microorganisms but do not necessarily kill
them
– 70% isopropyl alcohol/isopropanol (most
common antiseptic)
• Other antiseptics:
– 70% Ethyl alcohol
– Benzalkonium chloride (e.g., Zephiran chloride)
– Chlorhexidine gluconate – 2% in 70% alcohol
– Hydrogen peroxide
– Povidone–iodine (0.1%–1% available iodine)
– Tincture of iodine
Blood Collection Equipment
• Tourniquet
– is a device that is applied
or tied around a patient’s
arm prior to venipuncture
to restrict blood flow.
• Latex
• Nitrile
• Vinyl
Blood Collection Equipment
• Needles
– has 3 types:
• multi sample needles (ETS)
• Hypodermic needles
(venipuncture)
• Winged infusion (butterfly)
needle
– Gauge
• number related to the size
of the lumen
• Length- 1 to 1.5 inches
Blood Collection Procedures
• EVACUATED TUBE SYSTEM
– a closed system in which the patient’s blood flows
through a needle inserted into a vein and then
directly into a collection tube without being
exposed to the air or outside contaminants
– Uses multisampling needles, tube holder,
evacuated tubes (tube stopper)
– For evacuated tubes –additive and non-additive
tubes
Blood Collection Procedures
• SYRINGE SYSTEM
– used for patients with small and difficult veins
– Uses hypodermic needle
Blood Collection Procedures
• WINGED INFUSION SET (Butterfly)
– is an indispensable tool for collecting blood from
small or difficult veins such as hand veins and
veins of elderly and pediatric patients
– Length of needle: ½ to ¾ inch
– Length of tube: 5 to 12 inches
Blood Collection Additives
(Anticoagulants)
• liquid, spray-dried, powder form
• Anticoagulants
– are substances that prevent blood from clotting
(coagulating)
– acts by inhibiting function of calcium
Blood Collection Additives
(Anticoagulants)
• EDTA (Ethylene diamine tetra acetic acid)
– prevents coagulation by binding or chelating calcium
– preserves cell morphology (shape and structure) and
inhibits platelet aggregation
– Types:
• Di-pottasium EDTA (K2)- versene
• Tri-pottasium EDTA (K3)- sequestrene
– Lavander, pink, royal blue top, white
– Most recommended is spray dried EDTA- does not
dilute specimen unlike liquid EDTA
Blood Collection Additives
(Anticoagulants)
• Citrates
– prevent coagulation by binding or chelating
calcium
– Most common is Sodium Citrate
– Used in coagulation tests (PT and APTT) because it
preserves the clotting factors
– Require immediate mixing after collection to
prevent activation of the coagulation process and
micro-clot formation, which invalidates test
results
Blood Collection Additives
(Anticoagulants)
• Citrates

Sodium citrate is also the additive in original

erythrocyte sedimentation rate (ESR) tubes with black
stoppers. Modified ESR- EDTA

Light blue top tube Black top tube

3.2% 3.8%
0.109 M 0.129 M
4:1 9:1
Blood Collection Additives
(Anticoagulants)
• Heparin
– prevents clotting by inhibiting thrombin formation
– Used in electrolyte testing, ABG tests, ammonia, OFT
– Naturally occurring anticoagulant
– Acts as co-factor for anti-thrombin III
– Released by basophils and mast cells

**thrombin is an enzyme needed to convert fibrinogen to fibrin

for clot formation
Blood Collection Additives
(Anticoagulants)
• Oxalates
– prevent coagulation by precipitating calcium
– Potassium oxalate
• is the most widely used- added to tubes containing
glucose preservatives for glucose testing
Blood Collection Additives
• ANTIGLYCOLYTIC AGENTS
– a substance that prevents glycolysis, the breakdown
or metabolism of glucose (blood sugar) by blood cells.
– most common is sodium fluoride- maybe used in
combination of the anticoagulant potassium oxalate

***If glycolysis is not prevented, the glucose concentration in a

blood specimen decreases at a rate of 10 mg/dL per hour; rate of
glycolysis- 10 mg/dL per hour

***antiglycolytic agents- rate of glycolysis- 2 mg/dL per hour

Blood Collection Additives
• CLOT ACTIVATORS
– is a substance that enhances coagulation in tubes
used to collect serum specimens
– enhances platelet activation
– Examples:
• silica particles
– serum separator tubes (SST); blood clots 15-30 mins
• Thrombin
– Blood clots 5 mins
• Cellite

***tubes with clot activators- 5 inversions

Blood Collection Additives
• THIXOTROPIC GEL
– is an inert (non-reacting) non-synthetic substance
initially contained in or near the bottom of certain
blood collection tubes
– moves between the cells and the serum or plasma
after centrifugation
– found in serum separator tubes (SST)
 ORDER OF DRAW WITH RATIONALE
Tube Stopper
Order of Draw Rationale for Collection Order
Color
Blood cultures Yellow (SPS) Minimizes chance of microbial contamination.
Coagulation tubes Light blue The first additive tube in the order because all other
additive tubes affect coagulation tests/ affected by
other additives
Glass non-additive Red Prevents contamination by additives of other tubes.
tubes
Plastic (clot activator) Yellow/Red Filled after coagulation tests because silica particles
activate clotting and affect coagulation tests
Heparin tubes Green Heparin affects coagulation tests and interferes in
collection of serum specimen
EDTA Lavander, Pink more carryover problems than any other additive
elevates Na and K levels
chelates and decreases calcium and iron levels
elevates PT and PTT results
Oxalate/fluoride Gray affect sodium and potassium levels;
tubes oxalate damages cell membranes, causes abnormal
RBC morphology
interferes enzyme reactions
TUBE COLOR ADDITIVE COMMON LABORATORY USE
Red None Chemistry tests on serum:
 Glucose
 Cholesterol
 Triglycerides
 HDL
 Potassium
 Amylase
 alkaline phosphatase
 BUN
 CK
 liver enzymes
Serological tests on serum:
 RPR, Monospot
 Rheumatoid factor
 TUBE COLOR ADDITIVE COMMON LABORATORY USE
Serum Separator Tube Serum Separator Gel Chemistry tests on serum:
(SST)  Glucose
 Cholesterol
Gold
 Triglycerides

TUBE COLOR ADDITIVE COMMON LABORATORY USE

Lavender EDTA Hematology tests on whole
blood:
 CBC
 differential count
 platelet count
 reticulocyte count
 erythrocyte
sedimentation rate
(ESR)
 sickle cell screen
 hemoglobin
electrophoresis
TUBE COLOR ADDITIVE COMMON LABORATORY USE
Light Blue Sodium citrate  Coagulation tests on
plasma
 Prothrombin time (PT),
 APTT or PTT (Activated
Partial Thromboplastin
Time)
 Fibrinogen

TUBE COLOR ADDITIVE COMMON LABORATORY USE

Green Sodium heparin Chemistry tests on plasma
Lithium heparin  Ammonia
Ammonium heparin

TUBE COLOR ADDITIVE COMMON LABORATORY USE

Gray Sodium fluoride  Glucose
Potassium oxalate  Lactate
 Alcohol levels
TUBE COLOR ADDITIVE COMMON LABORATORY USE
Yellow Sodium polyanethol  Blood cultures
sulfonate (SPS)
(0.025%)

 Cellular studies
Acid citrate dextrose  HLA typing
 Paternity Testing

TUBE COLOR ADDITIVE COMMON LABORATORY USE

Royal Blue Clot Activator (Plastic)  Trace elements
EDTA (Plastic)  Toxicology
 Nutritional Chemistry
Testing

TUBE COLOR ADDITIVE COMMON LABORATORY USE

Tan EDTA (Plastic)  Lead Testing
TUBE COLOR ADDITIVE COMMON LABORATORY USE
White EDTA with Gel  Molecular diagnostic tests
such as DNA testing

TUBE COLOR ADDITIVE COMMON LABORATORY USE

Pink EDTA  Blood Banking tests on
plasma
End of Lecture