Chapter 7 r Specimen Collectiorr and Processrng
Figure 7-l Assembled venipuncture set. (From Ftynn JC.
Procedures in phlebotomy, ird editjon. St Louis: Saunders,2005.)
such as RNA isolation. These less common tubes must be
validated by each laboratory before use if not approved by the
manufacturer for the specific analysis to be conducted.
Stoppers may contain zinc, invalidating the use of evacu_
ated blood tubes for zinc measurement, and TBEp
[tris(2_
butoxyethyl) phosphate], a constituent of rubber, which may
interfere with the measurement of certain drugs. With time,
the vacuum in evacuated tubes is lost and their effective
draw diminishes. The silicone coating also decays with age.
Therefore the stock of these tubes should be rotated and
careful attention paid to the expiration date. Blood collected
into a tube containing one additive should never be trans_
ferred into other tubes, because the first additive may inter_
fere with tests for which a different additive is specified.
Additionally, transfer of the additive from one tube toanother
should be minimized (or adverse effects reduced) through
strict adherence to recommendations for order of tube u.se
(see Table 7-2).
A tlpical system for collecting blood in evacuated tubes
is shown in Figure 7-1.17 This is an example of a commonly
used single-use device that incorporates a cover that is
designed to be placed over the needle when collection of
thc blood is complete, thereby reducing the risk of puncture
of the phlebotomist by the now contaminated needle. A
needle or winged (butterfly) set is screwed into the collection
tube holder, and the tube is then gently inserted into this
holder. The tube should be gently tapped to dislodge any
additive from the stopper before the needle is inserted into
a vein; this prevents aspiration of the additive into the
patient's vein.
After the skin has been cleaned, the needle should be
guided gently into the patient's vein (Figure 7-Z); once the
needle is in place, the tube should be pressed forward into the
holder to puncture the stopper and release the vacuum. As
s-oon
T blood begins to flow into the tube, the tourniquet
should be released without moving the needle (see earlier
discussion on venous occlusion). The tube is filled until the
vacuum is exhausted. It is critically important that the evacu_
ated tube be filled completely. Many additives are provided
in the tube based on a "full" collection; deviation or short
draws can be a source of preanalytical error because they
can significantly affect test results.T Once the tube is filled
completely, it should be withdrawn from the holder, mlxed
149
Figure 7 -7 Venipuncture . (Courtesy Ruth M.locobsen, Moyo Clinic,
Rocheste6 Minn.)
gerrtly by inversion, and replaced by another tube, if this is
necessary. Other tubes may be filled using the same technique
with the holder in place. When several tubes are required
from a single blood collection, a shut-of valve-consisting of
rubber tubing that slides over the needle opening-is used to
prevent spillage ofblood during exchange oftubes.
Blood Collection With Syringe
Syringes are customarily used for patients with difficult veins.
if a syringe is used, the needle is placed firmly over the nozzle
of the syringe, and the cover of the needle is removed. If the
syringe has an eccentricnozzle,the needle should be arranged
with the nozzle downward but the bevel of the needle upward.
The syringe and the needle should be aligned with the vein
to be entered and the needle pushed into the vein at an angle
to the skin of approximately 15 degrees.-When the initial
resistance of the vein wall is overcome as it is pierced, forward
pressure on the syringe is eased, and the blood is withdrawn
by gently pulling back the plunger of the syringe. Should a
second syringe be necessary, a gauze pad may be placed under
the hub of the needle to absorb the spill; the first syringe is
then quickly disconnected, and the second put in place to
continue the blood draw. Using the same needle or a new
needle, the cap of the evacuated tube should be punctured
and the evacuated tube allowed to fill passively. Uncapping
the evacuated tube is not recommended. Vigorous with-
drarr.al of blood into a syringe during collection or forceful
transfer from the syringe to the receiving vessel may cause
hemoivsis of blood. Hemolysis is usually less when blood is
drau'n through a smail-bore needle than when a larger-bore
needle is used.