When Using The Safer Plastic Vacuum Tubes, Which Of The Following Is The Correct Order Of Draw?

Blood COLLECTION:

ROUTINE VENIPUNCTURE AND SPECIMEN HANDLING

Objectives for the tutorial:

Depict and perform the venipuncture process including:
1. Appropriate habiliment and protective equipment
2. Ensuring the comfort of the patient
3. Proper patient identification procedures.
4. Proper equipment pick and use.
5. Proper labeling procedures and completion of laboratory requisitions.
6. Order of describe for multiple tube phlebotomy.
7. Preferred venous access sites, and factors to consider in site selection, and power to differentiate between the experience of a vein, tendon and artery.
8. Patient intendance following completion of venipuncture.
9. Prophylactic and infection control procedures.
10. Quality balls problems.
Place the additive, condiment function, book, and specimen considerations to be followed for each of the diverse color coded tubes.
List 6 areas to be avoided when performing venipuncture and the reasons for the restrictions.
Summarize the issues that may be encountered in accessing a vein, including the procedure to follow when a specimen is not obtained.
List several furnishings of practice, posture, and tourniquet application upon laboratory values.

VENIPUNCTURE PROCEDURE

The venipuncture procedure is complex, requiring both cognition 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 foreclose contact with blood. Laboratory coats or work smocks are not typically needed equally 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 effect in an employee's need for laboratory coats or other personal protective equipment to prevent contact with blood. It is an employer's responsibility to provide, clean, repair, supervene upon, and/or dispose of personal protective equipment/clothing. As role of presenting a professional appearance, an institutional dress code may include wearing of a laboratory glaze 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 least v minutes to avoid beingness rushed or confused?
Carry out hand hygiene before and after each patient procedure, before putting on and subsequently removing gloves.
Identify the patient using two different identifiers, asking open up ended questions such as, "What is your name?" and "What is your date of birth?"
Assess the patient's physical disposition (i.east. diet, exercise, stress, basal state).
Bank check the requisition form for requested tests, patient information, and any special requirements.
Characterization the collection tubes at the bedside or drawing area.
Select a suitable site for venipuncture.
Set the equipment, the patient and the puncture site.
Perform the venipuncture, collecting the sample(s) in the appropriate container(due south).
Recognize complications associated with the phlebotomy procedure.
Assess the demand for sample recollection and/or rejection.
Promptly send the specimens with the requisition to the laboratory.

Social club Class / REQUISITION

A requisition form must accompany each sample submitted to the laboratory. This requisition course must contain the proper information in order to process the specimen. The essential elements of the requisition class are:

Patient's surname, first proper name, and centre initial.
Patient's ID number.
Patient'south date of birth and sex activity.
Requesting physician's complete name.
Source of specimen. This data must be given when requesting microbiology, cytology, fluid analysis, or other testing where analysis and reporting is site specific.
Engagement and time of drove.
Initials of phlebotomist.
Indicating the test(southward) requested.

An example of a simple requisition class with the essential elements is shown below:

LABELING THE SAMPLE

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

Patient's surname, outset and center.
Patient's ID number.
Note: Both of the in a higher place MUST match the same on the requisition form.
Date, time and initials of the phlebotomist must exist on the label of EACH tube.

Automated systems may include labels with bar codes.

Examples of labeled drove tubes are shown below:

EQUIPMENT:

THE Following ARE NEEDED FOR ROUTINE VENIPUNCTURE:

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

ORDER OF DRAW

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

First - claret culture bottle or tube (yellow or xanthous-black meridian)
Second - coagulation tube (light blue meridian). If just a routine coagulation assay is the only exam ordered, then a unmarried light blueish top tube may be drawn. If there is a concern regarding contamination by tissue fluids or thromboplastins, and so 1 may describe a non-additive tube first, then the light blue top tube.
3rd - not-additive tube (red peak)
Last depict - additive tubes in this gild:
1. SST (red-gray or aureate tiptop). Contains a gel separator and clot activator.
2. Sodium heparin (dark light-green peak)
3. PST (light green top). Contains lithium heparin anticoagulant and a gel separator.
4. EDTA (lavender top)
5. ACDA or ACDB (stake yellow elevation). Contains acid citrate dextrose.
6. Oxalate/fluoride (light gray top)

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

PROCEDURAL ISSUES

PATIENT RELATIONS AND IDENTIFICATION:

The phlebotomist's role requires a professional, courteous, and understanding mode in all contacts with the patient. Greet the patient and identify yourself and indicate the procedure that will have place. Effective advice - both verbal and nonverbal - is essential.

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

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

If possible, speak with the patient during the process. The patient who is at ease will be less focused on the procedure. Always give thanks the patient and excuse yourself courteously when finished.

PATIENT'Southward BILL OF RIGHTS:

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

The patient has the right to:

Impartial access to treatment or accommodations that are available or medically indicated, regardless of race, creed, sex, national origin, or sources of payment for intendance.
Considerate, respectful care.
Confidentiality of all communications and other records pertaining to the patient'south care.
Look that any discussion or consultation involving the patient'due south instance will be conducted discretely and that individuals not directly involved in the instance will not be nowadays without patient permission.
Expect reasonable safety congruent with the infirmary practices and environment.
Know the identity and professional condition of individuals providing service and to know which physician or other practitioner is primarily responsible for his or her care.
Obtain from the practitioner complete and current data nearly diagnosis, treatment, and whatsoever known prognosis, in terms the patient can reasonably exist expected to sympathise.
Reasonable informed participation in decisions involving the patient'due south wellness care. 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 handling. The patient has the correct to turn down participation in such activity.
Consult a specialist at the patient's own request and expense.
Turn down treatment to the extent permitted by law.
Regardless of the source of payment, request and receive an itemized and detailed explanation of the total pecker for services rendered in the hospital.
Be informed of the hospital rules and regulations regarding patient conduct.

VENIPUNCTURE SITE SELECTION:

Although the larger and fuller median cubital and cephalic veins of the arm are used most frequently, the basilic vein on the back of the arm or dorsal hand veins are also acceptable for venipuncture. Foot veins are a concluding resort because 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 be affected because of lymphedema.
Hematoma - may cause erroneous test results. If some other site is non available, collect the specimen distal to the hematoma.
Intravenous therapy (4) / blood transfusions - fluid may dilute the specimen, so collect from the opposite arm if possible. Otherwise, satisfactory samples may be drawn beneath the Iv past following these procedures:
- Turn off the IV for at to the lowest degree ii minutes before venipuncture.
- Apply the tourniquet below the IV site. Select a vein other than the one with the IV.
- Perform the venipuncture. Draw 5 ml of blood and discard before drawing the specimen tubes for testing.
Lines - Cartoon from an intravenous line may avoid 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 avert hemolysis.
Cannula/fistula/heparin lock - hospitals have special policies regarding these devices. In general, blood should not exist drawn from an arm with a fistula or cannula without consulting the attending medico.
Edematous extremities - tissue fluid aggregating alters examination results.

PROCEDURE FOR VEIN SELECTION:

Palpate and trace the path of veins with the index finger. Arteries pulsate, are near elastic, and have a thick wall. Thrombosed veins lack resilience, feel cord-like, and roll easily.
If superficial veins are non readily apparent, you can forcefulness blood into the vein by massaging the arm from wrist to elbow, tap the site with alphabetize and second finger, apply a warm, damp washcloth to the site for 5 minutes, or lower the extremity over the bedside to allow 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 proceeds the patient'southward cooperation.
Identify the patient correctly.
Properly fill up out appropriate requisition forms, indicating the test(southward) ordered.
Verify the patient'due south condition. Fasting, dietary restrictions, medications, timing, and medical treatment are all of concern and should be noted on the lab requisition.
Cheque for whatever allergies to antiseptics, adhesives, or latex by observing for armbands and/or by asking the patient.
Position the patient. The patient should either sit in a chair, lie down or sit down upwards in bed. Hyperextend the patient's arm.
Apply the tourniquet iii-iv inches above the selected puncture site. Practise not place too tightly or go out on more than than 2 minutes (and no more a minute to avoid increasing risk for hemoconcentration). Look 2 minutes before reapplying the tourniquet.
The patient should make a fist without pumping the mitt.
Select the venipuncture site.
Gear up the patient's arm using an alcohol prep. Cleanse in a circular fashion, beginning at the site and working outward. Allow to air dry out.
Grasp the patient's arm firmly using your pollex to draw the peel taut and anchor the vein. The needle should form a fifteen to 30 degree angle with the surface of the arm. Swiftly insert the needle through the pare and into the lumen of the vein. Avoid trauma and excessive probing.
When the last tube to be drawn is filling, remove the tourniquet.
Remove the needle from the patient'south arm using a swift backward motion.
Press down on the gauze once the needle is out of the arm, applying acceptable pressure to avoid germination of a hematoma.
Dispose of contaminated materials/supplies in designated containers.
Mix and label all appropriate tubes at the patient bedside.
Deliver specimens promptly to the laboratory.

PHLEBOTOMY PROCEDURE ILLUSTRATED:

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

Operation OF A FINGERSTICK:

Follow the process as outlined higher up for greeting and identifying the patient. As always, properly fill out advisable requisition forms, indicating the test(s) ordered.

Verify the patient's status. Fasting, dietary restrictions, medications, timing, and medical handling are all of business organization and should be noted on the lab requisition.

Position the patient. The patient should either sit in a chair, lie downwards or sit upward in bed. Hyperextend the patient's arm.

The all-time locations for fingersticks are the third (middle) and 4th (band) fingers of the not-dominant manus. Practice not apply 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 2nd (alphabetize) finger tends to have thicker, callused skin. The fifth finger tends to have less soft tissue overlying the bone. Avert puncturing a finger that is common cold or cyanotic, swollen, scarred, or covered with a rash.

Using a sterile lancet, make a pare puncture simply off the center of the finger pad. The puncture should be made perpendicular to the ridges of the fingerprint so that the drop of blood does not run downwardly the ridges.

Wipe away the showtime drib of blood, which tends to contain excess tissue fluid.

Collect drops of claret into the collection device by gently massaging the finger. Avoid excessive pressure that may clasp tissue fluid into the driblet of blood.

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

Take the patient agree a small gauze pad over the puncture site for a couple of minutes to stop the bleeding.

Dispose of contaminated materials/supplies in designated containers.

Label all appropriate tubes at the patient bedside.

Deliver specimens promptly to the laboratory.

FINGERSTICK Process ILLUSTRATED:

Equipment

Proper location on finger

Puncture with lancet

Drop of blood

Wipe first drib

Collecting the specimen

Specimen container

ADDITIONAL CONSIDERATIONS:

To prevent a hematoma:

Puncture simply the uppermost wall of the vein
Remove the tourniquet earlier removing the needle
Use the major superficial veins
Make sure the needle fully penetrates the upper almost wall of the vein. (Fractional penetration may let blood to leak into the soft tissue surrounding the vein by way of the needle bevel)
Use force per unit area to the venipuncture site

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

Mix tubes with anticoagulant additives gently five-10 times
Avoid cartoon blood from a hematoma
Avert drawing the plunger back too forcefully, if using a needle and syringe, or too modest a needle, and avoid frothing of the sample
Make sure the venipuncture site is dry
Avoid a probing, traumatic venipuncture
Avert 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 gamble of thrombosis
Discard a sample at to the lowest degree 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 awarding (no more than 1 minute)
Massaging, squeezing, or probing a site
Long-term Iv therapy
Sclerosed or occluded veins

Prolonged Tourniquet Awarding:

Master event is hemoconcentration of non-filterable elements (i.e. proteins). The hydrostatic pressure causes some water and filterable elements to exit the extracellular infinite.
Significant increases can be found in total protein, aspartate aminotransferase (AST), total lipids, cholesterol, iron
Affects packed cell volume and other cellular elements
Hemolysis may occur, with pseudohyperkalemia.

Patient Preparation Factors:

Therapeutic Drug Monitoring: different pharmacologic agents have patterns of assistants, torso distribution, metabolism, and emptying that bear on the drug concentration equally measured in the blood. Many drugs will take "meridian" and "trough" levels that vary co-ordinate to dosage levels and intervals. Cheque for timing instructions for drawing the appropriate samples.
Effects of Practise: Muscular activeness has both transient and longer lasting effects. The creatine kinase (CK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and platelet count may increment.
Stress: May cause transient elevation in white blood cells (WBC's) and elevated adrenal hormone values (cortisol and catecholamines). Anxiety that results in hyperventilation may cause acid-base imbalances, and increased lactate.
Diurnal Rhythms: Diurnal rhythms are torso fluid and analyte fluctuations during the day. For example, serum cortisol levels are highest in early morning just are decreased in the afternoon. Serum fe levels tend to drop during the day. You lot must check the timing of these variations for the desired drove indicate.
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: Historic period, gender, and pregnancy take an influence on laboratory testing. Normal reference ranges are oftentimes noted co-ordinate to age.

REASONS FOR CANCELING A LABORATORY TEST

A test that has been ordered may exist cancelled due to problems unrelated to drawing the specimen, and these are the most mutual causes for cancellations:

Duplicate test request
Incorrect test ordered
Examination no longer needed

A examination may be cancelled due to a technical problem in the specimen collection procedure:

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 besides one-time

SAFETY AND INFECTION Command

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

PROTECT YOURSELF

Exercise universal precautions:
- Clothing gloves and a lab coat or gown when handling claret/body fluids.
- Change gloves subsequently each patient or when contaminated.
- Wash hands frequently.
- Dispose of items in advisable containers.
Dispose of needles immediately upon removal from the patient's vein. Do not bend, break, recap, or resheath needles to avert accidental needle puncture or splashing of contents.
Clean up whatever blood spills with a disinfectant such as freshly made ten% 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 area well with lather and water.
- Record the patient's name and ID number.
- Follow establishment's guidelines regarding treatment and follow-upward.
- 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 away from patients, particularly children and psychiatric patients.
Practise hygiene for the patient's protection. When wearing gloves, change them between each patient and wash your hands frequently. E'er wear a clean lab coat or gown.

TROUBLESHOOTING GUIDELINES:

IF AN INCOMPLETE Collection OR NO Blood IS OBTAINED:

Modify the position of the needle. Move information technology forward (it may not be in the lumen)
or movement it backward (it may have penetrated also far).
Adapt the bending (the bevel may exist against the vein wall).
Loosen the tourniquet. It may be obstructing blood flow.
Attempt another tube. Use a smaller tube with less vacuum. At that place may be no vacuum in the tube being used.
Re-ballast the vein. Veins sometimes roll away from the point of the needle and puncture site.
Have 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 increase blood menstruation.
Have the patient drink fluids if dehydrated.

IF BLOOD STOPS FLOWING INTO THE TUBE:

The vein may have collapsed; resecure the tourniquet to increase venous filling. If this is not successful, remove the needle, take care of the puncture site, and redraw.
The needle may have pulled out of the vein when switching tubes. Concord equipment firmly and place fingers against patient'south arm, using the flange for leverage when withdrawing and inserting tubes.

Problems OTHER THAN AN INCOMPLETE COLLECTION:

A hematoma forms nether the skin next to the puncture site - release the tourniquet immediately and withdraw the needle. Apply firm pressure level.

Hematoma germination is a problem in older patients.
The blood is bright cherry (arterial) rather than venous. Apply firm pressure for more than 5 minutes.

BLOOD COLLECTION ON BABIES:

The recommended location for claret collection on a newborn baby or infant is the heel. The diagram below indicates in green the proper area to employ for heel punctures for blood collection:
Prewarming the infant's heel (42 C for 3 to v minutes) is important to obtain capillary blood gas samples and warming as well profoundly increases the menstruation of claret for collection of other specimens. However, do not apply too high a temperature warmer, considering baby's skin is sparse and susceptible to thermal injury.
Make clean the site to be punctured with an alcohol sponge. Dry the cleaned area with a dry cotton sponge. Hold the baby's human foot firmly to avert sudden movement.
Using a sterile blood lancet, puncture the side of the heel in the appropriate regions shown above in green. Do not utilise the central portion of the heel because you might hurt the underlying bone, which is shut to the skin surface. Practice not use a previous puncture site. Make the cut across the heelprint lines so that a drop of claret tin can well up and not run down along the lines.
Wipe away the first drop of blood with a piece of clean, dry cotton. Since newborns do non often bleed immediately, use gentle pressure to produce a rounded drop of blood. Do not use excessive force per unit area or heavy massaging because the blood may become diluted with tissue fluid.
Fill up the capillary tube(s) or micro drove device(s) as needed.
When finished, elevate the heel, place a piece of clean, dry cotton on the puncture site, and hold it in place until the bleeding has stopped.
Be sure to dispose of the lancet in the appropriate sharps container. Dispose of contaminated materials in advisable waste receptacles. Remove your gloves and launder your hands.

HEELSTICK PROCEDURE ILLUSTRATED:

Heelstick on baby

PEDIATRIC PHLEBOTOMY:

Children, particularly under the age of 10, may experience pain and feet during the phlebotomy procedure.
A multifariousness of techniques can be employed to reduce pain and anxiety. Effective methods use lark. 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 on, using wink cards, and squeezing a condom ball. (Uman et al, 2022)

Collection TUBES FOR PHLEBOTOMY

Collection tubes can vary in size for book of claret drawn, advisable 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 ten mL.
Smaller collection tubes for sample sizes of 2 mL or less may be advisable in situations where a smaller amount blood should be drawn, every bit in pediatric patients, or to minimize hemolysis during collection, or to avoid insufficient sample volume in the collection tube.

Red Top
ADDITIVE	None
Style OF Activity	Blood clots, and the serum is separated past centrifugation
USES	Chemistries, Immunology and Serology, Blood Bank (Crossmatch)

Gold Height
Additive	None
MODE OF Activity	Serum separator tube (SST) contains a gel at the bottom to separate blood from serum on centrifugation
USES	Chemistries, Immunology and Serology

Light Green Top
ADDITIVE	Plasma Separating Tube (PST) with Lithium heparin
MODE OF ACTION	Anticoagulates with lithium heparin; Plasma is separated with PST gel at the bottom of the tube
USES	Chemistries

Regal Superlative
ADDITIVE	EDTA
MODE OF Activeness	Forms calcium salts to remove calcium
USES	Hematology (CBC) and Blood Depository financial institution (Crossmatch); requires total describe - invert 8 times to forbid clotting and platelet clumping

Lite Blue Peak
Condiment	Sodium citrate
Style OF ACTION	Forms calcium salts to remove calcium
USES	Coagulation tests (protime and prothrombin time), full draw required

Green Top
ADDITIVE	Sodium heparin or lithium heparin
MODE OF Action	Inactivates thrombin and thromboplastin
USES	For lithium level, use sodium heparin For ammonia level, employ sodium or lithium heparin

Dark Bluish Top
Additive	EDTA-
MODE OF Activity	Tube is designed to comprise no contaminating metals
USES	Trace chemical element testing (zinc, copper, lead, mercury) and toxicology

Calorie-free Gray Top
Condiment	Sodium fluoride and potassium oxalate
MODE OF ACTION	Antiglycolytic agent preserves glucose up to 5 days
USES	Glucoses, requires full draw (may cause hemolysis if short depict)

Yellow Top
ADDITIVE	ACD (acid-citrate-dextrose)
MODE OF Activity	Complement inactivation
USES	HLA tissue typing, paternity testing, Dna studies

Yellow - Black Meridian
ADDITIVE	Broth mixture
Style OF ACTION	Preserves viability of microorganisms
USES	Microbiology - aerobes, anaerobes, fungi

Black Top
ADDITIVE	Sodium citrate (buffered)
MODE OF Activeness	Forms calcium salts to remove calcium
USES	Westergren Sedimentation Rate; requires full draw

Orange Height
ADDITIVE	Thrombin
MODE OF ACTION	Quickly clots claret
USES	STAT serum chemistries

Low-cal Brown Height
ADDITIVE	Sodium heparin
Way OF ACTION	Inactivates thrombin and thromboplastin; contains near no lead
USES	Serum pb determination

Pink Top
ADDITIVE	Potassium EDTA
MODE OF ACTION	Forms calcium salts
USES	Immunohematology

White Meridian
Condiment	Potassium EDTA
MODE OF Action	Forms calcium salts
USES	Molecular/PCR and bDNA testing

References

Giavarina D, Lippi One thousand. Claret venous sample collection: Recommendations overview and a checklist to ameliorate quality. Clin Biochem. 2022;50(10-11):568-573.

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

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

Lippi G, Salvagno GL, Montagnana Thou, Franchini K, Guidi GC. Phlebotomy issues and quality improvement in results of laboratory testing. Clin Lab. 2006;52(5-6):217-thirty.

Lippi G, Blanckaert N, Bonini P, Green Southward, Kitchen S, Palicka V, 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 Rubber and Wellness Administration, United States Section 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 January x, 2022).

Phelan MP, Reineks EZ, Berriochoa JP, Schold JD, Hustey FM, Chamberlin J, Kovach A. Impact of Use of Smaller Book, Smaller Vacuum Claret Collection Tubes on Hemolysis in Emergency Department Blood Samples. Am J Clin Pathol. 2022;148(iv):330-335.

Uman LS, Birnie KA, Noel M, et al. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev. 2022 Oct ten;(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, vii.

World Health Organisation. WHO guidelines on drawing blood: best practices in phlebotomy. https://www.ncbi.nlm.nih.gov/books/NBK138650/pdf/Bookshelf_NBK138650.pdf (Accessed January 10, 2022)

And for our furry friends:

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

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

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