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Department of Pathology and Laboratory Medicine

Department of Pathology and Laboratory Medicine

Phlebotomy

Locations and Service Hours

General Information

The patient must be positively identified when the blood specimen is collected. Identification of the patient is crucial to ensuring that the blood specimen is drawn for the correct patient.

The likelihood of error occurring in the area of collecting and handling specimens is probably greater than the likelihood of error occurring in the procedure itself. Much attention needs to be devoted to the process of collecting and handling specimens.

Assemble the necessary supplies for the venipuncture. The evacuated tube system is the most commonly used means of collecting specimens. This system is preferable to the needle and syringe since it allows the blood to pass directly from the vein to the evacuated tube. The evacuated tube system decreases the possibility of needlesticks, helps to eliminated some labelling errors and decreases the likelihood of inappropriate specimens.

It is important to not leave the tourniquet on for longer than one minute; to do so may result in either hemoconcentration or variation in blood test values.

For accurate test results, follow the proper vacutainer draw order. The following is an example of the most common draw order:

  1. Blue (citrate tube)
  2. Red
  3. SST (serum separator tube)
  4. Green (heparin)
  5. Lavender (EDTA)
  6. Grey (sodium fluoride)

Also, to eliminate tissue fluid contamination, it is suggested that 3 to 4cc of blood be drawn into sodium citrate tubes (blue) before filling sodium citrate tubes (blue).

Some tests require that blood specimens be cooled in ice water, placed in warm water, or protected from light immediately following the venipuncture in order to prevent metabolic processes which may cause alteration of some test values. Specimen handling instructions are included in the test list in this manual.

Use "universal precautions" at all times.

WITHOUT capping needles, dispose of the puncture unit in an appropriate Sharpes container. Bag each specimen as required by Infection Control policies and place in laboratory courier box at the nursing station.

Phlebotomy Service

The laboratory phlebotomy team makes routine adult and pediatric blood drawing rounds 7 days a week at 0500 and 1900.

Nursery rounds are at 0600.

Laboratory phlebotomist are not available to procure STAT or Timed specimens.

Laboratory phlebotomist are instructed to procure specimen from properly identified patients only. A list indicating patients drawn or attempted and specimens collected is left at each nursing station. Accession logs for specimen collected in our outpatient laboratories are kept at each of the blood drawing stations.

Clinical laboratory results can be obtained by contacting the Specimen and Report Center at 4-0500, 24 hours a day and 7 days a week. The patient's medical record number and the patient's full name are necessary in order to obtain clinical results.

Phlebotomy Specimen Containers

SIZE STOPPER COLOR ADDITIVE

  • 7 mL red
  • 6 mL gold (SST) silicone
  • 5 mL lavender EDTA
  • 5 mL green lithium heparin
  • 5 mL plastic
  • 4.5 mL blue citrate
  • 5 mL gray sodium fluoride
  • 2 mL light blue thrombin
  • 3 mL red
  • 3 mL lavender EDTA
  • 3 mL green lithium heparin
  • 1.8 mL blue citrate
  • 600 mL plastic silicone (SST)
  • 300 mL plastic
  • 700 mL lavender EDTA
  • 0.3 mL yellow sodium fluoride
  • 5 mL lavender silicone (Nichols tube)
  • 5 mL black Acidified sodium citrate

Minimum Blood Amounts Required

ICU CONDENSED LIST

TEST COLOR OF TUBE MINIMUM
BMP
CMP

Osmolality, Blood

Magnesium, Blood

Amylase, Blood

Liver Panel

Calcium, Total, Blood

Phosphorus, Inorganic, Blood
one small red or green
one small red or green
2.5 - 2.8 cc's
3.0 cc's
Creatine Kinase - MB
LD Isoenzyme Panel
one small red 2.8 cc's
Digoxin one small red 2.8 cc's
Dilantin one small red 2.8 cc's
Blood Culture resin bottle
(1 blue)

(1 yellow)
4 cc's/bottle
Type & Cross one large red for 4 units
one large EDTA for 2 units
7 cc's
5 cc's
Vancomycin
Gentamycin
one small red 2.8 cc's
Procan
NAPA
one small red 2.8 cc's
Fibrinogen
PT/PTT

D-Dimer
one small or
medium liquid

blue
filled to
maximum
Calcium, Ionized, Whole Blood heparinized
syringe
1 cc- no ice
to Stat lab
Whole Blood Panel
with Blood Gas Panel

pH

pO2

pCO2

Sodium

Potassium

Chloride

Calcium, Ionized

Glucose

Hematocrit
Contact Blood Gas Lab



 

PEDIATRICS/SELECTED ADULTS

These minimums are assuming a Hct of <45-50%. If the Hct is >50% of the minimum amounts to be collected in bullets, then red tops and microtainers must be increased to obtain the minimum serum amounts for the test. The ones to look out for are children less than 1-2 months of age and children with heart problems. These children may tend to have a Hct of >50%. Neonatal Requirements, where different from adult minimums, are listed under the alphabetical listing of analytical methods. If there are any questions, call Pathology (ext. 2525) or SARC (ext. 4-0500) to double-check the minimum before attempting a draw.

 

Absolute Bullets

Use when minimum 300 mL allowable

Bactericidal 1.0 mL 4 2

titer

CBC 2 lavender EDTA microvettes filled

between second & third lines

Coombs, direct 900 mL 4 1

Copper 3 mL red top

Dilantin 500 mL 2 No

(Phenytoin)

If ordered with a phenobarbital, may draw both in same 1-3 mL purple; or if very small or need absolute minimum, 2 lavender microtainers or 3 bullets-full can be drawn for both

G-6-PD 3 Lavender top tube

Gentamycin 200 mcl s/p (2 bullets)

Hematocrit 2 heparinized (red) capillary tubes

HgB electro- 5 mL lavender top No

phoresis

Lead 3 mL lavender top

Phenobarbital 200 mcl s/p (2 bullets) 2 No

Platelets lavender EDTA microvettes filled between first and second lines

PTT 2 mL blue (citrate) top tube

Reticulocyte 2 lavender top microvettes

Sed rate cc lavender top

Theophylline 200 mcl s/p (2 bullets)

(aminophylline)

Type and 900 mL 2-3cc red top or EDTA

Crossmatch

for Pedi red

cell units