SPECIMEN
COLLECTION AND
PROCESSING
TOPIC 4
Public Relations and Client Interaction
Professionalism
•Appearance: lab coat, clean shoes, good
personal hygiene, hair pulled back (if long), short
fingernails
• Attitude: honest, compassionate, motivated,
dependable, diplomatic, ethical
• Communication skills: active listening, clear
vocabulary, nonverbal cues
• Bedside manner: discretion in dealing with
patient’s visitors
Patient Consent: must be obtained before
procedure
Confidentiality and HIPAA
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Legal Issues and Infection Control
Legal Issues
○ Most legal proceedings dealt with in medical
offices are between two private parties and
are civil actions.
○ Civil actions: damages awarded monetarily
○ Tort (most common civil action)
■ Wrong committed without just cause,
intentional or not
■ Examples: assault, battery, invasion of
privacy, breach of confidentiality,
negligence, malpractice, standard of
care
Infection Control: personal protective equipment,
hand hygiene, isolation
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The Vascular System Artery, vein, and capillary structure
● Arteries
○ Thick walls to withstand pressure of
contraction; pulse is felt
○ Arterial blood pumps or pulses into syringe
under its own power.
○ Bright red, oxygen-rich blood
● Veins
○ Thinner walls, under less pressure,
collapse easier
○ Blood kept moving by skeletal muscle
movement and valves
○ Bluish-red, oxygen-poor blood
● Capillaries
(Reprinted with permission from McCall R. & Tankersley C:
○ one cell thick; easily punctured with lancet Phlebotomy Essentials 4th edition, Baltimore: Lippincott Williams &
Wilkins, 2008)
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Source and Composition
of Blood Specimens
Arterial
Blood composition is uniform throughout body.
Arterial puncture is technically difficult and
potentially hazardous.
Reserved for blood gas evaluation,
emergencies; special training required
Venous
Blood composition affected by metabolic activity
of tissue, varies
Lower oxygen content than arterial blood
Capillary
contains arterial and venous blood, tissue fluid
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Types of Blood
Specimens
Serum
Clear, pale yellow fluid; if non-fasting, cloudy
due to lipids
Separated from blood by centrifugation
Plasma
Clear to slightly hazy, pale yellow fluid; contains
fibrinogen
Separated from cells when blood is centrifuged
in anticoagulant tube
Whole Blood
Contains both cells and plasma
Used for most hematology, many point-of-care
tests
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Venipuncture Equipment
• Tourniquet
• Needles
• Evacuated Tube System
• Syringe System
• Butterfly System
• Tube Additives
• Trace-Element-Free Tubes
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Order of Draw and
Additive Carryover
• Order of Draw
Special sequence of tube collection that
reduces risk of specimen contamination by
microorganisms and additive carryover
• Order of tubes
sterile, light blue, red, serum separator tube,
plasma separator tube, green, lavender, gray
• Additive Carryover
Occurs when blood in an additive tube
touches needle during venipuncture or
transfer from a syringe
Additive in blood on or within needle can be
transferred to next tube drawn or filled
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Venipuncture Procedures
Troubleshooting Failed Venipuncture
• Improper tube position
• Loss of vacuum
• Bevel against vein wall
• Needle too deep, not deep enough,
beside vein
• Collapsed vein
• Undetermined needle position
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Venipuncture Procedures
Multiple Venipuncture Attempts
• If first attempt fails, try once more below
first site, on other arm, or on hand or wrist
vein.
• If second attempt fails, ask someone else
to try.
• If second person fails after two attempts,
give patient a rest and try again later.
• Notify nurse or physician if specimen is
not obtained.
10
Venipuncture Procedures
Pediatric Venipuncture
• If age <2 years, limit to superficial veins
of forearm.
• Collect minimum amount required to
prevent anemia.
• Approach child slowly and lower yourself
to child’s level.
• Explain procedure in simple terms and
answer questions.
• Don’t say it won’t hurt.
• Offer reward for being brave.
• Immobilize child for safety.
• Use 23-gauge butterfly & tube holder,
small-volume tube.
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Venipuncture Procedures
Geriatric Venipuncture
• Alzheimer’s/dementia: solicit caregiver’s
assistance
• Arthritis: never use force to extend arm or
open hand
• Coagulation issues: hold firm pressure to
stop bleeding
• Cataracts/dim vision: guide, escort
patient as needed
• Hearing loss/stroke: take extra time to
communicate
• Fragile skin and veins: anchor veins
securely, gently
• Slower learning/reaction time: speak
clearly, slowly
• Parkinson’s: help patient hold arm still
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Venipuncture Procedures
Geriatric Venipuncture
• Alzheimer’s/dementia: solicit caregiver’s
assistance
• Arthritis: never use force to extend arm or
open hand
• Coagulation issues: hold firm pressure to
stop bleeding
• Cataracts/dim vision: guide, escort
patient as needed
• Hearing loss/stroke: take extra time to
communicate
• Fragile skin and veins: anchor veins
securely, gently
• Slower learning/reaction time: speak
clearly, slowly
• Parkinson’s: help patient hold arm still
13
Preanalytic Considerations
Problem Sites
• Burns, scars, tattoos
• Damaged veins
• Edema
• Hematoma
• Arm on same side of mastectomy
• Vascular Access Devices
• Procedural Error Risks
• Patient Conditions and Complications
14
Capillary Specimen
Collection
• Alcohol, Gauze, Bandages
• Lancets
• Warming Devices
• Microcollection Tubes
• Microhematocrit Tubes
• Sealants
• Capillary Order of Draw
• Indications for Capillary Puncture
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Capillary Puncture
Procedures
Neonatal Bilirubin Collection
• Collect carefully to avoid hemolysis.
• Collect as close as possible to requested
time.
• Minimize light exposure: turn off UV lights,
collect quickly, use amber microtubes.
Neonatal Screening (heel puncture)
• Press filter paper against punctured heel
until circle is completely filled; fill all circles.
• Air-dry paper elevated, horizontally, away
from heat/light.
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Specimen Handling
Routine Handling
Mixing tubes: invert 3–8 times immediately
after collection
Transporting specimens: plastic bag,
biohazard symbol, liquid-tight closure, slip
pocket for paperwork, stopper up
Delivery time limits: within 45 minutes of
collection
Special Handling
Analyte protection: from heat, cold, light
Chain of custody: date & time of receipt,
condition of specimen, signature must be
documented by all who handle specimen
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Specimen Processing
Processing Safety
Use gloves, lab coats/aprons, mask,
goggles/face shields.
Specimen Suitability
Specimens may be rejected due to hemolysis,
wrong tube, improper timing or handling,
insufficient quantity, clotting.
Centrifugation
Serum specimens must be fully clotted before
centrifugation.
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Specimen Processing
Stopper Removal
• Stopper removal devices or robotics should
be used.
• Processor should be wearing full-length
shield, or tube held behind splash shield.
• Stoppers should be covered with gauze or
tissue and pulled straight up and off.
Aliquot Preparation
• Portion of a specimen created when multiple
tests are ordered
• Prepared by transferring portion of specimen
into one or more tubes labeled with same ID
information as specimen tube
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REFERENCE
• Chapter 2: Phlebotomy and Specimen Considerations By Ruth E. McCall and Cathee M.
Tankersley
• Bishop, M.,Fody,E., & Schoeff L.(2018) Clinical Chemistry Principles, Techniques and
Correlation (8th ed).
• Wolters Kluwer Health Lippincott Williams & Wilkins By Vicki S. Freeman
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