BSMLS - 1202 | MEDICAL LABORATORY SCIENCE

Unit 6: Blood Collection Equipment, Additives, and Order of Draw

2nd SEMESTER | S.Y 2021 – 2022 BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE
LECTURER: MS. MICHELLE T. MABASA TRANSCRIBED BY: MANYLL REIGNE A. MAGANA

A phlebotomist should be familiar with the equipment and Your gloves should be in good fit (not too tight or too loose)
supplies in order for them to know which equipment should and glove liners may be used if gloves cause allergies
be used on patients; which differs with their condition or even (especially with latex) or dermatitis. Hand creams can also be
the vein to be used for collection. used to prevent an allergic reaction happening when using.

GENERAL BLOOD COLLECTION EQUIPMENT AND SUPPLIES Powdered gloves such as sterile gloves is not advisable to use
because the powder inside the glove could be a source of
A blood drawing station is a dedicated area inside a clinical contamination during tests.
laboratory that is solely used for blood collection to patients
who can visit the laboratory. It consists of: ANTISEPTICS

• Phlebotomy Chair These are used prevent or inhibit the growth and development
It should be comfortable for the patient, here of microorganisms in the blood and considered safe to use on
should be an adjustable arm rest with a lock human skin and are used to clean the site prior to blood
to secure and hold the patient while making collection. It only reduces the number of microorganism on the
sure they are comfortable enough. surface of the skin and not sterilize the skin.

• Equipment Carrier They come in dividually wrapped

o Phlebotomy Tray prep pads or in a form of a swab stick.
These are handheld which makes blood The most common antiseptics used
collection portable and can be done contain 70% isopropyl alcohol
anywhere. However, it is only ideal when (isopropanol) or povidone-iodine for
catering a few patients. It contains: plaster, higher degree antisepsis.
antiseptics such as alcohol, container for
sharp disposal, tubes, and more. Antiseptics Used in Blood Collection
• 70% ethyl alcohol
o Phlebotomy Carts • 70% isopropyl alcohol (isopropanol)
Only ideal when catering a big number of • Benzalkonium chloride (e.g., Zephiran chloride
patient; usually used by hospitals. It could • Chlorhexidine gluconate
be a source of infection since it is carried • Hydrogen peroxide
throughout the hospital. Thus ideally, • Povidone-iodine (0.1% - 1% available iodine)
should not be brought inside the patient’s • Tincture of iodine
room to avoid any nosocomial infections.
DISINFECTANTS
GLOVES
These are chemical substances or solutions used to remove or
An equipment set by the Centers for Disease Control and kill microorganisms on surfaces and instruments.
Prevention (CDC) OSHA rule that a new pair must be used for
each patient and removed when done in order to protect not However, these chemicals are corrosive
only the patient but also the phlebotomist. It is a must to and thus, not safe when in contact with
disinfectant your hands before and after wearing the gloves. skin. When using disinfectants, even at
home, it is advisable to wear gloves and
When choosing your gloves, you could use: should be APA approved and should be
• non-sterile made daily or as needed for efficacy.
• disposable latex
• nitrile Suggested Concentration:
• neoprene • 1:100
• polyethylene o used for decontaminating nonporous
• vinyl surfaces after cleaning up blood or other
body fluid spills
o can use sodium hypochlorite
MANYLL REIGNE A. MAGANA
1
 BSMLS - 1202 | MEDICAL LABORATORY SCIENCE
Unit 6: Blood Collection Equipment, Additives, and Order of Draw
2nd SEMESTER | S.Y 2021 – 2022 BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE
LECTURER: MS. MICHELLE T. MABASA TRANSCRIBED BY: MANYLL REIGNE A. MAGANA

• 1:10
o large amount of blood
o should be highly concentrated

HAND SANITIZERS

Alcohol-based hand sanitizers can be used for

routine decontamination of hands as a
substitute for hand washing, only when there
is no visible contamination such as blood.

Whenever there is contamination, you can

use detergent-containing wipes first to
remove the visible contamination then follow
up with hand sanitizer.

GAUZE PADS OR COTTON BALLS

These are used to hold

pressure over the site following
blood collection procedure.
However, gauze pads are
referred over cotton balls since
cotton balls tend to have fibers. BIOHAZARD BAGS
The said fibers might attach to the primary platelet plug and
when the cotton ball is removed, the platelet plug may be These are leakproof plastic bags and
disturbed causing the wound site to bleed again. used to transport blood and other
specimens from the collection site to
BANDAGES the laboratory. There are outside
pockets for request forms.
These are used to cover a blood
collection site after the bleeding has
stopped; can also use paper, cloth, or GLASS SLIDES
knitted tape over folded gauze.
Some glass slides are frosted while
Gauzes are latex-free bandages are other are not. The main purpose for
available for those with latex allergies. frosted slides is for labeling. Glass
There are also pressure bandages that are helpful with slides used to make blood films for
patients having bleeding problems. hematology determinations.

NEEDLE AND SHARPS DISPOSAL CONTAINER The pen to be used for labeling the
glass slides should have permanent
The containers are very important wherein the sharps used ink, you can also use markers. It is also ideal for a phlebotomist
during the venipuncture are disposed here. These containers to have their own watch in order to time the tests done.
should be:
• rigid VENIPUNCTURE EQUIPMENT
• puncture-resistance
• leakproof • Vein-Locating Devices (optional)
• disposable o typically shine high-intensity LED or infrared
red light in the dermis

MANYLL REIGNE A. MAGANA

2
 BSMLS - 1202 | MEDICAL LABORATORY SCIENCE
Unit 6: Blood Collection Equipment, Additives, and Order of Draw
2nd SEMESTER | S.Y 2021 – 2022 BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE
LECTURER: MS. MICHELLE T. MABASA TRANSCRIBED BY: MANYLL REIGNE A. MAGANA

o the hemoglobin in the vein is able to absorb Used on the veins of infants and
the light, making the veins visible 23 Butterfly children and on difficult or hand
o helpful in locating veins that are hard to feel veins of adults
or palpate
• Tourniquet
o to restrict blood flow; should not be too tight
or too loose
o dispose if visibly soiled

The restriction of venous flow distends or inflates the veins,

making them larger and easier to pierce with a needle.
Tourniquets should not be placed more than 1 minute as
restriction of blood flow can change blood components.

NEEDLES Part of
Description
Gauge
Needles used for phlebotomy include: end that pierces the vein
• sterile and disposable
o designed for a single use only Bevel allows the needle to easily slip into the skin
• multi-sample and vein without coring (removing a portion
• hypodermic (syringe) of the skin or vein
Shaft the long cylindrical portion
• winged infusion set (butterfly)
end that attaches to the blood collection
Hub
Keep in mind that it is important to examine the packaging or device
seal of a needle before use. If the packaging is open or the seal Lumen internal space of the needle
is broken, the needle is no longer sterile and should not be Threaded
to lock and twist into the vacutainer
used. Hub
Is the diameter of the lumen; the higher the
Gauge Needly Type Typical Use gauge number, the smaller the actual
Special needle Collection of donor units, diameter of the needle
15 – 17 attached to autologous blood donation,
collecting bag and therapeutic phlebotomy common color gauge:
Used primarily as a transfer • yellow = gauge 20
needle rather than for blood Gauge • green = gauge 21
18 Hypodermic • black = gauge 22
collection; safety issues have
diminished used
Sometimes used when large- length
volume tubes are collected or • 1 or 1.5 inch are commonly used for
Multi-sample venipuncture
20 large-volume syringes are used
Hypodermic • butterfly needles = ½ to ¾ inch long
on patients with normal-size
veins provide immediate permanent containment
Safety
Considered the standard and be activated using one hand, which must
Feature
venipuncture needle for stay behind the needle at all times
Multi-sample routine venipuncture on Resheathing shields that cover the needle after use and
21 Devices are devices that retract the needle after use
Hypodermic patients with normal veins or
for syringe blood culture
collection EVACUATED TUBE SYSTEM
Used on older children and
Multi-sample adult patient with small veins or The ETS are preferred by the CLSI for collecting blood samples.
22 It is closed system which the patient’s blood flows through a
Hypodermic for syringe draws on difficult
veins needle inserted into a vein and then directly into a collection

MANYLL REIGNE A. MAGANA

3
 BSMLS - 1202 | MEDICAL LABORATORY SCIENCE
Unit 6: Blood Collection Equipment, Additives, and Order of Draw
2nd SEMESTER | S.Y 2021 – 2022 BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE
LECTURER: MS. MICHELLE T. MABASA TRANSCRIBED BY: MANYLL REIGNE A. MAGANA

tube without being exposed to the air or outside Syringes

contaminants. • commonly used sizes: 2, 5, and 10 mL
• with a barrel (cylinder with graduated marking either
An ETS allows numerous tubes to be collected with a single in milliliters (mL) or cubic centimeters (cc)) and a
venipuncture. The three basic components of ETS are: plunger (rod-like device that fits tightly into the barrel
• a special blood-drawing needle
• a tube holder Syringe Transfer Device
• various types of evacuated tubes • allows the safe transfer of blood into the tubes
without using the syringe needle or removing the
Multi-sample Needle tube stopper
• allows multiple tubes of blood to be collected during • greatly reduces the chance of accidental needlesticks
a single venipuncture and confines any aerosol or spraying of the specimen
• threaded in the middle, beveled point on each end
WINGED INFUSION SET
Tube Holders
• a clear, plastic, disposable cylinder with a small It is an indispensable tool for collecting blood from small or
threaded opening at one end, hub difficult veins such as hand veins and veins of elderly and
pediatric patients.
EVACUATED TUBES
Sizes ½ to ¾ inch stainless
Evacuated tubes are used in both ETS and the syringe method steel needle is permanently
(blood is collected in a syringe and must be immediately connected to a 5 to 12 inch
transferred into the tubes length. The needle is used by
specially trained personal
The tubes contain vacuum for which evacuated tubes fill with used to collect blood from
blood automatically because there is a vacuum The amount of scalp or other tiny veins of
vacuum is measured precisely by the manufacturer so that the premature infants and other
tube will draw the exact volume of blood indicated on the label neonates.
in order to avoid short draw (underfilled tube).
Caution: When using a needle smaller than 23 gauge increases
Tubes may contain additives which are any substance placed the chance of hemolyzing the specimen.
within a tube other than the tube stopper. These prevent
clotting or preserving certain blood components. COMBINATION SYSTEMS

Other characteristics: It is a complete system for

• plastic or glass blood collection in which
• rubber stopper the blood collection tube
• color-coded and collection apparatus
• expiration dates are combined in a single
unit.
SYRINGE SYSTEM
It allows the specimen to
The syringe system is an alternative for patients with small or be collected by either an
difficult veins. A sterile syringe needle (hypodermic needle) evacuated tube or syringe
and a sterile plastic syringe with Luer-lock tip (a special tip that system techniques.
allows that needle to attach more securely than a slip tip) is
used.
ADDITIVES
Syringe Needles
• generally gauges 21 – 23 in 1 or 1.5 inch lengths • available in liquid, spray-dried, and powder forms
• antiglycolytic agents – sodium fluoride

MANYLL REIGNE A. MAGANA

4
 BSMLS - 1202 | MEDICAL LABORATORY SCIENCE
Unit 6: Blood Collection Equipment, Additives, and Order of Draw
2nd SEMESTER | S.Y 2021 – 2022 BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE
LECTURER: MS. MICHELLE T. MABASA TRANSCRIBED BY: MANYLL REIGNE A. MAGANA

• clot activators • royal blue – top tubes with lavender color-coding or

o silica label
o celite – POCT coagulation
o thrombin CITRATES
• thixotropic gel separators
• trace-element free tubes – royal blue stoppers • prevents coagulation by binding or chelates calcium
• preserves coagulation factors
ANTICOAGULANTS • most common is sodium citrate
• light blue stopper
• substances that prevent blood from clotting o contains 9:1 ration of blood to anticoagulant
o chelating (binding) or precipitating calcium o filled to the stated volume and must be filled
o inhibiting the formation of thrombin within 90% of that volume
• mix immediately to prevent micro clot formation
Caution: Underfilled tubes can cause artificially prolonged
clotting times and visible underfilled tubes will not be accepted
for testing by most laboratories.

HEPARIN

• inhibit thrombin formation

• used for some chemistry tests, especially STAT tests
• ammonium, lithium, and sodium heparin
• green top tubes
• green top and light green top gel tubes
• mottled green and gray top tubes
• royal blue tubes with green color coding on the label
• green top and light green microtubes
• red banded and green banded microhematocrit tubes

OXALATES

• prevent coagulation by precipitating calcium

• potassium oxalate (most used)
• gray stoppers

• common: EDTA, citrate, heparin oxalates SPECIAL ADDITIVES

• special: ACD, CPD, SPS
Acid Citrate Dextrose (ACD)
EDTA • immunohematology, paternity tests, transplant
compatibility
• powdered di-potassium (K2) or liquid tri-potassium
(K3) Citrate Phosphate Dextrose (CPD)
• preserves cell morphology • for blood transfusion
• chelates calcium • phosphate stabilizes Ph
• lavender (purple) – top tubes
• micro collection containers with lavender tops Sodium Polyanethol Sulfonate (SPS)
• pink plastic-top tubes with a special blood banking • for blood culture
patient ID label • reduces the action of a protein called complement
• pearl-top tubes with thixotropic gel separator • slows down phagocytosis
• reduces the activity of certain antibiotics

MANYLL REIGNE A. MAGANA

5
 BSMLS - 1202 | MEDICAL LABORATORY SCIENCE
Unit 6: Blood Collection Equipment, Additives, and Order of Draw
2nd SEMESTER | S.Y 2021 – 2022 BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE
LECTURER: MS. MICHELLE T. MABASA TRANSCRIBED BY: MANYLL REIGNE A. MAGANA

ORDER OF DRAW

It is the order in which tubes are collected during a multi-

sample tube draw or are filled from a syringe. These should be
followed to prevent carry over or cross contamination such as:
• tissue thromboplastin contamination
o activates the extrinsic coagulation pathway
• microbial contamination
Order:
1. Sterile Tube
2. Blue-top Coagulation Tube
3. Serum Tube with our without clot activator, or with
or without gel
4. Heparin Tube with or without gel plasma separator
5. EDTA tube
6. Glycolytic inhibitor tube

MANYLL REIGNE A. MAGANA

6