CLS 1113 Clinical Laboratory Practices

1. CLS 1113Clinical Laboratory Practices Phlebotomy Wrap-Up

3. Lt. Blue Top: (Citrate tube) • Volumes: 2.7 mL and 4.5 mL draws • Anticoagulant: Sodium Citrate • Anticoagulant method of action: a chelating agent that binds calcium, forming insoluble calcium salts. • Tube purposes: • Used for all coagulation determinations and factor assays. • Used for platelet counts when EDTA tube platelet results display aberrant phenomenon such as platelet satelliting

4. Serum Separator Tube ( SST® ) • Volumes: 4.0 mL, 9.5 mL and Microtainer® for capillary punctures • Additives: • Polymer Gel: upon centrifugation, this gelatin forms a barrier between the cell and serum layers, thus making it easier to pour-off and reducing reactivity between cell and serum components. Silica activator: Increases speed of clot formation. • Tube purposes: • With only a few exceptions, can be used whenever serum is required for testing. NEVER draw this tube for Blood Bank use, since both serum and cells are required for performing testing. A very limited number of highly specialized therapeutic drug levels may require the use of plain red top tubes

5. Plain Red Top(Silicone-coated interior) • Stopper color: plain red • Volume: 7 mL draw • Tube additives: none (silicone-coating) • Tube purpose: General serum tube MUST be used for Blood Banking. May be used whenever serum is required for testing. • Pseudonym: Clot Tube, Plain Red

6. Green Top • Volume: 3.0 mL draw, 10.0 mL draw, Microtainer® for capillary punctures available. • Anticoagulant: freeze dried Sodium Heparin. Also available with ammonium heparin or lithium heparin anticoagulants. • Anticoagulant mechanism of action: inactivates thrombin and thromboplastin. • Tube purpose: plasma determinations such as ammonia, ionized calcium and plasma hemoglobin. Also used for tissue typing and cytogenetic determinations.

7. Lavender Top • Volumes: 3.0 mL draw, 5.0 mL draw, *Microtainer®: for capillary punctures • Anticoagulant: K2EDTA (ethylenediamine tetraacetate) • Anticoagulant mechanism of action: a chelating agent that binds calcium, forming insoluble calcium salts. • Tube purposes: Platelet counts and platelet function studies due to EDTA's ability to inhibit platelet aggregation. Complete Blood Counts (CBC) and preparation of blood films for cell differentiation. Miscellaneous testing such as cyclosporin levels, hemoglobin A1C, viral load testing, sickle cell testing, sedimentation rates and others.

8. Yellow Top • Volumes: • Solution A: 8.5 mL draw • Solution B: 3.0 mL draw and 6.0 mL draw • Anticoagulant: ACD = Acid-Citrate-Dextrose • Solution A: trisodium citrate, 22.0 g/L; citric acid, 8.0 g/L; and dextrose, 24.5 g/L • Solution B: trisodium citrate, 13.2 g/L; citric acid, 4.8 g/L; and dextrose, 14.7 g/L • Tube purposes: Primarily for use in blood bank studies, HLA phenotyping, DNA and Paternity testing.

9. Order of Draw – Vacutainer 1. Blood culture bottles and tubes 2. Tubes with no additives and plain red tops (serum) 3. Citrate (Coagulation tube) 4. Heparin 5. EDTA 6. Serum Separator Tubes (SST® tube) 7. Other additive tubes

10. Order of Draw - Syringe • Blood culture bottles and tubes • Citrate tubes (coagulation tests) • Other anticoagulant containing tubes • Tubes without anticoagulants (red tops)

11. Needle Selection • Vacutainer • 21 gauge most draws • Butterfly • 22, 23 or 25 gauge • Syringe • Most gauges are availble 25 ga 23 ga 21 ga

12. Approaching the VEIN • Same direction vein is running • 15 - 30 angle to the arm • Anchor the vein with other hand • Bevel up – thread the vein