CLS 1113 Clinical Laboratory Practices

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CLS 1113Clinical Laboratory Practices

• Phlebotomy Wrap-Up

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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

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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

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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

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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.

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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.

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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.

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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

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Order of Draw - Syringe

• Blood culture bottles and tubes
• Citrate tubes (coagulation tests)
• Other anticoagulant containing tubes
• Tubes without anticoagulants (red tops)

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Needle Selection

• Vacutainer
• 21 gauge most draws
• Butterfly
• 22, 23 or 25 gauge
• Syringe
• Most gauges are availble

25 ga
23 ga
21 ga
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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