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Locations and Service HoursGeneral InformationThe 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 Vacutainer®. 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:
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 ServiceThe 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 ContainersSIZE STOPPER COLOR ADDITIVE
Minimum Blood Amounts RequiredICU CONDENSED LIST
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 BulletsUse 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 What can happen to the sample if a phlebotomist fails to notice the collection tube used is expired when drawing blood for testing?What can happen to the sample if a phlebotomist fails to notice the collection tube used is expired when drawing blood for testing? The tube may underfill. Which of the following would ensure positive patient identification prior to specimen collection? Patient's full name and hospital or medical record number.
What is the most critical error a phlebotomist can make before collecting a specimen?The most serious error is failure to properly identify the patient. Even if everything else is done perfectly, the final result will not apply to the patient incorrectly presumed to be the source.
What is the most serious error a phlebotomist can make?Most often these errors can be prevented by the phlebotomist following correct venipuncture procedure for every procedure, every time. Hidden errors include hemoconcentration, incorrect order of draw, and (the most serious of all errors) misidentification of patient or specimens (Table 5).
How can a phlebotomist prevent reflux of an additive during collection?Use a pillow if necessary to prop the arm or hand. If possible position the patient's arm or other site in a downward position to prevent reflux or “backflow” from the collection tube into the vein.
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