PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE -

LECTURE MLS 123

Ms. Katherine Pascua || 2nd Semester – A.Y. 2021-2022
Transcriber: Heramia, Aaron Ezekiel S.

Module 5 margarine, cheese,

cream, and some
Pre-Analytical Considerations in Phlebotomy enteral (tube
feeding)
preparations. High
levels of lipid
OUTLINE manifest lipemia
which is turbidity
I. Pre-Analytical Phase caused by abnormal
- Pre-Analytical Considerations high levels of fat and
- Problematic Venipuncture Sites cause specimen to
- Various Types of Vascular Access Device (VAD) and appear milky and
cloudy white.
Sites Lipemia is present
- Patient Complications and Conditions for 12 hours that is
- Procedural Errors why 12-hr fasting is
required.
- Specimen Quality Issues  Triglycerides, certain
liver enzymes, and
Pre-Analytical Phase other liver function
analytes when
Pre-Analytical Considerations consuming alcohols,
causing
Definition of Terms hypoglycemia
 Preanalytical (before analysis) or pre-examination Starvation or  Creatinine  Cholesterol
phase – begins in the laboratory when a test is Overfasting  Bilirubin  Glucose
 Lactate  Insulin
ordered and ends when testing begins.  Fatty Acid  Thyroid hormone
 Reference range – refers to values which patient  Glucagon  Triglycerides
results are compared to. The previous results of the  Ketone  Urea
 Uric acid
patient are also looked after by doctors. Diurnal/Circadian  Melatonin during  Melatonin during
 Basal state – resting metabolic state of the body early Variations night morning
in the morning after fasting for approximately 12 hours.  Cortisol around 8 am  Blood levels of
o Ideal in establishing reference ranges on  Renin and TSH Eosinophils,
during pre-dawn Creatinine, Glucose,
inpatients because it minimizes/eliminates the hours of the morning Growth hormone,
effects of diet, exercise, and other controllable while asleep Triglycerides, and
factors on test results.  Aldosterone, Phosphates in the
Estradiol, Bilirubin, morning
o Influenced by physiologic factors: age, Cortisol,
gender, and uneliminated body conditions. Hemoglobin, Insulin,
o Out-patient specimens – not basal state- Iron, Potassium,
Testosterone, RBC
specimens, may have slightly different in the morning
reference ranges Chemotherapy   WBC, platelets
Drugs
 Hemoconcentration – condition in which blood Most drugs  AST, ALP, LDH  Clotting factors
(toxic to liver)
components that cannot easily leave the bloodstream Oral  Erythrocyte  Vit. B12
become concentrated in the smaller plasma volume Contraceptives Sedimentation Rate
Steroids and  Amylase 
diuretics  Lipase
Physiological Variables Thiazide  Calcium  Sodium
diuretics  Glucose  Potassium
Variable Increased Decreased Exercise Due to moderate muscular  Arterial pH
Age  RBC and WBC  Kidney functions in activity  CO2
values in newborn elderly (e.g.,  Glucose  False decrease of
and children creatinine clearance)  Creatinine platelets due to
Sex  RBC, hemoglobin,   Insulin clumping
and hematocrit in  Lactic Acid
males than females  Total Protein
High Altitude  RBC Count  Urinary creatinine  Potassium
 Hemoglobin and  Plasma renin  Creatine kinase and
Hematocrit (RBC lactate
Volume Percentage) dehydrogenase (for
 Uric Acid 24 hrs. or more)
Dehydration  RBC   Cholesterol (1 hr.
 Enzyme after exercise)
 Iron Supine to upright  Aldosterone  Plasma volume
 Calcium sitting/standing  Ca, Fe
 Sodium position  Cholesterol and HDL
 Coagulation factors Standing  RBC (after 15 mins.) 
Diet  Ammonia, urea and  position  Potassium ions
uric acid in high- (after 30 mins.)
protein diets Pregnancy  Body fluids  RBC count (caused by
 Cortisol and ACTH body fluid diluting
when consuming effect)
coffee Smoking Prior to blood collection  IgA, IgG, IgM
 Glucose when  Cholesterol
consuming sugars  Growth hormone
and carbohydrate  Cortisol
(will return to normal  Triglycerides
after 2 hours if  Glucose
glucose metabolism  WBC count
is normal) Chronic
 Lipid levels when  RBC Count
ingesting butter or  Hemoglobin
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[MLS 123] PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 - LECTURE– Ms. Katherine G. Pascua
General 14. Smoking – affect blood components depending to the
 IgE
number of cigarettes smoked.
Stress  ACTH  Fe
 Catecholamines o Capillary puncture may be difficult to acquire
 Cortisol in smokers because of impaired circulation of
1. Age – blood components may vary upon the age of fingertips
patient. Reference ranges are established different age 15. Stress – emotional stress such as anxiety, fear, or
and sex groups trauma can cause transient (short-lived) elevations in
2. High Altitude – blood analytes vary at higher WBCs.
elevations. Analytes take weeks to adapt at high o CBC/WBC specimens for infants are acquired
elevations, but return to adapt in sea level within days after at least 30 minutes of sleep to prevent
3. Dehydration – causes hemoconcentration. May not crying. If acquired from crying infant, it should
accurately reflect patient’s normal status. It is difficult to be noted in the report
obtain blood from dehydrated patients 16. Temperature and Humidity – influence the composition
4. Diet – ingested food and drink may alter blood analyte of body fluids. Acute heat exposure increases plasma
composition and specimen becomes unsuitable for volume. Extensive sweating without fluid replacement
many tests. Effects are generally temporary and vary cause hemoconcentration. Environmental factors
on amount and type of food eaten, and the length of associated with geographic location are accounted for
time between ingestion and specimen collection. when reference values are established.
a. Fasting – strictly no eating for 8-12 hours. Nil
per os (nothing by mouth, NPO) patients are Problematic Venipuncture Sites
also not allowed to drink water at this
moment. Done overnight after the last
Sites must not Sites needing Sites should be
evening meal, which specimen collection is
be used physician’s avoided
done the next morning.
permission
b. Overfasting – fasting beyond 12 hours. May
cause serious problems such as electrolyte Arm with Fistula Arms on sides of Extensive scarring
imbalance and heart rhythm disturbance, Arteries and mastectomy or healed burns
therefore specimen collected from them will Arterial Lines Lower extremities Above and below
not be accepted. Lateral and (for diabetic IV line
5. Diurnal or Circadian Variations – blood analytes may palmar surface of patients and Inflamed sites
vary or fluctuate in diurnal (daily) and circadian (24-hr wrists coagulopathy, Edematous sites
cycle. Factors playing role in diurnal variations include Infected sites may cause Stroke-affected
o Posture necrosis and extremity
o Activity thrombophlebitis) Heparin or saline
lock
o Eating
o Being awake or asleep
o Daylight and Darkness Burns, Scars, and Tattoos
6. Drug Therapy – drugs alter physiological conditions  Usually avoided for venipuncture because:
causing changes in blood analytes. They may interfere o Difficult to palpate or penetrate these areas
test procedures, causing false positive or negative. o Have impaired circulation and yield erroneous
o Drugs that interfere blood tests should be test results especially ones with extensive
stopped 4-24 hours prior to blood collection scarring
o Drugs that interfere urine tests should be o Tattooed areas are more susceptible to
stopped 48-72 hours prior to blood collection infection, and dyes may interfere testing
7. Exercise – may increase or decrease blood  Try to insert needle in area with no tattoo dye if you
components depending on the physical condition of the have no choice but to draw in a tattooed area
patient, and duration and intensity of activity. Moderate Damaged Veins
and strenuous exercise have highest effect, and levels  Veins may sclerosed (hardened) or thrombosed
typically return to normal as soon as the activity stops. (clotted) as it feels hard and cord-like, and lack
8. Fever – affect levels of hormones. Hypoglycemia may resiliency.
also occur. Glucagon, cortisol may also increase,  This is due to:
disrupting normal diurnal variation o Regular blood donation
9. Sex – affect concentration of blood components. o Inflammation
Differences are apparent after sexual maturity
o Chemotherapy drugs
10. Intramuscular Injection – increase levels of creatine
kinase (CK) and the skeletal muscle fraction of LDH. o Chronic illnesses such as cancer
Blood should be drawn before injection or at least 1 o Illegal drug use through IV
hour after injection. Muscular trauma and surgery may  As much as possible, find another site or draw below
also increase CK levels the damaged vein
11. Jaundice (icterus) – increased bilirubin (by-product of Edema
RBC breakdown) in blood. Causes yellow discoloration  Swelling caused by excessive fluid accumulation in the
of skin, mucous membrane, and sclera due to bilirubin tissues
deposits.  Sometimes results when IV fluid infiltrates surrounding
o Icteric specimen – specimen relating to tissues
patient with jaundice, has abnormal dark  Avoid edematous areas because:
yellow to yellow brown color due to high o Yield inaccurate test results from
bilirubin contamination of tissue fluid or altered blood
o Affect blood chemistry tests based on color composition due to swelling
reactions and reagent strip analysis for urine o Veins are harder to locate, fragile, and easily
12. Position – standing, supine, or transition from supine to injured by a tourniquet or antiseptic
sitting/standing may affect specimen composition o Prolonged healing in these areas
13. Pregnancy – cause physiologic changes that may
affect blood composition

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[MLS 123] PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 - LECTURE– Ms. Katherine G. Pascua
Hematoma 
Collection for coagulation tests is not recommended as
 Swelling or mass of blood accumulated that can be traces of heparin or saline dilution interferes with the
caused by blood leakage during or following result
venipuncture  Only specially trained personnel should draw blood
 Large bruise spreads through the surrounding area from these devices.
 Avoid areas with bruise or hematoma because: Intravenous (IV) Sites
o Site is painful  Intravenous – pertaining to or within a vein
o Site is contaminated with hemolyzed blood  IV Line – catheter inserted in a vein to administer fluids
from outside the vein  Blood specimens should not be drawn in arms with IV
o Clotting may be affected as blood flow is lines as IV fluid may be diluted/contaminated in this
obstructed, yielding to inaccurate results area especially above the IV line
Obesity  Arm without IV line is the preference
 Present challenges as veins of obese patients are  Capillary puncture is used if both arms have IV line. If
deep and difficult to palpate large amounts of blood are needed, consider veins in
 Proper tourniquet selection and application is the first the foot and ankle for collection.
step needed for successful venipuncture  Blood collection below IV line may also be considered
 Blood pressure cuff may be used to make the vein but follow certain protocols before extracting.
more prominent
 Things to remember:
o Check antecubital area, since the median
cubital vein is still palpable
o You may ask for previous successful sites of
venipuncture if no vein is easily palpable
o Check the cephalic vein by rotating the arm in
a prone position if the patient has no history of
venipuncture or forgot the site.
Mastectomy
 Never draw blood in arm of the same side with site of
surgical breast removal (mastectomy) without
physician consultation
o Removal of lymph node which is part of the
procedure causes lymphostasis (disruption of
lymphatic circulation)
o Impaired lymph flow risks the arm for swelling
called lymphedema, causing infection.
Previously Active IV Sites
Various Types of Vascular Access Device (VAD)  Present potential errors in testing
and Sites  Blood collection should be done in a previous IV site
within 24-48 hours after discontinuation
Arterial Lines
 A.K.A A-line or Art-line, is a catheter placed in the Central Vascular Access Devices (CVADs)
artery  Also called as indwelling line, consist of inserted tubing
 Commonly placed in radial artery and used to provide inserted into a main vein or artery
continuous measurement of patient’s BP  Practical for patients who need IV access for extended
 Also used to collect blood gas and other blood time, or patients with difficult-to-access veins
specimen, and also for drug administration such as
dopamine
 Specially trained personnel e.g., Respiratory Therapist
are only allowed to access A-lines
 Never perform venipuncture on an arm with A-line.
Arteriovenous Shunt, Fistula, or Graft
 Devices providing permanent surgical connection of
artery and vein
 Direct infusion (fistula) resulting in bulging vein, or with
a piece of vein or tubing (graft) creating a loop under
that skin.
 Used typically in dialysis, commonly joins radial artery
and cephalic vein above the wrist on the underside of
the arm
 Never apply pressure using tourniquet and perform
venipuncture in a fistulated/grafted arm.
 Use a discard tube when drawing in this device to
Heparin or Saline Lock
ensure that there is no contamination. The amount of
 Catheter/cannula with stopcock or a cap with a blood discarded depends upon the dead-space volume
diaphragm of the line. (Two times for non-coagulation and six
 Provides access for administering medication or times for coagulations
drawing blood  It is recommended that specimens for coagulation test
 Placed in a vein in the lower arm above the wrist, and are not be drawn from CVADs
may be left in place for up to 48 hrs.
 5 mL discard tube is drawn first when blood specimen
is collected from this device

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[MLS 123] PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 - LECTURE– Ms. Katherine G. Pascua
Patient Complications and Conditions  After regaining consciousness, instruct the patient to
Allergies to Equipment and Supplies remain in the area for at least 15 mins., and not
operate a vehicle for at least 30 mins.
 Adhesive Allergy – allergic to glue used in adhesive
bandages
o Place a clean, folded gauze over the site and
wrap with self-adherent bandaging material
such as Coban for 15 mins., then the patient
is instructed to remove the bandage.
o Instruct the patient to hold pressure for 5
minutes in lieu of applying a bandage.
 Antiseptic Allergy – used in skin preparation prior to
venipuncture such as povidone-iodine. Use alternate
antiseptic available.
 Latex Allergy – in tourniquets and gloves. They are
minor and involve irritation and rashes from contact to
latex.
o Ask patient if they are allergic to latex
o Use non-latex materials
Excessive Bleeding
 Bleeding usually stops within few minutes after
venipuncture. But some patients particularly under
aspirin or anticoagulant therapy may take longer to Nausea and Vomiting
stop bleeding  Patient may state that he or she is feeling nauseous or
o Apply pressure to puncture site until bleeding show signs similar to fainting, such as becoming pale
stops or having beads of sweat appear on the forehead or
o Call official or personnel if bleeding persists has the urge to vomit.
 Do not attempt to draw blood until patient subsides
Fainting  Discontinue blood draw if it’s in progress
 Syncope (fainting) – loss of consciousness and Pain
postural tone caused by insufficient blood flow in the
brain  Small amount of pain is normally associated to routine
o Vasovagal Syncope – sudden faintness or venipuncture and capillary puncture
 Warn the patient when inserting needle to avoid a
loss of consciousness due to a nervous
startle reflex
system response to abrupt pain, stress, or
 Stinging sensation is avoided by allowing the alcohol to
trauma
dry before inserting the needle
 The potential to faint varies from person to person
 Application of an ice pack to the site after needle
before, during, and immediately after venipuncture
removal may help prevent or reduce inflammation
 Contributing factors to fainting
 Probing – excessive, deep, blind, or lateral redirection
o Anemia
of the needle in the puncture site. Painful and may
o Dehydration cause injury to arteries, nerves, and other tissues
o Emotional problems
Petechiae
o Fatigue
 Excessive, deep, blind, or lateral redirection of the
o Hypoglycemia
needle in the puncture site
o Hyperventilation
 Minute drops of blood escaping from capillaries and
o Medications come to surface of the skin below tourniquet
o Nausea  Sign of capillary wall defect or platelet abnormality
o Phobia to needles  Not an indication of incorrect procedure by
o Poor compromised breathing phlebotomist
 Ask the patient if there is a history of fainting during  Presence of this may indicate excess bleeding to the
venipuncture site
o If they feel fainting, they will be asked to lie Seizures and Convulsions
down until recovered  May happen during procedure, although there is no
o Outpatients are more likely to feel fainting evidence for direct causation
compared to in-patients  Discontinue the procedure immediately if this happens.
 Routinely ask the feeling of the patient during blood Then hold some pressure over the site without overly
collection restricting patient’s movement
 Watch signs of fainting, and be prepared to protect  Do not attempt to put anything into patient’s mouth
them from falling. Signs include  Protect the patient from self-injury without completely
o Paleness restricting movement of extremities
o Perspiration  Notify appropriate first aid personnel. Document
o Hyperventilation
o Vertigo (ask the patient if he is experiencing a Procedural Errors
sensation of spinning) Hematoma Formation
o Dizziness
 Most common complication of venipuncture
o Light-headedness
 Blood leaking into the tissues during or following
o Nausea venipuncture, identified with rapid swelling, bruising,
 Fainting can occur without warning, keep an eye to and skin discoloration
your patient  Painful, may cause compression injuries to nerves and
 Ammonia inhalants may have unwanted side effects lead to lawsuits
such as respiratory distress to asthmatic patients and  If hematoma forms, discontinue the draw immediately
therefore not recommended and hold pressure over the site for a minimum of 2
minutes
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[MLS 123] PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 - LECTURE– Ms. Katherine G. Pascua
 Ice pack is applied for first 24 hours to reduce the pain, o Pain that radiates up or down the arm
then warm compress is done after 24 hours for 
If needle insertion does not result for successful vein
accumulated blood resorption entry, there’s slight forward or backward redirection of
Iatrogenic Anemia the needle, or use of a new tube does not result in
 Iatrogenic – complication that is correlated to effects of blood flow, remove the needle and choose an alternate
a treatment site preferably the opposite arm
 Iatrogenic blood loss – blood loss result of blood  Apply ice pack to the site after needle removal
removed for tests Reflux of Additive
 Iatrogenic anemia – happens when large quantities of  There is a possibility for blood to flow back (reflux) into
blood are removed in a regular basis, especially infants the patient’s vein from blood collection tube
 Exsanguination – blood loss to a point of life cannot be  Some patients have adverse reactions to tube
sustained. Happens when 10% of blood volume is additives particularly EDTA, attributed to blood reflux
removed from a patient  Patient’s arm must be kept downward so the collection
 Prevent iatrogenic anemia by: tube is remained below and filled from bottom up.
o Coordinating with physicians to minimize  Back-and-forth movement of blood in the tube should
number of draws also be avoided until tube is removed from the holder
o Following quality assurance protocol to o An outpatient can be asked to lean forward
minimize redraws and extend the arm downward over the arm of
o Collecting minimum required specimen the drawing chair
volume especially to infants o Achieve proper positioning of bedridden
o Keeping a log of draws patient by raising the head of the bed,
Inadvertent Arterial Puncture extending the patient’s arm over the side of
 Rare when proper venipuncture procedures are the bed, or supporting the arm with a rolled
followed. towel
 Most often associated with deep or blind probing, Vein Damage
especially in the area of the basilic vein, which is in  Occasional venipuncture will not damage veins if
close proximity to the brachial artery. properly performed
 If IAP is left undetected, blood leakage and  Numerous and regular venipunctures will eventually
accumulation may cause compression injury to nearby cause buildup of scar tissue and increase the difficulty
nerves of performing future venipunctures
 Signs of IAP:  Blind probing and improper technique when redirecting
o Rapidly forming hematoma the needle can also damage veins and impair patency.
o Blood filling the tube very quickly
o Arterial blood is recognized by its Specimen Quality Issues
spurting/pulsing or by the bright red color  Quality of specimen may be compromised by improper
 If IAP is suspected, immediately discontinue collection techniques
venipuncture and apply direct forceful pressure to the  This may yield to inaccurate and poor-quality results,
site for at least 5 mins. until bleeding stops affecting patient’s care
Infection  Compromise of quality is not usually apparent, that is
 Follow proper aseptic technique to prevent risk of why a phlebotomist should be aware of the pitfalls of
infection collection
o Do not open adhesive tape or bandages Hemoconcentration
ahead of time, or temporarily stick them to lab  Venous stasis – stagnation of normal venous blood
gown cuffs or contaminated surfaces flow due to compression, i.e., tourniquet application
o Do not preload needles onto tube holders to o Venostasis – blood trapping in an extremity by
have a supply for many draws ready ahead of compression of veins
time. The sterility of the needle is breached  In response, some of the plasma and filterable
once the seal is broken. components of the blood pass through the capillary
o Do not touch the cleaned venipuncture site walls into the tissues, causing hemoconcentration (low
with your finger, gauze, or any unsterile object fluid content with high nonfilterable, large molecules or
before or during procedure protein-base blood components)
o Try to minimize the time between removing  May increase due to hemoconcentration:
the needle cap and performing the o RBC
venipuncture. o Albumin
o Remind the patient to keep the bandage on o Ammonia
for at least 15 minutes after specimen o Ca, K, Fe
collection. o Coagulation factors
Nerve Injury o Enzymes
 Median cutaneous nerve – main nerve possibly injured o Cholesterol (5% 2 minutes after applying
during venipuncture tourniquet, 15% after 5 mins.)
 Possible causes of nerve injury:  Changes 1 minute after applying torniquet are slight,
o Poor site or improper vein selection prolonged application may mark some significant
o Inserting the needle too deeply or quickly changes
o Movement by the patient as the needle is  Other factors leading to hemoconcentration
inserted o Massaging/squeezing the site
o Excessive or lateral redirection of the needle, o Vein probing
or blind probing while attempting venipuncture o Long-term IV therapy
 Signs of possible nerve injury: o Venipuncture to sclerosed/occluded veins
o Extreme pain o Vigorous hand pumping (making a fist)
o Burning or electric shock sensation  Increase K levels up to 20%
o Numbness of the arm  May also increase lactate and
phosphate
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[MLS 123] PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 - LECTURE– Ms. Katherine G. Pascua
Hemolysis (light blue top tubes)
 Results when RBC is damaged and hemoglobin
escapes to the fluid portion/serum, causing the serum Specimen Contamination
to be discolored  Typically, inadvertent and generally the result of
o Pink (slight hemolysis) improper technique or carelessness
o Dark pink to light red o Contamination of alcohol, fingerprints, glove
(moderate powder, baby powder, or urine from wet
o hemolysis) diapers
o Dark red (gross o Contamination of glove powder, alcohol, or
hemolysis) perspiration in capillary collection
 Errors that can cause hemolysis: o Using correct antiseptic but wrong procedure
o Drawing from site with hematoma  Improper cleaning of blood culture
o Failed to wipe first drop of capillary blood that tips or collection sites
may contain alcohol residue  Touching of site after being cleaned
o Forceful aspiration of blood in syringe draw  Inserting the needle before the
o Forcing the blood from a syringe into an antiseptic dries
evacuated tube o Using wrong antiseptic to clean
o Blood frothing cause by improper fit of needle  Using alcohol as antiseptic may
on a syringe interfere blood ethanol tests
o Horizontal tube transfer causing blood  Using povidone-iodine may cause
sloshing back and forth high levels of uric acid, phosphate,
o Mixing, shaking or inverting blood tubes and potassium.
quickly or vigorously Wrong or Expired Collection Tube
o Partial filling of normal draw sodium fluoride  Drawing in wrong tube affect test results and
tube (gray) jeopardize patient safety if the error is not caught
o Pulling back the syringe plunger too quickly before testing.
o Rough handling during transport  Additives in expired tubes may not work properly. For
o Squeezing the site during capillary collection example, expired anticoagulant may allow the
o Syringe transfer delay, partially clotted blood formation of microclots.
is forced into a tube  Routinely check labels and expiry dates
o Using large-volume tube in a small-diameter
butterfly needle Troubleshooting Hints
o Using needle with a diameter too small for  Correct needle insertion
venipuncture
Hemolysis erroneously Hemolysis erroneously
increases decreases
Ammonia RBC Count
Catecholamines
Phosphates
CK
Fe, Mg, K

Partially-filled Tubes
 Short draw – refers to partially filled evacuation tubes
o Short-draw tubes such as red tops and SST  No blood seen or little blood flow in the tube
are generally accepted for testing as long as o Caused by needle positioning
there is no hemolysis and there is enough o Tourniquet is applied for too long, or vacuum
specimen for the test.
is lost
o Underfilled anticoagulant tubes and other
o Needle is place too shallow or too far into the
additive tubes are not acceptable because
vein
they may not contain enough blood-to-
o Needle is inserted in the tissue
additive ratio designed for the specific tube
 Never pour two partially filled additive tubes together to
fill one tube, as this will also affect the blood-to-additive
ratio.
 Partial-vacuum tubes – same size to normal tubes but
designed to contain smaller volume of blood. Also
referred as short-draw tubes. Manufacturers have line
or arrow on the tube label indicating the proper fill
level. The blood-to-additive ratio will be correct even
there is few amounts of blood collected.
Effects
Excess EDTA in lavender RBC shrinking, decreasing
tubes low blood cell counts and
hematocrits
Alter staining characteristics
of blood cells in blood smear
Excess Heparin in green Interfere come clin. chem.  Blood stops during collection
tubes analytes o Collapsed vein or the needle moved during
Excess sodium fluoride in Cause hemolysis collection
gray tubes
Underfilled coagulation tubes Produce erroneous results
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[MLS 123] PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 - LECTURE– Ms. Katherine G. Pascua
 Remove tourniquet, remove needle, o Without using needles or removing tube
let arm rest, then insert new needle stopper/cover
again o Similar to ETS holder but has permanently
o Needle is in wall of vein attached needle inside
 Withdraw the needle a little, o Advantages:
reposition, and continue  Reduces the chance of needlestick
venipuncture injuries
 Confines any aerosol or spraying of
specimen generated when tubes are
removed
Module 6
Venipuncture Procedure

Unit 1
Syringe System and Method

OUTLINE
I. Parts of Syringe System
II. Considerations in Syringe Method
III. Procedure and Rationale of Syringe Method
Considerations in Syringe Method
Parts of Syringe System  Unlike in ETS system, pulling back the plunger creates
Facets of the Procedure vacuum for drawing blood, which can be manipulated
by the phlebotomist
 Older venipuncture procedure
o Vacuum created by applying pressure to the
 Not used often due to great risk of needle-stick injuries
 Causes delay from collection to transfer of specimen to plunger is gradual and can be controlled by
tubes containing additives/anticoagulants the phlebotomist so that sufficient pressure
 Sometimes used for patients with small or difficult can be applied to draw blood into the barrel
veins without causing the vein to collapse.
 Consists of o When vein collapses, vein wall is pulled
o sterile syringe needle called hypodermic against the bevel of the needle in the vein so
needle a that it obstructs blood flow.
o sterile plastic syringe with a Luer-lock tip (a  If the needle is too large for the vein, it will tear the vein
and cause bleeding–hematoma.
special tip that allows the needle to attach
 If the needle is too small, it will damage the blood cells
more securely than a slip tip)
during sampling, and laboratory tests that require blood
o barrel
cells or hemoglobin may be invalid.
Parts of Needle and Syringe System
 Pros and Cons of Syringe Method
 Traditional

Procedure and Rationale of Syringe Method

 Needle-and-Syringe with Safety

 Syringe needles – hypodermic needles, usually 21-

23G for phlebotomy procedures, with 1-1.5 in. lengths
o Must have a re-sheathing feature to allow it to
be safely covered and removed so that a
transfer device can be attached to the syringe
to fill the evacuated tubes.
 Syringe barrel and plunger – routinely used for
phlebotomy are 5-10mL
 Syringe transfer devices – allow safe transfer from
syringe to tubes
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[MLS 123] PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 - LECTURE– Ms. Katherine G. Pascua

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[MLS 123] PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 - LECTURE– Ms. Katherine G. Pascua

Order of Draw

Using a Syringe Transfer Device

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[MLS 123] PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 - LECTURE– Ms. Katherine G. Pascua

Unit 2
Evacuated Tube System

OUTLINE
I. Parts of Evacuated Tube System
II. Order of Draw Significance
III. Evacuated Tubes

Parts of Evacuated Tube System

 Evacuated Tube System – closed system, most
preferred collection method
o Direct blood collection to the tube
o Minimizes risk of specimen contamination
o Allow multiple tubes to be drawn
 Uses vacuum to collect blood. Tubes as air-evacuated,
when inserted in the vein, the evacuated space serves
as suction in collecting

Significance of Order of Draw

The order of draw must be followed in order to prevent certain
issues in the ETS collection

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