What 5 pieces of information should be labeled on a blood tube after blood collection?

Blood Collection - Performance Of A Routine Venipuncture

Most laboratory tests are performed on anticoagulated whole blood, plasma, or serum. Please see our individual test directory section for specific storage and transport requirements.

Plasma: Draw a sufficient amount of blood with the indicated anticoagulant to yield the necessary plasma volume. Gently mix the blood collection tube by inverting 8-10 times immediately after collection. If required, separate plasma from cells by centrifugation within 30 minutes. 

Serum: Draw a sufficient amount of blood to yield the necessary serum volume. Gently mix the blood 5 times if SST tube is used. Allow blood to clot at ambient temperature, approximately 30 minutes. Separate serum from clot by centrifugation within 60 minutes at RPM's required to give a clean spin.

Whole Blood: Draw a sufficient amount of blood with the indicated anticoagulant. Gently mix the blood collection tube by inverting 8-10 times immediately after collection.

Blood samples used for laboratory testing are typically obtained by venipuncture. The proper procedures for routine venipuncture are outlined below. All these procedures should be conducted observing OSHA "Universal Precaution Procedures" regulations. When collecting, processing, or handling specimens, they should be considered a biohazard source with the potential of transmitting infectious diseases.

Order Of Draw

When drawing for multiple specimen types, establish the correct order of draw to avoid contamination with additives. Draw the tubes in the following order: 

1. Blood culture
2. Light blue-top (citrate)
3. Plain red-top (glass, or plastic with clot activator)
4. Gold-Top (Serum separator tube)
5. Green-top (heparin)
6. Lavender-top (EDTA)
7. Gray-top (K-Oxalate)

Venipuncture Procedure

This procedure must be performed only by medical professionals who have been trained in phlebotomy / venipucture.

Patient Identification:

Ask the patient to state his or her full name and date of birth. Verify that the test request form and all labels to be used match with name and date of birth give by the patient.

If the phlebotomy is to be performed on a hospital patient, an arm band must be present. Properly identify the patient by asking the patient to state their name and date of birth. Check the armband for name, date of birth and billing number. Verify a match with name and date of birth given verbally to that printed on test request forms and all labels to be used. If applicable, scan wristband bar code and test labels with Symbol Palm Powered Scanner per laboratory procedure.

Prepare the tubes and other needed equipment: (Use only latex free products for patients with latex allergy)

• Gloves
• Tourniquet
• 70% alcohol prep pads
• Dry cotton balls or gauze pads
• Appropriate evacuated tubes for tests ordered
• Holder or syringe and appropriate safety needle (21-22 gauge, 1-1.5" long)
• Adhesive pressure strip or bandage.
• Biohazard waste container

1. Review the request form(s) or physician order to determine that the appropriate evacuated tubes have been selected. Position the patient so that a stationary object, such as a drawing chair, drawing table, or bed supports the arm. Never draw blood from a standing patient. Do not draw blood from a compromised limb (i.e., due to mastectomy, stroke, surgery, etc.). Do not draw above an intravenous infusion. Do not draw blood from a fistula, or the arm with a fistula.
2. Reassure the patient. Explain that there will be slight pain associated with the procedure. Never tell the patient "this will not hurt."
3. Always wear gloves and work quickly so that the tourniquet does not remain on the patient's arm longer than one minute. Apply the tourniquet approximately 2-4 inches above the elbow, snug - not tight. Ask the patient to make and hold a fist; avoid vigorous hand pumping.
4. Palpate (feel) for a vein. The most commonly used veins are the median cubital, cephalic, and basilic veins. The preferred selection of veins is the median cubital first, then the cephalic, and lastly, the basilic vein. A vein should have an elastic feel that "gives" under pressure.
5. Clean the chosen puncture site using the alcohol pad, starting at the center of the site, moving in an ever widening concentric circle. Allow the skin to dry. Place the index finger on the vein above the puncture site, the thumb on the vein below the puncture site, and pull the skin tight to prevent the vein from "rolling."
6. With the needle bevel facing upward, line up the needle with the vein at an upward angle of approximately 15-30°. Puncture the vein in a rapid smooth motion, without penetrating through the vein. Push the evacuated tube forward until the back of the needle punctures the rubber stopper.
7. Fill the light blue-top tube until the vacuum is exhausted, a 4.5 mL draw. Partially filled citrate tubes are unacceptable. Never pour the contents of one tube into another.
8. After each tube has completed filling, remove and insert other tubes as required, into the tube holder. Immediately and gently invert all additive tubes after filling.
9. Remove the tourniquet and ask the patient to relax his/her hand. Do not keep the tourniquet on a patient's arm for more than 1 minute.
10. Remove the needle and place a clean gauze or a cotton ball on the puncture site and apply a slight pressure. Activate safe needle device immediately post draw. Dispose of the needle into an appropriate sharps container. Request that the patient hold the gauze or cotton ball with pressure, usually 3-5 minutes. After labeling the tubes, inspect the puncture site. If bleeding has stopped apply an adhesive strip over the gauze or cotton ball. Instruct the patient to leave the bandage in place for at least 30 minutes, for 60 minutes if the patient is taking coumadin. Dispose of all contaminated items appropriately.
11. At the completion of a venipuncture be sure that the bleeding has stopped. If blood flow has not stopped apply pressure with a fresh gauze or cotton ball until it does. This is critical with patients receiving anticoagulants. If post puncture bleeding persists for longer than 5 minutes, alert the attending physician so that he/she can be advised of any potential bleeding problems. Bandage the site.
12. There are many different types of bandages and tape available. An elastic wrap bandage works well for elderly patients with fragile skin and can be used for patients on anticoagulant therapy. Latex sensitive patients should be bandaged with latex-free tape only.
13. For patients admitted to the hospital, verify that the patient name and date of birth on all labeled samples match the information on the arm band. Complete the electronic validation by bar code scanning, by scanning your ID, the patient arm band and blood sample labels per laboratory procedure.

Small Samples - Collection Of Capillary (Fingertip) Samples From Adults

This procedure must be performed only by medical professionals who have been trained in the collection of capillary blood samples.

Microtainers

• Red cap with Gel barrier - no additive - used for most chemistry tests.
• Lavender cap - EDTA additive - used for all cbc, differential, reticulocyte testing.

Procedure:

Avoid a finger that is cold, cyanotic (blue), swollen or inflamed. (Use only latex free products for patients with latex allergy)

Patient Identification - Identify the patient exactly as outlined above.

1. A fresh pair of gloves must be worn.
2. With your left thumb and index finger, grasp either the patient's long or ring finger about 3 inches from the tip of the finger. Moving your left hand toward the tip of the patient's finger, apply a massaging motion to the fleshy portion of the finger.
3. Repeat this massaging process five or six times.
4. Cleanse the ball or pad of the finger with an alcohol swab. Do not use iodine solutions to cleanse the skin.
5. Thoroughly dry the ball or pad of the finger with a piece of dry cotton or gauze, to avoid hemolysis due to residual alcohol.
6. Pick up a sterile lancet device and remove the lancet from its container.
7. With your right hand, firmly grasp the sterile lancet. With your left hand, firmly grasp the patient's finger.
8. With a quick motion, depress the button on top of the lancet, making a deep cut on the side of the ball of the finger. The cut should be across the fingerprints.
9. If the blood flows freely, wipe away the first drop with a clean piece of cotton or gauze.
10. If the blood does not flow freely, increase the blood flow by holding the finger downward and applying gentle continuous pressure just above the puncture site. Do not massage the area since this may contaminate the blood sample with tissue fluid. If the blood does not flow easily after gentle massage, make another puncture at a different site.
11. EDTA MICROTAINER: Fill microtainer quickly, then stopper and mix thoroughly. Do not scrape the blood specimen from the finger as it may cause hemolysis. Blood specimen volume should be between 250-500ul (see lines on Microtainer vial).
12. Mix well by inverting 8-10 times.
13. Label the microtainer with the appropriate bar code label, and place each one in an empty, plain clot tube for transport.
14. When accessioning the specimen, please note in accessioning comments that this was a "fingerstick" or "Micro" collection.

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