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November, 2007


Copyright 2007 Center for Phlebotomy Education, Inc.
 All rights reserved. View our copyright policy.

 

Tubes and their Additives

One of the most common questions we receive here at the Center for Phlebotomy Education is “what tests go in which tubes?” Unfortunately, we can’t answer that question definitively. That’s because every facility is a little different in that regard. In some facilities, electrolytes are tested in heparinized (green-stopper) tubes whereas others test serum from red-stopper tubes. Some measure sedimentation rates on lavender-stopper EDTA tubes while others perform them on  blood in a black-stopper tube containing sodium citrate. Because of this variability, there is no universal list of tubes and tests that applies to all facilities. However, some generalities do exist. Here is a list of some of the more common tests specimen collection personnel draw on their patients and the tubes they are most likely to be collected in.
[Editor’s note: this chart is meant only as a guide. Check with your facility’s protocol for variations, and always follow your facility’s procedures.]

Key

B=blue top=plasma=sodium citrate

Bc=blood culture bottle

Bl=black top=sodium citrate

Go=gold top=serum=clot activator/gel

Gr=green top=plasma=heparin

Gy=gray top=plasma/whole blood=sodium fluoride

Lp=pink top=EDTA

Ll=lavender top=EDTA

P=pearl=EDTA

R=red top=serum=clot activator/gel

Y=yellow top=ACD



Test

Tube(s) most commonly required

Test

Tube(s) most commonly required

A1c

Ll

Hepatitis A, B, C

R,Go,Ll

ACTH

Ll

HIV Antibody

P

Albumin

R,Go,Gr

HLA-B27

Y

ALT

R,Gr

INR

B

Ammonia

Gr

Ionized Calcium

R,Go,

Amylase

R,Go,Gr

Iron

R,Go,

ANA

R,Go

LDH

R,Go,Gr

Antiglobulin, Direct

Lp

LDL

R,Go,Gr

Antiglobulin, Indirect

R (without gel)

Lead

Ll

APTT (PTT)

B

Lipid Profile

R,Go,Gr

AST

R,Go,Gr

Lithium

R,Go

Bicarbonate (CO2)

R,Go,Gr

Liver Panel

R,Go,Gr

Bilirubin

R,Go,Gr

Magnesium

R,Go,Gr

Blood Culture

BC, Y

Mono

R,Go

Blood Gases

Heparinized syringe

Myoglobin

Gr

BMP

R

Phenytoin

R,*Go*,Gr*

BNP

Ll

Phosphorus

R,Go,Gr

BUN

R

Platelet Count

Ll

Calcium

R,Go,Gr

Potassium

R,Go,Gr

Cardiac Risk

R

Pregnancy Test

R,Go

Catecholamines

Gr (sodium heparin)

Protein Electro.

R,Go

CBC

Ll

PSA

R,Go,Gr

Chemistry Panels

R,Go,Gr

PT

B

Chloride

R,Go,Gr

RBC

Ll

Cholesterol

R,Go,Gr

Renin

Gr, Gr

CK

R,Go,Gr

Reticulocyte Count

Ll

CK-MB

R,Go,Gr

Rheumatoid Factor

Go, R

CMV

R,Go

Rubella

R,G

Coagulation Factors

B

Sodium

R,Go,Gr

Comp. Metabolic Panel

R,Go,Gr

T3

R,G

Cortisol

R,Go,

T4

R,G

Creatinine

R,Go,Gr

Testosterone

R*,Go,*

CRP

R,Go,Gr

Therapeutic Drug Monitoring

R*,Go*

D-dimer

B

TIBC

R,Go

Differential

Ll

Total Protein

R,Go,Gr

Digoxin

R

Triglycerides

R,Go,Gr

EBV Antibodies

R,Go

Troponin

R,Go,Gr

Electrolytes

R,Go,Gr

TSH

R,Go,Gr

ESR

Ll

Uric Acid

R,Go,Gr

Ethanol

R,Go,Gy

Valproic Acid*

R*,Go

Ferritin

R,Go,Gr

Vancomycin

R,*Go*

Fibrinogen

B

Vitamin B12

R,Go

Folate

R,Go

WBC

Ll

GGT

R,Go,Gr

 

 

Glucose

R,Go,Gr,Gy

 

 

hCG

R,Go

 

 

HDL

R,Go,Gr

 

 

Hematocrit

Ll

 

 

Hemoglobin

Ll

*gel interference is manufacturer-specific

 


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This Month in Phlebotomy Today

Hereís what subscribers to Phlebotomy Today, the Center for Phlebotomy Educationís paid-subscription newsletter currently in its 8th year of publication, are reading about this month:

  • Feature Article: How Collection Personnel Unknowingly Alter Test Results, Part III: Hemolysis
  • Center Creating Expert Witness Database
  • Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in October including these stories:
    • Venipuncture Infection Puts Arizona Law Under Scrutiny
    • Therapeutic Phlebotomy Linked to Healthy Liver
  • According to the Standards: Documenting Newborn Blood Withdrawal
  • Center Adds to CEU Offerings
  • Product Spotlight: Venipuncture Training Aids
  • Tip of the Month: Deal, or No Deal?
  • On a Personal Note: What is Belgium famous for besides chocolate?
  • CEU questions (institutional version only).

Buy this issue for only $9.95.

For subscription rates and to subscribe to Phlebotomy Today, visit www.phlebotomy.com/PhlebotomyToday.html. The current monthís issue will be emailed to you immediately upon subscribing.

Feel free to forward this newsletter to a friend!

 

Featured FAQ: Face shields and phlebotomy

Question: Iím confused. Someone at a conference recently said face shields are required for phlebotomy. This is new to me and I want to make sure Iím not in violation of the standards. Iím afraid to call my local OSHA office for fear that theyíll show up on my doorstep.

Response: Your fear is unfounded. OSHA actually wants to help you comply with the standards and would look favorably on your willingness to contact them for guidance. The passage in the Bloodborne Pathogens Standard that addresses the issue reads as follows: "Masks in combination with eye protection devices, such as goggles or glasses with solid side shields, or chin-length face shields, shall be worn whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated." Routine phlebotomy doesn't usually pose that risk, but it's up to the employer to make that determination. So the information you received is not exactly correct. Some companies warn against splatter on the packaging of their safety needles. Make sure you address such warnings with the appropriate precautions.

Each month, PT-STAT! will include one of the hundreds of phlebotomy FAQs in the growing database of questions and answers culled from Phlebotomy Central, the members-only section of the Center for Phlebotomy Education's web site. For information on joining Phlebotomy Central, visit www.phlebotomy.com/PhlebotomyCentral.html.


Specimen Collection Safety: Syringes

Do you use syringes to draw blood? A study conducted by the National Institute of Occupational Safety and Health (NIOSH) associates syringe use with the highest rate of accidental needlesticks among all healthcare professionals injured during a 4-year period. The Clinical and Laboratory Standards Institute (CLSI), the committee that establishes the standards by which laboratory procedures should be performed, discourages their use for safety reasons. Officials at the International Healthcare Worker Safety Center echo their sentiments.

However, draws outside of the antecubital area are seldom successful unless syringes are used. In the antecubital area, they should be employed only when attempting to access small veins and/or veins that are anticipated to collapse if tube holders are used. Syringes must have a safety feature or be used with a safety needle and activated immediately after use.

 What Would You Do?

Each month, What Would You Do? presents a different case study, then asks readers to contribute their ideas as to how each situation would best be handled. The following month, selected responses will be chosen by the editor and published (sender will be identified by first name and state only). The most accurate, well written response will receive a free "Accurate Results Begin With Me!® t-shirt. The exercise will conclude with a review of the selected submissions and a discussion of the standards pertinent to the case study.


 

This Month's Case Study:
Is the Customer Always Right?

You step into a patientís room to draw his blood. After you introduce yourself and state your purpose, you start your survey for veins. The patient immediately points to the inside aspect of his antecubital area, the vein that is closest to the nerves, and instructs you to draw from a vein he says is right there beneath the skin. Knowing that the standards say you should only draw there if you have no other options, you politely inform him you need to survey for all available veins first. But he insists you draw from the vein he has selected, his basilic vein, and becomes adamant. What would you do?

 

Tell us what you'd do in this case. Submit your response by the 20th of the month and send it to this address and this address only: WWYD@phlebotomy.com. Submissions sent to any other address will not be considered. Keep your suggested solutions less than 100 words. Although you donít have to be an English scholar to be considered for inclusion, submission with proper grammar and punctuation will be given priority. If youíre not sure of the appropriate solution, check your facilityís procedure manual or ask your manager. Who knows, you might be presented with the very same dilemma tomorrow.

 

Last Monthís Case Study:
A Mastectomy Mystery

Helen Sampson walks in to your outpatient lab with a requisition for lab work. You seat her comfortably in the drawing chair and she immediately tells you that she has had a mastectomy on her left side. Knowing itís not acceptable to draw from that side, you tighten up the tourniquet around her right arm and survey the antecubital for a vein. Thereís none. You look at the hand and the side of the wrist. Nothing. Sensing your frustration, she gives you permission to draw from her left arm. She offers to put her approval in writing. What would you do?

 

Here's a sampling of what PT-STAT! readers said they'd do. Most of you responded just as Susan from Michigan did:

"You cannot accept the patient's consent to perform a procedure you know may inflict harm upon her. The best plan is to call the physician's office and explain the situation to the patient's doctor to see if he/she will give approval or suggest an alternative course of action. If the physician cannot be reached and you cannot obtain blood from the opposite arm/hand, the patient will have to have her labs drawn at a different time or place after she has been advised to speak with her physician regarding this situation."

For her accurate and well-written response, Susan will be receiving a free "Accurate Results Begin With Me!® t-shirt. Congratulations, Susan.

But we particularly liked the confidence that came from one anonymous submission:

"A good phlebotomist would find a vein on the right arm!"

From the overwhelming number of responses, preliminary indications all suggest the What Would You Do? feature is a phenomenal success. Not only that, but what the vast majority of respondents, a full 86 percent, would do is exactly what the standards require. About 10 percent indicated a willingness to perform a capillary puncture on the affected side, which is just as forbidden by the standards as a venipuncture. The risk is for lymphadenopathy due to infection, which is just as likely to come from a skin puncture as a venipuncture. Therefore, a skin puncture on the affected side requires the same precaution and permission as a venipuncture.

Several submissions entertained thoughts of performing an arterial puncture. However, the standards state that arterial punctures are not to be considered an alternative to a venipuncture in case the draw is difficult. The risk of injury is substantially greater, and therefore unjustified.


Product Spotlight: Venipuncture Training Aids

The Center for Phlebotomy Education, Inc. has searched the world over for an artificial training model that provides the most life-like venipuncture experience for students and new employees upon which to learn the art of phlebotomy. The result of its search has led to the Advanced Venipuncture Training Aid. The device includes four visible and/or palpable veins, each embedded in a latex-free semi-transparent block of tissue-like material at varying depths, simulating the diversity of human antecubital anatomy phlebotomists regularly encounter. A physical "pop" is felt as the needle enters the vein, followed by a realistic "flashback" of simulated blood confirming the proper needle placement.

The Advanced Training Aid sells for $265.95, and includes a bag of simulated blood that allows for tube- or syringe-filling attached to a backboard. The backboard doubles as a cover to protect the tissue block when not in use. An optional carrying case is also available. Longevity for the Advanced model is rated at 7200 punctures.

"We will not embrace a product unless it meets our strict standards for quality, durability, lasting value, and customer satisfaction," says Dennis J. Ernst MT(ASCP), the Center's founding director. "When it comes to training arms for phlebotomy, we've seen them all. We find the Advanced Venipuncture Training Aid to be way beyond the competition in terms of realistic feel, quality construction, longevity, and price."

Advanced Venipuncture Training Aid 
The Advanced Venipuncture Training
Aid from the Center for Phlebotomy Education, Inc.

______________________________

The simulated tissue is latex-free and available in two shades of color to simulate light and dark skinned patients. The Center also offers a basic version without the simulated blood. For more information, visit www.phlebotomy.com/TrainingAid.html

 

Center Adds to CEU Offerings

The Center for Phlebotomy Education has added a new continuing education (CE) exercise, the sixth this year, to its growing menu of in-house and P.A.C.E.® offerings. Starting this month, every purchase of the Center's Accurate Results Begin With Me! ® poster will be shipped with test questions managers and educators can distribute to students and staff to assure the poster is read and comprehended. The exercise can be implemented into a facility's in-house CE program. There is no additional charge for the exercise. Earlier this year, the Center began shipping a similar exercise with each purchase of the Blood Collection Sites & Precautions wall atlas.

The exercise is the latest addition to the Center's seven different categories of phlebotomy CE opportunities including an online training program, printed material, an e-newsletter, and videos. Other in-house CE exercises include the Applied Phlebotomy textbook with end-of-chapter CE questions, and institutional subscriptions to the Center’s newsletter, Phlebotomy Today, which provides test questions at the end of each issue pertinent to the content.

For formal P.A.C.E.® credits, those who purchase and view any of the Center’s Applied Phlebotomy videos have the option of completing and submitting an exam covering its content, which is now shipped with each video. New this year is the To the PointTM series of booklets, each one qualifying for 3 P.A.C.E.® credits. Finally, PhlebotomyWeb, an online training program, offers up to 9.5 P.A.C.E.® credits.

All of the Center's P.A.C.E.® credits are recognized by the California Department of Health Services for maintaining state phlebotomy certification. For a summary of all the Center's CE exercises, click here.

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PT STAT! is a free, monthly educational service provided by the Center for Phlebotomy Education, Inc., the most respected authority in phlebotomy. For a complete company profile and product list for all healthcare professionals who perform, teach or manage specimen collection procedures, visit us on the Internet at: http://www.phlebotomy.com.
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Copyright 2007, Center for Phlebotomy Education, Inc. All rights reserved. Newsletters may contain links to sites on the Internet owned and operated by third parties. The Center for Phlebotomy Education, Inc. is not responsible for the availability of, or the content located on or through, any such third-party site. Information in this document is provided "as is," without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability, fitness for a particular purpose and freedom from infringement. The user assumes the entire risk as to the accuracy and the use of this document. We will not be liable for any damages of any kind arising from the use of this information, including, but not limited to direct, indirect, incidental, punitive, and consequential damages.