Open vs closed systems

Some situations involve the use of an open system (and historically this is what we generally used before closed system sampling)

BUT

Open systems pose more risk of contamination and needlestick injury.

SO

BD Vacutainer minimised these problems by creating a closed system of sampling.

BUT

The vacuum can put a lot of pressure on fragile veins causing them to collapse.

SO

S-Monovette developed a syringe system for more fragile veins.

All the benefits of open sampling within a closed system!

Some do's and don'ts of handling sample tubes.

• DO insert window facing up. Fill lines are important

• DO NOT underfill (ratio of blood to additive can cause sample damage or inaccuracy in certain blood samples)

• DO NOT stick labels over windows

• DO NOT obscure colours on the label

• DO NOT pre-label

• DO NOT take lids off and release vacuum, or re-use if unsuccessful first time

• DO check expiry dates

• DO remove all sample tubes before removing needle from site

• DO handle vials with care – Invert, don’t shake / drop

• DO store correctly before transportation: Temp? Light? Orientation?

• DO NOT expose samples to extreme heat or cold (unless specified)

• DO manage vacuum and forces on blood cells to avoid heamolysis (destruction of red blood cells)

• DO use correct size of needle for vein and be careful with tourniquets – more about this later.

• DO pick the right tube for the right request and the right vial for the right needle and take the right amount for the right tests!

Order of Draw is also IMPORTANT!

Note inversion amounts too.

Don't forget a DISCARD or PURGE tube if indicated – prime your line if volume is specific!

One of the most dangerous mistakes is not actually a procedural or clinical error – IT’S BAD DOCUMENTATION AND LABELING!

It’s a skill in itself writing on these!

Needles

Features:

• Size matters! Important to consider the size and stability of the vein against the size of the needle

• Most common for adults is 21g green or 22g black. Needles can be much smaller for infants or REALLY tricky veins, and much larger for blood donation

• Use 23g blue (or smaller) for extremities / small veins / young children / frail veins

• Straight or butterfly or syringe? Preference / cost / anatomy / age of client / compliance

• Safety needles can protect by up to 75% more

• Always insert bevel UP (facing you)

• Always check expiry

Handling of needles:

• Connecting to hubs: Assemble first – careful now! Needles are double ended (unless using open systems with syringe). Hubs are a safety feature

• Do not expose needle until ready to puncture

• Do not twist to remove cap

• Taking blood from IV cannulas? – only on insertion

• How to hold them? PRACTICE LOTS on something that doesn’t care before stabbing an actual person

• How far do you go in? Avoid transfixation

• Keep Steady!! Use your knuckles

• Don’t probe. Only move forwards and backwards – NOT sideways!

• DO NOT disassemble after use – entire unit goes in sharps bin

• Practice as much as you can: inserting, anchoring, inserting sample vials, removing tourniquets while holding needles steady – all the motions

Other Equipment

• Why is infection control so important?

• Who is most at risk?

• What could the consequences be of a contaminated sample?

Ensure you have completed more broad infection control training if you are new to clinical practice in general

Also ensure you know your sharps incident policy. Don't wait for a needle stick injury to find out what to do!

What other important phlebotomy tool is missing here?

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