What is the volume of blood needed to complete an ordered laboratory test?  

Which is the correct specimen container to place the blood in?

These are questions that should be addressed to fulfill the nurses' responsibility in collecting lab specimens.

General guidelines for serum specimen collection:

Pre-procedure:
•   Gather supplies for phlebotomy procedure.
•   What is missing from this picture?   Appropriate size syringe(s) and access device as necessary.  Butterfly needles are excellent for venipunctures in children.
•   Identify client / order.
•   Correct lab slip.
•   Labels for tube(s)
•   Wash hands.
blood collection supplies
Make sure you have the right tube to collect the specimen in.  If in doubt, call the lab.
varied collection tubes
Technique for collection will depend on the source of the blood:
•   Venipuncture
•   Small bore needle
•   Butterfly easier to manage.
•   Central venous catheter
•   Peripheral intravenous line
•   Arterial line
•   Blood used to clear line is replaced (Take measures to prevent contamination of specimen/line.)
•   Heelstick
3 cc syringe
Post-procedure care
•   Dependent upon technique.
•   Is a bandaid an absolute requirement following venipuncture for the preschool child?  (Why?)
•   Double check label before affixing to tube.
•   Double check correct lab identified.
•   Dispose of used materials appropriately.
•   Wash hands.
•   Transport to lab according to unit protocol.
bandaid

The following lists* identify MINIMUM requirements.  Please note that more specimen volume is preferable.  However, circumstances such as access difficulty, serial lab collections, and condition of child may preclude judicious nursing decision-making in collection of the specimens.  One of the differences in pediatric lab collection may be the use of microcontainers.

Lavender top (tube or microcontainer)
contains EDTA

lavender top bullet
CBC with differential 0.5 ml
Platelets 0.5 ml
Sed rate
Reticulocyte count
Sickle cell
G6PD
Ammonia

1.5 ml
0.5 ml
0.5 ml
2 ml
1 ml (place    on ice immediately)
Rotate tube gently to prevent clotting and platelet clumping.   No vigorous mixing EVER.

Green top (lithium heparin)* (tube or microcontainer)
 green top bullet
Chemistry 7
Chemistry 12
Chemistry 18
Chemistry 24
Separate tests
 Albumin / Total protein
 Alkaline Phosphatase
 AST (SGOT) / ALT (SGPT)
 Bilirubin (total & direct)
 BUN / Creatinine
 Calcium
 Chloride / CO2
 Cholesterol / Lipase / Triglyceride
 Glucose / GGT
 Ionized Calcium (green top only)
 Iron/UIBC
 Magnesium / Phosphorous
 Potassium / Sodium
0.6 ml
1 ml
1 ml
1.5 ml

0.6 ml
0.6 ml
0.6 ml
0.6 ml
0.6 ml
0.6 ml
0.6 ml
0.6 ml
0.6 ml
0.6 ml on ice
0.6 ml
0.6 ml
0.6 ml
*Red top may be used, but fibrin clot & instrument problems are eliminated with the use of green top tubes.  Sometimes a greater volume of blood may be required with red top tubes.

Red top (Clot tube ONLY)
 red top bullet
(micro-
container
contains
gel)
Chemistry
 Acetone
 Amylase
 CK
 Ferritin
 Folate
 Immunoglobulins
 Osmolality
 HCG
 Thyroid profile
 TSH

Serology
 ANA
 CMV or EBV IgM, IgG
 HIV
 Monospot
 RPR

Blood Bank   NO GEL TUBES
 Type & Crossmatch
 Cold Agglutinins
 Direct Coombs

1.5 ml
2 ml
1 ml
2 ml
1.5 ml
2 ml
1 ml
2 ml
2 ml
1.5 ml


2 ml
3 ml
2 ml
0.6 ml
1 ml


3 ml
3 ml
0.5 ml

Medication Monitoring
Red or Green  (unless otherwise indicated)
Acetaminophen
Amikacin
Cyclosporin
Digoxin
Gentamicin
OKT3
Phenobarbital
Phenytoin
Procainamide
Prograf (FK506)
Salicylate
Tegretol
Theophylline
Tobramycin
Valporic Acid
Vancomycin
1 ml
1 ml
1 ml
1 ml
0.6 ml
1 ml on ice
0.6 ml
0.6 ml
1 ml
1 ml
1 ml
0.6 ml
0.6 ml
0.6 ml
0.6 ml
0.6 ml


lavender


lavender



lavender
*Adapted from lists compiled by Lisa Nold, RN, MSN, CS, PNP,
 
Linda D. Puryear, RN, MSN