Transcript Slide 1 - MGH Laboratory Handbook

Specimen Collection Update
Glass to Plastic Conversion
Change in “Order of Draw”
Laura Listro, MM, MT(ASCP)
Associate Director of Quality & Safety
MGH Pathology Service
George Souza
Technical Director, Lab Support Services
MGH Pathology Service
November 2009
Quality & Safety ~ Glass vs. Plastic
Advances in Exposure Prevention, Vol. 3, 5, 1998, pg 49.
- Protect health care workers from injury
- Laboratory Automation
- Robotics will break glass tubes
-All tubes will be plastic except for
-Blood culture bottles
-Yellow ACD solution tubes
SPECIMEN COLLECTION ALERT
December 1, 2009
NEW 10ml GREEN TOP PLASTIC TUBE
REPLACES 10ml GLASS Green top collection tube
Plastic 10mL Green top tube with the additive Sodium
Heparin is replacing the glass 10ml version.
This is not the commonly used 4ml Lithium heparin gel
separator tube used for general chemistry testing.
The 10ml green tube is used for Special testing , for
example; Vitamin B1 testing
Plastic Green tops must now be mixed by inversion 8-10
times
-Mix the anticoagulant, (Sodium Heparin)
to prevent clotting
-Refer to the NEW Order of draw flyer (Nov. 2009)
New Product Information
Item BD Ref # 367874
Peoplesoft # 290201
SPECIMEN COLLECTION ALERT
December 1, 2009
NEW RED TOP PLASTIC TUBE
REPLACES GLASS Red top collection tube
Plastic Red top tubes now have an additive
- a clot activator is spray coated inside the
collection tube
Plastic Red tops must now be mixed by inversion
8-10 times
- mix the clot activator with the blood
to initiate clotting
The additive affects the order blood collection
tubes are drawn - the “Order of Draw”
- Must now draw red top tubes after light blue
sodium citrate tubes to prevent erroneous test
results in the light blue tube
Draw 4ml tube for
all tests with r beside
the test.
New Product Info.
BD Ref# 367812
Peoplesoft # 45764
Draw 10ml tube
for all tests with R
beside the test.
New Product Info
BD Ref # 367820
Peoplesoft # 45765
• If using a paper Lab requisition –
– Use 4ml Red top plastic tube for all
tests with a small “r” beside the test
– Use 10 ml Red top plastic tube for all
tests with a large “R” beside the test
• Continue to collect Ionized Calcium
first, using ABG sampling syringe
– Plan to change to a collection tube
sometime early 2010
• For Line draws –
– Change in practice
• Follow new order of draw
• Cannot use plastic red top as discard if
you have other tubes to collect first
• Clear lines using a syringe, discard, then
collect specimens for testing
Reminder ~ Butterfly Needles & Blue Tops- 06/2009
For proper filling of Blue top tubes when using a Butterfly (winged
collection set) and to avoid specimen rejection due to quantity
not sufficient…
Draw a Light Blue “discard tube” first!
Discard tube MUST be a Light Blue top, to avoid cross
contamination of anticoagulants.
It is only necessary to draw a discard tube 1st when using a
Butterfly for venipuncture.
The tube vacuum fills the length of the tubing to pull blood into
the tube. This is why the first tube will not completely fill and is
your discard tube.
When tubing is filled and flowing into the first blue top; switch to
the second blue top and it will fill properly.
Throw away (discard) the first blue top. Send the second, properly
filled tube to the lab.
Refer to proper FILL LINE below, the minimum line is etched on
the tube
Draw Volume Guide:
Completely fill the collection
tube to avoid test refusal.
Blood drawn must fall above
Minimum Fill Indicator (frosted
line on tube) and below
Maximum Fill Line (as
illustrated).
1.8 mL
Psoft
#91657,
BD Ref
#363080
Completely fill the tube as shown
to avoid test refusal
Invert to mix additive with blood
For blood transfer from a
syringe, do not fill above
illustrated dashed Maximum Fill
line.
2.7mL
Psoft #91879,
BD Ref #363083
Butterfly Blues
06182009
Summary
• Dec.1, 2009 – Conversion Date
– Plastic tubes will start to be on PARS supply carts.
– Others; place an order for plastic tubes
• Plastic tubes have spray coated
additive including the Red tops
– Plastic Red tops have a clot activator, All other tubes
have a clot inhibitor (anticoagulant)
– Invert Plastic tubes to properly mix the additive with
the blood
• Additives affect the order of draw
• Nov. 2009 - Follow New Order of Draw
to prevent:
– Cross contamination of tube additives
– Wrong test results
– Refused tests for questionable quality of the specimen or
wrong tube type
• Refer to Butterfly Needle & Blue Top
Flyer
– Only when using a Butterfly needle & drawing a blue
top first – must include a blue top as a discard tube
Resources & Contacts
• RESOURCES
• Online MGH Laboratory Handbook
– http://mghlabtest.partners.org/index.asp
– From Start menu
> Partners applications
> Clinical References
> MGH Laboratory Handbook
• Call Lab Support Services
– 4-LABS (x45227)
• CONTACTS
• For supply questions call:
- Lisa Martino at 617-726-1692
• All other questions, please contact:
- Laura Listro at 617-726-0690 or
[email protected]
- George Souza at 617-726-2678 or
[email protected]
Questions
Dennis Cox© at www.acclaimimages.com