Phlebotomy Tray Essentials

A well-organized and well-stocked phlebotomy tray is every phlebotomist’s best friend. It ensures that a procedure is carried out quickly and blood specimens are handled safely and properly.

The best tray must be sectioned according to the supplies needed in blood collection. It has to be compact, deep and lightweight. Even when filled, it must remain light for mobility’s sake. It has to be well-constructed as well, so that it can withstand much abuse.

What does a phlebotomy tray have?

Essentials of a sample collection tray or cart

The supplies included in a tray depend on the type of collection that must be done, or the type of laboratory or hospital that a phlebotomist works in. Nonetheless, it should at least have the following:

• Alcohol swabs

Alcohol swabs must use 70% isopropyl alcohol. These are often used in various blood collections, except when specimen for blood culture is drawn. In this case, iodine wipes or swabs are recommended.

• Gauze squares or cotton balls

Once the needle has been removed, a gauze square or cotton ball is pressed down on the site to avoid formation of hematoma. This is often accompanied by an adhesive bandage or tape that is added only after the excess blood is kept under control.

• Assorted evacuated tubes

A phlebotomy tray must have an evacuated tube holder where the collection tubes are placed. Tubes are color-coded based on the additives and coatings applied to them.

• Red top tubes have no additives and are used for collection of serum. Volume of draw ranges from 2 to 20 ml.
• Tiger-colored top tubes (yellow with black) contain polymer gel and clot activator. It is used to collect serum at a volume from 2.5 to 13 ml.
• Lavender top tubes have EDTA (ethylenediaminetetraacetic acid) and are used for collection of whole blood of between 3 to 10 ml volumes.
• Green top tubes for the collection of whole blood contains herapin, an anticoagulant that activates antithrombins that block the coagulation cascade. Collection of whole blood must be at volumes of 2 to 10 ml.
• Blue top tubes are intended for coagulation tests and contain buffered sodium citrate. The sodium citrate binds the calcium in blood needed for clotting. Since this is not enough to fully separate plasma from red blood cells, the additive is buffered with tri-sodium citrate solution. Volume of draw is from 1.8 to 5 ml.
• White top tubes are used for glucose determinations. They contain an anticoagulant and glycolytic inhibitor. Blood drawn must be from 3 to 10 ml.
• Yellow top tubes contain ACD (acid citrate dextrose) solutions for the preservation of blood cells. Volume of draw is from 4.2 to 8.5 ml. The same tubes are used for sterile blood cultures, parental testing and HLA phenotyping.
• Dark blue tops for analysis of trace metals
• Gold top or red-grey speckled top for serum and infectious disease test
• Dark green top tubes contain herapin and are used for clinical chemistry tests
• Light gray tops for glucose testing

Evacuated collection tubes must be arranged according to the order of draw (http://www.uwhealth.org/lab/order-of-draw-of-blood-collection-tubes/11905) in a phlebotomy tray, which is as follows:

1. Blood Culture
2. Coagulation tubes
3. Non-additive tubes
4. Additive tubes

• Syringes

For patients with small or fragile veins, syringes are best used. This is because it allows a phlebotomist to have better control over the amount of vacuum applied, keeping the vein from collapsing.

• Syringe transfer device

A syringe transfer device protects the phlebotomy technicians from being pricked by the needled while transferring blood from the syringe to the vacuum tubes. It has a stopper that is punctured by the syringe needle to begin transfer of blood.

• Various-size syringe and evacuated system needles

Needles come in various sizes as indicated by the gauge number. The smaller it is the larger the needle bore. The size also defines their application. When collecting the blood, the most used are the following:

1. Straight Vacutainer needle that is used for patients with larger veins
2. Needle screwed directly into a tube-holder
3. Straight hypodermic needle, exclusively for use with a syringe
4. Butterfly needles that can be used directly with Vacutainer System for difficult draws

As for venipuncture, the size of the needles used range from 21 to 25 gauges, depending on the application. A 23 gauge needle, for example, is used to draw blood for laboratory testing.

When organizing a phlebotomy tray, needles must be arranged according to type and gauge, and must be separated between single draws and butterfly system.

• Butterfly collection sets

A butterfly collection set is used for difficult draw. Patients with small or fragile veins often call for the use of a butterfly needle.

• Microcollection equipment

Microtainers or microcollection tubes are used to collect blood from a skin puncture on the heel or finger. They are often used on elderly, infants, small children or patients with difficult veins. Microcapillary tubes, on the other hand, are used to collect small volumes of blood.

• Tourniquets

To make veins more prominent, tourniquets are used which occlude venous blood flow. For patients allergic to latex, latex-free tourniquet is highly recommended.

• Disposable gloves

Gloves protect the phlebotomist and the patient from bloodborne pathogens and help reduce exposure to infection. They are available in latex, rubber or vinyl.

• Sharps container

The sharps container is needle disposal equipment that help reduce the occurrence of accidental puncture. It comes in various sizes and marked with a biohazard icon, alerting anyone of potential danger.

• Marking pen

A phlebotomy tray must not be without a marking pen, since evacuated tubes must be labelled accordingly. A phlebotomist must not leave a patient without labelling the collection tubes.

To ensure a smooth process, a tray must be stocked in such a way that it allows for at least five procedures. Before leaving with the tray, a phlebotomist must check the order for a patient, so that the right supplies are provided, especially for special blood testing (http://www.aarogya.com/conditions-and-diseases/diagnostic-tests/4188-special-blood-tests.html) where items that are not usually found in a tray may be required. It is also important that the tray is dismantled completely and cleaned thoroughly at least once a week.

When the tray is used from one patient’s room to another, it is highly advised that it is placed on top of a clean towel to eliminate contamination of the bedside table.