Syringe Information and Courses from MediaLab, Inc.

These are the MediaLab courses that cover Syringe and links to relevant pages within the course.

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Cerebrospinal Fluid
Specimen Collection (continued) A syringe is used to remove 6 - 15 ml of spinal fluid. Less fluid is removed in babies and small children. The CSF sample is divided among 3 - 4 tubes, with 2 - 4 ml in each tube. Glass tubes should be avoided due to cell adhesion which may affect the cell counts or differential. The tubes are numbered in the order in which the CSF is obtained.	View Page

Introduction to Bone Marrow
Which of the following statements are FALSE regarding the bone marrow BIOPSY specimen?	View Page
Collection of the Aspirate The marrow aspiration is usually performed before a biopsy is done. A syringe is attached to the needle, the plunger is pulled and 1.0-1.5 ml. of marrow particles and blood from marrow sinuses is withdrawn. If additional bone marrow samples are needed, a separate syringe must be used each time. If more than 2 cc. per syringe is taken out, the blood to marrow ratio will be too high and the preparations will not accurately reflect the marrow contents. As the marrow is aspirated into the syringe the patient will feel some pain and pressure even though local anesthetic has been administered.	View Page
Which of the following statements are TRUE for aspirated specimens?	View Page
Preparation of Direct Smears The sample in the first syringe is quickly delivered into a watchglass or onto a slide. After the technologist verifies the presence of white-gray marrow particles in the sample, push smears and/or coverslip smears from this unanticoagulated sample are made immediately. All films should be rapidly air dried. The appearance of fat as irregular holes in the films also give the assurance that marrow and not just blood has been obtained. This type of smear is referred to as a direct smear and is usually used to evaluate morphology. Although some evaluation of cellularity and M:E ratio is possible, particle smears or biopsy sections provide a more accurate representation of these factors.	View Page

Phlebotomy
Discussion Hemolysis can easily be caused by improper phlebotomy techniques. Hemolysis occurs when RBCs are broken up and hemoglobin is released into the plasma, causing it to become pink rather than its natural straw color. Hemolysis can occur by using too small a needle, pulling a syringe plunger too rapidly, expelling blood vigorously into a tube, or shaking a tube of blood too hard. Hemolysis can cause falsely increased potassium, magnesium, iron, and ammonia levels, and other aberrant lab results.In this case, Marcie did not properly wipe the site with gauze after cleaning it with alcohol, and alcohol contacting the blood could have caused RBCs to break up or hemolyze. Marcie also squeezed the baby’s foot too hard, causing hemolysis.Relevant topics:Site selection and preparation, Heelstick: Puncture, Hemolysis, Causes of hemolysis	View Page
What could have caused the clotting?	View Page
Discussion Tubes are drawn in a specific order to avoid the possibility of erroneous test results caused by carryover of an additive from one tube to the next. If a blood culture is ordered, it should be drawn as the first tube. Additional tubes should follow this order of draw. Sodium citrate - coagulation tube (light-blue top) Serum tube - with or without clot activator or gel. This tube is either a red top tube or a gold top tube depending on manufacturer and tube additive. Sodium or lithium heparin with or without gel plasma separator (green top) Potassium EDTA (lavender or pink top) Sodium fluoride, and sodium or potassium oxalate (gray top)	View Page
Single draw needles Single draw needles are of the type that fit on a syringe, and can be used only to fill the syringe to which they are connected.	View Page
Syringes with built-in safety devices Syringes are used for injections, as well as to collect blood. There a various syringes with built-in safety features.One example is the Monoject™ (Sherwood Services AG), Safety Syringe, shown here.	View Page
Syringes with built-in safety devices contd. After use, a safety shield is slid over the needle, and locked into place. The safety syringe with the shield locked in place is shown here.	View Page
Blood transfer device A blood transfer device allows the transfer of blood from a syringe into a blood collection tube or a blood culture bottle. The BD™ blood transfer device is shown here.	View Page
Butterfly needles continued Butterfly needles may be used with a syringe or a holder and vacuum collection tube system. They are usually 21, 23, or 25 gauge.	View Page
Syringe - Syringe blood collections Syringes may be used to collect blood from patients having small or delicate veins that might be collapsed by the vacuum of the evacuated tube system.Syringes may also be used to collect blood culture specimens.	View Page
Syringe - Syringe blood collections continued Syringes may be used in two ways:Syringes may be used in two ways:A syringe may be attached to a butterfly or winged infusion set.	View Page
Syringe - Transferring blood to collection tubes After collecting the blood specimen into a syringe, properly activate the appropriate safety device, and dispose of the needle in a sharps container.Attach the syringe to a blood transfer device by twisting the needle tip into the hub of the device.Push a vacuum blood collection tube into the holder of the transfer device, and let the tube fill to the appropriate level.	View Page
Syringe - Transferring blood to collection tubes contd It is important to transfer the blood to appropriate tubes immediately because a syringe contains no anticoagulant, and the transfer must be complete before blood starts to clot.Do not push the plunger while transferring blood into a collection tube. This may cause hemolysis, ruining the specimen.	View Page
Butterfly needle - Butterfly needle collections continued Butterfly needles come attached to a small tube which may be connected to:An evacuated tube holder, orA syringe.	View Page
Collection methods Blood for culture can be collected in several ways:Standard needle attached to a syringe.Butterfly needle attached to a syringe.Blood culture bottle attached directly to tube holder (not generally recommended).Follow you own facilities’ procedure for blood culture collection.	View Page
Activate needle safety device After collecting the blood, activate the needle safety device according to manufacturer’s instructions, and place it in a sharps disposal container. If blood was collected into a syringe, insert the syringe tip into the hub of a blood transfer device, and rotate the syringe clockwise to secure it to the device. Push the blood culture bottle into the holder of the transfer device, and draw the appropriate volume of blood into the blood culture bottles.	View Page
Causes of hemolysis Hemolysis can be caused by: Shaking the tube too hard.Using a needle that is too small.Pulling back too hard on a syringe plunger.Pushing on a syringe plunger too hard when expelling blood into a collection device.	View Page
Causes of clotting Clotting can be caused by: Inadequate mixing of blood and anticoagulant within the collection tube.Delay in expelling blood within a syringe (which contains no anticoagulant), into a collection tube with anticoagulant.	View Page

Routine Venipuncture
Do Not Tamper With the Specimens A phlebotomist should not uncap a blood tube and pour blood between tubes or combine two partially filled tubes of blood into one. This may lead to over-fill of tubes and more importantly, invalid patient results. Combining two tubes with the same additive into one tube will alter the blood to anticoagulant ratio by doubling the amount of anticoagulant in the tube. When blood is being transferred from a syringe to a tube, the phlebotomist must not apply pressure to the plunger to force blood into the tube. This may cause over-filling of the tube and hemolysis of blood cells. With the aid of a transfer device, the tube will draw the amount of blood required to fill the tube based on the amount of vacuum in the tube.	View Page
Syringe The syringe and needle combination should be the last equipment option that is considered; it is not as safe a choice as the self-contained blood collection systems because it involves more manipulation. However, the phlebotomist may choose to use a syringe to prevent vein collapse if the phlebotomist thinks that the vein is too fragile to withstand the pressure exerted by the vacuum as it pulls blood into the collection tube. A transfer device aids in the safe transfer of blood from the syringe into blood collection tubes. During blood transfer, do not manually push plunger as this may cause hemolysis of the specimen.	View Page
Winged Device The winged device is another popular choice for the phlebotomist. This may be chosen for pediatric venipuncture, small delicate veins on adults (particularly geriatric patients), or hand veins. The device can be used with a needle holder and evacuated tube or a syringe. A needle safety device is incorporated into the design of the winged device to prevent needlestick injury.	View Page
Handle With Care Equipment: To successfully enter a hand vein, the phlebotomist must choose equipment that will allow needle entry at a very small angle. A winged device with a small gauged needle of 3/4 inch length is most often used to obtain blood from a hand vein. A syringe is usually attached to the end of the tubing of this device. By using a syringe, the phlebotomist can control the amount of pressure on the vein and avoid vein collapse. Evacuated tubes may collapse a vein by exerting too much pressure on the delicate vein. If available, smaller tubes containing less vacuum may be used.Insertion angle: The angle at which the needle is inserted into a hand vein is smaller compared to the angle of needle insertion into veins of the antecubital area. When drawing from a hand, the needle should be inserted into the vein at approximately a 15 degree angle to allow easier access of the surface hand veins. By inserting the needle at this angle, the risk of the needle going "through" the vein and puncturing the bony structures underneath are reduced.	View Page

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