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The Vacutainer® System...

Vacutainer Blood Collection System

The Vacutainer System consists of a double-pointed needle, a plastic holder or adapter and a series of vacuum tubes with rubber stoppers of various colors. The colors indicate the type of additives (or no additives). Blood collection using the evacuated tube collection system produces the best blood samples for analysis by the laboratory. They also are safe and easy to use because the patient's blood flows directly into the appropriate test tube.

Vacutainer is a registered trademark of Becton, Dickinson and Company.

Watch this short phlebotomy video clip!

A phlebotomist taking blood using the a needle holder with safety needle. Never mind, however, the repeated digging for a vein (ouch... it hurt to watch!):

Click here!

ATTENTION: Please realize that this video (published form YouTube using YouTube code) is NOT HERE TO TEACH you phlebotomy techniques, but merely to show you different scenarios of the phlebotomist's daily routine. The video may contain techniques, or procedures that do not conform to proper, and safe venipuncture protocol. Viewer discretion is strongly advised. If you spot errors share your tip how to do better here! Remember to add which video it was.

The following Vacutainer Tutorial was written

by Terry Kotrla, MS, MT(ASCP)BB, Austin Community College, TX

Reprint permission granted 06/15/04 by author - Thank you!

Vacutainer® Needle

The Vacutainer needle has a sharp point at both ends, and usually is covered by a rubber sheath, with one end being shorter than the other. The long end of the needle is used for penetrating the vein, the shorter end is used to pierce the rubber stopper of the vacuum tube. The sheath makes it possible to draw several tubes of blood by preventing leakage of blood as tubes are changed, this is called a multi-draw. If the short end is not covered with a rubber sheath, it is a single sample needle and only one tube of blood can be collected.

There are several sizes of Vacutainer needles available, the size depends on the length and gauge of the needle. Vacutainer needle lengths range from 1 to 1 ½ inches. One inch needles are used for routine venipuncture, 1 ½ inch needles are used for patients with very deep veins. The gauge of a needle is a number that indicates the diameter of its lumen; the lumen, also called the bore, is the circular hollow space inside the needle. A very well known phrase among phlebotomy students is "The bigger the gauge, the smaller the needle," which means the higher the gauge number of the needle, the smaller is the needle's lumen. The most frequently used gauges for phlebotomy are 20, 21 and 22.

The bevel is the slanted opening at the end of the needle. the phlebotomist performs a venipuncture so that the bevel of the needle is facing upward when the needle is inserted into the vein. Vacutainer needles come in single use, sterile packages, either peel apart envelopes or plastic cases.

Vacutainer® Holder

The Vacutainer holder is a plastic sleeve into which the phlebotomist screws the double pointed Vacutainer needle. Holders are available in different colors and in two sizes, one for adults and one for pediatric use. Some Vacutainer holders are single use with emphasis on safety. Here the needle is covered after use and the whole apparatus is disposed of. Most holders are used repeatedly and therefore must be disinfected in between uses.

Vacutainer Tubes

Vacutainer tubes are glass tubes sealed with a partial vacuum inside by rubber stoppers. The air pressure inside the tube is negative, less than the normal environment. After inserting the longer needle into the vein, the phlebotomist pushes the tube into the holder so that the shorter needle pierces the stopper. The difference in pressure between the inside of the tube and the vein causes blood to fill the tube. The tubes are available in various sizes for adult and pediatric phlebotomies. Adult tubes have volumes of 5, 7, 10 and 15 mL and pediatric tubes are available in volumes of 2, 3 and 4 mL.

Author: Terry Kotrla MT(ASCP)BB kotrla@austincc.edu

Collection Tubes & Their Additives For Phlebotomy

Red Top
Contains:	None
Effects on Specimen:	Blood clots, and the serum is separated by centrifugation
Uses:	Chemistries, Immunology and Serology, Blood Bank (Crossmatch)

	Red-Gray Mottled Top ("Tiger top")
Contains:	Serum Separating Tube (SST) with clot activator
Effects on Specimen:	Forms clot quickly and separates the serum with SST gel at the bottom of the tube
Uses:	Blood type screening and chemistries

Gold Top
Contains:	Separating gel and clot activator
Effects on Specimen:	Serum separator tube (SST) contains a gel at the bottom to separate blood from serum on centrifugation
Uses:	Serology, endocrine, immunology, including HIV

Light Green Top
Contains:	Plasma Separating Tube (Na Heparin)
Effects on Specimen:	Anticoagulants with lithium heparin; Plasma is separated with PST gel at the bottom of the tube
Uses:	Chemistries

Lavender/Purple Top
Contains:	EDTA (liquid form)
Effects on Specimen:	Forms calcium salts to remove calcium
Uses:	Hematology (CBC) and Blood Bank (Crossmatch); requires full draw - invert 8 times to prevent clotting and platelet clumping

Light Blue Top
Contains:	Sodium citrate (Na Citrate)
Effects on Specimen:	Forms calcium salts to remove calcium
Uses:	Coagulation tests (PT, PTT, TCT, CMV), tube must be filled 100% full.

Dark Green Top
Contains:	Sodium heparin or lithium heparin
Effects on Specimen:	Inactivates thrombin and thromboplastin
Uses:	Ammonia, lactate, HLA typing For lithium level, use sodium heparin For ammonia level, use sodium or lithium heparin!

Dark Blue/Royal Blue Top
Contains:	Sodium heparin or Na2 EDTA
Effects on Specimen:	Forms calcium salts Tube is designed to contain no contaminating metals
Uses:	Toxicology and trace element testing (zinc, copper, lead, mercury) and drug level testing

Light Gray Top
Contains:	Sodium fluoride and potassium oxalate
Effects on Specimen:	Antiglycolytic agent preserves glucose up to 5 days
Uses:	For lithium level, use sodium heparin Glucoses, requires full draw (may cause hemolysis if short draw)

Yellow Top
Contains:	ACD (acid-citrate-dextrose)
Effects on Specimen:	Complement inactivation
Uses:	Paternity testing, DNA studies

Tan/Brown Top
Contains:	Sodium heparin
Effects on Specimen:	Inactivates thrombin and thromboplastin
Uses:	Serum lead determination

Black Top
Contains:	Sodium citrate (buffered)
Effects on Specimen:	Forms calcium salts to remove calcium
Uses:	Westergren Sedimentation Rate; requires full draw

Orange Top
Contains:	Thrombin
Effects on Specimen:	Quickly clots blood
Uses:	STAT serum chemistries