Purpose:  To ensure safe blood product administration. Type and screen and type and crossmatch blood products requiring a Typenex patient armband only applies to potential red blood cell transfusion. A Typenex patient armband is not required for potential transfusion of platelets, crossmatched platelets, plasma, or cryoprecipitate. For these components, the blood bank only needs to know the patient’s blood type (ABO, Rh).

Policy:  Physician order is required for type and screen and for type and crossmatch. A registered nurse, LPN, medical assistant, or physician extender may collect specimens for type and screen and type and crossmatch.

At the bedside, staff member must verify the patient’s name and medical record number from the facility armband before the blood specimen is drawn. If applicable, patient should be asked to state his or her name. *If the patient does not have a facility armband, transfusion nurse must verify patient identity with another RN and apply a facility armband prior to obtaining the type and screen/type and cross sample.

All patients who are to be crossmatched must have a Typenex armband (applies to potential red blood cell transfusion only). The blood bank uses the same Typenex specimen for up to 72 hours after collection.

After 72 hours, a new Typenex  specimen must be obtained due to possible antibody formation. When collecting a new Typenex banded specimen, do not remove the older Typenex armband unless it is greater than four days old.

At the patient’s bedside, identifying information must be entered onto the Typenex armband in the presence of the patient.  The patient, if able, may be asked to read back the name on the band. The phlebotomist must label all blood samples and arm bands at the time the sample is drawn and before leaving the patient’s bedside. The Typenex armband must contain the following information: patient name, medical record number, date and time sample obtained, and name of person obtaining blood sample (for Typenex banded specimen for crossmatched blood products, phone number of phlebotomist also acceptable). The Typenex armband must be compared to the patient facility armband to insure that name and medical record number are correct when placing the Typenex  band on the patient.

Supplies:

  1. Purple top tube.
  2. Blood sampling devices:
  3. Personal Protective Equipment.
  4. 70% alcohol swabs for skin disinfection.
  5. Gauze or cotton-wool ball to be applied over puncture site.
  6. Laboratory specimen labels.
  7. Ballpoint pen.
  8. Leak-proof transportation bags/containers.
  9. Puncture-resistant sharps container.

PROCEDURE

  1. Secure phlebotomy supplies, equipment, and Typenex armband.
    1. Typenex armbands are kept in the transfusion nurse supply bag.
    2. One 7 mL purple top tube for adult is to be drawn for the crossmatch.
    3. Use a ballpoint ink pen for writing on the Typenex armband.
    4. Do not use label stickers on the Typenex  patient armband labels or on the blood tube patient sample.
  2. Identify patient.
    1. Verify correct patient by comparing the patient’s name and facility medical record number on the armband with the physician order before performing venipuncture.
      1. If the patient does not have a facility armband, transfusion nurse must verify patient identity with another RN and apply a facility armband prior to obtaining the type and screen/type and cross sample.
    2. Patient should also state name, if able.
  • Obtain specimen.
    1. Assemble equipment.
    2. Select the site.
      1. Extend the patient’s arm and inspect the antecubital fossa or forearm.
      2. Locate a vein of a good size that is visible, straight, and clear. The median cubital vein lies between muscles and is usually the easiest to puncture. Under the basalic vein runs an artery and a nerve, so puncturing here runs the risk of damaging the nerve or artery and is usually more painful. Do not insert the needle where veins are diverting, because this increases the chance of a hematoma.
        1. The vein should be visible without applying the tourniquet. Locating the vein will help in determining the correct size of needle.
        2. Apply the tourniquet about four to five finger widths above the venipuncture site and reexamine the vein.
        3. Do not take blood from an existing peripheral venous access site because this may give false results. Hemolysis, contamination, presence of intravenous fluid, and medication can alter results. Nursing staff and physicians may access central venous lines for specimens following protocols. However, specimens from central lines carry a risk of contamination or erroneous laboratory test results.
        4. It is acceptable, but not ideal, to draw blood specimens when first introducing an indwelling venous device, before connecting the cannula to the intravenous fluids.
      3. Perform hand hygiene and put on gloves.
        1. Wash hands with soap and water, and dry with single use towels.
        2. After performing hand hygiene, put on well fitting, non sterile gloves.
      4. Disinfect the entry site.
        1. Unless drawing blood cultures, or prepping for a blood collection, clean the site with a 70% alcohol swab for 30 seconds and allow to dry completely.
        2. Apply firm but gentle pressure. Start from the center of the venipuncture site and work downward and outwards to cover an area of two centimeters or more.
  • Allow the area to dry. Failure to allow enough contact time increases the risk of contamination.
  1. Do not touch the cleaned site; in particular, do not place a finger over the vein to guide the shaft of the exposed needle. If the site is touched, repeat the disinfection.
  1. Take blood sample.
    1. Apply tourniquet.
    2. Holding the patient’s arm in place, place a thumb below the vena puncture site.
  • Ask the patient to form a fist so the veins are more prominent.
  1. Enter the vein swiftly at a 30 degree angle or less, and continue to introduce the needle along the vein at the easiest angle of entry.
  2. Once sufficient blood has been collected, release the tourniquet before withdrawing the needle. Some guidelines suggest removing the tourniquet as soon as blood flow is established, and always before it has been in place for two minutes or more.
  3. Withdraw the needle gently and apply gentle pressure to the site with a clean gauze or dry cotton wool ball. Ask the patient to hold the gauze or cotton wool in place, with the arm extended and raised. Ask the patient not to bend the arm, because doing so causes a hematoma.
  1. Fill the laboratory sample tubes.
    1. When obtaining blood, use evacuated tubes with a needle and tube holder. This system allows the tubes to be filled directly. If this system is not available, use a winged needle set with tube holder instead.
  2. Clean contaminated surfaces and complete patient procedure.
    1. Discard the used needle  or blood sampling device into a puncture resistant sharps container.
    2. Check the label and forms for accuracy. The label should be clearly written with the information required for the blood bank.
  • Discard used items into the appropriate waste containers. Items used for phlebotomy that would not release a drop of blood if squeezed may be discarded in the general waste, unless local regulations state otherwise.
  1. Perform hand hygiene.
  2. Recheck the labels on the tubes and the forms before dispatch.
  3. Inform the patient when the procedure is over.
  1. Place lab sample in bag with lab requisition form in preparation for transport to the blood bank.
  2. Clean up spills of blood or body fluids.
    1. If blood spillage has occurred, clean it up. Put on PPE appropriately, mop up liquid from large spills using paper towels, and place them in the biohazard waste. Remove as much blood as possible with wet cloths before disinfecting.
    2. Disinfect the area as directed by the facility policy where the blood sample was obtained.
  3. Label specimen immediately after venipuncture at the bedside:
    1. From facility armband handprint patients name, medical record number, date, and time legibly onto the long blank red label.
      1. Do not use chart sticker labels on the Typenex  label or purple top tube.
      2. Do not write on the Typenex  label prior to patient encounter.
  • Use ballpoint pen to make labels.
  1. Do not use a gel pen which may smear.
  1. The patient’s name and medical record number are hand printed on the Typenex  label by using a ballpoint pen, by the person obtaining blood specimen, onto the long blank red label with the date, time, and the employee name/phone number of the person obtaining the blood sample.
  2. The name should show on the remaining pressure sensitive area under the red label on the arm band with the specimen label an arm band reading exactly the same.
  3. Illegible, incomplete, or mislabeled specimens will not be used for type and screen or type and crossmatch.
  4. Patient, if able, may be asked to read name on band.
  5. Remove this label and place on purple top tube along one side of tube. Do not wrap label around tube or cover any part of the purple stopper in the top of the tube.
  1. Label patient:
    1. Compare the Typenex  band with the patient’s facility armband to ensure name and medical record number are correct.
    2. The Typenex  band is placed on the arm and secured by locking the white clamps together so that the band becomes tamperproof.
    3. The remaining stickers are then cut off and the clear protective backing is removed in order to place them on the clotted sample purple top tube evenly along the side opposite of the patient ID label.
    4. Do not cover any portion of the purple stopper in top of tube. Staff member must confirm patient identification, labeling of the specimen, and that the employee ID name and phone number of the person obtaining the blood sample is on the requisition at the bedside.
  2. Sample and requisition should be forwarded immediately to the blood bank for processing by the transfusion nurse or other licensed personnel.