what is the safest way for emptying blood sample in a test tube to avoid needlestick injury?
Question:
Answers:
Good question. Don't take off the rubber stopper. In some, rare cases you can (say you have got just a trickle of blood coming out of the hub of the IV and your only chance to get anything is to drip it it...that is just about the only time that you should take off the rubber stopper). There are two reasons not to take off the rubber stopper, and both deal with the fact that you are dealing with vacuum tubes. The first is because the amount of air evacuated from the tube is equal to the amount of blood that the manufacturer (and the lab) want you to put into the tube. With most cases you can get by with only a cc or so in the tube (at a minimum) if you have a good tech in the lab. However, some tests require the extact amount of blood in the tube...until the tube stops filling. If you put more or less in these tubes the lab will reject it and you will have to restick the patient. I was working on a pilot after an airplane accident once and the investigators needed a legal blood draw in addition to what the doctor ordered. It was hectic (a plane did crash and we had other patients) and I was trying to draw all 30cc of needed blood from this pilot. I did so after inserting my IV, and I laid the syringe down next to my lined up tubes on a Mayo stand at my elbow, while I finished working on my IV. A helpful busybody newbie came by and decided to help me by putting the blood in the tubes. He popped the caps off of all of them and filled them all the way to the top. The additives in the tubes were grossly diluted and I had to restick the poor man who had just spent an hour hanging in a tree. The second reason for not taking the rubber caps off is that once off, they are very hard to get back on...especially if you have much blood in there at all. And you are bound to make a big, bloody mess. Lastly, with some tests (such as blood cultures) it is an absolute no-no to take off the rubber stopper. If you do that, if you manage to do that without breaking the tubes, you will be the laughing stock of the minute and will never, ever live it down.
If you do ever end up pulling the stopper out, please leave the needle on if you do not have a safety needle. If you don't have a safety shield to click over the needle you will will have to recap the needle, or try and take off the needle while it is exposed. Either way you are asking to get stuck.
Although I do often use a needle to pierce the rubber stopper when transferring blood from a syringe to tubes, there are safer ways. There are several transfer devices on the market that will screw onto the end of a syringe and have a shield surrounding the needle so that you won't stick yourself. Some have a metal needle, but my hospital stocks ones with a plastic needle that will not stick you unless you really work at it. They will go through a rubber stopper easily enough, though. They are a pain to use with pediatric tubes. When I do use a needle to push through the rubber stopper I fill the tubes in order, and then leave the needle in the last tube. I then walk the needle/tube over to the sharps container and pull the needle out as I am throwing it away.
One very safe method is to use a vacutainer when you are drawing blood. If you are drawing out of a butterfly that does not have an adaptor (only a luer lock end) or out of an IV hub you can use the blue luer lock adaptors. I personally perfer a syringe...I feel that I have better control over the draw and hardly ever get a hemolyzed specimen. Also, if I don't get as much blood as I hoped for I can ration it out after I am done drawing. Some of my co-workers use them all of the time and really like them.
Other Answers:
safest way to prevent blood contamination or possible spillage is the needle insertion into the rubber cap
Most hospitals (in the US anyway) have gone needleless, so it really isn't an issue. But to answer your question, don't remove the stopper because it will corrupt the sample and give you a false reading.
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