CLS 424 Phlebotomy Student Lab Rotation Basic Principles of Phlebotomy Part IV: The Patient, Collection Site and Problems with Collection Sites CLS 424 Phlebotomy Student Lab Rotation

The Patient: Approach Communication Empathy Handling special situations Patient identification Arm band Legal document Prepare patient for blood draw Latex allergy? CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

Selecting the Site: Antecubital area most often accessed Hand or wrist Remember: 2 arms Use tip of index finger on non-dominant hand to palpate area to feel for the vein CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

Collection Site Problems: Veins that lack resiliency Extensive scarring Hematomas Edematous area Side of mastectomy CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

Collection Site Problems: Intravenous line NEVER draw above an IV Draw from other arm Draw from hand on other arm Draw below the IV CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

Draw Below IV site: CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

Collection Site Problems: Indwelling lines: Hickman catheters Heparin locks Used to administer medication Only nurse may access these lines Can obtain blood: called a ‘line draw’ Must clear line of heparin contamination by discarding first 5-10 cc of blood CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

Hickman Catheter: CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

Inserting the Needle: Anchor the vein Grasp arm with your non-dominant hand Use thumb to pull skin taut Smoothly and confidently insert the needle bevel up 15-30 degree angle CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

No Needle Movement! You must anchor the blood-drawing equipment on the patient’s arm to minimize chance of injury CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

Fill Tubes: Use correct order of draw: Blood cultures Red top Blue (baby blue) Green Purple Grey CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

Be careful not to: Push needle further into vein when engaging evacuated tube Pull needle out of vein when disengaging tube Pull needle out of vein as you pull back on the plunger Pull up or press down when needle in vein Forget to mix additive tubes 8-10 times CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

Withdraw Needle: First release tourniquet Disengage tube Place cotton directly over needle, without pressing down Withdraw needle in swift, smooth motion Immediately apply pressure to wound Do not bend arm CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

Label Tubes Immediately: In sight of patient Patient name Identification number Date of draw Time of draw (military time) Your initials CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

Recheck Draw Site: CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

Failure to Obtain Blood: Check tube position and vacuum Always have back up tubes near by Needle position Collapsed vein CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

Needle Position: CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

You should try again Look at alternate site Use clean needle Other arm Hand Use clean needle Use fresh syringe if contaminated Only try twice CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

Poor Collection Techniques: Venous stasis Prolonged application of tourniquet (>1 min) Hemodilution Drawing above IV Short draw (blood to anticoagulant ratio) Hemolysis Traumatic stick Too vigorous mixing Alcohol still wet Using too small of needle Forcing blood into syringe CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

Poor Collection Techniques: Clotted sample Inadequate mixing Traumatic stick Partially filled tubes Short draw Sodium citrate tube draw volume critical Using wrong anticoagulant CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

Poor Collection Techniques: Specimen contamination Using incorrect cleanser Alcohol still wet Powder from gloves Drawing above IV Specimen handling Exposure to light Pre-chilled tube Body temperature CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture