1. Phlebotomy: Venipuncture

2. Phlebotomy What does it mean? Dates back to ancient Egypt
Process of collecting blood
Dates back to ancient Egypt
Bloodletting-”bad” blood
Greek translation
Phlebos- vein
Tome –incision

3. Why collect blood? Diagnosis and treatment of disease
Therapeutic purposes
Blood donation

4. The Medical Assistant’s Role
Perform venipuncture accurately and efficiently
Reliable test results
Provide quality care
Patient safety and confidentiality
Phlebotomist safety (PPE)

5. Anatomy and Physiology of the Circulatory System
Blood forms in body’s organs and bone marrow
Blood carries oxygen and nutrients to cells and removes waste products and carbon dioxide
(Review your terminology textbook Hematology and Immunology)

6. The difference between an artery and a vein?
Do you know?
The difference between an artery and a vein?

7. Circulatory System Cont’d Arteries and Veins
Carry oxygenated blood away from the heart
Pulse
Thick walls
No Valves
Veins
Carry deoxygenated blood to the heart
No pulse
Thin elastic walls
Valves

8. Circulatory System Cont’d
Body contains about 6 liters of blood
Forty-five percent of blood is formed elements
Erythrocytes
Leukocytes
Thrombocytes (platelets)
Two mL of blood will yield about 1 mL of fluid
Liquid part of blood is plasma

9. Important Terms
Fibrinogen –substance in blood Converted by the blood clotting process to fibrin
Fibrin- “sticky” web like substance –traps the formed elements-result is a “blood clot”
Serum- clear liquid portion of blood extracted from the “blood clot” used for many tests

10. Important Terms
Anticoagulant-used to prevent blood from clotting. Found in certain blood tubes
Buffy coat-layer separating plasma from RB
Centrifuge- machine which spins blood separating the RBC from the serum

11. Anatomy and Physiology of the Circulatory System
Centrifuge separates serum from blood
Anticoagulant prevents blood from clotting to produce plasma specimen
Buffy coat

12. Phlebotomy Sites Order of Draw by sites Arm-Antecubital Space includes
Median cubital
Cephalic
Basilic
Veins in hand
Veins in feet

13. Preferred Sites in the arm

14. Arteries of Arm
Note locations of arteries in the arm. You DO NOT want to draw from an artery
Brachial
Radial
Ulnar
How can you distinguish an artery from a vein?

15. Venipuncture Methods There are three main methods of drawing blood
Vacuum Tube
Syringe
Butterfly

16. Evacuated Tube Method Vacutainer tube Adapter Double-pointed Needle
This method includes:
Vacutainer tube
Adapter
Double-pointed Needle
Features of this method are:
Closed system - needle stick risk low
Vacuum draws blood inside the tube
Safety needles meet OSHA guidelines

17. Venipuncture Technique
Butterfly collection system
Combines benefits of syringe and vacuum methods
Used for small or fragile veins that are difficult to draw
Winged needle inserted at about 5° angle then threaded into vein
Syringe method
Used for small or fragile veins
Control flow

18. Venipuncture Equipment
Safety needles
Required
Protects patient and health care worker

19. Equipment/Supplies Needed
Physician order and Lab requisition form
Pen –black ink
Appropriate PPE (gloves, gown, goggles)
Needle holder and Needle (varying sizes)
Tubes –varying sizes and types used

20. More Equipment/Supplies
Tourniquet or blood pressure cuff
Constrict flow of blood in arm
Make veins more prominent
Alcohol or Betadine
Cotton balls or gauze-(preferred)
Bandages or tape

21. Order of draw
Why? Prevent carryover or contamination - Order may vary between laboratories.
Basic order:
Sterile- sterile specimens
Light blue-sodium citrate
Red or plain tubes no additives or gel
SST –Serum separator tube (Red/Gray, Yellow)
Green –heparin
Lavender-EDTA
Gray –oxalate-fluoride

22. Venipuncture Equipment
Additives, anticoagulants, and gels
Thixotropic separator gel >>
Separator gel tube: centrifuging process
Glass particles activate clotting

23. Venipuncture Equipment
Specimen collection trays
Hold all equipment necessary
Carts also used

24. Venipuncture Technique
A Phlebotomist needs to use all these skills:
Technical skills
Prepare for the draw-equipment (spare tubes)
Positioning the patient
Administrative skills
Note order-required tests and
Complete the lab requisition
Social skills
Small talk (weather, pets, entertainment)
Good Therapeutic Communication
Assess patient comfort level
Put patient at ease-show confidence
Ask about past experiences

25. Preparing the patient Note fasting or non-fasting
Identify yourself and explain the procedure
Properly Identify your patient ask them to:
State their name and date of birth
For non-English speaking photo ID
Note fasting or non-fasting
Ask patient about allergies
Taking blood thinners
Past Experiences

26. Remember to
Wash your hands

27. The Draw sit lie down Scars Hematomas A Pulse
Position your patient for safety:
sit
lie down
(note past history of fainting or loss of consciousness)
Select the appropriate site and vein free of:
Scars
Hematomas
A Pulse

28. The Draw Cont’d Find site that will give best blood return
(remember the location order)
Palpate vein with tip of finger
Differentiating between veins, tendons, and nerves
Use the tourniquet appropriately

29. Proper Tourniquet Technique
To prevent inaccurate blood test results-do not leave on longer than one minute
Tourniquet may be applied over clothing for patient comfort
Remove tourniquet when blood flow is achieved or prior to inserting last tube
Always remove tourniquet prior to removing needle

30. Proper completion of draw
Remove tourniquet
Remove needle and apply safety device while Applying pressure to site (patient can assist)
Bandage appropriately
Tend to the safety of your patient
Label specimen tubes in front of patient

31. Venipuncture Technique
Patient and specimen identification
Computer label >>
Compare lab requisition with patients information

32. Important Tips Do Not draw from a resistant patient
Do Not draw if you are not comfortable
Uncooperative children must receive special care and be restrained for safety
Note Patient reactions, stop if patient complains of pain-assess patient

33. Venipuncture Technique
The unsuccessful venipuncture
Reposition tube and needle
Rotate needle Advance further into vein
Try another tube-maybe the tube is defective
If you haven’t succeeded in getting blood after 2 tries ask someone else to try

34. Venipuncture Technique
Factors affecting laboratory values
Incorrect specimen handling and storage
Drawing procedure incorrect
Alcohol in specimen
Tourniquet on too long
Wrong tube
Tubes not filled to appropriate levels will cause inaccurate test results

35. Patient Factors Affecting Lab Results
Blood Alcohol-elevate results
Diurnal rhythm-RX or daily activity level
Exercise-runner’s anemia, change results
Fasting (not)-inaccurate results
Hemolysis-destroys RBC’s
Heparin-incorrect use interferes with results
Stress-Increase in WBC’s
Tourniquet on too long-dilution hemoconcentration

36. Challenging Patients Pediatric Geriatric
The child, parents or guardians
Approach-explain –get down to their level
Resistant-restraints ?
Geriatric
Physical-skin, hearing or vision impaired
Effects of disease-stroke, arthritis, Parkinson’s –tremors,
Dementia-Alzheimer's
Safety issues-wheelchairs, balance

37. More Challenges Dialysis or Cancer patients -fistulas and shunts
(AV-arteriovenous-permanent access for dialysis)
Long-Term Care patients, Home Care, or Hospice Patients
Traveling phlebotomists

38. Problem Sites Burns, Scars, Tattoos
Damaged Veins (sclerosed-thrombosed)
Edema-swelling due to abnormal accumulation of fluid
Hematoma-swelling or mass of blood
Mastectomy-caution lymph node removal
Obesity

39. Complications or Conditions
Allergies-adhesive, antiseptic, latex
Excessive bleeding due to medications, hemophilia
Fainting
Nausea and vomiting
Pain while drawing-what is normal –what is NOT-stopping the draw
Seizures/Convulsions-stop draw immediately-get help

40. Comprehensive Medical Assisting 4th Edition
Clinical Medical Assisting: A professional, Field Smart Approach to the Workplace, Textbook and Workbook
Phlebotomy Essentials 4th Edition