1. PHLEBOTOMY BASICS
Dr. Jennifer Lucy DNP, RN

2. OBJECTIVES After completing this unit the student will be able to:
Define the terms
List the components of blood
Describe how to prepare a patient for a venipuncture.
Describe how to collect a specimen via venipuncture.
Describe how to process blood specimens for testing

3. TERMINOLOGY
Anticoagulant:substance that prevents clotting (EDTA and Heparin)
Hematocrit: the % of RBC in blood
Hemoglobin: iron containing protein of blood that carries oxygen
Hemolysis: breakdown of blood cells
Lumen: the diameter of…. e.g. needle or vein
Phlebotomy: blood collection using venipuncture
Venipuncture: process of withdrawing blood from a vein

4. Phlebotomy Why DO WE NEED IT?
Webster’s – the act of bloodletting as a therapeutic measure
To aid in diagnosis of illness
Monitor effectiveness of treatment
Screening for absence of illness

5. What is Blood?
Thick red fluid flowing through circulatory system consisting of liquid components and cellular components
Plasma: Liquid part of blood
Serum: Liquid part of blood after clotting (minus fibrin)
Cells: erythrocytes, leukocytes and platelets
Volume: approx.10 pints in average adult
                                           

6. Blood’s Function Carries O2 and nutrients to tissue=Artery
Carries CO2 and waste from tissue=Vein
Capillary= tiny blood vessels connecting arterioles and venules
RBC’s composed of Hemoglobin=O2/CO2 carrier
WBC’s fight infection
Platelets – Hemostasis/coagulation

7. To Spin or Not to Spin?

8. TUBES

9. TUBE ORDER: Depends on what you need.
Choice of tube depends on lack of additive or additive.
Blood Cultures First ( Yellow or glass tops) Looking for Pathogens in the blood. Because you don’t know if it is anaerobic or aerobic you draw for both ( aerobic first)
Blue (Coagulation Studies) Sodium Citrate PTT/ PT ( Clotting times)

10. Marbled or Red (Serum tubes) Chemistry/ Blood Typing
Green : Heparin tubes: Also for chemistries
Lavender (CBC) EDTA additive ( invert 8 times to prevent clotting)
Gray ( Alcohol/ Blood Glucose
Glycolytic additive
Dark Blue ( Fibrin Degradable Products) Toxicology, zinc. Lead, drug levels

11. Test Requisition Computerized Paper Must include: Patient Name,
Physician Name
Date
Patient ID/age/birthdate
Test request,
Your initials
Test Requisition

12. Patient Identificaton
The most critical step in phlebotomy
Inpatients – Must have correct wristband prior to collection
Ask patient to state their full name and birth date.
Match wristband information with test req.
                                                                                    

13. Technology & patient identification

14. NEEDLES Needles vary in length and diameter
Diameter is measure in gauge
The smaller the gauge the LARGER the needle.
The manufactures use colors to differentiate the gauges.

15. Basic Phlebotomy Supplies
Requisition
Gloves
Tourniquet
Needle
Barrel or Syringe
Tubes
Alcohol
Cotton or Gauze
Bandage or Tape

16. Wash hands after every patient
Always wear gloves
Keep needle sterile
Use proper protective equipment – PPE’s
Remove tourniquet
prior to removing needle
Never recap needles
Wear gloves
Wash hands after every patient
Dispose of equipment properly
Standard Precautions

17. The integrity of the specimen
THE RIGHT PATIENT
THE RIGHT CONTAINER
THE RIGHT TIME
USE CORRECT TECHNIQUE/SITE
LABEL CORRECTLY AND COMPELETLY
AVOID HEMOLYSIS

20. Technique
Identify patient
Reassure patient and position arm
Assemble equipment
Verify order and paperwork
Select vein site
Apply tourniquet (NO MORE THAN 1 min)
Vigorously alcohol site/dry with gauze
Perform venipuncture
Remove last tube

21. Puncture at 15-30 degree angle

22. Veins feel soft and bouncy. Blood is dark red
Veins are more superficial than arteries
Arteries have a pulse and blood is bright or
scarlet red
Damage to an artery can endanger distal tissue

23. Technique continued
Release the tourniquet
Remove as soon
as collection is complete
10. Remove needle
11. Gently agitate tube
12. Correctly label the tubes
13. Bandage arm
14. Dispose of vacutainer/tube & trash
15. Deliver sample to lab or prepare
specimen for lab pickup.

24. LABEL THE TUBES
Patient name
Patient ID (DOB, Age, Bar code)
Dr name
Date & time
Test
Your initials

25. Special Considerations
Do not collect above an IV

26. Avoid Hemolysis GENTLY agitate tube to mix
                                                                               
GENTLY agitate tube to mix
Allow blood to enter tube slowly

27. Geriatric Considerations
Treat elderly as if they were your parents
Use smaller needles / tubes
Use syringe or butterfly instead of Vacutainer
Assess hearing acuity
Avoid tape – use “Koban”
Minimize hematomas – apply pressure longer

28. Butterfly

29. Syringe / Butterfly Alternative to Vacutainer
Elderly, young, collapsing veins
Using the hand or foot
Acquire adequate amount of blood as you will be filling tubes after the blood draw
Instill blood into tube at angle to prevent hemolysis

30. Heel Collections

31. Finger Puncture
Puncture across the fingertip
Wipe away the first drop
Collect in microtubes or capillary tubes

32. Blood Cultures Aseptic Technique
Cleanse site with 2% Chlorhexidine gluconate or Iodine
Allow site to dry – do not touch site
Fill bottles with appropriate volume of blood

33. Only stick a person twice. Get another person to try after that.
Syncope ( fainting) Client becomes pale and clammy: Remove tourniquet, then needle and apply pressure . Apply cold compress to back of neck and forehead. Elevate legs if on floor.
Nausea: Apply cold compress and advise client to take deep , slow breaths
Convulsions : Do not restrain patient and move objects furniture out of way. Notify the provider once the client recovers.
Patient Reactions

34. Hematoma:
Blood can leak out of a vein and under the skin during venipuncture.
This can cause discomfort and pain and can complicate further collections from that site. As soon as a hematomas noted, remove the needle and tourniquet and apply pressure at the site for a minimum of 3 minutes.
Check the site and if the hematoma has stopped forming, put on a bandage or gauze with tape and inform the patient of the hematoma.
The bandage should remain in place for a minimum of a half hour.
HEMATOMA

35. Bleeding into the skin can occur from broken blood vessels that form tiny red dots (called petechiae).
PETECHIAE