1. Phlebotomy Venipuncture

3. Steps Identify the Patient Assess the patient’s physical dispositon (i.e. diet, exercise, stress) Check the requisition form for requested tests, patient information and any special requirements. Select suitable site. Prepare the equipment and the patient and puncture site. Perform venipuncture Collect the sample in appropriate container Recognize complications Assess need for sample recollection and/or rejection Label collection tubes at bedside or drawing area Promptly send the specimens with the requisition to the lab

4. Requisition Form Must accompany each sample submitted to the lab Must contain proper information Requisition Form

5. Essential Elements of Requisition form Patient’s surname, first name and middle initial Patient’s ID number Patient’s date of birth and sex Requesting physician’s complete name Source of specimen Date and time of collection Initial’s of phlebotomist Indicating the test(s) requested

6. Labeling Sample Proper labeling ensures the results of the test match the patient. Key elements: – Patient's surname, first and middle – Patient's ID number – (Both of the above must match the same on the requisition form.) – Date, time and initials of the phlebotomist must be on the label of each tube

7. Materials needed for Venipuncture Evacuated Collection tubes Needles Holder/Adapter Tourniquet Alcohol Wipes Povidone-iodine wipes/swabs Gauze sponges Adhesive bandages/tape Needle disposal unit Gloves Syringes

8. Order of Draw Must be drawn in a specific order to avoid cross-contamination of additives between tubes. – First- blood culture bottle or tube (yellow or yellow-black top) – Second –coagulation tube (light blue top) – Third- non-additive tube (red top) – Last draw- additive tubes in this order: – 1. SST (red-gray or gold top) Gel separator and clot activator

9. Order of the draw – 2. Sodium heparin (dark green top) – 3. PST ( light green top). Contains lithium heparin anticoagulant and a gel separator. – 4. EDTA (lavender top) – 5. ACDA or ACDB (pale yellow top). Contains acid citrate dextrose. – 6. Oxalate/fluoride (light gray top *Tubes with additives must be thoroughly mixed. Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive.

10. ID Patient ID yourself and indicate procedure Ask patient for full name and always check the armband or bracelet. Do not draw blood if armband or bracelet missing. Talk to the patient while drawing blood to ease anxiety

11. Site selection Median cubital and cephalic veins of the arm Basilic ven on the dorsum of the arm or dorsal hand veins Feet last resort

13. Areas to avoid Extensive scars from burns and surgery Upper extremity on side of previous mastectomy Hematoma IV fluids/blood transfusions Lines Cannula/fistula/heparin lock Edematous extremeties