1. 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

2. 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

3. 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

4. CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

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

6. 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

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

8. 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

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

10. 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

11. CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

12. 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

13. CLS 424 Phlebotomy Student Lab Rotation: Phlebotomy Lecture

14. 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

15. 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

16. 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

17. 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

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

19. 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

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

21. 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

22. 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

23. 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

24. 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