Denielle

Genesis B. Camato

PHLEBOTOMY
HEMATOLOGY 1 | LABORATORY

PHLEBOTOMY

A process of collecting blood

Literally means to cut a vein

STANDARD PRECAUTIONS

Potentially infectious body fluids

include; Blood, Semen, Vaginal
Secretion, Peritoneal, Pericardial
and Pleural Fluids, and Saliva

Sweat and tears are not generally

considered infectious

PHLEBOTOMIST

Performs the phlebotomy procedures

They have been specifically trained in blood collection

techniques

They are primarily employed primarily to collect blood

specimens
LABORATORY WORK FLOW
Lab Test
Ordered

Spx acessioned
& processed

Lab result
reported to
Doctor

Order received
in Lab

Spx transported
to lab

Doctor treat px
based on lab
result

Work List and

Labels
generated

Phlebo draws,
labels spx

Phlebotomist
Dispatched

Phlebo
iden>es px

PERSONAL PROTECTIVE EQUIPMENT

Lab coat

Gloves

Face masks

(certain type of isolation)

HAND WASHINGP

Hand washing is the single most important infection control

measure.

Wash hands thoroughly before, after, and between all

patient contacts.
HAZARDOUS WASTE DISPOSAL

All needles & other sharps must be disposed of in approved

sharps disposal containers.

Other contaminated waste must be discarded in an

appropriate biohazard bag or waste receptacle.

PUBLIC RELATIONS AND CLIENT INTERACTION

Professionalism

HOW TO PREVENT NEEDLE STICKS?

Safety Device should always be encouraged

P
P

ANATOMY & PHYSIOLOGY

m Blood Collection sites

H-pattern vein

M-pattern vein

Other veins

CONFIDENTIALITY

All employees are responsible for maintaining

confidentiality of medical information
ATTITUDE

Tone of voice and facial expression will determine

how patients respond to you.

Always be polite, friendly, calm, and considerate.

SAFETY

Protect yourself from blood-borne pathogens

Infectious micro-organisms which live in the

bloodstream.

You can exposed to blood-borne pathogens if you

are injured with a contaminated needle.

You can also be exposed if your mucous

membranes, including eyes, mouth, or the inside of
your nose come into contact with contaminated body
fluids.

Cephalic
Median
cubital
Basilic
EQUIPMENT
1) PHLEBOTOMY BOX

Tool box should be sanitized daily using

appropriate disinfectant

Kept organized and well-stocked.

BLOOD-BORNE PATHOGENS

Diagram of
Hepatitis C Virus
1

Denielle Genesis B. Camato

PHLEBOTOMY
HEMATOLOGY 1 | LABORATORY

2)

3)

4)

5)

COLLECTION TUBES

Glass or plastic tube with a rubber stopper.

It has a vacuum so that blood will flow into the

tube.

Anticoagulants and/ or other chemical additives.

B.

MULTIPLE DRAW NEEDLE

Used with vacuum collection tubes.

They have a retractable sheath over the

portion of the needle that penetrates the
blood tube.

C.

BUTTERFLY NEEDLE

Winged infusion set

Difficult venipunctures including

pediatric draws

With a syringe or a holder and vacuum

collection tube system.

21, 23, or 25 gauge.

HOLDERS

A plastic holder must be used with the evacuated

tube system.

6)

LANCETS

Lancets are used for difficult venipunctures,

including pediatric draws.

7)

TORNIQUETS

Applied 3-4inch above antecubital on patient

during venipuncture

This distends the vein, making them larger and

easier to find

Must not left no longer than 1 minute.

8)

STERILIZATION

Cleaning with an antiseptic such as 70% isopropyl

alcohol

It avoids contaminating the specimen

9)

BANDAGE MATERIAL

Cotton or gauze

Placed over the site so the pressure can be

applied after the needle removal

SYRINGES

NEEDLES

Different sizes.

Size = gauge

The larger the needle, the smaller the gauge

number.

21 or 22 gauge needle is mostly used.

A.

A SINGLE DRAW NEEDLE

Single draw needles are of the type that

fit on a syringe, and can be used only to
fill the syringe to which they are
connected.
10) MARKING PEN

For labeling the specimen

2

Denielle Genesis B. Camato

PHLEBOTOMY
HEMATOLOGY 1 | LABORATORY

INAPPROPRIATE SITE FOR VENIPUNCTURE

Arm on the side of mastectomy

Edematous areas

Haematomas

Scarred areas

Arms with cannulas, fistulas or vascular grafts

Site beyond IV line of any kind

TROUBLESHOOTING
1. Incomplete collection or no blood is obtained:

Change the position of the needle. Move it forward (it

may not be in the lumen)

COLLECTING BLOOD

Patient identification TIPS:

Make sure the name, medical record number, and

date of birth on your order/requisition match those
on the patients armband.

Verify the patients identity by politely asking them

to state their full name.

Properly identifying patients and specimens is

probably the single most critical part of your job.

The consequences of misidentifying a specimen

can be life threatening.

Never rely on the patient name on the door or

above the bed. Patients are frequently moved from
room to room.

A hospitalized patient must always be correctly

identified by an ID band that is attached to the
patient.

Or move it backward (it may have penetrated too far).

Adjust the angle (the bevel may be against the vein

wall).

Loosen the tourniquet. It may be obstructing blood

flow.
Try another tube. There may be no vacuum in the one
being used.
Re-anchor the vein. Veins sometimes roll away from
the point of the needle and puncture site.

VENIPUNTURE PROCEDURE

Prepare all the necessary materials

Allow the patient to be in comfortable position.

Examine arms for prominent vein.

2.

Other Problems

A hematoma forms under the skin adjacent to the

puncture site release the tourniquet immediately and
withdraw the needle. Apply pressure.

Aseptically treat the area in a circular manner; inside-out

Attach needle to holder
Place tube into holder
The tourniquet above the site of venipuncture.
Insert the syringe in 15-30 degree angle away from the arm.
The bevel should face upward Bevel up
Insert the tube and wait until the vacuum is exhausted.

The blood is bright red (arterial) rather than venous.

Apply firm pressure for more than 5 minutes

MULTIPLE TUBE COLLECTION

If you are drawing more than one tube:

Keep a firm grip in the needle holder while

pressing down on the patients arm.

Use your other arm to interchange tubes.

ORDER OF DRAW

Order of draw

WHAT IF THE BLOOD WONT FLOW?

If you do not see blood flow, the tip of the needle:

1. May not yet be within the vein.
2. May have already passed through the vein.
3. May have missed the vein entirely.
4. May be pushed up against the inside wall of the
vein.

Tube Stopper color

Additive

Inversions

Determinations

Yellow

Sodium
polyanethanol
sulfonate

6-8

Blood cultures

Light blue

Sodium citrate

3-4

Coagulation studies

Gold / red

Clot activator / Gel

separator / no
additive

68

For serum chemistry

determinations

Green

Lithium heparin
Sodium heparin

68

For plasma chemistry

determinations

Lavender / violet

EDTA

68

For whole blood

hematology and blood
banking

Gray

Sodium flouride
Potassium oxalate

6 -8

For glucose
determinations

Denielle Genesis B. Camato

PHLEBOTOMY
HEMATOLOGY 1 | LABORATORY

VENIPUNCTURE PROCEDURE

Remove the tourniquet

Remove the vacutainer tube

Withdraw the needle and put dry cotton on the punctured

site.

Removed the needle from the holder if appropriate, and

properly discard it in an approved sharps disposal container.

Discard all waste and gloves in the appropriate

biohazardous waste container.

Wash hands.

Label specimens at the bedside according to your

institutions standard procedures, or apply preprinted labels.

Proper labeling is the single most critical task you are asked
to performed.

(continuationFinger stick)

Select a safety lancet appropriate for the size of the patients

finger.

You may warm the finger prior to puncture to increase blood

flow.

Wipe away the first drop of blood using gauze to remove

tissue fluid contamination

Collect blood into an appropriate tube

Label specimens appropriately

Make sure bleeding has stopped. Apply an adhesive

bandage if necessary

Discard sharps appropriately

HEEL STICK

Veins of small children and infants are too small for

venipuncture;

Butterfly needles may be used to collect venous blood in

older children.

Firmly grasp the infants foot.

Do not use a tourniquet.

The heel may be warmed with a cloth to help increase blood

flow.

Wipe the collection site with an alcohol prep pad, and allow
the alcohol to dry.

Wipe the site with sterile cotton or gauze, to be sure all the
alcohol has been removed.

Puncture the left or right side (outskirt) of the heel, not the
bottom of the foot.

Wipe away the first drop of blood since it may contain

excess tissue fluid or alcohol which could alter test results.

Collect the blood into the appropriate tube.

Do not: Squeeze the infants foot too tightly and wipe with
alcohol during the collection.

After collection is completed, apply pressure to the puncture

site with a sterile gauze pad until bleeding has stopped.

Do not apply an adhesive bandage to an infants foot since it

may injure its delicate skin.

SUMMARY OF VENIPUNCTURE TECHNIQUE

1) Requisition form
2) Greet the patient
3) Identify the patient
4) Reassure the patient and explain the procedure
5) Prepare the patient
6) Select equipment and supplies
7) Wash hands and apply gloves
8) Apply the tourniquet
9) Select the venipuncture site
10) Release the tourniquet
11) Cleanse the site
12) Assemble the equipment
13) Reapply the tourniquet
14) Confirm the venipuncture site
15) Examine the needle
16) Anchor the vein
17) Insert the needle
18) Push the evacuated tube completely into adapter
19) Gently invert the specimens, as they are collected
20) Remove the last tube from the adapter
21) Release the tourniquet
22) Place the sterile gauze over the needle
23) Remove the needle, and apply pressure
24) Activate needle safety device
25) Dispose of the needle
26) Label the tubes
27) Examine the patients arm
28) Bandage the patients arm
29) Dispose of used supplies
30) Remove and dispose of gloves
31) Wash hands
32) Complete any required paperwork
33) Thank the patient
34) Deliver specimens to appropriate locations

PATIENTS REFUSING BLOOD WORK

Explain to them that their blood test results are

important to their care.

Patients have a right to refuse blood tests

If the patient still refuses, report and document

patient refusal

SYRINGE COLLECTION

Small or delicate veins that might be collapsed by the

vacuum of the evacuated tube system.

May also be used to collect blood culture specimens.

FAINTING

Rarely, patients will faint during venipuncture.

It is therefore important that patients are properly seated

or lying in such a way during venipuncture so that if they
do faint, they wont hurt themselves.

Self-limited

Gently remove the tourniquet and needle from the

patients arm, apply gauze and pressure to the skin
puncture site.

If the patient is seated, place his head between his

knees.

A cold compress on the back of the neck may help to

revive the patient more quickly.

Call for help

SKIN PUNCTURE

A safety lancet, which controls the depth of incision

Finger-sticks should not be performed on children under one

year of age.
FINGER STICK

If possible, use the fourth (ring) finger or the middle finger.

Many patients prefer that you use fingers on ther

nondominant hand.

Choose a puncture site near the right or left edge of the

finger tip.

Clean the site as you would for routine venipuncture.