CHAPTER I

PRELIMINARY

A. Background
The practice of bloodletting has long been known to man and is part of the treatment of
patients. The first technique of expelling blood (100 BC) was done by doctors from Syria using
leeches. Before known Hippocrates with the title "Father of Medical Science" (5th century BC),
the art of blood taking a lot of changes as well as various tools for the purposes of taking and
storage of blood material. The levers for blood collection were first used before the 5th century
BC by still referring to leeches as a basic form. With this lanceolate a doctor (practitioner)
perforated the vein, sometimes up to several holes. Towards the end of the 19th century then
technology took over producing "artificial leech". It has now become known for a variety of
blood-picking tools and is easily available on the market.
Most current patient blood specimen collection is still performed by technicians /
laboratory analysts both in the laboratory and in the care setting; Whereas the position and task
of a technician or laboratory analyst is inconsistent with the responsibility and activity / activity
of a blood specimen taker (in this case a flebotomist). Objects faced by laboratory technicians /
analysts are medium-sized checking apparatus faced by flebotomis adal patients (or healthy
people) attached by many things: nature, behavior, internal / personal issues and others. These
things are a bit bias to be a barrier in the smooth process of taking blood specimens and these
things also must be faced and overcome a flebotomist.
The recently developed healthcare system for patient welfare purposes refers to health
care by the team (team oriented). By itself, laboratory services will always be an integral part of
comprehensive health care and a flebotomist becomes a very important person (crucial) because
it occupies the starting position in the series. The process of examination of laboratory tests. This
initial position is in controlling the quality assurance program (pre-analytic phase) of the
laboratory results so that flebotomis incorrectly performing its duties will affect the quality of the
test results. Correct and accurate laboratory results are the share of laboratory teams (including
flebotomists) in diagnosing and monitoring disease. Therefore, the role and responsibility of a
flebotomist in carrying out his duties must always be realized.

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B. Problem Formulation

A. What is Flebotomy?
B. What are the minimum competencies of a Flebotomist?
C. What is the professional behavior of a Flebotomist?
D. How to get blood?
E. What are the possible complications of Flebotomy?
F. What are the failures that can occur at the time of taking blood?

C. Purpose
In order for students to understand about Flebotomy, to know the minimum
competence and professional behavior of a Flebotomi, to know and understand how to obtain
blood specimen, to know the complications and failures that can occur in Flebotomi

D. Benefits
Able to improve understanding of the flebotomi properly and correctly

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 CHAPTER II
DISCUSSION

A. Definition of Flebotomy
Flebotomi (english: phlebotomy) comes from the Greek phleb dantomia. Phleb means
veins and tomia means slicing / cutting ("cutting"). It used to be known as the sectie vein (Bld),
venesection or veni section (Ing). While Flebotomist is a medic who has been trained to remove
and collect blood specimens from veins, arteries or capillaries. Flebotomi technique is a way of
taking blood (sampling) for the purpose of laboratory tests or blood collection can also be
donated

B. Competence of at least a Flebotomist

The minimum competence of a flebotomy include:

1. Flebotomis is able to communicate with patients to explain the purpose of taking blood, what
to do and how, to explain the purpose and how to prepare the patient
2. Able to do administrative tasks
3. Must understand and adhere to the patient's and himself's safety procedures.
4. Must be able to prepare materials and tools to be used and choose anticoagulansia
5. Must understand the procedures and techniques flebotomi venipuncture and skinpuncture
correct
6. Properly labeling the tube / sample container
7. Able to transport the samples properly and on time to the laboratory
8. Must be able to handle complications due to the implementation of flebotomi correctly and
quickly. (Rikawati 2010)

C. The professional behavior of flebotomist

A person in carrying out his duties and work has high competence and expertise in
taking blood based on professional behavior and acting based on aspects of moral ethics, legal
ethics and professional ethics.

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 There are 3 kinds of ethical aspects that must be adhered to are: moral ethics, legal
ethics and professional ethics
1. Moral ethics: It is the norms that provide guidelines in behaving that may or may not be done
based on morals and conscience.
2. Legal ethics: It is a rule made by the state that is generally accepted in society and is binding,
has the force of law based on a law (Rules) applicable.
3. Professional ethics: Is a rule made by professional organizations as moral pedooman to
manage its members and aims to maintain the quality of the profession, maintaining the dignity
and dignity of the profession. Sanctions may include strikes, suspensions or scribes. Professional
ethics which have been in written form systematically as professional code of ethics (Rikawati
2010).

D. How to Get Blood

1. Venous Blood Collection

The tools used to take the venous blood, namely:
A. Gloves
It is the most important physical barrier to prevent infection, but it must be replaced by
contact with one patient to another to prevent cross-contamination. Gloves should be worn when
handling blood, body duh, secretions and excretion (except sweat). The health worker
(plebotomist) uses gloves for three reasons:

Reduce the risk of health workers affected by infection from patients.

· Prevent transmission of skin flora officers to patients.
· Reduced contamination of health care workers' hands with microorganisms that can move from
one patient to another

B. Mask
Masks are used to keep splashes out when health workers or surgeons speak, cough, sneeze, and
also prevent contaminated blood or body fluids from entering the nose or mouth of health
workers

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C. Spuit
 Is a tool used for blood collection or intravenous injection with a certain volume. The
syringe has a scale that can be used to measure the amount of blood to be taken, the
volume of the syringe varies from 1ml, 3ml, 5ml and even up to 50ml which is usually
used for administration of sonde or syring pump.

D. Tourniquet
 Is a tool used for blood collection or intravenous injection with a certain volume. Spuits
have a scale that can be used to measure the amount of blood to be taken, the volume of
the syringe varies from 1ml, 3ml, 5ml and even up to 50ml which are usually used for
sonde or syring pump. Tourniquet Is a flexible mechanical material, usually made of
stretchable karetsintetis. Used for healers or blood vessel levers on organs that will be
stabbed plebotomy. The purpose of this containment is for fixation, inauguration of the
veins to be taken. And also to increase the venous pressure to be taken, so it will simplify
the process of siphoning blood into the syringe.
E. an alcohol swab
 Is an ingredient of wool or cotton which is easy to absorb and wetted with antiseptic in
the form of ethyl alcohol. The purpose of using alcohol cotton is to remove dirt that can
interfere with the observation of the location of the vein as well as sterilize the stabbing
area so that the risk of infection can be suppressed.
F. Needle, Wing Needle
 It is the tip of the syringe or needle used for vacuum retrieval. This needle is non fixed or
mobile so it is easily removed from the syringe and vacuum container. Needle
replacement is intended to adjust to the magnitude of the vein to be taken or to the
comfort of the patient requiring small needle removal.
G. Vacuum Tube
 The vacuum tube was first marketed under the trade name Vacutainer. This type of tube
is a vacuum reaction tube, made of glass or plastic. When the tube is attached to the
needle, the blood will flow into the tube and stop flowing when a certain amount of
volume has been reached

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H. Blood Container
 Tube where the blood shelter is not air vacuum. This is commonly used for manual
inspections, and with specific uses such as the creation of self-containers for cost
efficiency.
I. Plaster
 Used for final fixation of plebotomy wound closure, thus helping the wound healing
process and preventing infection due to injury or trauma due to stabbing.

Work Procedures

In venipuncture, a blood sample is generally taken from the median cubital vein,
anterior to the arm (the side in the elbow crease). This is located close to the surface of the skin,
large enough, and no large nerve supply. If not possible, chepalica vein or basilica vein may be
the next choice. Venipuncture in the basilica vein should be done with caution because it is
adjacent to the brachial artery and median nerve. If the vena cephalica and basilica turn out to be
unusable, then blood can be taken in the vein in the wrist area. Take with extreme care and use
smaller size needles. Sites that are not allowed to be taken by blood are:

· Arm on the side of the mastectomy

· Edema area
· Hematoma
· Areas where blood is being transfused
· Area scar
· Areas with cannula, fistula or vascular grafts
· Intra-vein area Blood collection in this area can cause the blood to become more dilute and can
increase or decrease the level of certain substances. There are two ways in the blood venous
removal, the manual and vacuum manner. Manual way is done by using syringes (syring), while
the vacuum by using vacuum tube (vacutainer).

6
Some important things to consider in the blood venous taking are:
1) Installation of long-time and over-tight attachment (overlap) belts can cause
hemoconcentration (increased hematocrit / PCV and elemensel values), increased substrate
levels (total protein, AST, iron, cholesterol, total lipids)
2) removing tourniquets after removable needles may cause hematoma
3) The needle is released before the vacuum tube is fully charged causing the air to enter the tube
and damaging the red blood cells.
4) stabbing that is not once subject to the entry of fluid tissue so as to activate the freezing. In
addition, multiple stabbings are also potentially causing a sigh. An improper needle improperly
enters the vein causing blood to leak with the result of a hematoma
5) The pierced skin is still wet by alcohol causing sample haemolysis due to contamination by
alcohol, burning and excessive pain in the patient when the stabbing is done.

A. Blood Collection with Syringe

Manual intake of venous blood by syringes is a common practice in clinical

laboratories and health care settings. This syringe is a simple piston pump consisting of a
cylindrical tube, a plunger, and a needle. Various needle sizes are often used ranging from the
largest size to the smallest are: 21G, 22G, 23G, 24G and 25G.Infection of blood by injection is
well done in elderly patients and patients with unreliable (fragile or small) vein.

Work procedures :
1) Explain to the patient (about what is done to the patient, patient cooperation, the sensation felt
by the patient, etc. (Reduce anxiety and improve cooperation Prevent hyperventilation due to
anxiety, which causes temporary changes in blood gas)
2) Find the vein to be pierced (superficial, big enough, straight, no inflammation, not diiinfus).
(Increase the ease of insertion of the needle.Allow the nurse to place the needle into parallel with
the vein.Thus, when the vein is displaced, the risk of piercing the vein to break out Infused veins
should be avoided as they increase the risk of mixing of infusion fluids with blood samples taken
which may result in invalid test results)

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3) Place the hand straight and extensively with the help of the operator's left hand or propped up
with the palm facing up while clenching (Allowing the vein dilation so that the veins can be
seen)
4) Perform disinfection area to be stabbed with sterile cotton that has been moistened 70%
alcohol and let it dry. ) Reduce the risk of bacteria in the skin entering the puncture.
5) Perform damming in the proximal region of approximately 4-5 fingers from the stabbings to
make the veins appear clearer (if the tourniquet has an open knot and its direction upwards)
(Increase vein dilatation Tourniquet must remove venous instead of arterial flow. Prevent venous
filling.)
6) Damage should not be up to a maximum of 2 minutes, best 1 minute. (Prevent
hemoconcentration and hematoma
7) Take the syringe to the size of the blood to be taken, check the needle and the rubber. (Ensure
enough syringe for the amount of blood taken).
8) Hold the syringe with the right hand, tighten the needle and push the suction up to the front
end (Prevent the release of the needle from the whistle, Removing the air in the syringe)
9) Fixation of blood vessels that are stabbed with the thumb of the left hand. (Increases vein
dilatation, Prevents shifting of veins.)
10) Pivot the needle with the side facing upwards to an angle of 15-30 ° until the needle tip
enters the vein and the blood is visible from the base of the needle (Allowing the nurse to place
the needle in parallel with the vein), so that when the vein is displaced, the risk of penetrating the
veins to the outside )
11) Fixation of the syringe with the left hand by forming the angle. (Avoiding the needle shift).
12) The sucker is pulled slowly until a cooled volume of blood is obtained (ensuring the amount
of blood taken as desired)
13) The fist is opened, remove the dam (Reduce the flow of blood back, prevent
hemokonsentrasi and hematoma, Streamlining the blood flow again)
14) Place 70% alcohol cotton over the needle, unplug the needle by pressing the cotton using the
right hand on the stitch for a few minutes to prevent bleeding, plaster, press with the index finger
and thumb for ± 5 minutes. (Prevent bleeding.)
15) Remove the needle, drain the blood in the container through the wall so as not to happen
hemolysis. (Prevent the occurrence of hemolysis).

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16) Pour the blood into a suitable volume vial (according to the type of inspection required)
Secure the specimen to be transported to the relevant laboratory)
17) If using an anticoagulant, shake the bottle a few minutes for anticoagulants to mix with blood
and no clotting occurs. (Prevent the occurrence of blood clots)

B. Blood Collection With Vacuum Tubes

The vacuum tube was first marketed by the US company BD (Becton-Dickinson) under
the trade name Vacutainer. This type of tube is a vacuum reaction tube, made of glass or plastic.
When the tube is attached to the needle, the blood will flow into the tube and stop flowing when
a certain amount of volume has been reached. The needle used consists of two needles connected
by a threaded joint. The needle on the anterior side is used to pierce the vein and the needle on
the posterior side is plugged in the tube. The posterior needle is covered with rubber material to
prevent the blood flowing from the patient. Threaded connections serve to attach the needle to a
holder and facilitate the push of the tube in the posterior needle. The advantage of using this
retrieval method is that it does not need to divide blood samples into tubes. Simply stabbing, it
can be used for multiple tubes in turn according to the type of test required. For the purposes of
bacteria culture test, this method is also better because the patient's blood can directly flow into
the tube containing the culture medium of bacteria. Thus, the possibility of contamination during
manual removal of the samples can be avoided. The lack of difficulty in parental, small children,
infants, or if the vein is unreliable (small, fragile), or if the patient is obese. To overcome this
may be used winged needle (winged needle). Winged needle or often called "butterfly" needle
almost the same as vakutainer needle as mentioned above. The difference is, between the anterior
and posterior needles there are two plastic wings at the base of the anterior needle and the hose
connecting the anterior and posterior needles. If proper stabbing of the veins, the blood will
appear in the hose (flash)

Procedure:
1. Prepare the necessary tools: needle, 70% alcohol cotton, straps (tourni), plaster, vacuum tube.
2. Place the needle on the holder, make sure it is firmly attached.
3. Apply patient approach calmly and pleasantly; Try as comfortable as possible.

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4. Identify the patient correctly according to the data in the request sheet.
5. Verify the patient's condition, such as fasting or taking medication. Note if the patient is taking
certain medications, not fasting etc.
6. Ask the patient to straighten his arm, select the arm that many activities.
7. Ask the patient to clench his hands.
8. Attach the rope (tourniquet) rope approximately 10 cm above the elbow fold.
9. Select the cubital or cephalic median vein section. Make palpation to ensure venous position;
The vein is palpable like a small pipe, elastic and has a thick wall. If the vein is not palpable,
perform a sequence from the wrist to the elbow, or warm compresses for 5 minutes of the arm.
10. Clean the skin on the part to be taken with 70% alcohol cotton and let dry. The cleansed skin
should not be held anymore.
11. Pivot the vein with the pinhole position facing upward. Insert the tube into the holder and
push it so that the posterior needle is stuck in the tube, then the blood will flow into the tube.
Wait until the blood stops flowing. If multiple tubes are required, after the first tube is filled,
unplug and replace with the second tube, and so on.
12. Take off the tourniquet and ask the patient to open his fist. The blood volume taken is
approximately 3 times the amount of serum or plasma required for the examination.
13. Place the cotton at the injection site and immediately release / pull the needle. Technically
take a few moments and then plaster for about 15 minutes. Do not pull the needle before the
tourniquet is opened.

C. Accommodating Blood In Tubes

Some types of blood sample tubes used in clinical laboratory practice are as follows:
1) The cap tube is red. This tube without the addition of additive substances, the blood will
become frozen and serum separated by centrifugation. Generally used for blood chemistry
examination, immunology, serology and blood bank (crossmatching test)
2) The yellow cap tube. This tube contains a separator gel (serum separator tube / SST) which
functions to separate serum and blood cells. After centrifugation, the serum will be at the top of
the gel and the blood cells are under the gel. Generally used for blood chemistry examination,
immunology and serology.

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3) The lid tube is bright green. This tube contains a separator tube (PST) gel with a lithium
heparin anticoagulant. After centrifugation, the plasma will be at the top of the gel and the blood
cells are under the gel. Generally used for blood chemistry examination.
4) Tube cover purple or lavender. This tube contains EDTA. Generally used for full blood count
and blood bank (crossmatch)
5) The blue cap tube. This tube contains sodium citrate. Commonly used for coagulation testing
(eg PPT, APTT)
6) The dark blue cap tube. This tube contains metal-free EDTA, commonly used for examination
of trace elements (zinc, copper, mercury) and toxicology.
7) The lid tube is light gray. This tube contains sodium fluoride and oxalate calium, used for
glucose examination.
8) The black cap tube; Contains sodium citrate buffer, used for ESR examination.
9) The pink cap tube; Containing potassium EDTA, used for immuno hematologic examination.
10) White cap tube; Potassium EDTA, used for molecular examination / PCR and bDNA.
11) Yellow cap tube with black on the top; Contains culture media, used for microbiological
examination - aerob, anaerob and mushroom Some important things in collecting blood samples
are:
A. Blood from a syring or injection should be inserted into the tube by removing the needle and
then draining the blood slowly through the tube wall. Incorporating blood by spraying, especially
without removing the needle, potentially causing hemolysis. Insert blood into the vacuum tube
by inserting the needle on the tube cap, allow the blood to flow to its own stop when the volume
has been met.
B. Homogenizing the sample when using anticoagulants by turning the tube 4-5 times or flipping
the tube 5-10 times gently. Shuffle samples potentially cause haemolysis.
C. The order of inserting the blood sample into the vacuum tube is: first - the blood culture bottle
or the second yellow-black cover tube - the coagulation test (blue cap tube), the third - the non
additive tube (red cap), the fourth - the red cap tube or Yellow with separator gel or clotactivator,
purple / lavendet cap tube (EDTA), green cap tube (heparin), gray lid tube (NaF and Na oxalate)

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2. Capillary Blood Collection and Arterial Blood

Capillary blood taking is intended for laboratory examination with fewer volumes of
intake through the vein. This collection is generally used for checks under 500 microliters.

The tools used for capillary removal:

A. Lancet
It is a small disposable needle used for capillary hemorrhaging on the surface of the
skin or the patient's fingertips. Can be a classic lancety apart from the lighter. Or it could be
automatic lancet which can be used directly without lighter anymore.
B. An alcohol swab
Is an ingredient of wool or cotton that is easy to absorb and moistened with antiseptic
in the form of ethyl alcohol. The purpose of using alcohol cotton is to remove dirt that can
interfere with the observation of the location of the vein as well as sterilize the stabbing area so
that the risk of infection can be suppressed.
C. Glass Object
It is a glass of preparation that will be used for exposure to available or other tests that
will be examined under a microscope
D. Deck Glass
Is a glass object cover, square shaped smaller and thin because it is intended to be able
to cover the preparations without disturbing the focusing of observations under the microscope
E. Capillary tube
Is a small tube with a diameter of 1mm so have the capillarity power or absorb the
blood fluids to be taken. So simply by attaching one end, then the blood will fill the tube as
needed. Capillary tube with anticoagulant marked red strip, while without coagulant with blue
strip.
F. Wax
Is a putty or cover that is used as a basic holder tube hematocrit so that when the
storage of blood samples or playback of hematocrit values, blood can be contained in the tube.

12
G. Gloves
It is the most important physical barrier to prevent infection, but it must be replaced by
contact with one patient to another to prevent cross-contamination. Gloves should be worn when
handling blood, body duh, secretions and excretion (except sweat).
The health worker (plebotomist) uses gloves for three reasons:
Reduce the risk of health workers affected by infection from patients.
· Prevent transmission of skin flora officers to patients.
· Reduced contamination of health care workers' hands with microorganisms that can move from
one patient to another
H. Mask
Masks are used to keep splashes out when health workers or surgeons speak, cough,
sneeze, and also prevent contaminated blood or body fluids from entering the nose or mouth of
health workers

A) Blood Collection: Capillaries:

Capillary blood capture or known as the termkinpuncture which means the process of
taking blood samples with a skin prick. Places used for capillary blood capture are:
· Fingerstick tip or earlobe.
· For small children and babies taken on the heel (heelstick) on 1/3 of the foot or foot toes.
• The shoot location should not indicate circulatory disturbances, such as vasoconstriction
(pallor), vasodilation (by inflammation, trauma, etc.), congestion or localized cyanosis. Capillary
blood collection is performed for tests requiring small volume samples, for example for glucose ,
Hb level, hematocrit (microhematocrit) or blood gas analysis (capillary method).
Procedure:
1. Prepare sampling equipment: sterile lancet, 70% alcohol cotton.
2. Select the location of the ago disinfection with 70% cotton alcohol, let it dry.
3. Hold the part so it will not move and press a little supailasa pain decreases.
4. Plug with sterile lancet. Punctures should be deep so the blood does not have to be scrambled
out. Do not stick the lancet if the fingertips are still wet with alcohol. This is not only because the

13
blood will be diluted by alcohol, but the blood also extends over the skin so it is difficult to fit in
the container.
5. After the blood comes out, throw the first drop of blood by using capaskering, the next drop
may be used for examination.
6. Taking blood is not too long and do not squeeze to prevent the formation of the stem.

B) Arterial Blood Collection

Arterial blood collection generally uses a radial artery in the wrist area. If not possible
can be selected brachial artery area of the arm or femoral artery in the groin. Blood collection
should be done with care and by trained personnel. Arterial blood samples are generally used for
blood gas analysis.

Arterial blood collection procedure:

1. Prepare sampling equipment in place / room where will be sampling.
2. Select the radial part of the artery.
3. Install the tourniquet if necessary.
4. Palpate with your fingers to make sure of the location of the artery.
5. Disinfect skin to be pierced with 70% cotton alcohol, let it dry. The cleansed skin should not
be held again.
6. Press the part of the artery to be stabbed with two fingers and stick the needle at the bottom of
the index finger with the position of the needle upright or slightly tilted. If the puncture is
successful the blood is seen entering the syringe and pushing the thorac up.
7. Once the desired volume of blood is reached, remove / pull the needle and immediately place
the cotton on the puncture and press the cotton firmly for ± 2 minutes. Put the plaster on this
section for ± 15 minutes.

C. Complications Flebotomi
Complications with regard to Flebotomy

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1. Syncope

Syncope is a state where the patient loses consciousness for a while as a result of
decreased blood pressure. Symptoms may include dizziness, cold sweat, rapid pulse, blurred /
dark vision, even vomiting. This usually happens because of feelings of fear or due to fasting
patients too long. Fear or anxiety can also arise because of lack of confidence That is why it is
necessary to provide explanations to the patient about the purpose of blood sampling and
procedures that will dialaminya.Pen and behavior of a Flebotomis can also affect the patient's
belief that arise a sense of suspicion / anxiety when the process of taking Blood will be executed.
Therefore, the appearance and behavior of a flebotomist must be such that it appears to be
competent and Fropesional

How to overcome
A. Stop taking blood
B. Lay the patient in bed, head tilted misunderstanding satisisi
C. The lower limb is raised (higher than the head position)
D. Loosen narrow clothes and belts
E. Ask the patient to take a deep breath
F. Call your doctor
G. Patients who had not been laid down, asked to bend their heads between their legs and take a
deep breath

Prevention
A. Patients are invited to speak so that their attention can be transferred. Patients to be treated for
syncope should be encouraged to lie down at the time of blood collection. The patient seat has a
backrest and a place / armrest.

2. Pain
The pain lasts not long so it does not require special handling. Pain may arise from an
unhulled alkosol or by the withdrawal of a needle that is too strong

15
Prevention
A. After skin disinfection, make sure that alcohol has dried before blood collection is done.
B. Withdrawal needle is not too strong
C. Explanation / Illustrate the nature of actual pain (give an example)

3. Hematoma
Hematoma is the accumulation of blood mass in the tissues (in the Flebotomi: tissue
under the skin) as a result of tearing of blood vessels. The cause factor lies in the technique of
taking blood:
A. The needle is too permissive to penetrate the vein wall
B. Needle needle impingement so that some of the pinhole is outside the vein
C. After blood collection, the stabbing site is less pressed or less pressed
D. When the needle is pulled out of the vein, the tourniquet (tourniket) has not been relaxed
E. The needle pricking is too close to the turnout.

How to overcome
If in the process of taking blood swelling of the skin around the place of needle sting
immediately
1) Remove the tourniquet and the needle
2) Press the needle stab with gauze
3) Raise the patient's arm higher than the head (+ - 15 minutes)
4) If necessary compress to reduce pain

4. Bleeding
Bleeding complications are more common in alter blood collection. Capillary blood
taking is less the risk. Excessive leverage (or difficult to stop) occurs due to disruption of the
patient's blood klilation system. This can happen because:
A. Patients experience treatment with anti-smoking drugs that inhibit blood clotting
B. Patients suffer from blood clotting disorders (thrombocytopenia, deficiency of blood-clotting
factors (eg hemophilia)
C. Patients have severe liver disease (prothrombin formation, fibrinogen disturbed)

16
How to overcome :
A. Press the bleeding place
B. Call the nurse / doctor for further treatment
Prevention
A. Need careful anamnesis (interview) premises patient
B. After taking the blood, the emphasis of the needle needle needs to be pressed for longer

5. Allergy
Allergies can occur with ingredients used in flebotomy, for example against antiseptic /
disinfectant, latex in gloves, tourniquet or plaster. Allergy symptoms may be mild or severe,
redness, rhinitis, inflammation of the lining of the eye; Sometimes even can (shock).

How to overcome :
A. Calm the patient, explain
B. Call a doctor or nurse for further treatment
Prevention
A. What interview is there allergy history
B. Wearing plaster or gloves that do not contain latex

6. Thrombosis
Occurs due to repeated blood taking in the same place causing local kerusaka and
inflammation and resulted in the occlusion of blood vessels. It is also seen in drug users
(narcotics) who use veins.

Prevention
A. Avoid repeated pickups in the same place
B. Guidance of narcotic sneakers
7. Inflammation of the bones
This disease often occurs in infants because of the narrow bone-skin distance and the use of long
lanceolate.

17
How to overcome: Overcoming bone inflammation
Prevention:
A. Using lanset of appropriate size. Currently already marketed lanset in various sizes tailored to
the age group.
B. Any occurrence of the complications Flebotomy should be reported to the physician and
recorded in a separate notebook by including the complete patient identity, date and time of the
event, and the action given.

8. Amnesia
In infants, especially newborns where the blood volume is low, repeated blood
collection can cause anemia. In addition, capillary blood capture in infants, especially bony can
cause cellulitis, abscesses, osteomyelitis, scar tissue and nodule classification. The classification
nodules initially look like a curve 12 months later will become nodules and disappear within 18-
20 months.

9. Neurological Complications
Neurologic complications can be localized by nerve pricking at the site of stabbing, and
cause pain or tingling pain that radiates to the arm, as described earlier. Although rare, seizures
may occur.

Handling:
A. Patients who have had an attack while taking blood should be protected from injury.
B. Stop taking blood, lay the patient with his head tilted to one side, free the airway, avoiding the
tongue to not bite.
C. Immediately activate safety equipment, contact your doctor
D. Apply sufficient pressure in the stabbing area while limiting the movement of the patient.
G. Failure to take blood

18
Factors that can cause include:
1. because the needle is less deep.
2. Needles are too deep / translucent, pinhole attached to the walls of blood vessels, venous
collapses or tubes are not vacuum. Collapsing veins can occur when pulling the suction quickly,
using a tube that is too large or the needle is too small.

1. Hemoconcentration
Hemoconcentration occurs due to a long, tight (> 1 minute) shutdown / attenuation, or
clenching the palms with massage or massage. This will lead to increased levels of hematocrit
and other cellular elements, total protein, GTO, total lipids, cholesterol and iron (Fe). Repeated
clenching of the hand will increase potassium, Flosfat and lactate.

2. Hemodilution
Occurs due to blood taking dilengan where there is intra venous fluid (infusion). Blood
sampling on the influs side should be avoided as far as possible, if not possible, stop the infusion
3-5min, take the distal blood where the infusion and discard the first 3-5 cc of blood taken. Some
of the things that can cause hemodilution include:
A. Contamination by interstitial fluid / tissue fluid in blood collection in the udem region or in
obese patients.
B. Contamination of alcohol that has not been dry on capillary blood taking
C. Blood rate: inappropriate anticoagulants

3. Hemolysis
Occurred due to blood taking with a needle that is too small, difficult blood collection
where needle manipulation is done, pulling the suction too quickly, removing the blood from the
needle by pressing hard / rough, shaking the tube with strong, alcohol contamination and wearing
the torniket for too long. Hemolysis will cause elevation of intracellular analytes such as LDH,
potassium, magnesium, Fedan inorganic phosphorus. Inclusion of tissue factors Blood picking is
difficult as in small veins, parents, small children and patients with udem or obesity, or too much
manpulation will cause the release of tissue factors that will activate blood clotting factors and

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result in changes in hemostasisi examination value. We recommend that blood collection for
coagulation is done with two tubes.

4. Contamination
On examination of blood cultures, inadequate asepsis or blood-pickup at a site with an
inflammatory site will cause contamination. Plasma is a blood fluid consisting of water in which
dissolved organic, inorganic, and waste substances are useless, while serum is one part of the
blood plasma, ie on the protein. Proteins have a large enough molecule, if blood is rotated in a
centifuge, then the protein substance will settle, the rest of a clear or clear liquid called serum.

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 CHAPTER III
COVER

A. Conclusion
Flebotomi (english: phlebotomy) comes from the Greek phleb dantomia. Phleb means
veins and tomia means slicing / cutting ("cutting"). It used to be known as the sectie vein (Bld),
venesection or veni section (Ing). While Flebotomist is a medic who has been given training to
remove and accommodate blood specimens from veins, arteries or capillaries. There are some
minimal competencies a flebotomist must possess, and professional behavior that a flebotomist
must adhere to. Blood can be obtained through the taking of venous blood, capillary blood and
arterial blood. Complications related to the action of Flebotomy are syncope, pain, hematoma,
bleeding, allergies, thrombosis, bone inflammation, amnesia, and neurological complications.
Failure factors that can occur at the time of blood collection are hemokosentrasi, hemodilusi,
hemolysis, contamination.

B. Suggestions
In order to avoid errors at the time of taking blood so a flebotomist must have the
competence and professional behavior so that it can work properly and correctly in order to
obtain accurate results.

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 Bibliography

https://id.scribd.com/doc/99863544/MAKALAH-FLEBOTOMI
http://adiyarea.blogspot.com/2011/06/komplikasi-flebotomi.html
http://yazhid28bashar.blogspot.com/2013/04/pengertian-flebotomi.html
http://dwirusmita.blogspot.com/2012/10/flebotomi.html
http://riskacantix.blogspot.com/2012/02/teknik-flebotomi.html

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