VENIPUNCTURE  Total Cholesterol has been reported to
increase with Mild stress, & HDL
PATIENT PREPARATION
1. EXERCISE
Physical activity can have different effects on
analyte concentrations
 VOLUME SHIFTS between the vascular &
interstitial compartments, VOLUME LOSS
by sweating & hormone concentrations
 Transient Increase in Lactate, Fatty acid,
& Ammonia
 Long term increased in CPK, AST, LD &
Aldolase
 Vigorous hand exercise (fist clenching)
increases Potassium, Lactate, & Phosphate
2. FASTING
 8 – 14 hrs = Glucose,Lipids, & Lipoproteins
 Glucose Test: 6-8 hrs
 Lipid Test: 12-14 hrs
 Glucose + Lipid Test: 10 hrs
How to instruct a patient for fasting:
Always ask for the last meal
Ex:
If a patient is scheduled for blood collection at
6 am, he/she must have had his/her last meal on:
 Glucose test: 10 pm – 12 mn
 Lipid test: 4 pm or 6 pm
 Glucose + Lipid Test: 8 pm
Beyond these hours, the patient must not eat,
drink, nor take medicine.
 48 hrs of Fasting may increase Serum
Bilirubin.
 Basal State Collection = Glucose,
Cholesterol, Triglycerides, & Electrolytes
o In collecting specimen, it must be
collected immediately after the
patient wakes up early in the
MORNING.
 At Least 12 hrs FASTING
 Basal Metabolic Panel = Glucose, BUN,
Creatinine, Sodium, Potassium, Chloride,
CO2 & Calcium
 Requires Fasting Spx = FBS, GTT, TAG,
Lipid & Lipoprotein, Gastrin, & Insulin.
3. STRESS
 Affects Adrenal hormone secretion.
 Increased: Catecholamines (adrenalin),
Cortisol, ACTH, Prolactin, Insulin,
Albumin, Glucose, & Lactate, WBC.
Cholesterol to decrease by as much as 15%
 Result in Hyperventilation which in turn,
affects Acid-Base Balance. Makes blood
alkali.
SPECIMEN COLLECTION
TIME OF COLLECTION
 Failure to follow the planned time schedule
can lead to erroneous results &
misinterpretation of a patient’s condition.
The most common tests in this category
are the ASAP & Stat Collections
 ASAP means “As Soon As Possible”.
 Stat comes from the Latin word statim
meaning “immediately”.
 Stat specimens are collected and analysed
immediately.
 At least 30 minutes to 1 hour of analysis.
 They are given the highest priority and are
usually ordered from the emergency
department & critical care units.
 Timed specimens are ordered usually to
monitor a patient’s condition.
PUBLIC RELATIONS & CLIENT
INTERACTIONS
Professionalism
APPEARANCE
 The impression a phlebotomist makes when
first approaching a patient sets the stage
for future interaction
 Lab coats should protect clothing
underneath
 Shoes should be conservative and clean
 Hair, if long, must be pulled back and
fingernails should be short for safety’s
sake.
ATTITUDE
 Integrity or honesty: doing what is right
regardless of the circumstances.
 Compassion: a deep awareness of the
distress of others and a desire to alleviate
it.
 Motivation: having the drive to meet a
need or achieve a goal
 Ethical behavior: conforming to a standard
of right and wrong conduct
 Dependability and work ethic: able to be
relied upon, and being self-directed
because of a belief in the importance of
work
 Diplomacy: skill in handling situations
without creating hostility
COMMUNICATION SKILS 2. SLEEPING PATIENTS

 If the phlebotomist responds properly to
the needs of a patient due to good
communication between the two of them,
the patient typically develops a favorable
impression of the phlebotomist and the
3. UNCONSCIOUS, MENTALLY
facility
INCOMPETENT PATIENTS
 Listening, forms the foundation for good
interpersonal communication and is
especially important in establishing rapport
with patients
4. INFANTS & CHILDREN
BEDSIDE MANNER
 A phlebotomist may encounter family or
visitors when collecting specimens.
 Discretion is important in dealing with
5. OUTPATIENT/AMBULATORY PATIENT
them as they can help calm the patient’s
fears or they can raise the patient’s
anxiety level.
 If the phlebotomist feels it would be best,
they can be asked to leave the room
VENIPUNCTURE
PATIENT’S CONSENT
Informed Consent
Implies voluntary permission for a medical
procedure, test, or medication will be given
Implied Consent
Does not require a verbal expression of
consent. Actions can imply consent
Expressed Consent
May be given verbally or in writing
HIV Consent
Laws specify exactly what type of information
must be given to inform the client properly
Consent for Minors
Parent or guardian consent is required
Refusal of Consent
An individual has a constitutional right to
refuse a medical procedure such as
venipuncture
 They are identified in the same manner as
conscious in-patients
 They MUST be awakened before Blood
Collection
 They are identified by asking the attending
nurse or relative; ID bracelets
 A nurse or relative may identify the
patient, or by means of an identification
bracelet.
 Verbally ask their full names, address, or
birthdate, & countercheck with driver’s
license, or ID card with photo.
 Process by w/c blood is obtained from a
patient’s vein.
 SITES: Antecubital Fossa, Veins on the
Wrist & Dorsal Aspect of Hands, Veins on
the Ankle.
 MEDIAN CUBITAL VEIN is the BEST
site for Venipuncture because it is the
largest and the best anchored vein.
 According to CLSI Standards, an attempt
must have been made to locate the Median
Cubital Vein on both arms before
considering an alternate vein.
 Cephalic Vein is the SECOND choice if
the median cubital vein is unsuitable
 Basilic Vein is the THIRD Choice.
 Basilic Vein should NOT be chosen unless
no other vein is more prominent due to its
close proximity to the brachial artery.
 Veins on the dorsal part of hand & wrist
area can be chosen provided the
antecubital veins are not Acceptable.
 Ankle vein should be used ONLY if arm
veins have been determined to be
unsuitable

PATIENT IDENTIFICATION PROCEDURES

1. CONSCIOUS INPATIENTS /
HOSPITALIZED PATIENTS

 Verbally ask their full names.

 Verify the name using the identification
bracelet w/c includes first & last names,
hospital/unit number, room/bed number,
and physician’s name
ETS & SYRINGE PROCEDURE
1. Greet the patient politely and with
gladness.
2. Determine the identity of the patient.
3. Decontaminate hands, put gloves &
prepare the materials.
4. Position the patient’s arm in a downward
and comfortable manner.
5. Apply the tourniquet 3 -4 inches above the
site, & instruct the patient to make a fist.
Check for potential sites by gently
palpating the vein. Never leave the
tourniquet longer than one minute.
6. If a suitable vein is not felt on the first
arm, remove the tourniquet and try the
other arm or other site.
7. If a vein has already been chosen, release
the tourniquet and disinfect the patient’s
skin with an alcohol pad starting at the
point where you expect to insert the
needle, and moving outward in even-
widening concentric circles.
8. Allow the site to dry by allowing the
alcohol to evaporate or remove excess
alcohol with sterile gauze pad. Do not
blow or touch the site after cleaning.
9. Re-apply the tourniquet and instruct the
patient to make a fist.
10. Pull the skin gently with the thumb, and
position the needle parallel or running in
11. Insert the needle quickly, with the
bevel side up at a 15-30 degree angle with
the skin. A slight “pop” should be felt as
the needle enters the vein.
11. the same direction as the vein.
12. For evacuated tube, push the tube and as
the blood begins to flow, instruct the
patient to open his fist, and release the
tourniquet. The tourniquet can be left on
until after the tubes have been filled if it
appears that blood flow is slow. But
always remove the tourniquet first before
withdrawing the needle.
a. For multidraw, carefully remove each
tube from the holder with a gentle
twist-and-pull motion.
b. For syringe, gently pull the plunger and
as blood begins to flow, instruct the
patient to open his fist, & release the
tourniquet.
13. When blood collection is done or all tubes
have been filled and removed from the
holder, withdraw the needle with a quick
motion and hold a dry sterile gauze pad
over the site. Apply pressure to the site
for a minimum of 2 minutes.
14. Label the tubes with patient’s full name,
date and time of collection, and initials of
the phlebotomist. Check the condition of
the patient before leaving.
15. Dispose all materials in the designated
waste bins.
BUTTERFLY PROCEDURE
1 – 8. Follow the same procedure as ETS &
Syringe procedure
9. Preparing it while the site dries, saves time.
Attach a butterfly to an ETS holder or syringe
adapter. Grasp the tubing near the needle end
and stretch it lightly to help keep it from
coiling back up. Position the first tube in the
holder now, or wait until after needle entry
10. Reapply tourniquet, Uncap, & inspect needle
11. Hold the butterfly wings between your
thumb and index finger or fold them upright
and grasp them together.
12. Cradle the tubing and holder in the palm of
your dominant hand or lay it next to the
patient’s hand. Uncap and inspect the needle
for defects, and discard it if flawed.
13. Anchor the vein & insert the needle into the
vein at a shallow angle (e.g., 10–15 degrees). A
“flash” or small amount of blood appears in the
tubing when the needle is in the vein. “Seat”
the needle by slightly threading it within the
vein to keep it from twisting out of it.
14. Establish blood flow & release tourniquet
15. Fill, Remove, and Mix Tubes in Order of
Draw.
16. Clean folded gauze is placed over the site so
pressure can be applied immediately on needle
removal.
17. The needle is removed in one smooth motion
without lifting up or pressing down on it.
18. Pressure is immediately applied with the
free hand while the needle safety device is
simultaneously activated with the other to
reduce the risk of a needle stick.
19. Discard the collection unit.
20. Label the tubes. Apply bandage or tape to
the patient’s arm. Thank patient, remove gloves,
& sanitize hands
○SITES TO AVOID○  If the child is in a bed, a parent or helper
leans over the child from the opposite side
 Intravenous line in both arms
of the bed, reaching one arm around the
 Burned or scarred areas
child to support the venipuncture arm and
 Areas with hematoma
the other over the child to secure the
 Thrombosed Veins
child’s other arm.
 Edematous arms
 Partial/Radical Mastectomy on one or
both arms
 Arms with arteriovenous (AV) shunt or
fistula
 Cast(s) on arm(s)

NOTES TO REMEMBER

MULTIPLE VENIPUNCTURE ATTEMPTS

 If you are unable to obtain a specimen on

the first attempt, try again below the
first site, on the other arm, or on a hand
or wrist vein
 If the second attempt is unsuccessful,
ask someone else to take over
 Unsuccessful venipuncture attempts
frustrate both patient and phlebotomist.
If a second person is unsuccessful on
two attempts, give the patient a rest and GERIATRIC VENIPUNCTURE
try later unless the test is stat or timed
 If a specimen is not obtained, notify the  It is extremely important to treat geriatric
nurse or physician according to facility patients with dignity and respect and not
policy. demean them
 It is best to address the patient with a
PEDIATRIC VENIPUNCTURE more formal title, such as Mrs., Ms., or
Mr., rather than by his or her first name
Interacting with the Child
 As with patients in general, older patients
 Approach the child slowly and determine may enjoy a short conversation
his or her degree of anxiety or fear  If a patient appears to be having difficulty
before handling equipment or touching hearing, speak slightly slower and louder
arms to look for a vein
 Physically lower yourself to the child’s
level to be less intimidating. Explain the
procedure in terms the child can
understand and answer questions
honestly.
 Never tell a child it will not hurt; instead
say it may hurt just a little, but it will be
over quickly.
 It is important to let the child know that
it is all right to cry

Immobilizing the Child

 Immobilization of pediatric patients is

critical to successful venipuncture and
helps ensure their safety. An infant can be
wrapped in a blanket
 A toddler can be restrained while sitting
on a parent’s lap
 The parent uses one arm to support and
steady the venipuncture arm and places
the other arm around the child and the
child’s other arm.