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Review of Phlebotomy and Laboratory Requirements

Review of Phlebotomy and Laboratory Requirements. Janet Vincent, MS, SBB(ASCP) Education Coordinator Department of Pathology. Phlebotomy!. One of the most often remembered experiences One of the least trained fields in all of medicine

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Review of Phlebotomy and Laboratory Requirements

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  1. Review of Phlebotomy and Laboratory Requirements Janet Vincent, MS, SBB(ASCP) Education Coordinator Department of Pathology

  2. Phlebotomy! • One of the most often remembered experiences • One of the least trained fields in all of medicine • One question on the Press Gainey survey that relates to the Laboratory.

  3. What is the most important step in drawing a blood sample? • Universal Precautions • Not hurting the patient • Wearing gloves • Getting the right tube of blood • Something else?

  4. The most important step in drawing a blood sample: • Patient Identification! • Second? • Labeling the specimen CORRECTLY

  5. Steps in the process • Introduce yourself and explain procedure • Patient Identification • Tie the tourniquet • Search for a vein • Prepare the site • Draw the correct tubes, in the correct order • Invert the tubes • Remove the tourniquet and needle. • Apply pressure to site

  6. The supplies Tourniquet, alcohol, gauze, gloves, tube, needle and holder

  7. ID Patient, look for a vein, cleanse site

  8. Anchor vein, perform venipuncture

  9. Angle of draw is 15-300

  10. Remove Tourniquet

  11. Label the tube!!!!

  12. Things you should not do! • Do not leave the Tourniquet on longer than 2 minutes. • Do not leave the tourniquet on when you are removing the needle • Do not perform the venipuncture while the alcohol is still wet • Do not leave the tube on the back of the needle when removing the needle from the arm • Do not enter the vein slowly.

  13. To prevent a hematoma: • Puncture only the uppermost wall of the vein • Remove the tourniquet before removing the needle • Use the major superficial veins • Make sure the needle fully penetrates the upper most wall of the vein. (Partial penetration may allow blood to leak into the soft tissue surrounding the vein by way of the needle bevel) • Apply pressure to the venipuncture site

  14. Hemotoma

  15. To prevent hemolysis • Mix tubes with anticoagulant additives gently 5-10 times • Avoid drawing blood from a hematoma • When using a needle and syringe, draw the plunger back gently to avoid frothing of the sample • Make sure the venipucture site is dry • Avoid a probing, traumatic venipucture

  16. Hemoconcentration: • Prolonged tourniquet application • Massaging, squeezing, or probing a site • Long-term IV therapy • Sclerosed or occluded veins

  17. IF AN INCOMPLETE COLLECTION OR NO BLOOD IS OBTAINED: • Change the position of the needle. • 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.

  18. IF BLOOD STOPS FLOWING INTO THE TUBE: • The vein may have collapsed • The needle may have pulled out of the vein when switching tubes

  19. PROBLEMS OTHER THAN AN INCOMPLETE COLLECTION: • A hematoma forms under the skin adjacent to the puncture site - release the tourniquet immediately and withdraw the needle. Apply firm pressure.

  20. Order of Draw • Cultures FIRST • Red top tube • Blue • SST • lavender, green, gray Hint: Always draw additive tubes last.

  21. The Blue Top Tube Problem • Must never be drawn first when using a vacutainer or butterfly set up • Must be filled to the required amount • Must be welled mixed - no clots.

  22. A B D C Completing the Requisition A. Requesting Physician name and ID number B. Diagnosis Code C. Patient Name and Number D. Collected by and date and time

  23. A B Completing the Requisition A. Information on the tube of blood B. The number identify tube with request form

  24. Suggestions • Internet Sites • http://www.vh.org/Providers/CME/CLIA/Phlebotomy/Phlebotomy.html • http://www.phlebotomy.com/ • http://www.utmb.edu/lsg • Ask for help!

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