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CHAPTER 17

CHAPTER 17. Phlebotomy. Introduction to Phlebotomy. Purpose of phlebotomy: collect blood for laboratory analysis Phlebotomy: incision of a vein for the removal of blood Phlebotomist: individual who collects the blood sample. Introduction to Phlebotomy. Types of blood collections

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CHAPTER 17

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  1. CHAPTER 17 Phlebotomy

  2. Introduction to Phlebotomy • Purpose of phlebotomy: collect blood for laboratory analysis • Phlebotomy: incision of a vein for the removal of blood • Phlebotomist: individual who collects the blood sample

  3. Introduction to Phlebotomy • Types of blood collections • Arterial puncture • Venipuncture • Skin puncture • Venipuncture is the puncturing of a vein for the removal of a venous blood sample and is performed when a large blood specimen is needed for testing

  4. Introduction to Phlebotomy • Methods of Venipuncture • Vacuum tube – uses an evacuated tube and is the fastest, most convenient, and most often used method • Butterfly and syringe – used for difficult draws such as small or sclerosed veins

  5. General Guidelines for Venipuncture • Patient preparation • Fasting • Avoidance of medications • Special preparation required by outside laboratories

  6. Collection and Handling Requirements • Collection Supplies • Type of specimen required • Amount of specimen required • Techniques for collecting specimen • Proper handling and storage of specimen

  7. Assembling Equipment and Supplies • Appropriate blood tubes • Ensure tubes are not broken, cracked or expired • Label each blood tube • Unique patient identifiers, such as name and date of birth • Date and time of collection as well as collector’s initials • Laboratory requisition

  8. Supplies and Equipment • Venipuncture needle • Double pointed needle with threaded hub that attaches to vacutainer • Has a bevel that facilitates easier insertion into the skin and vein • Gauge sizes are 20 to 22 with 21 G being the most common size used • Length is 1 to 1 ½ inches

  9. Supplies and Equipment, cont. • Vacutainer/Plastic Holder • Used to secure the needle and hold the evacuated tubes • Evacuated tubes • Glass or plastic tubes with rubber stopper on one end • Tubes have a vacuum that assists in drawing the blood into the tube • Evacuated tubes have different colored stoppers which indicate the type of additive in the tube

  10. Supplies and Equipment, cont. • Tourniquet • Makes patient veins stand out; they are easier to see and palpate • Different types of tourniquets • Velcro closure • Rubber • Latex and non-latex

  11. Reassuring the Patient • Explain the procedure • Instruct the patient to remain still • Tell patient there will be a small amount of pain associated with the procedure • Make sure patient is ready for procedure; tell them they will “feel a small stick”

  12. Venipuncture – Vacuum Tube Method • Review requirements and tubes from order • Sanitize your hands • Greet and identify patient; discuss previous draw experiences • Assemble equipment • Tubes, vacutainer, needle, tourniquet, gloves, alcohol pads, gauze, cotton, co-ban • Check for expirations on all equipment

  13. Venipuncture – Vacuum Tube Method, cont. • Prepare equipment • Place tube loosely in vacutainer • Apply tourniquet to assess veins • Take tourniquet off, clean area with alcohol • Put tourniquet back on, position arm • Anchor vein using thumb and first finger of non-dominant hand

  14. Venipuncture – Vacuum Tube Method, cont. • Insert needle at a 15 degree angle • Stabilize the tube, never change hands during the procedure • Fill each tube to exhaustion • As last tube fills to 3/4 s full, remove tourniquet and remove tube • Place gauze or cotton at site and apply pressure

  15. Venipuncture – Vacuum Tube Method, cont. • Apply co-ban • Place tubes in upright position after labeling • Remove gloves and sanitize • Chart the procedure • Appropriate sites for antecubital vacuum tube method of venipuncture

  16. Butterfly Method of Venipuncture • Called the Butterfly method because of the “wings” located between the tubing and needle

  17. Butterfly Method of Venipuncture, cont. • Used when veins are smaller, have a thin wall or are more likely to collapse • Gauge of needle is 21 to 23 • Length of needle is ½ to ¾ inch • After collecting equipment and supplies: • Seat patient • Assess veins and locate vein for venipuncture

  18. Butterfly Method of Venipuncture, cont. • Follow procedure used for antecubital draw • Compress plastic wings together with bevel up • Insert at 15 degree angle to skin • After inserting, decrease angle to 5 degrees • Follow order of draw

  19. Alternate Venipuncture Sites • Inner forearm • Wrist area above the thumb • Back of the hand • Top of the foot

  20. Types of Blood Specimens • Clotted Blood – has no additives in tubes • Serum – required for most blood chemistry studies • Obtained from clotted blood which is obtained from tubes with no anticoagulants • Whole blood – required for blood hematology studies such as a complete blood count • Plasma – obtained from tubes that have anticoagulants to prevent clotting

  21. OSHA Safety Precautions • To avoid exposure to bloodborne pathogens: • Wear gloves • Avoid hand-to-mouth contact while working with blood specimens • Wear a face shield or mask and eye protection • Perform all procedures in a manner to minimize the splashing, spraying, or splattering of blood • Bandage cuts before gloving

  22. OSHA Safety Precautions, cont. • Sanitize hands after removing gloves • If exposure to blood occurs, wash with soap and water immediately • If mucous membranes come in contact with blood flush with water immediately • Do not break, bend, or shear contaminated venipuncture needles • Do not recap contaminated venipuncture needles

  23. OSHA Safety Precautions, cont. • Locate sharps containers and keep close • Place blood specimens in containers that prevent leakage during collection, handling, processing, storage, transport, and shipping • Handle lab equipment and supplies properly • Do not store food in refrigerator where testing supplies and specimens are stored • If exposed to blood – report incident to physician or employer immediately

  24. Order of Draw for Multiple Tubes • Tubes must be drawn in a specific order as to not contaminate specimens

  25. Problems Encountered with Venipuncture • Failure to obtain blood • Can occur with obese or elderly patients • After two attempts ask for assistance • Reasons for not getting blood: • Needle not inserted far enough • Needle inserted too far • Bevel lodged against the wall of vein

  26. Hemolysis • Hemolysis is the breakdown of blood cells • This can occur due to rough handling and can cause inaccurate test results • To prevent hemolysis: • Store tubes at room temperature • Allow alcohol to air dry completely • Do not use small gauge needles to collect specimen • Handle tubes carefully • Do not shake or handle tubes

  27. Fainting • Some patients do not do well with venipuncture • Protect patient from injury • Place patient in a position that will promote blood flow to brain • Notify provider for further treatment

  28. Inappropriate Puncture Sites • When not to use a potential site: • Scarred areas or sclerosed veins • Bruised areas • Burned skin • Adjacent to areas of infection • Edema • Avoid the arm on the same side of a radical mastectomy

  29. Preparation of Specimen • If centrifuging is required: • Allow tube to stand upright 20 to 30 minutes at room temperature • Do not let blood stand for more than one hour as this causes leaching and will lead to inaccurate test results • Centrifuge specimen for 10 minutes • Hold tube up to light to look for intact red blood cells or hemolysis • If so, re-centrifuge specimen

  30. Skin Punctures • Used to obtain capillary blood specimens • Also known as a capillary puncture • Example of tests: • Hemoglobin • Hematocrit • Blood glucose • Prothrombin time

  31. Skin Punctures, cont. • Puncture sites: • Finger tip is preferred for adults • Earlobe as a back-up • Plantar surface of heal for infants, birth to one year

  32. Skin Puncture Devices • Disposable semiautomatic retractable lancet devices • Disposable lancets recommended by OSHA • Reusable semiautomatic retractable lancet device

  33. Skin Puncture Devices, cont. • Depth of puncture • Adults: no deeper than 3.1 mm • Infants and children: no deeper than 2.0 mm • If puncture is too deep, may penetrate bone • Could result in osteochondritis or osteomyelitis

  34. Micro-collection Devices • Specimens can be collected on various devices: • Reagent strips • Capillary tubes • Micro-collection tubes

  35. Performing a Finger Puncture • Use lateral part of tip of third or fourth finger • Do not use index finger because it is too callused • Do not use little finger because the amount of tissue is not deep enough and could cause injury to bone • Cleanse site with antiseptic wipe • Ask patient to remain still • Firmly grasp finger, select site, firmly press lancet against site, and perform puncture

  36. Performing a Finger Puncture, cont. • Wipe away the first drop of blood, it is not suitable for testing • Allow large drop to form • Can massage the finger, but do not squeeze, this can cause inaccurate readings • Collect specimen • Apply pressure to ensure bleeding stops; apply bandaid

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