Phlebotomy

Phlebos Greek word meaning Vein & Tome to cut

-an invasive procedure performed by trained phlebotomist
Phlebotomists Primary Roles:
1. Obtain blood specimens for diagnostic testing by either Venipuncture or Dermal puncture
2. Remove blood from donor of blood transfusion or from patient with polycythemia vera
3. Responsible for collecting and properly packing of other bodily specimen for laboratory
analysis.
Blood collection procedure:
a. Identifying the name of Patient; check request
b. Prepare suitable site for collection
c. Prepare equipments
d. Performing blood collection and placing samples in appropriate containers
e. Labeling of samples, proper storage and handling
f. Sending blood samples for processing
3-step Process of Identifying a Patient:
1. ASK the patient to state his/her name and date of birth
2. COMPARE name on the rest requisition to patient response
3. VALIDATE patient ID by checking record #, armband or wrist band
NOTE: do not draw blood if the armband or bracelet is missing
Specimen Collection Equipments:
1. Gloves
2. Tourniquet
3. Alcohol Prep Pads
4. Gauze pads or cotton
5. Needles and lancets
6. Evacuated tube holder or adapter
7. Needle disposal (sharps) container
8. Adhesive tapes
9. Permanent marker or pen
10. Appropriate tubes or sample container
2 Common Collection Method:
1. Venipuncture needle insertion (Vacuum or syringe)
2. Dermal Puncture use of lancet or puncture device

VENIPUNCTURE SITES:

Areas/ Site to avoid:

1. Arm on side of mastectomy
2. Edematous areas
3. Hematoma
4. Scarred areas
5. Arms with cannulas, fistulas or vascular grafts
6. Sites with IV line of any kind
Note: If there is no other site to collect Phlebotomist must ask healthcare provider to turn off IV
for at least 2 minutes, select vein other than the one with the IV. Discard the first 5 ml of blood
and before collecting the actual samples.
Additional Information:
ANGLE of the needle 15-30
Tourniquet must be 3-4 inches above from the puncture site and do not leave tourniquet for
more than 1 minute.
Disinfecting the site by solutions i.e., 70%alcohol, should be done in concentric circle manner.

Order of Draw
Blood collection tubes must be drawn in a specific order to avoid cross-contamination of additives between
tubes. The recommended order of draw for evacuated tubes:

ADDITIVE

MODE OF
ACTION

Invertions
USES

For Blood Culture

Blood Culture Bottle

Light Blue

Forms Calcium
salts to remove
calcium

Coagulation tests
(protime and
prothrombin time), full
draw required

3-4

Red

Blood clots, and

the serum is
separated by
centrifugation

Chemistries, Immunology
and Serology, Blood Bank
(Crossmatch)

6-8

Serum separator
tube (SST)
contains a gel at
the bottom to
separate blood
from serum on
centrifugation

Chemistries, Immunology
and Serology

6-8

Inactivates
thrombin and
thromboplastin

For Lithium level, use

sodium heparin for ammonia
level, use sodium or heparin

6-8

6-8

6-8

Sodium citrate

None

None
Yellow

Green

Sodium
heparin or
lithium heparin

Lavender

EDTA

Forms calcium
salts to remove
calcium

Hematology (CBC) and

Blood Bank (Crossmatch);
requires full draw - invert 8
times to prevent clotting and
platelet clumping

Gray

Sodium
fluoride and
potassium
oxalate

Antiglycolytic
agent preserves
glucose up to 5
days

Glucoses, requires full draw

(may cause hemolysis if
short draw)

Note: Tubes with additives must be thoroughly mixed. Erroneous test results may be obtained when the blood
is not thoroughly mixed with the additive.

LABELING THE SAMPLE

A properly labeled sample is essential so that the results of the test match the patient.
The key elements in labeling are:

Patient's surname, first and middle.

NOTE: Both of the above MUST match the same on the requisition form.

Date, time and initials of the phlebotomist must be on the label of EACH tube.
Automated systems may include labels with bar codes along with Patient's ID
number.

Dermal Puncture Sites:

3rd and 4th finder of non-dominant hand

infants

Heel punctures are best for newborn and

Sites to avoid in Dermal Puncture:

Finger that is cold or cyanotic, swollen, scarred or with rash

2nd finger have thicker-callused skin

Additional information:
Wipe off the first drop of blood, tends to have excess tissue fluid.

Prewarming the infant's heel (42 C for 3 to 5 minutes) is important to obtain capillary blood gas
samples and warming also greatly increases the flow of blood for collection of other specimens.
However, do not use too high a temperature warmer, because baby's skin is thin and susceptible to
thermal injury.

SAFETY AND INFECTION CONTROL

Protect Yourself
Practice Standard precautions:

Wear gloves and a lab coat or gown when handling blood/body fluids.

Change gloves after each patient or when contaminated.

Wash hands frequently.

Dispose of items in appropriate containers.

Dispose of needles immediately upon removal from the patient's vein. Do not bend, break,
recap, or resheath needles to avoid accidental needle puncture or splashing of contents.

Clean up any blood spills with a disinfectant such as freshly made 10% bleach.

If you stick yourself with a contaminated needle:

Remove your gloves and dispose of them properly.

Squeeze puncture site to promote bleeding.

Wash the area well with soap and water.

Record the patient's name and ID number.

Follow institution's guidelines regarding treatment and follow-up.

NOTE: The use of prophylactic zidovudine following blood exposure to HIV has shown
effectiveness (about 79%) in preventing seroconversion
Protect The Patient

Place blood collection equipment away from patients, especially children and psychiatric
patients.

Practice hygiene for the patient's protection. When wearing gloves, change them between
each patient and wash your hands frequently. Always wear a clean lab coat or gown.

COMPLICATIONS
1. Fainting/Syncope
2. Hematoma
3. Thrombosis
4. Petichaie
5. Excessive bleeding
6. Siezures
7. Collapsed veins
8. Hemoconcentration
9. Hemolysis
10. Allergies