PHINMA-UNIVERSITY OF PANGASINAN

COLLEGE OF ALLIED HEALTH SCIENCES

DEPARTMENT OF NURSING

ACTIVITY NO. 12
BLOOD

NAME: DATE:

GROUP NO.: SCORE:

I. DISCUSSION
A. BLOOD COLLECTION
B. BLOOD SMEAR
C. BLOOD TYPING
II. PROCEDURES
A. BLOOD COLLECTION
➔ VENIPUNCTURE PROCEDURE
1. Prepare the accession (TEST REQUEST) order.
2. Greet the patient and identify the patient by having the patient verbally state his or
her full name and confirm with the patient’s unique identification number, address,
and/or birth date. Ensure the same information is on the request form.
3. Sanitize hands.
4. Verify that any dietary restrictions have been met (e.g. fasting, if appropriate) and
check for latex sensitivity.
5. Assemble supplies and appropriate tubes for the requested tests. Verify paperwork
and tube selection.
6. Reassure and position the patient.
7. If necessary to help locate a vein, request that the patient clench his or her first.
8. Apply the tourniquet and select an appropriate venipuncture site, giving priority to
the median cubital or median vein. Ensure the tourniquet is on for no longer than 1
minute.
9. Put on gloves.
10. Cleanse the venipuncture site with 70% isopropyl alcohol using concentric circles
from the inside to outside. Allow skin to air-dry.
11. Inspect the equipment and needle tip for burrs and bends.
12. Perform venipuncture by anchoring the vein with the thumb 1 to 2 inches below the
side and inserting the needle bevel up, with an angle less than 30 degrees between
needle and the skin. Collect tubes using the correct order of draw, and invert each
tube containing any additive immediately after collection.
13. Release and remove the tourniquet as soon as blood flow is established or after no
longer than 1 minute.
14. Ensure that the patient’s hand is open.
15. Place gauze lightly over the puncture site without pressing down.
16. After the last tube has been released from the back of the multisample needle,
remove the needle and activate the safety device according to the manufacturer’s
directions.
17. Apply direct pressure to the puncture site using a clean gauze pad.
18. Bandage the venipuncture site after checking to ensure that bleeding has stopped.
19. If a syringe has been used, fill the evacuated tubes using a syringe transfer device.
20. Dispose of the puncture equipment and other biohazardous waste.
21. Label the tubes with the correct information. The minimal amount of information
that must be on each tube is as follows:
a. Patient’s full name
b. Patient’s unique identification number
c. Date of collection
d. Time of collection
e. Collector’s initials or code number
NOTE: Compare the labeled tube with the patient’s identification bracelet or
have the patient verify that the information on the labeled tube is correct
whenever possible.

➔ CAPILLARY PROCEDURE
1. Prepare the accession (TEST REQUEST) order.
2. Greet the patient and identify the patient by having the patient verbally state his or
her full name and confirm with the patient’s unique identification number, address,
and/or birth date. Ensure the same information is on the request form.
3. Position the patient and the parents (or individual designated to hold an infant or
small child) as necessary.
4. Verify that any dietary restrictions have been met (e.g. fasting), and check for latex
sensitivity.
5. Wash hands and put on gloves.
6. Assemble supplies and appropriate tubes for the requested tests. Check paperwork
and tube selection.
7. Select the puncture site.
8. Warm the puncture site
9. Cleanse the puncture site with 70% isopropyl alcohol using concentric circles,
working from the inside to outside. Allow the skin to dry.
10. Open and inspect the sterile disposable puncture device, and perform the puncture
while firmly holding the heel or finger. Discard the device in the appropriate sharps
container.
11. Wipe away the first drop of blood with a clean, dry gauze pad. This removes any
residual alcohol and any tissue fluid contamination.
12. Make blood films if requested.
13. Collect blood in the appropriate collection tubes and mix as needed.
14. Apply pressure and elevate the puncture site until bleed has stopped.
15. Label each specimen with the required information and indicate skin puncture
collection.
16. Handle the specimens appropriately.
17. Discard all puncture equipment and biohazardous materials appropriately.
18. Remove gloves and wash hands.
19. Deliver the proper labeled specimens to the laboratory.

B. BLOOD SMEAR
➔ MATERIALS
● Glass slides
● Spreading slide
● Dryer (cold air) or a fan
➔ PROCEDURE
1. Place a drop of blood (from a finger or capillary tube) on a clean microscope slide
(about 2 cm from one end.
2. Hold the end of another clean slide at a 50 degree angle against the first slide and
push the blood drop away from the middle of the first slide. Now push the second
slide toward the middle of the first slide. This makes an even smear across the slide.
Stop before reaching the end of the slide. Put the spreader directly into the
BIOHAZARD container.
3. When the blood has dried, draw two lines on the sample slide with a wax pencil.
Mark on clean glass, not through the smear. Drop a few drops of Wright stain on the
smear. Drop a few drops of Wright stain, counting them as you do so. After 4
minutes, add an equal number of drops of distilled water to the smear. After 10
minutes, gently rinse the slide under tap water for 30 seconds; then blot it dry with
bibulous paper.
4. Scan the slide under low power on your microscope until you find an area where the
cells are thinly spread. Switch to high power and observe the blood cells on the
slide.
DRAW A BLOOD SMEAR

BLOOD CELL TYPES

DRAW AND COLOR THE FOLLOWING CELLS
OBSERVED UNDER THE MICROSCOPE

RED BLOOD CELLS

NEUTROPHILS
EOSINOPHILS

BASOPHILS

LYMPHOCYTES

MONOCYTES
C. BLOOD TYPING AND RH TYPING
➔ MATERIALS NEEDED
- Lancet, alcohol, cotton, pricker/lancet, glass slides, anti-A,B and anti-
D
➔ PROCEDURE
1. First, scrub the middle finger with cotton saturated with 70% of alcohol.
2. Then, prick the middle finger with a sterilized needle or lancet.
3. After that, place three drops on a clean glass slide.
4. Then after this, add antisera in a sequence of anti- A in the first drop, anti- B in the
second drop and anti- D to the third drop, respectively.
5. Mix the blood with the antisera separately by using a sterilized toothpick.
6. Allow the slide to stand for 2-3 minutes and then note down the results based on
clump formation or agglutination reaction.

INTERPRETATION OF RESULTS

1. BLOOD TYPE: AB
RH TYPE: POSITIVE

2. BLOOD TYPE: O
 RH TYPE: POSITIVE

3. BLOOD TYPE: B
RH TYPE: POSITIVE

ACTIVITY QUESTIONS:
1.What are the equipments used in venipuncture?
-A Tourniquet, used to provide a barrier against venous blood flow to help locate a vein.
Should be apply 3-4 inches above the venipuncture site and left on for no longer than 1
minute before the venipuncture is performed
-Collection Tubes, collecting blood specimens is through the used of an evacuated tube
system. Evacuated Tube can be plastic or glass. And Adapter that used to secure the needle
and the tube. When the needle in inserted into a vein and a tube is inserted into the holder,
the back of the needle pierces the stopper, allowing the vacuum pressure in the tube to
automatically draw blood into the tube
Needles, venipuncture needles are sterile and are available in a variety of length and
gauges. Needles used with evacuated tube systems screw into a plastic needle holder and
are double pointer. The end of needle that is inserted to vein is longer and has a point
with a slanted side or bevel. A plastic cap cover this ends of the needle that pierces the
stopper of the evacuated tube is shorter and is covered by rubber sleeve in multiple sample
needles
-The Gauge Number of a needle inversely related to the bore size: the smaller the gauge
number, the larger the bore. Needles for drawing blood range 19 to 23. The most needle
size for adult venipuncture is 21 gauge with a length of 1 inch. The advantage of using 1 inch
needle is that it provides better control during venipuncture
-Winged Blood Collection Set (butterfly), useful in collecting specimens from children or
other patients whom who it is difficult to draw blood
-Syringes, consist of a barrel, graduated in millimiters, and a plunger. Syringe needles have
a point at one end and an open hub at the other end that attaches to the barrel of syringe.
Syringe are available with different types of needle attachments and in different sizes
-Solution for skin Antisepsis, most common skin antiseptic is 70% isopropyl alcohol in a
commercially prepared pad. The phlebotomist cleans the phlebotomy site in a circular
motion beginning in the center and working outward

2.What are the complications encountered in venipuncture? Enumerate 3 and explain. -

Bruise, most common complication encountered in obtaining a blood specimen. It is cause
by leakage of a small amount of blood in the tissue around the puncture site
-Hematoma, result when leakage of a large amount of blood around the puncture site
causes the area to rapidly swell
-Fainting, common complication encountered. Before drawing blood, the phlebotomist
should always ask the patient whether he or she had any prior episodes of fainting during
or after blood collection
-Hemoconcentration, an increased concentration of cells, larger molecules and analytes in
the blood as a result of a shift in water balance
-Hemolysis, the rupture of red blood cels with the consequent escape of hemoglobin
-Petechiae, small red spots indicating that small amounts of blood have escaped into the
skin.
-Allergies, some patients may be allergic to skin antiseptic substances and adhesive
bandages and tape

3.What is the important step in phlebotomy? Explain briefly.

-The phlebotomist is responsible for correctly identifying the patient using two unique
patient identifiers that include the patient’s complete name, medical record or hospital
number, and date of birth. The patient location or room number and bed tag

4.What will you do if your patient begins to faint during venipuncture? Explain briefly.
-I the patient begins to faint, the phlebotomist should remove and discard the needle
immediately, apply pressure to the side with a gauze pad, lowers the patient’s head and
loosen any constrictive clothing. The phlebotomist should also notify the designated first
aid providers at the facility.

5. Can agglutination occur when Type A blood is given to a person with Type O blood?
-A person with TYPE A blood can not donate to a person with TYPE O blood. This would
cause a blood transfusion reaction, hence agglutination. Agglutination occurs when the
same antigens found on the RBC’s from the donor come into contact with it’s
corresponding antibody

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