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Phlebotomy

The document provides guidelines for venipuncture and skin puncture procedures. It describes patient preparation, equipment needs, vein selection, blood collection techniques, post-procedure care, types of blood specimens, tube additives, order of draw, and prevention of problems like hemolysis. Skin puncture is preferred for pediatric patients, difficult access, or point-of-care testing using single-use disposable or reusable lancets activated by pressing against the skin.

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Susan F
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11 views4 pages

Phlebotomy

The document provides guidelines for venipuncture and skin puncture procedures. It describes patient preparation, equipment needs, vein selection, blood collection techniques, post-procedure care, types of blood specimens, tube additives, order of draw, and prevention of problems like hemolysis. Skin puncture is preferred for pediatric patients, difficult access, or point-of-care testing using single-use disposable or reusable lancets activated by pressing against the skin.

Uploaded by

Susan F
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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General Guidelines for Venipuncture:

Patient Preparation:

 Confirm patient identity.


 Explain the procedure to the patient.
 Obtain informed consent.
 Ensure patient comfort.

Equipment Preparation:

 Gather necessary supplies: gloves, tourniquet, alcohol swabs, tubes, needles, etc.
 Inspect equipment for defects.

Site Selection:

 Choose an appropriate vein (typically median cubital vein).


 Avoid veins near joints or areas with inflammation.

Tourniquet Application:

 Apply the tourniquet 3-4 inches above the venipuncture site.


 Tighten enough to slow venous return but not arterial flow.

Patient Positioning:

 Ensure the patient is seated or lying down.


 Extend the patient's arm and keep it downward.

Vein Palpation:

 Palpate the vein to confirm suitability.


 Anchor the vein by pulling the skin taut.

Needle Insertion:

 Insert the needle at a 15 to 30-degree angle.


 Use a swift, smooth motion.
 Maintain control of the needle.

Blood Collection:

 Fill tubes in the correct order.


 Remove the tourniquet after blood flow is established.
 Monitor the patient for adverse reactions.

Post-Procedure:

 Apply pressure to the puncture site.


 Label tubes accurately.
 Dispose of sharps safely.
 Document the procedure.

2. Blood Specimens:

Clotted Blood:
 Obtained by allowing blood to clot before centrifugation.
 Used for certain tests like serum assays.

Serum:

 Obtained from clotted blood after centrifugation.


 Used for various chemistry tests.

Whole Blood:

 Collected directly into anticoagulant tubes.


 Used for hematology studies and blood transfusions.

Plasma:

 Obtained from anticoagulated blood after centrifugation.


 Used for tests requiring plasma, like coagulation studies.

3. Blood Separation with Anticoagulant:

Layers:

 Top Layer: Plasma


 Middle Layer: Platelets
 Bottom Layer: Red Blood Cells

4. Blood Separation without Anticoagulant:

Layers:

 Top Layer: Serum (if allowed to clot)


 Bottom Layer: Clotted Blood

5. OSHA Safety Precautions:

Universal Precautions:

 Use personal protective equipment (PPE).


 Dispose of sharps properly.

Exposure Control Plan:

 Training on infection control.


 Hepatitis B vaccination for employees.
 Post-exposure procedures.

6. Vacuum Tube Additives:

Red:

 No additive.
 Serum.

Lavender:
 EDTA.
 Whole blood for hematology.

Gray:

 Potassium Oxalate/Sodium Fluoride.


 Glucose testing.

Light Blue:

 Sodium Citrate.
 Coagulation studies.

Green:

 Heparin.
 Plasma for chemistry tests.

Royal Blue:

 EDTA or no additive.
 Trace element analysis.

7. Order of Draw:

Vacuum Tube Method:

 Sterile tubes first, then non-additive tubes, followed by additive tubes.


 Prevents cross-contamination.

Butterfly Method:

 Similar to vacuum tube method.

8. Guidelines for Evacuated Tubes:

 Follow the manufacturer's instructions.


 Ensure proper tube filling.
 Invert tubes gently to mix additives.

9. Possible Problems:

 Hematoma formation.
 Nerve injury.
 Excessive bleeding.
 Infection.

10. Preventing Hemolysis:

 Use appropriate needle size.


 Avoid excessive suction during blood collection.
 Mix tubes gently; avoid vigorous shaking.
 Ensure proper needle insertion.
11. Serum Separator Tube:

Function:

 Gel separates serum from blood cells during centrifugation.


 Allows for easier serum extraction.

Venipuncture Demonstration:

Vacuum Tube Method:

Perform all steps according to guidelines.

Butterfly Method:

Perform all steps using a butterfly needle.

Skin Puncture

12. Preferred Over Venipuncture:

Indications:

 Pediatric patients.
 Difficult venous access.
 Point-of-care testing.

13. Skin Puncture Devices:

 Disposable Semiautomatic Lancet:


 Single-use.
 Activated by pressing against the skin.

Reusable Semiautomatic Lancet:

 Can be used multiple times.


 Activated similarly to disposable lancets.

14. Guidelines for Finger Puncture:

 Choose the side of the finger.


 Clean the site with an alcohol swab.
 Use a disposable lancet.
 Wipe away the first drop of blood.
 Collect blood into appropriate microtainer tubes.

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