NH No.: 8, Village: Dhamdod, Ta. Mangrol, Near Kosamba, Surat – 394 125. (GUJARAT).

COLLECTION OF BLOOD PROCEDURE (PHLEBOTOMY)

INTRODUCTION

Phlebotomy – the drawing of blood – has been practiced for centuries and is still one of the most
common invasive procedures in health care. The primary methods of obtaining a blood
specimen are through venipuncture, capillary draw, central venous access, arterial puncture,
and arterial line. The most common use of blood sampling is for laboratory tests for clinical
management and health assessment. If a blood sample is poorly collected, the results may be
inaccurate and misleading to the clinician, and the patient may have to undergo the
inconvenience of repeat testing. phlebotomy has the potential to expose health workers and
patients to blood from other people, putting them at risk from bloodborne pathogens. These
pathogens include human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C
virus (HCV) etc. Therefore, this procedure has to be done carefully.

DEFINITION

Phlebotomy is the process of making a puncture in a vein, usually in the arm, with a cannula for
the purpose of drawing blood. Also called as Venipuncture. Venipuncture involves inserting a
needle into the lumen of a vein.

PURPOSES:

 To diagnose the disease condition.

 To confirm the diagnosis.
 To examine/monitor the patient’s ongoing treatment.

INDICATION: -

Blood may be tested for:

 Complete blood study.

 Blood grouping & cross-matching
 Culture and sensitivity.
 Antigens & antibodies.
 Electrolyte analysis (from serum of blood).
 LFT (Liver Function Test)
 Lipid profile & enzymes

CONTRAINDICATION: -

o Edematous sites (swollen sites filled with serous fluid)

o Scarred or burned areas
o Fistulas and grafts
o Hematomas
 o Sites above an IV cannula in the same vessel
o Arm with PICC (Peripherally Inserted Central Catheter) line
o Arm with a preexisting or current blood clot
o Arm on the side of a mastectomy
o Via an open wound or area of infection
o Arm in which blood is being transfused
o Arm on the side of a surgical procedure

ARTICLES FOR (Phlebotomy)

1. Laboratory requisition form

2. Sterilized syringe
3. Sterilized needles (According to gauge need)
4. Tourniquet (1)
5. Blood collection tubes (Vacutainers) or specimen vials as ordered.
6. Spirit swabs
7. Dry gauze
8. Disposable Gloves if available (1)
9.Adhesive tape or bandages
10.Small mackintosh.
11.A bowl containing dry cotton balls.
12. Sharps Disposal Container (1)
13. Steel/plastic kidney Tray (1)
14. Ball point pen (1)
15. Record sheet

SITES: -
3 most common sites used in phlebotomy:

1.The median cubital veins

2. basilic veins ( in Antecubital fossa).

3. Cephalic veins

Other sites:

Metacarpal veins.

Radial artery (mainly for ABG analysis).

Foot veins.
CHECKLIST OF blood collection procedure:

Sr. Steps Rationale

no
PREPROCEDURAL STEPS
1 Check the physician’s order.  Ensures right patient, time &
Introduce yourself. route.
2 Identify the patient. Outpatient are called into the
phlebotomy area and asked their name and date of  Ensures performance of
birth. Inpatient are identified by asking their name procedure on right patient.
and hospital registration number i.e. MRD.

 This information must match the

requisition.
3 Reassure the client that the minimum amount of To Obtains patient’s confidence.
blood required for testing will be drawn.
4 Assemble the necessary equipment appropriate to Organization facilitates accurate
the client's physical characteristics. skill performance
5 Explain to the client about the purpose and the  Providing explanation fosters
procedure by using patient-friendly language: “Today his/her cooperation and reduce
I need to take a blood sample, which involves inserting anxiety
a small needle into your vein. You may briefly
experience a sharp scratch as the needle is inserted.”.
6 Perform hand hygiene and put on gloves. To prevent the spreading of
infection.
7 . Positioning  To make the position safe and
1) Make the client to be seated comfortably or supine comfortable is helpful to success
position venipuncture at one try.
2) Assist the client with the arm extended to form a  To easily access the vein.
straight-line from shoulder to wrist.
3) Place a protective sheet (Mackintosh) under the  To prevent the spread of blood
arm.
8 Select the appropriate vein for venipuncture. The larger median cubital, basilica
Ask patient to make a tight fist to make the veins and cephalic veins are most
more prominent. frequently used, but other may be
necessary and will become more
prominent if the client closes
his/her fist tightly
9 Applying the tourniquet: To prevent the venipuncture site
1) Apply the tourniquet 3-4 inches (8 - 10 cm) from touching the tourniquet and
above the collection site. keep clear vision
NOTE:
 Never leave the tourniquet on for over 1 minute.  Tightening of more than 1 minute
Do preliminary vein selection, then apply the may bring erroneous results due to
tourniquet, the change of some blood
composition.
INTRAPROCEDURAL STEPS
10 Selection of the vein:  To assure venipuncture at one try.
1) Feel the vein using the tip of the finger and detect
the direction, depth and size of vein.
2) Massage the arm from wrist to elbow. If the vein is
not prominent, try the other arm.
11 . Disinfect the selected site:  To prevent the infection from
1) Clean the puncture site by making a smooth venipuncture site.
circular pass over the site with the spirit
swab, moving in an outward spiral from the
zone of penetration (i.e. center to periphery).
 Disinfectant has the effect on
2)Allow the skin to dry before proceeding. drying.

3) Do not touch the puncture site after cleaning.  To prevent the site from
contaminating.
12 Select the proper size needle and attach it to the  To complete procedure
syringe or Vacutainer hub. appropriately without any
NOTE: error.
If using a syringe, before proceeding, inspect the
needle, and move the plunger up and down in the
barrel once or twice to expel all the air, making sure
the barrel does not stick.

With the bevel of the needle up, the needle should

point in the same direction as the vein.

The angle of needle insertion should be less than 30

degree (i.e. 15 or 25 degree)

Draw the blood slowly.

13 After blood is drawn the desired amount, release the  To release the unnecessary
tourniquet and ask the client to open his/her fist. pressure from the venipuncture
site.
14  Place a dry gauze over the puncture site and
remove the needle.  To prevent blood loss.
 Immediately apply slight pressure. Ask the client  To avoid making ecchymoma
to apply pressure for at least 2 minutes.  The normal coagulation time is 2-
 When bleeding stops, apply a fresh bandage or 5 minutes.
gauze with tape.
1) Transfer blood drawn into appropriate blood  A delay could cause improper
15 specimen bottles or tubes as soon as possible using a coagulation
needleless syringe.
2)The container or tube containing an additive should  Do not shake or mix vigorously.
be gently inverted 5-8 times or shaking the specimen
container by making figure of 8
POST PROCEDURAL STEPS
16 Dispose of the syringe and needle as a unit into an To prevent the spread of infection
appropriate sharp container.
 Label all tubes or specimen bottles with client To prevent the blood tubes or
name, age, sex, inpatient/ MRD no., date and time. bottles from misdealing.
17 Send the blood specimen to the laboratory  To avoid misdealing and taking
immediately along with the laboratory form. erroneous results
18 Put off gloves and perform hand hygiene.  To prevent the spread of infection
AFTER CARE OF PATIENT
19 Explain to the patient that the procedure is  To prevent client from any
now complete and that they should report if the inconvenience.
venepuncture site becomes painful or inflamed.

Thank the patient for their time.

AFTER CARE OF ARTICLES

20  To prepare for the next
Replace equipment and disinfects materials if needed. procedure and prevent the
spread of infection.
DOCUMENTATION
21 Record the procedure by documenting the procedure  For maintaining the record.
with date, time & patient’s response.

 COMPLICATIONS OF PHLEBOTOMY PROCEDURE:

 Phlebitis (inflammation of vein)

 Syncope (sudden fall due to low BP)
 Pain (due to needle puncture)
 Hematoma (collection of blood inside skin)