1. Methodologies and Regulations in Specimen Collection and Management
Module 4: Special Draws
Methodologies and Regulations in Specimen Collection and Management
Module 6:
Special Draws

2. Objectives After this presentation you will be able to:
Module 4: Special Draws
After this presentation you will be able to:
Describe the steps in using a winged infusion needle for the collection of blood
Discuss the use of a syringe for blood collection
Describe dermal or skin punctures
Describe the correct procedure for capillary blood collection

3. Today’s Agenda
Describe the steps in using a winged infusion needle for the collection of blood
Discuss the use of a syringe for blood collection
Describe dermal or skin punctures
Describe the correct procedure for capillary blood collection
Module 4: Special Draws

4. Butterfly or Winged Infusion Set
Module 4: Special Draws
Used for small veins on infants and small children
Adults with difficult veins
Hand or wrist veins
Most commonly used needle is a 23g and sometimes a 25g
Note:
Specimens can hemolyze
Tubes that are too large can collapse the vein

5. The Butterfly Winged Infusion Procedure
Module 4: Special Draws
Follow the same procedure as for a routine venipuncture
When removing the butterfly from the package pull on the tubing to keep from coiling

6. The Butterfly Winged Infusion Procedure
Module 4: Special Draws
If using a hand vein, insert the needle at a degree angle
Either a syringe or an evacuated tube holder can be added to the end of the tube

7. Butterfly Module 4: Special Draws
A flash of blood will appear in the tubing
Seat the needle by threading it up the lumen of the vein. This action will prevent the butterfly from twisting
If the needle needs to be held in place, use the index finger of your left hand with light pressure on the wing (do not tape wings)
Collection
Vial
Needle
Link Tubing
Safety Barrel

8. Butterfly
Module 4: Special Draws
Keep the tube and holder in a downward position so that the tube fills from the bottom up
Follow order of draw
Safety cover the needle
Be careful when disposing the needle, sometimes it tends to twist

9. Module 4: Special Draws
Any questions?

10. Today’s Agenda
Describe the steps in using a winged infusion needle for the collection of blood
Discuss the use of a syringe for blood collection
Describe dermal or skin punctures
Describe the correct procedure for capillary blood collection
Module 4: Special Draws

11. Syringe Draw The syringe is another method of blood collection
Module 4: Special Draws
The syringe is another method of blood collection
It is used for fragile veins, elderly patients, and children
The phlebotomist can control the amount of pressure by pulling on the plunger slowly

12. Parts of a Syringe Plunger Barrel Needle Hub Needle
Module 4: Special Draws
Plunger
Used to pull the blood out
Barrel
To hold the syringe in place
Needle Hub
Needle attaches to
Needle
Various sizes
Needle
Barrel
Plunger
Needle Hub

13. Syringe Procedure
Module 4: Special Draws
Follow the same procedure as for a routine venipuncture
Place needle on the hub of the syringe securely
Move the plunger up and down, make sure it moves freely
Push the plunger all the way to the down to the hub end where the needle is attached

14. Syringe When blood enters the syringe, pull the plunger slowly
Module 4: Special Draws
When blood enters the syringe, pull the plunger slowly
Be careful not to pull the plunger out of the syringe
Fill syringe to capacity but do not pull out the plunger
Immediately transfer the contents of the syringe to the appropriate tubes with a safety transfer device

15. Safety Transfer Device
Module 4: Special Draws
Follow Order of Draw
Always use a safety blood transfer device when filling tubes from a syringe draw

16. Transferring Blood From a Syringe to a Tube
Module 4: Special Draws
Transferring Blood From a Syringe to a Tube
If a safety transfer device is unavailable, use the following method:
Place the tube in a tube holder
Keep your free hand behind your back, DO NOT hold the tube or the tube holder
Slowly pierce the vacuum of the tube with the syringe
Let the blood flow into the tube

17. Knowledge Check
Module 4: Special Draws
What is the purpose of using a butterfly or syringe for blood collection?
Answer: Both can be used on babies, small children, geriatric patients with small veins. You have more control over how much pressure you apply when drawing blood.

18. Module 4: Special Draws
Any questions?

19. Today’s Agenda
Describe the steps in using a winged infusion needle for the collection of blood
Discuss the use of a syringe for blood collection
Describe dermal or skin punctures
Describe the correct procedure for capillary blood collection
Module 4: Special Draws

20. Skin Puncture Venous Arterial Tissue Capillary
Module 4: Special Draws
Venous
Arterial
Tissue
Capillary
More closely resembles arterial; especially if area is warmed
Reference values for skin are different than venipuncture

21. When to Perform a Skin or Dermal Puncture
Module 4: Special Draws
Adults
No accessible veins
Infants
Difficult to perform venipuncture, may damage veins, to remove small amounts
Babies over the age of 1 year
Some laboratory tests are designed to be performed by the skin puncture

22. Skin or Dermal Puncture Equipment
Module 4: Special Draws
Lancet
Microcontainers
red
purple
green
Microhematocrit Tubes
Hematology or Chemistry Testing
Warming Devices
Increase the blood flow as much as 7X

23. Site Selection
Module 4: Special Draws
Skin puncture sites should be warm, pink and free of cuts, bruises or rashes.
Do not choose a site that is cold, cyanotic or swollen
Cold fingers and heels DO NOT BLEED- warm before puncturing!

24. Finger Punctures Finger punctures can be used for adults
Module 4: Special Draws
Finger punctures can be used for adults
Should not be performed on infants and children less than one year
Recommended site: middle finger of the non-dominant hand (second choice: ring finger)
Remember: Band-aids should not be placed on pediatric patients

25. Module 4: Special Draws
Finger Punctures
The puncture should be done perpendicular to the fingerprint on the fleshy pad
Never puncture the tip or sides of the finger
Never use the pinky or thumb
Correct
Not Correct
Puncture Site

26. Finger Punctures
Module 4: Special Draws

27. Finger Stick Procedure
Module 4: Special Draws
Wash hands and put on gloves
Greet the client
Identify the client
Clean the site
Make sure site is warm
A clients hand can be warmed by washing with warm water or applying a paper towel soaked in warm water

28. Finger Stick Procedure
Module 4: Special Draws
With the palm facing upward, grasp the finger firmly between you thumb and index finger
Puncture across the fingerprint
Wipe off first drop of blood

29. Finger Stick Procedure
Module 4: Special Draws
Follow order of draw for the skin puncture
Label all tubes properly

30. Finger Stick Procedure
Module 4: Special Draws

31. Module 4: Special Draws
Any questions?

32. Today’s Agenda
Describe the steps in using a winged infusion needle for the collection of blood
Discuss the use of a syringe for blood collection
Describe dermal or skin punctures
Describe the correct procedure for capillary blood collection
Module 4: Special Draws

33. Module 4: Special Draws
Heel Stick Site
Infant
Recommended heel site for blood collection is the medial or lateral portion of the heel
Primary
Site
Primary
Site
Secondary Site

34. Cleaning Procedures Clean heel with 70% isopropanol
Module 4: Special Draws
Clean heel with 70% isopropanol
Site should dry completely
Remember: Alcohol + RBC’s = Lysed cells
Iodine should not be used for skin punctures because it interferes with bilirubin, potassium, phosphorus and uric acid results

35. Heel Stick Procedure Wash your hands and put on gloves
Properly identify of the client
Select the site, warm area for at least 3 minutes
Cleanse the site and let completely dry
Module 4: Special Draws

36. Heel Stick Procedure
Module 4: Special Draws
Hold the foot with a firm grip, grasp heel with thumb
placed below puncture site
and index finger placed over the arch
Puncture site at a 90 degree angle parallel to the heel
Use a quick continuous motion

37. Heel Stick Procedure Wipe away the first drop of blood
Module 4: Special Draws
Wipe away the first drop of blood
Ease thumb pressure and apply intermittent pressure. Avoid milking and scraping
Follow recommended order of draw
When blood collection is complete, clean area, apply pressure.
Never apply band-aid under the age of two
Label specimens immediately after the draw; never before

38. Heel Stick Technique
Infant heels are appropriate for blood collection until approximately 6 months to one year
Never exceed 2.0 mm in puncture depth
Never puncture the posterior curvature of the heel or the arch of the foot
Never use sites previously punctured, bruised, swollen or red in color
Never puncture the heel more than twice for any one collection
Module 4: Special Draws

39. Any questions?
Module 4: Special Draws

40. Knowledge Check
What is the maximum length of a lancet for performing a heel stick?
Answer: 2.0 mm
Why is the first drop of blood wiped away during the collection of the finger stick?
Answer: first drop is contaminated with tissue fluid and will dilute specimen (give false lower results)
What is the finger of choice for performing a finger stick?
Answer: Middle finger of either hand
Module 4: Special Draws

41. Remember: Order of Draw for Skin Puncture
Module 4: Special Draws
Remember: Order of Draw for Skin Puncture
Peripheral bloods smear
Hematology tests (EDTA)
All other additive tubes
All plain / serum tubes

42. Successful Blood Collection through Skin Puncture
Module 4: Special Draws
Successful Blood Collection through Skin Puncture
Warming the site increases the flow sevenfold
Avoid milking or scraping the site which can cause hemolysis
Alternately applying and releasing pressure will promote a good flow

43. Successful Blood Collection through Skin Puncture
Module 4: Special Draws
Successful Blood Collection through Skin Puncture
Betadine or iodine should not be used to cleanse. It interferes with bilirubin, potassium, calcium, phosphorus, uric acid, total protein, and glucose results
Failure to allow alcohol to dry will cause hemolysis and stinging

44. Challenging / Difficult Patients
Injection Drug Users
Babies / Infants
Geriatric patients
Obese patients
Patients with mastectomies
Patients with IVs
Patients with broken bones

45. Summary After this presentation, you can now:
Describe the steps in using a winged infusion needle for the collection of blood
Discuss the use of a syringe for blood collection
Describe dermal or skin punctures
Describe the correct procedure for capillary blood collection and Order of Draw
Module 4: Special Draws

46. Any questions? Thank you!
Module 4: Special Draws