2 Phlebotomy means collecting blood Venipuncture is the act of puncturing a vein with a needleThrombophlebitis is the inflammation of a vein with blood clot formationThrombus a blood clotHemolysis is the breaking of blood cellsCoagulate “the act of blood clotting”Hematoma a blood-filled bruise caused when a blood vessel is broken; collection of blood under the skin
3 Lumen is the hollow center of a structure (needle) Bevel is the slant at the end of a needleVacutainer is a vacuum tube used to draw bloodButterfly smaller needle with wings on each side used to draw blood; winged infusion needleStraight needle is a straight needle used to draw blood
4 Anticubital space is the area in front of the elbow Ecchymosis a bruiseThrombus a blood clot formed in a blood vesselCoagulate is the medical term describing blood clotting
5 Centrifuge is a device used in the lab to spin blood and separate the liquid and solid portions of the blood
6 Screen for Latex Allergy Always ask pt if he/she is allergic to latex before drawing blood!Why?Many medical supplies still contain latex and could cause an allergic reaction
7 Which needle is larger in diameter? Choosing a NeedleSize/diameter of lumen: smaller the gauge= larger the lumen. Choice depends on amount of blood being drawnLength: user preference, may need longer needle for obese patientsUse a 21 gauge or bigger to prevent hemolysisWhich needle is larger in diameter?16 gauge or 20 gauge
8 Choosing a site Places to avoid: -arm w/ IV solution infusing -infected/swollen are-area w/ rash-arm w/ a dialysis graft or same side as a mastectomy-site w/ injury, burn, scarring-lower extremities-inner portion of wrist- why?
9 Choosing a Site Use a tourniquet to evaluate which vein to use Apply tourniquet 2-3 inches above elbow. How? See pt 132; practiceNot too tight; tight enough to cause the veins to stand out but not so tight to occlude arterial flow- check pulseEvaluate vein selectionRemove tourniquet until ready to perform full procedure ( within 1-2 minutes)
10 Choosing a Site Antecubital space are most commonly used Apply tourniquet 2-3 inches above elbow or desired blood draw siteA good vein stands our when the tourniquet is appliedUse “touch” more than “sight”Use vein that feels “springy”
13 Steps to Phlebotomy Gather supplies Explain procedure/screen for latex allergyStandard precautionsExamine armPlace tourniquet; find vein (1-2 min max)Release tourniquetready supplies and clean siteReplace tourniquet without contaminatingStabilize the vein
14 10. Enter vein at 15 degree angle 11 10. Enter vein at 15 degree angle 11. When you see “flash”, push vacutainer into adapter 12. Allow tube to fill( if multiple tubes drawn; follow correct order) 13. Release tourniquet as last tube is filling 14. Place gauze over site as needle is removed 15. Hold pressure x 2-3 minutes 16. Place bandaid if bleeding has stopped
15 Invert blood tubes 5-10 times. See 137 Label tubes according to facility requirementsSend to lab in biohazard bag x 2
16 Blood CulturesUsed when a doctor suspects septicemia: the presence of pathogenic organism in the blood streamBlood is drawn into an aerobic/anaerobic bottle and sent to lab to “grow”MUST be very careful not to contaminate draw site with bacteria while drawing blood cultures…….. Why?
17 Capillary PunctureMicrodraw: is a small skin puncture (capillary puncture) used for collecting blood specimens.This technique for obtaining a blood sample provides a very small sample.The blood is a mixture of venous, capillary, and arterial blood
18 Capillary PunctureA lancet is a tiny, sharp, sterile device used to puncture the skin to collect small blood samplesDiscuss types of lancets………..Smaller lancets for babiesLarger lancets for adultsUse recommendations of the facility you work
19 Capillary PunctureWhen the blood is collected from a capillary puncture, it is tested on a reagent strip or microvette collection device(must be ¾ full)
20 Capillary Puncture Sites Sides of the middle and ring fingertipsDo not use the tip/pad of fingertipMay use earlobe (not preferred)Puncture perpendicular to fingertipWarm area if neededAlways alternate sitesMedial or lateral heel(preferred)Great toePuncture at 45 degree angleAlways alternate siteswarm area if neededAdult(1yr and up)Infant(birth to 1yr)
21 Capillary PunctureGather supplies: lancet , gloves, alcohol, gauze, bandaid, microvette collection device, biohazard bag, sharps box……Check order, identify correct patientIntroduce yourself and explain procedureWash hands/ Standard PrecautionsChoose siteClean site w/ alcohol in circle w/ 2 inch diameter
22 7. Allow alcohol to dry 8. Hold plastic end of lancet with dominant hand and remove plastic cover 9. Pierce the skin at the appropriate angle by holding the finger/foot with your nondominant hand. 10. Discard lancet in sharps box 11. Wipe first drop of blood w/ gauze
23 12. Allow next drops of blood to fill microvette or place on reagent strip 13. May apply gentle squeeze to area but not too hard- allow tube to fill ¾ full 14. Hold pressure over site until the bleeding stops and apply band aid 15. Label sample and place in biohazard bag according to facility’s standards
Your consent to our cookies if you continue to use this website.