1. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Assisting in Phlebotomy Chapter 52

2. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 2 Phlebotomy The practice of drawing blood. The most common method of obtaining blood is by venipuncture.

3. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 3 Venipuncture Equipment Gloves: – Glove use during venipuncture is mandated by OSHA. Tourniquet – Prevents venous flow out of the site, causing veins to bulge. – Makes veins easier to locate and puncture.

4. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 4 Venipuncture Equipment (cont’d)

5. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 5 Venipuncture Equipment Tourniquet – Prevents venous flow out of the site, causing veins to bulge. – Makes veins easier to locate and puncture.

6. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 6 Venipuncture Equipment Antiseptics – The most commonly used is 70% isopropyl alcohol, also known as rubbing alcohol. Evacuated collection tubes – Consists of evacuated tubes of various sizes, with color-coded tops indicating tube contents (Table 52-1).

7. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 7 Tube Additives Red-topped tube – No additive Ethylenediaminetetraacetic acid (EDTA) – Lavender-topped tube Thixotropic gel – SST and the PST green-gray marbled topped tubes by Becton- Dickinson

8. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 8 Order of Collection Order applies to the filling of tubes when blood is collected in a syringe. 1. Blood culture tubes. 2.Red-topped tubes. 3. Light blue-topped tubes with sodium citrate. 4.Serum tubes without (red stopper) or with (red-gold or speckle stopper) clot-activator. 5.Green-topped tubes. 6.Lavender-topped tubes follow. 7.Red/gray marble-topped tubes are next. 8.Gray-topped tube.

9. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 9 Needles The venipuncture needle has a shaft with one end cut at an angle (bevel). The other end attaches to the syringe or to an adaptor (hub). Gauge is designated by a numeric value. – The higher the number, the smaller the lumen.

10. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 10 Syringes Used when there is concern that the strong vacuum in a stoppered tube will collapse the vein. The syringe needle fits on the end of the barrel and comes in different gauges. It must be transferred immediately to another tube because the blood will clot in the syringe barrel.

11. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 11 BD Vacutainer Blood Transfer Device

12. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 12 Winged Infusion Sets (Butterfly Needles) Designed for use on small veins such as those in the hand or in pediatric patients. Needle size is 23 gauge. Needle is ½ to ¾ inch long with a plastic, flexible butterfly-shaped grip attached to a short length of tubing.

13. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 13 Winged Infusion Set (Butterfly Needle) (cont’d)

14. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 14 Needle Holders Translucent cylinders. Cylinders have a ring that indicates how far the tube can be pushed onto the needle without losing the vacuum. Needles are not removed from the needle holder, and the safety feature must be activated before disposal.

15. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 15 Needle Safety Never recap a needle. Use safety needles and shields. – Self-sheathing safety devices

16. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 16 Needle Safety Retractable safety device – Needle blunting SESIP for the needle holder

17. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 17 Needle Safety Needle blunting SESIP for winged infusion sets – Hinged or sliding safety SESIP

18. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 18 Needle Safety Postexposure management of needlesticks Care of the exposure site Evaluation of the exposure Follow-up care and testing

19. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 19 Routine Venipuncture Prepare the patient Prepare for the venipuncture Perform the venipuncture Complete the procedure

20. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 20 Problems Associated with Venipuncture Failure to obtain blood Hematoma Syncope Refer to Table 52-4

21. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 21 Specimen Recollection Unlabeled or mislabeled specimen Quantity not sufficient Defective tube Incorrect tube used for test ordered Hemolysis Clotted blood in an anticoagulated specimen Improper handling

22. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 22 Capillary Puncture Older patients Pediatric patients (especially under the age of 2 years) Patients who require frequent glucose monitoring Patients with burns or scars in venipuncture sites Obese patients Patients receiving intravenous therapy Patients who have had a mastectomy Patients at risk for venous thrombosis Patients who are severely dehydrated Tests that require a small volume of blood When venous blood and capillary blood are not identical

23. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 23 Equipment Skin puncture device – Lancet

24. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 24 Equipment Collection containers

25. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 25 Equipment – Unopette system – Manufacturers also provide various collection devices designed to obtain small quantities of blood for “point-of-care” testing for such analytes as glucose, hemoglobin A 1c, and cholesterol – Paper cards

26. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 26 Capillary Puncture Site selection Patient preparation Collection of the specimen Specimen handling

27. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 27 Patient Education The medical assistant must maintain a professional attitude and still be sympathetic to the fears and apprehensions of the patient. Use the patient’s suggestion in choosing the site for the removal of a blood specimen.