Chapter 47b

Blood Specimen Collection Vacuum Container Method Important to use a large vein, because the vacuum can collapse smaller veins If patient has no accessible veins, use a small needle with a syringe or a butterfly needle to obtain specimen

FIGURE 47-10 Vacutainer evacuated specimen tubes with Hemogard closure blood collection tubes. Alexander Tihonov/Shutterstock

FIGURE 47-11 Vacutainer brand safety lock needle holder.

Blood Specimen Collection Sterile Syringe and Needle Method Biggest drawback is that the amount of blood that can be collected for testing is limited to the size of the syringe used Has a higher incidence of injury or contamination than the vacuum container method

Obtaining Venous Blood with a Sterile Syringe and Needle Prepare necessary equipment and work area on an aseptic field. Check expiration dates. Perform hand hygiene and apply gloves. Securely attach the sterile needle to the syringe, if required. Pump the plunger several times, to ensure that it moves freely. Depress the plunger completely, to expel the air from within.

Obtaining Venous Blood with a Sterile Syringe and Needle Identify the patient and explain the procedure, making sure he or she understands the procedure.

Obtaining Venous Blood with a Sterile Syringe and Needle Confirm that the patient has followed any pretest preparation requirements. Verify allergies, the last time the patient ate, and if there is a history of complications ( syncope, hematoma, etc.). Ensure that the patient does not have anything in his or her mouth, such as candy or gum, to prevent choking in the case of syncope.

Obtaining Venous Blood with a Sterile Syringe and Needle Apply a tourniquet 3 to 4 inches above the antecubital space. Palpate the area to locate the vein of choice. Remove the tourniquet if the vein of choice is not located immediately and the specimen(s) cannot be collected within 60 seconds.

Obtaining Venous Blood with a Sterile Syringe and Needle Clean the venipuncture site with an alcohol wipe and allow to air dry. Leave the opened alcohol wipe on the aseptic field within reach. Reapply the tourniquet, if necessary. Have the patient make a gentle fist and hold it shut until told to release it. Instruct not to pump vigorously.

Obtaining Venous Blood with a Sterile Syringe and Needle Verify that there is no air in the syringe and remove the needle guard. From beneath the puncture site, pull the skin down so that it is taut. With the bevel facing up, insert the needle into the vein. Slowly pull back the syringe plunger until the proper amount of blood has been obtained. Do not force it to fill quickly.

Obtaining Venous Blood with a Sterile Syringe and Needle Instruct the patient to open his or her fist. Release the tourniquet and withdraw the needle quickly. Immediately cover with gauze. Instruct the patient to keep firm pressure on the site and raise the arm to prevent hematomas from occurring.

Obtaining Venous Blood with a Sterile Syringe and Needle (A) If using a transfer device, engage the safety mechanism over the needle; safely remove the needle from the syringe and place it in the sharps container. Apply the blood transfer device to the end of the syringe.

Obtaining Venous Blood with a Sterile Syringe and Needle (B) If no transfer device is available, place the vacuum-sealed tube in a tube rack so that it is standing upright. Do not hold the tube or the rack. Gently pierce the tube stopper with the needle.

Obtaining Venous Blood with a Sterile Syringe and Needle For either (A) or (B), allow the vacuum to pull blood into the tube until filled to the desired level. Do not push on the plunger to speed the process. Be sure to use the appropriate collection tube for the ordered tests, following the correct order of the draw.

Obtaining Venous Blood with a Sterile Syringe and Needle Discard the syringe in a sharps container, always inserting the needle end first to avoid injury. Gently invert the tubes, as required by the manufacturer; do not shake them. Immediately label the specimen with the patient's name, date and time of collection, test's name, and the name of the person collecting the specimen.

Obtaining Venous Blood with a Sterile Syringe and Needle Follow correct procedures for decontaminating the work area and equipment according to OSHA guidelines. Remove gloves and dispose in appropriate container. Perform hand hygiene. Dispose of all used needles and other equipment in a biohazard waste container.

Obtaining Venous Blood with a Sterile Syringe and Needle Thank the patient and observe for any signs or symptoms of inappropriate response to the procedure. Document the procedure in the patient's chart. If the specimen is to be transported to an outside laboratory, prepare it for transport in the proper container, with all the appropriate information according to OSHA guidelines.

Blood Specimen Collection Butterfly Needle Method Winged infusion or butterfly method uses a needle that is attached to 6- to 12-inch tubing Can be used as a temporary intravenous (IV) infusion

Blood Specimen Collection Butterfly Needle Method Used for small veins that are difficult to draw from with the standard vacuum container method or syringe and needle method Needle used for this method is a small 21-, 23-, or 25-gauge needle

Blood Specimen Collection Butterfly Needle Method Small device is easier to hold and manipulate than larger devices Smaller needle is less uncomfortable for the patient Smaller needle is that it is more likely to result in hemolysis

Blood Specimen Collection Butterfly Needle Method More expensive than a standard needle Winged infusion set is not typically the first choice for phlebotomy Several types designed for safety and ease of use

FIGURE 47-12 Butterfly systems designed for safety and ease of use FIGURE 47-12 Butterfly systems designed for safety and ease of use. (A) A safety shield slides down over the needle after use. (B) A button is pressed to retract the needle while it is still in the vein. (C) Butterfly needle pre-connected to holder to prevent accidental disconnections.

Blood Specimen Collection Equipment Blood Collection Tubes Designed to automatically draw in the exact amount of blood required for testing Color coded according to chemicals or preservatives within the container Wait until the flow of blood stops before removing the tube

Blood Specimen Collection Equipment Blood Collection Tubes Made of glass or plastic; come in a variety of sizes Plastic tubes always safer to work with Glass is best for testing medication levels

FIGURE 47-13 Venipuncture equipment.

Blood Specimen Collection Equipment Blood Collection Tubes Always check the expiration date. Visually inspect the contents for abnormalities. Always use the same manufacturer for a tube, holder, and needle to ensure proper fit and to prevent complications.

Blood Specimen Collection Equipment Tourniquet Applied to an extremity to impair the circulation Standard tourniquet is a large strip of disposable latex that can be tied around the arm (rubber used for those with latex allergies)

Blood Specimen Collection Equipment Tourniquet Blood pressure cuff may be used for the patient whose veins are difficult to locate Should not be left in place for more than 60 seconds, otherwise blood will begin to hemolyze

Blood Specimen Collection Equipment Tourniquet New phlebotomists Apply tourniquet first Remove it to allow for setup and cleansing of skin Reapply tourniquet after the alcohol has dried Advanced phlebotomists Choose the one-tie method