Hematology 425 Blood Collection Russ Morrison September 8, 2006 11/20/2018

Safe Collection Practices Understand equipment and handle with care Always wear gloves WASH HANDS between patients and every time gloves are removed Remove gloves to make sure outer surface does not contact bare skin Dispose of sharps in puncture-resistant container 11/20/2018

Collection Equipment for Venipuncture Evacuated Tube Systems Tube, tubes contain appropriate additives and are sealed in a vacuum tube holder needle Needles Sterile, disposable Adapt to tube holders or to a syringe May be single or multi-sample Safety needles now required 11/20/2018

Collection Equipment for Venipuncture Needle Holders Manufactured to fit specific needles and tubes Disposable, single use Safety products required Tourniquet Provides barrier to venous blood return Latex-free Applied 2-4 inches above puncture site Applied no longer than 1 min prior to puncture 11/20/2018

Collection Equipment for Venipuncture Syringes Useful for tiny fragile veins Pressure controlled by phlebotomist Butterflies Short needle, IV tube, wings Attached to tube adapter, syringes or blood culture bottles Useful with pediatric patients, long term studies (GTT) 11/20/2018

Collection Equipment for Venipuncture Solutions for skin preparation 70% isopropyl alcohol Work from puncture site outward in a spiral Allow to air dry before puncture Sterile skin prep (blood culture, donation) Alcohol followed by iodine Defined time for scrub Blood Alcohol testing requires benzalkonium chloride or other nonalcohol antiseptic 11/20/2018

Selecting the Venipuncture Site Superficial veins of anterior surface of upper extremities are most often used (see figure 2-3 in text) Cephalic, basilic and median cubital veins located in the antecubital fossa Secondary choice of dorsal side of wrist/hand or veins in the feet Avoid intravenous fluids 11/20/2018

The Routine Venipuncture Wash hands Identify the patient (2 IDs required) Assemble supplies and glove up Position the patient, select a vein – have pt squeeze ball, make fist Cleanse site with prep solution Allow site to air dry Apply tourniquet 2-4 inches above site for no longer than 1 minute 11/20/2018

The Routine Venipuncture Inspect needle Anchor vein with thumb 1-2 inches below puncture site and insert needle, bevel up, at 15-degree angle with skin Release and remove tourniquet as soon as blood return is obtained Patient’s hand should be relaxed and open Place dry gauze lightly over puncture site (do not press down while needle is in arm) 11/20/2018

The Routine Venipuncture After the last tube has been collected, remove the needle and apply direct pressure to the puncture site using the dry gauze. Bandage the puncture site when bleeding has stopped. Properly dispose of puncture equipment and biohazardous waste Label the tubes (name, ID #, date, time initial of collector) 11/20/2018

The Routine Venipuncture Send tubes for analysis Release patient from diet restrictions (if any) and send patient on their way. Watch patient for adverse reaction Sample identification is critical to provision of useful diagnostic information. It is a JCAHO patient safety initiative. SVH has adopted “Collection Manager”. 11/20/2018

Complications Encountered in Venipuncture Special challenges of pediatric patients Additional complications: Echymoses (bruising) Syncope (fainting) Hematoma Failure to obtain a sample (fig.2-4) Petechiae Edema The child who screams, kicks, bites, parents quarrel, parents pass out, etc. Echymoses is a small amount of blood seeping under the skin, hematoma is a larger amount usually caused by passing through or not completely into the lumen of the vein. 11/20/2018

Complications Encountered in Venipuncture Obesity Intravenous Therapy Hemoconcentration Hemolysis Burned,damaged,scarred veins are to be avoided Seizures, tremors, vomiting, choking Allergies to skin prep/tourniquet 11/20/2018

Capillary Punctures Newborns Children less than 2 years of age Adults with difficult or reserved venous access Provide a mix of arterial and venous blood as well as some tissue fluid Generate slightly different test results 11/20/2018

Capillary Puncture Sites Heel, big toe or finger Adults, finger or big toe Infants, lateral or medial side of bottom of heel Puncture with blade perpendicular to the fingerprint lines Warming will increase blood flow Alcohol only as skin prep 11/20/2018

Capillary Puncture Technique Immobilize the finger, toe or heel Use blade <2.0 mm to avoid bone (premature infants may require shorter blade for puncture) Avoid swollen, bruised or previously punctured areas Wipe away first drop of blood, collecting only when free flowing is achieved 11/20/2018

Capillary Collection Devices Capillary tubes Microcollection tubes with and without additives Unopettes for introducing pre-diluted samples to automated equipment or for manual techniques Labeling/appropriate identification is critical as with all patient samples 11/20/2018

Capillary Collection Procedure Assemble equipment and supplies Identify patient Position patient, designate holder Wash hands and put on gloves Select puncture site Warm puncture site Cleanse puncture site Allow site to air dry 11/20/2018

Capillary Collection Procedure Perform the puncture Wipe away first drop of blood Prepare blood smears, if needed Collect specimens mixing and diluting as needed Elevate wound and apply pressure until bleeding stops Label samples Dispose of sharps and biohazardous waste Deliver samples for analysis 11/20/2018

Legal Issues in Phlebotomy The patient has the right to say no Document competency of staff Follow established procedure Respect the patient’s bill of rights Laboratory test results are only as good as the sample that is tested 11/20/2018

Have some fun this weekend Gallo 11/20/2018