PHLEBOTOMY Chapter 6 ART OF COLLECTING BLOOD Advanced Skills for Health Care Providers, Barbara Acello, Thomson Delmar, 2007

OBJECTIVES Spell and define key terms List factors that effect the condition of the veins How to select a vein for venipuncture How to clean and puncture the skin Explain why standard precautions are used during phlebotomy procedures, and list PPE to wear

OBJECTIVES CONTINUED. Explain the similarities and differences between the vacuum-tube and syringe and needle methods of drawing blood List 8 precautions to take regarding venipuncture site selections List two common complications of venipuncture

Objectives continued Demonstrate how to: Apply a tourniquet, dilate a vein, and perform a venipuncture Collect a specimen using the vacuum-tube system, needle and syringe, and butterfly and syringe methods

KEY TERMS Phlebotomy- collecting blood Venipuncture- act of puncturing a vein with a needle Thrombophlebitis- inflammation of a vein with blood clot formation Lumen- inside diameter of the needle Bevel- slant at the end of the needle 

Key Terms  Hemolysis- breaking of fragil blood cells Vacutainer- vacuum tube with a needle attached Butterfly- winged infusion needle Kelly Clamp- curved clamp with teeth

Key Terms  Hematoma - blood filled bruise caused by a broken blood vessel Anticoagulants - blood thinning medications Antecubital space - area in front of elbow to separate liquids from solids within the tubes

Key Terms Septicemia- systemic infection Aerobic microbes- pathogens that can live only in the presence of oxygen Anaerobic microbes - pathogens that live without oxygen

Phlebotomy Phlebotomy means collecting blood Venipuncture is the act of puncturing a vein with a needle Before performing this procedure, check the requisition slip and make sure you understand the procedure you will be using. Gather all necessary equipment or supplies in advance.

Phlebotomy continued To perform venipuncture, you must first select a vein Age Illness Dehydration Previous needle sticks all affect the condition of the veins

Factors that affect condition of the veins Age: Young adults have many veins to choose from Veins in the elderly are often limited; they may roll or break upon puncture Children may be difficult because they move during the procedure.

STANDARD PRECAUTIONS  Always apply the principles of standard precautions when performing phlebotomy  Most health care facilities require workers to wear long-sleeved lab coats or gowns when drawing blood which must be fluid-resistant  Always wear gloves and pull the cuffs of your gloves over the cuffs of your sleeves

Risk of Contamination The risk of contamination is increased if you must transfer blood from one container to another, such as a syringe to a test tube.

HOW TO CLEAN AND PUNCTURE THE SKIN  Clean the site with alcohol in a circular motion  Allow alcohol to dry  Reapply the tourniquet without touching prepped area  Insert needle with bevel facing up  Hold skin taunt below prep site  Insert needle at a 15 degree angle, And advance slowly

HOW TO SELECT A VEIN FOR VENIPUNCTURE Veins in the forearm (antecubital space) are usually larger and straighter than those in other areas; this is the most common site for adults. If unable to find one in the forearm you could use veins in the hand

HOW TO SELECT A VEIN FOR VENIPUNCTURE (continued) You must be able to see or feel a vein A good vein will feel springy, and stand out when the tourniquet is tightened

Locating a Vein

Vacutainer

Biohazard Container

Blood Collecting Tubes

Methods of Drawing Blood

Tourniquet The tourniquet causes the veins to fill with blood Apply the tourniquet tightly enough to make the veins stand out

PRECAUTIONS TO TAKE 1) An arm with an IV 2) An infected or edematous area 3) Area with a rash 4) Extremity with a shunt, graft, or dialysis device 5) Affected arm of a stroke 6) Side of a mastectomy 7) Site of previous injury or hematoma 8) Burned or scarred area

COMPLICATIONS OF VENIPUNCTURE 1) Hematoma most common complication 2) Bleeding from the site 3) Ecchymosis- bruise 4) Signs and symptoms of phlebitis 5) Signs and symptoms of generalized infection 6) Signs and symptoms of air embolis