1. Chapter 47b

2. 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

3. FIGURE Vacutainer evacuated specimen tubes with Hemogard closure blood collection tubes. Alexander Tihonov/Shutterstock

4. FIGURE 47-11 Vacutainer brand safety lock needle holder.

5. 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

6. 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.

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

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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

20. 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

21. 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

22. 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

23. FIGURE 47-12 Butterfly systems designed for safety and ease of use
FIGURE 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.

24. 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

25. 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

26. FIGURE 47-13 Venipuncture equipment.

27. 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.

28. 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)

29. 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

30. 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