1. Phlebotomy
M. Rich, RN, BSN

2. Bell Work
1. What disorder is usually due to chronic blood loss caused by excessive menstruation, bleeding into or from the gut as a result of a peptic ulcer, gastritis, or hemorrhoids? This condition is treated with iron supplementation. 2. What is the medical term for abnormal decrease in the number of circulating platelets? 3. What is the medical term for an abnormal increase in White Blood Cells?

3. Bell Work Answers Iron- Deficiency Anemia Thrombocytopenia
Leukocytosis

4. Standard
20) Understand principles of and successfully perform skills of a phlebotomist, incorporating rubrics from National HOSA, textbooks, or clinical standards of practice.
a. Distinguish sites and/or veins for blood draws in all populations using the required equipment and safety precautions.
b. Perform collection procedures for microspecimens and venipuncture on a mannequin using appropriate collection containers and identifying factors affecting collection/test results.
c. Provide guidelines for obtaining blood from neonates, pediatrics, and geriatrics.
d. Perform skills of patient/specimen identification and transporting of specimens.

5. Objective
Understand purpose of phlebotomy and two types of blood draw – venipuncture and dermal (capillary) puncture Understand proper communication techniques Distinguish sites for blood draws

6. Introduction Phlebotomy means to cut into a vein.
This procedure of cutting or puncturing a vein is performed by a phlebotomist.
The primary role of a phlebotomist is to obtain blood specimens for testing.
Other roles include packaging urine specimens, accepting incoming specimens, and routing specimens to other departments.
Chapter 1

7. History of Phlebotomy P h l e b o t m y
Removing blood from veins dates back to about 1400 B.C. when leeches were applied to the skin of sick people.
History of
Phlebotomy
leeches
In the early 1800’s, medicinal leeches were used for the procedure known as bloodletting.
Bloodletting was typically performed by barbers or anyone claiming medical training.
Chapter 1

8. Phlebotomist
To become a certified Phlebotomist – HSD and apply to programs at Jackson State or Southwest Tennessee Community College (Memphis)
Average Salary is $27,000 in state of TN
Renew Certification every 2 years
Chapter 1

9. Roles and Responsibilities of the Phlebotomist
PATIENT IDENTIFICATION
Check armband or ID label in acute care settings
Check driver’s license or picture ID in outpatient settings
Proper Identification Is a Three-Step Process
COMPARE 
ASK 
VALIDATE 
Chapter 1

10. Roles and Responsibilities (cont’d)
Verbal and nonverbal communication should be appropriate, such as:
Avoiding the use of slang
Speaking in a calm, clear voice
Avoiding inappropriate terms
Maintaining eye contact
Neat, well-groomed appearance
Respecting personal space
The phlebotomist must be able to communicate using nonmedical terms.
Chapter 1

11. Roles and Responsibilities (cont’d)
When providing customer service:
Be empathetic
Observe the patient’s behavior
Listen to the patient’s concerns
Address any situation promptly
Be flexible
Chapter 1

12. Step-by-Step Approach cont’d 3
Preparing for Venipuncture
Patient Identification
For Inpatients
For Outpatients
Always check the ID band on the arm or ankle
May require verbal verification by a nurse if patient is sedated
Ask the patient to verify information on the requisition form
At least two to three verification items should be asked to ensure proper identification
The most important step in the venipuncture procedure!!
Always ask for the name and date of birth
Always verify at least two patient identifiers before proceeding
Chapter 4

13. Performing Venipuncture and Dermal Puncture
Chapter 4

14. Roles and Responsibilities (cont’d)
Specimen Collection and Handling
Physician orders indicate type of specimen and time of collection
Most Commonly Used Methods
Venipuncture
Insertion of a needle into a vein to remove blood
Dermal (capillary) Puncture
Use of puncture device to obtain capillary blood by pricking the skin
Chapter 1

15. Preparing for Venipuncture
Assembling the Venipuncture Equipment
Supplies for Venipuncture
Gloves
Tourniquet
Alcohol prep pads
Gauze pads
Needle
Evacuated tube holder or syringe
Appropriate evacuated tubes
Sharps container
Adhesive bandage or tape
Permanent marker or label
Chapter 4

16. Venipuncture Equipment
Evacuated tubes— plastic or glass tubes, contain a vacuum, various sizes, some contain additives (may be preservative or anticoagulant)
Sizes vary by amount of sample needed
Each tube has a color coated top depending of the contents of the tube
Different tests require different tubes

17. Preparing for Venipuncture
Patient Positioning
The patient should be lying supine or sitting in a phlebotomy chair.
A straight chair with an arm is preferable.
If necessary, a pillow or rolled up towel can be placed under the arm for positioning.
Chapter 4

18. Preparing for Venipuncture
The tourniquet:
Should not pinch the skin
Should be kept flat against the skin
Should be applied 3 to 4 inches above the venipuncture site
Apply the tourniquet, which will make the veins more visible and palpable
Chapter 4

19. Venipuncture Site Selection
Antecubital site: preferred site
Anterior surface of arm
Median cubital vein
Cephalic vein
Basilic vein

20. Sites to Avoid Mastectomy side Bruises, scars, rashes, swelling
Above an existing IV site
Fistulas or vascular grafts
Above bend in arm
Dominant hand/arm

21. Preparing for Venipuncture
Special Considerations—Children
It is a good practice to ask a child to help with the procedure to decrease the child’s anxiety.
Special Considerations—Elderly
Sensory impairment may exist, so extra time may be required
A shallower angle is required during insertion
Skin is fragile and veins tend to roll, so hold the skin taut
Chapter 4

22. Preparing for Venipuncture
Special Considerations—HIV or Hepatitis
Use proper PPE to avoid occupational exposure
Special Considerations—Psychiatric
Evaluate the patient carefully for any signs that the blood collection process could be difficult
If concerned, ask a staff member to assist
Chapter 4

23. Preparing for Venipuncture
Cleansing the Site
Cleaning the site with an antiseptic (70% isopropyl alcohol) helps prevent microbial contamination
Cleanse the site using concentric circles
Allow alcohol to dry completely or use a gauze, but NEVER blow on the site
Chapter 4

24. Use of Alcohol
Be sure to allow the alcohol to dry before attempting the venipuncture procedure. Wet alcohol entering the specimen can affect the laboratory results!
Chapter 4

25. Apply Your Knowledge BRAVO!
You are about to draw blood from Mr. Harrell. When you ask him to be seated in the phlebotomy chair, he states “Why do I need to sit down? This should not take long.” Which of the following would be the best response?
A. “You are right; this will not take long, so you may continue to stand.”
B. “No, this may take much longer than you think, so please be seated.”
C. “No, it should not take long, but it is much safer for you to be seated, and sitting will enable you to keep your hand steady.
Answer: C. Patients should be seated or lying down for safety.
BRAVO!
Chapter 4

26. Petechiae
Petechiae or a hematoma may develop if the tourniquet is left on too long, or if a needle has gone though the vein.
Any form of temporary or permanent disfigurement should be avoided.
Be sure to remove the tourniquet in a timely manner. If a hematoma develops, apply firm pressure to the site.
Chapter 4

27. Unsuccessful Venipuncture
If the Venipuncture Is Not Successful
Unsuccessful Venipuncture
Causes of Blood Collection Failure
Needle inserted too far
Insufficient vacuum in tube
Bevel on lower wall of the vein
Tourniquet too tight
Poor site selection (vein hard and sclerosed)
Patient fails to maintain “still” positioning
Sometimes repositioning the needle will cause blood to flow. Do not “probe” or change the position of the needle while it is inserted.
Chapter 4

28. Disposing of the Needle
Dispose of the needle and adapter as one piece
Most sharps containers are made of puncture-proof material and display the biohazard symbol. Remember, never overfill a biohazard container!
Chapter 4

29. Labeling the Specimen Labeling the Specimen OR
Use a permanent marker to label
Computer-generated label
Remember for either type of label you must mark the tube after collection with patient name, medical ID #, DOB, date drawn, time and your initials.
Chapter 4

30. Applying the Bandage Applying the Bandage
Check the patient’s arm after about three minutes to see if the bleeding has stopped
Tape or an adhesive bandage can be used to hold the pressure gauze on the site
Do not use tape on anyone with thin, fragile skin or on people with allergies to tape
The patient can remove the bandage after 15 minutes
Chapter 4

31. Patient Preparation Identify patient Explain procedure
Assist patient into a comfortable position
Conduct pretesting preparation
Determine if patient is allergic to latex
Determine if patient had any previous problems with venipuncture

32. Put it into practice Correctly place a tourniquet on your partner
Take time to correctly identify veins
Palpate the veins
Select an insertion site
Switch roles with your partner

33. Dermal Puncture Dermal Puncture
Dermal puncture is the preferred blood collection technique for infants and small children.
It is difficult to locate a vein that is large enough to withstand the vacuum created by the evacuated collection tubes.
Children do not enjoy venipuncture and usually will not remain still for the length of time venipuncture requires.
Dermal puncture is much easier to perform.
Dermal puncture is less traumatic for the child.
Chapter 4

34. Dermal Puncture Part 2 Dermal Puncture
Selecting the Site for Dermal Puncture
Heels are the site of choice in infants who are less than 1 year old
Fingers are used in adults and children
Attempt to find an unused area
Area should be warm, pink, and free of scars
Do not use the arch of the foot, the back of the heel, or the plantar area of the foot
The site selected for the heel should be well away from the heel bone because puncture of the calcaneus can cause osteomyelitis.
Chapter 4

35. Dermal Puncture Part 3 Dermal Puncture
Plantar Surface
For older children and adults, the preferred site is the palm side of the ring or middle finger
Do not cut in the same direction as the fingerprint
NOTE: Warming the finger or heel will increase blood flow
Chapter 4

36. Dermal Puncture Part 4 Dermal Puncture
Hold the finger in the proper position
Performing a Dermal Puncture
Clean the site with an alcohol pad and allow to dry completely
Puncture the finger with a properly selected safety device
Apply a steady amount of pressure to the site before and during the puncture
Chapter 4

37. Dermal Puncture Part 6 Dermal Puncture
Be sure to make the puncture deep enough to collect the amount of blood needed
Wipe away the first drop of blood
Use a microcollection device to collect the specimen
NOTE: This procedure will cause pain, so be sure to collect an adequate amount of blood initially to prevent repeat sticks.
Chapter 4

38. Dermal Puncture Dispose of the safety lancet in the sharps container
After the Dermal Puncture
Dispose of the safety lancet in the sharps container
Label the microcontainers
Check the site of puncture and apply a bandage if necessary
Collect and dispose of your supplies appropriately
Dismiss the patient
Transport the specimen to the laboratory
Chapter 4

39. Apply Your Knowledge
Which is the site of choice for performing a dermal puncture in an infant under 1 year of age?
ANSWER: The heel
GREAT!
Chapter 4

40. Assignment
Diagnosis of the Day – On Web Site. Put in Notebook under today’s date.
Chapter 4

41. Bell Work 3-20-2018 1. What does phlebotomy mean?
2. Where in West TN could you go to become a certified phlebotomist?
3. How would you identify a patient?
Chapter 4

42. Phlebotomy Children’s Book
Due Friday, March 23
Time in class to complete
Remaining Today
Avg. 45 minutes on Wednesday
Avg. 30 minutes on Thursday
Chapter 4

43. Bell Work
Insertion of a needle into a vein to remove blood is called?
Use of puncture device to obtain capillary blood by pricking the skin is called?
What is the preferred vein site for blood draw?
What are good sites for dermal puncture?
Chapter 4

44. Phlebotomy Video
Chapter 4