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

2. 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
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3. 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

4. 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

5. 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)
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6. 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
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7. 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
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8. 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

9. 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)
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10. 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)
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11. 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”.
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12. 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.
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13. 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
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14. 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
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15. 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
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16. 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
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17. 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
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18. 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
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19. 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
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20. 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
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21. Have some fun this weekend
Gallo
11/20/2018