1. Phlebotomy

2. Phlebotomy means collecting blood
Venipuncture is the act of puncturing a vein with a needle
Thrombophlebitis is the inflammation of a vein with blood clot formation
Thrombus a blood clot
Hemolysis is the breaking of blood cells
Coagulate “the act of blood clotting”
Hematoma a blood-filled bruise caused when a blood vessel is broken; collection of blood under the skin

3. Lumen is the hollow center of a structure (needle)
Bevel is the slant at the end of a needle
Vacutainer is a vacuum tube used to draw blood
Butterfly smaller needle with wings on each side used to draw blood; winged infusion needle
Straight needle is a straight needle used to draw blood

4. Anticubital space is the area in front of the elbow
Ecchymosis a bruise
Thrombus a blood clot formed in a blood vessel
Coagulate is the medical term describing blood clotting

5. Centrifuge is a device used in the lab to spin blood and separate the liquid and solid portions of the blood

6. Screen for Latex Allergy
Always ask pt if he/she is allergic to latex before drawing blood!
Why?
Many medical supplies still contain latex and could cause an allergic reaction

7. Which needle is larger in diameter?
Choosing a Needle
Size/diameter of lumen: smaller the gauge= larger the lumen. Choice depends on amount of blood being drawn
Length: user preference, may need longer needle for obese patients
Use a 21 gauge or bigger to prevent hemolysis
Which needle is larger in diameter?
16 gauge or 20 gauge

8. Choosing a site Places to avoid: -arm w/ IV solution infusing
-infected/swollen are
-area w/ rash
-arm w/ a dialysis graft or same side as a mastectomy
-site w/ injury, burn, scarring
-lower extremities
-inner portion of wrist- why?

9. Choosing a Site Use a tourniquet to evaluate which vein to use
Apply tourniquet 2-3 inches above elbow. How? See pt 132; practice
Not too tight; tight enough to cause the veins to stand out but not so tight to occlude arterial flow- check pulse
Evaluate vein selection
Remove tourniquet until ready to perform full procedure ( within 1-2 minutes)

10. Choosing a Site Antecubital space are most commonly used
Apply tourniquet 2-3 inches above elbow or desired blood draw site
A good vein stands our when the tourniquet is applied
Use “touch” more than “sight”
Use vein that feels “springy”

11. Supplies Alcohol Betadine Chlorhexidine Tourniquet
Needle(smaller number=bigger needle)
Vacutainer
Adapter
Gauze
bandaid

12. Supplies

13. Steps to Phlebotomy Gather supplies
Explain procedure/screen for latex allergy
Standard precautions
Examine arm
Place tourniquet; find vein (1-2 min max)
Release tourniquet
ready supplies and clean site
Replace tourniquet without contaminating
Stabilize the vein

14. 10. Enter vein at 15 degree angle 11
10. Enter vein at 15 degree angle 11. When you see “flash”, push vacutainer into adapter 12. Allow tube to fill( if multiple tubes drawn; follow correct order) 13. Release tourniquet as last tube is filling 14. Place gauze over site as needle is removed 15. Hold pressure x 2-3 minutes 16. Place bandaid if bleeding has stopped

15. Invert blood tubes 5-10 times. See 137
Label tubes according to facility requirements
Send to lab in biohazard bag x 2

16. Blood Cultures
Used when a doctor suspects septicemia: the presence of pathogenic organism in the blood stream
Blood is drawn into an aerobic/anaerobic bottle and sent to lab to “grow”
MUST be very careful not to contaminate draw site with bacteria while drawing blood cultures…….. Why?

17. Capillary Puncture
Microdraw: is a small skin puncture (capillary puncture) used for collecting blood specimens.
This technique for obtaining a blood sample provides a very small sample.
The blood is a mixture of venous, capillary, and arterial blood

18. Capillary Puncture
A lancet is a tiny, sharp, sterile device used to puncture the skin to collect small blood samples
Discuss types of lancets………..
Smaller lancets for babies
Larger lancets for adults
Use recommendations of the facility you work

19. Capillary Puncture
When the blood is collected from a capillary puncture, it is tested on a reagent strip or microvette collection device(must be ¾ full)

20. Capillary Puncture Sites
Sides of the middle and ring fingertips
Do not use the tip/pad of fingertip
May use earlobe (not preferred)
Puncture perpendicular to fingertip
Warm area if needed
Always alternate sites
Medial or lateral heel(preferred)
Great toe
Puncture at 45 degree angle
Always alternate sites
warm area if needed
Adult(1yr and up)
Infant(birth to 1yr)

21. Capillary Puncture
Gather supplies: lancet , gloves, alcohol, gauze, bandaid, microvette collection device, biohazard bag, sharps box……
Check order, identify correct patient
Introduce yourself and explain procedure
Wash hands/ Standard Precautions
Choose site
Clean site w/ alcohol in circle w/ 2 inch diameter

22. 7. Allow alcohol to dry 8. Hold plastic end of lancet with dominant hand and remove plastic cover 9. Pierce the skin at the appropriate angle by holding the finger/foot with your nondominant hand. 10. Discard lancet in sharps box 11. Wipe first drop of blood w/ gauze

23. 12. Allow next drops of blood to fill microvette or place on reagent strip 13. May apply gentle squeeze to area but not too hard- allow tube to fill ¾ full 14. Hold pressure over site until the bleeding stops and apply band aid 15. Label sample and place in biohazard bag according to facility’s standards