Master The Art of Phlebotomy and IV Insertion Ebook Compressed

PHLE
BOTO
MY
Essentials of Phlebotomy
& Intravenous therapy
Master the Art of Phlebotomy | IV Insertion
Table of Contents
General Overview
Quick Review
Quick Tips for Beginners
Preferred Venipuncture Sites
Phlebotomy | IV Tips
Additional Venipuncture Attempts
Circulatory System at a Glance
Blood Components
Blood Types
Blood Tests
Color-Coded Top
Blood Collection
Step-By-Step Instruction
Preferred IV and Venipuncture Sites
Careful Considerations
Vascular Access Devices
Needle 101
Needle Features
Tools, Techniques, & Equipment
Types Of Phlebotomy Needles
Evacuated Blood Collection Tubes
Tube Additives
Copyright ©️2023 ProjectMedi. All rights reserved.

General Overview
The Proper
purpose training
of phlebotomy is to obtain and the appropriate
a blood specimen for equipment are essential to
further diagnostic testing ensure the safety & comfort
of the patient
Medical Phlebo-
intervention tomy
and treatment are often requires technical skills,
dependent on lab results expertise, training, and
and other testing finesse
Skill sets for obtaining blood specimens are

essential and highly sought out
Venipuncture skills are performed by all types of healthcare
professionals.
Including but not limited to:

‣ Registered Nurses ‣ Respiratory therapists
‣ Phlebotomists ‣ Certified Medical Assistants
‣ Emergency medical ‣ Clinical laboratory personnel
technicians (EMTs)

Quick Review
Label specimen containers correctly according to
lab’s policy
‣ Receiving lab may be unable to run a mislabeled specimen
‣ Specimens labeled correctly will ensure timely results and
prevent repeat venipunctures
Dispose of sharps and supplies in the correct

biohazard containers
Remove tourniquet after one minute
Tourniquets may not always be necessary (assess

the patient’s veins)
Release the tourniquet after flash of blood flow is evident

‣ Tourniquets may be left on up to 1 minute to prevent:
˃ Hemoconcentration (specimen may coagulate)
˃ Hemolysis (red blood cell destruction)
> Petechiae (purplish red spots)
Apply direct pressure with clean gauze and remove

needle carefully
Hold gauze bandage until bleeding stops
Assist the patient and ensure comfortable positioning
Provide patient instruction if needed
Thank the patient and ensure their comfort
Transport/handling of the specimen appropriately

Quick Tips
for Beginners
Verify the patient with 2 identifiers
01
& obtain their consent (DOB & Name)
Review hospital policies for order

02
of lab draw and procedure
Perform hand hygiene |

03
Introduction
04 Remain calm & exude confidence
05 Verify test order and match labels
06 Explain procedure to the patient
07 Assess the patient for needle phobia
08 Be aware of patient allergies (Latex)

09 Be confident & professional
Ask the patient if there are any

10
contraindications to the procedure
11 Prepare venipuncture supplies
12 Don gloves and set up supplies
13 Investigate the patient’s veins

14 Select the most appropriate site
Apply tourniquet 3-4 inches above the

15
puncture site
16 Remove/reapply tourniquet > 1 minute
17 Start with distal veins and work proximally

Preferred 1 2
Venipuncture
Sites
1
4
1st preferred site:
Median (center);
lateral cubital veins
2 2nd preferred site: 2
Lateral aspect;
cephalic vein 1
3
3
3rd preferred site:
Medial (inner) basilic vein &
median cubital vein
1
*
Cephalic
Veins on the dorsal vein
(back) of hand are
also acceptable 2
Basilic
vein
3
Median
! Ask the vein
patient 4
The patient may Median
know what veins basilic
are successful vein

Phlebotomy | IV Tips
INVESTIGATE –
LOOK | TOUCH | FEEL
Veins can be located Bevel-Up. Keep the bevel

by feel facing upward to ease
insertion
Allow the skin to dry
before puncture Hold tension to keep the
vein taught and prevent
rolling
Spongy, firm, & bounce
Angle the needle no more
than 15-30 degrees to
Palpate the vein with
prevent blowing the vein
gloves to prevent
• Recalls veins are superficial
contamination
Use Gravity to help veins Take advantage of

be more visible topical anesthetics, cold,
an vibration to reduce
pain on insertion
Encourage fist clenching
Avoid repositioning
needles without
Warm compress applied
determining vein location
to vein
(blind stick)
Use a vein locator if If blood does not flow or
available stops flowing consider
the following:
Flick or tap vein |
• Needle is too shallow or too deep
Avoid slapping – slightly advance or withdraw
• Tube is defective – select another

Select the appropriate tube of the same type
size needle:
• Vein rolls, collapses, or blows
• Smaller gauge # = larger lumen (hematoma forms) – repeat
• Larger gauge # = smaller lumen venipuncture

Additional
Venipuncture
Attempts
Unsuccessful
venipuncture
may require additional attempts –
obtain patient consent
Record additional
attempts
in the patient’s chart per
institution’s policies/EHR
Follow your
institution’s policies
regarding number of attempts
allowed per healthcare professional

Circulatory System
at a Glance
The human body contains on average
5-6 liters of blood. Most blood tests are performed using
venous blood, which is safer than arterial puncture.
Veins Capillaries
• Superficial and carry • Smallest of the blood
deoxygenated blood back to vessels in the body
the heart
• Allow for transport of
• One-way valves to prevent oxygen, water, nutrients, and
backflow of blood and carbon dioxide between
pooling blood and tissues
Blood Arteries
• Responsible for • Deeper and thick
providing oxygen, nutrients, elastic walls
chemical substances and
waste removal to each • Bright red highly
individual cell oxygenated blood
• Blood tests reveal critical • Carries blood from the

data about organ function, heart to the capillaries
infection, and other diseases

Blood
Components
Erythrocytes
red blood cells, RBCs
Leukocytes
white blood cells, WBCs
Platelets
large cells in bone marrow
Thrombocytes
helps blood clot to stop bleeding
Plasma
liquid portion of the blood
Serum
plasma, without clotting factors

Blood Types
Based on the presence or absence
of A and B antigens on the surface of RBCs
01 02 03
Antigen Blood Blood

group AB group O
Substance that
creates antibo- contains both neither A or B
dies to genera- A and B antigens
te an immune antigens on (Universal
response the surface of donor /
their RBCs recipient)
Blood type needs to be determined before

blood transfusion
Type and screen (T&S) T&S identifies antibodies
procedure - performed to that may react with
determine the ABO/Rh. transfused blood products.
Type A/B Antigen (Presence/Absence)
AB A&B antigen
A A antigen
B B antigen
O + or - (no antigens)

Blood Tests
Table 1.
Specimen Type Indications For Use Note
Whole Blood Most hematology tests Collected and mixed with

anticoagulation
Blood typing / cell counts
Specimen will not clot
Determining hormones
and metals
Serum Fluid portion of blood Clotting around 30-60

which remains after clotting min after blood is drawn
and may need to be put
Anticoagulation is into a centrifuge (device
not needed that separates
components of blood)
Plasma Fluid portion of the blood Collected for coagulation

including fibrinogen & other studies & STAT chemistry
clotting factors – emergencies
Obtained from whole blood No wait time for clotting
by adding an anticoagulant to occur before centrifuge
then centrifuging process
Complete Most commonly performed Standard of care

hematology test
Blood
Count (CBC) Provides full analysis of
blood

Table 2.
Canula Size Color Recommended Uses
14G Orange Massive trauma;

may be difficult to obtain
16G Gray Trauma, large bore IV, multiple

infusions required, ICU patients, burn
victims
18G Green Large volume infusion, standard

for most surgical procedures, blood
transfusion, dependable
20G Pink Multi-purpose IV, hydration, routine

therapy
Minor surgical procedures, preferred

for majority of IVs, more reliable and
durable
22G Blue Pediatric and elderly patients, chemo

infusions, ideal for smaller veins,
shorter procedures
24G Yellow Ideal for pediatric and elderly patients;

fragile veins, not as durable and bend
easily
Select
the color-coded top based on the
test that is ordered to ensure the
integrity of the specimen

Color-Coded Top QUOTE
If at first you don't succeed
try, try and try again.
INVERT TUBES
PER LAB POLICY Robert the Bruce
Table 3.
Color - Coded Indications for Use

Top Gently invert tubes per policy
ABRed Chemistry, blood bank, serology
Light Blue Coagulation testing – Fill the sample tube
Lavender Complete Blood Count (CBC)
Gold Blood chemistry (contains clot activators)
Gray Lactic acid, GTT, FBS, blood alcohol (ETOH)
Black Erythrocyte Sedimentation Rate -

ESR (inflammatory marker)
Green STAT blood chemistry, ammonia, electrolytes, ABGs
Light Green STAT potassium
Orange/Yellow STAT blood chemistry
Royal Blue Toxicology and heavy metals analysis
Tan Blood lead analysis
Yellow (sterile) Blood Cultures (requires two separate

venipuncture sites)
Yellow (non sterile) Human leukocyte antigen (HLA), paternity tests,

tissue typing
* Additives in the Tube - Affect Order of Draw

Blood Collection
COLOR CODES & ORDER OF DRAW
HEMATOLOGY BLOOD
BLOOD COAGULATION GROUP
CULTURE STUDIES CHEMISTRY CHEMISTRY CHEMISTRY HEMOGLOBIN
A1C CROSS
MATCHING
CLOT GET FOR

SODIUM ACTIVATOR SERUM
CULTURE SEPARATOR HEPARIN EDTA
MEDIA CITRATE SILICON- K2 EDTA
COATED CLOT
ACTIVATOR
MUST DRAW
FIRST: INVERT 3-4 INVERT 5 INVERT 5 INVERT 8 INVERT 8-10 INVERT 8
USE STERILE TIMES TIMES TIMES TIMES TIMES TIMES
TECHNIQUE
Example of Order of Draw:
Blood cultures – disin- Lavender tubes –

01 05
fect stopper and fill drawn towards the end of
aerobic container first lab draw
Light Blue – coagulation Gray top tube is last –

02 06
studies are next contains potassium
oxolate, which can elevate
Red/gray (gold) tops – potassium
03
contain clot activators
Other tubes
07
Green – heparin in the may be added after the
04 above draw order is
tubes can interfere with
EDTA tubes performed

Step - By - Step
Instruction
Review and understand the hospital’s
01
phlebotomy and or IVpolicies
02 Obtain physician order and verify orders with

patient labels
03 Review patient’s allergies (latex) and medical

history
04 Introduce yourself professionally
05 Display confidence in your abilities

and remain calm
Obtain patient consent before
06
starting the procedure
07 Verify the patient (2 ID’s : Name/DOB)

08 Explain the procedure to the patient
09 Assess physiological factors
10 Perform hand hygiene before contact
Gather, prepare, and setup appropriate
11
supplies
12 Determine the order of lab draw
13 Ask your patient – veins with previous success
14 Apply tourniquet 3 - 4 inches above site
15 Investigate: Look, touch, and palpate the veins
16 Select the vein to puncture

17 Use antiseptic cleaning techniques
18 Cleanse venipuncture site using 70% isopropyl alcohol with

back-and-forth motion
19 Ensure vein is clean and dry before puncturing
20 Insert the needle bevel up at a 15–30° angle

a. Anchor the vein from below to
secure the arm
b. Hold the needle in your dominant
hand
c. Maintain a shallow 15–30° angle
for insertion
21 Re cleanse the site as needed and if compromised
Once blood flow is established, release the
22 tourniquet to prevent a hematoma
Using non - dominant hand reach for lab

23 tubes and fill accordingly
Apply direct pressure with gauze and

24 remove the needle
Hold pressure until bleeding stops & instruct

25 patient to hold gauze up to two minutes
Ensure bleeding has stopped after

26 10-15 seconds of direct pressure
Instruct the patient to protect venipunc-

27 ture site for a few hours
28 Assist the patient to original position
Dispose of biohazardous material and

29 sharps appropriately
Label specimens correctly in the

30 presence of the patient
31 Thank the patient
32 Refer to institution’s policy for specimen

transport and handling

Preferred IV and
Venipuncture Sites
Venipuncture and IV sites are selected with careful
consideration
Consider why the patient requires an IV or bloodwork
Ask the patient if there is a preferred location for venipuncture
Based on the indication, determine the most appropriate

location for venipuncture
Example: ‣ A patient undergoing right should surgery should

have the IV placed on the left extremity
‣ A patient with a history of left mastectomy has a
contraindication to procedures on the left arm
Start at the distal end of the extremity and work your way up
Once a site is compromised you cannot use the site below it
2nd attempts for obtaining IV access must be above the

initial puncture
Utilize Resources: Select

vein finder, blacklight, the appropriate size
warm compress, needle gauge based on
gravity and ultrasound the patient’s veins

Careful Considerations
Elderly
Ask the patient and select an
appropriate size needle to
prevent trauma to the vein
Prewarm the site and secure

veins before inserting the
needle
Use low-volume tubes, small

needles, and be gentle
Children
Utilize distractions, parents,
and calming resources when
available
Select appropriate size

needle based on the child
Infants
Requires exceptional talent,
finesse, and skills to master

Other patients
Patients with lymphedema,
history of mastectomies,
obesity, drug addictions,
amputees, cancer, and other
conditions that may affect
what veins can be used
Anchor veins and may

require a deeper insertion
angle to access vein
Utilize vein finders,

ultrasound devices, and
prewarming techniques to
ease access
Collect blood specimens Collect blood distal to an

from the arm that is NOT IV site and discontinue
receiving IV fluids to infusion for at least 2 min
minimize contamination before venipuncture
Vascular Access Devices

NEVER attempt venipuncture above a VAD
01 02 03
Collection from a Reduce the risk
VAD may cause of contamina- Anticoagulation
erroneous test tion by samples should
results due to discarding NOT be
hemolysis and volume based collected from
contamination on dead space VADs

Red (glass tube) Gray Orange
Tests – chemistry, Tests – lactic acid measu- Tests – STAT blood

serology, blood bank rement, glucose intoleran- chemistry
Additives - none ce, fasting blood sugar, Additives - thrombin
Specimen - serum blood alcohol level Specimen - serum
Inversion number – 0 Additives - iodoacetate Inversion number – 8
sodium fluoride,
Note: anticoagulant Note:
Let sit for 30 minutes to Specimen - plasma Allow 5-minute clotting
clot, then centrifuge Inversion number – 8 time for patients on antico-
agulation therapy
Note:
Fluoride prevents glucose
metabolism, place lactic
Red (plastic tube) acid specimens on ice per Royal Blue
policy
Tests – chemistry,
serology Tests – toxicology, trace
metals, nutritional analysis
Additives - clot activators
Black Additives - EDTA or none
Specimen - serum
Specimen - plasma or serum
Inversion number – 0
Inversion number – 8 or
Tests – erythrocyte none
sedimentation rate –
inflammatory marker
Light Blue Additives - sodium citrate
Specimen - whole blood Yellow (sterile)
Tests – coagulation
testing Note: Tests – blood cultures
Additives - sodium citrate No inversion to allow Additives - sodium
Specimen - plasma settlement of blood, fill polyanethol sulfonate
Inversion number – 3-4 tube completely Specimen - whole blood
Note: Inversion number – 8
Fill tube completely, main- Note:
tains ration (nine parts of Green Requires 2 different speci-
blood to one part sodium mens from 2 separate
citrate) veins. Do not confused with
Tests – STAT blood nonsterile yellow top
chemistry, ammonia,
electrolytes, arterial blood
gases (ABG)
Lavender
Additives - sodium heparin Yellow (nonsterile)
Specimen - plasma
Tests – CBC Inversion number – 8 Tests – human leukocyte
Additives - EDTA antigen (HLA), used for pater-
Specimen - whole blood nity testing & tissue typing
Inversion number – 8 Additives - acid citrate
Note: Light Green dextrose
Most commonly performed Specimen - whole blood
blood test Inversion number – 8
Tests – STAT potassium
Additives - lithium heparin, Note:
thixotropic gel Do not confused with
Specimen - plasma sterile yellow top
Gold or Red/Gray Stopper Inversion number – 8
Tests – most blood Pink

chemistry
Additives - clot activators, Tan
thixotropic gel Tests – hematology, blood
Specimen - serum bank
Tests – lead analysis Additives - EDTA
Additives - EDTA Specimen - whole blood,
Note: Specimen - plasma plasma
Jungle or tiger top Inversion number – 8 Inversion number – 8

Needle 101
Selecting the correct type All needles are sterile,

of needle & the tube to use disposable, and intended
are critical to the process for one time use only
Inspect packaging before use Ensure seal is not broken
Smaller gauge number = Larger gauge number =

larger lumen smaller lumen
Needle Features
Point Bevel Shaft

sharp tip of the angel at the tip body of the
needle to ease of the needle to needle that
entry into the ease insertion varies in length
skin with mini- into the vein to and diameter
mal resistance minimize pain
Lumen Gauge Hub

hollow tube diameter of the connects the
within the shaft lumen; size needle to the
of the needle; indicated by tube or syringe
varies in color-coded intended for
diameter packaging use

Tools, Techniques, &
Equipment
‣ Gloves (avoid latex ‣ IV start kits
when possible)
‣ Vein finder
‣ Needles / needle holder
‣ Antiseptic cleaning
‣ Syringes solutions
‣ Collection tubes ‣ Gauze pads
‣ Butterfly needles ‣ Bandages
(winged infusion sets)
‣ Tourniquet
‣ Marking pens
‣ Vital sign monitoring
‣ IVs (various sizes)
Types Of
Phlebotomy Needles
Multi-sample
Most commonly used, double-ended, and inserted into
evacuation tube
Retractable rubber sleeve and remains in the vein while
exchanging tubes
Safety syringe
Ideal for small and fragile veins with a lower pressure to
prevent vein collapse

Winged infusion sets (a.k.a. butterfly needles)
Ideal for venipuncture on small and fragile veins, such as
veins in the hand, pediatric, and elderly patients
Allows flexibility and causes less trauma and pain to the vein
Most commonly used size is 23 - gauge, which help ease
blood draws from veins that tend to roll
Needle adapters (a.k.a. tube holder)

ensure a secure attachment between the needle and the tube
Evacuated
Blood Collection Tubes
Multifunctional for the Used for transferring blood
evacuated tube system from a syringe into the tube
and syringe method to
obtain blood specimens
Consists of 3 components
Direct & efficient to allow • Evacuated sample tube
blood to flow directly into • Multi - sample needle
the tube during venipuncture • Needle holder
! !
Tubes that lose Expiration
their vacuum evacuation tubes
ability will NOT need to be
fill with blood discarded (check
expiration dates)

Tube Additives
Except for the red-topped glass tube, which contains NO additives,
ALL other tubes contain at least one
Anticoagulants
prevent clotting and or bind calcium
Heparin - inhibits clotting & preferred for plasma chemistry
and blood gases
EDTA – preserves blood cell integrity
Sodium Citrate – coagulation studies
SPS – blood cultures by inhibiting certain immune system
components that kill blood-borne bacteria
Clot activators
Promotes coagulation and preferred for STAT chemistry
Thixotropic gel
Separates components within the blood and requires centri-
fuge to separate layers
Preservatives and inhibitors

of various cellular reactions to maintain specimen integrity
ALL tubes containing additives must be inverted and mixed immedi-

ately after collection
Invert tubes after the needle is removed and separated from the
needle adapter

Be Confident, Stay
Calm, and Persevere
WARNING:
Although the author and publisher have made every effort to ensure that the
information in this pamphlet was correct at press time, the author and publish-
er do not assume and hereby disclaim any liability to any party for any loss,
damage, or disruption caused by errors or omissions, whether such errors or
omissions result from negligence, accident, or any other cause.
This product is exclusively intended for educational purposes - specifically for

training in the medical field. All items in this kit are intended exclusively for
non-clinical purposes. The user is stricly prohibited from using any of these
items on actual human or animal patients - even in an emergency!
ProjectMedi Venipucture Kit contains sharp objects. Recommended ages are 18

years old and older. Adult supervision required for students of 15-17 years. Keep
out of reach of children under the age of 14 years, especially babies and toddlers.
NEVER dispose any sharps (e.g., used or unused needles) into a regular waste bin!
©ProjectMedi. All rights reserved. support@projectmedi.com

Master The Art of Phlebotomy and IV Insertion Ebook Compressed

Uploaded by

Copyright:

Available Formats

You might also like

Master The Art of Phlebotomy and IV Insertion Ebook Compressed

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Master The Art of Phlebotomy and IV Insertion Ebook Compressed

Uploaded by

Copyright:

Available Formats

PHLE

Copyright ©️2023 ProjectMedi. All rights reserved.

Skill sets for obtaining blood specimens are

Including but not limited to:

Copyright ©️2023 ProjectMedi. All rights reserved.

Dispose of sharps and supplies in the correct

Remove tourniquet after one minute

Tourniquets may not always be necessary (assess

Release the tourniquet after flash of blood flow is evident

Apply direct pressure with clean gauze and remove

Hold gauze bandage until bleeding stops

Assist the patient and ensure comfortable positioning

Provide patient instruction if needed

Thank the patient and ensure their comfort

Transport/handling of the specimen appropriately

Copyright ©️2023 ProjectMedi. All rights reserved.

Review hospital policies for order

Perform hand hygiene |

04 Remain calm & exude confidence

05 Verify test order and match labels

06 Explain procedure to the patient

07 Assess the patient for needle phobia

08 Be aware of patient allergies (Latex)

Ask the patient if there are any

13 Investigate the patient’s veins

Apply tourniquet 3-4 inches above the

Copyright ©️2023 ProjectMedi. All rights reserved.

2 2nd preferred site: 2

! Ask the vein

Copyright ©️2023 ProjectMedi. All rights reserved.

Veins can be located Bevel-Up. Keep the bevel

Use Gravity to help veins Take advantage of

• Tube is defective – select another

Copyright ©️2023 ProjectMedi. All rights reserved.

Copyright ©️2023 ProjectMedi. All rights reserved.

• Blood tests reveal critical • Carries blood from the

Copyright ©️2023 ProjectMedi. All rights reserved.

Copyright ©️2023 ProjectMedi. All rights reserved.

Antigen Blood Blood

Blood type needs to be determined before

Type A/B Antigen (Presence/Absence)

Copyright ©️2023 ProjectMedi. All rights reserved.

Specimen Type Indications For Use Note

Whole Blood Most hematology tests Collected and mixed with

Serum Fluid portion of blood Clotting around 30-60

Plasma Fluid portion of the blood Collected for coagulation

Complete Most commonly performed Standard of care

Copyright ©️2023 ProjectMedi. All rights reserved.

Canula Size Color Recommended Uses

14G Orange Massive trauma;

16G Gray Trauma, large bore IV, multiple

18G Green Large volume infusion, standard

20G Pink Multi-purpose IV, hydration, routine

Minor surgical procedures, preferred

22G Blue Pediatric and elderly patients, chemo

24G Yellow Ideal for pediatric and elderly patients;

Copyright ©️2023 ProjectMedi. All rights reserved.

Color - Coded Indications for Use