CHAPTER 5 ROUTINE BLOOD COLLECTION

Venipuncture is the most common technique for acquiring blood specimens. For routine venipuncture,
the phlebotomist must follow these steps to ensure that the procedure is performed safely and accurately.

Venipuncture Steps

 Greet and identify patient

 Select and assemble equipment
 Perform the draw using aseptic technique and Standard Precautions
 Provide post-puncture care
 Label specimens properly
 Handle and transport specimens correctly

Requisition form-identifying patients, information about the patient, lab test requested by the doctor

How to identify patient:

a. Ask the patient his/her name

b. Let the patient state his/her name ☆

Equipment- tourniquet, cotton, alcohol, blood collection equipment (syringe method, ets method, butterfly
method) micropore tape, tube holder, gauze pad, ballpen, evacuated tube, gloves

Equipment Assembly

 Place equipment near patient

 Line up tubes in order of draw
 Screw needle into adapter
 Insert first tube into tube adapter

Order of Draw (BCNHES)- to avoid contamination

 Blood culture tube

 Coagulation tube (blue/light blue tube)
 Non-additives (tubes without coagulant)
 Heparin (green or light green)
 EDTA (lavender)
 Sodium fluoride (grey top)

Positioning the Patient

 Position patient lying supine or sitting in phlebotomy chair

 Straight chair with arm
 Use pillow or towel if necessary

How many minutes should patient (blood cholesterol) be seated first before obtaining blood? 5 mins ☆ If
not performed, may cause false increase in blood cholesterol if the patient is standing up

Applying the Tourniquet

 Position Tourniquet
 Cross Left End Over Right
 Tuck Left End Under Right End
 Loose Ends Point Toward Shoulder

Selecting the Site

  Position arm at downward angle
 Ask patient to make a fist
 Examine antecubital area first
 Palpate vein with fingertip
Obese patient- cephalic vein
No suitable vein in the antecubital- Dorsal veins on the back of the hand

Cleansing the Site

 Use aseptic technique

 Use antiseptic (70% alcohol pad)
 Use concentric circles
 Begin at the site and move outward
Aseptic technique- disinfection- we remove disease-causing germs, but not necessarily all
germs
Sterile technique-sterilization- we kill all the germs

Performing the Venipuncture

 Reapply the tourniquet

 Visually confirm the site
 Anchor the vein
 Insert the needle
Inserting needle- bevel up
Needle partially inserted- appearance of bruise, hematoma, ecchymosis

Unsuccessful Venipuncture

Collecting the Specimen

 Insert the first evacuated tube to start blood flow

 Hold equipment steady during tube changes
 Allow each tube to fill completely
 Mix tubes with additives immediately

Removing the Needle

 Release the tourniquet

 Place gauze on puncture site
 Remove needle smoothly
 Engage needle safety mechanism
 Apply gentle pressure to patient’s arm

Completing the Procedure

Labelling tube
 1. Patient's full name
2. Patient's unique ID number (makikita sa requisition form)
3. Date of collection
4. Time of collection (military type)
5. Collector's initial

At what angle should the needle be inserted when performing a venipuncture? At a 15° to 30°
angle.

Using a Butterfly Set

 Use only when standard draw is not possible

 Do not use with evacuated tubes if patient has fragile veins

Butterfly Venipuncture

 Assemble evacuated tubes for specimen transfer

 Follow same procedure as for standard venipuncture

Transferring the Specimen

1. Remove Backing from Transfer Device

2. Attach Syringe to Transfer Device
3. Push Evacuated Tube into Transfer Device
4. Discard Transfer Device and Syringe in Sharps Container

Why is it important to pull the plunger slowly when drawing blood into a syringe?

Answer: A hard pull may cause small veins to collapse or may cause hemolysis of the specimen.

Dermal Puncture

 Preferred method for young patients

 Infants
 Very small children
 May also be used for other patients
 Obese
 Elderly
 Severely burned

Preparing for Dermal Puncture

 Examine the requisition slip

 Greet and identify the patient
 Explain the procedure
 Verify any diet restrictions
 Wash your hands
 Put on gloves

Diet restrictions- fasting

 request fasting blood sugar-dapat nakapagfast ang patient (no food and liquid except water) for 8
to 10 hours
 How to confirm fasting? Confirm exact time

Select the Puncture Sites

Children and adults: Use the third or fourth finger of the hand.

 Use the palmar surface of the finger.

 Use the sides of the fingertip instead of the middle of the finger.
 Warm the finger slightly to increase blood flow.

Infants: Use the plantar surface of the heel.

 Never perform a dermal puncture on the heel of an infant who has begun to walk.
 Use the lateral surface of the heel, well away from the calcaneus (heel bone).

Equipment for Dermal Puncture

 Requisition slip
 Alcohol prep pad
 Gauze pad
 Gloves
 Adhesive bandage or tape
 Sharps container
 Computer label
 Permanent marker or pen
 Lancet
 Microspecimen containers

Planning the Puncture

 Examine the fingers

 Choose a finger for the puncture
 Plan to cut across the fingerprint

Performing a Dermal Puncture

 Clean the site with alcohol

 Allow to dry completely*
 Hold the finger to stretch skin tightly
 Puncture the finger

1. Wipe Away First Drop- sagana sa tissue juice

2. Apply Steady Pressure
3. Collect Specimen

*Allow to dry completely

1. Painful
2. To prevent damage to the specimen

After the Dermal Puncture

 Place used lancet in sharps container

 Check patient’s finger
 Apply bandage if appropriate
 Collect and dispose of supplies
 Clean the area
 Thank and dismiss the patient
 Remove gloves
  Transport specimen to laboratory

URINE

Common urine test

1. Routine Urinalysis

A. Physical examination of urine- color, clarity, specific gravity, odor

 Phenylketonuria (PKU) - mousy odor (amoy daga)
 Hawkinsinuria- swimming pool odor of urine

Routine UA preservatives- refrigerator, formaline

B. Chemical examination

Parameters:

1. pH
2. Glucose
3. Protein
4. Ketones
5. Blood
6. Bilirubin
7. Urobilinogen
8. Nitrite
9. Leukocyte esterase
10. Specific gravity

C. Microscopic examination-casts, crystals, cells, parasite

2. Urine culture and sensitivity

 detect bacteria that is invading our urinary tract

 detecting UTI
 What is the most common causative agent of UTI? Eschericia coli (kadalasang nakikita sa
tae)
 Female- prone to uti
 What is the most common causative agent of UTI among sexually active female?
Staphylococcus saphrophyticus
 What is the urine preservative used to preserve urine for culture and sensitivity? Boric acid

3. Urine cytology studies

 detect cancer, cytomegalovirus and other viral and inflammatory disease of urinary system
 Papanicolaou staining (PAP)
 Preservative for urine cytology studies- Saccomano's fixative

4. Drug test

 What is the validity of a urine drug test? 1 year

5. Urine glucose and ketone testing

 for diabetic mellitus patients

6. Urine pregnancy testing

  detecs the hCG particularly B-hCG (beta-human gonadotropin hormone) can be detected 8 to 10
days after conception
 What is the preferred urine sample for pregnancy test? First morning urine (it is the most
concentrated) to prevent false negative

Types of urine specimen

A. Random Urine specimen- collected anytime

B. First morning/ 8-hour urine specimen- collected after 8 hours of sleep

C. Fasting- to detect diabetes

D. Timed specimen

a) Tolerance test - detect glucose

 collect fasting urine, collect after 30 minutes urine, collect after 1 hr
 Example:
Fasting urine- 8:00 am
Next urine- 8:30 am
Next urine- 9:30 am
 to know if the glucose is stable

b) 2-hour postprandial (pagkatapos kumain)

 collected 2 hours after a meal
8 am (meal)- 10 am (collect urine)
 to detect diabetes

c) 24-hour
 collect lahat ng ihi sa buong 24 hours (ireref yung ihi or lalagyan ng preservative)

URINE COLLECTION METHODS

1. Regular voided- iihi sa malinis na container

2. Midstream

I. Ihi muna sa toilet- (wag munang ilalagay yung unang lumalabas na ihi sa container)
II. Ihi- Icocollect yung kalagitnaan ng ihi

3. Midstream clean catch

 Clean catch- lilinisan yung ari bago umihi

 used for urine culture and sensitivity to ensure no contamination

4. Catheterized - ihi na kinuha sa catheter

5. Suprapubic aspiration- ipapasok syringe sa urinary bladder to collect urine

 used in urine cytology (to determine bladder cancer....)

6. Pediatric method- collection method for baby

AMNIOTIC FLUID

 Collection technique for ambiotic fluid-amniocentesis

 Fetal lung maturity- determine if the lungs of the fetus are matured enough
Cerebrospinal fluid (CSF)

 Tubig na nagsusurround sa utak at spinal cord

 Collection method for CSF- lumbar puncture
 To detect meningitis or meningoencophalitis -impeksyon sa utak

CSF- must collect 3 tubes

 1st tube- pinapadala sa chemistry and serology dept

 2nd tube- pinapadala sa microbiology dept (for culture and sensitvity)
 3rd tube- pinapadala sa hematology dept (for cell counts) if the wbc count is high, there is
meningitis

If only one tube, should test Microbiology first- to prevent bacterial contamination

Meningitis can be:viral, bacterial, fungal, parasitic

4. Gastric fluid

 Appearance of gastric fluid - pale gray and mucoid

 Collection of gastric fluid- through tube

2 types of tubes

1. Rehfuss tube- tube via the mouth

2. Levine tube- via the nose
 to determine if acidic or unacidic

5. Nasopharyngeal secretion

 to detect:
1. diphteria (Corynebacterium diphtheriae)
2. meningitis
3. Pertussis (whoopinv cough) (Bordetella pertussis)
4. Pneumonia
5. SARS-CoV-2 COVID 19

6. Saliva

 Alcohol and drugs

 Red cross- saliva testing

7. Semen

1. To check fertility or sterility

 Sperm mutility- paggalaw ng sperm cells
2. To check for the completion or effectiveness of vasectomy
3. Collection method for semen- via masturbation

8. Serous fluid

3 types of serous fluid

1. Pleural fluid- fluid found surrounding the lungs

 collection through thoracentestis
 Pleural effusion- dumadami ang tubig sa baga
 2. Pericardial fluid- fluid found surrounding the heart
 collection through pericardiocentesis
3. Peritonial fluid or ascites- fluid found surrounding the abdomen
 collection method- paracentesis

9. Sputum

- monitors lower respiratory tract infection (lungs) such as TB

10. Sweat

 Pinakasikat na ginagawa sa sweat- sweat chloride

 Sweat chloride- detects cystic fibrosis

11. Synovial fluid

 fluid found inside the joint or in between two bones

 Collection method for sybovial fluid- arthrocentesis
 Arthritis, gout

12. Buccal or cheek swab

 for DNA testing

13. Bone marrow

 Pelvis- common pinagkukuhanan ng bone marrow

 to determine leukemia (blood cancer), lymphoma

14. Breath sample

1. C-urea breath test- detects the presence of the bacterium called Helicobacter pylori (causative
agent of peptic, gastric, or duodenal ulcers)
2. Hydrogen breath test- detects problems in the digestion of carbohydrates (lactose or fructose)
 Lactose intolerance-
3. Alcohol breath test

15. Feces

used in determining:

1. Gastrointestinal disorder
2. detect ova and parasite (O and P)
3. To check for the presence of pathogenic bacteria or virus
4. To check fat and urobilinmogen content
5. To test for the presence of occult blood
 occult - hidden
 occult blood- most common fecal analysis; for the early detection of colorectal cancer

16. Hair

1. Analysis of trace and heavy metals

heavy metals- arsenic
2. Chronic drug abuse

17. Throat swabs

To determine:
  Throat infection
 Strep throat- throat infection caused by streptococcus pyogene
- can be determined through throat swabs

18. Tissue specimens

 Histopathologic techniques- tissues are processed to be observed under microscope