Unit 1 Module # 6

Introduction to the Theory and Practice of Phlebotomy

The primary duty of the phlebotomist is to collect blood specimens for laboratory testing. Blood
is collected by several methods, including arterial puncture, capillary puncture, and
venipuncture. A phlebotomist must be familiar with all the types of equipment in order to select
appropriate collection devices for the type and condition of the patient’s vein and the type and
amount of specimen required for the test. Choosing the appropriate tools and using them
correctly helps assure the safe collection of high-quality blood specimens.

There are three different methods to performing a routine venipuncture:

-Evacuated tube system (ETS)

-Butterfly

-Needle and syringe

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Evacuated tube system (ETS)
Most venipunctures are routine and can be performed on antecubital veins using an ETS system.
This system is preferred because it is direct, efficient, relatively safe for the patient and the blood
drawer, and allows multiple tubes to be easily collected.

Steps for the ETS

1. Review and accession test request.

2. Approach, identify and prepare patient.

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3. Verify diet restrictions and latex sensitivity.
4. Sanitize hands.
5. Position patient, apply tourniquet, and ask patient to make a fist.
6. Select vein, release tourniquet and ask patient to open their fist.
7. Clean and air-dry the desired site.
8. Prepare equipment and put on gloves.
9. Re-apply tourniquet, un-cap and inspect needle.
10. Ask patient to remake a fist, anchor vein and insert the needle.

11. Establish blood flow, release tourniquet and ask patient to open fist.

12. Fill, remove and mix tubes in order of draw.

13. Place gauze, remove needle, activate safety feature and apply pressure.

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 14. Discard collection unit.
15. Label tubes.
16. Observe special handling instructions.
17. Check patient’s arm and apply bandages.
18. Dispose of used and contaminated materials.
19. Thank the patient, remove gloves and sanitize hands.
20. Transport specimen to the laboratory.

Butterfly Procedure
A phlebotomist may elect to use a winged infusion set (butterfly) in attempting to draw blood
from antecubital veins of infants and small children or from difficult adult veins, such as small
antecubital veins or wrist and hand veins. A butterfly needle (i.e., 23 gauge) is appropriate in
these situations because it is less likely to collapse or “blow” (rupture) the vein. A butterfly can
be used with an ETS tube holder or a syringe. Small-volume tubes should be chosen when a
butterfly is used with an ETS holder because the vacuum of large tubes may collapse the vein or
hemolyze the specimen.

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Steps for the butterfly procedure

1. Review and accession test request.

2. Approach, identify and prepare patient.
3. Verify diet restrictions and latex sensitivity.
4. Sanitize hands.
5. Position patient’s hand and apply tourniquet, ask patient to close the hand.
6. Select vein, release tourniquet, ask patient to relax hand.
7. Clean and air-dry site.
8. Prepare equipment and put on gloves.
9. Reapply tourniquet, uncap and inspect needle.
10. Anchor vein and insert needle.

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11. Establish blood flow and release tourniquet.

12. Fill, remove and mix tubes in order of draw.

13. Place gauze, remove needle, activate safety device, and apply pressure.
14. Discard collection unit.
15. Label tubes.
16. Observe special handling instructions.
17. Check patient’s arm and apply bandages.
18. Dispose of used and contaminated materials.
19. Thank the patient, remove gloves and sanitize hands.
20. Transport specimen to the laboratory.

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Syringe Venipuncture System
The preferred method of obtaining venipuncture specimens is the evacuated tube method. In fact,
according to CLSI standard H3-A5, blood collection with a needle and syringe should be
avoided for safety reasons. Even so, a needle or butterfly and syringe are sometimes used when
the patient has extremely small, fragile, or weak veins. The vacuum pressure of an evacuated
tube may be too great for such veins and cause them to collapse easily. This is often the case
with elderly patients and newborn infants. When a syringe is used, the amount of pressure can be
reduced somewhat over that of a tube by pulling the plunger back slowly. If the syringe fills too
slowly, however, there is the possibility that the specimen will begin to clot either before enough
blood is collected or before it can be transferred to the appropriate tubes. A special syringe
transfer device is required to safely transfer blood from the syringe into the ETS tubes.

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Steps in Syringe Venipuncture System

1. Review and accession test request.

2. Approach, identify and prepare patient.
3. Verify diet restrictions and latex sensitivity.
4. Sanitize hands.
5. Position patient’s hand and apply tourniquet, ask patient to close the hand.
6. Select vein, release tourniquet, ask patient to relax hand.
7. Clean and air-dry site.
8. Prepare equipment and put on gloves.
9. Re-apply tourniquet, uncap and inspect needle.
10. Ask patient to make a fist, anchor vein and insert needle.

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11. Establish blood flow, release tourniquet, ask patient to open fist.

12. Fill syringe.

13. Place gauze, withdraw needle, activate safety device, apply pressure.

14. Fill tube in order of draw.

15. Discard needle and syringe.
16. Label tubes.
17. Observe special handling instructions.
18. Check patient’s arm and apply bandages.

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19. Dispose of used and contaminated materials.
20. Thank the patient, remove gloves and sanitize hands.
21. Transport specimen to the laboratory.

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