Module 2.

4
 What A procedure in which a needle is
used to take blood from a vein,
is usually for laboratory testing.
Phlebotomy may also be done to
Phlebotomy remove extra red blood
from the blood, to treat
cells
? certain blood disorders.
 1. To obtain blood samples in
Reason order to perform diagnostics.

s of 2.To collect blood for later use

should the patient’s condition
performi requires transfusions.

ng 3.To remove blood that was found

with excessive levels of
erythrocytes or iron.
  Syringe method

Phlebotomy
 Winged Blood infusion set (Butterfly
Techniques method)

/ Methods
  Evacuated Tube System (ETS)

Phlebotomy

Techniques
/ Methods
 Blood specimens are obtained through:

Phlebotom - Capillary skin punctures (finger, toe,

heel), arterial or venous sampling.

y Sites •Capillary / dermal /skin puncture, earlobe

stick, finger stick, heel stick (infants).
•Venous puncture (direct puncture of vein
by venipuncture)
• Arterial puncture
Routine
 All procedures begin with the receipt of a
Venipuncture test requisition form.
 Patient’s first & last name
 Identification number

Requisition  Px date of birth

 Px location
 Attending physicians
s  Tests requested
 Request date & time of sample
collection
 Status of sample
 Special collection information
Greeting the
Patient
 A phlebotomist’s professional demeanor
instills confidence and trust in the patient.
 Procedure must be explained in nontechnical
Room terms.
 Observe any signs on the px’s door (Allergix
Signs & to latex, DNR, NPO, px expired, infection
control precautions, do not draw blood from

Entering a particular arm)

 When entering the room, knock lightly on

the room the door

Patient
Identification  At least two identifiers:
 Compare information obtained by
verbally and

Inpatient  From patient’s wrist ID band

identificatio  Verbal identification (ALWAYS HAVE

PATIENT STATE THEIR NAMES)
n  Be particular on the hospital ID
number.
  Ask the px to state his/her full name,
address, date of birth and/or unique ID
number.
Outpatient
identificatio  Failure to properly identify the patient may
result in patient medication and treatment
n mismanagement.
Patient  Px’s arm should be firmly supported and
Preparation extended downward in a straight line.

Positionin
g The
patient
  Collect all necessary supplies.

Equipmen
t
Selection
Wash hands
 Occupational Safety & Health
Administration (OSHA) regulations mandate
that gloves be worn when performing
And venepuncture.
 Patients are reassured that proper safety
Apply measures are being followed when gloves
are donned.
Gloves
  Tourniquet should be applied twice.
 first: vein selection
 2nd: before the puncture is performed
Tourniquet  CLSI recommends that it should be released
for 2 minutes.
 Should be placed on the arm 3-4 inches

Applicatio above the puncture site.

n
 A tourniquet applied too close to the site
may cause the vein to collapse.
Site
 Antecubital fossa
Selection  Median cubital vein
 Cephalic
 Basilic
 “H pattern” – cephalic, medical cubital
and  basilica
 “M pattern” – cephalic, median
cephalic,  median basilica and basilica

 Veins on the underside of the

wrist  SHOULD NOT be used.
Cleansin  Use 70% isopropyl alcohol
 Performed using circular motion (2-3 inches)
 Should be allowed to dry for 30 – 60

g The seconds.
 Alcohol contamination may cause sample

site hemolysis affecting the integrity of the

sample.
Assembly  Place assembled venepuncture equipment

Of
within easy reach.

Puncture
Equipmen
t
 Examine the needle
 Examine point of needle for any
defects.
 Positioned for entry into the vein with
the bevel up.
  Anchoring the vein
 Use thumb of non-dominant hand to
anchor the vein.

Performing
Venipunctur
e
  Inserting the needle
 Align the needle with the vein and
insert it, bevel up and an angle 15 to

Performing 30 degrees.
 Filling the tubes

Venipunctur
 Tubes should be held at a downward
angle.
 Follow the Order of Draw

e
Order Of
Draw
Removal  Remove tourniquet first – then needle.

And  Place cotton over the site and withdraw

needle
 Apply pressure (2 to 3 minutes)
Disposa  Disposal of needle
 Sharps container

l Of  Under no circumstance should the needle

be bent, cut, placed on a counter or bed,

Needle
or manually recapped.
  Labelled with:

Labellin  Time of collection & after sample is

collected
 Px’s name & ID number, phlebotomist’s
g The initials
 Bandaging the patients arm
Tube  Bleeding should stop w/in 5 mins.
Completing  Is complete when sample is delivered to
the laboratory in satisfactory condition.
 Centrifugation of clotted tubes and

The anticoagulated tubes and separation of

the serum/plasm from the cells

Venipunctur
within 2 hours.
 Sample should reach the laboratory
w/in 45 minutes.

e
 1. There is a patient name or file number

Criteria discrepancy between specimen label

and request form.

for 2.There is no patient name or other

unique identifier on specimen.

Rejectio 3. Specimen is too old when

received.

n 4.There is apparently no specimen in

container.
5.The expiration date of the transport
medium has been exceeded.
 1. Arm on side of mastectomy. If drawn here, the
test results could be inaccurate because of lymph

Sites edema.
2. Scarred or burned areas.

to
3.Arm in which blood is being transfusion / IV
cannula. The fluid in the IV could dilute the
specimen.

be
Avoid
ed
 4. A hematoma (A hematoma is an
abnormal collection of blood outside of a

Sites blood vessel.

5. Edematous (Edema is swelling caused by fluid
retention) should be avoid because the accumulated
to fluid could alter testresults.

be
Avo
ided
 Incomplete collection or no blood is
obtained:
• Change the position of the needle. Move it
forward (it may not be in the lumen) or move it
backward (it may have penetrated too far).
Troubleshooting
 Adjust the angle (the bevel may be against the
vein wall).
Loosen the tourniquet. It may be obstructing
blood flow.
•Try another tube. There may be no vacuum in
Troubleshootin the one being used.
•Re-anchor the vein. Veins sometimes roll

g away from the point of the needle and

puncture site.
 A hematoma forms under the skin adjacent to
the puncture site - release the tourniquet
immediately and withdraw the needle. Apply

Other
firm pressure.

Problem The blood is bright red

s (arterial) rather than

venous. Apply firm
pressure for more than 5
minutes
 1. requisition form.
2. Greet the patient.
3. Identify the patient.
4.Reassure the patient and explain the

Summar procedure.
5. Prepare the patient.
6. Select equipment and supplies.

y
7. Wash hands and apply gloves.
8. Apply the tourniquet.
9.Select the venipuncture site.
10.Release the tourniquet.
11.Cleanse the site.
12.Assemble equipment.
 13.Reapply the tourniquet.
14.Confirm the venipuncture site.
15.Examine the needle.
16.Anchor the vein.

Summar 17.Insert the

needle.
18.Push the evacuated tube completely into adapter.
19.Gently invert the specimens, as they are

y collected.
20.Remove the last tube from the adapter.
21.Release the tourniquet.
22.Place sterile gauze over the needle.
23.Remove the needle, and apply
pressure. 24.Activate needle safety
 25.Dispose of the needle.
26.Label the tubes.
27.Examine the patient’s arm.
28.Bandage the patient’s

Summar arm. 29.Dispose of used

supplies.
30.Remove and dispose of gloves.
31.Wash hands.

y
32.Complete any required paperwork.
33.Thank the patient.
34.Deliver specimens to appropriate
locations.
References and
Sources Introduction to Medical Technology:
Practice in the Philippine Setting (2015)

Introduction to Medical Technology with

Science, Technology and Society (2015)

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