Inc. BarCharts - Phlebotomy

• Phlebotomy is derived from the Greek, phlebo- (relating to veins), and -tomy (relating to cutting)
• Phlebotomy (a.k.a., venipuncture) can be summarized as the incision of the vein for blood letting
• The main purpose of phlebotomy is to obtain blood for diagnostic testing and to remove blood for transfusion
• It involves highly developed and rigorously tested procedures and equipmentto ensure the safety and comfort of the patient and the integrityof the sample collected
• Phlebotomy skills and responsibilities are performed in a variety of healthcaresettings, ranging from hospital care units to home-health settings
• Furthermore, phlebotomy practice is more widely performed by all types of healthcare professionals, including:
  • nurses
  • respiratory therapists
  • emergency medical technicians (EMTs)
  • clinical laboratory professionals
• In hospital and clinical settings, the person performing the venipunctureprocedure is often called a phlebotomist

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[NOTE: Detailed procedural steps are outlined throughout the sections of this guide]

• Greet and identify patient
  • introduce yourself
  • explain that you are going to take a blood sample
  • make sure that you have the correct patient by checking the requisition or prescription
• Position and prepare the patient
  • position for both safety and comfort
  • explain the procedure and get a verbal informed consent from the patient
• Assemble your equipment
  • gloves
  • tourniquet
  • tubes
  • gauze
  • needle adapter
  • antiseptic pads, etc.
• Apply the tourniquet
  • 34 inches above the puncture site
  • REMEMBER: tourniquet should not be left on longer than one minute; a tourniquet left on too long may cause the following:
    • hemoconcentration (too many blood elements in plasma)
    • hemolysis (destruction of red blood cells)
    • petechiae (red spots on the skin)
  • patients with difficult veins may be asked to make a fist or squeeze a rubber ball after the tourniquet is applied; once blood starts flowing, the patient is asked to open the fist or stop squeezing the ball, after which the phlebotomist releases the tourniquet
• Select the site for the blood draw
  • best veins are in the antecubital fossa (inside of elbow)
    • first choice:median cubital vein
    • second choice:cephalic vein
    • third choice:basilic vein
  • if blood is to be drawn from hand or wrist, the phlebotomist may want to consider using a winged infusion set (butterfly) with smaller needles
• Palpate the vein
  • veins are best located by feel
  • be sure to palpate with the tourniquet on
  • veins will feel spongy, bouncy and firm
• Clean the site of venipuncture
  • antiseptic pads are used
  • clean the area in concentric circles spiraling upward fromthe puncture sight
  • allow to dry before puncturing the skin
• Examine the needle for defects
• Perform the venipuncture
  • anchor the vein and brace the arm
  • hold the needle with your dominant hand
  • angle the needle 1530 degrees
  • insert the needle, bevel up
  • hold the needle steady
  • keep the needle assembly downward to prevent reflux (backflow)
• Fill the first tube, then remove the tourniquet
  • to be sure the tourniquet stays on no longer than one minute, remove the tourniquet when blood flow has been established
  • this is usually done when the first tube is being filled
  • tourniquet MUST BE removed prior to needle removal to prevent a hematoma (swollen, red area under skin)
• Advance and change tubes
  • if it is a multi-tube draw, be sure to hold needle assembly still in patients arm when changing tubes
• Prepare the needle for removal
  • remove the last tube before removing the needle to prevent blood fromdripping out of the tube
• Withdraw the needle
  • apply gauze to the puncture area
  • press down on the site after the needle has been removed
  • DO NOT bend the arm over the puncture site as this can cause a hematoma
  • apply pressure for up to two minutes
  
• Dispose of the needle in the sharps container
• Label tubes properly
  • must contain patients name, ID number, date and time of draw
  • if using computer-generated labels, be sure the correct information is on the label
• Attend to the patient
  • make sure bleeding has stopped
  • apply a bandage; for patients on blood thinners (e.g., warfarin, aspirin), use special compression wraps (prevents/lessens bruising)
  • dispose of biohazardous materials in the correct containers
  • thank the patient
• Deliver specimen to the lab
  • follow the institutions policy for blood draw procedures