Chapter 40

Phlebotomy: Venipuncture and

Capillary Puncture

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Why Collect Blood?

Phlebotomy used to determine disease and
treatment
Bloodletting dates back to ancient
Egyptians
Phlebotomy historically used to cure
patients with bad blood

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

The Medical Assistants

Role in Phlebotomy
To collect blood as efficiently as possible
for accurate and reliable test results
Role varies
Direct contact with patient

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

The Medical Assistants

Role in Phlebotomy
Provide high-quality care
Focus on safety

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Anatomy and Physiology

of the Circulatory System
Blood forms in bodys organs and bone
marrow
Blood carries oxygen and nutrients to cells
and removes waste products and carbon
dioxide
Click here to see an animation

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Anatomy and Physiology

of the Circulatory System
Veins
Usually carry deoxygenated blood, containing carbon
dioxide and other cellular wastes
Thin-walled (thinner than arteries)
Carry blood back to the right side of the heart from the
cells
No pulse

Capillaries connect most arteries and veins

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Anatomy and Physiology

of the Circulatory System
Arteries
Usually carry oxygenated blood
Thick-walled
Branch to form arterioles, which branch to form
capillaries
Have pulse
Path of blood away from the heart

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Anatomy and Physiology

of the Circulatory System
Body contains about 6 liters of blood
Forty-five percent of blood is formed
elements
Erythrocytes
Leukocytes
Thrombocytes (platelets)

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Anatomy and Physiology

of the Circulatory System
Two mL of blood will yield about 1 mL of
fluid
Liquid part of blood is plasma

Clotting converts fibrinogen into fibrin

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Anatomy and Physiology

of the Circulatory System

Centrifuge separates serum from blood

Anticoagulant prevents blood from clotting to produce
plasma specimen
Buffy coat
Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Anatomy and Physiology

of the Circulatory System
How to obtain blood sample

Antecubital area
Median cubital vein
Superficial veins in hand
Veins in wrist
Veins in feet or legs
Arteries of arms

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Equipment
Syringes and needles
Do not destroy integrity of vein
Syringes vary in volume from 1 mL to 50 mL
Pull plunger of syringe to create vacuum within barrel

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Equipment
Syringes and needles
Avoid causing vein collapse
Use with butterfly collection set
Recommended length of needle

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Equipment

Safety needles
Required
Protects patient and health care worker

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Equipment
Vacuum tube system
Vacuum tube system
Closed system
Tube with vacuum already in it attaches to needle
Tubes vacuum is replaced by blood

Double-pointed needle with different-length needle on

each end and screw hub near center

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Equipment
Vacuum tube system
Needle acts as pipeline to deliver blood from patient to
tube
Bevel of needle should face upward when inserted into
vein
Insert at 15 angle
Safety tube holders

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Equipment
Additives, anticoagulants, and gels
Different tests require different types of blood
specimens
Anticoagulants prevent clotting of blood
Steps to a clot
Basic anticoagulant tubes
Other additives improve quality of specimen

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Equipment
Additives, anticoagulants, and gels
Thixotropic separator gel >>
Separator gel tube: centrifuging process
Glass particles activate clotting

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Equipment
Tourniquets
Constrict flow of blood in arm
Make veins more prominent
Rubber or elastic strip 1 inch wide by 1518 inches
long
Blood pressure cuff may be used instead

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Equipment
Specimen collection trays
Hold all equipment necessary
Carts also used

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
Approaching the patient
Social skills
Technical skills
Administrative skills

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
Preparing supplies and greeting the patient
Prepare before venipuncture
Keep spare tubes
Put patient at ease

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
Patient and specimen identification

Ask patient to state full name

Check wristband if applicable
Label sample tubes before leaving examination room
Check paperwork against tubes

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
Patient and specimen
identification
Computer label >>
Aliquot specimen

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
Positioning the patient
Selecting the appropriate venipuncture site
Order of preferred sites

Antecubital
Back of hand
Wrist (difficult)
Ankle or foot (needs a doctors written order)

Use of tourniquet

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
Performing a safe venipuncture

Find site that will give best blood return

Palpate vein with tip of finger
Differentiating between veins, tendons, and nerves
Use the tourniquet appropriately
Avoid scars and compromised arms

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
Click Here to play the video

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
Syringe specimen collection

Identify patient
Verify paperwork and tubes
Assemble equipment
Situate patient in comfortable position
Wash hands

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
Syringe specimen collection

Select vein
Tie tourniquet
Don gloves
Clean site and allow to air-dry
Palpate for vein

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
Syringe specimen collection
Hand position to hold syringe >>

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
Syringe specimen collection

Place blood in appropriate containers

Fill tubes according to recommended order
Activate safety device immediately
Place empty syringe and needle into sharps container

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
Vacuum tube specimen order of draw
Procedure follows syringe method with only slight variations
Proper hand position >>
Order of draw

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
Butterfly collection system
Combines benefits of syringe and vacuum methods
Used for small or fragile veins that are difficult to draw
Winged needle inserted at about 5 angle then threaded
into vein

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
Blood Cultures
Use a surgical solution rather than alcohol
Use sterile techniques
Blood is collected into special transport bottles
Aerobic bottle is filled first, then anaerobic

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
Patient reactions
Vary
Stop if pain persists

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
The unsuccessful venipuncture
Try another tube
Change position of needle by rotating needle half a turn
Advance further into vein

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
The unsuccessful venipuncture

Pull back a little

Methods of vein stimulation
Probing of vein not recommended
After two attempts, have someone else try

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
Criteria for rejection of a specimen
Quality assurance for specimen collection and
processing
Another specimen often obtained to recheck results

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Venipuncture Technique
Factors affecting laboratory values
Incorrect specimen handling and storage
Patient factors
Not fasting

Drawing procedure incorrect

Alcohol in specimen
Tourniquet on too long
Wrong tube

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Capillary Puncture
Method of obtaining one to several drops of
blood
Tests that use blood obtained by capillary
puncture

CBC, RBC, and WBC

Hemoglobin and Hematocrit
Glucose testing
Phenylketonuria testing

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Capillary Puncture

Puncture sites

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Capillary Puncture
Preparing the puncture
site
Promoting circulation
Cleaning and disinfecting
>>

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Capillary Puncture
Performing the puncture
Wear appropriate PPE
Perform the puncture in one
steady motion >>
Wipe away the first drop of
blood
Collect in capillary tubes or
other capillary collection
device >>

Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.