Académique Documents
Professionnel Documents
Culture Documents
Phlebotomy
Objectives
Theory and practice of phlebotomy
How to interact professionally with patients
Occupational health hazards and appropriate
precautions
Related anatomy and physiology
Phlebotomy equipment and supplies
Phlebotomy procedures
Complications of venipuncture and how to
handle them.
What is phlebotomy
The term phlebotomy refers to the ancient
practice of bloodletting
Phlebotomy: Historical Practice
4
5
6
7
8
9
10
What is phlebotomy
The term phlebotomy refers to the ancient
practice of bloodletting
Now the term phlebotomy is used for the
withdrawal of blood from a vein, artery, or
the capillary bed for lab analysis or blood
transfusion.
Modern Phlebotomy
Diagnosis and management of disease
Therapeutic reasons:
Polycythemia
Hemochromatosis
12
Who is a phlebotomist
Collects blood and other specimens
Diagram of
Hepatitis C
Virus
Occupational Health and Safety
Administration of the federal government
has mandated bloodborne pathogen
training for all workers who are at risk of
exposure.
OSHA Training
Standard Precautions
Personal Protective Equipment
Hand Washing
Hazardous waste disposal
Needle sticks and prevention act
Standard Precautions
Standard Precautions
Standard Precautions means treating all
body fluids and substances as if they were
infectious.
Standard Precautions
Potentially infectious body fluids include:
Blood, Semen, Vaginal Secretion,
Peritoneal, pericardial and pleural fluids,
and Saliva
Sweat and tears are not generally
considered infectious.
Personal Protective Equipment
Personal Protective Equipment
lab coat
Gloves
Face masks ( certain types of isolation)
Hand Washing
Hand washing is the single most important
infection control measure.
Wash hands thoroughly before, after, and
between all patient contacts.
Be sure to turn off faucets using a paper
towel to avoid contamination.
Hand washing
Remove rings
Stand by the sink but do not touch it
Apply soap and rub hands together
Both sides of the hand, between fingers,
around knuckles, under fingernails
Rinse hands in a downward motion
Dry hands with a clean paper towel
Turn off water with another paper towel
Hand Washing
Hazardous waste disposal
All needles & other
sharps must be
disposed of in
approved sharps
disposal containers.
Other contaminated
waste must be
discarded in an
appropriate
biohazard bag or
waste receptacle.
Needlestick
Needle sticks and prevention
act
Safety Devices should always be
encouraged
Anatomy & Physiology
Anatomy & Physiology
Anatomy is the branch of science
concerned with the study of the structure
of the body.
Physiology is the branch of science
concerned with the study of the function of
the body.
Anatomy & Physiology
The cardiovascular
system consists of the
Heart, and Blood Vessels.
Its main function is
circulate oxygenated
blood from the lungs to
various organs, and
return blood depleted of
oxygen to the lungs,
where it is reoxygenated.
Blood Function:
1. Supplies nutrients to tissues:
O2, hormones, glucose
Centrifuge serum
57
Coagulation:
In vivo
Blood is fluid
Clot is formed to
protect injured vessel
In vitro
Spontaneous reaction
Triggered by glass or poor drawing technique
58
Blood Clot
When a blood sample
is left standing without
anticoagulant, it forms
a coagulum or blood
clot.
The clot contains
coagulation proteins,
platelets, and
entrapped red and
white blood cells.
Serum
Serum contains all
the same substances
as plasma, except for
the coagulation
proteins, which are
left behind in the
blood clot.
Blood with anticoagulant:
Clotting is prevented and
irreversible
Whole blood
Centrifuge plasma
Whole blood
Plasma
Serum
63
Plasma
Appearance
Normal: clear and yellow
Abnormal:
Hemolyzed = pink to red (ruptured RBC)
Icteric = dark orange-yellow (bilirubin)
Lipemic = cloudy (fat, triglycerides)
65
Appearance
66
Equipment
Valid Test Results Require:
Trained personnel
Causes of pre-analytical error
Invalid test results
Quality control
Quality assurance
Sophisticated
instruments
68
Safety Practices:
For infection to spread:
1. Infectious substance: HBV, HCV, HIV
2. Mode of transmission
3. Susceptible host
69
Modes of Transmission:
Parenteral: any route other than the
digestive tract
Intramuscular Non-intact skin: chapped
Intravenous hands, cuts, cuticles
Subcutaneous Percutaneous: needles, sharps
Mucosal Permucosal: mouth, nose, eyes
Ingestion
70
Safety Practices:
Infection Control: stop the spread of infection
71
Safety: Infection Control
Hand washing
Primary means of preventing spread of
infection (especially nosocomial)
Minimum 15 seconds, soap, friction
Wash hands before and after each blood draw
PPE
Lab coat
Gloves
Mask
Standard precautions at all times 72
Safety: Engineering Controls
PPE
Sharps containers
Safer medical devices
73
Safer Medical Devices:
74
Equipment:
1. PPE: gloves, lab coat, mask
2. Cleaning agent
Alcohol pads: routine
Povidone iodine: blood culture collection and
blood gases
Soap and water: alcohol testing, allergies
76
Equipment: coat
77
Equipment:
4. Bandage, tape (use caution with children)
5. Sharps container:
Discard needles,
lancets
Biohazard marking
Puncture resistant
79
Tying on the Tourniquet:
80
Equipment:
7. Needles
NEVER reuse a needle
NEVER use if shield is broken
NEVER recap, cut, bend or break
83
Butterfly Needle:
84
Butterfly Needle:
Most often used with
syringe
Threaded
Flanges
86
Equipment:
9. Syringe
10. Black
water proof
pen
87
Syringe Safety Device:
88
Workstation
Mobile phlebotomy
workstation
Workstation
phlebotomy
drawing
station
Workstation
Portable infant
phlebotomy
station
Trays
96
Red-top tube:
Glass
No additive
Glass surface activates clotting sequence
Do not mix
SERUM: use for TDM (therapeutic drug monitoring)
Plastic
Contain additive to activate clotting sequence
Contain inert gel SST (serum separating tube)
Do invert to mix additive and initiate clotting sequence
SERUM
97
RED
No additives
Blood bank tests,
toxicology, serology
Must not be inverted
after filing
Gold or Mottled-red-gray top tube:
Contain clot activator
and gel (SST)
SERUM
99
Tubes containing
anti-coagulant
100
Blue-top tube:
Anticoagulant = sodium citrate
PLASMA
Binds calcium Whole blood
Must be full
Blood:anticoagulant ratio critical
Coagulation studies
101
LIGHT BLUE
sodium citrate.
coagulation (clotting)
studies.
must be completely
filled
must be inverted
immediately after
filling
Green-top tube:
Anticoagulant = heparin
Three formulations: Lithium heparin
Ammonium heparin PLASMA
Sodium heparin Whole
blood
Inhibits thrombin formation
103
Green-top tube:
104
GREEN
sodium or lithium
heparin
for tests requiring
whole blood or
plasma such as
ammonia
Purple-top tube:
Anticoagulant = EDTA
PLASMA
Binds calcium Whole blood
106
LAVENDER
EDTA to prevent
clotting
hematology studies.
Should be completely
filled
Must be inverted after
filling
Grey-top tube:
Anticoagulant = potassium oxalate
Binds calcium
PLASMA, Whole blood
108
GRAY
Inhibitor for glycolysis
+ anticoagulant
Sodium Fluride
+potassium oxalate.
glucose levels.
Fibrin-split Products tube
Light blue top tube with 2 yellow bands on the
label
110
Yellow-top tube:
ACD = acid citrate dextrose
Paternity testing
DNA
113
ROYAL BLUE
heparin or Na EDTA
anticoagulants
Tube is designed to
contain no contaminating
metals
Trace element and
toxicology studies
Blood Culture Bottles
Different blood culture
bottles are used for
aerobic, anaerobic,
and pediatric
collections.
Blood collection tubes: Safety
The rubber stopper is
positioned inside the
plastic shield
Blood collection tubes: Safety
The rubber
stopper is
positioned inside
the plastic shield
Sizes
Adult:3 - 10 ml
Pediatric 2 - 4 ml.
Tubes for fingersticks
or heelsticks or
less
Type and Amount of Specimen:
Dependent upon
Test
Whole blood: EDTA or heparin?
Plasma: EDTA or heparin?
Serum: trace free? Separator gel interference?
146
147
Collection Site Problems:
Veins that lack
resiliency
Extensive
scarring
Hematomas
Edematous
area
150
Collection Site Problems:
Indwelling lines:
Hickman catheters
Heparin locks
Used to administer medication
Only nurse may access these lines
Can obtain blood: called a line draw
Must clear line of heparin contamination
by discarding first 5-10 cc of blood
151
Hickman Catheter:
152
Inserting the Needle:
Anchor the vein
Grasp arm with your
non-dominant hand
Use thumb to pull skin
taut
Smoothly and
confidently insert the
needle bevel up
15-30 degree angle
153
154
No Needle Movement!
You must anchor the blood-drawing equipment
on the patients arm to minimize chance of injury
155
156
Fill Tubes:
Use correct order of draw:
Blood cultures
Red top
Blue (baby blue)
Green
Purple
Grey
157
Be careful not to:
Push needle further into vein when
engaging evacuated tube
Pull needle out of vein when disengaging
tube
Pull needle out of vein as you pull back on
the plunger
Pull up or press down when needle in vein
Forget to mix additive tubes 8-10 times
158
Withdraw Needle:
First release tourniquet
Disengage tube
Place cotton directly over needle, without
pressing down
Withdraw needle in swift, smooth motion
Immediately apply pressure to wound
Do not bend arm
159
Label Tubes Immediately:
In sight of patient
Patient name
Identification
number
Date of draw
Time of draw
(military time)
Your initials
160
Recheck Draw Site:
161
Failure to Obtain Blood:
Check tube position and vacuum
Always have back up tubes near by
Needle position
Collapsed vein
162
Needle Position:
163
You should try again
Look at alternate site
Other arm
Hand
Use clean needle
Use fresh syringe if
contaminated
164
Poor Collection Techniques:
Venous stasis
Prolonged application of tourniquet (>1 min)
Hemodilution
Drawing above IV
Short draw (blood to anticoagulant ratio)
Hemolysis
Traumatic stick
Too vigorous mixing
Alcohol still wet
Using too small of needle
Forcing blood into syringe 165
Poor Collection Techniques:
Clotted sample
Inadequate mixing
Traumatic stick
Partially filled tubes
Short draw
Sodium citrate tube draw volume critical
Using wrong anticoagulant
166
Poor Collection Techniques:
Specimen contamination
Using incorrect cleanser
Alcohol still wet
Powder from gloves
Drawing above IV
Specimen handling
Exposure to light
Pre-chilled tube
Body temperature
167
Venipuncture Procedure
Remain calm
Organize yourself
168
Equipment: Stick to Eleven
Gloves Needle
Lab coat Syringe or vacutainer
Alcohol wipe holder
Cotton ball Collection tubes with
Bandage/tape backup tubes
Sharps container Water-proof marker
Tourniquet
169
Venipuncture Procedure:
Wash hands
Put on gloves
Identify patient
Latex allergy?
Position arm
Apply tourniquet
170
171
Venipuncture Procedure:
Locate vein
Release
tourniquet
Cleanse site in
outward rotation
Allow to air dry
172
Venipuncture Procedure:
Reapply tourniquet
Do not contaminate
site
Anchor vein
Insert needle
Fill tubes
Quick mix additive
tubes
Release tourniquet
Withdraw needle
173
Venipuncture Procedure:
Engage safety device
Dispose of needle
immediately
Apply pressure to
puncture site
Label tubes
Recheck puncture
site
Thank patient
Remove gloves,
wash hands 174
Accidental Needle Stick:
Remain calm
Cleanse wound with alcohol
Wash wound thoroughly
Notify supervisor, instructor
Follow site protocol
Page OUCH hotline: 1-402-888-OUCH
1-402-888-6824
Complete incident report
175
Syringe draw
176
Syringe Safety
Transfer Device
177
Mark your spot
178
Hand Vein Draw
179
Skin Puncture:
Method of choice for infants, children
under 1 year
Adults
Scarred
Fragile veins
Hardened veins
Home glucose monitoring (POCT)
Patients with IV
180
Capillary Blood
Mixture of arterial, venous, capillary blood
and fluid from surrounding tissues
2. Cleaning agent
Alcohol pads: routine
Soap and water: alcohol testing, allergies
DO NOT use providone iodine
5. Sharps container
6. Warming device
Commercial warmer
Warm wet washcloth
183
Skin Puncture Equipment:
7. Lancet
Always use
standardized
equipment
NEVER use a
surgical blade
184
Skin Puncture Equipment:
8. Micro-specimen
containers
Capillary tubes
Microtainers
Capillary blood gas
tubes
Micropipet diluting
system
185
Skin Puncture Equipment:
9. Glass slides:
used to prepare
blood smears
186
Skin Puncture Procedure:
1. Wash hands
2. Approaching the patient
3. Patient identification
4. Latex allergy?
5. Bedside manner
6. Site selection
7. Cleanse site: DO NOT use providone- idodine
8. Perform puncture: Wipe away first drop of blood
9. Label the specimen 187
Skin Puncture Site Selection:
188
Skin Puncture Procedure:
Hold finger between your index finger and thumb
189
Skin Puncture Procedure:
Collect sample
DO NOT touch collecting device to skin surface
DO NOT scrape collecting device across skin surface
DO NOT scoop blood into collecting device
190
Skin Puncture Procedure:
Order of draw is critical: platelets accumulate at
puncture site causing clot formation
Blood smear
EDTA
Heparin
Serum