Phlebotomy Flashcards
What Equipment is needed for Phlebotomy?
What considerations should you make before starting?
It is important to review the treatment plan with the patient and to assess which site would be best for performing the procedure, which equipment to use and which vacutainer (blood collecting tube/s) to use.
You should consider the following:
Patient History and Treatment Plan
- The patient’s overall physical and psychological condition
- Have there been problems with previous Phlebotomy attempts
- What are the indications for the procedure and how does the blood sample require to be processed (e.g. which vacutainer / blood collection tube/s are we required to use).
Patient’s Veins
- Vein Size
- Condition of Veins (e.g. are the veins very mobile or fragile?)
List the steps involved?
- Patient First Name, Surname and DOB
- Check Patient Wrist Band
Understand and explain indications for the
procedure in the particular patient.
- What will happen?
- Positive outcomes / expected outcomes.
- Possible unexpected outcomes/possible complications
Obtain and document informed valid consent.
Choose appropriate site for the procedure,
checking for any contraindications.
Check all for expiration date.
Open all packaging for access, assemble the
equipment
Disinfect top of Blood Culture Bottles after removing the caps (if drawing, use aseptic technique and Cleanse top - 2% chlorhexidine/70% alcohol swab
Perform Hand hygiene.
Apply tourniquet and select a vein..
Cleanse site for 30 seconds and allow to dry.
DO NOT RE-PALPATE VEIN!
Perform Hand hygiene. Apply gloves.
Blood Collection Needle;
- Take cap off of needle – make sure that the bevel is up.
Place thumb on top of Vacutainer holder and two
fingers below to secure holder.
Winged infusion SET / Safety-Lok Blood Collection Set / Butterfly needle / Push Button Collection Set
- Hold wings between index finger and thumb, take cap off of needle, make sure that the bevel is up.
- REMEMBER TO DUMP FIRST BIT OF BLOOD INTO SHARPS CONTAINER!!!
Apply skin traction
Alert patient when about to puncture skin.
Insert needle into vein at an angle of approximately 15-30 degrees, adjusting
angle according to vein depth and Aligning
the needle so that it is parallel to the
direction of the vein.
Do NOT switch equipment/needle between
hands.
Introduce the blood collection tube deeply
into the holder, piercing the rubber section (in the correct order of draw if drawing more than one specimen).
Once you know you are in the vein, release the tourniquet.
Allow blood to finish being drawn into tube and remove the tube.
Invert the tube the number of instructed times (gently). None for culture, 3-4 Blue, 5-6 Red and Gold, 8-10 for Green, Lavender, Pink, Grey, Dark Blue
Remove the needle.
Apply firm pressure to puncture site using a
cotton ball, keeping the patient’s arm extended. You may need to apply a plaster.
Engage safety mechanism and Dispose of needle & holder in sharps container that you have taken with you to the patient’s side.
Discard equipment as per local policy.
Remove gloves and dispose of in orange clinical waste bag.
Perform Hand hygiene.
Label blood specimen(s) and place in specimen bag with a fully completed request form in outer pocket while in the presence of the patient.
Place a ‘Blood Culture Case Note Sticker’ in patient’s case notes if the facility is using them.
Aftercare - Thank the patient and make sure
that they are comfortable.
Aftercare - Document completion of the procedure including any complications and aftercare required.
Aftercare - Reassess the patient for any
problems.
What bloods can you and cant you do as a student?
- Blood Sampling
- Pre-transfusion blood sampling (Cross match/group and screen) if completed ‘Safe Transfusion Practice’ module and are fully supervised during the whole procedure and form countersigned by supervisor
CANNOT draw bloods from a central line !
Why do we do phlebotomy?
- To take blood cultures (e.g. suspected bacteraemia, sepsis, septic shock)
- To allow blood analysis (e.g. suspected anaemia, infection, to assist with
disease diagnosis, research) - Drug level monitoring / effectiveness of Drug therapy (e.g. anti-coagulants, digoxin,
vancomycin) - Cross Matching (e.g. prior to blood transfusion or blood volume problem)
What is the most common sized needle used in ARI and the size bigger and smaller?
21G, size bigger is 14G and size smaller is 24G
Should IV cannulas be used for blood sampling?
No - They should never be used if they have been in situ for a while. In
a clinical emergency a newly inserted cannula may be used to draw blood but only
if the cannula has not been flushed. Such specimens may be more likely to be
haemolysed which can result in a falsely elevated K+ level in the results from the
lab. “Hemolysis, the number one cause for rejection of a blood sample, occurs in 0-
3.8% of samples drawn by venepuncture and in up to 77% of samples obtained
from an I.V. catheter
Should a needle and syringe be used to draw blood?
No this is not best practice (suction)
Why do we throw away the first vacutainer when using a winged needle?
Each Vacutainer tube has a vacuum level set for the specific amount of blood needed for analysis. When using a winged blood collection set, you will need to put a
vacutainer tube on initially to draw the air out of the phlebotomy tubing and blood into it (this will be demonstrated in class). This initial tube is then put into the Sharps
Container (it is a “throw away” tube) because it will not have enough blood in it to run
the test because some of the vacuum volume has been taken up by the air. The only
container that has more vacuum present than the amount of blood needed is the Blood Culture bottles (i.e. a “throw away” tube is not needed).
How will you know if you have enough blood?
Will be marking on Vaccutainer (little black one?). Each vacutainer must have a specific amount of blood to mix with the specific amount of additive already in the tube. Otherwise over-dilution of the blood occurs, invalidating the results, and another sample would need to be drawn.
When are Single Use Torniques used?
Tourniquets are used to impede venous flow but not arterial flow; thereby distending
the vein. Disposable Single use tourniquets are recommended for infection prevention and control reasons – they are disposed of in an orange waste bag. Reusable quick release tourniquets, if used, should be able to withstand cleansing between each patient.
What is the maximum time a torniquet should be on a patient for?
It is suggested Tourniquets should not be tightened for more than 2 minutes.
Where is phlebotomy normally carried out?
The most common site used for phlebotomy is the antecubital fossa although any vein in the arm and hand that is accessible can be used. You are advised to attempt to use distal veins first and then proceed proximally as needed. You are
looking for easily palpable veins with good capillary refill. Remember that veins do not pulsate.
What is important to get the patient to do when taking blood from the Anticubital fossa?
If you are going to use the antecubital fossa site, then ask the patient to keep their arm straight throughout the procedure as any bending at the elbow may lead to transfixation and thus increase the risk of a haematoma.
What veins is the Wingned needle good for?
The winged blood collection set can be utilized for veins from the fingers to the shoulder.
What order do you collect bloods in (tube colours?)
- Blood Cultures (Silver label with blue top – aerobic), (Gold label with gold top – anaerobic)
- Blue (Coagulation Studies, INR)
- Red (Bacteriology + Virology)
- Gold (Most routine biochemistry + Troponin I Haematinics Assays)
- Green (RBC Osmotic Fragility, Ammonia)
- Lavender (PTH, Lead, Cyclosporin, Tacrolimus, COHb, Full Blood Count (FBC), RBC Folate, IM Test, Malarial, Parasites, CMV, PCR (Virology)
- Pink (Blood Grouping,Cross match)
- Grey (Glucose, HbA1C, Alcohols, Lactate)
- Dark Blue (Consult Biochemistry)
