Phlebotomy

Question 1

What should be said/asked in an introduction for phlebotomy?

Answer 1

Wash hands (use alcohol gel or soap and water if your hands are visibly soiled)
Introduce yourself
Confirm patient details – name / DOB

Check if the patient has any allergies

Explain procedure:

“I need to take a blood sample which will involve inserting a needle into your vein.“

“It will feel like a sharp scratch and shouldn’t take too long“

Check understanding and gain consent:

“Does everything I’ve said make sense?”

“Do you have any questions?”

“Are you ok for me to go ahead with the procedure?”

Question 2

How do you prepare for venepuncture?

Answer 2

Preparation

Ensure the patient is lying or sitting comfortably (place a pillow under the arm if possible).

1. Wash hands again
2. Position the patient’s arm in a comfortable extended position that provides adequate exposure of the planned venepuncture area
3. Inspect the antecubital fossa or forearm for a suitable vein (it should ideally be visible without applying the tourniquet)
4. Apply the tourniquet about 4-5 finger widths above the planned venepuncture site
5. Palpate the vein:Choose a vein has a sizeable lumen and feels “springy”
   Tapping a vein gently can make it easier to visualise and feel

Things to avoid when performing venepuncture:

Pre-existing medical conditions may prevent particular limbs from being used (e.g. arterio-venous fistula, lymphoedema, previous mastectomy)
Avoid areas of broken, bruised or infected skin (cellulitis)
Do not use veins that feel hard feel hard or cord like (thrombosis / thrombophlebitis)
Do not perform venepuncture on an arm that has an intravenous infusion in progress as this may alter blood test results
You should avoid areas where two veins are joining as valves are often present

6. Wash hands again
7. Don gloves (gloves don’t need to be worn for cleaning the site, but they should always be donned prior to performing venepuncture itself)
8. Clean the site with an alcohol swab for 30 seconds and then allow to dry completely over 30 seconds:You should start cleaning from the centre of the venepuncture site and work outwards to cover an area of 2cm or more
   DO NOT touch the cleaned site afterwards at any point, otherwise the cleaning procedure will need to be repeated prior to venepuncture

Question 3

How do you insert the needle for venepuncture?

Answer 3

Insertion of the needle

1. Attach the needle to the barrel (some blood collection systems come pre-assembled, such as the butterfly needle with barrel shown in the video)
2. Unsheathe the needle
3. Anchor the vein from below with your non-dominant hand by gently pulling on the skin distal to the insertion site
4. Warn the patient of a sharp scratch
5. Insert the needle through the skin at a 30-degree angle or less, with the bevel facing upwards (you should see flashback and feel a decrease in resistance as the needle enters the vein)
6. Advance the needle a further 1-2 mm into the vein after flashback is seen
7. Lower and anchor the needle to the patient’s skin
8. Fill the blood sample bottles by attaching each in turn to the collection system
9. Release the tourniquet
10. Withdraw the needle and then apply gentle pressure to the site with some gauze or cotton wool
11. Ask the patient to hold the gauze or cotton wool in place whilst you dispose of the needle into a sharps container
12. Apply a dressing to the patient’s arm (cotton wool / gauze / plaster)
13. Discard the used equipment into the appropriate waste bin

Question 4

What is the order of draw?

Answer 4

1) Cultures
2) Light blue (citrate)
3) Yellow (SST)
4) Dark blue (heparin for trace elements)
5) Dark green (lithium heparin PST)
6) purple (EDTA)
7) Pink (EDTA - cross match)
8) silver (fluoride oxalate)