PRINCIPLES OF MEDICAL LABORATORY SCIENCE

BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE

BLOCK 1D
2nd Semester

TOPIC 1 FOR PRELIMS (LABORATORY): PHLEBOTOMY: EQUIPMENT

PHLEBOTOMIST  The phlebotomist must remember that it is

 A person trained to obtain blood samples
primarily by venipuncture and micro techniques
DUTIES OF THE PHLEBOTOMIST
desirable to integrate those very important
personal qualities of friendliness, compassion,
and honesty with the standards of conduct
required of a medical professional

 Traditional Duties
o Correct identification and preparation of the
patient before sample collection
o Collection of appropriate amounts of blood
venipuncture or dermal puncture for the
specified tests
o Selection of the appropriate sample
containers for the specified tests
o Correct labeling of all samples with the PROFESSIONAL AND PERSONAL
required information CHARACTERISTICS
o Appropriate transportation of samples back
to the laboratory in a timely manner  Dependable
o Effective interaction with patients and  Cooperative
hospital personnel  Committed
o Processing of samples for delivery to the  Compassionate
appropriate laboratory departments  Courteous
o Performance of computer operations and  Respectful
record-keeping pertaining to phlebotomy  Honesty Integrity
o Observation of all safety regulations, quality  Competence
control checks, and preventive maintenance  Organized Responsible Flexible
procedures o Technical Tip 1-3
o Attendance at continuing education programs  When organizing requisitions, check to
 Additional Duties of Phlebotomists be sure that you have all of the patient’s
o Evaluation of protocols associated with requisitions. Missing a requisition can
sample collection result in patient receiving an additional
o Performing and monitoring point-of-care puncture.
testing (POCT) o Technical Tip 1-4
 The abbreviation for work that must be
PROFESSIONALISM done immediately, as in an emergency, is
STAT or stat.
 “Conduct that manifests fine artistry or  Appearance
workmanship based on sound knowledge and
conscientiousness.”
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 o Clothing and lab coats must be clean and
unwrinkled
o Shoes must be clean, polishes, closed toed
and skid-proof
o Jewelry and makeup must be conservative;
tattoos must be completely covered
o Perfume and cologne are usually not
recommended or must be kept to a minimum
o Hair including facial hair must be clean, neat
and trimmed. Long hair must be neatly
pulled back
o Personal hygiene and clean fingernails
 Communication Skills
o Phlebotomist greeting a patient.
o Phlebotomist standing away from the patient
to introduce herself.
o Phlebotomist explaining the procedure and
still maintaining distance. APPEARANCE

BLOOD WITH ANTICOAGULANT  Normal: clear and ‘yellow’

 Abnormal
 Clotting is prevented and irreversible o Hemolyzed = pink to red (ruptured RBC)
 Mix: completely invert 8-10x o Icteric = dark orange-yellow (Bilirubin)
 Whole blood o Lipemic = cloudy (fat, triglycerides)
 Centrifuge plasma
 Plasma contains fibrinogen BLOOD COLLECTION TUBES

 Contain a vacuum
 Used with Vacutainer and Syringe systems
 Stoppers universal color coded: indicates
contents
 Have an expiration date
 Red-Top Tubes
o Glass
 No additive
 Glass surface activates clotting sequence
 Do not mix
 SERUM: use for TDM (Therapeutic drug
monitoring)
BLOOD WITHOUT ANTICOAGULANT o Plastic
 Contain additive to activate clotting
 Spontaneous clotting occurs and is irreversible sequence
 Fibrinogen fibrin strands  Contain inert gel SST
 Fibrin strands entrap cells  Do invert to mix additive and initiate
 Centrifuge serum  SERUM
 Serum lacks fibrinogen

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 Gold or Mottled-red-gray top
o Contain clot activator and gel (SST)
o Invert to mix and initiate clotting sequence
o SERUM

 Purple-top Tube
o PLASMA and Whole Blood
 Anticoagulant = EDTA
 Binds Calcium
o Hematology studies: CBC
 Blue-top Tube
o PLASMA and Whole Blood
 Anticoagulant = sodium citrate
 Binds calcium
o Must be full Blood: Anticoagulant ratio  Grey-top Tube
critical o Anticoagulant = potassium oxalate
o Must be on ice if not analyzed within 30  Binds calcium
minutes  Plasma, Whole blood
o Coagulation studies o Antiglycolytic agent = sodium fluoride
 Maintains plasma glucose levels
o Limited use: glucose, lactic acid

 Green-top Tube
o PLASMA and Whole Blood
 Anticoagulant = heparin  Yellow-top tube
 Three Formulations: o ACD= acid citrate dextrose
 Lithium Heparin  Paternity testing
 Ammonium Heparin  DNA
 Sodium Heparin o SPS= sodium polyanethol sulfonate
o Inhibits thrombin formation  Used for special blood culture studies
o Must be full and on ice if need pH, ionized  Inhibits certain antibiotics
Ca o Both bind calcium
o Most chemistry tests, STAT lab (PST) o PLASMA, Whole blood
decreases time needed for blood to clot,
makes turnaround time better

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 SAFETY: ENGINEERING CONTROL

 PPE
TYPE AND AMOUNT OF SPECIMEN  Sharps containers
 Safer medical devices
 Dependent upon
o Test
 Whole Blood: EDTA or Heparin?
 Plasma: ESTA or Heparin?
 Serum: Trace free or separator gel
interference?
 Amount of sample needed to perform test
 Multiple labs needing the same specimen
at the same time

SAFETY PRACTICES

 For infection to spread:

1. Infectious Substance: HBV, HCV, HIV
2. Mode of Transmission
3. Susceptible Host

MODES OF TRANSMISSION

 Parental EQUIPMENT
o Any route other than the digestive tract
 Intramuscular Non-intact Skin:
chapped hands, cuts,
 PPE
 Intravenous  Cleaning Agent
cuticles
 Subcutaneous Percutaneous: needles, o Alcohol pads: routine
 Mucosal sharps o Povidone iodine: blood culture collection and
 Ingestion Permucosal: mouth,
nose, eyes
blood gases
o Soap and water: alcohol testing, allergies
SAFETY INFECTION CONTROL
 Cotton balls, gauze
 Bandage, tape (use caution with children)
 Hand Washing
o Primary means of preventing spread of  Sharps containers
o Discard needle, lancets
infection (especially nosocomial)
o Minimum 15 seconds, soap, friction o Biohazard marking
o Wash hands before and after each blood draw o Puncture resistant
o NEVER recap, bend break needles
 PPE
o Lab coat  Tourniquets
o Gloves o Slows venous blood flow down
o Mask o Causes veins to become more prominent
o NEVER leave on for >1 minute
 Standard precautions at all times
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 o AVOID rigorous fist clenching or hand
pumping (potassium, lactic acid, LD)
o Latex allergy
TYING ON THE TOURNIQUET
Butterfly Needle
 Most often used with syringe
 Expensive, thus not used for routine draws
 Used for small, fragile veins
 Increased risk of needle stick injury

 Needles
o NEVER reuse a needle
o NEVER use if shield is broken
o NEVER recap, cut, bend or break
o Drop immediately into sharps container after
venipuncture
o Size of needle is indicated by gauge:  Tube Holder/ Vacutainer adapter
 Larger gauge number indicates smaller o Threaded
needle diameter o Flanges
 21, 23-gauge needles routinely used for
phlebotomy

 Syringe
 Black water proof pen

Multi-sample needle

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 Syringe Safety Device
 Veins that lack resiliency
 Extensive scarring
 Hematomas
 Edematous area
 Side of mastectomy
 Intravenous line
o NEVER draw above an IV
o Draw from other arms
o Draw from hand on other arm
o Draw below IV
LABELLING BLOOD COLLECTION TUBES

 Black indelible marker (water proof)

o Never pencil
o Legal Document
o Print legibly
 Required information: 5 items
o Patient name
o Identification number
o Date of draw (mm, dd, yyyy)
o Time of draw (military time)
o Phlebotomist signature: first initial, last name
SELECTING THE SITE

 Antecubital area most often accessed

 Hand or wrist
NO NEEDLE MOVEMENT
 Remember: 2 arms
 Use tip of index finger on non-dominant hand to
 You must anchor the blood-drawing equipment
palpitate area to feel for the vein
on the patient’s arm to minimize chance of injury

WITHDRAW NEEDLE

 First release tourniquet

 Disengage tube
 Place cotton directly over needle, without
pressing down
 Withdraw needle in swift, smooth motion
 Immediate apply pressure to wound
 Do not bend arm

LABELS TUBES IMMEDIATELY

 In sight of patient
COLLECTION SITE PROBLEMS
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 Patient name
 Identification number
 Date of draw
 Time of draw (military time)
 Your initials
 Recheck Draw Site

NEEDLES POSITION

VENIPUNCTURE PROCEDURE

 Locate vein
 Release tourniquet
 Cleanse site in outward rotation
o Allow to air dry

POSITION COLLECTION TECHNIQUES

 Venous stasis
o Prolonged application of tourniquet (>1 min)
 Hemodilution  Reapply tourniquet
o Drawing above IV o Do not contaminate site
o Short draw (blood to anticoagulant ratio)  Anchor vein
 Hemolysis  Insert needle
o Traumatic stick  Fill tubes
o Too vigorous mixing o Quick mix additive tubes
o Alcohol still wet  Release tourniquet
o Using too small of needle  Withdraw needle
o Forcing blood into syringe

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 Engage safety device MARK YOUR SPOT
 Dispose of needle immediately
 Apply pressure to puncture site
 Label tubes
 Recheck puncture site
 Thank patient
 Remove gloves, wash hands

SKIN PUNCTURE

 Methos of choice for infants, children under 1

year
 Adults
o Scarred
o Fragile veins
o Hardened veins
o Home glucose monitoring (POCT)
o Patients with IV

CAPILLARY BLOOD
SYRINGE DRAW
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 Mixture of arterial, venous, capillary blood and
fluid from surrounding tissues
 Fluid from surrounding tissues may interfere
and/or contaminate the specimen
 Warming skin puncture site increases arterial
blood flow to the area
 Reference ranges often differ from venous

CAPILLARY BLOOD

 Lancets
o Always use standardized equipment
o NEVER use a surgical blade
SKIN PUNCTURE PROCEDURE

 Hold finger between your index finger and

thumb
 Puncture the finger using a quick, smooth motion
 Wipe away the first drop of blood

SKIN PUNCTURE EQUIPMENT  Collect Sample

o DO NOT touch collecting device to skin
 Micro-specimen Containers surface
o Capillary tubes o DO NOT scrape collecting device across skin
o Microtainers surface
o Capillary blood gas tubes o DO NOT scoop blood into collecting device
o Micropipette diluting system  Order of draw is critical: platelets accumulate
at puncture site causing clot formation
o Blood smear
o EDTA
o Heparin
o Serum
 Apply pressure to puncture site
 Label specimen in sight of patient (indelible
marker)

SKIN PUNCTURE SITE

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