HEMATOLOGY 2 LABORATORY: BLOOD COLLECTION (TRANS-1)

ARTERIAL PUNCTURE Complications:

 Puncturing the artery to collect
 Arteriospasm
arterial blood
 Involuntary contraction of the
 Not performed by MEDTECHS
artery
 Only performed by respiratory
 Maybe due to stress or anxious
therapist and physicians
before the procedure
 can be obtained either through a
 Hematoma
catheter placed in an artery, or by
 Or excessive bleeding
using a needle and syringe to
 Prevented by inserting the needle
puncture an artery
without puncturing the vessels
 collecting from artery for analysis of
 Prevented by applying pressure
blood gases (oxygen,c02)
 arterial blood placed in pre-
 Nerve damage
heparinized syringes or directly on
 by choosing an appropriate
iced box
sampling site and avoiding
 test immediately to avoid clotting
redirection of the needle
 can be used to test analytes in the
 what makes dangerous for the
body and protein levels
arterial puncture
PUNCTURE SITES:  When you keep searching on the
artery it may hit and damage the
Radial artery Brachial Femoral
nerves
artery artery
 Fainting
Most On basilica Same with
 by ensuring that the patient is
common used vein on brachial which
site antecubital hard to locate supine with feet elevated before
fossa beginning the blood draw
Found on 4 collateral  patient must be on lying position
wrist circulation of  Prevented by ensuring that the
blood block patient is supine
There is a Block by
pressure tissue and
ligaments
Skills and
practice is
essential in
performing
this
Performed by
medtechs if (45 degree or 90 degrees angle)
they are
supervised by
SKIN PUNCTURE
immediate
 Collecting capillary blood
staff
HEMATOLOGY 2 LABORATORY: BLOOD COLLECTION (TRANS-1)

 a mixture of capillary, venous, and

arterial blood with interstitial
(tissue) fluid and intracellular fluid
 For small amount of blood
 Used 3rd or 4th finger of non-
dominant hand
 Must be 2-4mm depth of puncture • Sites to avoid
 More nerve ending as compared to o inflamed and pallor areas
antecubital fossa o Cold and cyanotic areas
o Congested and edematous areas
o Scarred and heavily calloused
 Capillary blood area
 mixture of chaos arterial and bit
tissue juices Indications for skin puncture:
 sometimes called peripheral blood
 Test which requires small amount of
blood
• Blood collection that requires small
 Blood typing
amount of blood:
 POCT/ glucose testing
o Blood type
 Blood smear preparation
o Mucous testing
 For Newborn patients
• Newborn: 350ml of blood because they  Geriatrics patients (too old patient)
have little amount of blood compare
adults
• Too much loss of blood for children that
may cause anemia called iatrogenic
anemia

 Iatrogenic anemia-type of anemia

occurs because of excessive loss of
blood during collection

 Indications for Skin Puncture:

• Sites of puncture
o Finger
o Earlobe
o <1yo: lateral portion of the
plantar surface of the heel/toe
Lateral –side portion for newborn
Note: Don’t hit iliac to avoid puncturing the
bones which is lot painful
 Advantages of Skin Puncture: Less
tedious
 Order of Draw: for skin puncture!
1. HEMATOLOGY (EDTA)
2. Blood bank tubes
3. chemistry tubes (no-anticoagulant)
HEMATOLOGY 2 LABORATORY: BLOOD COLLECTION (TRANS-1)

 Localized or generalized necrosis

 skin breakdown from repeated use of
adhesive strips (micropore and tapes)

VENIPUNCTURE
 Manner of inserting a needle attached
to a syringe to a palpable vein to
collect blood for laboratory testing
 Specimen collected:
 Most widely/commonly used blood
1. Blood culture sample in all laboratory tests
2. Citrate (blue)  Lot test to performed
3. Non-additive (red)
4. Heparin
5. EDTA Things to remember!
6. Black oxalate

SIR BABY: In skin puncture there also order of
draw because finger is puncture it is normal
process and platelets attracted and go to those
sites to form the clot so there could be
AGGREGATED platelet that can interfere your
testing
Tube should be filled with blood starts with:
1. Proper identification of patient
a. You’ll let the patient state their
own name
b. In Coma state patient you’ll ask the
relative of the patient and let them
state the name of the patient
c. If there is no relative check the id
tag or let nurse identify patient for
you

1. Tubes for Hematology (I.e. EDTA): to prevent 2. Tourniquet application

a) Applied for a maximum of 1 min
unwanted aggregation of blood
beyond that may cause hemolysis
2. Additive tube b) Applied 10-15 cm away to the
puncture site
3. Non additive tub
3. Disinfection
Complications:
a) Disinfect using 70% Alcohol in a
 Collapse of veins if the tibial artery is circular motion (inner to outer)
lacerated from puncturing the medial
aspect of the heel 4. Angle of needle insertion
 Osteomyelitis of the heel bone a) In book suggest for about 25-45
angle
(calcaneus)
b) In real life it depends on the veins
 Nerve damage if the fingers of neonates
of the patient.
are punctured c) If veins is very prominent= 20 or 25
 Hematoma and loss of access to the degree
venous branch used d) Fat or Obese patient= increase
 Scarring angle
HEMATOLOGY 2 LABORATORY: BLOOD COLLECTION (TRANS-1)

 TUBES MUST CONTAIN VACUUM

5. Bevel up  Able to transfer into multiple test tube
a) Hit Skin to vein puncture to prevent in a single puncture
hematoma WINGED COLLECTION
b) SKIN TO VEIN INSERTION  Using a butterfly needle attached in the
syringe
6. Needle length : 1-1.5 inches
Bore:
→ gauge 16 blood donation
→ gauge 21 GREEN
→ gauge 22 BLACK
→ gauge 23 BLUE

7. Position of the patient

a) Supine to seating
b) Position may affect some result
such as increasing potassium etc.
c) Not allow patients to open and
close their fist

8. Label
a) Label them accordingly and after
transfer the blood (name, age,
gender, room, initials of
phlebotomist)
b) We’re not allowed to Relabel

9. Disposal
a) Needle should be in puncture
resistant bottle
b) Yellow bag in infectious material

3 IMPORTANT FACTORS FOR SUCCESFUL

VENIPUNCTURE
1. Phlebotomist
2. Quality of patient’s pain
3. Availability of treatment
SITES OF PUNCTURE

Newborns up to 18 months
METHOD OF COLLECTION: • External Jugular Vein
• Temporal vein
SINGLE COLLECTION *Antecubital fossa (SITE OF CHOICE)
 SYRINGE
 Transfers to a single tubes Older children (18months to 3 yo)
MULTIPLE COLLECTION • Femoral vein
 ETS • Long saphenous vein
HEMATOLOGY 2 LABORATORY: BLOOD COLLECTION (TRANS-1)

• Popliteal vein collected must be discarded because it

• Ankle vein still contains IV fluids
*Antecubital fossa
ADVERSE EVENT:

3yo to adult life

• Wrist vein
• Dorsal vein of hand
• Dorsal vein of ankle Hematoma
*Antecubital fossa  Maybe due to improper collection of
blood or prolonged tourniquet
ANTECUBITAL FOSSA application
 Most ideal site for venipuncture  To prevent it you must apply pressure
to the site
Median- most preferred because it is stable  DO NOT ADVICE PATIENT TO BEND
Cephalic and basilica-unstable and movable so THEIR AR
anchor the vein to collect blood Complications:
• Hematoma
TWO PATTERNS OF VEIN: • Pain
 “H pattern” • Syncope and fainting
 Median capital vein • Iatrogenic anemia
 Cephalic • Infections
 Basilica • Edema
• Allergies
 “M” pattern • Petechiae
 Median vein
 Accessory cephalic Microbiology studies: first draw to conduct
 Basilica *Yellow tube contain gel separator treated like
serum tube.
Sites to Avoid:
• Sites with hematoma- There’s non In transferring the collected blood in a tube:
circulation of blood 1. First way is to transfer it by removing
• Occluded veins the cup of the tube and inject the blood
 impaired blood collection in eye level (Prefer
 Repeat puncturing same 2. . Second is transferring it directly,
syringe to the cup of the tube (before
• Edematous area - Sites with burns, this is not acceptable cause they
scar, tattoo thought it may cause hemolysis but
recent studies prove that it doesn’t
• Sites with Fistula (don’t pass)- After of affect at all
surgery or injury

• IV fluid sites- If it is really necessary to

collect, you must call the attention of
the nurse and let them stop the IV
infusion for about 2-5 mins and after
that the first 5ml of blood that is