Topic 2: Blood Collection Three general procedures in

obtaining blood:
We call blood collection as Phlebotomy
Phlebotomy - extraction or collection of blood also
known as Venipuncture (if it's derived or extracted
from the vein.)
Phlebotomist – a person trained in blood
collection. (Medical Technologists are also
Phlebotomists but there are some Medical
Professionals who are not MedTechs but also
qualified to be Phlebotomists. And not all
Phelobotomists are registered MedTech)
General Precautions:
1. Done in the morning if the result is subject
to diurnal variation.
- When collecting blood especially if
the specimen is subject to Diurnal
(daylight) variation, the results are
higher in the morning, and lower in
the afternoon. That's why the
preferred time to extract the blood is
in the morning.
2. Heavy meals and prolonged fasting results
to leukocytosis.
- If the patient has just eaten lunch or
any meal and just extracted blood,
expect that the patient’s white blood
cells and platelet count increase.
1. Skin Puncture (Capillary Puncture)
2. Venipuncture
3. Arterial Puncture
1. SKIN PUNCTURE (Capillary Puncture)
- Blood obtained is called peripheral, arterial,
capillary blood.
- Often derived or extracted from the peripheries
- It’s also called arterial blood because it is a
mixture of capillary, venous, and arterial blood but
mostly resembles arterial blood especially if the site
was warmed before extraction.
- and also contains interstitial and intracellular
fluids. That’s why we always wipe the first drop to
remove those contaminants. And the second drop
produced, is the one collected.
It is done for:
a. obtaining small volume of blood
b. infants particularly newborns
c. obese patients (hard to locate their veins)
d. geriatric patients (veins are very fragile)
e. extremely small or severely damaged
veins
f. patient with burns
g. patient with IV flowing into the only
accessible veins
h. patient with thrombotic tendencies
(venipuncture could trigger factors that can
activate the coagulation pathway leading to
a thrombotic complications
i. safe to perform (not too invasive or
dangerous)

COMMON SKIN PUNCTURE SITES

a. earlobe (margin) – older pediatric
b. heel (lateral plantar heel surface or
medial plantar heel surface) – neonates;
infants
- Sometimes we don’t hit the middle
part because the bone there is
1. Sharp mind
closer to the skin.
2. Calm tone of our voice
c. big toe (plantar surface and lateral site) –
3. Cheerful
neonates; infants
4. Compassionate and kind
d. finger (palmar surface of the last digit of
5. Communication skills
the 2nd, 3rd, or 4th fingers; lateral site of
6. Steady hands
a finger adjacent to the nail)
7. High level of patience
8. Strong feet
 - Usually the 3rd finger, but the most
common is the ring finger or the 4th
finger which is the least callus finger.
Big toe and Heel - For babies, infants, or
newborns
Fingers - For children or adults
Earlobe - old site / no longer performed because if
the patient is a keloid performer, it can cause a
scar on the ears
Depth of puncture:
0.85 – 2.0 mm deep and 1.75 – 3.0 mm in length
Often used 1mm deep
Note:
The direction of the puncture should be
Perpendicular to the fingerprint.
If the wound healed, it should be against the grains
of your fingerprint
Purpose: of Skin Puncture
1. To produce an ample sample to come out to
the site
2. Less messy than the parallel
3. More blood can be collected
PROCEDURE: of Skin Puncture
1. Select site.
- As much as possible use the 3rd or the 4th
finger
2. Warm site at 37° – 42°C.
- Use a warmer or warm cloth that is if the
patient is tense.
- If you press the fingertips and the color is
purple or white (Meaning, there is no blood
yet flowing to the site), so you need to warm
the site.
3. Puncture.
- Before you start, you need to perform
proper disinfection (up and down method).
- Then, let it dry first. As much as possible
“Air dry”. Do not wipe it with dry cotton.
4. Discard first drop (regulate blood flow by thumb
pressure).
- Discard the first drop of blood after the
puncture because it’s contaminated with
tissue juices (coagulation factor III; factor 3
of coagulation pathway) (can cause early
clotting of your blood because it promotes
coagulation.
- That’s why we don’t milk the site (milk
means applying firm pressure) because
you're actually extracting tissue juices from
you skin that could enter your sample.
- Direction for collecting the blood: Press,
release, Press, release
- Press - to collect blood
- Release - so that more blood will flow to the
site.
5. Collect in an appropriate container by
capillary action.
- Blue - plain or no anticoagulant (can collect
serum) No need to seal because the blood will
clot inside.
- Red - heparinized or has heparin so you need
to seal the tip to prevent the blood from coming
out of the tube because it’s anticoagulated with
heparin so it remains whole blood. And if it’ll be
separated, it’s now Plasma that will be
produced.
6. Seal, label, and indicate it comes from skin
puncture.
NOTE:
1. RBC count, platelet count, hemoglobin and
hematocrit are decreased in skin puncture;
while WBC count is higher by 1000 as compared to
venous blood.
2. Do not milk the site as it hemolyzes the
specimen and introduce excess tissue fluid.
3. Avoid calloused, scarred, cold, congested,
edematous, pallor, cyanotic, inflamed and
previously punctured site.
4. Increased pressure of the arterioles yields
increased arterial blood.
2. VENIPUNCTURE
More dangerous
• Blood obtained is called venous blood
• Characteristics:
a. easy to obtain
b. large amount of blood is obtained
c. additional and repeated test can be done
d. fast
e. specimens can be stored and transported to
laboratory
f. ideal for chemistry determination

Blood Collection Methods (ETS) Evacuated tubes routinely used in

blood collection
1. Evacuated tube system (ETS) Stopper Additive Purpose
2. Syringe method color
3. Butterfly infusion set Pink None For tissue culture
Red None For serum
chemistry and
serological exam
1. Evacuated tube system (ETS) Amber None For blood lead
Components of evacuated system: (dark determination
yellow) - Some amber
1. 2-way needle
has gel
a. shorter end – screws securely into separator
the plastic holder; also called which also
adapter. used to
b. longer end – sterile and kept derived serum
covered until the phlebotomist is Yellow None For bacterial
ready to enter the vein to avoid culture and
unknowns; can
contamination.
be autoclaved
2. plastic tube holder and incubated
3. evacuated glass tube (Vacutainer) – Red and None also contains gel
container that has vacuum inside. So do not Gray separator AKA
remove the rubber stopper. (mixture inert polymer
Disadvantage: you cannot see the back of the barrier material
flow. two)
Lavender EDTA (K3 or CBC, ESR; most
NA4) commonly used
Multisample needle – more than 1 tube of - Tripotassium for Hema
blood is to be collected or Disodium
Blue Citrate (could Blood
(usually vary) coagulation,
light blue) modified ESR,
cell count

- For ESR 3.8%

- For blood
coagulation
Na citrate,
3.2%
Green Heparin For plasma
chemistry
- Chemistry test
that requires
plasma
Gray NaF (Sodium For glucose
Fluoride) testing
black Na Citrate For ESR
(Sodium Citrate)

2. Components of Syringe
Method
3 Major Parts of the Syringe
1. barrel – body of the syringe with
calibrations; to puncture the site
2. plunger – for extracting the blood
3. needle –
length – individual preference (1 and 1.5
inches)
gauge – refers to the diameter or bore
- gauge number pertains to the size
of the bore (hole of the needle)
- gauge number reflects the bore
size
- the higher the gauge number, the
smaller the bore size
- the lower the gauge number, the
bigger the bore size (indirectly
proportional)
The most common gauge number used for adults
with good veins, 20-21
23 – is not commonly used; should be used for
people who have weak or fragile veins and small
veins; children patients (DON’T USE this to adult
patients with good veins because this could lead to
hemolysis of the red blood cells.
3. Components of Butterfly
Infusion Method (Wing
Infusion Method)
- for patients with weak, small, fragile veins and for
pediatrics
1. Stainless steel bevelled needle with attached
plastic wings. (for easy attachment to the skin via
micropore)
2. Piece of plastic tubing which connects the
needle to an adapter that in turn is attached to a:
a) Syringe
b) Luer adapter that screws into a tube
holder, making a modified evacuated
system.
Appearance of Butterfly Needles
 Needle is a bit shorter than the syringe in
the ETS
 Bore size of the gauge is 23
- 27-gauge (for babies, for insulin
injection)
Smaller gauge can lead to hemolysis. That’s why
you have to pull the plunger slowly.
VENIPUNCTURE SITES
Major common site for venipuncture = Antecubital
fossa
(the common venipuncture sites for babies is the
same as the adults = antecubital fossa
specifically, the median cubital vein)
Newborn infants up to 18 months old
1. External jugular vein
2. Temporal vein
3. Superior longitudinal sinus - head
18 months to 3 years old
1. long saphenous vein - upper leg to the lower leg
2. femoral vein - upper leg
3. popliteal vein - at the back of your knees
4. ankle vein
3 year old up to adult life
1. wrist vein - often used for IV *For both arms with IV fluid, get blood below IV site other than
2. veins on dorsal hand and fingers (back of hand the one with IV line after IV fluids have been stopped for 2
minutes.
and fingers) - also used for IV and elderly *Small amount be discarded before specimen collection
3. ankle otherwise diluted specimen (with IV fluid) is obtained.
4. foot ask nurse or doctor because it cannot be *Glucose and phosphorous – altered always either below or
used with certain conditions after IV; other tests are accepted using this process.
5. ventral forearm
2. Vigorous fist hand pumping – causes hemoconcentration
6. Major veins of antecubital fossa
3. Tourniquet should never be left longer than 2 minutes
a. Basilic because:
b. cephalic bruise and roll more easily a. it causes hemoconcentration
b. it activates certain blood components and leads to
c. median cubital vein – generally chosen inaccurate hemostasis. It should be released as blood
c.1 large begins to flow and always BEFORE needle removal.
c.2 close to the skin
c.3 usually well anchored by tissue 4. On selecting exact site –
* Vein – is pliable and spongy; elastic tube
so that it does not roll more easily
* Thrombosed vein – not pliable; cordlike
* Arteries – pulsating sensation
Basilic = connected to pinky
Cephalic = connected to the thumb 5. Position of patient
 Lying down during collection – leukocyte and Packed cell
volume is decreased by 8 (hemodilution)
Basilic and cephalic vein could also be used if the
 Gets out of bed prior to collection – leukocyte and Packed
median cubital is not visible, but basilic is prone to cell volume is elevated (hemoconcentration.)
bruising and cephalic is more painful.
6. Alignment of needle with vein – at 15° angle

7. If blood does not enter syringe:

 If blood fails to enter the syringe when you pull the plunger
back, the needle is not in the vein. Using the index finger of
your left hand you should then feel to find the point of the
needle. When you locate the point of the needle, you should
correct one of the 3 following mistakes:
a) If it appears that the needle has gone far enough,
you should push the needle in further. Failure to push
the needle in far enough is the most frequent mistake
the beginner makes.
b) If it appears that the needle has gone to the right or
left of the vein, you should partially remove the
needle, fix the vein, and make the proper insertion.
c) If it appears that the needle has gone through the
vein, you should proceed as follows: Slowly pull back
the plunger and, at the same time, slowly withdraw
the needle. By pulling back the plunger, you create a
suction in the syringe. This suction draws blood into
the syringe when the point of the needle is drawn
SITES TO BE AVOIDED: back into the vein. The needle, of course, should not
do not collect from these sites be withdrawn entirely out of the arm.
If the above techniques fail and blood does not enter the
syringe you should release the tourniquet and completely
1. hematomas
withdraw the needle. Then you should make another
2. burns venipuncture, using either the same arm or the other arm of
3. scars the patient.
4. edema (swelling)
5. site on which a mastectomy was performed 8. If blood starts to enter the syringe and then stops:

Sometimes the blood will start to enter the syringe and then
NOTE: stop. This may be caused by any one of 3 different factors:
a) The bevel of the needle may be pressing against
1. On arms with IV fluid the wall of the vein and preventing the flow of blood. If
*Get blood on opposite arm without IV so, you should very gently wiggle the needle and, at
the same time, pull back on the plunger.
 b) The needle may have slipped out of the vein. If so,
you should fix the vein and carefully reinsert the
needle.
c) The needle may have gone through the vein. If so,
you should slowly pull back the plunger and
simultaneously withdraw the needle until the needle is
again in the vein.
QUESTION: How can you tell which of the above 3 factors are
involved?
ANSWER: The only answer is the “touch” which comes with
experience. If the above techniques fail to resume the flow of
blood into the syringe, you should release the tourniquet, apply
the piece of cotton moistened with alcohol, and carefully
withdraw the needle. Then you should transfer any blood that
you did get to the anticoagulated test tube.
VENIPUNCTURE PROCEDURE
1. Patient interaction
2. Assemble supplies and equipment
3. Venipuncture
a. Site
b. application of tourniquet
- Allow the patient to close his fist for pressure
and para mag gwa gd ang ugat. DO NOT
APPLY TOURNIQUET FOR MORE THAT 1
MINUTE since it could lead
hemoconcentration - the transfer of your
plasma from the blood vessel into the
interstitial spaces causing your cells to
falsely increase.
c. select exact site
d. Cleaning
e. inspection of needle
f. perform venipuncture
g. release tourniquet
h. position gauze over puncture site
i. remove needle and apply pressure
- Apply pressure for 1-2 minutes para indi mag lead into
hematoma and bruising.
PEDIATRICS VENIPUNCTURE IS DONE:
1. blood culture
2. coagulation studies
3. combined test
Veins that are usually used:
1. antecubital
2. wrist
Method used:
1. syringe with 21-23 gauge needle using 3 ml
syringe
2. butterfly set with 23 gauge needle
Complications of Venipuncture:
A. Local Immediate - can be seen immediately
1. Hemoconcentration - although it's not visually seen, it
can be reflected in the lab results
2. Failure of blood to enter the syringe
3. Circulatory failure
4. Fainting or syncope
to
5. Excessive bleeding - hitting an artery instead of a vein
B. Local Delayed - does not manifest immediately
1. Hematoma - common cause; did not apply pressure
2. Thrombosis of vein
3. Thrombophlebitis - if the thrombosis or the clot traveled
to other sites or veins
C. General Delayed - if it transmits infectious organism
1. Serum hepatitis
2. AIDS
- Due to improper disinfection or sanitation when it
comes to blood collection
- Punctured by a syringe needle nga HIV or hepatitis +

Hematoma - if nag swell ang skin

Bruising or Ecchymosis
Order of Collection Multiple Tubes
1. Blood culture
2. Non additive tubes
3. Coagulation tubes
4. Other tubes with
additives
ARTERIAL PUNCTURE
- is used to measure CO2 tension, O2 and pH
(Arterial Blood Gas)
Characteristics:
a. Easy to obtain (not that easy if beginner)
Red stopper b. Large amount of blood is obtained
Blue stopper c. Additional and repeated test can be done
Green, lavender, gray d. Fast
e. Can be stored and transported to laboratory
f. Ideal for chemistry determination

Additive Containing Tubes

Arterial puncture sites:
1. Citrate Blue (for coagulation)
1. radial artery
2. Heparin Green - common. When you collect, hold the syringe upright. You will
3. EDTA Lavender know If it's really the artery that you've hit if may backflow.
4. Fluoride Gray
When you pull the plunger, ang color sang blood is cherry red
or light red since this one is an oxygenated blood
Anticoagulant is put inside the syringe because when we
proceed to the equipment, we do not transfer the blood
anymore to any test tubes. The blood nga ara sa syringe is
mixed with an anticoagulant then proceed to the machine for
reading of your blood gases. It should be transported
immediately because we need to check the actual levels of
gas.
Cover the tip of a needle using a rubber stopper from a
vacutainer tube to prevent the entrance of other gas from the
atmosphere
2. brachial artery
3. femoral artery
Anticoagulant
- A compound that irreversibly interrupts the
coagulation process.
Common Anticoagulants
*EDTA -the violet tube – Disodium or tripotassium
salt of ethylenediamine tetraacetic acid
*Citrate - Blue tube – Trisodium citrate
*Heparin - heparin na label (green tube)
ADDITIVES
ANTICOAGULANT – A compound that
irreversibly interrupts the coagulation process or
prevents blood from clotting.
1. EDTA - Disodium or tripotassium salt of
ethylenediamine tetraacetic acid
● Most commonly use anticoagulant in
Hematology
● Blood coagulation is inhibited by chelating
or binding of Calcium ions
● Optimum concentration is 1.5 mg / ml
blood.
● Chelation of calcium
*same with citrate - both of them remove calcium or
the chelate (sila ang gatapik) to calcium so that the
calcium will separate from the blood and will not
activate the other coagulation factors
*calcium is essential for the activation of the
coagulation factor of the blood
* If calcium is removed, the blood will not clot
* Chelation - main mechanism of EDTA and Citarte
Advantages:
a. Prevents platelet aggregation thus preferred
for platelet count
b. Preserves cellular morphology when blood
smears are made within 2 hours of blood
collection.
Disadvantage:
a. Increased concentration induces red cell
shrinkage thus decreasing ESR and Hct
2. CITRATE - Trisodium Citrate
● Inhibits clotting by binding calcium in a
soluble complex
● Usual concentration used is 3.8 % ( 0.129
M ) with a blood anticoagulant ratio of 9:1 –
for persons with normal Hct; 3.2 % ( 0.129
M ) – coagulation studies and with
increased Hct
Advantages:
a. Used for many coagulation studies
b. Preserves labile factors V and VII
c. Satisfactory for platelet aggregation studies
3. HEPARIN - Inhibits coagulation by activation of
thrombin or antithrombin
● Optimum concentration is 15 – 20 U/ml
blood
● Against Thrombin: mechanism of heparin (it
activates or enhances the anti-thrombin in
the blood to prevent the action of thrombin)
● Thrombin: another coagulation factor that
converts fibrinogen to become fibrin and the
latter is the one that form clot
Advantage:
a. Good for osmotic fragility
Disadvantage:
a. Not good for blood film preparation because
it causes morphologic distortion of platelets
and leukocytes causes error in automated
cell counting

NOTE!!!
EDTA, Oxalate and Citrate remove Calcium
Oxalate while Heparin Prevents prothrombin to
thrombin
SPECIAL HEMATOLOGIC COLLECTION
PROCEDURES
A. DEFIBRINATION – removal of fibrin from whole
blood specimen
- More on mechanical way/procedure
- Basically, you used an anticoagulant
“heparin” to remove the fibrin
- but in case may ara ma form na fibrin, we
can use glass beads. The whole coagulated
blood, you put the glass beads and shake it
vigorously, the fibrin will bind to the beads
therefore removing the fibrin in the blood
specimen
Advantages: good for:
a. Osmotic fragility
b. Autohemolysis - for hereditary spherocytosis
c. Acid Serum test - for paroxysmal nocturnal
hemoglobinuria na analysis
B. SILICONIZED GLASSWARE – prevents
coagulation by preventing the adhesion of platelets
to wettable surfaces, thereby preventing breakage
of platelets and release of PF 3
- Why we use plastic: reusable, cannot
activate the coagulation factor
- But if it’s glass, it should be coated with
Silicon (to prevent the negative surface of
the glass to come in contact with the blood)
- The glass should not be expose because it
will activate the contact factor
- Contact factor: group of coagulation factors
that are activated by contact with negatively
charged surfaces
● Posture
- From supine to sitting/standing
- increase in lipids, enzyme, and
proteins
- Sit: no great change of the result
- Admitted (gahigda then gn
pabangon): there will be
hemoconcentration “most of the test
will increase”
- Prone to hemodilution: kung ga
higda lang gd sya (because the
plasma and interstitial fluid are
entering the blood vessel)
- Shift of water from blood vessels to
interstitial spaces; large molecules
retain and concentration in the blood
● Diurnal Rhythm
- Daily body fluid fluctuation
- Afternoon: decrease of hormones;
decrease in iron and eosinophils
- Morning: increase in iron and
eosinophils
(check your book on the iron deficiency anemia “di
sure si miss dri na part”)
● Exercise
- Increase of creatinine, protein, CK,
AST, LDH
- Creatinine kinase (CK), Aspartate
aminotransferase (AST), Lactate
dehydrogenase (LDH)
- Increase if platelet and WBC count
- Needs to hemoconcentration
● Stress
- Anxiety increase of WBC and acid-
base imbalance
● Diet
- fasting: no food or beverages except water
for 8-12 hours (that is why we need fasting
when taking blood)
- eating ,2 hours before, increase of glucose
and lipid

Physiologic Factors affecting the test

● smoking
Result - increase of WBC count and cortisol levels
- long term: increase of Hb levels
– give rise to fluctuation in routine hematological
tests include:
Order of Draw in evacuated glass tubes
 ● Heparin: prevents prothrombin to thrombin
“YCRHEF”

● Blood-cultures tube (yellow) CLOT ACTIVATOR

- Bacteriologic test - usually a glass or silica particles, (looks like beads
inside the tube)
- To prevent the contamination
- if you really want to hasten the coagulation of
● Sodium-citrate tube (blue stopper)
blood
- For coagulation ● Helps initiate or enhance the clotting
- As much as posible in na mechanism
maapektuhan ni sya sa tissue GEL SEPARATOR
factors - polymer inert barrier material, it changes in
● Serum tubes with/without clot viscosity during centrifugation, enabling it to serve
activator or gel separator as a barrier separating the serum from the packed
- Red RBC
- No additive and for serum ● Cannot be used for blood bank procedures
chemistry but used for chemistry
● Heparin tube with/without gel (green
stopper)
THREE PRIMARY VEIN
-plasma chemsitry
1. Cephalic vein
● EDTA tube (lavender)
2. Basilic Vein
-hematology test 3. Median Cubital Vein - vein of choice
● Glycolytic inhibitor tube (gray
stopper)
- Fluoride COMPLICATION ENCOUNTERED
- Glucose testing
DURING BLOOD COLLECTION
- So that the glucose will not be
decrease due to the consumption
1. Ecchymosis (Bruise)
of cells
● Most common complication
● Bruising of site after puncture
“Follow YCRHEF”
● Caused by leakage of a small amount of
fluid around the tissue
Additives: something you add in ● Direct pressure should be applied to the
venipuncture site
vacutainer tube ● Common cause is lack of pressure

Antiglycolytic Agent 2. Syncope (Fainting)

● Inhibit glucose consumption
● For glucose determination
● Sodium fluoride (if you want to generate
serum); lithium iodoacetate (generate
plasma)
● Prevents glycolysis or glucose
consumption
ANTICOAGULANT –
● Prevent blood from clotting
● Prevents coagulation of blood
● EDTA, citrate, oxalate:
● EDTA, citrate, oxalate mechanism: remove
calcium
● Second most common complication
● Common if the patient is nervous or haven’t
eaten yet
● The collector should ask the patient whether
he or she had a history of fainting before
and after blood collection
● If the patient begins to faint, remove the
needle immediately, lower the patient's
head, apply cold compress at the back of
the neck and loosen any constructive
clothing.
● Patient should drink orange juice or cold
water.
● Patient should sit for 30 minutes before
leaving.
 3. Hematoma
● Results when leakage of a large amount of
fluid around the puncture site causes area
to swell.
● If swelling begins the needle should be
remove immediately and pressure is applied
to the site for at least 2 mins.
● Most commonly occurs when the needle
goes through the vein, is only partially on
the vein and failure to apply pressure after.
● Common sa mga tigulang Kay Ang skin nila
very thin.
4. Failure to draw blood
● Vein is missed because of the improper
needle positioning
● Occasionally, an evacuated tube has
insufficient vacuum.
PROPER AND THE IMPROPELE INSERTION
*this cause hematoma
*Makakuwa man pero dutay lang kag mauntat siya
in the middle
*Galiko ang vein kag nluckily, na bingo Ang needle
sa wall sang vein. May makwa man pero ngaa ga
bura? Kay because it's either nag collapse kay
nabunggo na sa vein. So e pull mo lang siya
gamay pabalik kag Kun makita mo nga nag balik
Naman iya flow so amo natu siya ang correct
positioning of the needle.
Collapsed vein is common in Cephalic Kay nipis na
siya na vein, so kun grabe ang pressure nga gin
apply mo,ma suyop siya kag ma collapse so nd ka
ka collect gd sang enough blood.
4. Petechiae
● Small red spots indicating that small amount
of blood escaped into the epithelium.
● Indicate a possible coagulation problem and
should alert the phlebotomist to be aware of
a possible prolong bleeding
● Family of bruises pero damo Sila nga small
red spots
● Indicate the rupture of capillaries
○ So if the patient has a patechiae
before you collect the blood, you
have to ask kay basi may underlying
disease, probably a coagulation
disorder or disease, so you are not
allowed to collect or you need to ask
the physician if pwede ka mag
collect because the patient is having
a bleeding disorder
5. Edema
● Swelling caused by abnormal accumulation
of fluid in the intercellular spaces of tissue
● Edematous sites should be avoided for
venipunctures because the veins are hard
to find and specimens may become
contaminated with tissue fluids.
○ Basi ang macollect mo is the fluid
and not the blood
6. Obesity
● Veins may neither be visible nor easy to
palpate
● Sometimes the use of blood pressure cuff
can aid in locating the vein
● The cuff should not be inflated any higher
than the patients' distolic pressure and not
to be left in the arm for longer of 1 min
because it may lead to hemoconcentration.
7. Intravenous Therapy
● Drawing a blood from an arm with an
intravenous catheter should be avoided as
possible
● If there is no available sites, blood can be
drawn below the IV
● Infusion should be stopped for 2 minutes
before the specimen is drawn.
- If two arms may IV, you have to ask
sa nurse Kun pwede e stop Ang
infusion for 2 mins before the
specimen is drawn, but the first
collected blood is discarded and the
second one will be the sample of the
patient.
8. Hemoconcentration
● Increase concentration of larger molecules
and analyte in the blood as a result of a shift
in water balance.
○ Meaning the plasma has entered the
interstitial space so those analytes
remain concentrated in the vein.
● Can be caused by leaving the tourniquet on
the patient’s arm for too long or by probing
or massaging the site.
- Occur when the tourniquet was left
in the arm of a patient for a long
period of time or by probing or
massaging the site
● Torniquet should not be left for more than 1
min.
9. Hemolysis
● Rupture of RBCs within consequent release
of hemoglobin
● Cause the plasma or serum to appear in
pink or red
● Common causes:
○ Needle is too small
■ We do not recommend 23
nga gauge, instead it is
always 20 or 21
○ Syringe plunger is pulled back
quickly.
○ Shaking tube is too hard or tight.
■ Figure of 8 Ang pagshake
○ Physiologically as a result of
hemolytic anemias or severe renal
problem
10. Burned, damaged, scarred, and
occluded veins
● Should be avoided because they don't allow
the blood to flow freely and may make it
difficult to obtain an acceptable specimen.
11. Seizures or Tremors
● Needle should be remove immediately
● Protects patient by preventing injury from
nearby objects
12. Vomiting and Choking
● Patients' head must be positioned so that
he or she does not aspirate any vomit.
○ Paduku-on ang patient para ang
suka nd ya mahaklo,to prevent
Aspiration pneumonia.
● Prevents patient from hitting his or her head
● Seek help for choking
13. Allergies
● Hypoallergenic tapes should be used or
apply pressure manually until bleeding has
stopped completely.
● Sensitivity to latex and antiseptics must be
determined before phlebotomy procedure.
14. Mastectomy Patients
● Mastectomy - removal of one or two
breast
● Pressure on the arm that is on the
same side as to the site of
mastectomy from a tourniquet of
blood pressure cuff can lead to pain
of lymphostatis from accumulating
lymph fluid.
● Use the other arm if possible
● Double mastectomy, perform a skin
puncture or draw blood at the back
of the hand without using a
tutniquet.
SPECIAL HEMATOLOGIC COLLECTION
PROCEDURES
A. DEFIBRINATION – removal of fibrin from whole
blood specimen
Advantages: good for:
a. Osmotic fragility
b. Autohemolysis
c. Acid Serum test

B. SILICONIZED GLASSWARE –prevents

coagulation by preventing the adhesion of platelets
to wettable surfaces, thereby preventing breakage
of platelets and release of PF 3.