Pre-Analytical

Considerations
in Phlebotomy
Prepared by:
Patricia Nicole
D. Fernandez, RMT
Pre-analytical lab phase
Test requisition
Test acquisition
Patient
identification
Specimen
collection
Specimen
handling/
transport
Proper control
measures
 VARIABLE Effect
Age RBC, WBC, creatinine clearance

Altitude RBC

Dehydration Hemoconcentration, RBC, enzymes,

Iron, Calcium , Sodium

Diet Glucose, lipids, electrolytes

Diurnal TSH, cortisol, Iron

variation
 VARIABLE Effect
Drug Therapy Enzymes, hormones

Exercise/
pH,PCO2,CK,LDH,glucose
IM Injection
Fever Hormones, cortisol

Gender RBC,HgB,Hct

Jaundice Yellow color interfaces due to increased

Biliburin
Intramuscular CK and the skeletal muscle fraction of
Injection LDH
 VARIABLE Effect
Position Protein, Potassium

Pregnancy RBC

Smoking CHOL,cortisol, glucose,GH, triglyceride,

WBC

Stress WBC,Iron,ACTH, catecholamine, cortisol

Temperature Hemoconcentration
and Humidity
PROBLEM AREAS and
TROUBLESHOOTING
in the site selection
1.Burns, Scars, & Tattoos
2.Damaged Veins
3.Edema
4.Hematoma
5.Mastectomy
6.Obesity
VASCULAR ACCESS
SITES & DEVICES
Arterial Line
Arteriovenous Shunt or Fistula
Blood Sampling Device
Heparin or Saline Lock
Intravenous (IV) Sites
Central Vascular Access Devices
also known as
INDWELLING LINES
tubing inserted to the
main vein or artery 3 types:
FUNCTION:
 central venous
█ blood collection
catheter lines
█ monitoring blood
 implanted port
pressure  peripherally inserted
█ administering central catheter
medications and fluids
CENTRAL VENOUS CATHETER
also known as

central line
tubing inserted
into the large vein
subclavian and
advanced into
superior vena cava
IMPLANTED PORT

surgically implanted
disk-shaped chamber
attached into the
indwelling line
placed on the upper
chest just below
the collarbone
PERIPHERALLY INSERTED CENTRAL CATHETER

flexible tube
inserted into the
veins of
extremities
and the
central veins
HANDLING PATIENT
COMPLICATIONS
ASSOCIATED WITH BLOOD COLLECTION
 Allergies to
Equipment and Place gauze, remove after
Supplies 15 minutes

Alternative antiseptic

Use non-latex equipment

Excessive
Bleeding Aspirin/anti-
coagulant/blood thinners

Apply pressure on the

collection site for
5 minutes
 Ask the patient to lie
Fainting/ down during the procedure
Syncope
If the patient faints
during blood collection,
stop, elevate the
patient’s feet

Notify the physician

Nausea &
Vomiting Wait until the patient
feels much comfortable for
the procedure

Provide emesis basin or

water basket
Pain
Extreme pain / numbness

Apply ice to the site

Notify the physician

Petechiae
Small red or purple spots

Release the tourniquet

Observe patient
 Seizures/ Patient must be turned to
Convulsions his/her side

Make sure that there is no

object that might injure
the patient

Notify the first aid

personnel/physician
AVOIDING & HANDLING
PROCEDURAL ERROR RISKS &
FAILURE TO DRAW BLOOD
HEMATOMA FORMATION
IATROGENIC ANEMIA
INADVERTENT ARTERIAL PUNCTURE
INFECTION
NERVE INJURY
REFLUX OF ANTICOAGULANT
VEIN DAMAGE
Hematoma Formation
hold pressure on
the site  Excessive or blind probing
immediately after  Inadvertent arterial puncture
 Size of the vein - too small
discontinuing the
 The needle penetration -
draw all through the vein
cold compress or  Needle is not completely
ice pack maybe inserted
offered to help  Tourniquet is still on when
address the the needle was removed
 Pressure - not adequate
swelling.
Iatrogenic Anemia

blood loss due to

Do not exceed

10%
blood draw

ensure to collect
only the required
specimen volume of total blood
volume
Inadvertent Arterial Puncture

blood is filling up
the tube rapidly
and there is a
rapid formation of
hematoma on the
site
Infection
DONTS:
 tapes or bandages opened
ahead of time
keep the
 needles are preloaded bandage on
into the tube holders the site for
 insertion site of the
needle is touched after
at least
sterilization
 cap is removed long
15 minutes
before venipuncture
Nerve Injury
redirect the needle
POSSIBLE CAUSES: by using a slightly
improper site
selection
forward or backward
rapid needle
movement
insertion
excessive redirection remove the needle
of the needle and and look for an
blind probing alternative site
Reflux of Anticoagulant
keep the arm of
adverse the patient in a
reaction on
patient
downward
position and the
unreliable test tube just below
results the venipuncture
site
Vein Damage
follow the
proper
collection
technique

avoiding blind
probing
SPECIMEN
QUALITY
Hemoconcentration
decrease fluid/plasma volume
Hemolysis
rupture of RBCs
Hemolysis
Short draw
incorrect blood-to-additive ratio
Specimen contamination
Incorrect handling
 Glove powder
 Perspiration
 Alcohol
Wrong or expired collection tube
quality of seal or pressure
Pre-Analytical
Considerations
in Phlebotomy
END OF PRESENTATION