MEDT 25 | VIRTUAL INTERNSHIP AND SKILLS ENHANCEMENT

L3: Phlebotomy
Transcribed by: MC, Centeno | 23 April 2023

Outline 3. Winged  can be used with

I. Phlebotomy infusion the ETS and
II. Work Instruction set syringe used to
III. Capillary Puncture (butterfly draw blood from
IV. Work Instruction ) infants and
children, hand
PHLEBOTOMY veins and other
 from the Greek words phlebo-, meaning "pertaining to a blood difficult to draw
vessel", and -tomy, meaning "to make an incision" situations.
 Phlebotomy is the process of making an incision in a vein
with a needle. Preparation of Equipment
 Tube holder & needle
1. Remove the cover from the valve section of the needle.
2. Thread the needle perpendicularly into the tube holder.
Ensure the needle is firmly seated so that it does not
unthread during use.

 Syringe and Needle

1. Twist the needle tight to assure that it is securely attached
to the syringe.
2. Slightly move the plunger back and forth.

ORDER OF DRAW
Inappropriate Sites for Venipuncture  a special sequence of tube collection that reduces the risk of
 Arm on side of mastectomy cross contamination by the tube additives that could lead to
 Edematous areas erroneous results.
 Hematomas Arm in which blood is being transfused 1. Yellow (SPS)
2. Light Blue (Citrate)
 Scarred areas
3. Plain red (no additive)
 Arms with fistulas or vascular grafts
4. Plastic red (clot activator)
 Sites above IV cannula 5. Gold (SST/Gel with clot activator)
6. Green (Li/Na heparin)
VENIPUNCTURE EQUIPMENT 7. Lavender / Pink (EDTA)
1. Evacuated tube system (ETS) 8. Gray (Sodium Fluoride)
2. Needle and syringe
3. Winged infusion set (butterfly)

ETS 3 Basic Components:

1. Multi-sample needle
2. Tube holder
3. Evacuated tubes

VENIPUNCTURE EQUIPMENT
Equipment Description Photo
1. Evacuate  most preferred
d Tube because blood is
System collected directly
(ETS) from the vein in
the tube, INVERSION OF TUBES
minimizing the Tube No. of Inversions
risk of specimen Na Citrate 3 – 5 times
contamination and Red and Gold top 5 times
exposure to the Heparin 8 – 10 times
blood. EDTA 8 – 10 times
2. Needle  used on small, Na Fluoride 8 – 10 times
and fragile and
syringe damaged veins

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 Lesson 3: Phlebotomy

Tourniquet Application BLOOD COLLECTION

 Apply the tourniquet 3-4 inches above the collection site. Evacuated Tube System (ETS)
 The tourniquet should be in place no longer than one minute 1. Place the torniquet 3-4 inches above the puncture site. Ask the
to prevent hemoconcentration. patient to make a fist.
 If a vein cannot be located and accessed within 1 minute, the 2. Palpate and locate the vein.
tourniquet should be released, and then reapplied after 2 3. Release the torniquet. Ask the patient to open fist.
minutes. 4. Cleanse and air-dry the puncture site.
5. Assemble needle and tube holder.
6. Reapply the torniquet. Ask the patient to make a fist.
7. Remove the cap and turn the bevel up. Insert the needle into
the skin at an angle of 30°.
8. Securely anchor the tube holder. Following the order of draw,
place tubes in the holder and advance them onto the needle.
9. Allow the tubes to fill until the normal vacuum is exhausted
and blood ceases to flow.
10. Mix by gentle inversion (depending upon the type of additive)
Cleansing the Puncture Site
as soon as it is removed from the holder and before putting it
 The skin at the venipuncture site should be cleaned with a down.
sterile disinfectant (70% isopropyl or ethyl alcohol) applied to 11. Release the torniquet.
a gauze or a cotton ball, using a firm but gentle pressure, in a 12. Place dry cotton ball directly over the puncture site. Remove
concentric motion starting from the center to peripheral. the needle.
 Allow the area to dry naturally for 30 seconds to 1 minute. 13. Apply pressure to the site for 3 to 5 minutes or until bleeding
stops.
Sharps Disposal 14. Label the collection tube(s) with the printed full name of the
 Contaminated sharps must be disposed in puncture-proof patient, age, sex, date and time of collection and initials of the
containers. phlebotomist.
 In lieu of commercially available sharps containers, sharps 15. Discard collection unit in a sharps container.
may be disposed in puncture-proof bottles/gallons containing 16. Remove and properly discard used gloves. Wash and dry
0.5% sodium hypochlorite solution. hands after collection.
17. Transport specimens to the laboratory.

Syringe System
1. Place the torniquet 3-4 inches above the puncture site. Ask the
patient to make a fist.
2. Palpate and locate the vein.
3. Release the torniquet. Ask the patient to open fist.
4. Cleanse and air-dry the puncture site.
5. Prepare the equipment.
6. Reapply the torniquet. Ask the patient to make a fist.
WORK INSTRUCTION 7. Remove the cap and turn the bevel up. Insert the needle into
PRE-COLLECTION PREPARATION the skin at an angle of 30°.
1. Review the request. Prepare all materials needed. 8. Securely anchor the syringe. Draw the desired amount of
2. Sanitize hands. blood by pulling back slowly on the plunger.
3. Identify the patient by asking him/her to state his/her full 9. Release the torniquet. Ask the patient to open fist.
name. Validate name given with that on the requisition form. 10. Place dry cotton ball directly over the puncture site. Remove
4. Check the completeness of data in the request form such as the needle.
patient information, test requests and any special 11. Apply pressure to the site for 3 to 5 minutes or until bleeding
requirements. stops.
5. Identify yourself and explain the procedure. 12. Fill in the tubes in correct order of draw. Let the tube fill to
6. Wear disposable gloves. the appropriate level.
13. Depending upon the additive/anticoagulant gently invert each
tube.
14. Label the collection tube(s) with the printed full name of the
patient, age, sex, date and time of collection and initials of the
phlebotomist.
15. Discard contaminated materials in appropriate container.
16. Remove and properly discard used gloves. Wash and dry
hands after collection.
17. Transport specimens to the laboratory.

CAPILLARY PUNCTURE
 an alternative collection procedure when minute amounts of
blood are needed for testing, or for patients for whom
venipuncture is inadvisable or impossible.
 useful in pediatrics where removal of larger quantities of
blood can have serious consequences

Indications in Adults
 Those with thrombotic tendencies
 Severe burns
 Geriatric or fragile veins
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 Lesson 3: Phlebotomy

 Need to preserve veins for therapy

 Obese patients
 Point-of-care testing BLOOD COLLECTION
1. Massage the finger gently to help increase blood flow.
COLLECTION SITES 2. Clean the site to be punctured with a wet cotton ball. Allow
1. Fingers the site to dry.
2. Heel 3. Carefully open packaging of the Lancet.
4. Grasp the finger then puncture the skin.
COLLECTION SITES 5. Wipe away the first drop of blood with a dry cotton ball.
Collection Site Description Photo 6. Gently massage the finger and fill the micro collection tube
only up to the mark indicated.
1. Fingers  adults and
7. Place a piece of dry cotton onto the puncture site. Apply
children over 6 pressure.
months
8. Cap then invert the tube gently for ten times.
 palm-up surface of 9. Dispose of used lancet into a sharps container.
the distal segment 10. Remove and properly discard used gloves. Wash and dry
(fingertip) of the hands after collection.
middle or ring 11. Transport specimens to the laboratory.
finger
2. Heel  infants less than 6
months old
 lateral or medial
plantar surface

Sites to Avoid
 Smallest finger – tissue depth is insufficient to prevent bone
injury
 Thumb or index finger – more sensitive than other fingers
and may have calluses or scars
 Swollen or previously punctured sites accumulated tissue fluid
will contaminate the blood sample.
 Fingers of the hand where infusion is being performed
 Fingers on the side of the body where mastectomy has been
performed

Order of Draw
1. Blood smear
2. Lavender – EDTA microtainers
3. Green – Lithium Heparin
4. Mint green – Lithium heparin PST
5. Grey
6. Gold – SST
7. Red – No additive

WORK INSTRUCTION
PRE-COLLECTION PREPARATION
1. Review the request. Prepare all materials needed. (Lancet,
Micro collection tube, Dry cotton balls, Wet cotton balls,
Adhesive tape)
2. Sanitize hands.
3. Identify the patient by asking him/her to, state his/her full
name. Validate name given with that on the requisition form.
4. Check the completeness of data in the request form such as
patient information, test requests and any special
requirements.
5. Identify yourself and explain the procedure.
6. Wear disposable gloves

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