Hematology (lab) | PRELIMS

1: SPECIMEN COLLECTION (Venipuncture, Capillary, Arterial etc.)

PHLEBOTOMY
 Came from the Greek word “PHLEB” which
means “pertaining to a vessel” and “OTOMY”,
meaning “to make an incision”.
 “process of making an incision in a vein with a
needle”
THREE TYPES OF BLOOD VESSEL
14. Applying basic principles in learning new
techniques and procedures by attending
continuing education programs.
HANDWASHING
 Has been identified as the most significant
practice to reduce transfer or transmission
of microorganisms.

ARTERY ARTERY

CAPILLARIES

DUTIES AND RESPONSIBILITIES OF THE

PHLEBOTOMIST:
1. Correct identification and preparation of the
patient before sample collection.
2. Collecting, transporting, handling, and
processing blood specimens for analysis.
3. Recognizing the importance of specimen
collection in the overall patient care system.
4. Relating the anatomy and physiology of the
body systems and anatomic terminology to the
major areas of the clinical laboratory, and to
general pathologic conditions associated with PRIMARY VEINS USED IN VENIPUNCTURE
body system.
5. Identifying and selecting equipment, supplies
and additives used in blood collection.
6. Correct labelling of all samples with required
information.
7. Recognizing factors that affect specimen
collection procedures and test results, and
taking appropriate actions with predetermined
limits when applicable.
8. Recognizing and adhering to infection control
and safety policies and procedures.
9. Monitoring quality control charts within
predetermined limit, as well as preventive
maintenance procedures.
10. Recognizing the various components of the
health care delivery system.
11. Recognizing the responsibilities of other
laboratory and health care personnel and
interacting with them with respect for their jobs
and patient care.
12. Demonstrating professional conduct, stress
management, interpersonal and
communication skills with patients, peers and
other health care personnel and with the
public.
13. Demonstrating as understanding of
requisitioning and the legal implications of their
work environment.

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Hematology (lab) | PRELIMS
1: SPECIMEN COLLECTION (Venipuncture, Capillary, Arterial etc.)

3. Quality control;
4. Standards for quality care for patients and
health workers
5. Quality of laboratory sampling
3.1. QUALITY CONTROL

STEPS/PROCEDURE FOR DRAWING BLOOD

1. PATIENT INTERACTION
 Identify the patient
 Note patient isolation restrictions
 Note patient dietary restrictions
 Reassure patient
ISSUES IN PHLEBOTOMY
 Verify paperwork
1. Hemolysis  Position patient
2. Contamination 2. ASSEMBLE SUPPLIES AND EQUIPMENTS
3. Inaccurate labelling 3. VENIPUNCTURE
FACTORS THAT INCREASE THE RISK OF  Select general venipuncture location
HAEMOLYSIS INCLUDE:  Apply the tourniquet
 Use of a needle of too small a gauge (23 or  Select exact venipuncture site
under), or too large a gauge for the vessel  Cleanse area
 Pressing the syringe plunger to force the blood  Inspect needle
into a tube, thus increasing the shear force on  Perform venipuncture
the red blood cells;  Release tourniquet
 Drawing blood specimens from an intravenous  Position gauze or cotton over puncture site
central line;  Remove needle and apply pressure
 Under filling a tube so that the ratio of 4. SPECIMEN PREPARATION
anticoagulant to blood is greater than 1:9  If syringe used, fill tubes
 Reusing tube that have been refilled by hand  Discard needle
with inappropriate amounts of anticoagulants;  Label specimens
 Mixing a tube too vigorously;  Transport specimens promptly and properly
 Failing to let alcohol or disinfectant dry
 Using too great a vacuum; for example, using
too large a tube for a pediatric patient or using
too large a syringe (10-20 ml)

BEST PRACTICES IN PHLEBOTOMY INVOLVE

THE FOILLOWING FACTORS:
1. Planning ahead;
2. Using an appropriate location;

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Hematology (lab) | PRELIMS
1: SPECIMEN COLLECTION (Venipuncture, Capillary, Arterial etc.)
ORDER OF DRAW BLOOD SAMPLING SYSTEM

ARTERIAL BLOOD SAMPLING

 An arterial blood sample is collected from an
artery, primarily to determine arterial blood
gases.
 The first choice is the radial artery, Alternative
sites for access are brachial or femoral
arteries
COMPLICATIONS RELATED TO ARTERIAL
BLOOD SAMPLING
1. Arteriospasm
2. Haematoma
3. Nerve damage
4. Fainting or a vasovagal response
FILLING OF TUBES 5. Other problems can include a drop in blood
CHOICE OF GAUGE pressure, complaints of feeling faint, sweating
or pallor that may precede a loss of
consciousness.
PEDIATRIC AND NEONATAL BLOOD SAMPLING
Choice of procedure and site
 venous site, finger-prick or heel-prick – also
referred to as “capillary sampling” or “skin

puncture”
 Will depend on the volume of blood needed for
the procedure and the type of laboratory test to
be done.
 Venipuncture is the method of choice for
blood sampling in term neonates; however, it
requires an experienced and trained
phlebotomist. If a trained phlebotomist is not
available, the physician may need to draw the
specimen
PROCEDURES/STEPS OF PEDIATRIC AND
PARTS OF SYRINGE NEONATAL BLOOD SAMPLING

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Hematology (lab) | PRELIMS
1: SPECIMEN COLLECTION (Venipuncture, Capillary, Arterial etc.)
CAPILLARY SAMPLING
 Capillary sampling from a finger, heel or
(rarely) an ear lobe may be performed on
patients of any age, for specific tests that
require small quantities of blood
 However, because the procedure is commonly
used in paediatric patients
CHOICE OF SITE FOR CAPILLARY PUNCTURE
Adult patients
 The finger is usually the preferred site for
capillary testing in an adult patient.
 The sides of the heel are only used in
paediatric and neonatal patients.
 Ear lobes are sometimes used in mass
screening or research studies.
Paediatric and neonatal patients
 DO NOT use a surgical blade to perform a skin
puncture.
 DO NOT puncture the skin more than once
with the same lancet, or use a single puncture
site more than once, because this can lead to
bacterial contamination and infection.
SELECTING THE LENGTH OF LANCET
Adult patients
 Lengths vary by manufacturer (from 0.85 mm
for neonates up to 2.2 mm).
 In a finger-prick, the depth should not go
beyond 2.4 mm, so a 2.2 mm lancet is the
longest length typically used.
Paediatric and neonatal patients
 In heel-pricks, the depth should not go
beyond 2.4 mm. For premature neonates, a
0.85 mm lancet is available.
ORDER OF DRAW
 With skin punctures, the haematology
specimen is collected first, followed by
the chemistry and blood bank specimens.
 1. Blood gas specimen (Capillary Blood
Gas), 2. EDTA, 3. Other tube with
additives, 4. non-additives
1. EDTA
2. HEPARIN
3. SST – SERUM
4. SEPARATOR GEL
COMPLICATIONS THAT CAN ARISE IN
CAPILLARY SAMPLING INCLUDE:
 collapse of veins if the tibial artery is lacerated
from puncturing the medial aspect of the heel;
 osteomyelitis of the heel bone (calcaneus);
 nerve damage if the fingers of neonates are
punctured;
 haematoma and loss of access to the venous
branch used;
 scarring;
 localized or generalized necrosis (a long-term
effect);
 skin breakdown from repeated use of adhesive
strips (particularly in very young or very elderly
patients) – this can be avoided if sufficient
pressure is applied and the puncture site is
observed after the procedure.
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Hematology (lab) | PRELIMS
1: SPECIMEN COLLECTION (Venipuncture, Capillary, Arterial etc.)
PROCEDURES/STEPS OF CAPILLARY PUNCTURE

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