PH 156: CLINICAL MICROSCOPY

PRINCIPLES OF BLOOD COLLECTION (LAB)

PROF. AZITA RACQUEL LACUNA | FEBRUARY 2022
TABLE OF CONTENTS 4. Use fingertip to palpate the antecubital fossa to locate the median
cubital vein.
I. Safe and Effective Blood
II. Phlebotomy
Draw
A. Materials
A. Procedure
B. Procedure
B. Poor Blood Collection
I. SAFE AND EFFECTIVE BLOOD DRAW
● Blood collection by venipuncture
→ one of the most common yet complex procedures performed in
a healthcare setting
→ Requires knowledge and skill
▪ to assure the accuracy and integrity of samples drawn
▪ to eliminate risk to both patients and healthcare workers
A. PROCEDURE
Introduction and Identification
1. Introduce yourself.
● “Good Morning, I’m [Name] and I’m here to draw your blood today.”
Note: Not explicitly stated as part of the procedure but was done by the
phlebotomist in the video.
2. Accurately ID the patient using at least two forms of identification
● Does the name and date of birth on the requisition form match
what the patient is telling you?
● Does it match what is on the patient ID wristband?
● Has the patient followed special orders such as fasting prior to the
blood draw process?
→ Address any inconsistency first with a requesting physician or Figure 2. Using the fingertip to palpate the antecubital fossa (Top). VIsual
healthcare worker on duty representation of the location of veins in the antecubital fossa. Take note of
Blood Extraction the median cubital vein (Bottom).
1. Wash hands and don a clean pair of gloves before proceeding. ● Palpation helps with the following:
● Make sure materials are already prepared and within reach but out → Determining direction of blood flow
of the reach of the patient → Gauging vein’s size and depth
→ Alcohol → Estimating its tendency to roll
→ Prep pads → Differentiating veins from arteries
→ Gauze ▪ Arteries have thicker feeling walls and are more elastic to
→ Tape touch
→ Correct gauge needles 5. Use alcohol prep pad to cleanse the skin around the site
→ Required evacuated collection tubes ● Swab from the center to the periphery of the site in a fluid circular
▪ color-coded based on additives motion
▪ Know the types of additives and which color tubes are to be → Be careful NOT to drag the pad back across the cleansed field
drawn based on requisition. 6. Let the area air dry
2. Speak reassuringly to the patient as you position them for the draw. ● Prevents contamination of either the patient or the specimen
● “I’m all set here. If you’d please straighten your arm? It’ll just take a 7. Grasp the patient’s arm firmly with your hand
moment while I apply the tourniquet” ● Place your thumb approximately 2 inches below the intended
3. Apply the tourniquet - do not leave tourniquet on for more than 1 puncture site.
minute ● With your thumb, pull the skin taut over the vein to help anchor it in
● Tourniquet place.
→ Slows vein blood flow and increases venous filling 8. Let the patient know you’re ready to make the puncture so the
▪ Makes veins more prominent, easier to locate and enter patient won’t get startled and jump.
→ Leaving the tourniquet for longer than a minute may affect ● “You’ll feel a pinch.”
laboratory results 9. Position the needle:
▪ Should be removed and reapplied if the procedure will take ● bevel side up
longer than a minute ● aligned with vein
● Should form a 15°- 30° angle with surface of the arm

Figure 1. Phlebotomist applying the tourniquet on a patient straightening

their arm.
Figure 3. The angle at which the needle enters the skin must be at 30°.

Trans # 2 Team H: Chaves, Mandawe, Sabangan, Vitug 1 of 4

(LAB)
10. Swiftly insert the needle through the skin and into the vein through a
single, short, but firm motion
11. Push the evacuated tube onto the needle when it enters the vein
→ As the vein aligns with a needle, blood will begin to move out of
the vein up into the needle
→ Maintain a constant slight forward pressure on the end of the
tube to prevent release of shut-off valve
12. As blood begins to flow into the collection tube, instruct the patient
to open their hand.
13. Remove the tourniquet on the patient’s arm.
● Allows the blood to return to its normal rate of flow through the vein Figure 5. Tubes required for routine venipuncture, in correct order from left
● Helps reduce bleeding at the puncture site to right.
14. Gently mix [tube] by inversion at least 8 times ● Ensure and maintain proper technique while drawing (Review Steps
● Ensures that any additives in the tube are incorporated into the blood 9 - 13 above)
sample ● Level of quality and integrity of the samples the laboratory receives
Note: In the video, the phlebotomist also assures the patient that the is dependent upon the level of skill, knowledge, and
procedure is almost over and asks if they’re okay. professionalism of the phlebotomist.
15. Engage the safety device on the needle and use sharps device for
proper disposal B. POOR BLOOD COLLECTION
16. Apply pressure at the needle entry site immediately after ● Negative Impacts of Poor Blood Collection
removing. → Loss of Sample Integrity
● Prevents hematoma from forming → Undue stress and pain on the patient
● Allows hemostasis to seal the wound → Physical harm on patient
● Factors Contributing to Negative impacts
→ Poor technique
→ Poor Judgment
→ Lack of knowledge
→ Loss of concentration
Situational Errors
● Invisible Errors
→ Missing a vein
▪ Causes:
− Failure to align needle with vein
− Inserting needle too steep or too shallow an angle (must
be at a 30°angle)
▪ Consequences [on patient]:
− further anxiety and discomfort from unwelcomed second
needle stick
− Serious (usually when targeting basilic vein)
Figure 4. Applying pressure ensures formation of platelet plug (whitish-gray o permanent damage to nerves due to their close proximity
star-shaped entities) and fibrin clot (yellow fibers). with basilic vein
Note: In this part of the video, the phlebotomist instructs the patient to o bleeding through nicking of the basilic artery
keep pressure on the injection site.
17. Apply the ID label on the filled evacuation tube and store it for
transport
● Label must include the following:
→ ID number
→ Patient’s full name
→ Date of birth
→ Date of collection
19. Dispose sharps in a sharps container and dispose of all other
used non sharp materials (gloves and gauze pads) in a trash receptacle
20. Disinfect all contaminated surface areas.
Multiple Tube Draw
● There are times when a single blood draw involves more than the
collection of a single sample. Figure 6. Visual representation of areas to avoid relative to the basilic vein,
● Multiple sample collection requires greater skill and careful planning the brachial artery and the musculocutaneous nerve.
● Two Keys in Planning Stage
→ Failure to use appropriate needle size
→ Determine appropriate gauge needle
▪ Cause: Poor judgment in selection of needle and gauge size
→ Plan Order of Collection to assure integrity
▪ Acceptable: butterfly needle
▪ Order is usually hospital-mandated
− Caveat: larger gauge (23 to 25 gauge) with small bore size
▪ Blood cultures always drawn first
o The small bore of 25 gauge needle may cause RBC
▪ Tube Order for Routine Venipuncture:
lysis despite accurate piercing of vein
o Light Blue
o Red
o Gold
o Green
o Lavender
o Gray

PH 156 Principles of Blood Collection (LAB) 2 of 4

 → Serum test requires at least 3 milliliters of blood
10. Keep in mind your patient may be nervous; Talk to them
11. Release tourniquet then use twicely-folded gauze to apply
pressure on punctured site
12. Pull out the needle then immediately put on the safety cap.
13. Set the syringe down on the table and finish bandaging the patient
first.
14. Unscrew safety cap needle then dispose in biohazard
container.
15. Screw in sterile transfer device to syringe to transfer blood to the
evacuated tube
16. Turn syringe upside right and insert tube from the bottom of
transfer device
→ Make sure the label is faced away so you can see whether the
tube is done collecting.
17. Disengage the evacuated tube and invert three to four times.
Figure 7. Butterfly needle. 18. Properly dispose the used materials
→ Consequence: Compromised integrity of sample due to lysed 19. Label tube with patient’s name, date and time of collection, and
RBCs collector’s initials.
▪ only seen upon analysis as blood drawn may appear of quality 20. Put the tube in a biohazard bag then transport to the laboratory
upon collection for analysis.
● Visible Errors III. REFERENCES
→ results in loss of blood draw quality and compromised patient ● Oakland University School of Health Sciences. (2012). Safe and
satisfaction Effective Blood Draw. Retrieved from
→ Unorganized Working Space https://www.youtube.com/watch?v=RKuUPO 6NNcU
▪ incorrect tube inserted ● SUNSOARS Company. (2013). Phlebotomy: Syringe Draw
▪ use of band aid instead of tape Procedure | Blood Collection (Rx-TN). Retrieved from
▪ improper disposal https://www.youtube.com/watch?v=7NSEFVbzTAU&t=1s
▪ unsanitary working area
→ Failure to apply pressure on puncture site immediately after
needle removal
▪ may cause hematoma
− Hematoma: skin surface that is bruised in appearance and
painful to the touch due to the collection of blood from the
vein into the space around it
II. PHLEBOTOMY: SYRINGE DRAW PROCEDURE
● For patients whose veins cannot handle the pressure of the
vacuumized tubes
A. MATERIALS
● Evacuated tube
● Barrel syringe
● Hypodermic needle with safety cap
● Transfer device
● Gauze
● Alcohol swabs
● Tape
● Tourniquet
B. PROCEDURE
1. Ask the patient for their consent and explain the procedure
2. Wash hands beforehand and don gloves
Note: In the video, the phlebotomist wore gloves only before cleansing
the injection site.
3. Apply tourniquet and palpate the vein using two index fingers of
your non-dominant hand; Release tourniquet after finding the vein
→ You may ask patient to make a fist to make finding the vein easier
4. Prepare the needle and syringe
→ Make sure they are not expired (expired needles and syringes
are no longer sterile)
→ Screw the needle into the syringe through the syringe’s Luer (“to
thread”) tip
4. Cleanse the patient’s arm using alcohol swab
→ Start at the center
→ Concentric method inside → out
5. Reapply the tourniquet (make sure ends are up)
→ Ask the patient to make a fist
6. Pull back and release down the needle safety cap
→ Chech and make sure everything is okay with the needle
7. Pull back on the plunger of the syringe to loosen it
8. Anchor vein; Insert the needle swiftly and slowly pull back the
plunger
→ Important to pull back the plunger gently and very slowly:
→ Recall: syringe draw procedure is for those who cannot tolerate
pressure in regular tubes
→ helps prevent specimen hemolysis
9. Collect required amount for test
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