Chapter 39

Phlebotomy:
Venipuncture and
Capillary Puncture

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 Why Collect Blood?
• Study of blood and its components, fluids and
cells
• Phlebotomy: also called venipuncture, is used to
acquire the blood for testing
• Testing can determine disease processes, levels
of chemical and medications in the body,
antibodies and blood cell activities

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 The Medical Assistant’s
Role in Phlebotomy
• To collect blood as efficiently as possible for
accurate and reliable test results
• Role varies
• Direct contact with patient
• Provide high-quality care
• Must act professionally

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 Anatomy and Physiology
of the Circulatory System (Slide 1 of 3)
• Blood forms in body’s organs and bone marrow
(blood cell production)
• Blood carries oxygen and nutrients to cells and
removes waste products and carbon dioxide
• Heart: pumps blood through body
• Arteries: oxygenated blood flows away from heart
• Veins: deoxygenated blood flowing back to heart
• Capillaries: connecting most arteries and veins

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 Anatomy and Physiology
of the Circulatory System (Slide 2 of 3)
• Body contains about 6 liters of blood
• 45% of blood is formed elements
- Erythrocytes
- Leukocytes
- Thrombocytes (platelets)
• 55% is liquid called plasma
- Fluid matrix
- Serum is clear straw colored liquid after the
blood has clotted, does not contain fibrinogen

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 Anatomy and Physiology
of the Circulatory System (Slide 3 of 3)
• Centrifuge separates serum from blood
• Vacuum collection tubes showing serum and
plasma
• Anticoagulant prevents blood from clotting
• Buffy coat: leukocytes and thrombocytes

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 Blood Collection (Slide 1 of 2)
• Centrifuge separates serum from blood
• Vacuum collection tubes showing serum and
plasma
• Anticoagulant prevents blood from clotting
• Buffy coat: leukocytes and thrombocytes
• Most laboratory tests performed on serum, plasma,
or whole blood
• Serum sample: serum separator vacuum tube with
thixotropic gel used

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Blood Collection (Slide 2 of 2)
• Venipuncture
- Antecubital space: most common site (See
Figure 39-5)
- Median cubital vein
- Superficial veins in hands or wrist
- Veins in feet or legs
- Arteries of arms

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 Venipuncture Equipment
(Slide 1 of 4)
• Three methods used:
- Syringe method
- Vacuum method
- Butterfly method
• See Table 39-1: Comparison of Blood Collection
Methods
• Syringes
- Vary in size from 1 mL to 10 mL; Luer-Lok tip
- Allows the needle to be securely twisted onto the
syringe

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 Venipuncture Equipment
(Slide 2 of 4)
• Needles
- Needles vary in gauge and length
- Special needle: multidraw needle
- Winged infusion set (butterfly) with safety
needle
- Most common sizes are gauges 20, 21 and 22,
either 1 or 1.5 inches in length
- Safety needles and blood collection systems
- OSHA requires safety needles
- Prevent on-the-job needlestick injuries
- Needlestick prevention devices (NPDs)
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 Venipuncture Equipment
(Slide 3 of 4)
• Vacuum tubes and adapters/holders (see Figure 39-
12)
- Vacuum tubes: vacuum-packed test tubes with
rubber stoppers
• Plain or with added chemicals or substances
necessary for appropriate test to be run
• Color coded designates additive
- Plastic holders or tube adapters used in
conjunction with vacuum tubes
- Replace frequently

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 Venipuncture Equipment
(Slide 4 of 4)
• Different tests require different types of blood
specimens
• Anticoagulants, additives, and gels
• Additives are put into the tubes during
manufacturing (see Figure 39-14)
- Thixotropic gel plugs
• Gel forms solid plug and separates cells/clot
from plasma/serum
• When centrifuged the gel changes to a liquid
- Clot activators

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 Order To Draw
• The order in which blood is drawn or mixed with
additives is important
- Clinical Laboratory Standards Institute (CLSI)
establishes lab procedures
- Latest publication 2011
• Sterile collection bottles need to be filled first to
prevent any contamination
• After sterile culture tubes drawn, order for other
tubes is related to additives in them

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 Tourniquets/
Specimen Collection Trays
• Tourniquets
- Constrict flow of blood in arm
- Can be disinfected or discarded
- Make veins more prominent
- Rubber or elastic strip 1 inch wide by 15–18
inches long
- Blood pressure cuff may be used instead
• Specimen Collect trays
- Available in a variety of sizes and shapes
- See Figure 39-18

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 Venipuncture Principles
(Slide 1 of 4)
• Approaching the patient
- Social skills
- Technical skills
- Administrative skills
- Quality assurance skills
- Interpersonal and therapeutic communication
- Greeting the patient guidelines

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 Venipuncture Principles
(Slide 2 of 4)
• Preparing supplies and greeting the patient
- Prepare before venipuncture
- Place all tubes within easy reach
- Keep spare tubes
• Patient and specimen identification
- Ask patient to state full name
- Check wristband if applicable
- Label specimen tubes before leaving
examination room
- Check paperwork against tubes

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 Venipuncture Principles
(Slide 3 of 4)
• Positioning the patient
• Selecting the appropriate venipuncture site
- Median cubital vein
• Applying the tourniquet
- Applied 3 to 4 inches above puncture site
- Tightly enough to slow flow of blood in veins but
not so tightly as to prevent flow of blood in
arteries
- On arm no longer than 1 minute
- Remove as soon as blood flow established

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 Venipuncture Principles
(Slide 4 of 4)
• Performing a safe venipuncture
- Find site that will give best blood return
- Palpate vein with tip of index finger
- Differentiating between veins, tendons, nerves
- Use tourniquet appropriately
- Be sure to distinguish the vein from the artery
(pulsating)
- No more than 2 attempts
- Avoid scars and compromised arms

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 Specimen Collection
(Slide 1 of 3)
• Hand washing critical step
• Tie tourniquet
• Apply gloves
• Select a vein
• Cleanse site firmly with 70% isopropyl alcohol pad
• Allow area to air dry
• Venipuncture is performed

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 Specimen Collection
(Slide 2 of 3)
• The syringe technique
• Vacuum tube/butterfly needle collection system
• See Procedure 39-5: Obtaining Blood for Blood
Culture
• See Table 39-6: Patient Reaction to Blood Draws
• The unsuccessful venipuncture
- Stimulate the vein/change position of needle by
rotating needle half a turn
- Advance further into vein/pull back a little/try
another tube/withdraw needle slowly
- Probing of site not recommended
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 Specimen Collection
(Slide 3 of 3)
• Criteria for rejection of a specimen
- Quality-assurance controls for specimen
collection and processing
- Retesting specimen or collecting another
sample
• See Table 39-9: Factors Affecting Laboratory
Values
- Improper specimen handling and storage
- Patient psychological factors
- Special handling requirements not met
- Patient alters results by certain actions
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 Capillary Puncture
• Method of obtaining one to several drops of blood
• Tests that use blood obtained by capillary puncture
- CBC, RBC, and WBC
- Hemoglobin and hematocrit
- Glucose testing
- Phenylketonuria testing
• Procedure

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