Lesson 4 - PMTP LEC

• phlebotomists are responsible for collecting blood specimen for testing in the lab
• it is imperative that phlebotomists are knowledgeable about the pieces of different equipment, devices, and supplies used for the different methods of drawing blood so they could prepare them appropriately
• selecting the correct tools and using them properly during the testing procedure does not only ensure safe collection but also guarantee accurate results
• Blood-drawing station

  • primarily used for the outpatient department
  • it contains table, chair, and bed
• phlebotomy chair - should be comfortable and with an adjustable arm rest
• equipment carrier - makes the collection portable
• hand-held phlebotomy equipment - used for "stat" cases
• phlebotomy cart

  • usually utilized for early-morning phlebotomy rounds
  • the carts are left in the hallway to avoid nosocomial infection
• it is best if the phlebotomist uses liners when his/her skin is prone to allergies and dermatitis
• antiseptics - used to prevent sepsis (the presence of harmful bacteria that typically enters the human body through a wound or a break in the skin)
• disinfectants - used in killing microorganisms on surfaces and instruments which should be handled with care because they could be harmful to the skin
• the use of hand sanitizer or wall-mounted hand sanitizer dispenser is recommended as a substitute for hand washing except when the hands are visibly soiled
• gauze pads

  • clean 2x2 inch gauze folded in fourths
  • they can be used to hold pressure after blood collection instead of cotton balls, since they have fluid-proof backing that prevents contamination
• bandages - can be used on the blood collection site once the bleeding has stopped
• microscope slides - 1x3 inch microscope slides for blood firms are used in hematology determinations
• a pen with a non-smear ink is recommended to be used when labeling specimen
• a watch with timer can be used to determine collection times and to time tests
• biohazard bags

  • used to transport blood and other specimens to the lab
  • these are leak-proof bags marked with biohazard logo
• an outside packet is used to hold requisitions and other documentation
• vein-locating devices - transillumination portable devices that use infrared light to help health professionals locate and assess veins for safe venous access
• tourniquet

  • a constricting device applied to a patient's arm prior to venipuncture with the aim of inflating the veins by restricting venous blood for a period of time
  • intended for single use only
• needles

  • used for withdrawing blood samples
  • sterile and for single use only
• needle gauge

  • classified according to the diameter of the lumen
  • the higher the number, the smaller the actual needle diameter is
• the appropriate gauge should be used is between 20 to 23, but a 21 needle gauge is the most commonly used
• the length of the needle in venipuncture is 1 to 1.5 inches
• the needles come with color-coded caps and hubs for easy identification
• needle gauge are equipped with safety features such as resheathing, blunting and retraction devices
• evacuated tube system - a closed collection system composed of multi-sample needle, tube holder and evacuated tubes that prevents exposure to contaminants
• the disinfectants preferred to be used in venipuncture are Environmental Protection Agency (EPA) registered sodium hypochlorite with 1:100 dilution
• for spills clean-up procedures, the 1:10 dilution is used which the contact time required is 10 minutes
• multi-sample needles

  • used in the ETS
  • equipped with safety features
• hypodermic needle

  • used in the syringe system and comes with different gauges and lengths for different types of usage
• winged infusion set (butterfly)

  • used for difficult veins such as those pediatric or elderly patients because it is more flexible than the needle or syringe
  • it is composed of 1/2 to 3/4 inch stainless needles, 23 to 25 gauge, with a 5 to 12 inch tubing
  • it has a Luer attachment for syringes or mutli-sampler Luer adapter for ETS
  • the wings of the plastic extensions facilitate the easy manipulation of the shallow angle needle insertion
• syringe system

  • used as an alternative method when drawing blood from patients with small or difficult veins
  • it is a traditional collection procedure that uses a syringe to draw blood from the patient, and the collected specimen is transferred into tubes
• The Components of Syringe System

  1. Syringe needle that has a resheating feature
  2. A syringe that is divided into a graduated barrel and plunger
• When drawing blood, the plunger is pulled back slowly, thus, creating a vacuum that causes the barrel to fill with blood
• syringes that are commonly used in phlebotomy are 2, 5, and 10 mL
• the blood collected by the syringe should be transferred into tubes using a syringe transfer device which is altered to the hub of the syringe after the syringe draw is completed
• syringe transfer devices facilitate the transfer of blood into tubes without stopper removal or the use of a syringe
• the blood collection tube may contain one or more additives depending on the test ordered by the physician that can be in liquid, spray-dried, or powdered form that has a specific function. The tube should be gently inverted 3 to 10 times after the collection to mix the additive with the specimen