ANACHEM

• Types of Specimen


  • Blood
  • Cerebrospinal Fluid
  • Urine
  • Synovial Fluid
  • Pleural Fluid
  • Pericardial Fluid
  • Peritoneal Fluid
• Proper Patient Identification


  • First step in sample collection
  • Prime factor in order to attain accurate results in the clinical laboratory
  • Proper techniques in specimen collection must be strictly followed including the observance on the confidentiality of results
• Patient Identification Procedures


  1. Conscious Inpatients/Hospitalized patients: Verbally as their full names including middle names. Verify the name using the identification bracelet which includes first and last names, hospital/unit number, room/bed number and physician’s name.

  2. Sleeping patients: Identified in the same manner as conscious in-patients. They must be awakened before blood collection.

  3. Unconscious, Mentally Incompetent Patients: Identified by asking the attending nurse or relative; ID bracelet.

  4. Infants and Children: Identified by a nurse or relative, or by means of an identification bracelet.

  5. Outpatient/Ambulatory Patient
• An average human body contains approximately about 5 quarts (4.72 L) of whole blood
• Adult males have approximately: 5 to 6 liters of whole blood
• Adult females have approximately: 4 – 5 L of whole blood
• Composition of whole blood: 60% plasma – 3 quarts (2.84 L), 40% cells – 2 quarts (1.89 L)
• Sites for performing venipuncture

  • Antecubital fossa region
  • Veins of the wrist and the dorsal aspect of hands
  • Veins on the ankle
• Venipuncture


  • Greet the patient politely and with gladness (prior to blood collection we would want to establish rapport with our patient to make them as comfortable as possible)
  • Determine the identity of the patient
  • Decontaminate hands by performing proper hand hygiene, look at the gloves and prepare the materials needed for venipuncture
  • Position the patient's arm in a downward and comfortable manner
  • Apply the tourniquet 3 to 4 inches above the site. Check for potential sites by gently palpating the vein. Never leave the tourniquet longer than 1 minute
  • If a vein has already been chosen, release the tourniquet and decontaminate the patient’s skin with alcohol padding starting at the point where you expect to insert the needle and moving outward in an even widening concentric circles
  • Allow the site to dry
  • Reapply the tourniquet and instruct the patient to make a fist
  • Pull the skin gently with the thumb, and position the needle parallel or running in the same direction as a vein
  • Insert the needle quickly (bevel up)
  • For evacuated tube, push the tube and as the blood begins to flow, instruct the patient to open his fist and release the tourniquet. Tourniquet can be left on until after the tube has been
• Venipuncture


  1. Insert the needle quickly (bevel up)

  2. Push the tube for evacuated tube and instruct the patient to open his fist and release the tourniquet

  3. Withdraw the needle with a quick motion and hold the dry sterile gauze pad over the site. Apply pressure until the bleeding from the puncture site stops

  4. Label the tubes with patient’s full name, date and time of collection, and phlebotomist's initials

  5. Dispose all materials used in their designated waste bins (Yellow for infectious wastes, Black for non-infectious waste, Needle goes to the sharps container)
• Sites adjacent to IV therapy should be avoided
• IV fluid contamination may lead to an increase of infused substances such as glucose, chloride, potassium, and sodium with a decrease in urea and creatinine
• 10% contamination with 5% dextrose can increase glucose in the blood sample by 500 mg/dl or more
• Tourniquet Application

  1. If a blood pressure cuff is used as a tourniquet, it is inflated at 60 mmHg

  2. Ask the patient for latex sensitivity prior to blood collection

  3. If the tourniquet is closer to the site, the vein may collapse

  4. Release and reapply the tourniquet after 2 minutes if used during preliminary vein selection

  5. Tourniquet is applied to obstruct the return of venous blood to the heart and distend the veins

  6. Ideally, the tourniquet is discarded after each phlebotomy
• Disinfection of the site for puncture

  No traces of alcohol should remain on the skin to avoid hemolysis and contamination of glucose testing
• Sites to be avoided in blood collection

  • Intravenous lines in both arms
  • Burned or scarred areas
  • Areas with hematoma
  • Thrombosed veins
  • Edematous arms
  • Partial or radical mastectomy on one or both arms
  • Arms with arteriovenous (AV) shunt or fistula
  • Casts on arms
• Pre-analytical variable

  • Exercise
  • Fasting
  • Diet
  • Posture
  • Position
  • Tourniquet application
  • Smoking
  • Alcohol
  • Stress
  • Drugs
• Other methods for blood collection

  • Skin Puncture/Capillary Method
  • Central Venous Access
  • Arterial Puncture