phleb

• Before collecting a blood sample:

  • Gain the patient's trust by properly greeting them
  • Decreases patient anxiety and increases compliance
  • Give your name and your immediate role on their care
• Proper patient identification is essential to accurate patient testing. Hospital identification bracelets often include last name, first name,

  hospital number, date of birth, and physician.

  • Ask the conscious patient to state his or her full name and spell the last name.

  • If the patient is sleeping, wake the patient.

  • If patient is in a state coma, ask the relative and confirm with the patients identification bracelet
• All samples should be labeled after the blood is drawn and before the phlebotomist leave the patient.
• ACCESSION ORDER • A number to identify all paperwork and supplies associated with each patient
• The patient must be in a seated or reclined position

  to prevent syncope
• The order of checking the best available site is: (1) Upper arm, (2) hand, (3) wrist, (4) ankle or foot
• • Pain

  • Reposition the needle slightly and release the tourniquet
  • Avoid deep probing venipunctures
• Nerve damage

  • First felt by the patient as tingling or numbing of the arm or hand
• Syncope

  • Preceded by the patient turning pale, perspiring, and starting to

  breathe shallowly
• Nausea

  • Make the patient as comfortable as possible

  • Instruct to breathe slowly and deeply

  • Apply cold compress to forehead

  • Prepare emesis basin
• Diabetic shock/hypoglycemia

  • Due to fasting

  • results from too much insulin in their blood stream • Give patient a glass of orange juice or cola
• Continued bleeding

  • Continue to apply pressure to the site

  • Apply for at least 15 minutes
• • Hematoma

  • Leaking blood under the skin at the site of venipuncture
• Iatrogenic anemia

  • Anemia caused by drawing excessive quantities of blood from a patient during the care of the patent; usually most concern with premature infants
• hemolysis is Breaking or rupturing of the membrane of red blood cells
• Serum or plasma that contains a large amount of bilirubin because of jaundice are icteric samples
• Large amount of fats and lipids, white milky is lipemic sample
• Phlebotomy is “the act or practice of bloodletting as a therapeutic measure”
• VENESECTION- most common procedure that uses lancet to bleed the vein
• CUPPING- the use of heated glass cup placed on person’s back.
• point of care testing” (e.g. bloodsugar/glucose)

  -speeds the process of treatment for the patient.
• Two skills that are important for a phlebotomist are:

  hand-eye coordination and Compassion.
• HMO- provide health coverage
• PPO- offers more freedom to choose whom they go.
• ESOTERIC TEST- not common laboratory test.
• Transillumination:

  • inspecting an organ by passing light through its walls
• tourniquet must be 3-4 inches above the site
• Bevel: end of the needle that pierces the skin
• Shaft: long cylindrical portion
• Hub: end of the needle that connects to the blood collecting device
• Lumen: the internal part of the needle
• 21 gauge is considered for the standard for most routine adult venipuncture.
• length of needle is 1.5 inches
• multisample needles allow multiple tubes of blood to be collected during a single venipuncture
• Hypodermic needles- used in a syringe system
• Winged infusion (butterfly) needles- used for collecting blood from small or difficult veins such as hand veins of elderly, and pediatric patients
• Evacuated tubes: volume may range form 1.8 ml to 15 ml
• blood culture

  tests: SPS

  send to: microbiology 
• citrate

  tests: d-dimer, fibrinogen, APPT, PPT

  send to: hematology

  anticoagulant: sodium citrate
• serum tubes

  tests: all biochemical test (FBS, BUN, CREA, BUA, Lipid Profile, Electrolytes)

  send to:  chemical test- Clinical Chemistry

                  antibody screening- immunology- serology