Module 4:Blood collection

• Phlebotomy Needles

  • Sterile and single use
  • Needle gauge refers to the diameter of the needle bore
  • Length: 1-1.5 inches
  • Gauge: 16-25
  • 3 Types of Needles: Multi-sample, Hypodermic, Winged infusion set
• General Blood Collection Equipment and Supplies

  • Phlebotomy area/Phlebotomy chair
  • Equipment carrier/Phlebotomy collection tray/Tackle box
  • Syringe/ETS/Lancets
  • Tourniquet
  • Evacuated Collection tubes
  • Gloves
  • Antiseptics/Disinfectants/Hand sanitizers
  • Gauze pads/Cotton
  • Bandages
  • Sharps container
  • Biohazard bags
  • Marking pen
  • Slides
  • Timer
• Phlebotomists are responsible for blood sample collection and should be familiar with materials used in blood collection
• Evacuated Tube System

  1. Closed collection system

  2. The most efficient and frequently used method for venipuncture

  3. Blood is collected directly into the evacuated tube

  4. Enables multiple tubes to be collected in a single venipuncture

  5. Composed of: Multi-sample needle, Tube holders, Evacuated tubes
• Phlebotomy or Venipuncture may be done either using the conventional needle and syringe or through the use of Evacuated Tube System (ETS)
• Butterfly System

  1. Used for IV fluid infusion and venipuncture for very small and fragile veins (pediatrics and geriatrics)

  2. Has short needle with a plastic part resembling butterfly wings

  3. Needle size: ½ to ¾ inches

  4. With long tubing with: Luer fitting – syringe, Luer adapter – ETS
• The median antecubital vein of the arm is the most frequent site for Venipuncture
• Phlebotomy or Venipuncture


  The act of obtaining a blood sample from a vein using a needle attached to a collection device or a stoppered evacuated tube
• Requisition Forms are used during the identification process of each patient prior to the venipuncture procedure to ensure proper healthcare is given to the appropriate individual
• Needle Adapter

  A translucent plastic cylinder with a small opening that accepts the multisample needle and a wide opening that accepts the collection tube
• Phlebotomists should be knowledgeable to help prevent pre-analytical errors that will be encountered in the laboratory, as these errors affect the validity of the results
• Syringe System

  1. Used as an alternative method when drawing blood

  2. Preferred method when drawing blood from patients with small or fragile veins

  3. Suction pressure on the vein can be controlled

  4. Routinely used: 2mL, 5mL and 10mL

  5. Composed of: Syringe needle, Syringe, Barrel, Plunger
• Blood collection tube additives may contain none to more than one additives depending on the test ordered
• Vein-locating Materials

  • Tourniquet is used as a vein compressor
  • Vein Locating Devices are transillumination portable devices that use infrared light to help health professionals locate and assess veins for safe venous access
• Gauze pad or Cotton ball is used at the completion of a venipuncture procedure and prior to withdrawing the needle to apply pressure to the venipuncture site and maintain sterilization
• Microcollection tubes


  • Common type of collection containers used for dermal puncture samples
  • Available with a plastic capillary tube that is fitted inside the container to aid in the collection of the sample
• Needle Adapters


  • Come in different sizes to fit tubes of different diameters
• Skin Puncture Devices

  1. Manual Lancets

  2. Automatic puncture devices deliver a swift puncture to a predetermined depth, which can be a significant advantage at sites where the bone is close to the skin

  3. Contact activated - The dimensions of the puncture are controlled by the width and depth of the point

  4. Some automatic puncture devices have a platform that is positioned over the puncture site and color coded for different depths
• Antiseptics and Disinfectants


  • ANTISEPTICS: 70% Ethyl alcohol
  • 70% Isopropyl alcohol
  • Benzalkonium chloride
  • Chlorhexidine gluconate
  • Hydrogen peroxide
  • Povidone-iodine
  • Tincture iodine
  • DISINFECTANTS: 10% Sodium hypochlorite
• General Blood Collection Equipment and Supplies

  • Phlebotomy area/Phlebotomy chair
  • Equipment carrier/Phlebotomy collection tray/Tackle box
  • Syringe/ETS/Lancets
  • Tourniquet
  • Evacuated Collection tubes
  • Gloves
  • Antiseptics/Disinfectants/Hand sanitizers
  • Gauze pads/Cotton
  • Bandages
  • Sharps container
  • Biohazard bags
  • Marking pen
  • Slides
  • Timer
• Butterfly System

  • Used for IV fluid infusion and venipuncture for very small and fragile veins (pediatrics and geriatrics)
  • Has short needle with a plastic part resembling butterfly wings
  • Needle size: ½ to ¾ inches
  • With long tubing with Luer fitting – syringe and Luer adapter – ETS
• Adhesive bandages are placed over the puncture site when the bleeding has stopped or when more pressure is required following arterial puncture or blood collection in patients with excessive bleeding
• Evacuated Collection Tubes


  • May be plastic or glass with a colored, rubber top
  • The color of each top will vary in accordance with its additive to indicate the specific diagnostic test to be performed
• Additive Categories

  • Anti-coagulants (Blood thinners) – chemical substances that prevent blood clots
  • Anti-glycolytic agents – prevent breakdown of glucose by blood cell or glycolysis
  • Clot activators – enhance coagulation
  • Thixotropic gel separator – inhibits cellular metabolism of substances by moving in between the cells and serum/plasma
  • Trace element-free tube – few of trace elements contamination
• Blood specimen collection order of draw

  1. Yellow SPS/Sterile Media Bottles for Blood Cultures (Sterile Collections) to minimize chance of microbial contamination

  2. Light Blue for Coagulation tubes as the first additive tube in the order because all other additives affect coagulation tests

  3. Red for Glass nonadditive tubes to prevent contamination by additives in other tubes

  4. Red for Plastic clot activator tubes filled after coagulation tests because silica particles activate and affect coagulation tests

  5. Red and Gray Rubber or Gold Plastics for Serum Separator Tubes, Green and gray rubber or Light-green plastic for Plasma-separator tubes, Lavender, pink, or purple or Pearl top for EDTA tubes, Gray for Plasma preparation tubes
• Additional materials for venipuncture

  • Gloves, Sharps Container, Biohazard bags, Pen/Marker, Computer-generated labels
• Blood collection tube additives


  • May contain none to more than one additives depending on the test ordered
  • Forms of additives: Liquid, Spray-dried, or Powdered
  • Additive Categories: Anti-coagulants (Blood thinners), Anti-glycolytic agents, Clot activators, Thixotropic gel separator, Trace element-free tube
• Venipuncture

  1. Gloves must be worn when collecting blood and changed after each patient

  2. Use of Sharps Container for proper and safe disposal of used needles, syringes, lancets, and any tool that can cause an incision

  3. Availability of Biohazard bags for transport of specimens based on institutional protocol

  4. Necessary information in the specimen tube labelling: Patient’s complete name (First and last names), Date of Birth, ID number if applicable, Date of collection, Initials of phlebotomist, Additional information such as “fasting”
• Self-adhesive gauze application


  Preferred for patients who are allergic to adhesive bandages, the elderly with thin skin
• Order of draw


  A special sequence of tube collection that reduces the risk of specimen contamination by microorganisms and additive carry over
• Order of Draw

  
• 1st Order of Draw Summary

  
• 2nd Order of draw Summary

  
• Evacuated Tube System - closed collection system

  • most efficient and the most frequently used method for venipuncture
  • directly into the evacuated tube
  • enables multiple tubes to be collected in a single venipuncture
• ETS is composed of;

  1. Multi-sample needle – allows collection of multiple tubes during venipuncture
  2. Tube holders - plastic cylinder with a small opening for a needle at one end and a large opening for tubes
  3. Evacuated tubes – collection tubes with premeasured vacuum that automatically draws the volume of blood indicated in the tube label.
• Needle Adapter - is a translucent plastic cylinder. One end has a small opening that accepts the multi-sample needle.
• Vein Locating Devices - Transillumination portable devices that use infrared light to help health professionals locate and assess veins for safe venous access.