04 Phleb Techniques

• VENIPUNCTURE

  • Refers to the process of collecting or “drawing” blood from a vein of the patient for laboratory testing purposes.
• Methods for Venipuncture:

  • Syringe
  • Evacuated Tube System
  • Butterfly
• VENIPUNCTURE EQUIPMENT:

  • Syringe/Needles
  • Tourniquet
  • Evacuated Collection Tubes
  • Multisample Needle
  • Holder/Adapter
  • Alcohol (70% isopropyl)
  • Povidone-iodine
  • Dry Cotton/Gauze
  • Micropore
  • Gloves
• Vein Locating Device

  – portable devices that use infrared light to help health professionals locate and assess veins for safe venous access
• Tourniquet

  – 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.
• Needles

  – used for withdrawing blood samples. The 3 types of needles used in venipuncture are multi-sample, hypodermic and winged infusion.
• Needle gauge

  – classified according to diameter of the lumen. The higher the number, the smaller the actual needle diameter.
• Evacuated tube system – closed collection system composed of multi-sample needle, tube holder and evacuated tubes, which prevents exposure to contaminants.
• Choice of gauge of needles:

  It is important to select the right gauge of the needle:

  • Type of Sample
  • Amount of Blood
  • Age of the patient
• • Hub Color: WHITE
  • Gauge: 16 G
  • Size: 1 x 1/2"
  • Diameter: 1.60 mm
• • Hub Color: PINK
  • Gauge: 18 G
  • Size: 1 x 1/2"
  • Diameter: 1.20 mm
• • Hub Color: CREAM
  • Gauge: 19 G
  • Size: 1 x 1/2"
  • Diameter: 1.10 mm
• • Hub Color: YELLOW
  • Gauge: 20 G
  • Size: 1", 1 x 1/4", 1 x 1/2"
  • Diameter: 0.90 mm
• • Hub Color: GREEN
  • Gauge: 21 G
  • Size: 1", 1 x 1/4", 1 x 1/2"
  • Diameter: 0.80 mm
• • Hub Color: BLACK
  • Gauge: 22 G
  • Size: 1", 1 x 1/4", 1 x 1/2"
  • Diameter: 0.70 mm
• • Hub Color: BLUE
  • Gauge: 23 G
  • Size: 1", 1 x 1/4", 1 x 1/2"
  • Diameter: 0.60 mm
• • Hub Color: MEDIUM PURPLE
  • Gauge: 24 G
  • Size: 1", 1 x 1/4", 1 x 1/2"
  • Diameter: 0.55 mm
• • Hub Color: ORANGE
  • Gauge: 25 G
  • Size: 1", 1 x 1/4", 1 x 1/2"
  • Diameter: 0.55 mm
• • Hub Color: BROWN
  • Gauge: 26 G
  • Size: 1/2", 1 x 1/2"
  • Diameter: 0.45 mm
• SYRINGE

  • For single draw
  • For drawing blood from patients with small or fragile veins.
  • Routinely used for venipuncture range from 2 to 20 mL
• Blood drawn in a syringe is immediately transferred to appropriate evacuated tubes to prevent the formation of clots.
• It is not acceptable to puncture the rubber stopper with the syringe needle and allow the blood to be drawn into the tube.
• EVACUATED TUBE SYSTEM

  • Blood is collected directly into the evacuated tube, eliminating the need for transfer of specimens and minimizing the risk of biohazard exposure
• EVACUATED TUBE SYSTEM includes:

  • Double-pointed needle
  • Needle holder
  • Color-coded evacuated tubes
• • Needle size varies by both length and gauge (diameter)
• Needle gauge -refers to the diameter of the needle bore.
• The smaller the gauge number the bigger the diameter of the needle.
• Needles should be visually examined before use to determine if any structural defects, such as nonbeveled points or bent shafts, are present.
• NEEDLE HOLDERS

  • made of rigid plastic and may be designed to act as a safety shield for the used needle.
  • Occupational Safety and Health Administration (OSHA) directs that these must be discarded with the used needle.
• NEEDLE DISPOSAL SYSTEMS

  • To protect phlebotomists from accidental needlesticks by contaminated needles
  • Rigid, puncture-resistant, leak-proof disposable “sharps” containers labeled BIOHAZARD that are easily sealed and locked when full.
• COLLECTION TUBES

  • Evacuated tubes also known as Vacutainers and are available in glass and plastic.
  • Contain a premeasured amount of vacuum for blood collection
• • The amount of blood collected in an evacuated tube ranges from 1.8 to 15 mL and is determined by the size of the tube and the amount of vacuum present.
• Stopper Color: LAVENDER

  Anticoagulant/Additive: Ethylenediaminetetraacetic Acid (EDTA)

  Sample Type: Whole blood/plasma

  Laboratory Use: Hematology
• Stopper Color: PINK

  Anticoagulant/Additive: EDTA

  Sample Type: Whole blood/plasma

  Laboratory Use: Blood Bank
• Stopper Color: WHITE

  Anticoagulant/Additive: EDTA and gel

  Sample Type: Plasma

  Laboratory Use: Molecular Diagnostics
• Stopper Color: LIGHT BLUE

  Anticoagulant/Additive: Sodium Citrate

  Sample Type: Plasma

  Laboratory Use: Coagulation
• Stopper Color: RED/GRAY, GOLD

  Anticoagulant/Additive: Clot Activator and gel

  Sample Type: Serum

  Laboratory Use: Chemistry
• Stopper Color: GREEN

  Anticoagulant/Additive:

  1. Ammonium Heparin

  2. Lithium Heparin

  3. Sodium Heparin

  Sample Type: Whole Blood/Plasma

  Laboratory Use: Chemistry
• Stopper Color: LIGHT GREEN, GREEN/BLACK

  Anticoagulant/Additive: Lithium Heparin and gel

  Sample Type: Plasma

  Laboratory Use: Chemistry
• Stopper Color: RED (Glass)

  Anticoagulant/Additive: None

  Sample Type: Serum

  Laboratory Use: Blood Bank, Chemistry, Serology