Blood collection

• Antiseptics


  Substances used to prevent sepsis
• The antiseptic most commonly used for routine blood collection is 70% isopropyl alcohol (isopropanol)
• povidone–iodine is used for blood culture collection
• Prep pads are used for blood gas collection
• Disinfectants


  Chemical substances or solutions regulated by the Environmental Protection Agency (EPA) that are used to remove or kill microorganisms on surfaces and instruments
• Disinfectants are corrosive and are NOT SAFE ON HUMAN SKIN
• CDC & HICPAC Guidelines for Environmental Infection Control in Healthcare Facilities recommend the use of EPA-registered sodium hypochlorite as a disinfectant
• A 1:100 dilution is recommended for decontaminating surfaces after cleaning up blood or other body fluid spills in patient-care settings
• 1. 10 dilution is recommended for large amounts of blood or other body fluid spills
• At least 10 minutes of contact time is required for disinfectants to be effective
• The CDC Guideline for Hand Hygiene in Health Care Settings recommends the use of alcohol-based hand sanitizers for routine decontamination of hands as a substitute for hand washing provided that the hands are not visibly soiled
• If hands are heavily contaminated with organic material and hand-washing facilities are not available
• A phlebotomy chair should be comfortable for the patient and have adjustable armrests to achieve proper positioning of either arm
• Nonsterile, disposable latex, nitrile, neoprene, polyethylene, and vinyl examination gloves are acceptable for most phlebotomy procedures
• The FDA regulates glove quality
• Handheld carriers come in a variety of styles and sizes designed to be easily carried by the phlebotomist and to contain enough equipment for numerous blood draws. They are convenient for "stat" or emergency situations or when relatively few patients need blood work
• Phlebotomy carts have swivel wheels, which glide the carts smoothly and quietly down hospital hallways and in and out of elevators. They normally have several shelves to carry adequate supplies for obtaining blood specimens from many patients. Carts are commonly used for early-morning hospital rounds
• The Centers for Disease Control/ Healthcare Infection Control Practices Advisory Committee (CDC/HICPAC) standard precautions and the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standard require the wearing of gloves when performing phlebotomy
• Hand sanitizers are recommended for routine decontamination of hands as a substitute for hand washing provided that the hands are not visibly soiled
• Hand hygiene in Health Care Settings

  1. Use of alcohol-based hand sanitizers for routine decontamination of hands as a substitute for hand washing provided that the hands are not visibly soiled

  2. If hands are heavily contaminated with organic material and hand-washing facilities are not available, it is recommended that hands be cleaned with detergent-containing wipes followed by the use of an alcohol-based hand cleanser
• Items for blood collection procedures

  • Gauze pads, Cotton balls, Bandages, Needle & Sharps Disposal Containers, Biohazard Bags, Slides, Pen, Watch
• Needle & Sharps Disposal Containers

  1. Used needles, lancets, and other sharp objects must be disposed of immediately in special containers referred to as “sharps” containers

  2. All must be clearly marked with a biohazard symbol and be rigid, puncture-resistant, leakproof, and disposable and have locking lids to seal the contents when filled to the appropriate volume
• Biohazard Bags


  1. Leakproof plastic bags that are commonly used to transport blood and other specimens from the collection site to the laboratory

  2. Marked with a biohazard label and often have an outside pocket in which requisitions or other forms can be placed
• Slides


  1. Precleaned 25- by 75-mm (1- by 3-in.) glass microscope slides are used to make blood films for hematology determinations

  2. Available either plain or with a frosted area at one end
• Pen


  Indelible (permanent) nonsmear ink to label tubes and record other patient information
• Watch


  Needed to accurately determine specimen collection times and time certain tests
• Vein-Locating Devices


  1. Shine high-intensity LED or infrared red light through the patient’s subcutaneous tissue to highlight veins

  2. The hemoglobin in the blood within the veins absorbs the light, causing the veins to stand out as dark lines. Most devices can be used in patients of all ages
• Tourniquet


  1. Device applied or tied around a patient’s arm prior to venipuncture to restrict blood flow

  2. Inflates the veins, making them larger and easier to find, and stretches the vein walls so they are thinner and easier to pierce with a needle
• MRSA stands for Methicillin-resistant Staphylococcus aureus
• Needles


  1. Phlebotomy needles are sterile, disposable, and designed for a single use only

  2. Multisample needles are commonly enclosed in sealed twist-off shields or covers

  3. Hypodermic needles and butterfly needles are typically sealed in sterile pull-apart packages
• Needle gauge


  • Indicated by a number related to the diameter of the lumen
  • Higher gauge number means smaller diameter
  • 21-gauge needle is considered standard for most routine adult antecubital venipunctures
  • Needles are color coded for easy identification: YELLOW - 20-gauge, GREEN - 21-gauge, BLACK - 22-gauge
• Needle length


  • Multisample needles: 1-1.5 inch
  • Syringe: 1 & 1.5 inches are most commonly used for venipuncture
  • Butterfly: ½ to ¾ inch long
• Needle colors and gauges

  • YELLOW: 20-gauge
  • GREEN: 21-gauge
  • BLACK: 22-gauge
• Needle lengths


  • Multisample needles: 1-1.5 inch
  • Syringe: 1 & 1.5 are most commonly used for venipuncture
  • Butterfly: ½ to ¾ long
• What needle to use depends primarily upon user preference and the depth of the vein
• 1. in. needles are used in routine situations, while 1.5-in. needles make it easier to achieve the proper angle for entering the vein
• Safety features


  1. Must provide immediate permanent containment and be activated using one hand, which must stay behind the needle at all times

  2. Include resheathing devices, blunting devices, and equipment with devices that retract the needle after use
• The evacuated tube system is a closed system where the patient’s blood flows through a needle inserted into a vein and then directly into a collection tube without being exposed to the air or outside contaminants
• The multisample needles allow multiple tubes of blood to be collected during a single venipuncture
• Tube holders are clear, plastic, disposable cylinders used to hold the needle and collection tube