PMLS2 P2

• Collection Priorities

  • Routine Samples
  • ASAP Samples
  • Stat Samples
• Routine Samples


  Tests ordered by the health-care provider to diagnose and monitor a patient's condition, usually collected early in the morning or during scheduled "sweeps"
• ASAP Samples

  Samples to be collected as soon as possible, with response time determined by each hospital or clinic
• Stat Samples

  Samples to be collected, analyzed, and results reported immediately, with the highest priority, usually ordered from the emergency department or for a critically ill patient
• Requisitions are frequently received requesting that blood be drawn at a specific time
• Methods to diagnose hyperglycemic

  1. 2-hour OGTT for diabetes mellitus

  2. One-step and two-step methods for diagnosing gestational diabetes
• Fasting

  Patient must have refrained from eating and drinking (except water) for 12 hours
• Basal state


  Patient must have refrained from exercise in addition to fasting
• Nonfasting patients


  Patients with glucose, cholesterol, triglycerides, or lipid profiles
• Prolonged fasting increases bilirubin and triglyceride values and decreases glucose levels
• Blood cultures


  • One of the most difficult phlebotomy procedures due to strict aseptic technique required and need to collect multiple samples in special containers
• Central Venous Catheters (CVCs)

  • Non-tunneled, noncuffed
  • Tunneled/cuffed
  • Implanted port
  • Peripherally inserted central catheters (PICCs)
• Cold agglutinins

  Autoantibodies produced by persons infected with Mycoplasma pneumoniae or with autoimmune hemolytic anemias
• Cryofibrinogen and cryoglobulin


  Proteins that precipitate when cold and must be collected and handled in the same manner as cold agglutinins
• Samples sensitive to light

  Exposure to artificial light or sunlight (ultraviolet) may decrease the concentration of various analytes, especially bilirubin
• Order of fill for CVAD blood sample collection

  1. First syringe—5 mL, discard or conserve

  2. Second syringe—blood cultures

  3. Third syringe—anticoagulated tubes

  4. Clotted tubes
• The Joint Commission recommends that phlebotomists be proficient with all age groups and that age-specific competencies be demonstrated and evaluated
• Physical factors related to aging

  • Gradual hearing loss
  • Failing eyesight
  • Decreased senses of taste, smell, and feeling
  • Malnourishment or dehydration
  • Muscle weakness
  • Memory loss
  • Thinner epithelium and subcutaneous tissues
  • Decreased collagen and elasticity in veins
  • Feeling cold due to decreased fatty tissue layer
• Disease states affecting geriatric patients

  • Alzheimer's disease
  • Stroke
  • Coma
  • Arthritis
  • Parkinson's disease
• Tourniquet application in elderly patients

  Tourniquet can be placed over the patient's sleeve and must not be applied too tight to avoid injury or collapsing the vein
• Site selection in elderly patients

  Veins in the hand or forearm may be a better choice than the antecubital fossa
• Performing venipuncture in elderly patients

  The angle of the needle may need to be decreased because the veins are often close to the surface of the skin
• Dermal puncture

  Also known as capillary blood collection, where blood is obtained by skin puncture from capillaries, arterioles, and venules
• Certain tests require capillary blood, such as newborn screening tests and capillary blood gases
• Importance of correct dermal puncture collection

  Critical due to smaller amount of blood collected and higher possibility of sample contamination, microclots, and hemolysis
• Dermal puncture devices

  Must have OSHA-required safety devices that retract and lock after use, and depth of puncture is critical to prevent contact with bone
• Microsample containers

  • Capillary tubes
  • Microcollection tubes
• Samples sensitive to light

  Exposure to artificial light or sunlight (ultraviolet) may decrease the concentration of various analytes, especially bilirubin
• Site selection in elderly

  Antecubital fossa may not be the best choice, veins in the hand or forearm may be better
• Pediatric population

  • Phlebotomist must develop interpersonal skills to gain trust and cooperation, and be skilled with special equipment, important to keep patient calm
• Methods of restraint for pediatric patients

  • Infant cradle pad
  • Vertical restraint (parent holds child upright)
  • Horizontal restraint (child lies down with parent on one side)
• Dermal puncture

  Also known as capillary blood collection, blood is obtained by skin puncture from capillaries, arterioles, and venules
• Situations where dermal puncture is used

  • Infants and children <1 yr
  • Adults and children >1 yr with burned/scarred patients, chemotherapy patients, thrombotic tendencies, inaccessible veins, obese patients, apprehensive patients, home glucose monitoring
• Importance of correct dermal puncture collection

  • Smaller amount of blood collected and higher possibility of sample contamination, microclots, and hemolysis
• Hemolysis in dermal puncture

  Can occur due to excessive squeezing, newborn RBC fragility, residual alcohol, vigorous mixing
• Differences in analyte concentrations

  Glucose is higher, potassium, total protein, and calcium are lower in dermal puncture
• Alternating between dermal puncture and venipuncture should not be done when results are to be compared
• Dermal puncture devices

  • Must have OSHA-required safety devices, puncture depth not to exceed 2.0 mm for heel sticks
• Dermal-subcutaneous junction

  Newborn 0.35 to 1.6 mm, Large Adult 3.0 mm
• Microsample containers

  • Capillary tubes
  • Microcollection tubes