PMLSP2 Moving

• Venipuncture


  A process of collecting or "drawing" blood from a vein of the patient for laboratory testing purposes
• Phlebotomist


  • Should acquire the knowledge and skill to perform venipuncture since he will perform this procedure frequently as part of his duties and responsibilities in the healthcare institution
• The request process


  1. Test request from a physician

  2. Request form includes information on the type of test ordered and any special instructions or conditions

  3. Test requisition could be manual, computerized or bar-coded
• Required requisition information


  • Name of the physician who ordered the test
  • Patient's full name including the middle initial
  • The medical record number for inpatients
  • Birthday and age of the patient
  • Room number and bed number if inpatient
  • Type of test ordered
  • Date when the test is to be performed
  • Billing information with ICD-9 codes for outpatient
  • Test status
  • Special precaution
• Accessioning the test request


  Helps improve the documentation, handling and reporting of test results by assigning a special number that will serve as the reference number for all associated processes and paperwork
• Status designations, status priorities and procedure for each status designation

  • Stat - Immediately collect test and report result, alert when delivered ER stats are priority
  • Med Emerg - Immediately collect, test and report result, alert when delivered ER stats are priority
  • Timed - Collect close to required time and record actual time, results needed to respond to serious but not yet critical situation
  • ASAP - Collect as soon as possible, second or third priority
• Fasting


  Prior to collection there should be no food or drink intake for 3-12 hours except for water
• Preop


  Before an operation, to determine eligibility for surgery
• Postop


  After an operation, to assess condition after surgery
• Routine


  Relating to established procedure, to establish diagnosis or monitor progress, collect on time but not urgent
• Approach, Identify, & Prepare Patient

  1. Organize the test request according to priority, prepare all the necessary equipment and supplies

  2. Check for phlebotomy-related signs and warnings regarding the condition of the patient

  3. Knock on the door gently before entering the room

  4. Make a good impression by greeting the patient warmly

  5. Stay organized and have all supplies available and approach the patient in a professional manner

  6. Maintain a calm expression, introduce yourself and explain the procedure

  7. Obtain the verbal or expressed consent of the patient before proceeding

  8. Remain compassionate and professional during the procedure

  9. Thank the patient for their cooperation before leaving
• If there is a physician or clergy in the room, interrupt only if the ordered test is stat or timed
• Family members or visitors can stay in the room, but it would be better if they could step out of the room until you are finished
• Proper patient identification


  Confirming the name and date of birth of the patient
• Obtaining a specimen from the wrong person


  Can have serious consequences and can even be fatal in cases that involve blood transfusion
• Misidentifying patients can be a ground for dismissal or lawsuit on the grounds of malpractice
• Identifying patients when the patient is fast asleep

  The phlebotomist should wake him up gently for proper identification
• Identifying patients when the patient is young, mentally incapacitated or there is language barrier

  1. The phlebotomist should ask a relative, attendant, or the nurse to identify the patient

  2. The information provided should match those on record and the information on the ID bracelet
• Patient preparation for testing


  The phlebotomist should explain the test procedure to the patient and confirm that the patient understood what was discussed
• It is best to direct inquiries on the purpose or result of the test to the patient's nurse or physician to avoid any miscommunication
• The phlebotomist must remain calm and professional even if the patient is being difficult or have needle-phobia
• Verify Diet Restrictions & Latex Sensitivity

  1. The phlebotomist should verify if there are special instructions on the diet of the patient that needs to be followed such as fasting for about 8 to 10 hours

  2. A patient with allergic reaction to latex can have life-threatening reactions upon exposure, so it is important to check that all equipment used on him is latex-free, and there are no latex items in the room
• Proper hand hygiene should be observed to avoid spreading infection
• Position Patient, Apply Tourniquet, and Ask Patient to Make a fist

  1. Be sure that the hand or arm for venipuncture procedure is well supported

  2. The tourniquet should be placed 3 to 4 inches from the intended site
• Select Vein, Release Tourniquet, and Ask Patient to Open Fist

  1. The antecubital area of the arm is the preferred venipuncture site

  2. Roll his finger from one side to the other to gauge its size

  3. Using your fingers, trace the path to determine a possible entry point

  4. If the vein is not suitable, look for an alternative site, or capillary puncture could be an option
• Tourniquet Application


  1. Place the tourniquet 3 to 4 inches from the intended puncture site

  2. Hold one side of the tourniquet in each hand. It should be a few inches from the end

  3. Apply a little tension so that it will be snug when tied

  4. Bring the two sides together. Hold both ends between the thumb and forefinger of the right hand

  5. Reach over the right hand and grasp the right side of the tourniquet between the thumb and forefinger of the left hand and release it from the grip of the right hand

  6. Near the left index finger, cross the left end over the right. Hold both sides together between the thumb and forefinger of the left hand, close to the patient's arm

  7. While securely holding both sides, use either the left middle finger or the right index finger to tuck a portion of the left side under the right side and pull into a loop

  8. A properly tied tourniquet has its ends pointing toward the shoulder
• Clean and Air-Dry the Site

  1. Clean the venipuncture site using an antiseptic like 70% Isopropyl alcohol

  2. Cover an area of 2-3 inches diameter in a circular motion moving outward

  3. Allow the area to dry for about a minute

  4. Avoid touching the site after cleaning
• Prepare Equipment and Put on Gloves

  1. Consider the age of the patient, volume of blood, and size/location of vein to choose the right system, needle size, and tube

  2. Wear a clean pair of gloves
• Evacuated Tube System (ETS) Preparation

  1. Select the appropriate tube and tap to dislodge additives

  2. Select and inspect the needle for defects

  3. Twist needle to expose the back and screw to the tube holder

  4. Place the first tube in the holder
• Winged Infusion Set (Butterfly) Preparation

  1. Use a 23-gauge butterfly with a safety feature

  2. Inspect the package before aseptically opening and removing the butterfly

  3. Attach the butterfly to an ETS holder or syringe

  4. Select the appropriate small-volume tube
• Syringe System Preparation


  1. Select the appropriate syringe and needle

  2. Test the plunger before opening the sterile package

  3. Open the package aseptically

  4. Securely attach the needle to the syringe
• Reapply Tourniquet, Uncap and Inspect Needle

  1. Reapply the tourniquet without touching the cleaned area

  2. Get the collection equipment using your dominant hand

  3. Remove the needle cover and inspect the needle

  4. Replace the needle if it has come into contact with anything
• Ask Patient to Remake a Fist, Anchor to Vein, and Insert Needle

  1. Ask the patient to make a fist

  2. Anchor the antecubital vein by holding the patient's arm with your free hand

  3. Insert the needle at a 30 degree angle with the bevel facing up using a smooth forward motion
• Establish Blood Flow, Release Tourniquet, and Ask Patient to Open Fist


  1. Press on the collection tube to ensure the needle has penetrated the stopper

  2. Release the tourniquet and ask the patient to release their fist
• Fill, Remove, and Mix Tubes in Order of Draw or Fill Syringe

  1. Make sure the required volume has been collected

  2. Invert tubes with additives gently several times to mix

  3. Release the tourniquet before removing the needle
• Place Gauze, Remove Needle, Activate Safety Feature, and Apply Pressure

  1. Place a folded gauze square lightly over the site

  2. Remove the needle and activate the safety feature (if applicable)

  3. Apply pressure with your free hand while the arms are extended or raised
• Label Tubes


  Include patient's full name, date of birth, ID number, date/time of collection, phlebotomist's initials, and any additional information like "fasting"
• Pediatric Venipuncture


  • Limit to superficial veins only
  • Veins are usually small and underdeveloped
  • Risk of permanent damage if not done properly
  • Risk of anemia due to smaller blood volume
• Challenges with Pediatric Patients


  • Dealing with parents/guardians
  • Gaining the patient's trust
  • Explaining the procedure in child-friendly terms
  • Offering rewards for cooperation
• EMLA


  Eutectic mixture of local anesthetics used for pain intervention, takes about an hour to take effect