Finals

• Venipuncture - most frequently performed procedure in phlebotomy. 

  • Process of collecting or drawing blood from a vein of the patient for laboratory testing purposes. 
  • Most common way to collect blood specimens for laboratory testing. 
• Two Ways Of Blood Collection By Venipuncture:

  • Open System - use of the needle and syringe. 
  • Closed System - use of the evacuated tube system. 
• Syringe Procedure - may be used if a patient has small, fragile, or weak veins that collapse easily. 
• • Phlebotomist - the person who performs phlebotomy.
• Requisition Form communication between the requesting physician and the laboratory. 

  • Includes:
  • Patient’s correct and complete name
  • Medical record number
  • Patient’s age and date of birth
  • Patient’s location (OPD or Room Number of IP)
  • Type of Test Ordered
  • Name of requesting physician
  • Date and Time of Sample Collection
  • Status of Sample 
  • Stat
  • Routine
  • Timed
  • Billing Information
  • Special Precaution
• Materials

  • Alcohol prep pads
  • Povidone-iodine swabs for blood cultures.
  • Non Alcohol-based antiseptic for blood alcohol collections
  • Gauze pads or cotton balls
  • Adhesive bandages or other bandaging materials
  • Gloves
  • Tourniquet 
  • Blood Collection Tubes
  • Syringe Needle
  • Syringe
  • Transfer Device
  • Sharps container
  • Permanent marker or pen
• Hand contact


  Most common way of transmitting infection
• Hand washing


  Single most effective way to prevent the spread of infections
• Hand washing


  • Important safety precaution
  • Should be practiced after direct contact with patients and laboratory specimens
• Use of gloves


  Not a substitute for hand washing
• Accidental skin contact with blood, body fluids, or tissues

  1. Immediately wash hands or other skin areas with soap and water

  2. Occurs through breaks in gloves

  3. Hands should be thoroughly washed
• When hands should be washed


  • Before eating, drinking, smoking, applying makeup
  • Changing contact lenses
  • Before and after using lavatory facilities
  • After the completion of work
  • Before leaving the laboratory
  • Before all other activities which entail hand contact with mucous membranes, eyes, and breaks in the skin
• Five steps to wash hands the right way

  1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap

  2. Lather hands by rubbing them together with the soap. Lather the backs of hands, between fingers, and under nails

  3. Scrub hands for at least 20 seconds

  4. Rinse hands well under clean, running water

  5. Dry hands using a clean towel or air dry them
• Gloves


  • Provide protective barriers against blood and other body fluids and from contamination of hands with microorganism
  • Designed to fit tightly to allow precision work
  • Must be worn when processing blood or body fluid specimens, when handling contaminated materials, during cleaning and decontamination procedures
• Removal of soiled gloves

  1. Grasp the outside of one glove at the wrist (do not touch your bare skin)

  2. Peel the glove away from your body, pulling it inside out

  3. Hold the glove you removed in your gloved hand

  4. Peel off the second glove by putting your fingers inside the glove at the top of your wrist, turning the second glove inside out while pulling it away from your body, leaving the first glove inside the second

  5. Dispose of the gloves safely (do not reuse the gloves)

  6. Clean your hands immediately after removing gloves
• Personal Protective Equipment (PPE)


  Includes gloves, laboratory gowns, mask, face shield, and goggles
• Wearing of Personal Protective Equipment


  • One of the most important aspects in performing laboratory work-ups
• Donning of PPE


  1. Identify and gather the proper PPE

  2. Perform hand hygiene

  3. Put on a laboratory/isolation gown

  4. Put on a mask (surgical mask, N95, respirators, etc.)

  5. Put on a face shield or goggles

  6. Put on gloves
• Doffing of PPE


  1. Remove gloves

  2. Remove gown

  3. Perform hand hygiene

  4. Remove face shields or goggles

  5. Remove and discard the mask (surgical mask, N95)

  6. Perform hand hygiene after removal of mask
• Phlebotomist


  • Responsible for blood sample collection
  • Should be familiar with materials used in blood collection

  
• Being knowledgeable in this area helps prevent pre-analytical errors that will be encountered in the laboratory
• Phlebotomy or venipuncture


  Act of obtaining a blood sample from a vein using a needle attached to a collection device or a stoppered evacuated tube

  
• General blood collection equipment and supplies

  • Phlebotomy Area/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

  
• Requisition form


  Used during the identification process of each patient, required prior to the venipuncture procedure to ensure proper healthcare is given to the appropriate individual
• Patient misidentification or no identification or tube label is a mortal sin
• Phlebotomy needles


  • Sterile and single use
  • Needle gauge - 20-23 Gauge appropriate for venipuncture, 21 Gauge standard
  • Needle length - 1-1.5 inches
  • Needle types - multi-sample, hypodermic, winged infusion set
  • Needle position - 15 to 30 degrees angle

  
• Syringe system


  Used as an alternative method when drawing blood, preferred for patients with small or fragile veins, allows control of suction pressure on the vein

  
• Syringe system components


  • Syringe needle with plastic hub
  • Syringe divided into graduated barrel and plunger

  
• Evacuated tube system


  Closed collection system, most efficient and most frequently used method for venipuncture, blood collected directly into the evacuated tube, enables multiple tubes to be collected in a single venipuncture

  
• Evacuated tube system components

  • Multi-sample needle, tube holders, evacuated tubes, needle adapter
• Butterfly system


  Winged infusion set or winged collection set, used for IV fluid infusion and venipuncture for small and fragile veins (pediatrics, geriatrics)

  
• Butterfly system


  • Has a short needle with a plastic part resembling butterfly wings, with long tubing with luer fitting and luer adapter
• Skin puncture devices


  Manual lancets, automatic puncture devices that deliver a swift puncture to a predetermined depth
• Skin puncture devices


  • Contact activated, dimensions of the puncture controlled by the width and depth of the point
• Evacuated collection tubes


  Necessary for phlebotomists to complete venipuncture procedures, may be plastic or glass with a colored rubber top to indicate the specific diagnostic test to be performed
• Microcollection tubes


  Most common type of collection containers used for dermal puncture samples, available with capillary tube fitted inside to aid in sample collection
• Tourniquet


  Vein compressor used to allow the vein of interest to become easily palpable and visible to the phlebotomist
• Tourniquet


  • Applied for less than one minute, 3-4 inches above the puncture site, prevents the return of venous blood to the heart

  
• Vein locating devices


  Transillumination portable devices that use infrared light to help locate and assess veins for safe venous access
• Antiseptics


  Commonly used to disinfect the area to be punctured for blood collection, examples include 70% ethyl/isopropyl alcohol, benzalkonium chloride, chlorhexidine gluconate, hydrogen peroxide, povidone-iodine, tincture iodine