Phlebotomy Basics

Phlebotomy: Venipuncture
Phlebotomy
What does it mean?
Process of collecting blood
Dates back to ancient Egypt

Bloodletting-”bad” blood
Greek translation
Phlebos- vein
Tome –incision
Why collect blood?
Diagnosis and treatment of disease
Therapeutic purposes
Blood donation
The Medical Assistant’s Role
Perform venipuncture accurately and
efficiently
Reliable test results
Provide quality care
Patient safety and confidentiality
Phlebotomist safety (PPE)
Anatomy and Physiology of the Circulatory
System
Blood forms in body’s organs and
bone marrow
Blood carries oxygen and nutrients
to cells and removes waste products
and carbon dioxide
(Review your terminology textbook Hematology and
Immunology)
Do you know?
The difference between an
artery and a vein?
Circulatory System Cont’d
Arteries and Veins
Arteries Veins
Carry oxygenated Carry deoxygenated
blood away from the blood to the heart
heart
Pulse No pulse
Thick walls Thin elastic walls
No Valves Valves
Circulatory System Cont’d
Body contains about 6 liters of blood
Forty-five percent of blood is formed elements
Erythrocytes
Leukocytes
Thrombocytes (platelets)
Two mL of blood will yield about 1 mL of fluid
Liquid part of blood is plasma
Important Terms
Fibrinogen –substance in blood
Converted by the blood clotting process to
fibrin
Fibrin- “sticky” web like substance –traps
the formed elements-result is a “blood clot”
Serum- clear liquid portion of blood
extracted from the “blood clot” used for
many tests
Important Terms
Anticoagulant-used to prevent blood
from clotting. Found in certain blood
tubes
Buffy coat-layer separating plasma
from RB
Centrifuge- machine which spins
blood separating the RBC from the
serum
Anatomy and Physiology
of the Circulatory System
Centrifuge separates serum from blood

Anticoagulant prevents blood from clotting to produce
plasma specimen
Buffy coat
Phlebotomy Sites
Order of Draw by sites
Arm-Antecubital Space includes
Median cubital
Cephalic
Basilic
Veins in hand
Veins in feet
Preferred Sites in the arm
Arteries of Arm
Note locations of arteries in the
arm. You DO NOT want to draw
from an artery
Brachial
Radial
Ulnar
How can you distinguish an artery from a
vein?
Venipuncture Methods
There are three main methods of
drawing blood
Vacuum Tube
Syringe
Butterfly
Evacuated Tube Method
This method includes:
Vacutainer tube
Adapter
Double-pointed Needle
Features of this method are:
Closed system - needle stick risk low
Vacuum draws blood inside the tube
Safety needles meet OSHA guidelines
Venipuncture Technique
Butterfly collection system
Combines benefits of syringe and vacuum methods
Used for small or fragile veins that are difficult to draw
Winged needle inserted at about 5° angle then threaded
into vein
Syringe method
Used for small or fragile veins
Control flow
Venipuncture Equipment
Safety needles
 Required
 Protects patient and health care worker
Equipment/Supplies Needed
Physician order and Lab requisition form
Pen –black ink
Appropriate PPE (gloves, gown, goggles)
Needle holder and Needle (varying sizes)
Tubes –varying sizes and types used

More Equipment/Supplies
Tourniquet or blood pressure cuff
Constrict flow of blood in arm
Make veins more prominent
Alcohol or Betadine
Cotton balls or gauze-(preferred)
Bandages or tape
Order of draw
Why? Prevent carryover or contamination - Order
may vary between laboratories.
Basic order:
Sterile- sterile specimens
Light blue-sodium citrate
Red or plain tubes no additives or gel
SST –Serum separator tube (Red/Gray, Yellow)
Green –heparin
Lavender-EDTA
Gray –oxalate-fluoride
Additives, anticoagulants, and gels
 Thixotropic separator gel >>
 Separator gel tube: centrifuging process
 Glass particles activate clotting
Specimen collection trays
 Hold all equipment necessary
 Carts also used
A Phlebotomist needs to use all these skills:
 Technical skills
 Prepare for the draw-equipment (spare tubes)
 Positioning the patient
 Administrative skills
 Note order-required tests and
 Complete the lab requisition
 Social skills
 Small talk (weather, pets, entertainment)
 Good Therapeutic Communication
 Assess patient comfort level
 Put patient at ease-show confidence
 Ask about past experiences
Preparing the patient
Identify yourself and explain the procedure
Properly Identify your patient ask them to:
State their name and date of birth
For non-English speaking photo ID
Note fasting or non-fasting
Ask patient about allergies
Taking blood thinners
Past Experiences
Remember to
Wash your hands

The Draw
Position your patient for safety:
sit
lie down
(note past history of fainting or loss of consciousness)
Select the appropriate site and vein free of:

Scars
Hematomas
A Pulse
The Draw Cont’d
Find site that will give best blood return
(remember the location order)
Palpate vein with tip of finger
Differentiating between veins, tendons,
and nerves
Use the tourniquet appropriately
Proper Tourniquet Technique
To prevent inaccurate blood test results-do
not leave on longer than one minute
Tourniquet may be applied over clothing
for patient comfort
Remove tourniquet when blood flow is
achieved or prior to inserting last tube
Always remove tourniquet prior to
removing needle
Proper completion of draw
Remove tourniquet
Remove needle and apply safety device while
Applying pressure to site (patient can assist)

Bandage appropriately
Tend to the safety of your patient
Label specimen tubes in front of patient

Patient and specimen
identification
 Computer label >>
 Compare lab requisition

with patients information
Important Tips
Do Not draw from a resistant patient
Do Not draw if you are not comfortable
Uncooperative children must receive
special care and be restrained for safety

Note Patient reactions, stop if patient
complains of pain-assess patient
The unsuccessful venipuncture
Reposition tube and needle
 Rotate needle Advance further into vein
Try another tube-maybe the tube is
defective
If you haven’t succeeded in getting blood
after 2 tries ask someone else to try
Factors affecting laboratory values
Incorrect specimen handling and storage
Drawing procedure incorrect
Alcohol in specimen
Tourniquet on too long
Wrong tube
Tubes not filled to appropriate levels will cause

inaccurate test results
Patient Factors Affecting Lab
Results
Blood Alcohol-elevate Hemolysis-destroys RBC’s
results Heparin-incorrect use
Diurnal rhythm-RX or daily interferes with results
activity level Stress-Increase in WBC’s
Exercise-runner’s anemia, Tourniquet on too long-
change results dilution hemoconcentration
Fasting (not)-inaccurate
results
Challenging Patients
Pediatric
The child, parents or guardians
Approach-explain –get down to their level
Resistant-restraints ?
Geriatric
Physical-skin, hearing or vision impaired
Effects of disease-stroke, arthritis, Parkinson’s –tremors,
Dementia-Alzheimer's
Safety issues-wheelchairs, balance
More Challenges
Dialysis or Cancer patients -fistulas
and shunts
(AV-arteriovenous-permanent access for
dialysis)
Long-Term Care patients, Home Care,
or Hospice Patients
Traveling phlebotomists
Problem Sites
Burns, Scars, Tattoos
Damaged Veins (sclerosed-thrombosed)
Edema-swelling due to abnormal
accumulation of fluid
Hematoma-swelling or mass of blood
Mastectomy-caution lymph node removal
Obesity
Complications or Conditions
Allergies-adhesive, antiseptic, latex
Excessive bleeding due to medications,
hemophilia
Fainting
Nausea and vomiting
Pain while drawing-what is normal –what is
NOT-stopping the draw
Seizures/Convulsions-stop draw immediately-get
help
Comprehensive Medical Assisting 4th Edition
Clinical Medical Assisting: A professional, Field

Smart Approach to the Workplace, Textbook and
Workbook
Phlebotomy Essentials 4th Edition

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What is the process of phlebotomy?

What is the process of phlebotomy?

What are the main roles and responsibilities of a phlebotomist?

What are the main roles and responsibilities of a phlebotomist?

Phlebotomy: Venipuncture

Dates back to ancient Egypt

Centrifuge separates serum from blood

Pen –black ink

Appropriate PPE (gloves, gown, goggles)

Needle holder and Needle (varying sizes)

Tubes –varying sizes and types used

Cotton balls or gauze-(preferred)

Wash your hands

Select the appropriate site and vein free of:

Remove needle and apply safety device while

Applying pressure to site (patient can assist)

Tend to the safety of your patient

Label specimen tubes in front of patient

 Compare lab requisition

Do Not draw if you are not comfortable

Uncooperative children must receive

special care and be restrained for safety

Tubes not filled to appropriate levels will cause

Clinical Medical Assisting: A professional, Field

Phlebotomy Essentials 4th Edition

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