Phlebotomy

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Phlebotomy

  1. 1. PHLEBOTOMY BASICS Janet J. Nelson RN,CMA
  2. 2. OBJECTIVES <ul><li>After completing this unit the student will be able to: </li></ul><ul><li>Define the terms </li></ul><ul><li>List the components of blood </li></ul><ul><li>Describe how to prepare a patient for a venipuncture. </li></ul><ul><li>Describe how to collect a specimen via venipuncture. </li></ul><ul><li>Describe how to process blood specimens for testing </li></ul>
  3. 3. TERMINOLOGY <ul><li>Anticoagulant:substance that prevents clotting (EDTA and Heparin) </li></ul><ul><li>Hematocrit: the % of RBC in blood </li></ul><ul><li>Hemoglobin: iron containing protein of blood that carries oxygen </li></ul><ul><li>Hemolysis: breakdown of blood cells </li></ul><ul><li>Lumen: the diameter of…. e.g. needle or vein </li></ul><ul><li>Phlebotomy: blood collection using venipuncture </li></ul><ul><li>Venipuncture: process of withdrawing blood from a vein </li></ul>
  4. 4. Phlebotomy Whys?? <ul><li>Webster’s – the act of bloodletting as a therapeutic measure </li></ul><ul><li>To aid in diagnosis of illness </li></ul><ul><li>Monitor effectiveness of treatment </li></ul><ul><li>Screening for absence of illness </li></ul>
  5. 5. What is Blood? <ul><li>Thick red fluid flowing through circulatory system consisting of liquid components and cellular components </li></ul><ul><li>Plasma: Liquid part of blood </li></ul><ul><li>Serum: Liquid part of blood after clotting (minus fibrin) </li></ul><ul><li>Cells: erythrocytes, leukocytes and platelets </li></ul><ul><li>Volume: approx.10 pints in average adult </li></ul>                                            
  6. 6. Blood’s Function <ul><li>Carries O 2 and nutrients to tissue=Artery </li></ul><ul><li>Carries CO 2 and waste from tissue=Vein </li></ul><ul><li>Capillary= tiny blood vessels connecting arterioles and venules </li></ul><ul><li>RBC’s composed of Hemoglobin=O 2 /CO 2 carrier </li></ul><ul><li>WBC’s fight infection </li></ul><ul><li>Platelets – Hemostasis/coagulation </li></ul>
  7. 7. To Spin or Not to Spin?
  8. 8. TUBES
  9. 9. TUBE ORDER <ul><li>Choice of tube depends on lack of additive or additive. </li></ul>Blood Culture Red or Marbled Blue Gold Green Lavendar Gray
  10. 10. Test Requisition <ul><li>Computerized </li></ul><ul><li>Paper </li></ul><ul><li>Must include: </li></ul><ul><ul><li>Patient Name, </li></ul></ul><ul><ul><li>Physician Name </li></ul></ul><ul><ul><li>Date </li></ul></ul><ul><ul><li>Patient ID/age/birthdate </li></ul></ul><ul><ul><li>Test request, </li></ul></ul><ul><ul><li>Your initials </li></ul></ul>
  11. 11. Patient Identification <ul><li>The most critical step in phlebotomy </li></ul><ul><li>Inpatients – Must have correct wristband prior to collection </li></ul><ul><li>Ask patient to state their full name and birth date. </li></ul><ul><li>Match wristband information with test req. </li></ul>                                                                                    
  12. 12. Technology & patient identification
  13. 13. NEEDLES <ul><li>Needles vary in length and diameter </li></ul><ul><li>Diameter is measure in gauge </li></ul><ul><li>The smaller the gauge the LARGER the needle. </li></ul><ul><li>The manufactures use colors to differentiate the gauges. </li></ul>
  14. 14. Basic Phlebotomy Supplies <ul><li>Requisition </li></ul><ul><li>Gloves </li></ul><ul><li>Tourniquet </li></ul><ul><li>Needle </li></ul><ul><li>Barrel or Syringe </li></ul><ul><li>Tubes </li></ul><ul><li>Alcohol </li></ul><ul><li>Cotton or Gauze </li></ul><ul><li>Bandage or Tape </li></ul>
  15. 15. Standard Precautions <ul><li>Always wear gloves </li></ul><ul><li>Keep needle sterile </li></ul><ul><li>Use proper protective equipment – PPE’s </li></ul><ul><li>Remove tourniquet </li></ul><ul><li>prior to removing needle </li></ul><ul><li>Never recap needles </li></ul><ul><li>Wear gloves </li></ul><ul><li>Wash hands after every patient </li></ul><ul><li>Dispose of equipment properly </li></ul>
  16. 16. The integrity of the specimen <ul><li>THE RIGHT PATIENT </li></ul><ul><li>THE RIGHT CONTAINER </li></ul><ul><li>THE RIGHT TIME </li></ul><ul><li>USE CORRECT TECHNIQUE/SITE </li></ul><ul><li>LABEL CORRECTLY AND COMPELETLY </li></ul><ul><li>AVOID HEMOLYSIS </li></ul>
  17. 19. To begin the phlebotomy procedure: <ul><li>Explain “This will not hurt” </li></ul><ul><li>Ask, “Are you Mr Perez?” </li></ul><ul><li>Ask the patient to spell his last name </li></ul><ul><li>Apply the tourniquet </li></ul>18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
  18. 20. What do you want to puncture during a venipuncture? <ul><li>A pulsating artery </li></ul><ul><li>A small capillary </li></ul><ul><li>A stringy tendon </li></ul><ul><li>A spongy vein </li></ul><ul><li>A hard vein </li></ul>18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
  19. 21. A needle’s colored cap indicates: <ul><li>Gauge </li></ul><ul><li>Length </li></ul><ul><li>Type </li></ul><ul><li>Recommended use </li></ul>18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
  20. 22. Which size needle is best used for a venipuncture? <ul><li>18 </li></ul><ul><li>19 </li></ul><ul><li>22 </li></ul><ul><li>25 </li></ul><ul><li>27 </li></ul>18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
  21. 23. What is serum? <ul><li>White blood cells </li></ul><ul><li>Red blood bells </li></ul><ul><li>Platelets </li></ul><ul><li>Liquid part of blood before clotting </li></ul><ul><li>Liquid part of blood after clotting </li></ul>18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
  22. 24. Technique <ul><li>Identify patient </li></ul><ul><li>Reassure patient and position arm </li></ul><ul><li>Assemble equipment </li></ul><ul><li>Verify order and paperwork </li></ul><ul><li>Select vein site </li></ul><ul><li>Apply tourniquet (NO MORE THAN 1 min) </li></ul><ul><li>Vigorously alcohol site/dry with gauze </li></ul><ul><li>Perform venipuncture </li></ul>
  23. 25. Puncture at 15 degree angle
  24. 26. <ul><li>Veins feel soft and bouncy. Blood is dark red </li></ul><ul><li>Veins are more superficial than arteries </li></ul><ul><li>Arteries have a pulse and blood is bright or </li></ul><ul><ul><li>scarlet red </li></ul></ul><ul><li>Damage to an artery can endanger distal tissue </li></ul>
  25. 27. Technique continued 9. Release the tourniquet 10. Remove needle 11. Gently agitate tube 12. Correctly label the tubes 13. Bandage arm 14. Dispose of vacutainer/tube & trash 15. Deliver sample to lab or prepare specimen for lab pickup.
  26. 28. LABEL THE TUBES <ul><li>Patient name </li></ul><ul><li>Patient ID (DOB, Age, Bar code) </li></ul><ul><li>Dr name </li></ul><ul><li>Date & time </li></ul><ul><li>Test </li></ul><ul><li>Your initials </li></ul>
  27. 29. Special Considerations <ul><li>Do not collect above an IV </li></ul>
  28. 30. Avoid Hemolysis GENTLY agitate tube to mix Allow blood to enter tube slowly                                                                                 
  29. 31. To avoid hemolysis you: <ul><li>Do not agitate tube </li></ul><ul><li>Gently agitate tube </li></ul><ul><li>Vigorously agitate tube </li></ul><ul><li>Use sterile technique to acquire specimen </li></ul>18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
  30. 32. The best angle of the needle during a venipuncture is: <ul><li>8-9 degrees </li></ul><ul><li>15 degrees </li></ul><ul><li>25 degrees </li></ul><ul><li>45 degrees </li></ul><ul><li>90 degreess </li></ul>18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
  31. 33. What is NOT included on the tube label? <ul><li>Dr. name </li></ul><ul><li>Your initials </li></ul><ul><li>Test </li></ul><ul><li>Patient name and ID </li></ul><ul><li>Pt blood type </li></ul><ul><li>Date & times </li></ul>18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
  32. 34. If the patient has an IV, your BEST choice is to: <ul><li>Use other arm </li></ul><ul><li>Stick above the IV </li></ul><ul><li>Stick below the IV </li></ul><ul><li>Use the foot </li></ul><ul><li>Draw directly from the IVs </li></ul>18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
  33. 35. Which is NOT important for the quality of the blood sample? <ul><li>Use right patient </li></ul><ul><li>Draw from correct site </li></ul><ul><li>Use the smallest needle that is possible </li></ul><ul><li>Label tubes correctly </li></ul>18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
  34. 36. What is the next step after filling the tubes? <ul><li>Remove the needle </li></ul><ul><li>Remove the tourniquet </li></ul><ul><li>Gently agitate the tubes </li></ul><ul><li>Press down on the needle with gauze pads while removing the needle </li></ul>18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
  35. 37. Geriatric Considerations <ul><li>Treat elderly as if they were your parents </li></ul><ul><li>Use smaller needles / tubes </li></ul><ul><li>Use syringe or butterfly instead of Vacutainer </li></ul><ul><li>Assess hearing acuity </li></ul><ul><li>Avoid tape – use “Koban” </li></ul><ul><li>Minimize hematomas – apply pressure longer </li></ul>
  36. 38. Butterfly
  37. 39. Syringe / Butterfly <ul><li>Alternative to Vacutainer </li></ul><ul><li>Elderly, young, collapsing veins </li></ul><ul><li>Using the hand or foot </li></ul><ul><li>Acquire adequate amount of blood as you will be filling tubes after the blood draw </li></ul><ul><li>Instill blood into tube at angle to prevent hemolysis </li></ul>
  38. 40. Heel Collections
  39. 41. Finger Puncture <ul><li>Puncture across the fingertip </li></ul><ul><li>Wipe away the first drop </li></ul><ul><li>Collect in microtubes or capillary tubes </li></ul>
  40. 42. Blood Cultures <ul><li>Aseptic Technique </li></ul><ul><li>Cleanse site with 2% Chlorhexidine gluconate or Iodine </li></ul><ul><li>Allow site to dry – do not touch site </li></ul><ul><li>Fill bottles with appropriate volume of blood </li></ul>
  41. 43. Butterflies are used for blood draws: <ul><li>For the elderly </li></ul><ul><li>For the young </li></ul><ul><li>For the hand </li></ul><ul><li>For the wrist </li></ul><ul><li>For arterial blood </li></ul>30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
  42. 44. Puncture the babies: <ul><li>Center of heel </li></ul><ul><li>Lateral side of heel </li></ul><ul><li>Toes </li></ul><ul><li>Lateral side of foot </li></ul>30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
  43. 45. When drawing a geriatric patient: <ul><li>Use a large lumen needle </li></ul><ul><li>Apply pressure for a longer period of time </li></ul><ul><li>Use small lumen needles or butterfly </li></ul><ul><li>a & b </li></ul><ul><li>a & c </li></ul><ul><li>b & c </li></ul>30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
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