Methods of blood collection in hematology laboratory.

1. BLOOD COLLECTION
MITHUN VENUGOPAL. A
HAEMATOLOGY & TRANSFUSION MEDICINE

2. Phlebotomy
• The surgical opening or puncture of a vein in order to
withdraw blood.
• Person who perform phlebotomy is called a
phlebotomist.

3. Types of blood samples used for
different laboratory tests
1. Whole Blood
2. Serum
3. Plasma

4. Best Practices
• Ensure blood is sampled safely, no exposure to blood
borne pathogens to patients, health care workers,
environment.
• Labelling.
• Selecting the right equipment for the right patient.
• Containers.
• Protecting the sample from contamination.
• Transport of the sample.
• Patient care.

5. STEPS OF SAFE BLOOD SAMPLING
Step 1: Preparation of area
Step 2: Equipment Selection
Step 3: Patient Preparation & blood collection
Step 4: Transfer of blood sample
Step 5: Waste management.

6. STEP 1
PREPARATION OF AREA
• Provide an appropriate
environment for blood
collection.
• Prepare a clean, designated
and if possible, dedicated
area for collecting blood
samples.

7. STEP 1
PREPARATION OF AREA
• Wash and/or disinfect your hands first.
• Cover any small cuts on your hands
(e.g., with a band aid/plaster).

8. STEP 2
EQUIPMENT SELECTION
• Wear a new pair of gloves for
each patient
• Use a sterile single-use lancet or
phlebotomy set for each patient
• Inspect packaging for breaches
in integrity
• Do not use equipment that may
not be sterile (punctured, torn or
damaged).

9. • Discard in an appropriate sharps disposal container
any needle or lancet that has touched a non-sterile
surface prior to sampling.
• When the use of a tourniquet is indicated, use a clean
device that has not been contaminated with blood or
body fluids.
STEP 2
EQUIPMENT SELECTION

10. STEP 3
PATIENT PREPARATION & BLOOD
COLLECTION
• Wash visibly soiled/dirty skin
• Avoid collecting blood if local infection or other skin
condition (e.g., weeping dermatitis, skin lesions)
compromises the skin integrity of your hands.
• Swab: Antiseptic -clean, single use swab and maintain
product-specific recommended contact time.
• Don’t touch the puncture site after skin disinfection or
before blood sampling.

11. • Anticipate and take measures such as appropriate
patient restraint to prevent sudden patient movement
during and after blood sampling.
STEP 3
PATIENT PREPARATION & BLOOD
COLLECTION

12. • After sampling, minimize bleeding by applying gentle
pressure on the sampling site with a dry, clean cotton
ball or other similar material.
• Apply clean dressing to the wound after bleeding has
stopped.
STEP 3
PATIENT PREPARATION & BLOOD
COLLECTION

13. STEP 4
TRANSFER OF BLOOD SAMPLE
• When using a syringe and a needle to perform
phlebotomy,
• Transfer the collected blood slowly and directly into the
collection tubes after removing the needle to prevent
spillage or splashing.
• Cover the tubes.

14. • Avoid recapping needles and other manipulations of
used needles.
• If recapping is necessary, use one hand only to avoid
puncturing the hand holding the cap.
STEP 4
TRANSFER OF BLOOD SAMPLE

15. • Collect used sharps at the point of use in puncture
resistant and leak-proof sharps containers.
• Prepare blood collection tubes for storage or
transport according to recommended national and/or
international packaging requirements.
STEP 4
TRANSFER OF BLOOD SAMPLE

16. • Disinfect the sampling area
to eliminate the risk of
contamination of equipment
with blood or body fluids for
future use, particularly if
spillage or splashing of
blood occurred.
• Wash hands after removing
gloves.
STEP 4
TRANSFER OF BLOOD SAMPLE

17. STEP 5
WASTE MANAGEMENT
• Seal sharps containers before they are completely full
for transport to a secure area in preparation for
disposal.

18. STEP 5
WASTE MANAGEMENT
• Manage waste in an efficient, safe and environment-
friendly way to protect people from voluntary and
accidental exposure to used equipment.

19. METHODS OF BLOOD COLLECTION
1. Capillary Blood Collection (Skin prick)
2. Venous Blood Collection (Venipuncture)
3. Arterial Blood Collection (Arterial puncture)

20. CAPILLARY BLOOD COLLECTION
• Safe
• Less time consuming
• Small amount of blood
• Cheap.

21. SITES
• Fingertip
• Ear lobe
• Great toe
• Heel

22. SITES

23. INSTRUMENT USED
Lancet
• Sterile.
• Single-use.
• Made up of stainless steel.
• Consists of a flat body and pointed tip.
• Tip of the lancet measures 3mm.

24. PROCEDURE
• If possible, use the fourth (ring)
finger or the middle finger.
• Many patients prefer to use
fingers on their non-dominant
hand.
• Choose a puncture site near the
right or left edge of the finger
tip.
• Clean the site as you would for
routine Venipuncture.

25. • Select a sterile lancet.
• Hold the finger tip
longitudinally to make
a ridge.
• Make the puncture
perpendicular, rather
than parallel, to the
finger print.
PROCEDURE

26. • The lancet is sharply plunged into the crest of the
ridge to a depth of 3mm.
• Release the pressure on the sides of the finger. This
will allow the wound to open.
• If the flow of blood is not free enough, tension should
be exerted on the skin in an outward direction in
order to open the wound more widely.
PROCEDURE

27. • Perform finger or heel
puncture across the
fingerprints as the blood
will more likely bead
rather than run down the
channels of the
fingerprints.
PROCEDURE

28. • Wipe away the first
drop of blood using
gauze to remove tissue
fluid contamination.
PROCEDURE

29. • Collect blood into an
appropriate tube.
• Label specimens appropriately.
• Make sure bleeding has
stopped. Apply an adhesive
bandage if necessary.
• Discard sharps appropriately.
PROCEDURE

30. • Veins of small children
and infants are too
small for Venipuncture.
• Butterfly needles may
be used to collect
blood in older children.
PROCEDURE

31. • Firmly grasp the infants foot.
• Do not use a tourniquet.
• The heel may be warmed with
a cloth to help increase blood
flow.
• Wipe the collection site with
an alcohol pad, and allow the
alcohol to dry.
• Wipe the site with sterile
cotton or gauze, to be sure all
the alcohol has been
removed.
PROCEDURE

32. • Puncture the left or right side
of the heel, not the bottom of
the foot.
• Wipe away the first drop of
blood since it may contain
excess tissue fluid or alcohol
which could alter test results.
PROCEDURE

33. • Collect the blood into
the appropriate tube.
PROCEDURE

34. • After collection is
completed, apply
pressure to the puncture
site with a sterile gauze
pad until bleeding has
stopped.
• Do not apply an
adhesive bandage to an
infant’s foot since it may
injure its delicate skin.
PROCEDURE

35. VENOUS BLOOD COLLECTION
• Done for tests which require
large quantity of blood and
when performing multiple
tests for the same patient.

36. SITES
• There are three veins most commonly used in
Venipuncture, or phlebotomy:
1. The Cephalic Vein
2. The Median Cubital Vein
3. The Basilic Vein

37. SITES
• These three veins are
found in the Antecubital
Fossa.
• The Cephalic Vein is found
on the lateral, or outside, of
the arm.
• The Median Cubital Vein,
the preferred one to use, is
found close to the center.
• The Basilic Vein is located
on the inner, or medial part
of the antecubital fossa.

38. Median Cubital Vein
• Veins can move, or roll,
which makes it more difficult
to perform phlebotomy.
• The Median Cubital Vein is
typically well anchored,
prominent and large.
• Less likely that the patient
will feel pain during
phlebotomy, or bruise
afterwards as there are very
few nerve endings close to
this vein.

39. Cephalic Vein
• Cephalic Vein which is
located on the lateral side
of the arm.
• This vein is usually well
anchored.
• The cephalic vein may lie
close to the surface.

40. Basilic Vein
• Located on the medial
side of the arm.
• In many patients this vein
may not be well anchored
and will roll, making it
difficult to access with the
needle.
• Additionally, this area is
often more sensitive, thus
more painful for the
patient.

41. SELECTION OF VEIN
• The cephalic and Basilic Veins are only used if
the Medial Cubital Vein is not felt.
• The Cephalic Vein is the second choice usually,
since it is fairly well anchored. This is often the
only vein that can be felt in patients who are
obese.
• The Basilic Vein is kept as a last choice option. It
rolls more easily and runs directly over a nerve
and an artery, making it a more dangerous and
painful area to use.

42. • When none of the veins of the
antecubital fossa will be felt or not able
to use due to intravenous placement or
injury, hand veins may be used.
• Veins of the hand and wrist are usually
close to the surface, but they are prone
to movement and rolling.
• Using these veins tends to be more
painful for the patient, since there are
nerves running through the hand as well.
• If using these veins, it is important to
anchor the vein with your hand, holding
it in place, when you are drawing the
blood.
SELECTION OF VEIN

43. REQUIREMENTS

44. REQUIREMENTS

45. • Different sizes.
• size =gauge.
• The larger the
needle, the smaller
the gauge number.
• 21 or 22 gauge
needle is mostly
used.
REQUIREMENTS

46. REQUIREMENTS

47. Anticoagulants in Vaccutainer

48. Order of Draw

49. PROCEDURE
• Always greet patient in a professional, friendly
manner.
• A good initial impression will earn the patients trust,
and make it easier and more pleasant to draw a good
specimen.
• Identify the patient by name and department.
• Explain the reason for your presence.

50. • The more relaxed and trusting your patient, the
greater chance of a successful non traumatic
Venipuncture.
• Good verbal, listening, and nonverbal skills are very
important for patient reassurance
PROCEDURE

51. • Make sure the name, medical record number, and date of
birth on your order/requisition match those on the patient’s
armband.
• Properly identifying patients and specimens is probably
the single most critical part of your job.
• The consequences of misidentifying a specimen can be
life threatening.
PROCEDURE
Patient Identification

52. PROCEDURE
Standard Precautions
Patients are often reassured that proper
safety measures are being followed when
gloves are put on in their presence.

53. • Comfortable position.
• Turn the arm so that the
wrist and palm face upward,
and the antecubital area is
accessible.
• When supporting the
patient’s arm, do not
hyperextend the elbow.
This may make vein
palpation difficult.
PROCEDURE
Position the Patient

54. • Tie the tourniquet just
above the elbow.
• The tourniquet should
be applied for a
maximum of 1 – 2
minutes only.
• After applying the
tourniquet, you may ask
the patient to make a fist
to further distend the arm
veins.
PROCEDURE
Applying the Tourniquet

55. • The Median Cubital Vein
• If not accessible: Cephalic
Vein, or the Basilic Vein.
• If not accessible: Veins on
the back of the hand.
• Use a much smaller
needle for these hand
veins.
PROCEDURE
Selection of Vein

56. Never draw blood from these areas
• Scarred, abraded, or inflamed
skin
• Arms containing IV catheters
• Edematous arms
• Occluded Veins
• Shunts
PROCEDURE
Selection of Vein

57. • Isopropyl alcohol swab
• Outward expanding spiral
starting with the actual
Venipuncture site.
• Allow the alcohol to dry:-
1-disinfect the site
2-prevent a burning sensation
PROCEDURE
Cleaning the site

58. PROCEDURE
1. Hold the vein in
place
2. Insert needle with bevel facing up at
an angle of 35-40 degree

59. 4. Pull the plunger slowly
once the needle enters
the vein.
PROCEDURE
3. Presence of blood in the
hub of the needle
indicates that the needle
is inside the vein.

60. 5. Withdraw the needle in a
single quick movement.
4. Release the tourniquet.
PROCEDURE

61. 6. Quickly place clean gauze over the site, and apply
pressure. Ask the patient to continue applying pressure
until bleeding stops.
7. Apply adhesive bandage.
PROCEDURE

64. PERFORM VENIPUNCTURE

65. Trouble shooting
If you do not see blood flow, the tip
of the needle:
• May not yet be within the vein.
• May have already passed
through the vein.
• May have missed the vein
entirely.
• May be pushed up against the
inside wall of the vein.

66. Trouble shooting
• Change the position of the needle. Move it forward (it
may not be in the lumen).
OR
• Move it backward (it may have penetrated too far).

67. Trouble shooting
• Adjust the angle (the
bevel may be against the
vein wall).
• A hematoma forms
under the skin adjacent
to the puncture site -
release the tourniquet
immediately and
withdraw the needle.
Apply firm pressure.

68. Trouble shooting
• The blood is bright red (arterial) rather than venous.
Apply firm pressure for more than 5 minutes

69. ARTERIAL BLOOD COLLECTION
• An arterial blood sample is collected from an artery,
primarily to determine arterial blood gases. Arterial
blood sampling should only be performed by a
trained technician or a physician.
• The sample can be obtained either through a catheter
placed in an artery, or by using a needle and syringe
to puncture an artery.
• These syringes are pre heparinized and handled to
minimize air exposure that will alter the blood gas
values.

70. • Several different arteries can be used for blood
collection. The first choice is the Radial Artery, which
is located on the thumb side of the wrist; because of
its small size, use of this artery requires extensive
skill in arterial blood sampling.
ARTERIAL BLOOD COLLECTION

71. • Alternative sites for access are
brachial or femoral arteries, but
these have several
disadvantages in that they:
 May be harder to locate,
because they are less superficial
than the radial artery.
 Have poor collateral circulation.
 Are surrounded by structures
that could be damaged by faulty
technique.
ARTERIAL BLOOD COLLECTION

72. Equipment
• Pre-heparinized syringe.
• Needles (20, 23 and 25 gauge, of different lengths) –
choose a size that is appropriate for the site (smaller
gauges are more likely to lyse the specimen).
• A safety syringe with a needle cover that allows the
syringe to be capped before transport, without
manually recapping (this is best practice for radial blood
sampling).
• A bandage to cover the puncture site after collection.
• A container with crushed ice for transportation of the
sample to the laboratory (if the analysis is not done at the
point of care).

73. Complications related to arterial
blood sampling
• Arteriospasm or involuntary contraction of the artery
may be prevented simply by helping the patient relax;
this can be achieved, for example, by explaining the
procedure and positioning the person comfortably.
• Haematoma or excessive bleeding can be prevented
by inserting the needle without puncturing the far side
of the vessel and by applying pressure immediately
after blood is drawn. Due to the higher pressure
present in arteries, pressure should be applied for a
longer time than when sampling from a vein, and
should be supervised more closely, to check for
cessation of bleeding.

74. • Fainting or a vasovagal response can be prevented
by ensuring that the patient is supine (lying down on
their back) with feet elevated before beginning the
blood draw. Patients requiring arterial blood sampling
are usually inpatients or in the emergency ward, so
will generally already be lying in a hospital bed.
Children may feel a loss of control and fight more if
placed in a supine position; in such cases, it may be
preferable to have the child sitting on the parent's lap,
so that the parent can gently restrain the child.
Complications related to arterial
blood sampling