Blood collection sunil

BLOOD COLLECTION
SUNIL KUMAR. P
Department of Clinical Pathology
St.John’s Medical College
Bangalore
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SUNIL KUMAR. P, ST.JOHN'S MEDICAL
COLLEGE

• What is Phlebotomy
• Order of Draw
• Different Sources of Blood Collection
• Methods of Blood collection
• Different Blood Collection tubes
• Procedure of blood collections..
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Phlebotomy
• Phlebotomy is the process of making an
incision in a vein with a needle.
• The procedure is known as a Venipuncture.
• A person who performs phlebotomy is called a
phlebotomist, although doctors, nurses &
medical laboratory scientists.
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Order of draw
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Blood can be collected from 3
different sources:
• I. Venous blood.
• II. Arterial blood.
• III. Capillary blood.
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Blood Specimen Collection and
Processing
• The first step in acquiring a quality lab. Test
result for any patient is the specimen collection
procedure.
• Blood specimens are obtained through
• skin Prick method (finger, toe, heel)
• venous sampling or Venipuncture
• capillary
• Arterial ( or )
• Capillary / dermal /skin puncture, earlobe stick,
finger stick, heel stick (infants).
• Venous puncture (direct puncture of vein )
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BLOOD COLLECTION TUBES
• Plastic tube with a rubber stopper include
color coded.
• Contain anticoagulants and/or other chemical
additives.
• Plain tubes contain no anticoagulants.
• All tubes must be mixed thoroughly
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ANTICOAGULANT TUBE
EDTA (Ethylene Diamine Tetra-Acetic Acid) liquid
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Light Blue
Sodium citrate (1:9 ratio).
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GREEN
Sodium Heparin or Lithium Heparin anticoagulant
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Red (Plain tube)
No preservative/anticoagulant.
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SST/ Gold top tube
SST (Serum Separator Tube)
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METHODS OF BLOOD COLLECTION
• SKIN PRICK METHOD :
• Materials and Equipment :
• 1. Disposable gloves
• 2 .Sharps disposal containers
• 3 .Alcohol swabs
• 4 .Sterile blood lancets
• 5 .Cotton wool
• 6 .10% house hold bleach
• 7 .Capillary tubes or disposable Pasteur pipettes
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Procedure
• 1 .Explain to the patient about the procedure.
• 2 .Wear disposable gloves and use aseptic technique
for blood collection.
• 3 .Position the patient ; he/she should sit in a chair and
hyperextend his/her arm.
• 4 .The best locations for a finger prick are the third and
fourth fingers of the hand. Do not use the tip or the
centre of the finger. Avoid the side of the finger
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• 5. Avoid puncturing a finger that is cold or blue,
swollen, scarred or covered with a rash.
• 6.Warm the finger by wrapping a warm cloth
during cold or by rubbing the finger with your
hand.
• 7. Clean the finger prick site with an alcohol
swab. Allow the alcohol to air dry completely
before making the prick.
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• 8. Use a sterile lancet. Full skin penetration by the tip
of the lancet should be accomplished in order to
obtain adequate blood flow for collection.
• 9. Make the skin puncture just off the centre of the
finger pad.
• 10.With dry and clean cotton wool, wipe off the first
drop of blood.
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• 11. Gently message the finger to allow a drop to form
at the punctured site. Collect sufficient quantities of
blood for the technique in question using the
recommended equipment.
• 12. Have the patient hold a small ball of dry cotton
wool over the puncture site for a few minutes to stop
the bleeding.
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• Venipuncture :
• Venipuncture is the process of obtaining
blood samples from veins for laboratory
testing, It is probably the most common
procedure in the medical field, usually
performed for the following reasons…….
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Venous blood ….??
• Most commonly required ….WHY??
• Because most majority of routine tests are
performed on venous blood.
• Blood can be taken directly from the vein.
• The best site for venous collection is the deep
veins of theante-cubital fossa.
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If difficult to obtain from the ante-cubital fossa we can
draw blood from following various site:
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MATERIALS FOR VEIN PUNCTURE
• A. Disposable, single use, 21 gauge needle or 22
gauge needle
• B. Disposable, single use, needle holder
• C. Evacuated Blood Tubes
• D. Disposable Tourniquet (non-latex)
• E. Sterile alcohol preps or Beta dine (povidone-iodine)
swab
• F. Disposable gloves (non-latex)
• G. Sharps Container
• H. Sterile gauze pads
• I. Sterile band aid /surgical tape/ paper adhesive tape
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Select the vein site.
• Apply tourniquet.
• Place tourniquet 3-4 inches above the
venipuncture site and hold ends up.
• Cross left hand over the right.
• With the right hand, hold the left strap.
• With the left hand, stretch the right strap.
• Maintain the tension and tuck a loop of
tourniquet, which is held in the left hand under
the tourniquet which encircles the arm.
• Check tension.
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Clean the venipuncture site
• Cleansing agents –
• Iodine,
• alcohol,
• chloroprep.
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Cleaning Procedure…..
• Move in circular motion from the center of the site
outward.
• Allow to air dry. Do not wipe, fan or blow area dry.
• Prevents hemolysis.
• Avoids burning sensation at site.
• Avoids contamination of the specimen.
• Increased bacteriostatic properties of cleansing agents.
• Do not touch after cleansing.
• Sterile vs. antiseptic puncture site
• Sterile - free from living microorganisms.
• Antiseptic - clean but not sterile.
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Perform the venipuncture
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Perform the venipuncture.
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Perform the venipuncture.
• Position the holder and needle in the direction of the
vein and parallel to it.
• Needle bevel should be facing up with the needle at a
15-30 degree angle.
• Place the tube in the holder.
• Enter the vein in a smooth quick motion.
• Grasp wings of the holder with index finger and
middle finger and push forward on the bottom of the
tube with thumb until the needle punctures the
stopper.
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• When pushing tube on the needle, it is
important to center the tube in the holder.
• Eliminates side wall penetration.
• Prevents potential loss of vacuum in tube.
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Collect the specimen.
• Fill the tube until the vacuum is exhausted and blood
flow ceases.
• Assures adequate specimen volume.
• Assures proper anticoagulant to specimen ratio.
• Remove tube
• Grasp holder tightly.
• Push wing with thumb and at the same time pull tube
off with fingers.
• Invert gently 5-10 times.
• Do not shake tube - vigorous mixing will cause
hemolysis.
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Provide care to the venipuncture site
• Apply non-latex adhesive, expandable or
coflex gauze and leave in place at least 15
minutes.
• Apply pressure bandage if patient has
bleeding problems or is on anticoagulant
therapy.
• Don't leave the patient until the bleeding has
stopped
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Label the specimen
• Specimens must be labeled following collection.
• Do not dismiss the patient until the specimen has
been properly labeled.
• Do not leave the bedside until the specimen has
been labeled.
• Do not pre-label tubes.
• Required Information
• Patient's full first and last name.
• Date of birth
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• Date and time of collection.
• Test(s) ordered.
• York Hospital Blood Bank specimens must also
include the Blood Bank armband identification
number and phlebotomist's identification.
• Gettysburg Hospital Blood Bank specimens and
Hollister card must also include patient location
at time of collection including bed number,
patient MRN #, and phlebotomist's identification)
• Include any other pertinent information such as
drawn from IV arm.
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Arterial Blood Collection
• Specially required for estimation of blood
gases (ABG):
• PH, CO2 and O2
• Collect quickly, fill completely and seal both
ends immediately
• No air bubbles
• Put in ice water and deliver STAT to the lab
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Arterial blood can be obtained from a
superficial artery such as:
Radial & Brachial
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BLOOD COLLECTION ON BABIES
The recommended location for blood
collection on a newborn baby or infant
is the heel
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• Prewarming the infant's heel (42 C for 3 to5
minutes) is important to obtain capillary blood
gas samples and warming also greatly increases
the flow of blood for collection of other
specimens. However, do not use too high a
temperature warmer, because baby's skin is thin
and susceptible to thermal injury. Clean the site
to be punctured with an alcohol sponge. Dry the
cleaned area with a dry cotton sponge. Hold the
baby's foot firmly to avoid sudden movement.
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• Using a sterile blood lancet, puncture the side
of the heel in the appropriate regions shown
above in green. Do not use the central
portion of the heel because you might injure
the underlying bone, which is close to the
skin surface.
Do not use a previous puncture site. Make the cut
across the heel print lines so that a drop of blood
can well up and not run down along the lines.
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• Wipe away the first drop of blood with a piece
of clean, dry cotton. Since newborns do not
often bleed immediately, use gentle pressure
to produce a rounded drop of blood.
• Do not use excessive pressure or heavy
massaging because the blood may become
diluted with tissue fluid.
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• Fill the capillary tube(s) or micro collection
device(s) as needed.
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Any Questions…??
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References
• EssentialHaematology by Hoffbrand and Moss
• Practical Haematology by Dacie, Lewis
• Diagnostic Haematology by B F Rodak
• Handbook of CMAI Medical laboratory
Technology .
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Blood collection sunil

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