Phlebotomy is the process of collecting blood samples from patients for diagnostic testing and treatment purposes. It requires specialized skills and knowledge of anatomy, the circulatory system, and effective communication. A phlebotomist must be able to perform venipuncture accurately and safely handle various types of blood collection tubes and equipment. Drawing blood can present challenges with different patient populations, so a phlebotomist must be prepared to address issues that may arise.

1. Med A 220 Phlebotomy Venipuncture

2. Phlebotomy What does it mean? Process of collecting blood Dates back to ancient Egypt Bloodletting-”bad” blood Greek translation Phlebos- vein Tome –incision

3. Why collect blood? Diagnosis and treatment of disease Therapeutic purposes Blood donation

4. Phlebotomist One who is trained in performing phlebotomy

5. Phlebotomists Role Perform venipuncture accurately and efficiently Reliable test results Provide quality care Patient safety and confidentiality Phlebotomist safety (PPE)

6. Circulatory System Knowledge of the anatomy and physiology important for safe venipuncture Blood forms in the bone marrow Blood transports oxygen and nutrients throughout the body and removes carbon dioxide Capillaries connect arteries to veins

7. Circulatory System Cont’dArteries and Veins Arteries Carry oxygenated blood away from the heart Pulse Thick walls No Valves Veins Carry deoxygenated blood to the heart No pulse Thin elastic walls Valves

8. More Circulatory Facts Our bodies contain approximately 6 liters of blood 45% “formed elements” (erythrocytes, leukocytes, and Thrombocytes) 55% liquid ”plasma” (a fluid allowing blood cells, electrolytes, proteins etc to travel the body via blood vessels).

9. 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

10. Important Terms Centrifuge- machine which spins blood separating the RBC from the serum Anticoagulant-used to prevent blood from clotting. Found in certain blood tubes Buffy coat-layer separating plasma from RB

11. Serum Blood Collection Diagnostic tests are most commonly performed on Serum, plasma, and whole blood Serum tests use a “serum separator” tube containing thixotropic gel Invert tube after draw in order to activate clotting Tube must be centrifuged after clot has formed

12. Plasma and Whole Blood Plasma and whole blood Tube must be inverted after drawing to mix additives Tube must be centrifuged Certain Serum, Plasma, and Whole blood specimens will require special treatment and/or transport to laboratory.

13. Phlebotomy Sites Order of Draw by sites Arm-Antecubital Space includes Median cubital Cephalic Basilic Veins in hand Veins in feet

14. Preferred Sites in the arm

15. 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?

16. Venipuncture Methods There are three main methods of drawing blood Syringe Vacuum Tube Butterfly

17. 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

18. 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

19. More Equipment/Supplies Tourniquet or blood pressure cuff Alcohol or Betadine Cotton balls or gauze-preferred Bandages or tape Note: always ask patient about allergies

20. A Specimen Collection Tray is a practical way to carry all necessary supplies

21. 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

23. Technical

24. AdministrativeButThe most important skill is:

25. Good Therapeutic Communication People don’t like to have their blood drawn Use your therapeutic communication skills to: Put your patient at ease –show confidence Assess their comfort level Ask them about past experiences

26. Preparing the patient Identify yourself and explain the procedure Remember your “bedside manner” Properly Identify your patient ask them to: State their name For non-English speaking photo ID Note fasting or non-fasting

27. Preparing to draw Complete lab requisition and prepare labels Organize equipment and supplies Have spare tubes available

28. Remember to Wash your hands

29. Preparing cont’d 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 any allergies to latex, alcohol, or tape

30. 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

31. The Tourniquet 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.

32. 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

33. Important Information If you haven’t succeeded in getting blood after 2 tries ask someone else to try If no blood appears after inserting needle-pull needle back or change position before withdrawing Tubes must be filled to appropriate levels for accurate test results

34. Factors Affecting Lab Results Blood Alcohol-elevate results Diurnal rhythm-RX or daily activity level Exercise-runner’s anemia, change results Fasting-inaccurate results Hemolysis-destroys RBC’s Heparin-incorrect use interferes with results Stress-Increase in WBC’s Tourniquet on too long-dilution hemoconcentration

35. 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

36. 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

37. 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

38. 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

39. Thanks to: Clinical Medical Assisting: A professional, Field Smart Approach to the Workplace, Textbook and Workbook Phlebotomy Essentials 4th Edition Laurel Lunden, BS CMA (AAMA) January 2010