to withdraw blood or introduce a fluid.

1. PHLEBOTOMY BASICSPHLEBOTOMY BASICS
Marjorie Moreau,RNMarjorie Moreau,RN

2. OBJECTIVES
After completing this unit the student will be able to:
o Define the terms
o List the components of blood
o Describe how to prepare a patient for a
venipuncture.
o Describe how to collect a specimen via
venipuncture.
o Describe how to process blood specimens for
testing

3. TERMINOLOGY
• Anticoagulant:substance that prevents clotting
(EDTA and Heparin)
• Hematocrit: the % of RBC in blood
• Hemoglobin: iron containing protein of blood that
carries oxygen
• Hemolysis: breakdown of blood cells
• Lumen: the diameter of…. e.g. needle or vein
• Phlebotomy: blood collection using venipuncture
• Venipuncture: process of withdrawing blood from a
vein

4. Phlebotomy Whys??
• Webster’s – the act of bloodletting as a
therapeutic measure
• To aid in diagnosis of illness
• Monitor effectiveness of treatment
• Screening for absence of illness

5. What is Blood?
• Thick red fluid flowing through
circulatory system consisting of
liquid components and cellular
components
• Plasma: Liquid part of blood
• Serum: Liquid part of blood after
clotting (minus fibrin)
• Cells: erythrocytes, leukocytes
and platelets
• Volume: approx.10 pints in
average adult

6. Blood’s Function
• Carries O2 and nutrients to tissue=Artery
• Carries CO2 and waste from tissue=Vein
• Capillary= tiny blood vessels connecting
arterioles and venules
• RBC’s composed of Hemoglobin=O2/CO2
carrier
• WBC’s fight infection
• Platelets – Hemostasis/coagulation

7. To Spin or Not to Spin?To Spin or Not to Spin?

8. TUBES

9. TUBE ORDER
• Choice of tube depends on lack of additive
or additive.
Blood CultureBlood Culture
Red or MarbledRed or Marbled
BlueBlue
GoldGold
GreenGreen
LavendarLavendar
GrayGray

10. Test Requisition
• Computerized
• Paper
• Must include:
– Patient Name,
– Physician Name
– Date
– Patient ID/age/birthdate
– Test request,
– Your initials

11. Patient Identification
• The most critical step in
phlebotomy
• Inpatients – Must have
correct wristband prior to
collection
• Ask patient to state their
full name and birth date.
• Match wristband
information with test req.

12. Technology & patient identificationTechnology & patient identification

13. NEEDLES
• Needles vary in length
and diameter
• Diameter is measure in
gauge
• The smaller the gauge
the LARGER the
needle.
• The manufactures use
colors to differentiate
the gauges.

14. Basic Phlebotomy Supplies
• Requisition
• Gloves
• Tourniquet
• Needle
• Barrel or Syringe
• Tubes
• Alcohol
• Cotton or Gauze
• Bandage or Tape

15. Standard Precautions
• Always wear gloves
• Keep needle sterile
• Use proper protective
equipment – PPE’s
• Remove tourniquet
prior to removing
needle
 Never recap needles
Wear glovesWear gloves
Wash hands afterWash hands after
every patientevery patient
Dispose ofDispose of
equipment properlyequipment properly

16. The integrity of the specimen
• THE RIGHT PATIENT
• THE RIGHT CONTAINER
• THE RIGHT TIME
• USE CORRECT TECHNIQUE/SITE
• LABEL CORRECTLY AND COMPELETLY
• AVOID HEMOLYSIS

19. To begin the phlebotomy
procedure:
Explain
“This
w
illnot...
A
sk,“Are
you
M
rPer...
A
sk
the
patientto
spel...
A
pply
the
tourniquet
0% 0%
88%
12%
1. Explain “This will not
hurt”
2. Ask, “Are you Mr
Perez?”
3. Ask the patient to
spell his last name
4. Apply the tourniquet
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

20. What do you want to puncture
during a venipuncture?
A
pulsating
artery
A
sm
allcapillary
A
stringy
tendonA
spongy
vein
A
hard
vein
0%
6%
0%
94%
0%
1. A pulsating artery
2. A small capillary
3. A stringy tendon
4. A spongy vein
5. A hard vein
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

21. A needle’s colored cap indicates:
G
auge
Length
Type
R
ecom
m
ended
use
59%
0%
35%
6%
1. Gauge
2. Length
3. Type
4. Recommended
use
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

22. Which size needle is best used for
a venipuncture?
18
19
22
25
27
24%
6% 6%
12%
53%
1. 18
2. 19
3. 22
4. 25
5. 27
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

23. What is serum?
W
hite
blood
cells
R
ed
blood
bells
Platelets
Liquid
partofblood
b...
Liquid
partofblood
af...
0% 0%
82%
18%
0%
1. White blood cells
2. Red blood bells
3. Platelets
4. Liquid part of
blood before
clotting
5. Liquid part of
blood after
clotting1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

24. Technique
1.1.Identify patientIdentify patient
2.2.Reassure patient and position armReassure patient and position arm
3.3.Assemble equipmentAssemble equipment
4.4.Verify order and paperworkVerify order and paperwork
5.5.Select vein siteSelect vein site
6.6.Apply tourniquet (NO MORE THAN 1 min)Apply tourniquet (NO MORE THAN 1 min)
7.7.Vigorously alcohol site/dry with gauzeVigorously alcohol site/dry with gauze
8.8.Perform venipuncturePerform venipuncture

25. Puncture at 15 degree anglePuncture at 15 degree angle

26.  Veins feel soft and bouncy. Blood is dark redVeins feel soft and bouncy. Blood is dark red
 Veins are more superficial than arteriesVeins are more superficial than arteries
 Arteries have a pulse and blood is bright orArteries have a pulse and blood is bright or
scarlet redscarlet red
 Damage to an artery can endanger distalDamage to an artery can endanger distal
tissuetissue

27. Technique continuedTechnique continued
9. Release the tourniquet9. Release the tourniquet
10. Remove needle10. Remove needle
11. Gently agitate tube11. Gently agitate tube
12. Correctly label the tubes12. Correctly label the tubes
13. Bandage arm13. Bandage arm
14. Dispose of vacutainer/tube & trash14. Dispose of vacutainer/tube & trash
15. Deliver sample to lab or prepare15. Deliver sample to lab or prepare
specimen for lab pickup.specimen for lab pickup.

28. LABEL THE TUBESLABEL THE TUBES
 Patient namePatient name
 Patient ID (DOB, Age, Bar code)Patient ID (DOB, Age, Bar code)
 Dr nameDr name
 Date & timeDate & time
 TestTest
 Your initialsYour initials

29. Special Considerations
• Do not collect above an IV

30. Avoid Hemolysis
GENTLY agitate tube to mixGENTLY agitate tube to mix
Allow blood to enter tubeAllow blood to enter tube
slowlyslowly

31. To avoid hemolysis you:
D
o
notagitate
tube
G
ently
agitate
tube
Vigorously
agitate
tube
U
se
sterile
technique...
0% 0%0%
100%1. Do not agitate
tube
2. Gently agitate
tube
3. Vigorously agitate
tube
4. Use sterile
technique to
acquire specimen
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

32. The best angle of the needle during
a venipuncture is:
8-9
degrees
15
degrees
25
degrees
45
degrees
90
degreess
0%
94%
0%
6%
0%
1. 8-9 degrees
2. 15 degrees
3. 25 degrees
4. 45 degrees
5. 90 degreess
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

33. What is NOT included on the tube
label?
D
r.nam
eYourinitials
Test
Patientnam
e
and
ID
Ptblood
type
D
ate
&
tim
es
0% 0% 0%
100%
0%0%
1. Dr. name
2. Your initials
3. Test
4. Patient name and
ID
5. Pt blood type
6. Date & times
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

34. If the patient has an IV, your BEST
choice is to:
U
se
otherarm
Stick
above
the
IV
Stick
below
the
IVU
se
the
foot
D
raw
directly
from
t..
65%
6%
0%0%
29%
1. Use other arm
2. Stick above the IV
3. Stick below the IV
4. Use the foot
5. Draw directly from
the IVs
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

35. Which is NOT important for the
quality of the blood sample?
U
se
rightpatient
D
raw
from
correctsite
U
se
the
sm
allestnee...
Labeltubes
correctly
6%
0%
94%
0%
1. Use right patient
2. Draw from correct
site
3. Use the smallest
needle that is
possible
4. Label tubes
correctly
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

36. What is the next step after filling the
tubes?
R
em
ove
the
needle
R
em
ove
the
tourniquet
G
ently
agitate
the
tubes
Press
dow
n
on
the
n...
18%
6%6%
71%
1. Remove the needle
2. Remove the
tourniquet
3. Gently agitate the
tubes
4. Press down on the
needle with gauze
pads while removing
the needle
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

37. Geriatric
Considerations
• Treat elderly as if they were
your parents
• Use smaller needles / tubes
• Use syringe or butterfly instead
of Vacutainer
• Assess hearing acuity
• Avoid tape – use “Koban”
• Minimize hematomas – apply
pressure longer

38. Butterfly

39. Syringe / Butterfly
• Alternative to Vacutainer
• Elderly, young, collapsing veins
• Using the hand or foot
• Acquire adequate amount of blood as you will be
filling tubes after the blood draw
• Instill blood into tube at angle to prevent
hemolysis

40. Heel Collections

41. Finger PunctureFinger Puncture
 Puncture acrossPuncture across
the fingertipthe fingertip
 Wipe away theWipe away the
first dropfirst drop
 Collect inCollect in
microtubes ormicrotubes or
capillary tubescapillary tubes

42. Blood Cultures
• Aseptic Technique
• Cleanse site with 2% Chlorhexidine
gluconate or Iodine
• Allow site to dry – do not touch site
• Fill bottles with appropriate volume of
blood

43. Butterflies are used for blood
draws:
Forthe
elderlyForthe
youngForthe
handForthe
w
rist
Forarterialblood
20% 20% 20%20%20%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
1. For the elderly
2. For the young
3. For the hand
4. For the wrist
5. For arterial blood

44. Puncture the babies:
C
enterofheel
Lateralside
ofheel
Toes
Lateralside
offoot
25% 25%25%25%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
1. Center of heel
2. Lateral side of
heel
3. Toes
4. Lateral side of
foot

45. When drawing a geriatric patient:
U
se
a
large
lum
en
n...
A
pply
pressure
fora
...
U
se
sm
alllum
en
nee...
a
&
b
a
&
c
b
&
c
17% 17% 17%17%17%17%
1. Use a large lumen
needle
2. Apply pressure for a
longer period of time
3. Use small lumen
needles or butterfly
4. a & b
5. a & c
6. b & c
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30