Title: Hematology 425 Blood Collection
1Hematology 425 Blood Collection
- Russ Morrison
- September 8, 2006
2Safe Collection Practices
- Understand equipment and handle with care
- Always wear gloves
- WASH HANDS between patients and every time gloves
are removed - Remove gloves to make sure outer surface does not
contact bare skin - Dispose of sharps in puncture-resistant container
3Collection Equipment for Venipuncture
- Evacuated Tube Systems
- Tube, tubes contain appropriate additives and are
sealed in a vacuum - tube holder
- needle
- Needles
- Sterile, disposable
- Adapt to tube holders or to a syringe
- May be single or multi-sample
- Safety needles now required
4Collection Equipment for Venipuncture
- Needle Holders
- Manufactured to fit specific needles and tubes
- Disposable, single use
- Safety products required
- Tourniquet
- Provides barrier to venous blood return
- Latex-free
- Applied 2-4 inches above puncture site
- Applied no longer than 1 min prior to puncture
5Collection Equipment for Venipuncture
- Syringes
- Useful for tiny fragile veins
- Pressure controlled by phlebotomist
- Butterflies
- Short needle, IV tube, wings
- Attached to tube adapter, syringes or blood
culture bottles - Useful with pediatric patients, long term studies
(GTT)
6Collection Equipment for Venipuncture
- Solutions for skin preparation
- 70 isopropyl alcohol
- Work from puncture site outward in a spiral
- Allow to air dry before puncture
- Sterile skin prep (blood culture, donation)
- Alcohol followed by iodine
- Defined time for scrub
- Blood Alcohol testing requires benzalkonium
chloride or other nonalcohol antiseptic
7Selecting the Venipuncture Site
- Superficial veins of anterior surface of upper
extremities are most often used (see figure 2-3
in text) - Cephalic, basilic and median cubital veins
located in the antecubital fossa - Secondary choice of dorsal side of wrist/hand or
veins in the feet - Avoid intravenous fluids
8The Routine Venipuncture
- Wash hands
- Identify the patient (2 IDs required)
- Assemble supplies and glove up
- Position the patient, select a vein have pt
squeeze ball, make fist - Cleanse site with prep solution
- Allow site to air dry
- Apply tourniquet 2-4 inches above site for no
longer than 1 minute
9The Routine Venipuncture
- Inspect needle
- Anchor vein with thumb 1-2 inches below puncture
site and insert needle, bevel up, at 15-degree
angle with skin - Release and remove tourniquet as soon as blood
return is obtained - Patients hand should be relaxed and open
- Place dry gauze lightly over puncture site (do
not press down while needle is in arm)
10The Routine Venipuncture
- After the last tube has been collected, remove
the needle and apply direct pressure to the
puncture site using the dry gauze. - Bandage the puncture site when bleeding has
stopped. - Properly dispose of puncture equipment and
biohazardous waste - Label the tubes (name, ID , date, time initial
of collector)
11The Routine Venipuncture
- Send tubes for analysis
- Release patient from diet restrictions (if any)
and send patient on their way. Watch patient for
adverse reaction - Sample identification is critical to provision of
useful diagnostic information. It is a JCAHO
patient safety initiative. SVH has adopted
Collection Manager.
12Complications Encountered in Venipuncture
- Special challenges of pediatric patients
- Additional complications
- Echymoses (bruising)
- Syncope (fainting)
- Hematoma
- Failure to obtain a sample (fig.2-4)
- Petechiae
- Edema
13Complications Encountered in Venipuncture
- Obesity
- Intravenous Therapy
- Hemoconcentration
- Hemolysis
- Burned,damaged,scarred veins are to be avoided
- Seizures, tremors, vomiting, choking
- Allergies to skin prep/tourniquet
14Capillary Punctures
- Newborns
- Children less than 2 years of age
- Adults with difficult or reserved venous access
- Provide a mix of arterial and venous blood as
well as some tissue fluid - Generate slightly different test results
15Capillary Puncture Sites
- Heel, big toe or finger
- Adults, finger or big toe
- Infants, lateral or medial side of bottom of heel
- Puncture with blade perpendicular to the
fingerprint lines - Warming will increase blood flow
- Alcohol only as skin prep
16Capillary Puncture Technique
- Immobilize the finger, toe or heel
- Use blade lt2.0 mm to avoid bone (premature
infants may require shorter blade for puncture) - Avoid swollen, bruised or previously punctured
areas - Wipe away first drop of blood, collecting only
when free flowing is achieved
17Capillary Collection Devices
- Capillary tubes
- Microcollection tubes with and without additives
- Unopettes for introducing pre-diluted samples to
automated equipment or for manual techniques - Labeling/appropriate identification is critical
as with all patient samples
18Capillary Collection Procedure
- Assemble equipment and supplies
- Identify patient
- Position patient, designate holder
- Wash hands and put on gloves
- Select puncture site
- Warm puncture site
- Cleanse puncture site
- Allow site to air dry
19Capillary Collection Procedure
- Perform the puncture
- Wipe away first drop of blood
- Prepare blood smears, if needed
- Collect specimens mixing and diluting as needed
- Elevate wound and apply pressure until bleeding
stops - Label samples
- Dispose of sharps and biohazardous waste
- Deliver samples for analysis
20Legal Issues in Phlebotomy
- The patient has the right to say no
- Document competency of staff
- Follow established procedure
- Respect the patients bill of rights
- Laboratory test results are only as good as the
sample that is tested
21Have some fun this weekend