Performing Phlebotomy

What information should you get from the patient before starting the procedure?

Whether they have experienced syncope (faint due to sudden blood loss)

How high should the tourniquet be above the hand if doing a dorsal venipuncture?

3-4 inches above the wrist

Why shouldn’t the patient “pump” their hand?

Increases the potassium concentration of the specimen

What diameter should you scrub the venipuncture site?

2-3 inches diameter

How long should you let a venipuncture site dry for?

30-60 seconds

What is “Thumb Anchoring”?

Using your thumb to anchor a vein in place 1-2 inches below the insertion point

What direction should the bevel of a needle face?

Up

Lumen

Middle of the vein

What color blood should make you stop the collection immediately?

Arterial blood

What is one inversion?

What should you do immediately after withdrawing a needle?

Engage the safety device, THEN apply pressure with a gauze pad

How long should you apply pressure on the gauze pad when done with venipuncture?

5-10 seconds, then look under pad to see if bleeding has stopped

Hemostasis

The process your body uses to stop bleeding through clots

What is the importance of the syringe needle and rubber tipped needle?

To create a vacuum seal

What should you do to a syringe when you first open it?

Pull the syringe all the way back and push it all the way forward to remove all of the air

What should you do before removing the needle from the Evacuated Tube System?

Ensure that the safety device of the syringe is properly engaged

What should you do if the patient faints or vomits?

Stop the venipuncture immediately

What should you do if you notice a hematoma developing during venipuncture?

Stop the venipuncture immediately and apply pressure for 5 minutes

What should you do if your patient asks to stop the venipuncture even if it is going well?

Stop the venipuncture because you no longer have consent

What should you do if you believe a vein has collapsed?

Release the vacuum pressure by removing the tube and wait for the vein to fill before reapplying the vacuum pressure

Why should you use protective eyewear during a capillary puncture?

Higher change of blood splash during capillary puncture

What are the two types of lancets?

Puncture and Incision

What are puncture needles used for?

Glucose tests, PSA tests, other tests that need capillary blood

What size is a puncture needle?

28 gauge and higher

What is an incision needle used for?

Newborn screening cards, microtainers, tests that require larger amounts of capillary blood

How long is an incision needle typically?

Shorter than 2mm

Microtainer

Small container that contains additives

What fingers should you perform a dermal puncture on?

The middle and ring finger

Where on the fingers should you perform a dermal puncture?

The meaty parts of the finger — the sides

Around what age group should you perform a capillary puncture on the heel?

Ages around 1 year old and younger

Including underweight babies, when should you not use lancets larger than 2 mm?

Average-weight newborns and older children

When should you not use lancets larger than 0.85 mm?

Preterm and low-birth weight infants

What should you do if your patients fingers are cold to the touch?

Warm the site up

How should you position your patient for a dermal puncture?

Hand’s dorsal side face down at a slight angle, keeping the chosen finger easy to reach

How should you position a baby for a dermal puncture?

Place the baby on their side with easy access to the heel

How should the recently cleaned site dry?

Air dry, do not fan or blow on the cleaned area

What kind of pressure should you use with lancets?

Firm pressure might cause the patient less pain than if you don’t push hard enough

What is the first thing you do after a dermal puncture?

Wipe away the first drop of blood, THEN dispose of the lancet

SST

Serum Separator Tube