(MLSP) INTRODUCTION TO PHLEBOTOMY

Whole Blood

has Plasma and formed elements (unclotted)

Serum

• Liquid portion of clotted blood

Serum

• Without anticoagulant

Serum

• Contains albumin and globulin

Plasma

• Liquid portion of unclotted blood

Plasma

With anticoagulant

Plasma

• Contains albumin, globulin and fibrinogen

Phlebotomy

• Is the process of collecting blood through the vein by using incision or puncture methods to draw blood for analysis or as part of therapeutic or diagnostic measures under the physician’s request.

PHLEBOTOMIST

people who are trained to draw blood from a person or animal for tests, transfusions, donation or research

MAIN GOALS OF PHLEBOTOMY

• For diagnosis and treatment using blood samples

MAIN GOALS OF PHLEBOTOMY

• For transfusion, to remove blood from the donor

MAIN GOALS OF PHLEBOTOMY

• For removal of blood for polycythemia or therapeutic purposes

ROLE OF PHLEBOTOMISTS

• To collect blood samples for laboratory testing or for transfusion.

ROLE OF PHLEBOTOMISTS

Properly label collected blood samples with the necessary data to identify the patient.

ROLE OF PHLEBOTOMISTS

• Responsible in delivering or transporting collected samples within appropriate prescribed time limits.

•  Venipuncture 

•  Capillary puncture

Two main methods used in phlebotomy

• Venipuncture 

•  Capillary puncture

•  Arterial puncture

METHODS OF BLOOD COLLECTION

Routine Samples

• are usually collected early in the morning but can be collected throughout the day during scheduled “sweeps” (collection times) on the floors or from outpatients.

ASAP Samples

• means “as soon as possible.” The response time for the collection of this test sample is determined by each hospital or clinic and may vary by laboratory tests.

Stat Samples

• sample is to be collected, analyzed, and results reported immediately. 

FASTING SAMPLE

• npo (nothing per orem); “nothing by mouth”

FASTING SAMPLE

FBS

FASTING SAMPLE

Lipid Profile

TIMED SAMPLES

Glucose Tolerance Tests

TIMED SAMPLES

2-Hour Oral Glucose Tolerance Test

TIMED SAMPLES

Lactose Tolerance Test 

Collection Attempts

When blood is not obtained from the initial venipuncture, the phlebotomist should select another site. Repeat the procedure using a new needle

Nerve Injury

Temporary or permanent nerve damage can be caused by incorrect vein selection or improper venipuncture technique and may result in loss of movement to the arm or hand and the possibility of a lawsuit.

Iatrogenic Anemia 

pertains to a condition of blood loss caused by treatment. An anemia can occur when large amounts of blood are removed for testing at one time or over a period of time.

Hemolyzed Samples

Rupture of the red blood cell membrane releases cellular contents into the serum or plasma and produces interference with many test results

Thrombosis of veins

• Formation of blood clots inside the lumen of the vein due to trauma

Thrombophlebitis

• Inflammation of the vein due to thrombus as manifested by an inflammatory reaction on the outer skin surface

Hematomas

• Blue or black skin discoloration commonly due to repeated trauma or puncture of the veins

General Delayed Complications

Serum Hepatitis, AIDS

Diet

• The tests most affected are glucose and triglycerides.

Diet

• Serum or plasma collected from patients shortly after a meal may appear cloudy or turbid (lipemic) due to the presence of fatty compounds such as meat, cheese, butter, and cream. 

Diet

• Alcohol consumption 🡪 transient elevation in glucose and 🡪 chronic consumption 🡪 liver function tests and triglycerides

Diet

Caffeine 🡪 hormone levels

Posture

Can cause variations in some blood constituents, such as cellular elements, plasma proteins, compounds bound to plasma proteins, and high molecular  weight substances.

Exercise

Increased activity of muscle enzymes

Exercise

Elevated concentration of sex hormones

Exercise

Elevated concentration of steroids

Stress

nervous patient before sample collection may increase levels of adrenal hormones, increase WBC counts, decrease serum iron, and markedly affect arterial blood gas (ABG) results

Acute effects in smoking

increase in glucose, BUN, cholesterol and triglycerides 

Chronic effects in smoking

Increase in blood hemoglobin values (carboxyhemoglobin)

Decrease in IgG, IgA, and IgM 🡪 weak immune system

Altitude

RBC counts and hemoglobin (Hgb) and hematocrit (Hct) levels are increased in high-altitude areas such as the mountains where there are reduced oxygen levels. 

Age and Gender

Laboratory results vary between infancy, childhood, adulthood, and the elderly 🡪 gradual change in the  composition of body fluids.

Age and Gender

Hormone levels vary with __

Age and Gender

RBC, Hgb, and Hct values 🡪 higher in male patients

Pregnancy

caused by the physiological changes in the body including increases in plasma volume.

Antecubital fossa

• The preferred site for venipuncture and is located anterior and below the bend of the elbow. 

• Median Cubital Vein 

• Cephalic Vein

• Basilic Vein

 Three Major Veins:

Median Cubital Vein

• vein of choice because it is large and does not tend to move when the needle is inserted. It is the easiest to access and least painful for the patient

Cephalic Vein

• is the second choice for venipuncture. It is harder to palpate but is usually better when drawing blood from an obese patient.

Basilic Vein

• last vein of choice for venipuncture as it is not well anchored and punctures on this vein are more painful. It has a tendency to “roll” and hematoma formation is more likely to occur. 

• H-shaped pattern

includes the cephalic, median cubital, and basilic veins in a pattern that looks like a slanted H.

• M-shaped pattern

 Includes the cephalic, median cephalic, median basilic, and basilic veins.

Dorsal hand veins

__ are also acceptable for venipuncture.

Foot veins

__ are a last resort because of the higher probability of complications.

Syncope or Fainting

Remedy: Let the patient lie down

LOCALIZED HEMACONCENTRATION OR VENOUS STASIS

Remedy: One minute application of tourniquet