Venipuncture

Blood Drawing Station

A dedicated area equipped for performing phlebotomy procedures on patients, primarily outpatients sent by their physicians for laboratory testing.

Phlebotomy Chair

A chair designed to be comfortable for the patient and have adjustable armrests to achieve proper positioning of either arm during blood collection.

Handheld Carriers

Easily carried by the phlebotomist. Convenient for STAT or emergency situations or when relatively few patients need blood work.

Phlebotomy Cart

Commong used for early morning blood collection. They have swivel wheels to carry adequate supplies.

Gloves

Non-sterile, disposable gloves, such as latex, nitrile, neoprene, polyethylene, and vinyl examination gloves, that should be used for each patient and removed after the procedure is completed.

Antiseptic

Substances used to prevent sepsis and inhibit the growth of microorganisms during blood collection, such as ethyl alcohol, isopropyl alcohol, benzalkonium chloride, chlorhexidine gluconate, hydrogen peroxide, povidone iodine, and tincture of iodine.

Disinfectants

Chemical substances or solutions used to remove or kill microorganisms on surfaces and instruments, such as bleach solutions.

1:10

Dilution of disinfectant when there is spills involving large amounts of blood or other body fluids

1:100

Dilution of disinfectant when nonporous surfaces after cleaning up blood or other body fluid spills in patient care settings

10 minutes

Contact time for disinfectants to be effective

Gauze Pads

Used to hold pressure over the site after blood collection procedure. Size: 2×2

Bandages

Used to cover a blood collection site after the bleeding has stopped.

Sharp Containers

Containers for disposal of used needles, lancets, and other sharp objects, marked with a biohazard symbol and designed to be puncture resistant and leakproof.

Biohazard Bags

Leakproof containers used to transport blood and other specimens from the collection site to the laboratory. Ziplock with biohazard label

Slides

Used to make blood films for hematology determination. Size: 25×75 mm (1×3 inch)

Pen

A pen of indelible non-smear ink used to label tubes and record patient information.

Watch

A watch with a sweep second hand or timer used to accurately determine specimen collection times and time certain tests.

Vein-locating devices

Transillumination devices that use high-intensity LED or infrared light to visualize vein placement and direction.

Hemoglobin in the blood within the veins absorbs the light causing the veins to stand out as dark lines

Principle of vein-locating devices

Tourniquet

A device applied or tied around a patient's arm prior to venipuncture to compress the veins and restrict blood flow. Bariatric tourniquet or blood pressure cuff (40-60mmHg) is used for obese patients and the most common is the strap tourniquet made of stretchy material such as latex, nitrile or vinyl.

Hypodermic needles

Needles used in syringe systems, available in gauges 20-22.

Multisample needles

Needles used in evacuated tube systems, available in gauges 20-22.

Butterfly needles

Needles used for patients with fragile veins, available in gauges 23-25. It is connected to a 5-inch or 12-inch tubing with a Luer attachment for syringe use or a Luer adapter for ETS use.

Bevel

The end of the needle that pierces the vein.

Shaft

The long cylindrical portion of the needle.

Lumen

The internal space of the needle.

Hub

The portion or end that attaches to the blood collection device.

Needle sizes

Indicated by gauge and length.

Needle gauge

Indicated by a number that is inversely related to the diameter of the lumen.

1 to 1.5 inches

Size of hypodermic and multisample needles

½ to ¾ inches (0.5 to 0.75 inches)

Size of butterfly needles

ISO 6009:2016

Needles are color coded by manufacturers according to

Resheathing devices - Luer Lock, Eclipse Needle

Needle safety feature that allows for safe retraction of the needle.

Syringes

Devices used for blood collection, typically placed in sterile pull-apart packages. Most common volumes include 2,5 and 10 mL.

Plunger

A rod-like device that creates a vacuum to fill the syringe barrel with blood.

Barrel

A cylinder with graduated markings in mL or cc.

Tube holders

Clear, plastic, disposable cylinders used to hold the collection tube.

Syringe transfer device

Allows for safe transfer of blood into tubes without using the syringe needle.

Evacuated tubes

Blood collection containers that automatically fill with blood due to negative vacuum pressure.

Stopper

Also known as cap, top, or closure; made of rubber with color-coded rings.

Additive tubes

Evacuated tubes that contain additives to preserve blood components or prevent clotting.

Nonadditive tubes

Evacuated tubes used for clearing or discarding purposes.

Lancets

Sterile, disposable instruments used to obtain capillary blood specimens.

Microcollection containers

Small plastic tubes used to collect tiny amounts of capillary blood.

Microhematocrit tubes

Disposable narrow-bore tubes used for manual hematocrit determination.

Sealants

Clay, plastic, or wax materials used to seal microhematocrit tubes.

Warming devices

Devices that increase blood flow, important for heel sticks in newborns.

Additives

Substances inside the tube that have specific functions.

Inversion

Turning of the wrist 180 degrees and back again to mix the additive in the tube.

Chelating or precipitating calcium

Method of anticoagulation using substances like EDTA, Citrate, and Oxalate.

EDTA

Ethylenediaminetetraacetic Acid, a chelating anticoagulant primarily used for hematological tests.

Citrates

Anticoagulants that chelate calcium, commonly used for coagulation testing.

Heparin

Anticoagulant that inhibits thrombin formation, commonly used for STAT chemistry tests.

Oxalates

Anticoagulants that precipitate calcium, commonly used in grey top tubes.

Special Use Anticoagulants

Anticoagulants combined with other additives for specific uses.

Acid Citrate Dextrose

Anticoagulant used for immunohematology tests, binds calcium and provides nutrients to RBCs.

Citrate Phosphate Dextrose

Anticoagulant used in blood collection for transfusion practices, stabilizes pH and provides energy to cells.

Sodium Polyanethol Sulfonate

Anticoagulant mainly used for blood culture collection, inhibits bacterial growth.

Antiglycolytic Agents

Additives used to prevent glycolysis, commonly Sodium Fluoride.

Clot Activators

Additives that promote coagulation, different types include Silica, Celite, and Thrombin.

Thixotropic Gel Separator

Non-reacting substance at the bottom of tubes that forms a physical barrier between blood components.

Trace Element Free Tubes

Tubes free from trace element contamination, used for specific tests.

Tan Top

Tube with K2-EDTA additive, used for Lead Determination.1. Pink Top:Additive:K2-EDTA. Used for:Crossmatching, Blood banking procedures, CBC.

White Top

Additive:K2-EDTA with Thixotropic Gel. Used for:Molecular Diagnostics, Nucleic Acid Testing, Polymerase Chain Reaction Test.

Black Top

Additive:Sodium Citrate. 4:1 (blood:additive). Used for:Westergren ESR.

Clear/Red Glass

No additives. Discard tube or; Can be used as 2nd specimen tube.

Order of draw

Refers to the order of tubes during collection in a multiple tube draw or filled from a syringe.

Carry over

May take place. Occurs when blood in an additive tube touches the needle during ETS collection or syringe transfer then carries it to the next tube.

Microbial Contamination

Collection for blood culture requires special site cleaning measures prior to collection.

Test Requisition

Receipt of the Test Request. Reviewing the Requisition.

Identifying Yourself

State your name, your title, and why you are there.

Sanitize Hands

Can be done by handwashing or use of alcohol-based sanitizers.

Positioning the Patient

Never be standing or seated in a chair without arms or on a high or backless stool due to the possibility of fainting.

Tourniquet Application and Fist Clenching

3 to 4 inches above the site. Application:1 minute. Reapplication:after 2 minutes.

Most Ideal Site

Antecubital Fossa - median cubital, cephalic and basilic.

Most Ideal Vein

Median Cubital Vein.

CLSI1

Indicates successful entry into the vein when using a syringe.

Tourniquet

A device used to restrict blood flow and make veins more visible during blood collection.

Order of draw

The specific sequence in which different types of blood collection tubes should be filled.

Coagulation tube

A type of blood collection tube used to collect blood for coagulation testing.

Discard tube

A tube drawn before the coagulation tube to fill the dead space in the tubing and ensure the correct blood-to-anticoagulant ratio.

Sharps container

A container used for the safe disposal of used needles and other sharp medical instruments.

Permanent-ink pen

A type of pen used to label blood collection tubes with patient information.

Phlebotomist's initials

The initials of the phlebotomist who performed the blood collection.

Special handling instructions

Specific instructions for handling and transporting certain types of blood specimens.

Bandage

A covering applied to the puncture site after blood collection to prevent bleeding and promote healing.

Biohazard containers

Containers specifically designed for the disposal of biohazardous materials, such as used needles and contaminated materials.

Pneumatic tube system

A system used to transport specimens from collection areas to the laboratory using air pressure.

Allergies to Equipment and Supplies

Adverse reactions to adhesive, antiseptic, or latex used during blood collection.

Problem Sites

Areas on the body that should be avoided for blood collection due to burns, scars, tattoos, damaged veins, or edema.

Mastectomy

Surgical removal of the breast, which may affect blood collection from the corresponding arm.

Intravenous Therapy

The administration of fluids through a catheter inserted into a vein, which may affect blood collection from the same arm.

Obesity

A condition where veins may be deep and difficult to locate for blood collection, requiring alternative methods for applying tourniquets.

Ecchymosis

Bruises greater than 1 cm caused by leakage of a small amount of blood in the tissue around the puncture site.

Hematoma

Rapid swelling caused by leakage of a large amount of blood around the puncture site. If a hematoma forms during blood collection, the phlebotomist should discontinue the draw immediately and hold pressure over the site for a minimum of 2 minutes.

Fainting (Syncope)

Loss of consciousness and postural tone resulting from insufficient blood flow to the brain. Patients with a history of fainting should be asked to lie down for the procedure.

Nausea and Vomiting

Experience of nausea and vomiting during blood collection. A blood draw should not be attempted until the experience subsides, and if the patient vomits during venipuncture, the procedure must be terminated immediately.

Petechiae

Tiny, non-raised red spots that appear on the patient's skin when a tourniquet is applied. Most commonly caused by capillary wall defects or platelet abnormalities.

Seizures/Convulsion

Sudden involuntary movements or loss of consciousness. If a patient experiences seizures or convulsions during blood collection, the needle should be removed, pressure should be applied over the site, and appropriate first-aid personnel should be notified.

Nerve Injury

Injury to a nerve during blood collection due to poor site or improper vein selection, inserting the needle too deeply or quickly, patient movement during needle insertion, excessive or lateral redirection of the needle, or blind probing while attempting venipuncture.