L.L.S.P unit 7 part 2

31-34. Clean Up
•                       Part 2               Part 2

Routine Practices
• Are always applied to blood collections
• Proper PPE is essential to keeping the collector and the patient safe
• Hand hygiene and new gloves are required between each patient
• Safety glasses are worn to reduce risk of blood splashes into the
collector’s eyes – don’t have your face directly over the puncture site
• Always treat patients and their collected blood tubes as infectious
• NEVER touch or handle a filled tube without gloves on

Routine Practices
• Are always applied to blood collections
• Proper PPE is essential to keeping the collector and the patient safe
• Hand hygiene and new gloves are required between each patient
• Safety glasses are worn to reduce risk of blood splashes into the
collector’s eyes – don’t have your face directly over the puncture site
• Always treat patients and their collected blood tubes as infectious
• NEVER touch or handle a filled tube without gloves on

Testing Priority
• STAT – TAT 1 hour
• Shortest TAT
• Test results are vital to immediate patient management in life threatening
emergencies
• Collected immediately and processed ahead of all other specimens
• Urgent – TAT 3/4 hours
• When test request are required sooner than routine testing
• Quick results for non-life threatening situations or patient discharge
• Routine – variations in TAT
• Processed last (typically within 8 hours unless batching)
• For results of non-STAT and non-urgent patient management

. Introduction
• “Hello my name is _________________, I am from the lab and I am
here to collect your blood.”
• This is a great way to introduce yourself when you are collecting in a
hospital setting. In an out-patient situation, still introduce yourself.
• You may be wearing a lab coat and you don’t want the patient to
think you are a doctor or a nurse.
• It is best NOT to ask, “how are you doing today”. The patient may
start sharing confidential medical information with you.

2. Explain the Procedure
• “I will be collecting blood from you today.”
• Most people have had blood drawn before, but don’t assume
• Usually the patient will extend their arm for you, this is referred to as
IMPLIED CONSENT
• Does a patient have the right to refuse a collection?
• Can a patient retract their consent in the middle of a collection?
YES!!
Document the refusal. Notify the ward nurse if an inpatient.

Explain the Procedure
• Speak clear and use easy vocabulary – avoid complicated medical
terms
• If a patient ask questions about the collection, inform them
• If the patient ask what the test are for or why the physician ordered
the testing, refer them to their nurse or physician

3. Identify the Patient
• Ask the patient to state and spell their first and last name
• Ask the patient to state their date of birth (DOB)
• These demographics are checked with their labels and their wristband
if they are an inpatient
• All must match!!!
• What if they are an inpatient and have no wristband?
• Look for one on the ankle, if not there...
• Ask the nurse to put a new one on BEFORE you begin your collection

Patient Identification
• This is the MOST important job of an MLA/T for this procedure
It doesn’t matter how good your collection was if it was
done on the wrong person.
What do you think a possible outcome of incorrect patient
identification could be?

Inpatient Identification
• All inpatients must have ID bands on their person (wrist or ankle)
• Check identifiers – if any discrepancies, do NOT continue collection
until resolved
• Do NOT rely on bed tags or charts
• If patient in is emergency and is unidentified, the hospital can assign a
temporary ID number
• Still needs to be on patient and will need to be cross-referenced to
patient once proper ID is available

Who Else Can Help Patient ID?
• If patient is too young or unable to identify themselves (unconscious,
comatose, or impaired in some way)
• Can ask patient’s healthcare provider, relative or friend to provide all
information
• You still need to compare against requisition or labels and ID band if
an inpatient
• Document name and title/relationship of person who has identified
patient

4-7. Prepare for the Collection
• Perform hand hygiene and put on safety glasses and gloves
• Ask the patient, “Have you had any problems with previous
collections?”
• This is the moment they get to tell you if they have a history of
fainting or a fear of needles. – Lay them down for the collection if this
is the case –
• Confirm with the patient how many hours they have fasted if
necessary, “When was the last time you ate or drank?”
• They will tell you a time, you will have to calculate that into hours
• Ensure nothing is in their mouth (candy, gum, etc.)

8-9. Prepare the arm with the Tourniquet
• Ensure the arm is extended and downward (if possible – this may be
more difficult in a hospital setting with the patient laying down)
• Apply the tourniquet 3-4 inches above the intended puncture site
(above the antecubital fossa)
• The tourniquet ends should NOT be falling into the puncture site

10. Assess the Veins for Collection
• You can ask the patient for their non-dominant arm
• You can ask the patient if they have a preferred arm
• Assess the extended arm for veins once the tourniquet is on
• Look for the H or M configuration and try to find/feel the median
cubital first, then the cephalic, then the basilic
• Palpate with your gloved index finger only
• If no viable veins found:
• Check to see if the tourniquet is too loose
• Ask to see the other arm

Veins in the Antecubital Fossa Area (CLSI)
1. The median cubital vein is
best as it is away from arteries
and nerves and is cushioned in
the middle of the antecubital
fossa area – less chance for
rolling and less painful for the
patient
2. Next choice: Cephalic
3. Last choice: Basilic (close to
brachial artery and median
nerve)

What if no veins are found?
• If nothing found in antecubital fossa:
• Assess veins on back of hand – do NOT collect from
the side of wrist above the thumb and the inside of
the wrist
• Lower extremities (i.e., foot) can only be
collected with physician permission due to
potential medical complications (thrombosis

11. Clean the Site
• Once you know where you want to collect from, remove the
tourniquet
• Clean the site using a commercial 70% isopropyl alcohol wipe
• Use a friction scrub (back and forth)
• Allow to AIR DRY for 30-60 seconds (needs time to be effective)
• Do NOT blow on it
• Do NOT wipe with a cotton swab or gauze
• Do NOT wave your hand over it
• Try not to touch the site after cleaning, if it is touched, clean again

12-13. Prepare for Collection
• Assemble all equipment needed
• Needle (appropriate gauge size for your patient)
• Holder (the needle and holder may come together or separate)
• Gauze or cotton
• Required tubes (ensure not expired, place in order of draw)
• Bandage or tape
• Have a sharps container nearby (within reach)
• Place equipment on correct side within reaching distance to avoid crossing
over your collection
• Assemble needle if required
• Reapply the tourniquet careful to not contaminate the clean area

14-15. Anchoring
• Ask the patient, “can you please close your hand / make a fist?”, hand
pumping is not recommended as can increase potassium levels
• Hold the arm and anchor the skin, 2-3 inches below the intended
puncture site using your thumb in a manner not to impede needle
insertion
• Do NOT do a ‘C’ hold anchor with your fingers also above the
insertion site, this increases the risk of a needle-poke

Anchoring
Function:
• Makes patient's skin tight/taut so the needle slides in easier
• Holding the patient arm gently to ensure they do not move away
while you are puncturing the site
• Keeps the vein from rolling when pushing the needle in

16-18. Insert Needle
• Firmly grasp the holder, warn patient (“take a deep breath”) and insert
the needle, bevel up at an angle of 30° or less (usually 15-30°) into the
vein based on depth of vein
• Steady holder and insert first tube – use your thumb to push the tube
from the bottom, while the index and middle finger pull from behind
the flange – this push/pull technique stops needle movement
• Ask patient to open hand/fist
This is a great time to assess the patient
• ask the patient how they are doing
• Look at their face for sweating, pallor, anxiety

19-23. Fill Tubes & Remove Tourniquet
• Once blood flow is established, remove tourniquet
• Remember, do NOT leave on for more than 1 minute to avoid
hemoconcentration of patient plasma
• Fill tubes to the maximum if possible using correct order of draw
• While changing tubes, gently mix the removed tube while next tube is
filling
• Best to place tubes into a rack so they don’t roll or fall
• ALWAYS remove the tourniquet before removing the needle
• When you remove last tube, place gauze pad over needle

troubleshooting Venipuncture
• If you don’t get blood...you need to assess
• If you feel the needle is too shallow, advance it slightly further
• If you feel the needle is too deep, withdraw it slightly
• According to CLSI, repositioning the needle without establishing vein
location is blind probing and is NOT allowed – can be painful and
result in nerve damage, hematoma or puncture of an artery
• A calculated lateral move in some areas may be attempted if the vein
location has been determined

Troubleshooting Venipuncture
• If the vein collapsed with the tourniquet on, remove the vacuum tube
to fill the vein again, try to reengage the tube again
• If you removed the tourniquet and the vein collapsed, ask for help to
reapply constriction.
• If no more blood flow, a repeat puncture may be necessary
• If you can’t understand why your venipuncture is not working, try a
new tube – your tubes vacuum may be not working
• You have TWO attempts for each patient, ask permission to perform a
second attempt if your first one was unsuccessful

24-26. Ending Venipuncture
• Remove and mix the last tube and place gauze pad lightly above the
needle on the arm
• Remove the needle (do NOT press down on the gauze at this time),
engage safety device (immediately) and then apply pressure to the
gauze over the puncture site
• Immediately discard needle into sharps container
• THEN ask patient to apply pressure
• No need to bend the elbow

27-28. Labeling
• Complete any tube inversion if necessary
• Gentle up and down motion
• Rocking tubes side to side is NOT mixing
• Beside the patient, label the blood tubes with prepared labels OR
write patient name (last, first), DOB, and accession number
• Document collection date, time and initials clearly on the tube
• Record date and time of collection on requisition (if present)

29. Check Tubes with Patient
• New CLSI Guideline as of 2017
• Compare the labeled tubes against the patient wristband or have the
patient verify their information is correct
• This is an easy step to ensure all tubes are labeled correctly before
heading to the lab
• Two seconds of double checking the tubes are labeled correctly can
save hours of troubleshooting in the lab or having a patient receive
incorrect lab results that can compromise their treatment

30. Check Patient
• Lift up the gauze and watch the site for 5-10 seconds looking for continued
bleeding or mounding (indicating bleeding under the skin)
• If still bleeding, the phlebotomist applies pressure for another couple
minutes
• Once bleeding has stopped, apply bandage or tape over clean gauze
• Good advice to give, “leave the bandage on for the next 15 minutes, do not
carry anything heavy with that arm for the next two hours.”
• Thank the patient (they are why you have a job) and let them know they
are good to go
• If your patient is feeling faint, allow them to sit for longer and then escort
them out of the collection area (ambulatory patient)

31-34. Clean Up
• Discard garbage and contaminated items into proper disposal
containers
• If you are in a patients room and had to move their dinner table or
bed rail, return the items to their original location and/or position
• Disinfect area
• Remove gloves
• Perform hand hygiene

Routine Practices
• Are always applied to blood collections
• Proper PPE is essential to keeping the collector and the patient safe
• Hand hygiene and new gloves are required between each patient
• Safety glasses are worn to reduce risk of blood splashes into the
collector’s eyes – don’t have your face directly over the puncture site
• Always treat patients and their collected blood tubes as infectious
• NEVER touch or handle a filled tube without gloves on

Routine Practices
• Are always applied to blood collections
• Proper PPE is essential to keeping the collector and the patient safe
• Hand hygiene and new gloves are required between each patient
• Safety glasses are worn to reduce risk of blood splashes into the
collector’s eyes – don’t have your face directly over the puncture site
• Always treat patients and their collected blood tubes as infectious
• NEVER touch or handle a filled tube without gloves on

Testing Priority
• STAT – TAT 1 hour
• Shortest TAT
• Test results are vital to immediate patient management in life threatening
emergencies
• Collected immediately and processed ahead of all other specimens
• Urgent – TAT 3/4 hours
• When test request are required sooner than routine testing
• Quick results for non-life threatening situations or patient discharge
• Routine – variations in TAT
• Processed last (typically within 8 hours unless batching)
• For results of non-STAT and non-urgent patient management

. Introduction
• “Hello my name is _________________, I am from the lab and I am
here to collect your blood.”
• This is a great way to introduce yourself when you are collecting in a
hospital setting. In an out-patient situation, still introduce yourself.
• You may be wearing a lab coat and you don’t want the patient to
think you are a doctor or a nurse.
• It is best NOT to ask, “how are you doing today”. The patient may
start sharing confidential medical information with you.

2. Explain the Procedure
• “I will be collecting blood from you today.”
• Most people have had blood drawn before, but don’t assume
• Usually the patient will extend their arm for you, this is referred to as
IMPLIED CONSENT
• Does a patient have the right to refuse a collection?
• Can a patient retract their consent in the middle of a collection?
YES!!
Document the refusal. Notify the ward nurse if an inpatient.

Explain the Procedure
• Speak clear and use easy vocabulary – avoid complicated medical
terms
• If a patient ask questions about the collection, inform them
• If the patient ask what the test are for or why the physician ordered
the testing, refer them to their nurse or physician

3. Identify the Patient
• Ask the patient to state and spell their first and last name
• Ask the patient to state their date of birth (DOB)
• These demographics are checked with their labels and their wristband
if they are an inpatient
• All must match!!!
• What if they are an inpatient and have no wristband?
• Look for one on the ankle, if not there...
• Ask the nurse to put a new one on BEFORE you begin your collection

Patient Identification
• This is the MOST important job of an MLA/T for this procedure
It doesn’t matter how good your collection was if it was
done on the wrong person.
What do you think a possible outcome of incorrect patient
identification could be?

Inpatient Identification
• All inpatients must have ID bands on their person (wrist or ankle)
• Check identifiers – if any discrepancies, do NOT continue collection
until resolved
• Do NOT rely on bed tags or charts
• If patient in is emergency and is unidentified, the hospital can assign a
temporary ID number
• Still needs to be on patient and will need to be cross-referenced to
patient once proper ID is available

Who Else Can Help Patient ID?
• If patient is too young or unable to identify themselves (unconscious,
comatose, or impaired in some way)
• Can ask patient’s healthcare provider, relative or friend to provide all
information
• You still need to compare against requisition or labels and ID band if
an inpatient
• Document name and title/relationship of person who has identified
patient

4-7. Prepare for the Collection
• Perform hand hygiene and put on safety glasses and gloves
• Ask the patient, “Have you had any problems with previous
collections?”
• This is the moment they get to tell you if they have a history of
fainting or a fear of needles. – Lay them down for the collection if this
is the case –
• Confirm with the patient how many hours they have fasted if
necessary, “When was the last time you ate or drank?”
• They will tell you a time, you will have to calculate that into hours
• Ensure nothing is in their mouth (candy, gum, etc.)

8-9. Prepare the arm with the Tourniquet
• Ensure the arm is extended and downward (if possible – this may be
more difficult in a hospital setting with the patient laying down)
• Apply the tourniquet 3-4 inches above the intended puncture site
(above the antecubital fossa)
• The tourniquet ends should NOT be falling into the puncture site

10. Assess the Veins for Collection
• You can ask the patient for their non-dominant arm
• You can ask the patient if they have a preferred arm
• Assess the extended arm for veins once the tourniquet is on
• Look for the H or M configuration and try to find/feel the median
cubital first, then the cephalic, then the basilic
• Palpate with your gloved index finger only
• If no viable veins found:
• Check to see if the tourniquet is too loose
• Ask to see the other arm

Veins in the Antecubital Fossa Area (CLSI)
1. The median cubital vein is
best as it is away from arteries
and nerves and is cushioned in
the middle of the antecubital
fossa area – less chance for
rolling and less painful for the
patient
2. Next choice: Cephalic
3. Last choice: Basilic (close to
brachial artery and median
nerve)

What if no veins are found?
• If nothing found in antecubital fossa:
• Assess veins on back of hand – do NOT collect from
the side of wrist above the thumb and the inside of
the wrist
• Lower extremities (i.e., foot) can only be
collected with physician permission due to
potential medical complications (thrombosis

11. Clean the Site
• Once you know where you want to collect from, remove the
tourniquet
• Clean the site using a commercial 70% isopropyl alcohol wipe
• Use a friction scrub (back and forth)
• Allow to AIR DRY for 30-60 seconds (needs time to be effective)
• Do NOT blow on it
• Do NOT wipe with a cotton swab or gauze
• Do NOT wave your hand over it
• Try not to touch the site after cleaning, if it is touched, clean again

12-13. Prepare for Collection
• Assemble all equipment needed
• Needle (appropriate gauge size for your patient)
• Holder (the needle and holder may come together or separate)
• Gauze or cotton
• Required tubes (ensure not expired, place in order of draw)
• Bandage or tape
• Have a sharps container nearby (within reach)
• Place equipment on correct side within reaching distance to avoid crossing
over your collection
• Assemble needle if required
• Reapply the tourniquet careful to not contaminate the clean area

14-15. Anchoring
• Ask the patient, “can you please close your hand / make a fist?”, hand
pumping is not recommended as can increase potassium levels
• Hold the arm and anchor the skin, 2-3 inches below the intended
puncture site using your thumb in a manner not to impede needle
insertion
• Do NOT do a ‘C’ hold anchor with your fingers also above the
insertion site, this increases the risk of a needle-poke

Anchoring
Function:
• Makes patient's skin tight/taut so the needle slides in easier
• Holding the patient arm gently to ensure they do not move away
while you are puncturing the site
• Keeps the vein from rolling when pushing the needle in

16-18. Insert Needle
• Firmly grasp the holder, warn patient (“take a deep breath”) and insert
the needle, bevel up at an angle of 30° or less (usually 15-30°) into the
vein based on depth of vein
• Steady holder and insert first tube – use your thumb to push the tube
from the bottom, while the index and middle finger pull from behind
the flange – this push/pull technique stops needle movement
• Ask patient to open hand/fist
This is a great time to assess the patient
• ask the patient how they are doing
• Look at their face for sweating, pallor, anxiety

19-23. Fill Tubes & Remove Tourniquet
• Once blood flow is established, remove tourniquet
• Remember, do NOT leave on for more than 1 minute to avoid
hemoconcentration of patient plasma
• Fill tubes to the maximum if possible using correct order of draw
• While changing tubes, gently mix the removed tube while next tube is
filling
• Best to place tubes into a rack so they don’t roll or fall
• ALWAYS remove the tourniquet before removing the needle
• When you remove last tube, place gauze pad over needle

troubleshooting Venipuncture
• If you don’t get blood...you need to assess
• If you feel the needle is too shallow, advance it slightly further
• If you feel the needle is too deep, withdraw it slightly
• According to CLSI, repositioning the needle without establishing vein
location is blind probing and is NOT allowed – can be painful and
result in nerve damage, hematoma or puncture of an artery
• A calculated lateral move in some areas may be attempted if the vein
location has been determined

Troubleshooting Venipuncture
• If the vein collapsed with the tourniquet on, remove the vacuum tube
to fill the vein again, try to reengage the tube again
• If you removed the tourniquet and the vein collapsed, ask for help to
reapply constriction.
• If no more blood flow, a repeat puncture may be necessary
• If you can’t understand why your venipuncture is not working, try a
new tube – your tubes vacuum may be not working
• You have TWO attempts for each patient, ask permission to perform a
second attempt if your first one was unsuccessful

24-26. Ending Venipuncture
• Remove and mix the last tube and place gauze pad lightly above the
needle on the arm
• Remove the needle (do NOT press down on the gauze at this time),
engage safety device (immediately) and then apply pressure to the
gauze over the puncture site
• Immediately discard needle into sharps container
• THEN ask patient to apply pressure
• No need to bend the elbow

27-28. Labeling
• Complete any tube inversion if necessary
• Gentle up and down motion
• Rocking tubes side to side is NOT mixing
• Beside the patient, label the blood tubes with prepared labels OR
write patient name (last, first), DOB, and accession number
• Document collection date, time and initials clearly on the tube
• Record date and time of collection on requisition (if present)

29. Check Tubes with Patient
• New CLSI Guideline as of 2017
• Compare the labeled tubes against the patient wristband or have the
patient verify their information is correct
• This is an easy step to ensure all tubes are labeled correctly before
heading to the lab
• Two seconds of double checking the tubes are labeled correctly can
save hours of troubleshooting in the lab or having a patient receive
incorrect lab results that can compromise their treatment

30. Check Patient
• Lift up the gauze and watch the site for 5-10 seconds looking for continued
bleeding or mounding (indicating bleeding under the skin)
• If still bleeding, the phlebotomist applies pressure for another couple
minutes
• Once bleeding has stopped, apply bandage or tape over clean gauze
• Good advice to give, “leave the bandage on for the next 15 minutes, do not
carry anything heavy with that arm for the next two hours.”
• Thank the patient (they are why you have a job) and let them know they
are good to go
• If your patient is feeling faint, allow them to sit for longer and then escort
them out of the collection area (ambulatory patient)

31-34. Clean Up
• Discard garbage and contaminated items into proper disposal
containers
• If you are in a patients room and had to move their dinner table or
bed rail, return the items to their original location and/or position
• Disinfect area
• Remove gloves
• Perform hand hygiene