Recording-2025-03-24T23:32:09.537Z

Blood Collection in Medical Offices

• Phlebotomy refers to the withdrawal of blood from a vein, synonymous with venipuncture.

• The task of collecting blood in medical offices has decreased due to outsourcing of blood tests to lab testing sites.

  • This reduces manpower and costs related to blood processing.

  • Familiarity with basic procedures remains essential for medical assistants.

Types of Blood Collection Procedures

• Venipuncture: The most common method where blood is drawn from a vein.

• Capillary Puncture: Involves collecting a small blood sample (drop of blood), less invasive, often used for pediatric patients and diabetics.

• Lancets: Needles used for capillary punctures, come in various gauges.

  • Larger gauge number means smaller needle (e.g., 30 gauge for capillary puncture, 21 gauge for venipuncture).

Essential Supplies for Blood Draws

• Tape/Koban: Used to secure gauze after procedure.

• Collection Tubes: Where blood specimens are stored post-draw.

• Venipuncture Set-Up: Includes a needle holder, tourniquet, alcohol wipes, and PPE (gloves).

• Tourniquet: Applied to restrict blood flow, making veins more prominent.

Blood Draw Techniques

• Evacuated System: Preferred for venipuncture, utilizes a double-pointed needle and vacuum tubes to draw blood.

• Butterfly System: Suitable for patients with small or weak veins due to less suction.

• Syringe Method: Least preferred; requires transferring blood from syringe to collection tube, causing more chances of vein collapse.

• Inversion of collection tubes (5-8 times gently) required to mix blood with additives.

Order of Draw for Blood Collection

• Important to maintain the order to avoid cross-contamination of samples.

• Order:

  1. Blood cultures (sterile bottles)

  2. Light blue tubes (sodium citrate for coagulation studies)

  3. Red stopper tubes (no additives)

  4. SST (serum separator tube)

  5. PST (plasma separator tube with fibrinogen)

  6. Green stopper tubes (heparin)

  7. Lavender tubes (EDTA for hematology tests)

  8. Gray tubes (sodium fluoride for glucose tests)

• Remember the mnemonic: "Stoplight Red, Stay Put, Green Light Go".

Labeling Collection Tubes

• Must include patient’s full name, date/time of specimen collection, patient ID number, date of birth, and initials of the person who drew the blood.

• Label tubes after drawing blood, never before.

Patient Interaction & Preparation

• Confirm patient identity using two identifiers: name and date of birth.

• Check for adherence to pre-test instructions (e.g., fasting) before drawing blood.

• Utilize calming techniques for anxious patients (e.g., focus on an object).

Complications to Monitor in Blood Draws

• Hematoma: Blood collection under the skin.

• Nerve Injury: When the needle hits a nerve, causing pain.

• Infection: Rare, but can occur; ensure hygiene before procedure.

• Hemolysis: Breakdown of red blood cells due to improper handling of blood specimens.

Completing Blood Tests

• Ensure correct collection tubes are used per provider orders to avoid testing errors.

• Common tests include CBC, blood glucose, lipid profile, and serology tests to detect antibodies.

• Understand difference between SST (gel for serum) and PST (fibrinogen present).

Types of Blood Tests

• Hematology Tests: Measure blood cells (CBC includes WBC, RBC counts).

• Coagulation Tests: Assess bleeding issues.

• Blood Chemistry Tests: Measure chemicals in blood (e.g., glucose, cholesterol).

• Serology Tests: Detect antibodies for infections.

Emergency Situations

• Handle fainting and anxiety in patients promptly without leaving them alone.

• For difficult sticks, consider using a venoscope or asking for assistance after two unsuccessful attempts.

• Report any complications immediately to the supervising provider.