Phlebotomy

  • Venipuncture - collection of blood from a vein

  • Methods of venipuncture: vacuum tube, butterfly needle, syringe

  • Antecubital Space - common venipuncture, inner arm below the bend in the elbow

Alternative Venipuncture Sites:

  1. Veins on the back of the hand or wrist (more painful, use butterfly needle)

  2. Veins in feet or legs (physician permission)

Equipment:

  1. Tourniquet

  2. Needles

    1. Double ends - one to puncture vein and the one in collection tube

    2. typical length 1 in to 1.5 in

    3. Gauge - needle’s diameter; the larger the gauge, the smaller the diameter; venipuncture range is 20 to 22

  3. Evacuated collection tubes

    1. color indicates the type of additive

  4. Adapters (aka holders)

STANDARD ORDER OF DRAW!

  1. Blood Culture tubes

  2. Coagulation tubes (sodium citrate) → light blue

  3. Serum tubes

    1. Non additive tubes → red

    2. Serum-separating tubes (SSTs) → gold or “tiger top”

  4. Heparin Tubes/PSTs → dark/light green

  5. EDTA Tubes → lavender/purple or pink

  6. Oxalate tubes → gray

  • mix by inverting - rotate around 8 - 10 times; DO NOT SHAKE

Process of blood draws:

  1. Select an arm

  2. Apply Tourniquet

  3. Palpate veins

  4. Feel for strong vein

  5. Have patients make a fist

  • Label tube with patient’s name, doctor’s name, date and time, patient’s DOB, my initials

What can go wrong:

  • Hematoma - black and blue mark around puncture site (find somewhere else to draw blood)

  • Hemolysis - Breaking down of blood cells

  • hitting an artery and not a vein

  • No blood flow → reposition needle/tube; loosen tourniquet

  • Stopped Blood flow → restick needle