Phlebotomy and Specimen Collection - Study Notes

Page 1

• Course focus: Introduction to methods of blood collection, histology and cytology specimen collection.
• Topics covered: appropriate phlebotomy equipment, anticoagulants, and how to draw, handle and store blood and other body fluids.
• Key term: Histo-Cyto Specimen Collection.

Page 2

• Importance of lab tests: Lab tests provide vital information about a patient’s health.
• Essential elements for accurate results: adequate patient preparation, proper specimen collection, and correct handling, storing, and transporting of specimens.
• Core principle: The accuracy of test results depends on the integrity of the collected specimens.
• Note: Fall 2025 (contextual timestamp).

Page 3

• Classroom Guidelines:
  • Cell phones: silent.
  • Arrive on time.
  • Laptops/tablets/phones: to be used for class activities (lectures, note taking, activities, etc.).
  • Title Here (placeholder).

Page 4

• Georgian College cheating and plagiarism policy will be enforced in this class.
• Drinks or snacks allowed if not distracting.
• Responsibility to obtain what you missed when absent.
• Be kind.

Page 5

• Contact information:
  • Email: Sergii.Selivanov@GeorgianCollege.ca
  • Blackboard: Blackboard messaging can be used to contact.
  • Office Hours: 04 (context suggests listed) / By Appointment: Appointments can be made based on both schedules.

Page 6

• Broad subject areas covered in the course: Venipuncture, Capillary Puncture, Patient Instruction, Patient Interactions, Mental Health, Urine, Stool, Sputum, Body Fluids, Accessioning, Specimen Requirements, Fixation, Staining, Anatomy, Performing ECGs, Tracings, Identifying Rhythms, Blood Collection, Specimen Collection, Histology + Cytology, ECGs + Holter Monitors, Course Outline.

Page 7

• Assessment structure (as listed, though formatting is mixed in the transcript):
  • There will be two tests throughout the semester, each worth 20% (text shows two tests and a sum that implies weight around this range).
  • Tests include two assignments, each worth 5%.
  • There are 3 assignments total.
  • Two quizzes, each worth 7.5%.
  • Quizzes total 30%.
  • Final Exam 20% (as listed in the transcript).
  • Additional items listed: Quizzes 15% (unclear context), Course Evaluation.
• Note: The exact distribution on this page is inconsistently formatted in the transcript; the above items are captured as stated, with an explicit note on potential ambiguity.

Page 8

• Missed tests:
  • Contact the Testing Center to book any missed tests or quizzes.
  • You will have 1 week to book missed assessment(s) or you receive an automatic 0.
  • Requests can be booked as soon as you miss something, subject to the instructor’s approval.
  • Testing Center.

Page 9

• Tests & Exam scope:
  • Content for each quiz, test, and exam will be mentioned in the previous week’s PowerPoint.
  • Any information included in procedures for lab are testable in this class.

Page 10

• Running Totals:
  • Grades are based ONLY on assessments that are entered.
  • Grades can increase OR decrease as the term progresses (fluctuation).
  • Example calculation: If a student completes the first quiz (worth 5 ext{%}) and earns $18/20$, then the running total can be shown as:
  • ext{RunningTotal} = rac{ ext{Earned Points}}{ ext{Total Possible Points}} imes 100 ext{%} = rac{18}{20} imes 100 ext{%} = 90 ext{%}

Page 11

• Introduction topics:
  • History of phlebotomy.
  • Phlebotomists and their role.
  • Safety precautions.
  • Anatomy of blood components.
  • Whole blood, serum vs. plasma.
  • Routine venipuncture.
  • Assembling and preparing equipment.
  • Sequence of procedure.
  • Patient identification.
  • Today’s agenda.

Page 12

• Introduction (abbreviation line in transcript):
  • I R N T O (as written in transcript).

Page 13

• The Lab:
  • The clinical lab provides physicians with approximately 14 billion lab tests per year.
  • Before results can be reported, specimens must be collected.
  • A large portion of samples are blood, which is where you come in.

Page 14

• Phlebotomy definition and context:
  • Collecting blood through a vein or a cut is called phlebotomy.
  • It is the most common invasive procedure performed.
  • Phlebotomists and Medical Laboratory Assistants (MLAs) make up the majority of those collecting blood samples.

Page 15

• History: Stone Age origins.
  • Puncture blood vessels and drain to rid the body of evil spirits and cleanse impurities.
  • Leeches used in Egypt for bloodletting; depicted in tomb paintings.

Page 16

• History (Middle Ages):
  • 5th–15th century: Surgery was a trade, not a profession.
  • Barbers skilled with sharp tools performed bloodletting.
  • Guild formed: “Barber Surgeons” in 1210.

Page 17

• History (Barber Surgeons):
  • Allowed to perform: Bloodletting, Wound surgery, Tooth extraction, Enema administration, Shaving.

Page 18

• Leeches:
  • Used for localized bloodletting.
  • Mechanism: Leeches latch to skin; they engorge and fall off.
  • Effects: Break up microclots; vasodilator in saliva promotes oxygen flow.

Page 19

• The Present:
  • Current practices and standards have drastically improved.
  • Procedures and standards are followed; currently not a regulated profession, but certificates of completion are often requested and preferred.
  • Course + Provincial/National Exam.

Page 20

• Present use of blood:
  • Blood collected by MLAs and phlebotomists is used for screening tests, diagnostic tests, monitoring treatment, donor units, and therapeutic purposes.

Page 21

• Phlebotomist vs MLA:
  • MLA has additional knowledge and skills in the 5 disciplines of a clinical laboratory.
  • Titles are often interchanged.
  • Phlebotomist: trained in methods to obtain blood for lab tests or blood donation.
  • MLAs work with MLTs to coordinate maintenance, run QC and set up tests.

Page 22

• Phlebotomist: Key player on the health care team.
  • Often function under supervision as a phlebotomist.
  • They are the face of the lab and have direct patient contact.
  • Collections and samples are critical to patient care.

Page 23

• Primary role and responsibilities:
  • Collect blood accurately and reliably.
  • Must be competent and ensure samples are handled properly and in compliance with guidelines.
  • Samples collected by evacuated tubes, syringe, or microtainer tubes.
  • Errors in laboratory testing mainly occur in the pre-analytical stage (specimen collection + handling).

Page 24

• Typical Duties (part 1):
  • 01 Prepare patients and select site for specimen collection.
  • 02 Collect blood samples with appropriate equipment (venous and capillary).

Page 25

• Typical Duties (part 2):
  • 03 Proper labeling, transport and shipping.
  • 04 Comply with safety, rules and regulations.

Page 26

• Safety and Infection Control (heading).

Page 27

• Safety overview:
  • Knowledge of safety protects yourself, patients, coworkers, and families from infection or injury.
  • Important to follow safety and infection control procedures when encountering sick patients and their specimens.
  • Following simple rules helps keep everyone safe.

Page 28

• Safety Rules (Part 1):
  • 1. Observe universal safety precautions.
  • 2. Observe all applicable isolation procedures.
  • Treat all human body fluids as infectious: Airborne, Droplet, Contact.

Page 29

• Airborne precautions:
  • For patients suspected of infections transmitted by airborne droplets.
  • Extra PPE indicated; signage on the outside of patient room.
  • N95 respirator commonly used (e.g., for TB, chickenpox).

Page 30

• Droplet precautions:
  • For infections transmitted by droplets.
  • Generated when patient talks, coughs, sneezes, or during suction procedures.

Page 31

• Contact precautions:
  • For infections transmitted by direct contact with patient or surfaces (e.g., C-diff).
  • Signage on patient room; gown used.

Page 32

• Safety Rules (Part 2):
  • 3. PPE worn at all times when dealing with patients.
  • 4. Handwashing with warm running water and appropriate product.
  • 5. If hands are not visibly contaminated, hand sanitizer can be used before/after each patient.
  • 6. Gloves during all phlebotomy; changed between patient collections.

Page 33

• Safety Rules (Part 3):
  • 7. Lab coat or gown must be worn during blood collection procedures.
  • 8. Needles and holders are single-use; disposed of in appropriate sharps container.
  • 9. Needles are never recapped, removed, broken or bent after phlebotomy procedure.
  • 10. Gloves discarded after procedure.

Page 34

• Safety Rules (Part 4):
  • 11. Contaminated surfaces must be cleaned with freshly prepared bleach solution.
  • 12. Benches should be cleaned and wiped down daily.
  • 13. In case of accidental needle-stick, wash area with antibacterial soap and contact your supervisor.

Page 35

• Blood-borne Pathogens:
  • Any infectious microorganism present in blood or other body fluids/t tissues.
  • Major pathogens listed: Hepatitis B, HIV, Syphilis, CMV, Malaria, West Nile, Ebola, Hepatitis C.

Page 36

• Hepatitis B:
  • Can survive up to a week in dried blood on surfaces.
  • Most frequently occurring blood-borne pathogen.
  • Best defense: vaccination (often required at facilities).
  • Targets the liver; found primarily in blood but also in urine, CSF and saliva.

Page 37

• HIV:
  • Can lead to AIDS; primary exposure through blood.
  • Attacks the body’s immune system.

Page 38

• Needle Safety:
  • Needle injuries can lead to serious or fatal infections with blood-borne pathogens (HBV, HCV, HIV).
  • Best practice: use safety needles activated with one-hand safety after use.

Page 39

• Preventing Needle Sticks:
  • Do not use needles when patients are violent/unsafe.
  • Always choose needles with one-handed safety features.
  • Never recap a contaminated needle.
  • Plan for safe handling and disposal before beginning any procedure using needles.

Page 40

• Contaminated Needle Stick:
  • Report needle sticks promptly.
  • Remove gloves and dispose properly.
  • Wash area with soap and water.
  • Record patient’s name and ID number.
  • Report to supervisor and complete incident report.
  • Refer to physician for bloodwork (initial and at 6 weeks).

Page 41

• Questions?

Page 42

• Anatomy of Blood (title).

Page 43

• Blood is a specialized body fluid with multiple functions:
  • Transports oxygen and nutrients to lungs and tissues.
  • Carries cells and antibodies to fight infection.
  • Forms blood clots to prevent excessive blood loss.
  • Removes waste products to kidneys and liver.
  • Regulates body temperature.
  • Main functions summarized.

Page 44

• Physical characteristics of blood:
  • About 5x thicker than water (viscosity).
  • Approximately 8% of total body weight.
  • Average blood volume and pH: $ext{pH} = 7.4$; Men: $5-6 ext{ L}$; Women: $4-5 ext{ L}$.

Page 45

• Components of Blood:
  • Centrifuged blood separates visually into two main components: Plasma (55%) and Formed Elements (45%).
  • Formed Elements include RBCs, WBCs, and platelets; Buffy coat contains WBCs and platelets.

Page 46

• Plasma composition:
  • Plasma is 91.5% water and 8.5% solutes.
  • Plasma proteins, nutrients, enzymes, hormones; Albumin is the largest concentration.

Page 47

• Plasma functions:
  • Helps maintain blood pressure.
  • Regulates body temperature.
  • Plasma prevents clotting when appropriate anticoagulants are present.
  • Contains minerals, salts, and hormones with important functions in the body.

Page 48

• Formed Elements:
  • The Buffy coat contains WBCs and platelets.
  • May appear green due to myeloperoxidase in some contexts.

Page 49

• Plasma vs Serum:
  • Both originate from the liquid portion of blood after cells are removed.
  • Plasma includes clotting factors; Serum is plasma minus the clotting proteins (fibrinogen) that are consumed in clot formation.

Page 50

• Serum characteristics:
  • Serum is collected in a tube without an anticoagulant.
  • Clotting occurs within $30-60\text{ minutes}$ (usually around 30).
  • Formed clot leaves cells in a fibrin meshwork.
  • Serum composition is like plasma except for the absence of fibrinogen/fibrin after clotting.

Page 51

• Preparation/Separation of Serum:
  • Serum is normally clear and yellow.
  • Blood is allowed to clot at room temperature for $30-60\text{ minutes}$.
  • When completely clotted, serum is rimmed with an applicator stick.
  • Centrifuged for $10\text{ min}$ at $3000\text{ rpm}$.

Page 52

• Coagulation measures and uses:
  • Measures coagulation factors: Plasma vs Serum distinction.
  • Applications include Molecular diagnostic testing (PCR), Hormones, Electrolytes, Enzymes.
  • Question posed: When are these used?

Page 53

• Whole Blood:
  • Most hematology tests require whole blood.
  • Collected in an anticoagulant tube to prevent clotting.
  • Sample will separate upon standing; mix a minimum of $2\text{ minutes}$ prior to testing.

Page 54

• Where can blood be found? (Heading only; content implies distribution contexts)

Page 55

• Arteries:
  • Arteries carry blood away from the heart.
  • Blood is under high pressure; thick-walled; pulsatile due to ventricular contraction.
  • The resultant pressure creates a palpable pulse.

Page 56

• Arterial blood characteristics:
  • Arterial blood is bright cherry red (oxygen-rich).
  • Arteries have arterioles as smallest branches; the aorta is the largest artery (≈1 inch in diameter).

Page 57

• Veins:
  • Veins return blood to the heart.
  • Lower in oxygen; deoxygenated blood appears bluish-red or dark red.
  • The venous system is the typical source for most blood collections.
  • Largest vein: vena cavae; longest vein: great saphenous (leg).

Page 58

• Capillaries:
  • Microscopic vessels, one cell thick.
  • Contain a mixture of arterial and venous blood.
  • In capillaries, arterial blood delivers oxygen and nutrients; CO₂ exchange occurs through the capillary walls; venous blood removes CO₂ and returns to lungs.

Page 59

• Capillaries (summary reiteration):
  • Arterial blood supplies O₂ and nutrients; venous blood removes CO₂; CO₂ exchange occurs across capillary walls.

Page 60

• Arterial blood collection context:
  • Blood leaving the heart is arterial and bright red; under pressure; arterial puncture causes rapid blood spurting in sync with heartbeat.
  • MLAs and physicians will establish and draw from arterial lines; MLAs/Phlebotomists do not draw from arteries.

Page 61

• Venous blood:
  • Found in veins; bluish-red color; deoxygenated.
  • The specimen of choice for the majority of blood collections.
  • Obtained by direct puncture to a vein, most often the antecubital space of the arm.

Page 62

• Site Selection:
  • Visually inspect both arms.
  • Prefer sites not repeatedly used for venipuncture.
  • Avoid veins that are scarred or feel hard to the touch.

Page 63

• Antecubital Fossa:
  • Definition: Antecubital = in front of the elbow; Fossa = a shallow depression.
  • The first choice location for venipuncture.
  • Veins lie close to the surface here, making them easier to locate and puncture.

Page 64

• Antecubital Fossa – Veins commonly used:
  • 01 Median Cubital
  • 02 Cephalic
  • 03 Basilic

Page 65

• Median Cubital:
  • Considered the first vein of choice.
  • Located in the antecubital fossa.
  • Usually large, well anchored, few problems; near to nerve endings.

Page 66

• Cephalic:
  • Located on the upper/shoulder side of the arm; second choice.
  • Often well anchored; may be more prominent in men.
  • Lies close to the surface; insertion angle around 15 degrees to avoid a drop at the puncture site.

Page 67

• Basilic:
  • Located on the underside of the arm; third choice.
  • Not always well anchored; vein may roll; more difficult collection.

Page 68

• Site Selection (summary):
  • Emphasizes choosing appropriate venipuncture sites and considerations for efficacy and safety.

Page 69

• Alternative Sites (when antecubital fossa is not usable):
  • Amputation, IVs running, Drug users, extensive burns or scars (limits/contraindications).

Page 70

• Alternative Site – Hand:
  • Dorsal hand vein often used when IVs are running.
  • Warm the patient's hands to improve collection.
  • Collection equipment may differ (syringe or butterfly).
  • Outcome: 50/50—vein may be well anchored or may roll.

Page 71

• Alternative Site – Foot:
  • Must be physician-approved.
  • Use must be justified; higher risk, particularly for diabetic patients (slower/healing wounds, infection risk).
  • Potential complications: clots, necrosis, gangrene, serial amputations.

Page 72

• Routine Venipuncture (heading).

Page 73

• Patient identification risk:
  • Collecting from the wrong patient can have serious and fatal consequences.
  • Each facility has a stated protocol for proper patient identification.

Page 74

• Patient Identification (critical step):
  • The identification and confirmation of the patient is YOUR responsibility.
  • Must be verified before any collections; minimizes medication and diagnostic errors; ensures appropriate treatment.

Page 75

• Patient Identification – How to approach:
  • Upon entering the patient room, identify yourself and explain why you are there.
  • Put the patient at ease; ensure understanding of the procedure.
  • Speak clearly, speak slowly, speak loudly; use writing, gestures, or signs as needed.

Page 76

• Patient flow considerations:
  • If the door is closed, knock first and proceed carefully.
  • Timed or STAT draws may be collected with others in the room.
  • Wards or ER rooms may have curtains; check with the patient before entering.

Page 77

• Patient Identification (SOP):
  • SOPs require asking for patient’s name and DOB.
  • Always verify using the patient’s armband and cross-check the requisition/labels.

Page 78

• Armband verification and identification rules:
  • Never draw blood from a patient without an armband.
  • Sometimes another staff member may identify the patient before drawing; this must be documented on the requisition.
  • Never identify a patient by reading the name tag above their bed.
  • Never ask the patient, “Are you Jim Smith?”

Page 79

• Handling discrepancies:
  • Do not collect if there is a discrepancy between the armband and requisition.
  • Notify nursing staff and resolve before collection.
  • If the patient is sleeping, wake them gently; do not draw from a sleeping patient.
  • If a patient is unconscious, the nurse or a family member may identify the patient.

Page 80

• Emergency Situations – Special Tags:
  • Examples: “Jane Doe”, “0001” (these identifiers follow patient records throughout requisitions, labels, charts, tubes, etc.).
  • If a patient refuses blood draw, you cannot proceed; document and notify nursing staff.

Page 81

• Try this Tip:
  • Ask for patient’s permission to draw their blood rather than assuming consent.
  • If there is no objection or gesture indicating willingness, you may proceed.

Page 82

• Equipment: Required (heading).

Page 83

• Equipment list (Blood collection carts or trays should include):
  • 1. Tourniquet
  • 2. Sterile disposable needle
  • 3. Needle holder/barrel
  • 4. Vacutainer Tubes/Microtainers
  • 5. Special Equipment – Blood cultures
  • 6. Alcohol

Page 84

• Equipment continued:
  • 7. Cotton Balls
  • 8. Tape or Bandaids
  • 9. Syringes or Winged Infusion Set
  • 10. Gloves
  • 11. Sharps
  • 12. Labels/Requisition

Page 85

• Labels:
  • Most are computer generated. If not available, tubes must be labeled in permanent ink; white-out is NEVER used in laboratories.
  • Labels must include:
  • Patient’s full name + DOB
  • Phlebotomist’s initials
  • ID Number
  • Date + time of collection

Page 86

• Label components (repeat emphasis):
  • ID Number
  • Phlebotomist’s Initials
  • Patient’s full name
  • Date of Birth
  • Date + time of collection

Page 87

• Vacutainer Tubes:
  • Plastic tubes with color-coded rubber stoppers.
  • Contain anticoagulants and/or other chemical additives.
  • Plain tubes contain no anticoagulant.

Page 88

• Info Check (quiz-style):
  • What is the first thing an MLA should do before drawing blood from a patient?
  • A. Clean the venipuncture site on patient
  • B. Make sure the patient isn’t nervous
  • C. Properly identify the patient
  • Correct answer: C

Page 89

• Venipuncture Procedure (overview):
  • Step-by-step process to perform venipuncture (detailed steps follow on subsequent pages).

Page 90

• Venipuncture Procedure – Step 1-4:
  1. Receive a requisition/label for bloodwork.
  2. Identify the patient; require two identifiers; compare labels/requisition to patient armband.
  3. Check requisition or labels for any special tests requested; confirm any diet or time restrictions.
  4. Explain the procedure and obtain consent.

Page 91

• Venipuncture Procedure – Step 5-6:
  5. Put gloves on; remove bandage, tape, or alcohol from wrapping; have cotton balls ready; choose the correct vacutainer tubes; assemble needle and holder; place all equipment on your non-dominant side.
  6. Twist the needle apart and screw the needle into the holder (short half into the holder).

Page 92

• Venipuncture Procedure – Step 7-8:
  • 7. Reapply tourniquet.
  • 8. Cleanse the venipuncture site with 70% isopropyl alcohol in a circular motion moving outward.
  • Remove plastic cap over needle; hold bevel up; inspect for burrs or bends; allow the skin to dry; do not touch the puncture site after cleaning.

Page 93

• Venipuncture Procedure – Step 9-12:
  • 9. Hold the barrel in your hand, thumb on top, fingers underneath; needle should be parallel to the vein.
  • 10. Anchor the vein with the free hand; pull skin tight to prevent vein from rolling.
  • 11. Enter the vein in one smooth motion at an approximate 15–30 degree angle.
  • 12. Once venipuncture is achieved, hold the needle/stem and prepare for tube insertion.

Page 94

• Venipuncture Procedure – Step 13-14:
  • 13. Hold the holder securely and insert the first tube into the holder; push the tube in with your thumb; allow the tube to fill completely.
  • 14. As blood starts to flow, release the tourniquet. If the patient had made a fist, ask them to open their hand.

Page 95

• Venipuncture Procedure – Step 15-16:
  • 15. Keep the needle steady at a 15–30 degree angle; anchor the vein and stretch the skin.
  • 16. Remove the tube and gently invert each one (do not mix vigorously).

Page 96

• Venipuncture Procedure – Step 17-18:
  • 17. Remove the needle quickly, in one smooth motion; cover the puncture site with a cotton ball.
  • 18. Ask the patient to apply pressure.

Page 97

• Venipuncture Procedure – Step 19-21:
  • 19. Dispose of the needle.
  • 20. While the patient applies pressure, gently mix the last tube.
  • 21. Properly label all tubes with patient’s full name + DOB; phlebotomist’s initials; ID Number; date + time of collection.

Page 98

• Venipuncture Procedure – Step 22-21 (continued):
  • 22. Check that bleeding has stopped and apply tape or bandage over the cotton ball.
  • 23. Dispose of any garbage and wash hands.
  • 24. Observe any special handling instructions (e.g., spin right away; protected from light).

Page 99

• Venipuncture Procedure – Step 22-24 (repeat emphasis):
  • Summary recap of steps 22–24 and final checks.

Page 100

• Venipuncture Procedure – Step 22-24 (finalizing):
  • Check bleeding, apply bandage, dispose waste, wash hands, and follow special handling instructions.

Page 101

• Documentation and labeling:
  • Phlebotomist’s initials and date + time of collection.
  • When computer-generated labels are not available, labels must be handwritten in permanent ink.
  • Commonly used marking tools: pen or Sharpie.

Page 102

• Final procedural checks (Step details):
  • Step 22: Check that bleeding has stopped and apply bandage.
  • Step 23: Dispose of garbage and wash hands.
  • Step 24: Observe any special handling instructions (e.g., spin immediately, protect from light).

Page 103

• Return to patient:
  • ALWAYS RETURN THE PATIENT’S BEDSIDE THE WAY YOU FOUND IT: chairs, garbage cans, bedrails.
  • Thank the patient for their cooperation and offer further assistance.

Page 104

• Questions? (Closing prompts)