In-Depth Phlebotomy Notes

Phlebotomy Review

Order of Draw

• Importance: Correct order prevents contamination and ensures accurate test results.

• Colors and Additives:

  • Red: No additive (serum tests)

  • Yellow: ACD (blood cultures)

  • Light blue: Sodium citrate (coagulation tests)

  • Green: Heparin (chemistry tests)

  • Lavender: EDTA (hematology tests)

  • Grey: Sodium fluoride (glucose and alcohol tests)

Common Tests Performed in Each Tube

• Red Tube: Serology, blood type

• Light Blue Tube: PT, APTT

• Green Tube: Stat chemistry tests

• Lavender Tube: CBC, blood smears

Names of Veins

• Common Veins for Venipuncture:

  • Median cubital vein (most common)

  • Cephalic vein

  • Basilic vein

When to Label Tubes

• Immediately after collection to ensure patient sample identification.

Tourniquets

• How long to keep on: No longer than 1 minute to prevent hemoconcentration.

• Why not so tight: Avoid damage to venous tissue and inaccurate test results.

• Where to tie it: 3-4 inches above puncture site.

• When to release it: Immediately after blood flow is established.

• Effects of leaving on too long: Hemoconcentration leading to false test results (increased concentration of cells and proteins).

Most Common Site in Phlebotomy

• Site: Antecubital fossa (elbow area).

• Cleaning the Site: Use an antiseptic wipe such as alcohol or iodine.

Anticoagulant

• Definition: Substances that prevent blood from clotting.

• Examples: EDTA, heparin, sodium citrate.

Parts of the Needle and Collection System

• Components:

  • Hub: connects to the collection tube.

  • Shaft: long part of the needle.

  • Bevel: angled tip for easy puncture.

  • Lumen: hollow center for blood flow.

Steps of Venipuncture

1. Assemble equipment (needles, tubes, tourniquet).

2. Position the patient.

3. Apply the tourniquet.

4. Clean the site.

5. Insert the needle at a 15-30 degree angle.

6. Insert tube into the holder.

7. Remove the tourniquet.

8. Withdraw the needle and apply pressure.

9. Dispose of needle correctly.

Inserting the Needle

• Technique: Insert with a swift motion, bevel up, at the appropriate angle.

Handling Fragile Veins

• Method: Use smaller gauge needles or a butterfly needle (winged infusion set).

Most Common Needle Sizes

• Common Sizes: 21G, 22G for adults; 23G for pediatric or fragile veins.

Angle for Venipuncture

• Recommended Angle: 15 to 30 degrees.

Stopping the Bleeding at Site

• Technique: Apply direct pressure with a gauze pad and then bandage after bleeding stops.

Winged Infusion Set

• Used for smaller veins and is easier for fragile veins.

Terminology

• Hematoma: Localized bleeding outside of blood vessels.

• Hemoconcentration: Increased concentration of cells due to decreased plasma volume.

• Hemolysis: Breakdown of red blood cells causing sample discoloration.

• Hemostasis: The process of stopping bleeding.

• Petechiae: Small red or purple spots on the body caused by bleeding.

Dermal Puncture Device

• Used for: Obtaining small blood samples, often from fingers or heels of infants.

Tube Handling Techniques

• Shaking vs. Inverting: Gently invert tubes to mix; harsh shaking may cause hemolysis.

Needle Sticks

• Most Likely Occur: During safety device activation, disposal, or when drawing blood without proper care.

Correct Method of Capillary Puncture

• Steps: Warm the site, use a lancet, perform puncture on the side of the fingertip.

Adverse Reactions

• Reactions: Fainting, hematoma, infection, or allergic reactions.

Capillary Tube Order

• Order: Lavender tube first in capillary blood draws to reduce contamination risks.

Performing Finger Sticks

1. Position the patient comfortably.

2. Clean the site and prepare the lancet.

3. Puncture the skin and collect drops of blood.

Clean Catch Test

• Procedure: Patient cleans genital area, collects mid-stream urine sample to avoid contaminants.

24 Hour Test

• Purpose: Measures total substances in urine over 24 hours (e.g., protein).

Routine Urinalysis

• Tests: Physical, chemical, and microscopic examination of urine.

Specimen Collections

• Sputum: Collected for respiratory tests; patient exhales deeply before collection.

• Stool: Collection for gastrointestinal tests; requires clean container and possibly preservatives.

• Semen: Collected for fertility testing; should be kept at body temperature.

Blood Culture Collection Cleaning

• Use: Alcohol or chlorhexidine for skin disinfection before drawing blood cultures.

Basal State

• Definition: The state of the body after fasting for at least 12 hours, used for accurate test results.

CLIA

• Definition: Clinical Laboratory Improvement Amendments - regulates laboratory testing.

Chain of Custody/Drug Testing

• Importance: Ensures integrity and accountability of specimens collected for drug testing.