Phlebotomy

Venipuncture

Steps• Identify the Patient• Assess the patient’s physical dispositon (i.e. diet, exercise, stress)• Check the requisition form for requested tests, patient information

and any special requirements.• Select suitable site.• Prepare the equipment and the patient and puncture site.• Perform venipuncture• Collect the sample in appropriate container• Recognize complications• Assess need for sample recollection and/or rejection• Label collection tubes at bedside or drawing area• Promptly send the specimens with the requisition to the lab

Requisition Form

• Must accompany each sample submitted to the lab

• Must contain proper information • Requisition Form

Essential Elements of Requisition form

• Patient’s surname, first name and middle initial• Patient’s ID number• Patient’s date of birth and sex• Requesting physician’s complete name• Source of specimen• Date and time of collection• Initial’s of phlebotomist• Indicating the test(s) requested

Labeling Sample

• Proper labeling ensures the results of the test match the patient.

• Key elements:– Patient's surname, first and middle– Patient's ID number– (Both of the above must match the same on the

requisition form.)– Date, time and initials of the phlebotomist must

be on the label of each tube

Materials needed for Venipuncture

• Evacuated Collection tubes• Needles• Holder/Adapter• Tourniquet• Alcohol Wipes• Povidone-iodine wipes/swabs• Gauze sponges• Adhesive bandages/tape• Needle disposal unit• Gloves• Syringes

Order of Draw

• Must be drawn in a specific order to avoid cross-contamination of additives between tubes.– First- blood culture bottle or tube (yellow or yellow-

black top)– Second –coagulation tube (light blue top)– Third- non-additive tube (red top)– Last draw- additive tubes in this order:– 1. SST (red-gray or gold top) Gel separator and clot

activator

Order of the draw

– 2. Sodium heparin (dark green top)– 3. PST ( light green top). Contains lithium heparin

anticoagulant and a gel separator.– 4. EDTA (lavender top)– 5. ACDA or ACDB (pale yellow top). Contains acid

citrate dextrose.– 6. Oxalate/fluoride (light gray top*Tubes with additives must be thoroughly mixed.

Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive.

ID Patient

• ID yourself and indicate procedure• Ask patient for full name and always check the

armband or bracelet.• Do not draw blood if armband or bracelet

missing.• Talk to the patient while drawing blood to

ease anxiety

Site selection

• Median cubital and cephalic veins of the arm• Basilic ven on the dorsum of the arm or dorsal

hand veins• Feet last resort

Areas to avoid

• Extensive scars from burns and surgery• Upper extremity on side of previous

mastectomy• Hematoma• IV fluids/blood transfusions• Lines• Cannula/fistula/heparin lock• Edematous extremeties