MLS 704
HEMATOLOGY II
Principles of Blood Collection
Revision For Practical Class –
Venipuncture and Capillary
collection
Clinical Laboratory Tests
• 70% of a doctor’s information comes from
laboratory test results obtained from a quality
specimen:
– Diagnose
– Treatment
– Monitoring
• A lab result is only as good as the specimen
received in the laboratory.
Phlebotomy is the practice of drawing blood from
patients and taking the blood specimens to the
laboratory to prepare for testing.
Phlebotomy Technician
• Works directly with patient
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Important responsibility of collecting
blood specimens from patients
• Accurate and excellent communicators
• Committed to quality healthcare delivery
• Interacts with all members of the healthcare
team
Duties of the Phlebotomist
•Correct identification of the patient before
sample collection.
•Collection of the appropriate amount of blood
by venipuncture, for the specified tests.
•Collection of arterial blood specimens
•Process specimens for laboratory testing
•Performing point of care laboratory tests.
•Assist the physician in bone marrow
aspiration procedures.
PROCEDURE
Think, Action & Rationale!
At every step
know:
WHAT are you doing?
WHY are you doing it?
CHECK PATIENT DETAILS
• Ask full Name, DOB, Gender and compare with blood
request form!
• Check blood form has been signed by the requesting
doctor
• If special requirements, check patient has complied,
e.g. fasting!
• Have you had blood taken before? (preferred vein)
Label blood bottle:
• Patient Name
• Identification Number (NHN)
• Date & Time …
• Document in patient record.
• Send to Pathology lab for analysis.
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Applying the Tourniquet
Position Tourniquet
Cross Left End
Over Right
Cleansing the Site
• Use aseptic
technique
– Use antiseptic
(70% alcohol pad)
– Use concentric
circles
– Begin at the site
and move outward
Performing the Venipuncture
• Reapply the
tourniquet
• Visually confirm
the site
• Anchor the vein
• Insert the needle
Correct Angle
Vein
Unsuccessful Venipuncture
Bevel on Lower
Vein Wall
Needle Rotated
Needle Inserted
Too Far
Needle Partially
Inserted
PROCEDURE for Capillary collection from a finger
Materials:
1.Lancet
2.Alcohol Pad
3.Biowipes or gauze pads
4.Microhematocrit tubes
5.Clay tube sealer (for use with micro-hematocrit
tubes)
6.Gloves
7.Bandage
8.Sharps container and trash can
Site Selection for Capillary Puncture
PROCEDURE for Capillary collection from a finger
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Identify self and purpose of visit.
Verify name and patient number by checking ID band or other form(s) of ID
Review request form(s).
Wash hands.
Put on gloves.
Position equipment in appropriate place close to patient.
Position the patient.
Select finger. Use the 3rd or 4th finger.
Warm the finger if cold. Massage gently 5 or 6 times from base to tip to aid blood
flow.
Clean the site with an alcohol prep. Allow to air dry.
Hold finger firmly with your thumb above and well away from the puncture
site. The puncture site should be halfway between the center of the ball of the finger
and its side.
Apply lancet to puncture site with firm pressure and activate the device.
PROCEDURE for
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Capillary collection from afinger
Wipe the first drop of blood away with a clean gauze.
Collect specimen by applying moderate pressure and scooping blood from cut into
the collection device.
Mix anticoagulated tubes during collection by shaking gently or flicking occasionally.
When collection is completed, apply clean gauze or cotton ball to the site and apply
pressure until the bleeding has stopped.
If using microtainer, remove the collection device from the microtainer and replace
the cap.
Invert to mix making sure that the bubble travels from top to bottom 2-3 times.
Apply a bandage when bleeding stops. DO NOT BANDAGE A PUNCTURE SITE THAT IS
STILL BLEEDING.
Before leaving the patient's side, correctly label tubes with appropriate information.
Discard used equipment properly.
Thank patient.
Remove gloves and wash hands
To Prevent Heamatoma!
• Puncture only the uppermost wall of the vein
• Ensure needle fully penetrates uppermost wall of the vein.
(Partial penetration may allow blood to leak)
• Remove tourniquet before removing needle (decreases pressure)
• Apply pressure to the puncture site
Order of Draw
The draw order for specimen tubes is as
follows:
1. Blood culture
2. Blue tube for coagulation (Sodium Citrate)
3. Red, No Gel
4. Gold SST (Plain tube w/gel and clot
activator additive)
5. Green and Dark Green (Heparin, with and
without gel)
6. Lavender (EDTA)
7. Gray (Oxalate/Fluoride)
Blood Draw
Order
1
2
3
4
5
6
7
8
9
Tube Color
Description
Color Varies
Light Blue
Red
Gold
Light Green
Dark Green
Lavender
Gray
Yellow
Blood Cultures
Sodium Citrate
Clot Activator
SST
Lithium Heparin
Sodium Heparin
EDTA
Sodium Flouride
ACD Solution
The acronym is Boys Love Ravishing Girls Like Dieters Love Greek Yogurt!
Boys – Blood Culture
Love – Light Blue
Ravishing – Red
Girls – Gold
Like – Light Green
Dieters – Dark green
Love – Lavender
Greek – Gray
Yogurt – Yellow
 Feel free to switch it up to make it easy to remember for YOU
Protect Yourself!
• Change gloves between patients.
• Disinfect the collection area to eliminate
the risk of contamination of equipment
with blood or body fluids for future use,
particularly if spillage or splashing of
blood occurred.
• Clean up spills with disinfectant.
• Procedure for disinfecting???
• Wash hands after removing gloves.
• Do not break, or recap needle.
(avoid accidental needle puncture or splashing of contents)
Protect Yourself!
• Avoid recapping needles and other
manipulations of used needles.
• If recapping is necessary, use one hand only to
avoid puncturing the hand holding the cap.
Waste Disposal
• Collect used sharps at the point of use in puncture
resistant and leak-proof sharps containers.
Waste management
• Seal sharps containers before
they are completely full for
transport to a secure area in
preparation for disposal.
• Manage waste in an efficient,
safe and environment-friendly
way to protect people from
voluntary
and
accidental
exposure to used equipment.
Protect Yourself!
• In Event of being pricked with needle:
– Remove and dispose of gloves.
– Squeeze puncture site to promote bleeding.
– Wash area well with soap and water.
– Record the patient’s name and ID number.
– Follow institution’s guidelines regarding treatment and
follow-up.
 Infectious Control Department
Patient Complications
• Allergic reactions
– Latex
– Alcohol
• Choking
• Syncope (fainting)
– Heavy perspiration, pale skin
– Shallow, fast breathing
– Weak, rapid pulse
– Unconsciousness
Patient Complications (cont.)
• Petechiae
– Small red spots on the
skin due to minute
hemorrhage
– May result if tourniquet
is left on too long
• Bleeding
• Hematoma
Hematoma
SUMMARY
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Tourniquet
Antiseptic wipe
Palpate
Insert
.... but be gentle!
• Don’t forget Safety and Communication.
Apply Your Knowledge
At what angle should the needle be inserted
when performing a venipuncture?
Answer: At a 15° to 30° angle.
Good Job!
Apply Your Knowledge
Why is it important to pull the plunger slowly
when drawing blood into a syringe?
Answer: A hard pull may cause small veins to
collapse or may cause hemolysis of the
specimen.
BRAVO!
Tutorial Questions – Principles of Blood collection
1. Name the different types of blood collection tubes used to collect blood
specimen
2. Indicate the anticoagulants/preservative used in each tube and their function.
3. What are the type of tests performed from each type of collection tube.
4. Name some of the complications that can arise in venepuncture and capillary
sampling?
5. What is bruising and hematoma?
6. Draw and label the three veins recommended for venipuncture
7. Draw and label parts of a needle and syringe
8. What are some of the trouble shooting for failed venipuncture?
Case Study
You are working in the blood collection room and you receive a request form stating
the following tests: UEC, FBS, FBC, ESR, LFTs, Coagulation profile, HBsAg, Hba1C.
Which specimen tubes and containers will be used for the above tests?