Assisting in Phlebotomy
Chapter 52
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Phlebotomy
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The practice of drawing blood.
The most common method of obtaining blood is by
venipuncture.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 2
Venipuncture Equipment
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Gloves:
– Glove use during venipuncture is mandated by OSHA.
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Tourniquet
– Prevents venous flow out of the site, causing veins to bulge.
– Makes veins easier to locate and puncture.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
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Venipuncture Equipment (cont’d)
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
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Venipuncture Equipment

Tourniquet
– Prevents venous flow out of the site, causing veins to bulge.
– Makes veins easier to locate and puncture.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
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Venipuncture Equipment
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Antiseptics
– The most commonly used is 70% isopropyl alcohol, also known
as rubbing alcohol.
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Evacuated collection tubes
– Consists of evacuated tubes of various sizes, with color-coded
tops indicating tube contents (Table 52-1).
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
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Tube Additives
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Red-topped tube
– No additive
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Ethylenediaminetetraacetic acid (EDTA)
– Lavender-topped tube
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Thixotropic gel
–
SST and the PST green-gray marbled topped tubes by BectonDickinson
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
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Order of Collection
Order applies to the filling of tubes when blood is collected
in a syringe.
1. Blood culture tubes.
2. Red-topped tubes.
3. Light blue-topped tubes with sodium citrate.
4. Serum tubes without (red stopper) or with (red-gold or speckle
stopper) clot-activator.
5. Green-topped tubes.
6. Lavender-topped tubes follow.
7. Red/gray marble-topped tubes are next.
8. Gray-topped tube.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
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Needles
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The venipuncture needle has a shaft with one end cut at
an angle (bevel).
The other end attaches to the syringe or to an adaptor
(hub).
Gauge is designated by a numeric value.
– The higher the number, the smaller the lumen.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
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Syringes
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Used when there is concern that the strong vacuum in a
stoppered tube will collapse the vein.
The syringe needle fits on the end of the barrel and
comes in different gauges.
It must be transferred immediately to another tube
because the blood will clot in the syringe barrel.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
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BD Vacutainer Blood Transfer Device
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
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Winged Infusion Sets
(Butterfly Needles)



Designed for use on small veins such as those in the
hand or in pediatric patients.
Needle size is 23 gauge.
Needle is ½ to ¾ inch long with a plastic, flexible
butterfly-shaped grip attached to a short length of
tubing.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 12
Winged Infusion Set
(Butterfly Needle) (cont’d)
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
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Needle Holders
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Translucent cylinders.
Cylinders have a ring that indicates how far the tube can
be pushed onto the needle without losing the vacuum.
Needles are not removed from the needle holder, and
the safety feature must be activated before disposal.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
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Needle Safety
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Never recap a needle.

Use safety needles and shields.
– Self-sheathing safety devices
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Needle Safety
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Retractable safety device
– Needle blunting SESIP for the needle holder
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Needle Safety

Needle blunting SESIP for winged infusion sets
– Hinged or sliding safety SESIP
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
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Needle Safety
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Postexposure management of needlesticks

Care of the exposure site
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Evaluation of the exposure

Follow-up care and testing
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
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Routine Venipuncture

Prepare the patient

Prepare for the venipuncture

Perform the venipuncture

Complete the procedure
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
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Problems Associated with Venipuncture
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Failure to obtain blood
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Hematoma

Syncope
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Refer to Table 52-4
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Specimen Recollection
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Unlabeled or mislabeled specimen
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Quantity not sufficient
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Defective tube

Incorrect tube used for test ordered

Hemolysis

Clotted blood in an anticoagulated specimen

Improper handling
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
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Capillary Puncture
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Patients at risk for venous
thrombosis

Patients who require
frequent glucose monitoring
Patients who are severely
dehydrated

Tests that require a small
volume of blood
Patients with burns or scars
in venipuncture sites

Older patients
Pediatric patients (especially
under the age of 2 years)
Obese patients
When venous blood and
capillary blood are not
identical
Patients receiving
intravenous therapy
Patients who have had a
mastectomy
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
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Equipment

Skin puncture device
– Lancet
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Equipment

Collection containers
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Equipment
– Unopette system
– Manufacturers also provide various collection devices designed
to obtain small quantities of blood for “point-of-care” testing for
such analytes as glucose, hemoglobin A1c, and cholesterol
– Paper cards
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Capillary Puncture

Site selection

Patient preparation

Collection of the specimen

Specimen handling
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 26
Patient Education
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The medical assistant must maintain a professional
attitude and still be sympathetic to the fears and
apprehensions of the patient.
Use the patient’s suggestion in choosing the site for the
removal of a blood specimen.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
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