Phlebotomy
By
Mrs. Saliu
Phlebotomy
Standard Practices
Using Vacuum Collection Set
Wash Hands (before and after the
procedure) and Wear New Gloves
Label tube with the client identification
number
Put tourniquet on client about 3-4” above
venipuncture site
Have client form a fist so veins are
more prominent
After palpating the path of the vein, clean
the venipuncture site with alcohol using a
circular motion. Allow the area to dry
Assemble needle and vacuum tube
holder
Insert the collection tube into the holder
until the tube reaches the needle
Remove cap from needle
Use your thumb to draw skin tight about 12” below the venipuncture site.
Hold skin tight
Insert the needle, bevel side up, into
the vein
Push the vacutainer tube completely onto
the needle. Blood should begin to flow
into the tube.
Release the tourniquet
Fill the tube until it is full or until
vacuum is exhausted.
After opening client’s hand, place
dry gauze over the venipuncture site
Apply mild pressure to the pad and
slowly remove the needle
Apply bandage or continue applying mild
pressure until bleeding has stopped
Collect Supplies;
New vacuum set (holder, needle and collection
tubes), new gloves, alcohol swab, sterile
gauge, tourniquet, sharp box and infectious
waste container
ORDER OF DRAW
Blood collection must be drawn in a specific order
to avoid cross contamination of anticoagulant.
The recommended order is
First draw – Blood culture tube (yellow-black
stopper)
Second draw – Plain tube (red stopper)
Third draw – Coagulation tube (light blue
stopper)
Last draw – Anticoagulated tube
 Red-grey, or gold stopper – gel separator and
clot
activator
ORDER OF DRAW
CONTD
Dark green stopper – sodium heparin.
Light green stopper – lithium heparin and
a gel separator.
Lavender stopper – Ethylene diamine tetra
acetic acid (EDTA)
Pale yellow stopper – acid citrate dextrose
Light gray stopper – oxalate fluoride
RED TOP
ADDITIVE: None
MODE OF ACTION: Blood clots, and the
serum is separated by centrifugation
USES: Chemistries, Immunology and
Serology, Blood Bank (Cross match)
LIGHT GREEN TOP
ADDITIVE: Plasma Separating Tube
(PST) with Lithium heparin
MODE OF ACTION: Anticoagulates with
lithium heparin; Plasma is separated with
PST gel at the bottom of the tube
 USES: Chemistries
PURPLE/LAVENDER TOP
ADDITIVE: EDTA liquid
 MODE OF ACTION: Forms calcium salts
to remove calcium
USES: Hematology (FBC) requires full
draw invert 8 times to prevent clotting and
platelet clumping
GOLD TOP
ADDITIVE: None
MODE OF ACTION: Serum separator
tube (SST) contains a gel at the bottom to
separate blood from serum on
centrifugation
USES: Chemistries, Immunology and
YELLOW TOP
ADDITIVE: ACD (acid-citrate-dextrose)
MODE OF ACTION: Complement
inactivation
USES: HLA tissue typing, paternity
testing, DNA studies
LIGHT GRAY TOP
ADDITIVES: Sodium fluoride and
potassium oxalate
MODE OF ACTION: Antiglycolytic agent,
preserves glucose up to 5 days
USES: Glucose requires full draw (may
cause hemolysis if short draw)
Venipuncture site selection
The larger and fuller median cubital and
cephalic veins of the arm are used most
frequently; wrist and hand veins are also
acceptable.
Sites for venipuncture
g
Site selection contd
Avoid these areas when choosing a site
Extensive scars from burns and surgery.
Hematoma
Intravenous therapy/ blood transfusion
Vein selection
Palpate and trace the path of veins with
the index finger.
Arteries pulsate, are more elastic than
vein and have thick wall.
Thrombosed veins lack resilience, feel
cord like and roll easily.
Performance of
venipuncture
Approach the patient in a friendly calm
manner.
Provide for their comfort as much as
possible.
Briefly explain the procedure to the patient
and assure him/her.
Gain the patient’s cooperation before
going ahead.
Performance contd
Verify the patient’s condition, e.g. fasting,
medication, timing etc.
Position the patient, can either sit in a
chair, lie down, or sit up in bed.
Hyperextend the patient’s arm.
Apply tourniquet 3 - 4 inches above the
puncture site.
Do not place too tightly or leave
tourniquet on the arm for more than 1 – 2
minutes.
Performance contd
The patient should make a fist without
pumping the hand.
Select the venipuncture site.
Prepare the patient' arm using alcohol
wipe.
Cleanse in a circular fashion, beginning at
the site and working outward. Allow to air
dry.
Grasp the patient’s arm firmly.
15º - 30º angle with the surface
of
the arm
Swiftly insert the needle through the skin
into the lumen of the vein with the bevel
side facing up.
Avoid trauma and excessive probing.
contd
When the last tube is about filling, remove
the tourniquet.
Remove the needle from the patient’s arm
using a swift backward motion when the
tube is filled
Press down the gauze once the needle is
out of the arm.
Apply adequate pressure to avoid
formation of a hematoma.
contd
Dispose of contaminated materials /
sharps in appropriate containers.
Dispose of needles immediately upon
removal from the patient’s vein.
Do not bend, break or re cap needles.
Mix by inversion and label all tubes at
patient’s side.
Deliver specimens promptly to the
laboratory.
LABELING SAMPLES
Properly labeled samples is essential so
that the results of the test match the
patient.
Key elements in labeling include
Patient’s surname, first name & middle
name.
Patient’s ID number/Hospital number.
Both of the above MUST match with the
request form.
An example of a properly labeled
tube
Do not recap. Dispose of all Parts in
a Sharp Container / Safety Box.
DO NOT reuse holder