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Phlebotomy - BASIC

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Dale Telgenhoff
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10 views32 pages

Phlebotomy - BASIC

Uploaded by

Dale Telgenhoff
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Introduction to Blood Collection

Laboratory Specimens
• Serum
• Plasma
• Whole Blood

• Type of test ordered determines the specimen


required
Non-anticoagulated Specimen Serum

• Red top - no anticoagulant, possible clot activator


• Gold/Tiger top – SST (serum separator tube) – has
clot activator AND serum separator gel.

• Blood will begin clotting process immediately


(requires about 10 minutes for complete clotting)
• Clot will retract, separating from clear serum if left
undisturbed
• Centrifuge and separate serum from cells within 30
minutes from draw time to maintain serum sample
integrity
Plasma & Whole Blood
• Anticoagulants - color-coded tubes
• Invert several times to mix
– Cells will fall to bottom of tube if left undisturbed,
separating from hazy, typically straw-colored
plasma)
• Centrifuge for plasma
Anticoagulants prevent clotting by:

• Precipitation of
calcium
• Binding/chelating
calcium
• Inhibiting thrombin
Common Anticoagulants & Color Codes of
Tubes
• Heparin—Green top—inhibits thrombin
formation; mucopolysaccharide, available as
Na, K, Li, NH4+ salt additive

Anticoagulant that interferes


least with chemical tests

Not suitable for hematology


slides—background stains
blue
Common Anticoagulants…
• EDTA—lavender top—chelates calcium; available as
sodium, potassium or lithium salt additive

• Used for hematology specimens—more than any other


anticoagulant in hematology
– Preserves cellular constituents
– Does not aggregate platelets
– Smears can be made within 2-3 hours
and cell counts up to 24 hours if refrigerated
Common Anticoagulants…
• Sodium citrate—light blue top—binds calcium

• Used for most coagulation testing


– Used as 1 part sodium citrate anticoagulant to 9
parts blood; must fill tube to completely with
vacuum draw to maintain ratio
Common Anticoagulants…
• Sodium fluoride—gray top—glycolytic
inhibitor as well as weak anticoagulant—may
be used with other anticoagulant additives
– Used for glucose preservation
– Inhibits some enzyme action; cannot be used in
certain procedures that use particular enzymes in
procedure
Common Anticoagulants…

• SPS—chelates calcium—used primarily for


blood cultures

• Has other properties desirable for blood


cultures
Other Blood Collection Tubes
• See text
Order of Draw
• Sterile/ Blood Culture specimens
• Coagulation (Light blue top)
• Tubes with no additives (Red top)
• Tubes with other additives
– SST
– Heparin
– EDTA
Blood Collection Systems
• Evacuated tube systems—preferred
• Syringe—primarily for blood cultures and difficult
draws
• Butterfly—usually 23 gauge needle attached to
tubing, which is attached to syringe or vacutainer
holder; good for young children
• Blood Bank collection systems
• Lancets for skin puncture—usually spring loaded and
have a controlled depth for cuts
SYRINGE DESCRIPTION
Performance of the Venipuncture
• Goal: Obtain (and
maintain) quality blood
specimen from patient with
as little discomfort as
possible, while preserving
veins in good condition and
availability

• Preferred veins: cephalic,


basilic, median cubital
• REQUIRED
– Evacuated Collection Tubes
– Needles - the larger the gauge number, the smaller the needle
bore
– Holder/Adapter - use with the evacuated collection system.
– Tourniquet - disposable.
– Alcohol Wipes - 70% isopropyl alcohol.
– Povidone-iodine wipes/swabs - Used if blood culture is to be
drawn.
– Gauze sponges - for application on the site from which the needle
is withdrawn.
– Adhesive bandages / tape - protects the venipuncture site after
collection.
– Gloves - can be made of latex, rubber, vinyl, etc.; worn to protect
the patient and the phlebotomist.
• Identify the patient.
• Assess the patient's physical disposition (i.e.
diet, exercise, stress, basal state).
• Check the requisition form for requested
tests, patient information, and any special
requirements.
• Select a suitable site for venipuncture.
• Prepare the equipment, the patient and the
puncture site.
• Perform the venipuncture.
• Collect the sample in the appropriate
container.
• Recognize complications associated with
the phlebotomy procedure.
• Assess the need for sample recollection
and/or rejection.
• Label the collection tubes at the bedside or
drawing area.
• Promptly send the specimens with the
requisition to the laboratory.
Pre-analytical errors
• 90% - Pre- and post-analytical errors

Errors at any stage of the collection, testing


and reporting process can potentially lead to a
serious patient misdiagnosis

Errors during the collection process are not


inevitable and can be prevented with a diligent
application of quality control, continuing
education and effective collection systems
Types of Collection Errors
• Patient Identification
• Phlebotomy Technique

• Test Collection Procedures

• Specimen Transport

• Specimen Processing
Problems…
• Difficult venipuncture:
– In vein, no blood specimen—bevel of needle may
be against vessel wall; pull needle back slightly or
rotate
– Vein rolled (always anchor below!)
– Don’t ‘dig’—will cause hematoma
– Small veins/ no veins: resort to fingerstick
– No palpable vein—(dehydration, etc. ?), call for
assistance
Problems…
• Patient with Mastectomy:

– If possible, do not take blood from arm on side of


the mastectomy
– If must be done, take utmost precaution and note
that blood was drawn from side of mastectomy
Problems…

• IV in Patient Arm:

– Use other arm


– If must use same arm, always draw below IV !!!
Problems…
• Fainting or Illness:

– May be a good idea to ask about fainting or


previous reaction to phlebotomy (?) Evaluate
demeanor of patient
– Patient should always be seated in an enclosed
chair or reclining in bed
HEMOLYZED SPECIMENS

 Appear pink-red
 Erythrocyte
destruction
ICTERIC SPECIMENS

 Appear dark
yellow
 Increased bilirubin
LIPEMIC SPECIMENS
 Appear milky
 Increased lipids
Error Prevention
• Phlebotomy Education
– Phlebotomists should have completed a standard academic course in
phlebotomy and undergo thorough on-the-job training under the
supervision of a senior phlebotomist
• Continuing Education
– Phlebotomists should participate in regular educational competency assessments
(written and observational)
– Professional Licensure

• Phlebotomy Staffing
– Adequate staffing to maintain collection standards
• Technology
– Use of barcode scanners for patient identification
Criteria for Rejection of Samples
• Inadequate sample identification
• Inadequate volume of blood collected into an
additive
• Use of an improper collection tube
• Hemolysis
• Improper transportation
• Interferents

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