blood collection

1. BLOOD COLLECTION BY
VENIPUNCTURE
By: Janeka Rose B. Java

2. • Blood is obtained from veins, arteries or
capillaries
• Venous blood- specimen of choice in
chemistry procedures (Venipuncture)
• Phlebotomy- process of collecting the
blood sample by a trained phlebotomist

3. • Samples that can be obtained after
collection:
– whole blood
– plasma or serum

4. VENIPUNCTURE
• procedure of inserting a needle into a vein
• purpose of withdrawing blood for
– haematological analysis
– biochemical analysis
– bacteriological analysis

5. SITE SELECTION

6. MEDICAL ETHICS
1.Professional appearance
personal cleanliness
good grooming
2.Professional attitude and interpersonal skills
3.Patient confidentiality

7. PROCEDURE
1.Patient greeting and identification
• conduct themselves in a professional manner
• be courteous and respectful
• introduce self and explain test/s ordered by
physician if patient is conscious
• let patient state his/her name and spell any
unusual name
• never ask yes/no questions

8. 2. Note patient-isolation restrictions
• for patients that have contagious conditions or
infections
• for patients that must be protected from
employees or visitors (immunosuppressed
patients)

9. 3. Note patient-dietary restrictions
• glucose is affected by diet so fasting is
required
• fasting should be done and for the right length
of time

10. 4. Reassure the patient
• collector's reassuring approach should be
calm but confident to relieve patient's anxiety
over the pain from the collection
• collector should be honest

11. 5. Position the patient
• patient position can affect analyte values
• erect posture increases concentration of
some analytes
• keep arm below shoulder level, extending
downward, keeping it straight (sitting)
• if lying down, patient should remain in his/her
back and extend arm fully outward the side
• pillow or patient's opposite fist can be used as
support

12. 6. Assemble supplies
• assemble sterile needle and syringe aseptically
• Gauge 20 and 21- forearm
• Gauge 23- wrist and ankle
• syringe depends on amount of blood required
• move plunger up and down attempting to force
air through the needle
*verify paperwork, select collection tubes and
venipuncture location

13. 7. Apply torniquet and ask patient to close
hand
• vein becomes more prominent
• never leave torniquet on arm for more than
two minutes
• tourniquet should be placed 3-4 inches above
puncture site

14. 8. Select venipuncture site
• inspect both arms to locate best veins
• use fingertips to gently press veins
- determine direction
- estimate size
• palpate to determine
• vein- pliable
• tendon or muscle- hard
• artery- pulsate

15. 9. Cleanse the site
• clean site with cotton moistened with 70%
ethyl alcohol by making outward concentric
circles
• air dry
*once the site it cleansed, it must not be touched; if
touched after cleaning, site must be cleansed again

16. 10. Inspect needle and syringe
• check for hooks or obstruction of opening the
tip
• pull plunger back and forth to ensure smooth
motion

17. 11. Anchor the vein
• place thumb 2-3cm below the puncture site
• pull the skin while grasping the arm with the
other four fingers

18. 12. Perform venipuncture
• inserting the needle
-hold syringe in the right hand
-grasp patient's arm with the left hand
-place thumb 2-3cm below the puncture site
-do not touch the sterile needle
-make sure bevel of the needle is facing upward
-insert needle with a quick steady motion through
the skin and into the vein

19. • withdrawing the blood
• exert gentle traction
-blood should flow freely, if not, needle must have
been pushed too far
-if blood cannot be obtained directly, withdraw the
needle
• apply pressure on the patient's arm
• withdraw blood gently to avoid frothing
-frothing can be minimized if plunger is rotated

20. 13. Release torniquet and ask patient to
open hand
• if desired amount is obtained, release
torniquet
• place sterile gauze or cotton to the site of
entry and withdraw the needle

21. 14. Remove needle and apply pressure
• apply pressure to the patient's arm to prevent
bleeding
• any bleeding will stop in 1-2 minutes

22. 15. Processing the collected sample
• slowly expel blood into the container
• tilt the container so that blood will run down
the side
• stop transfer when nothing but froth remains
in the syringe
• immediately remove plunger and place in
detergent/disinfectant solution
• label tubes
• patient's surname, first name, and middle
• date and time, and initials of phlebotomist
*automated systems may include labels with bar codes

23. ORDER OF DRAW
1. Yellow
• Citrate dextrose
• Blood culture
2. Blue
• Buffered citrate
• Coagulation assay (APTT & PT)
3. Red
• Non-additive tube
• Chemistry and serology

24. 4. Green
• Heparin
• Blood gas
5. Lavender
• EDTA
• Hematologic assays
6. Grey
• Sodium Fluoride & Potassium oxalate
• Glucose determination

25. AREAS TO AVOID
• Intravenous therapy
• Edematous area
• Burned, scarred areas
• Upper extremity on the side of previous
mastectomy
• Areas with hematoma

26. SOURCES OF ERROR
1. Improper patient identification
2. Failure to check patient adherence to dietary
restrictions
3. Use of improper equipment/tubes
4. Prolonged torniquet application
5. Failure to dry site after cleansing
6. Inserting needle with bevel down
7. Wrong insertion depth of needle
8. Venipuncture above the intravenous line

27. 9. Venipuncture in an unacceptable area
10. Incomplete tube filling
11. Vigorous shaking/hemolysis of specimens
12. Neglecting to release torniquet before
needle withdrawal
13. Mislabeling of tubes
14. Failure to put initials, date and time
15. Neglecting to chill specimens requiring
refrigeration
16. Slow transport of specimens to the
laboratory