Phlebotomy is the act of drawing blood from the body. This is a specialized skill.

It is important that anyone performing a phlebotomy understands the proper technique in order to be safe.

Verify the order Appropriate equipment Patient identification Site Selection Obtain specimen

Aseptic technique Correct order of draw for multiple tube phlebotomy Correct amount of blood in the correct tubes

Proper labeling and mixing of samples. Send the samples to lab for analysis. Provide safety and comfort to the patient
An alert, lucid patient always has the right to refuse phlebotomy. If so, document the refusal in the nurses notes.

Follow proper infection control procedures

Before obtaining a specimen from a patient always double-check the Doctor's orders. Check for duplicate orders. Verify order with physician if it is unclear.

Gloves Tourniquet A needle Correct tubes for the tests you need to draw Alcohol Gauze and a bandage or tape.
You should be absolutely certain there is a sharps container close by for disposal of your needle and you should always have extra supplies nearby in case you drop something or find something that is not usable.

Follow the Joint Commission National Patient Safety Goal on using two patient identifiers
1. Verify the patient first and last name or have family confirm 2. Compare Hospital Number on ID band with chart 3. Ask for date of birth

All inpatients must be wearing their hospital bracelet before any laboratory specimens are obtained.

rights

Right patient Right orders Right specimen/container/tube Right date, time & initials/collection site Right label affixed at the bedside

Once you have properly identified your patient and arranged your supplies, you will be ready to begin the phlebotomy. You should first make sure your patient is comfortable. Introduce yourself and explain what you are going to do. Ask patient if has ever had problems with a phlebotomy before. Encourage to ask questions and advise to tell you if becomes uncomfortable at any point in the process.

Two best sites in antecubital

fossa area (AC) Medial Cubital vein-medial aspect of AC fossa Basilic vein-slightly lateral and slightly more painful

Other locations:
Hands Forearms

Avoid mastectomy arms Avoid veins above IV infusions Avoid veins that are red, irritated, bruised, painful Do not use veins in a dialysis arm

Ask the patient where they would like lab drawn or their best site (if possible) Dr. Order required for Adult foot phlebotomy Is there a treatment room available for pedi phlebotomy?

Assemble supplies and put on your gloves

Place a tourniquet on the patient's arm and identify the vein you will use. Clean the area with the appropriate antiseptic for the patient and the test ordered.
Tell the patient they might feel a slight pinch before you pierce the skin.

Quickly draw the correct tubes needed for all tests. Loosen the tourniquet and withdraw the needle while simultaneously placing gentle pressure on the needle site with gauze. Hold pressure on the site for a minute or so and then bandage

Standard Precautions- this protects the healthcare worker from exposure Safe Sharps are everybodys responsibility
NO recapping! Needle covers Push button devices Blood transfer devices

Order of draw What tubes do I use? How much do I need for each tube? Does it need to be on ice? Fasting specimen? Peak or trough? Blood bank? Blood cultures?

Order of Draw
Blood culture

Lt. Blue

Serum tubes (red) ( gold, tiger top)

Green Lavender Gray

Bacterial growth medium and activated charcoal When a culture is ordered along with any other blood work, the blood cultures MUST be drawn first.

Should be first in order of draw

Choose and Prep site

Usually drawn from two different sites

Fill Aerobic bottle first with 5 ml Fill Anaerobic bottle second with 5 ml.
Then repeat from second site

See notes for labeling

Second in order of draw

ID Patient!
NO Armband = NO Specimen Drawn!!

Use plain red top, glass tube, 10 mLs required Mislabeled/Incomplete T&C tubes will be discarded- NO exceptions! Draw lavender top tube also, if possible

Red top without gel (red top)

Uses:
Must be used for drug levels ABO typing Antibody Screen Type and Screen (T&S) Crossmatch or Type and Cross (T&C) Rh Immune Globulin Antibody Titer Antigen Typing

Gold or Red tiger top

Gel separator and clot activator
Usually referred to as serum separator tube. After centrifugation, the gel forms a barrier between the clot and the serum.

Uses:
Chemistries (CMP, BMP, lipids, liver function tests, etc.)

Light Blue top

Has additive of Sodium Citrate which is an anticoagulant which binds calcium in the blood. So that the blood cannot clot resulting in a whole blood sample, red blood cells and plasma.

Routine coagulation tests include:

Prothrombin Time (PT) Partial Thromboplastin Time (PTT) Thrombin Time (TT) Fibrinogen

Light green top / Heparin tubes

The interior of the tube wall is coated with heparin which activates antithrombins, thus blocking the coagulation cascade and producing a whole blood / plasma sample instead of clotted blood plus serum.

Uses:
Electrolytes Glucose Protein electrophoresis, Lipid panels Hepatic function tests

Lavendar top
interior of the tube wall is coated with either EDTA, blocking the coagulation cascade

Uses:
CBC Hemoglobin / Hematocrit WBC count / RBC count Platelet Count Reticulocyte count / Eosinophil count ESR Sickle cell test

Gray top - Glycolytic inhibitor

Has additive of Potassium Oxalate and Sodium Fluoride used for tests requiring plasma or whole blood chemistry procedures where glycolytic inhibition of specimen is required. The antiglycolytic properties prevent the blood cells from using the glucose in the sample.

Uses:
Glucose tolerance test

At the bedside, label specimens properly with patient name, patient ID#, date, time, and your initials. Use pre-printed labels whenever possible. Do not pre-label tubes before you draw the blood. Send remaining labels back to the laboratory with specimen.

What? Hand PRINT appropriate pt info on band

last name, first name medical record number Phlebotomist initials, date and time

Use ball point pen ink NOT gel Press firmly Blood band expires after 72 hours

Place specimen in biohazard bag and deliver to lab by padded pneumatic tube or by hand. Chill specimen if required (eg. Ammonia or Lactic Acid)

Hemolysis

Usually caused by mechanical trauma Avoid shaking or dropping the tube Cells are broken down and release their contents into the blood plasma Potassium level is a common lab that cannot be obtained from a hemolysed specimen

Bleeding Bruising Infection

 What Peak

What is a peak and trough or is it a Trough and peak?

drug?

Trough