Basic Principles of Phlebotomy Part IV: The Patient, Collection Site and Problems with Collection Sites

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Basic Principles of Phlebotomy Part IVThe
Patient, Collection Site and Problems with
Collection Sites

• CLS 424 Phlebotomy
• Student Lab Rotation

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The Patient

• Approach
• Communication
• Empathy
• Handling special situations
• Patient identification
• Arm band
• Legal document
• Prepare patient for blood draw
• Latex allergy?

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Selecting the Site

• Antecubital area most often accessed
• Hand or wrist
• Remember 2 arms
• Use tip of index finger on non-dominant hand to
  palpate area to feel for the vein

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Collection Site Problems

• Veins that lack
• resiliency
• Extensive
• scarring
• Hematomas
• Edematous
• area
• Side of mastectomy

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Collection Site Problems

• Intravenous line
• NEVER draw above an IV
• Draw from other arm
• Draw from hand
• on other arm
• Draw below the IV

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Draw Below IV site
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Collection Site Problems

• Indwelling lines
• Hickman catheters
• Heparin locks
• Used to administer medication
• Only nurse may access these lines
• Can obtain blood called a line draw
• Must clear line of heparin contamination by
  discarding first 5-10 cc of blood

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Hickman Catheter
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Inserting the Needle

• Anchor the vein
• Grasp arm with your non-dominant hand
• Use thumb to pull skin taut
• Smoothly and confidently insert the needle bevel
  up
• 15-30 degree angle

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No Needle Movement!

• You must anchor the blood-drawing equipment on
  the patients arm to minimize chance of injury

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Fill Tubes

• Use correct order of draw
• Blood cultures
• Red top
• Blue (baby blue)
• Green
• Purple
• Grey

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Be careful not to

• Push needle further into vein when engaging
  evacuated tube
• Pull needle out of vein when disengaging tube
• Pull needle out of vein as you pull back on the
  plunger
• Pull up or press down when needle in vein
• Forget to mix additive tubes 8-10 times

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Withdraw Needle

• First release tourniquet
• Disengage tube
• Place cotton directly over needle, without
  pressing down
• Withdraw needle in swift, smooth motion
• Immediately apply pressure to wound
• Do not bend arm

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Label Tubes Immediately

• In sight of patient
• Patient name
• Identification number
• Date of draw
• Time of draw
• (military time)
• Your initials

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Recheck Draw Site
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Failure to Obtain Blood

• Check tube position and vacuum
• Always have back up tubes near by
• Needle position
• Collapsed vein

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Needle Position
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You should try again

• Look at alternate site
• Other arm
• Hand
• Use clean needle
• Use fresh syringe if contaminated
• Only try twice

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Poor Collection Techniques

• Venous stasis
• Prolonged application of tourniquet (gt1 min)
• Hemodilution
• Drawing above IV
• Short draw (blood to anticoagulant ratio)
• Hemolysis
• Traumatic stick
• Too vigorous mixing
• Alcohol still wet
• Using too small of needle
• Forcing blood into syringe

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Poor Collection Techniques

• Clotted sample
• Inadequate mixing
• Traumatic stick
• Partially filled tubes
• Short draw
• Sodium citrate tube draw volume critical
• Using wrong anticoagulant

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Poor Collection Techniques

• Specimen contamination
• Using incorrect cleanser
• Alcohol still wet
• Powder from gloves
• Drawing above IV
• Specimen handling
• Exposure to light
• Pre-chilled tube
• Body temperature