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Venipuncture AKA: Phlebotomy The Practice of Drawing Blood Objectives Learn phlebotomy terminology Understand the art of phlebotomy (venipuncture) Learn some ... – PowerPoint PPT presentation

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Title: Venipuncture

  • AKA Phlebotomy
  • The Practice of Drawing Blood

  • Learn phlebotomy terminology
  • Understand the art of phlebotomy (venipuncture)
  • Learn some interesting facts about how phlebotomy
    got its start
  • Understand order of draw
  • Understand capillary draws

The humors
  • Blood, phlegm, yellow bile, black bile
  • The foundation of med tx was (at one time) to
    keep the biles balanced by bloodletting, purging,
    starving, vomiting
  • Bloodletting was flourishing by middle ages

Barbers (??) Surgeons
  • Barbers and surgeons performed bloodletting
  • Barber pole red stripes represented blood,
    white represented tourniquet, pole represented
    the stick the pt squeezed during bloodletting

  • It was thought that blood was the carrier of
    disease, and by letting blood out it would be
    replaced by new, healthy blood. So 1 to 4 pints
    of blood was removed from the patient
  • It is believed that bloodletting killed George
    Washington. He had a throat infection that was
    thought would be cured by bloodletting
  • By end of 19th century bloodletting declared

Bloodletting today
  • Modern phlebotomy is used for diagnosis, and
    monitoring pts condition
  • Highly developed pt safety, comfort are
  • MAs are trained, and may be certified or
    licensed as phlebotomists, but that is not
    required in Oregon
  • Certification requires course work and training
    at accredited institution, passing national exam

  • Venipuncture most common method of obtaining
    blood taken directly from superficial vein
  • Vein is punctured by needle, and blood is
    collected in syringe or stoppered tube
  • Takes a lot to become skilled and confident

Venipuncture Equipment
  • Chair w/locking arm to catch pt who faints during
    blood draw
  • Double pointed safety needles usually 21g
  • Evacuated stoppered tubes
  • Needle/tube holder (vacutainer holder)
  • Syringes
  • Butterfly needles
  • Sharps container
  • Tourniquet
  • Marking pen
  • Alcohol swabs
  • Gauze pads
  • Tape and cotton balls
  • Gloves

Vacutainer Tubes
  • Stoppered tubes vacutainers, evacuated
    collection tubes
  • Most common system includes tubes of various
    sizes, with color-coded tops indicating tubes
  • Tubes all have additives except the red one
  • Additives include anticoagulants, clot
    activators, and thixotropic gels
  • Each test requires specific tubes usually with
    specific additives

More about tubes
  • Each tube has vacuum the larger the tube, the
    greater the vacuum
  • Each test requires specific amt of blood, the
    size of vacuum tube used depends on amount of
    specimen required for the test
  • Example a red top contains 10ml, to draw a pint
    would require 40-50 tubes

Tubes continued
  • Tubes may be glass or plastic
  • Additives
  • Powder or liquid additives are visible in the
  • liquid might be sprayed on interior of tube
  • Red top has no additive
  • Anticoagulants additives are to prevent blood
    clotting, and might be in lgt blue, lavender,
    grey, green, dark blue, or pink tubes

Tubes continued
  • SST tubes contain a coagulant additive (clot
    activator) and gel for serum separation
  • SST tubes need to be centrifuged to separate
    serum from RBCs
  • Other special tubes contain coags

Draw Order
  • First - blood culture bottle or tube (yellow or
    yellow-black top)
  • Second - coagulation tube (light blue top)
  • Third - non-additive tube (red top)

Draw Order continued
  • Last draw - additive tubes in this order
  • SST (red-gray or gold top). Contains a gel
    separator and clot activator.
  • Sodium heparin (dark green top)
  • PST (light green top). Contains lithium heparin
    anticoagulant and a gel separator (centrifuge)
  • EDTA (lavender top)
  • ACDA or ACDB (pale yellow top). Contains acid
    citrate dextrose.
  • Oxalate/fluoride (light gray top)

Invert your tubes to mix
  • NOTE Tubes with additives must be thoroughly
    mixed. Erroneous test results may be obtained
    when the blood is not thoroughly mixed with the

The Needles
  • Routine venipuncture uses 21g
  • Smallest are butterflies or 23g used for fragile
    and small veins
  • For typical blood draw a multisample (double
    pointed) needle is used. One ends punctures the
    skin, the other end punctures the rubber stopper
  • Use a larger lumen needle to prevent blood from
    hemolyzing (destruction of RBCs)

Syringe Draws
  • Syringe used when concern that the strong
    vacuum in the vacutainer will cause the vein to
    collapse because it draws out too rapidly we
    will do three of these small veins are most
    likely to collapse

  • Apply to prevent venous flow out of the site,
    making veins bulge
  • Different types, but NOT using latex these days
  • Placement about 3-4 inches above the AC area
  • Leaving on over 2 minutes can alter the test
    results One minute is recommended limit

  • Can also tie on wrist for hand draw and on ankle
    for foot draw (dont go there)
  • Make sure tourniquet lies flat on arm
  • Place over clothes when possible
  • Clean between uses

Tourniquet Practice
  • Do not use alcohol to cleanse before blood
    alcohol testing
  • For blood culture tests use povidone iodine
    (betadine) to cleanse site
  • Cleanse venipuncture site before using w/alcohol
    prep pads Clean in circular motion inner to outer
  • Alcohol does not sterilize the skin, but inhibits
    the reproduction of bacteria

Routine venipuncture
  • Veins in forearm or inner elbow (Antecubital/AC
  • The median cephalic vein is considered to be the
    best vein to use for venipuncture
  • Inspect both arms
  • Do not use scarred, bruised, burned skin, or
    areas that are more painful to pt. A scarred
    vein will feel stiff and hard and maybe lumpy

Venipuncture Steps see Steps PPRemember this
  • Remember to apply traction by applying firm
    pressure below the vein to help keep it from
  • Insert needle at 15-30 degree angle, bevel up
    if you go in at less than 15 degrees the needle
    may enter above the vein and not puncture it

  • Cover the needle w/the safety device and dispose
    in sharps
  • Disposing of a needle in a biohazard bag is a
    violation of OSHA standards

Capillary puncture
  • Collect capillary blood specimen when only a
    small amount is needed
  • Reasons to use older pts, peds
  • Point of care testing like glucose,
    cholesterol, coumadin
  • Lastly filter paper like PKU for infants
  • Lancet tool for capillary puncture spring
    loaded puncturing device with a sharp tip
    always discard in sharps container

Capillary Collection containers
  • Microtainer tubes color-coded like vacutainer
    tubes called unopettes
  • Capillary tubes fill without need for suction
    red band signifies heparin anticoagulant used
    for microhematocrit testing

Suggested Sites for Cap Specimens
  • Infant, plantar surface of the heel, R or L side
  • Middle and ring fingers at
  • the sides of the tip (NOT
  • the index
  • finger)

Patient Prep
  • Cleanse site well pt should wash hands prior if
    they are noticeably dirty
  • If hands are cold, warm them by rubbing or with
    warm water
  • Puncture dermis
  • Wipe away 1st drop
  • Grasp finger firmly but dont milk it as that can
    affect results

Chain of custody
  • Evidence in legal proceedings/job testing
  • Chain of custody legal term -the ability to
    guarantee the identity and integrity of specimen
    from collection to reporting results of test
  • Collection kit - has tube, needle or urine cup,
    chain of custody forms and seals, antiseptic, and
    tourniquet you are required to sign
    off/initial, date, and add required information

The End
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