PHLEBOTOMY Chapter 6

ART OF COLLECTING BLOOD

Advanced Skills for Health Care Providers, Barbara Acello, Thomson Delmar, 2007

OBJECTIVES

Spell and define key termsList factors that effect the condition of

the veinsHow to select a vein for venipunctureHow to clean and puncture the skinExplain why standard precautions are

used during phlebotomy procedures, and list PPE to wear

OBJECTIVES CONTINUED.

• Explain the similarities and differences between the vacuum-tube and syringe and needle methods of drawing blood

• List 8 precautions to take regarding venipuncture site selections

• List two common complications of venipuncture

Objectives continued

Demonstrate how to:Apply a tourniquet, dilate a vein, and

perform a venipunctureCollect a specimen using the vacuum-tube

system, needle and syringe, and butterfly and syringe methods

KEY TERMS

Phlebotomy- collecting blood

Venipuncture- act of puncturing a vein with a needle

Thrombophlebitis- inflammation of a vein with blood clot formation

Lumen- inside diameter of the needle

Bevel- slant at the end of the needle

Key Terms

Hemolysis- breaking of fragil blood cellsVacutainer- vacuum tube with a needle

attachedButterfly- winged infusion needleKelly Clamp- curved clamp with teeth

Key Terms

Hematoma - blood filled bruise caused by a broken blood vessel

Anticoagulants - blood thinning medications

Antecubital space - area in front of elbowto separate liquids from solids within the tubes

Key Terms

Septicemia- systemic infection

Aerobic microbes- pathogens that can live only in the presence of oxygen

Anaerobic microbes - pathogens that live without oxygen

Phlebotomy

Phlebotomy means collecting bloodVenipuncture is the act of puncturing a

vein with a needleBefore performing this procedure, check the requisition slip and make sure you understand the procedure you will be using. Gather all necessary equipment or supplies in advance.

Phlebotomy continued

To perform venipuncture, you must first select a vein

• Age • Illness• Dehydration• Previous needle sticks

all affect the condition of the veins

Factors that affect condition of the veins

Age:• Young adults have many veins to choose

from

• Veins in the elderly are often limited; they may roll or break upon puncture

• Children may be difficult because they move during the procedure.

STANDARD PRECAUTIONS

Always apply the principles of standard

precautions when performing phlebotomy Most health care facilities require

workers to wear long-sleeved lab coats or

gowns when drawing blood which must be

fluid-resistant Always wear gloves and pull the cuffs of

your gloves over the cuffs of your sleeves

Risk of Contamination

The risk of contamination is

increased if you must transfer

blood from one container to

another, such as a syringe to a

test tube.

HOW TO CLEAN AND PUNCTURE THE SKIN

Clean the site with alcohol in a circular motion

Allow alcohol to dry Reapply the tourniquet without touching

prepped area Insert needle with bevel facing up Hold skin taunt below prep site Insert needle at a 15 degree angle, And

advance slowly

HOW TO SELECT A VEIN FOR VENIPUNCTURE

• Veins in the forearm (antecubital space) are usually larger and straighter than those in other areas; this is the most common site for adults.

• If unable to find one in the forearm you could use veins in the hand

HOW TO SELECT A VEIN FOR VENIPUNCTURE (continued)

• You must be able to see or feel a vein

• A good vein will feel springy, and stand out when the tourniquet is tightened

Locating a Vein

Vacutainer

Biohazard Container

Blood Collecting Tubes

Methods of Drawing Blood

Tourniquet

• The tourniquet causes the veins to fill with blood

• Apply the tourniquet tightly enough to make the veins stand out

PRECAUTIONS TO TAKE

1) An arm with an IV2) An infected or edematous area3) Area with a rash4) Extremity with a shunt, graft, or dialysis

device5) Affected arm of a stroke6) Side of a mastectomy7) Site of previous injury or hematoma8) Burned or scarred area

COMPLICATIONS OF VENIPUNCTURE

1) Hematoma most common complication

2) Bleeding from the site

3) Ecchymosis- bruise

4) Signs and symptoms of phlebitis

5) Signs and symptoms of generalized infection

6) Signs and symptoms of air embolis