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Review of Phlebotomy and
Laboratory Requirements
Janet Vincent, MS, SBB(ASCP)
Education Coordinator
Department of Pathology
Phlebotomy!
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One of the most often remembered experiences
 One of the least trained fields in all of medicine
 One question on the Press Gainey survey that
relates to the Laboratory.
What is the most important step
in drawing a blood sample?
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Universal Precautions
Not hurting the patient
Wearing gloves
Getting the right tube of blood
Something else?
The most important step in
drawing a blood sample:
 Patient
Identification!
 Second?
• Labeling the specimen CORRECTLY
Steps in the process
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Introduce yourself and
explain procedure
Patient Identification
Tie the tourniquet
Search for a vein
Prepare the site
Draw the correct tubes, in the correct order
Invert the tubes
Remove the tourniquet and needle.
Apply pressure to site
The supplies
Tourniquet, alcohol,
gauze, gloves, tube,
needle and holder
ID Patient, look for a vein, cleanse
site
Anchor vein, perform venipuncture
Angle of draw is
0
15-30
Remove Tourniquet
Label the tube!!!!
Things you should not do!
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Do not leave the Tourniquet on longer than 2
minutes.
Do not leave the tourniquet on when you are
removing the needle
Do not perform the venipuncture while the
alcohol is still wet
Do not leave the tube on the back of the needle
when removing the needle from the arm
Do not enter the vein slowly.
To prevent a hematoma:
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Puncture only the uppermost wall of the vein
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Remove the tourniquet before removing the
needle
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Use the major superficial veins
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Make sure the needle fully penetrates the upper
most wall of the vein. (Partial penetration may
allow blood to leak into the soft tissue
surrounding the vein by way of the needle bevel)
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Apply pressure to the venipuncture site
Hemotoma
To prevent hemolysis

Mix tubes with anticoagulant
additives gently 5-10 times
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Avoid drawing blood from a hematoma
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When using a needle and syringe, draw the
plunger back gently to avoid frothing of the
sample
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Make sure the venipucture site is dry
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Avoid a probing, traumatic venipucture
Hemoconcentration:
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Prolonged tourniquet
application
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Massaging, squeezing,
or probing a site
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Long-term IV therapy
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Sclerosed or occluded
veins
IF AN INCOMPLETE COLLECTION
OR NO BLOOD IS OBTAINED:
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Change the position of the needle.
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Loosen the tourniquet. It may be obstructing
blood flow.
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Try another tube. There may be no vacuum in
the one being used.
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Re-anchor the vein. Veins sometimes roll
away from the point of the needle and
puncture site.
IF BLOOD STOPS FLOWING
INTO THE TUBE:
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The vein may have collapsed
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The needle may have pulled out of the vein when
switching tubes
PROBLEMS OTHER THAN AN
INCOMPLETE COLLECTION:
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A hematoma forms under the skin adjacent
to the puncture site - release the tourniquet
immediately and withdraw the needle. Apply
firm pressure.
Order of Draw
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Cultures FIRST
Red top tube
Blue
SST
lavender, green, gray
Hint: Always draw
additive tubes last.
The Blue Top Tube Problem
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Must never be drawn first when
using a vacutainer or butterfly
set up
 Must be filled to the required
amount
 Must be welled mixed - no
clots.
Completing the Requisition
A. Requesting Physician name and ID number
B. Diagnosis Code
C. Patient Name and Number
D. Collected by and date and time
A
B
D
C
Completing the Requisition
A. Information on the tube of blood
B. The number identify tube with request form
A
B
Suggestions
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Internet Sites
• http://www.vh.org/Providers/CME/CLIA/
Phlebotomy/Phlebotomy.html
• http://www.phlebotomy.com/
• http://www.utmb.edu/lsg
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Ask for help!