Transcript vein - Highline Canvas

Phlebotomy: Venipuncture
Phlebotomy
 What does it mean?
 Process of collecting blood
 Dates back to ancient Egypt
 Bloodletting-”bad” blood
 Greek translation
 Phlebos- vein
 Tome –incision
Why collect blood?
 Diagnosis and treatment of disease
 Therapeutic purposes
 Blood donation
The Medical Assistant’s Role
 Perform venipuncture accurately and
efficiently
 Reliable test results
 Provide quality care
 Patient safety and confidentiality
 Phlebotomist safety (PPE)
Anatomy and Physiology of the Circulatory
System
 Blood forms in body’s organs and
bone marrow
 Blood carries oxygen and nutrients
to cells and removes waste products
and carbon dioxide
 (Review your terminology textbook Hematology and
Immunology)
Do you know?
The difference between an
artery and a vein?
Circulatory System Cont’d
Arteries and Veins
 Arteries
 Carry oxygenated
blood away from the
heart
 Pulse
 Thick walls
 No Valves
 Veins
 Carry deoxygenated
blood to the heart
 No pulse
 Thin elastic walls
 Valves
Circulatory System Cont’d
 Body contains about 6 liters of blood
 Forty-five percent of blood is formed elements
 Erythrocytes
 Leukocytes
 Thrombocytes (platelets)
 Two mL of blood will yield about 1 mL of fluid
 Liquid part of blood is plasma
Important Terms
 Fibrinogen –substance in blood Converted
by the blood clotting process to fibrin
 Fibrin- “sticky” web like substance –traps
the formed elements-result is a “blood clot”
 Serum- clear liquid portion of blood
extracted from the “blood clot” used for
many tests
Important Terms
 Anticoagulant-used to prevent blood
from clotting. Found in certain blood
tubes
 Buffy coat-layer separating plasma
from RB
 Centrifuge- machine which spins
blood separating the RBC from the
serum
Anatomy and Physiology
of the Circulatory System
 Centrifuge separates serum from blood
 Anticoagulant prevents blood from clotting to produce
plasma specimen
 Buffy coat
Phlebotomy Sites
 Order of Draw by sites
 Arm-Antecubital Space includes
Median cubital
 Cephalic
 Basilic

 Veins in hand
 Veins in feet
Preferred Sites in the arm
Arteries of Arm
 Note locations of arteries in the
arm. You DO NOT want to draw
from an artery
 Brachial
 Radial
 Ulnar
 How can you distinguish an artery from a
vein?
Venipuncture Methods
 There are three main methods of
drawing blood
 Vacuum Tube
 Syringe
 Butterfly
Evacuated Tube Method
 This method includes:
 Vacutainer tube
 Adapter
 Double-pointed Needle
 Features of this method are:
 Closed system - needle stick risk low
 Vacuum draws blood inside the tube
 Safety needles meet OSHA guidelines
Venipuncture Technique
 Butterfly collection system
 Combines benefits of syringe and vacuum methods
 Used for small or fragile veins that are difficult to draw
 Winged needle inserted at about 5° angle then threaded
into vein
 Syringe method
 Used for small or fragile veins
 Control flow
Venipuncture Equipment
 Safety needles
 Required
 Protects patient and health care worker
Equipment/Supplies Needed
 Physician order and Lab requisition form
 Pen –black ink
 Appropriate PPE (gloves, gown, goggles)
 Needle holder and Needle (varying sizes)
 Tubes –varying sizes and types used
More Equipment/Supplies
 Tourniquet or blood pressure cuff
 Constrict flow of blood in arm
 Make veins more prominent
 Alcohol or Betadine
 Cotton balls or gauze-(preferred)
 Bandages or tape
Order of draw
 Why? Prevent carryover or contamination - Order may
vary between laboratories.
 Basic order:
 Sterile- sterile specimens
 Light blue-sodium citrate
 Red or plain tubes no additives or gel
 SST –Serum separator tube (Red/Gray, Yellow)
 Green –heparin
 Lavender-EDTA
 Gray –oxalate-fluoride
Venipuncture Equipment
 Additives, anticoagulants, and gels
 Thixotropic separator gel >>
 Separator gel tube: centrifuging process
 Glass particles activate clotting
Venipuncture Equipment
 Specimen collection trays
 Hold all equipment necessary
 Carts also used
Venipuncture Technique
 A Phlebotomist needs to use all these skills:
 Technical skills


Prepare for the draw-equipment (spare tubes)
Positioning the patient
 Administrative skills
 Note order-required tests and
 Complete the lab requisition
 Social skills
 Small talk (weather, pets, entertainment)
 Good Therapeutic Communication
 Assess patient comfort level
 Put patient at ease-show confidence
 Ask about past experiences
Preparing the patient
 Identify yourself and explain the procedure
 Properly Identify your patient ask them to:
 State their name and date of birth

For non-English speaking photo ID
 Note fasting or non-fasting
 Ask patient about allergies
 Taking blood thinners
 Past Experiences
Remember to
Wash your hands
The Draw
 Position your patient for safety:
 sit
 lie down
 (note past history of fainting or loss of consciousness)
 Select the appropriate site and vein free of:
 Scars
 Hematomas
 A Pulse
The Draw Cont’d
 Find site that will give best blood return
(remember the location order)
 Palpate vein with tip of finger
 Differentiating between veins, tendons,
and nerves
 Use the tourniquet appropriately

Proper Tourniquet Technique
 To prevent inaccurate blood test results-do
not leave on longer than one minute
 Tourniquet may be applied over clothing for
patient comfort
 Remove tourniquet when blood flow is
achieved or prior to inserting last tube
 Always remove tourniquet prior to removing
needle
Proper completion of draw
 Remove tourniquet
 Remove needle and apply safety device while Applying
pressure to site (patient can assist)
 Bandage appropriately
 Tend to the safety of your patient
 Label specimen tubes in front of patient
Venipuncture Technique
 Patient and specimen
identification
 Computer label >>
 Compare lab requisition
with patients information
Important Tips
 Do Not draw from a resistant patient
 Do Not draw if you are not comfortable
 Uncooperative children must receive special
care and be restrained for safety
 Note Patient reactions, stop if patient
complains of pain-assess patient
Venipuncture Technique
 The unsuccessful venipuncture
 Reposition tube and needle
Rotate needle Advance further into vein
 Try another tube-maybe the tube is
defective
 If you haven’t succeeded in getting blood
after 2 tries ask someone else to try

Venipuncture Technique
 Factors affecting laboratory values
 Incorrect specimen handling and storage
 Drawing procedure incorrect
Alcohol in specimen
 Tourniquet on too long
 Wrong tube
 Tubes not filled to appropriate levels will cause
inaccurate test results

Patient Factors Affecting Lab Results
 Blood Alcohol-elevate
 Hemolysis-destroys RBC’s
results
 Diurnal rhythm-RX or daily
activity level
 Exercise-runner’s anemia,
change results
 Fasting (not)-inaccurate
results
 Heparin-incorrect use
interferes with results
 Stress-Increase in WBC’s
 Tourniquet on too longdilution hemoconcentration
Challenging Patients
 Pediatric
 The child, parents or guardians
 Approach-explain –get down to their level
 Resistant-restraints ?
 Geriatric
 Physical-skin, hearing or vision impaired
 Effects of disease-stroke, arthritis, Parkinson’s –tremors,
 Dementia-Alzheimer's
 Safety issues-wheelchairs, balance
More Challenges
 Dialysis or Cancer patients -fistulas and
shunts
 (AV-arteriovenous-permanent access for
dialysis)
 Long-Term Care patients, Home Care,
or Hospice Patients
 Traveling phlebotomists
Problem Sites
 Burns, Scars, Tattoos
 Damaged Veins (sclerosed-thrombosed)
 Edema-swelling due to abnormal
accumulation of fluid
 Hematoma-swelling or mass of blood
 Mastectomy-caution lymph node removal
 Obesity
Complications or Conditions
 Allergies-adhesive, antiseptic, latex
 Excessive bleeding due to medications, hemophilia
 Fainting
 Nausea and vomiting
 Pain while drawing-what is normal –what is NOTstopping the draw
 Seizures/Convulsions-stop draw immediately-get
help
 Comprehensive Medical Assisting 4th Edition
 Clinical Medical Assisting: A professional, Field
Smart Approach to the Workplace, Textbook and
Workbook
 Phlebotomy Essentials 4th Edition