2. It is a blood collection used an all labs to find
out why symptoms are appear in the
patient…
Phlebotomy(“to cut a vein” in Greek) is the
process of making incision in a vein.
A person who practices phlebotomy is termed
as phlebotomist.
3. Blood analysis is one of the most
important diagnostic tools
available to clinician within
healthcare. Its data is relied upon
in the clinical setting for
interpretation of clinical signs and
symptoms…
4. Requires social, clerical and technical skills
Phlebotomy is a link between the patient
and the laboratory
Apart of the healthcare team
5. To collect blood for accurate and
reliable test results
Accurate identification and
collection procedures are critical
Important procedure to assist in
the diagnosis and monitoring of
patients
6. SAMPLE COLLECTION
PATIENT PREPARATION PRIOR TO TEST
ESR : FASTING
Hb , TLC, DLC, PBF, RED CELL
INDICES, RETICULOCYTE COUNT , PLATELET
COUNT : NEED NOT FASTING
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7. Identify tests & Determine :
proper volume to be collected
*NOTE :
◦ ”.5ml serum/plasma”
◦ = 1ml of whole or un-centrifuged blood)
Determine proper procedure based upon
age and size of patient
Communicate with patient about previous
blood collection experiences
Collect proper patient identifiers, request
and equipment.
8.
9. OUTPATIENTS: Sitting in chair
INPATIENTS: lying in bed or sitting in chair
•Position check
list:
–There is no danger of the
patient falling
–There is easy access to
the arms
–The patient is comfortable
–There is adequate space
to place supplies within
reach
14. IV lines
Injuries
Presence of edema
Medication
Patient alertness
Patient emotional
and mental status
15.
16. Clean the selected pt. finger with spirit swab
Pick up sterile blood lancet with your right
hand.
With your left hand, firmly grasp the pt.
middle finger.
make deep stab on the ball of the finger.
Eliminate the first drop.
after that collect blood for require tests…..
17. Blood from capillary network can be used to perform
test for which only few drops of blood is required.
Capillary blood is not recommended for those tests
which require large amount of blood.
It is not used for platelet count.
Suitable for
Hb , TLC, DLC, RBC count by microdilution method.
For preparation of thin blood film to determine
blood picture.
18. Blood is collected from the
veins of the patient. it is
require when the large amount
of blood is required
21. Surface of the forearm, Wrist area above the thumb or index
finger, Back of the wrist, Knuckle of the thumb or index finger, Foot or
ankle, Infants: head veins
22. Choose the veins that are large
and accessible.
Large veins that are not well
anchored in tissue frequently
roll, so if you choose one, be
sure to secure it with the thumb
of your non dominant hand
when you penetrate it with the
needle.
Avoid bruised and scarred areas.
23. 1. Median cubital vein - first choice, well
supported
2. Cephalic vein - second choice
3. Basilic vein - third choice, often the most
prominent vein, but it tends to roll easily
and makes venipuncture difficult
24. INAPPROPRIATE SITES
ARM ON SIDE OF MASTECTOMY
EDEMATOUS AREAS
HAEMATOMAS
SCARRED AREAS
ARMS WITH CANULAS
SITES BEYOND IV LINE OF ANY KIND
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25.
26. Apply approximately 3-5 inches above anticubital
fossa. (Not more than 1 min)
If the skin appears blanched above and below the
tourniquet it is too tight.
If your finger can be inserted between the
tourniquet and the patient's skin it is too loose.
27. After tourniquet application have patient clench fist.
Feel for a vein that rebounds (bounces) when pushed or
tapped on.
PALPATE any potential vein to help determine size, direction
and depth. A slight rotation of the arm may help to better
expose a vein that may otherwise be hidden.
28. Tricks to Help Distend Veins:
◦ Have the patient "pump" the hand 3 times.
Don't overdue it because over-pumping can create
hemoconcentration
◦ Warm the area with a hot pack or warm, moist cloth
heated to approximately 42°C.
◦ If all else fails, consult another technician for their
opinion and/or intervention.
29. After selecting a vein, clean the puncture site with a cotton ball
saturated with 70% isopropyl alcohol or prepackage alcohol swabs.
Rub the alcohol swab in a circular motion moving outward from the
site Use enough pressure to remove all perspiration and dirt from
the puncture site.
Discreetly look at the swab when finished, if it appears excessively
dirty repeat the cleansing process with a fresh alcohol swab. After
cleansing do not touch the site, if the vein must be repalpated the
area must be cleansed again. Some experts allow cleansing of the
index finger before repalpating but this technique is debatable.
30. Clean the selected area with spirit swab.
The patient arm is gripped tightly with the
help of tourniquet.
The vein is penetrated by positioning the
needle at 20 to 30 degree angle.
31. After blood has been drawn, the patient
should release the fist & the tourniquet is
also released.
A cotton ball is held firmly over the
venipuncture site as soon as the needle is
removed.
After removing the needle the collected blood
is dispensed in the appropriate tubes.
32. The blood in the anticoagulant tubes are
mixed carefully.
The tubes are covered with appropriate
stoppers.
the needle should be disposed by using
needle destroyer.
Disposed used cotton, syringes into a non-
penetrable containers. (Blue basket)
33. Maintain stability of Coagulation Factors
Prevent clot formation in sample prior to
testing
Prevent Factor activation in tube - even if
clot does not form
Additives in tube must not interfere with
individual Coagulation Factors
34. 19 - 21gauge to avoid hemolysis in
adults and 21 - 23 for pediatric
samples.
Non-wettable, siliconized surface or
plastic tubes so as not to activate
factors
Contains buffered Sodium Citrate
which…Ratio 1:9
1part anticoagulant
9 part blood
Sample is mixed by inversion of tube 2
to 3 times.
35.
36. Consider all patients as potentially infectious
Wear coat or apron when there is a
possibility of a splash
Wear mask/eye protection when there is a
possibility of a splash
All sharps must be disposed into a puncture-
proof biohazard container.
37. Frequent hand washing is an important
safety precaution
Wash hands when changing gloves and
between patients if gloves become soiled
Gloves are required to be worn during the
phlebotomy procedure
Wear gloves when handling body fluids
38. BEVEL ON UPPER WALL OF VEIN DOES NOT ALLOW BLOOD TO FLOW
•SOLUTION
•PULL BACK SLIGHTLY THE NEEDLE.
•BE ALERT TO HEMATOMA
NEEDLE PARTIALLY INSERTED CAUSES BLOOD LEAKAGE INTO
TISSUE(HEMATOMA LIKE)
•SOLUTION
•RELEASE TORNIQUET AND REMOVE NEEDLE
•APPLY FIRM PRESSURE OVER SWOLLEN AREA (OR ELEVATE AFFECTED ARM).REASSURE PATIENT
THAT BRUISE WILL ASSURE. REPEAT VENIPUNTURE AT A DIFFERENT SITE(OPPOSITE ARM OR
DISTAL DISTAL TO ORIGINAL ARM)
NEEDLE INSERTED THROUGH BOTH VEIN WALLS
•SOLUTION
•RELEASE TORNIQUET AND REMOVE THE NEEDLE
•APPLY FIRM PRESSURE OVER SWOLLEN AREA(OR ELEVATE AFFECTED ARM).REASSURE PATIENT
THAT THE BRUISE WILL RESOLVE. REPEAT VENIPUNCTURE AT A DIFFERENT SITE (OPPOSITE 38
ARM OR DISTAL TO ORIGINAL SITE)
39. COLLAPSED VEIN.
REDUCED OR NIL BLOOD FLOW
•ALLOW VEIN TO RECOVER BY RELEASING TORNIQUET
•REAPPLY TORNIQUET
NEEDLE NOT COMPLETELY IN VEIN OR HAS
NOT REACHED THE VEIN
•ADVANCE THE NEEDLE FORWARD UNTIL YOU FEEL THE
„GIVE‟ AS NEEDLE PENETRATES
CORRECT INSERTION OF NEEDLE
•BLOOD FLOWS FREELY INTO NEEDLE
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40. FAINTING HAEMATOMA
When the needle has
Patient become dizzy & gone completely
may faint during through the vein & not
collection enough pressure is
applied.
The tourniquet &
Should be aware of the needle should be
patient condition removed immediately
throughout the and firm pressure is
procedure applied to the area for
atleast 5 min.
41. EXCESSIVE
PETECHIAE Small red spots
BLEEDING
appearing on patient
skin, indicating minute Patient on
amount of blood anticoagulant therapy
escaping into the skin
epithelium
This defect is due to
coagulation defect. Remember to apply
pressure to the
Make sure bleeding has venipuncture site until
stopped before leaving bleeding stops
patient side
42. COLLAPSED
SEIZURES
VEIN
This is rarely occur If the syringe
during blood plunger is
collection withdrawn quickly
Immediately call
Release tourniquet,
for help from the
remove syringe
nursing station
43. Intravenous HEMO
therapy CONCENTRATION
Increase conc. Of
Veins are visible &
larger molecule or
palpable but
elements in the
partially occluded.
blood.
Prolong tourniquet
Avoid arm with IV application.
line Exessive massaging
or squeezing a site.
45. For many purposes blood may be safely persevered
at 4ºC in Refrigerator.
EDTA is best preservative for Hemogram.
Tri-sodium citrate best for coagulation
study.
Before procedure, the blood should be first
allowed to warm up to room
temperature, then mixed, preferably by
rotation, for atleast 2 min.
46. RBCs starts to swell resulting in increase in PCV.
The reticulocytes count decrease as early as 6
hours
Osmotic fragility increases.
Prothrombin time slowly increases.
ESR decreases.
Reticulocytes decreases after 6 hrs.
The red cells may leads to progressive crenation
and sphering.
The nucleated red cells disappear from the blood
within 1-2 days
47. It is best to count leucocytes and platelets within
2 hours
If any delay:
Some but not all neutrophils are affected. The
nuclear lobes may become seperated and the
cytoplasmic margin may appear less well defined.
small vacuoles appear in the cytoplasm
Some of the lymphocytes undergo some changes.
Few vacuoles may be seen in the cytoplasm & and
the nucleus may undergo major budding so as to
give rise to the nuclei with 2 or 3 lobes.
Platelet count, TLC, RBCs count decreases.