2. List the required information on a requisition form.
Describe correct patient identification and
specimen labeling procedures.
Describe patient preparation and the variables
that can affect some laboratory tests.
3. Correctly assemble venipuncture equipment and
supplies.
Name and locate the three most frequently used veins
for venipuncture, and describe when these sites would
be unacceptable.
Correctly apply a tourniquet and state why the tourniquet
can be applied for only 1 minute.
4. List four methods used to locate veins that are not
prominent.
Describe the different antiseptics used to cleanse the
venipuncture site.
State the steps in a venipuncture procedure, and
correctly perform a routine venipuncture using an
evacuated tube system.
5. Demonstrate safe disposal of contaminated
needles and supplies.
Deliver specimens to the laboratory in a timely
manner.
8. Purpose
◦ Patient identification
◦ Organization of
equipment
◦ Collection of
appropriate
specimens
9.
10. Name
Identification number
Accession number
Location
Health-care provider’s name
Test requested
Date and time of collection
11. Patient’s date of birth
Special collection information
Special patient information
Numbers and type of collection tubes
Status of specimen
12. Introduce yourself
◦ Begin communication process
◦ Look and listen
Explain purpose of visit
◦ Informed consent
◦ Patient has the right to refuse–Patient Bill of Rights
Guilty of assault if patient has the perception that blood collector is
ignoring his or her refusal
Wake a sleeping patient
Greet unconscious patients
13. THIS IS THE MOST
IMPORTANT STEP !
Written protocol
◦ Hospital inpatients
◦ Outpatients
Two identifiers
14. Primary identifier
Always compare with the
requisition
Must be worn by the patient
◦ Wrist of older children and
adults
◦ Ankles of newborns
Do not trust room and bed
signs
16. Primary identifier
◦ Have the patient state full name
Secondary identifier
◦ Ask additional information
Date of birth
Spell name
Compare unique data with the requisition form
17. CLSI requires a caregiver or family member to
provide information on patient’s behalf if patient is
unable to before drawing specimen
Document the name of the verifier
Drug testing might require photo ID
18. Unidentified patients
◦ Tagged with temporary number
◦ Tentative name
Commercial blood bank system
◦ Place additional stickers from ID band on:
Specimen
Requisition form
Units of blood
19. Reassure the patient
Explain procedure
◦ Do not explain the purpose of the test!
Do not say procedure is painless!
Alert patient to every step of the procedure
Remind patient to hold still
20. Basal state
◦ Preferred state
Fasting
Activities
◦ Medications
A variety of both prescription and over-the-counter
medications can influence lab test results
21.
22.
23. Site is convenient and
supported
◦ Place pillow under arm
◦ Place fist under elbow
◦ Place arm at downward angle
to prevent reflux
Safety
◦ Patient is sitting or lying down
◦ Remove objects from patient’s
mouth
◦ Be alert for syncope
24.
25. Place all supplies close to patient
◦ Collection equipment
◦ Antiseptic pads
◦ Gauze
◦ Bandage
◦ Needle disposal system
◦ Examination requisition
form
Number and type of tubes
Extra tubes in case of loss of vacuum
26. Wash hands between patients
Change gloves between patients
28. Locate tourniquet 3 to 4 inches above site
Avoid or cover arms with skin conditions
Avoid arms on the side of a mastectomy
Do not use a tourniquet for lactate test
29. Maximum time is 1 minute
Apply for site selection
Release for 2 minutes
Reapply
Release when blood flows
Prolonged tourniquet application
◦ Causes hemoconcentration
Increase in the ratio of certain analytes to plasma
Biochemical changes take place in the trapped blood
30. Other causes
◦ Excessive squeezing
◦ Probing a site
◦ Long-term IV therapy
◦ Sclerosed or occluded veins
◦ Vigorous fist clenching
Increases cellular elements
31. ◦ Uncomfortable for patient
◦ Obstruct blood flow
◦ No radial pulse
◦ Appearance of petechiae
33. Vein of choice
◦ Large, well anchored
◦ Closer to surface
◦ More isolated from
other structures
◦ Least painful–fewer
nerve endings
34. ◦ Located on thumb side
of arm
◦ Second site of choice
◦ Close to the surface
Use lower angle of needle
insertion (15°)
Possible blood spurt
◦ May be prominent in
larger patients
35. ◦ Located on the underside of the
arm
◦ Third choice for venipuncture
(H3-A6 recommends using only
as a last resort)
Least firmly anchored (vein may
“roll”)
Near brachial artery and median
nerve
Hematoma formation more likely
Consider using a syringe for
more control
36. Apply tourniquet 3 to 4 inches above venipuncture
site
Have patient form a fist
◦ Do not pump fist
Causes hemoconcentration
Only acceptable for blood donations
37. ◦ Feeling is more important
than sight
◦ Probe with index finger,
thumb has a pulse
◦ Push, don’t stroke
◦ Determine: size, depth,
direction
◦ Remember: veins are
spongy, tendons are rigid,
arteries have a pulse
38. Check both arms
Listen to patient’s suggestions of
previously successful areas
39. Massage the arm upward from the
wrist
Briefly hang the arm down
Apply heat
Transilluminator device
40. Wrists and hands
◦ Apply tourniquet to forearm
◦ Consider a smaller needle, syringe, winged blood
collection set
H3-A6 states to avoid veins from the underside of
the wrist
◦ Possibility of puncturing the radial or ulnar nerve or artery
Can cause permanent nerve
damage and inability to open and close
the hand
41. Require physician approval
More susceptible to infection and thrombi
Avoid in patients with diabetes, cardiac
problems, coagulation disorders
42. Occluded veins
◦ Thrombi
◦ Multiple punctures
◦ Feel hard
◦ Impaired circulation
Hematomas
◦ Do not puncture hematoma, noncirculation of blood
◦ Draw below hematoma
◦ Use other arm
Areas with edema
Areas with extensive burns, scars or tattoos
◦ More susceptible to infection
◦ Decreased circulation
◦ Difficult to palpate
43. Mastectomies
◦ Lymphostasis
Increased lymphocytes
Increased waste products
◦ Patient danger
Lymphedema
Infection
Double Mastectomies
◦ Consult physician
◦ Possibly perform fingerstick
Never obtain blood from a finger on the side affected by a mastectomy
(CLSI H$A6) without physician-written permission
44. IV Fluids
◦ Ideally use other arm
◦ Avoid sites of previous IVs for 24–48 hours
◦ Note same arm collection on requisition
◦ Select site below infusion site, caregiver turns off IV for 2 minutes
◦ Preferably use a different vein
◦ Avoid drawing blood at the same time dye for radiological procedure
or blood components are being infused
45. Fistulas
◦ Renal dialysis patients
◦ Permanent artery-vein connection
◦ Must avoid this arm
◦ Possibility of infection
46. Cannula
◦ Temporary (external) AV shunt
◦ T-tube connector with diaphragm
◦ Only specially trained personnel can
draw from a cannula
47. Turn off IV for at least 2 minutes
◦ Discard first 5 mL blood
◦ Collect specimen in a new syringe
◦ Coagulation tests, discard 10 mL
Second 5 mL can be used for other tests
Document the type of IV fluid and location on
requisition
48.
49. Apply 70% isopropyl alcohol
using a circular motion cleanse
from inside to outside
Allow to air dry, 30–60 seconds
will give maximum bacteriostatic
action
Avoid wiping off with gauze
Failure to let alcohol dry causes a
stinging sensation for patient
Specimen hemolysis
50. Blood cultures or arterial blood gases
◦ Povidone-iodine
◦ Tincture of iodine
◦ Chlorhexidine gluconate
Blood Alcohol Collection
◦ Do not cleanse site with alcohol
◦ Soap and water are recommended
◦ Iodine or benzalkonium chloride (Zephiran
Chloride) may be acceptable
51. Perform while alcohol is drying
Screw the stopper-puncturing end of
needle into the holder
Insert first collection tube into the
holder
Advance tube only to mark on holder
53. Reapply tourniquet
Confirm puncture site
Cleanse gloved palpating finger if
necessary
Place holder in dominant hand
Place thumb on top, fingers underneath
After insertion, fingers can be braced on patient’s
arm
54.
55. Place thumb of nondominant
hand 1–2 inches below site
Place fingers on back of arm
Do not anchor above and
below site with thumb and
index finger
◦ Possible accidental self-puncture
56.
57. Bevel up
15-to-30 degree angle
Resistance lessens
when the needle
enters the vein
59. Brace the hand
holding the holder
against the patient’s
arm
Gently twist tubes
on and off the
needle
60. Mix tubes as they are removed from
the holder needle
◦ Can be done before next tube is inserted
Remove and mix the last tube before
removing the needle from the vein
◦ Blood will drip from the needle
61. Remove the tourniquet if still
applied
Failure to remove can cause a
hematoma
Patient may relax fist
Withdraw needle and apply
pressure to gauze at the same
time
62. Capable patients can apply pressure
using digital pressure
Arm is raised and outstretched
◦ Do not bend the elbow
Collector must apply pressure if necessary
63. Immediately activate
needle safety device
Dispose in a
conveniently located
sharps container
NEVER BEND, CUT,
OR RECAP NEEDLE
64. Label tube before leaving the
patient
Less chance of tubes being
mixed up
Use a pen
Confirm information on
preprinted labels
Verify correct labeling with the
patient (CLSI H3-A6)
65. Patient’s name and ID number
Date and time of collection
Collector’s initials
Additional information
◦ Blood bank identification
66. Check arm before bandaging
H3-A6 states collector must
observe for hematoma formation
before applying bandage
Apply hypoallergenic bandage
over gauze for extra pressure
Self-adhering material
Patient’s instructions
Avoid carrying heavy objects
Remove bandage within 1 hour
67. Pressure must be applied until bleeding stops
◦ Patients on anticoagulants/aspirin/herb therapy
Accidental arterial puncture
◦ Collector must apply pressure for 5 minutes or until bleeding has
stopped
◦ Notify nursing staff and physician
Allergy to adhesive
◦ Avoid use in children under 2 years old
68. Place in biohazard containers
Remove gloves
Wash hands
71. Observe any special handling procedures
Deliver as soon as possible
◦ No longer than 45 minutes
Transport in an upright position
◦ Facilitate clotting
◦ Prevent hemolysis
Complete all required paperwork
72. Separate serum and plasma from the cells
within 2 hours of collection
o Hemolysis severely affects potassium values
o Cellular metabolism decreases glucose levels
73. Coagulation specimens for a PTT can remain
at RT for 4 hours; if patient is on unfractionated
heparin, the plasma must be removed from the
cells within 1 hour, test within 4
PT are stable for 24 hours at RT
Blood smears from EDTA tubes should be
made within 1 hour of collection.
Specimen can be refrigerated for up to 4 hours