Hematology 425 Blood Collection

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Hematology 425 Blood Collection

• Russ Morrison
• September 8, 2006

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Safe Collection Practices

• Understand equipment and handle with care
• Always wear gloves
• WASH HANDS between patients and every time gloves
  are removed
• Remove gloves to make sure outer surface does not
  contact bare skin
• Dispose of sharps in puncture-resistant container

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Collection Equipment for Venipuncture

• Evacuated Tube Systems
• Tube, tubes contain appropriate additives and are
  sealed in a vacuum
• tube holder
• needle
• Needles
• Sterile, disposable
• Adapt to tube holders or to a syringe
• May be single or multi-sample
• Safety needles now required

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Collection Equipment for Venipuncture

• Needle Holders
• Manufactured to fit specific needles and tubes
• Disposable, single use
• Safety products required
• Tourniquet
• Provides barrier to venous blood return
• Latex-free
• Applied 2-4 inches above puncture site
• Applied no longer than 1 min prior to puncture

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Collection Equipment for Venipuncture

• Syringes
• Useful for tiny fragile veins
• Pressure controlled by phlebotomist
• Butterflies
• Short needle, IV tube, wings
• Attached to tube adapter, syringes or blood
  culture bottles
• Useful with pediatric patients, long term studies
  (GTT)

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Collection Equipment for Venipuncture

• Solutions for skin preparation
• 70 isopropyl alcohol
• Work from puncture site outward in a spiral
• Allow to air dry before puncture
• Sterile skin prep (blood culture, donation)
• Alcohol followed by iodine
• Defined time for scrub
• Blood Alcohol testing requires benzalkonium
  chloride or other nonalcohol antiseptic

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Selecting the Venipuncture Site

• Superficial veins of anterior surface of upper
  extremities are most often used (see figure 2-3
  in text)
• Cephalic, basilic and median cubital veins
  located in the antecubital fossa
• Secondary choice of dorsal side of wrist/hand or
  veins in the feet
• Avoid intravenous fluids

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The Routine Venipuncture

• Wash hands
• Identify the patient (2 IDs required)
• Assemble supplies and glove up
• Position the patient, select a vein have pt
  squeeze ball, make fist
• Cleanse site with prep solution
• Allow site to air dry
• Apply tourniquet 2-4 inches above site for no
  longer than 1 minute

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The Routine Venipuncture

1. Inspect needle
2. Anchor vein with thumb 1-2 inches below puncture
   site and insert needle, bevel up, at 15-degree
   angle with skin
3. Release and remove tourniquet as soon as blood
   return is obtained
4. Patients hand should be relaxed and open
5. Place dry gauze lightly over puncture site (do
   not press down while needle is in arm)

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The Routine Venipuncture

1. After the last tube has been collected, remove
   the needle and apply direct pressure to the
   puncture site using the dry gauze.
2. Bandage the puncture site when bleeding has
   stopped.
3. Properly dispose of puncture equipment and
   biohazardous waste
4. Label the tubes (name, ID , date, time initial
   of collector)

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The Routine Venipuncture

• Send tubes for analysis
• Release patient from diet restrictions (if any)
  and send patient on their way. Watch patient for
  adverse reaction
• Sample identification is critical to provision of
  useful diagnostic information. It is a JCAHO
  patient safety initiative. SVH has adopted
  Collection Manager.

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Complications Encountered in Venipuncture

• Special challenges of pediatric patients
• Additional complications
• Echymoses (bruising)
• Syncope (fainting)
• Hematoma
• Failure to obtain a sample (fig.2-4)
• Petechiae
• Edema

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Complications Encountered in Venipuncture

1. Obesity
2. Intravenous Therapy
3. Hemoconcentration
4. Hemolysis
5. Burned,damaged,scarred veins are to be avoided
6. Seizures, tremors, vomiting, choking
7. Allergies to skin prep/tourniquet

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Capillary Punctures

• Newborns
• Children less than 2 years of age
• Adults with difficult or reserved venous access
• Provide a mix of arterial and venous blood as
  well as some tissue fluid
• Generate slightly different test results

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Capillary Puncture Sites

• Heel, big toe or finger
• Adults, finger or big toe
• Infants, lateral or medial side of bottom of heel
• Puncture with blade perpendicular to the
  fingerprint lines
• Warming will increase blood flow
• Alcohol only as skin prep

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Capillary Puncture Technique

• Immobilize the finger, toe or heel
• Use blade lt2.0 mm to avoid bone (premature
  infants may require shorter blade for puncture)
• Avoid swollen, bruised or previously punctured
  areas
• Wipe away first drop of blood, collecting only
  when free flowing is achieved

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Capillary Collection Devices

• Capillary tubes
• Microcollection tubes with and without additives
• Unopettes for introducing pre-diluted samples to
  automated equipment or for manual techniques
• Labeling/appropriate identification is critical
  as with all patient samples

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Capillary Collection Procedure

1. Assemble equipment and supplies
2. Identify patient
3. Position patient, designate holder
4. Wash hands and put on gloves
5. Select puncture site
6. Warm puncture site
7. Cleanse puncture site
8. Allow site to air dry

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Capillary Collection Procedure

1. Perform the puncture
2. Wipe away first drop of blood
3. Prepare blood smears, if needed
4. Collect specimens mixing and diluting as needed
5. Elevate wound and apply pressure until bleeding
   stops
6. Label samples
7. Dispose of sharps and biohazardous waste
8. Deliver samples for analysis

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Legal Issues in Phlebotomy

• The patient has the right to say no
• Document competency of staff
• Follow established procedure
• Respect the patients bill of rights
• Laboratory test results are only as good as the
  sample that is tested

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Have some fun this weekend

• Gallo