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Chapter 6
Phlebotomy
Phlebotomy
• Collecting blood
• Venipuncture
– Puncturing a vein to draw blood, start IVs,
administer medications
– Select a vein in the upper extremities
– Always apply the principles of standard
precautions
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Drawing Blood
• A vacuum tube (vacutainer) is the safest
and easiest way to collect blood.
• A butterfly (winged infusion needle) may
also be used with a vacuum tube or
syringe
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Drawing Blood
• Blood in a syringe will coagulate, or clot
within 1 to 2 minutes
• Complete coagulation occurs within 30 to
45 minutes
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Drawing Blood
• Avoid drawing blood from:
– An arm with an IV, infection, edema, or rash
– An arm with a dialysis access device
– Affected arm of a mastectomy or stroke
patient
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Drawing Blood
• Avoid drawing blood from:
– The site of previous injury or hematoma
– Any burned or scarred area
– Leg and foot veins
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Drawing Blood
•
•
•
•
Use aseptic technique
Avoid injecting air into a vein
Immobilize vein before inserting needle
Position the needle with the bevel up
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Drawing Blood
• Insert needle in the direction of blood flow
• Avoid sticking the patient more than twice
• Keep the tourniquet on for 2 minutes or
less
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Drawing Blood
• Be sure the vessel has no pulse
• Remove tourniquet when blood flows
freely
• Label all tubes after blood is collected
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Drawing Blood
• Transport tubes in a tube holder or a
sealed, plastic transport bag labeled with
the biohazard emblem
• Discard needles in a puncture-resistant
container
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Complications
• Hematoma is the most common
– Blood-filled bruise caused by blood vessel
breakage
– May also occur if inadequate pressure is used
on the insertion site after needle removal
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Complications
• Infection is common
• Infection has the potential to spread
throughout the body
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Performing the Venipuncture
• Use a new tourniquet for each patient
• Wait until the vein feels springy
• Use the median or cephalic veins, if
possible
– If not, try the basilic vein
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Performing the Venipuncture
• Avoid veins on the underside of the wrist
• Allow the skin prep to dry before
performing the venipuncture
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Selecting a Needle
• 19 gauge
– Large draw (10 to 20 tubes)
• 21 gauge
– For moderate to large veins
• 22 gauge
– Most common size
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Selecting a Needle
• 23 gauge
– Most comfortable; for large to moderately
small veins
• 25 gauge
– For small veins and those that may collapse
• Carry the needle and test tube in a carrier;
discard when finished
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Order of the Draw
• Use plastic tubes, if possible
• A coagulation tube has a blue top
– Should not be the first tube drawn
• If coagulation is the only test, use a plain
red top tube to remove contamination
• Draw blood into a sodium citrate collection
tube and gently mix
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Order of the Draw
1. Sterile - Blood culture tube/bottle
2. Citrate - light blue top tube (PT, PTT)
3. Serum - non-additive tube (red, gold, or
tiger top tubes)
4. Heparin - green top tube
5. EDTA - lavender top tube
6. Oxalate - gray top (fluoride)
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Blood Cultures
• A blood culture tests for the presence of
systemic infection
– Prep skin with povidone-iodine
– Some facilities scrub with alcohol for one
minute
– Paint with iodine and let dry
– Wear sterile gloves
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Blood Cultures
• Use a 20 ml syringe and butterfly
• Draw one set of aerobic tubes and one set
of anaerobic tubes each time
• Inject the anaerobic bottle first
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Using a Lancet or Microlance
• Microdraw
– Small skin puncture
• Lancet
– Tiny, sharp, sterile device used to puncture
skin
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Using a Lancet or Microlance
• Microlance
– Small lancet for infants
• Capillary blood
– Tested on a reagent strip or is drawn into a
capillary tube
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Skin Puncture Sites
• Infant or child
– Medial or lateral heel or great toe
• Adults
– Sides of middle and ring fingers; earlobes
– Avoid the pad in the center of fingers
– Avoid sites that are edematous or infected
– Do not use the same site repeatedly
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Skin Puncture Sites
• Puncture skin perpendicular to the
fingerprint
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Measuring Bleeding Time
• The bleeding time test measures how long
it takes bleeding to stop
• Make a small incision in the forearm
– Time how long it takes for bleeding to stop
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Measuring Bleeding Time
• Fill each circle with a hanging drop of
blood
– Avoid smearing
• If bleeding has not stopped within 15
minutes
– Apply pressure
– Inform RN
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Transporting Specimens to the
Laboratory
• Transport to the lab in a test tube carrier or
plastic transport bag.
• Use proper packaging for a pneumatic
tube system
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Transporting Specimens to the
Laboratory
• Make sure the specimen is bar coded and
the requisition is attached
• Time and temperature degrade samples
– Send them to the lab promptly
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Biohazard Emblem
• Lab specimens are biohazardous waste
– Affix a biohazard label to the sample
• Never store the sample in a refrigerator or
other area with food or drugs
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The Centrifuge
• The centrifuge holds and spins test tubes
to separate liquids from solids
• Always counterbalance the centrifuge
– Place a tube filled with the same volume of
water opposite the tube you are spinning
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