Primary duty of phlebotomist – collect blood specimens for laboratory testing Methods of Blood Collection: 1. Arterial puncture 2. Capillary puncture 3. Venipuncture General Blood Collection Equipment & Supplies 1. Blood drawing station 2. Phlebotomy chairs 3. Equipment carriers 4. Glove & glove liners 5. Antiseptics 6. Disinfectants 7. Hand sanitizers 8. Gauze pads/cotton balls 9. Bandages 10. Slides 11. Pen 12. Watch 13. Needle & sharps containers Blood-drawing station – dedicated area of a medical laboratory or clinic equipped for performing phlebotomy procedures on patients, primarily outpatients sent by their physicians for laboratory testing.
A typical blood drawing station includes: a. a table for supplies, b. special chair where the patient sits during the blood collection procedure and c. a bed or a reclining chair for patients with a history of fainting Equipment carriers – help make blood collection equipment portable Hand held carriers are convenient for ‘stat’ or emergency situations or when relatively few patients need blood work Usage of phlebotomy carts in a hospital setting: a. early morning phlebotomy rounds when many patients need lab work b. scheduled ‘sweep’ round occur at regular intervals throughout the day.
Phlebotomy carts are bulky and a potential source of nosocomial infections and are not normally brought into patient rooms. Instead, they are parked outside in the hallway. A tray of supplies to be taken into the room is often carried on the cart. Antiseptics – prevent or inhibit the growth and development or microorganisms, but do not necessarily kill them. They are considered safe to use on human skin and are used to clean the site prior to blood collection 70% isopropyl alcohol – most commonly used for routine blood collection For higher degree of antisepsis, the traditional antiseptic has been Povidone-Iodine in the form.
Of swabsticks or sponge pads for blood culture collection and prep pads for blood gas collection Antiseptics used in blood collection: 1. 70% Ethyl alcohol 2. 70% isopropyl alcohol 3. Benzalkonium choride (e. g. zephiran chloride) 4. Chlorhexidine gluconate 5. Hydrogen peroxide 6. Povidine-Iodine (0. 1-1% available iodine) 7. Tincture of iodine •5. 25% SODIUM HYPOCHLORITE (HOUSEHOLD bleach) may be used as 1:100 dilution – recommended for decontaminating nonporous surfaces after cleaning up blood or other body fluid spills in patient-care setting •1:10 DILUTION OF 5. 25% SODIUM hypochlorite – when spills involve large
amounts of blood or other body fluids or occur in the laboratory •AT LEAST 10 MINUTES OF CONTACT TIME IS required for disinfectants to be effective •FRESH BLEACH SOLUTIONS ARE MADE DAILY OR as needed •ACCORDING TO CDC, ‘GUIDELINE FOR HAND Hygiene in Health care settings’ recommends use alcohol-based hand sanitizers for routine decontamination of hands as a substitute for hand washing, provided hands are not visibly dirty Three (3) forms of alcohol-based cleaners: 1. Rinses 2. Gels 3. Foams •ADHESIVE BANDAGES ARE USED TO COVER blood collection site after the bleeding has stopped.
Paper, cloth, or knitted tape placed over a folded gauze square can also be used. , RMT, IMT(ASCP), MPH|? •SELF-ADHESIVE GAUZE, IS ALSO USED TO FORM A pressure bandage following arterial puncture or venipuncture in patients with bleeding problems Six (6) requirements of all Needle & “sharps” container: 1. Clearly marked biohazard symbol 2. Rigid 3. Puncture resistant 4. Leak proof 5. Disposable 6. Locking lids to seal contents when full The following equipment is equipment for venipuncture procedures in addition to the general blood collection supplies and equipment: a. Vein locating devices b. Tourniquet c. Needles d. Evacuated tubes system (ETS).
e. Tube holders f. Evacuated tubes g. Syringe system h. Winged infusion set i. Combination systems Vein locating devices: a. Transillumination devices (e. g. Venoscopell, Neonatal transilluminator and transillumination vein locator [VL-U]) b. Vein entry indicator Venoscopell, Neonatal transilluminator and transillumination vein locator (VL-U) – use high intensity LED lights to shine through the patients subcutaneous tissue and highlight veins, which absorb the light rather than reflecting it and stand out as dark lines Vein entry indicator (VEID) – uses pressure sensing technology that attaches to catheter needle insertion unit.
When needle penetrates the device senses the change in pressure and emits a beeping signal that stops when the needle exits the vein Tourniquet – a device that is applied or tied around patient’s arm prior to venipuncture to restrict blood flow. If properly applied is tight enough to restrict venous flow out of the area but not so tight as to restrict arterial flow into the area. Tourniquet – a device that restrict venous blood flow distends or inflates the veins making them larger and easier to find, stretches the vein walls so they are thinner and easier to pierce with needle.
Latex or vinyl made tourniquet – most common type that is fairly cheap and disposable Four (4) types of tourniquets: 1. Velcro closure and buckle closure – stay on arm when released and be tightened again if necessary; require regular cleaning with disinfectant or autoclaved, some will not fit extremely obese patients, not easy to clean 2. Latex strap 3. Nonlatex strap Common venipuncture needle gauges with needle type and typical use: a. Gauges 15-17 needles Use: collection of donor units, autologous blood donation and therapeutic phlebotomy Needle type: Special needle attached to a collection bag b. Gauge 18 needle Type: syringe.
Use: primarily as a transfer needle rather than for blood collection, safety issues have diminished used c. Gauge 20 needle Type: multisample syringe Use: sometimes when large volume tubes are collected or large volume syringes are used on patients with normal sized veins d. Gauge 21 needle Type: multisample syringe Use: considered the standard venipuncture needle for routine venipuncture on patients with normal veins or syringe blood culture collection e. Gauge 22 needle Type: multisample syringe Use: Older children and adult patients with small veins or syringe draws on difficult veins f. Gauge 23 needle Type: Butterfly, or syringe.
Use: Veins of infants and children and difficult or hand veins of adults •LENGTH OF SYRINGE NEEDLES COMMONLY USED for venipuncture: a. 1 inch or b. 1. 5 inch , RMT, IMT(ASCP), MPH|? Five (5) causes of premature loss of vacuum in evacuated tubes: 1. Improper storage 2. Opening the tube 3. Dropping the tube 4. Advancing the tube too far onto the needle before venipuncture 5. Pulling the needle bevel partially out of the skin during venipuncture “Short draw” – premature loss of vacuum, removing the tube before the vacuum is exhausted, or stoppage of blood flow during the blood draw can result in an under filled tube.