Phlebotomy Blood Collection. Do s and Don ts

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1 Phlebotomy Blood Collection Do s and Don ts

2 Objective Draw specimens correctly to provide the lab with a quality specimen, the physician with meaningful test results, & the patient with a minimum of sticks

3 Organization of Collection Physician Order Phlebotomy Supplies and Labels Patient Identification Tourniquet Application Vein Selection and Dilation Site Cleansing Needle Selection

4 Organization of Collection Order of Draw Vacutainer Collection Syringe Collection Tube Inversion Recheck Labels Specimen Delivery

5 Phlebotomy Supplies

6 Patient Identification DO: Properly perform 2 patient ID: Compare name and MRN on ID bracelet with EACH label and when possible have patient state name and DOB DON T: State patient s name and wait for the patient to nod or use patient s room number as ID

7 Failure to properly identify the patient causes: Transfusion errors possibly resulting in death Patient treatment and/or medication mismanagement

8 Tourniquet Application DO: Apply tourniquet 3-5 inches from intended site Dispose of tourniquet after each collection DON T: Leave the tourniquet on longer than 1 minute (hint: not longer than you can hold your breath)

9 Prolonged Tourniquet application beyond 1 minute causes: Hemolysis Falsely elevated or falsely decreased laboratory test results If the Tourniquet is on the arm longer than 1 minute use an initial discard tube

10 What is Hemolysis? Release of hemoglobin into plasma from ruptured red cells mostly occurring when specimen is being drawn Whole Blood Centrifuge Separates red cells from plasma rarely causes hemolysis Not Hemolyzed Hemolyzed

11 Vein Selection DO: Choose appropriate site to perform venipuncture DON T: Draw specimen above IV site Draw through an existing hematoma

12 Drawing specimen above IV causes: Contamination by IV fluids in sample tested Inaccurate Test Results

13 Dilating the Vein DO: Ask patient to tighten their fist to dilate vein DON T: Allow patient to pump fist

14 Fist pumping causes: Increase in K+ and ionized calcium levels Inaccurate Test Results

15 Site Cleansing DO: Use alcohol to clean site and allow to air dry DON T: Blow, fan or stick while alcohol is still wet

16 Performing the Venipuncture before the alcohol dries causes: Hemolysis

17 Needle Selection DO Use appropriate gauge needle - 21 or 23 gauge Use butterflies only for hard sticks and blood cultures DON T Use a small gauge needle, such as 25 gauge

18 Using Small Gauge Needle 25 Gauge - causes: Increased risk of Hemolysis

19 Order of Draw DO: Draw blood in appropriate tube in correct order: 1. Blood Culture 2. Blue Top 3. Red Top 4. Green Top 5. Lavender Top DON T: Collect blood in wrong order

20 Collecting blood in wrong order causes: Cross contamination of additives in lab tubes False increase in Coag times Contaminated Blood Cultures Inaccurate Test Results

21 Vacutainer Collection DO: Large veins only Allow tube to fill to capacity - premeasured vacuum DON T: Use on small veins Under-fill tubes

22 Using a Vacutainer on small veins causes: Unsteady flow of blood Vein to collapse from the vacuum in the tube Hemolysis

23 Under-Filling Tubes causes: Blue Tubes: Falsely increased Coag times Lavender Tubes: Falsely decreased HCT and MCV Green Tubes: Altered K+, Sodium, ALT, AST, (mint green) amylase, and lipase Blood Culture: False-negative result

24 Syringe Collection DO: Pull gently on plunger when using a syringe to draw blood Remove safety needle and dispose in a sharps container Attach transfer device to the syringe and let vacuum fill the evacuated tubes DON T: Apply excessive force while pulling back on the syringe plunger Forcibly fill evacuated tubes with a syringe Use needle directly into the tube to fill

25 Excessive Pulling on Syringe Plunger Causes: Vein to Collapse Hemolysis

26 Tube Inversion DO: Invert tubes immediately after collection 8-10 times DON T: Shake tubes Not invert tubes

27 Shaking or not inverting tubes causes: Hemolysis / Clotting Recollection and Delay in Patient Care

28 Specimen Delivery DO: Label specimens at patient bedside Recheck patient ID and labeled specimens Bag specimens and barcode label in Bio Hazard bag Tube the specimen bag to the lab in a timely manner DON T: Label patient s specimens at the nursing station Bag multiple specimens and barcode labels in one bag Delay tubing specimen to the lab

29 Bagging multiple specimens in one bag causes: Errors in identification resulting in Wrong Test Results Delaying specimen delivery causes: Delays in Test Result Turnaround Time Inaccurate results for certain tests

30 Conclusion Specimens drawn correctly provide the laboratory with a quality specimen, the physician with meaningful test results, and the patient with a minimum of sticks

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