Hospital identification bracelet includes:

➢ Patient’s first and last names

1. Social ➢ Hospital numbers (often two sets)
➢ Interpersonal ➢ Birth date
2. Administrative/Clerical ➢ Physician
3. Technical
Unidentified patients
➢ Temporary identification number and bracelet

1. Check the completeness of the required information.

2. Verify the tests to be collected including information Requisition must contain specific information:
such as the time and date of collection. ★ Patient’s complete name
3. Take note of any dietary restrictions or special conditions ★ Patient’s age or date of birth
that should be followed before the actual collection. ★ Patient’s identification number
4. Determine the test status or priority of collection. ★ Date and time sample is to be obtained
★ Type of test to be collected
★ Accessioning number
★ Physician’s name
★ Department or location where work is to be done
★ Other specific-sample information
★ ICD-10 diagnosis codes for outpatients

All should be labeled after tubes are filled and before leaving the
patient.
The following minimum information is required:
★ Patient’s first and last names
★ Identification number such as date of birth
★ Collection date
★ Time the sample was collected
★ Initials or name of person collecting sample

Each request for blood sample may include an accession number

● Number to identify all paperwork and supplies
associated with each patient.
● Can be used to trace sample back to patient.

Gain patient’s trust through proper greeting of the patient:

★ Greet patient in a positive manner Position of patient is critical for proper blood collection.
★ Establish eye contact
★ Introduce yourself Patient must be in a seated or reclined position before any
★ Explain the procedure and how long it will take attempt is made to draw blood.
★ Listen closely with eyes and ears ● Possibility of syncope (another word for fainting or passing out)
★ Be attentive
Appropriate site can vary depending on patient ● Use of transfer device to transfer blood from syringe into
Primary vein for venipuncture: tube.
● Median cubital vein of antecubital area of arm
Second choice:
● Basilic, cephalic, or median veins
● Cephalic is preferred second site
Basilic vein
● Least preferred site
● Use with caution ● Used only when transfer device not immediately
● Brachial artery and major nerves are along this vein. available

Other areas to check for venipuncture sites in order of

preference:
● Back of hand
● Wrist vein that is present when the hand is positioned so
the thumb is facing up.
● Ankle or foot with physician’s approval

★ Edematous arms
★ Arms in casts
★ Arms with IVs (intravenous lines)
★ Cannulas
★ Fistulas
★ Areas of scarring ● Select a vein, noting the location and direction of the

★ Side of a mastectomy vein.

● Clean the venipuncture with 70 percent isopropyl
alcohol swab

1. Locate a vein.
2. Identify patient restrictions.
3. Assemble supplies.
● Draw the patient’s skin taut with your nondominant
4. Greet the patient.
thumb.

● Hold syringe in dominant hand.

● Perform the venipuncture.

● Nondominant hand pulls on plunger.

● Do not change hands once venipuncture is made.
 ● Fill tubes until vacuum is exhausted to ensure proper
blood-to- anticoagulant ratio
● Blood culture bottles or yellow-stoppered blood culture
● Remove tube from holder
tubes
- Sterile procedure
● Coagulation tubes
- E.g., light-blue stopper
● Serum tube with or without clot activator or gel serum
separator
- E.g., red stopper, red/black stopper, plastic or ● Apply tourniquet
glass ● Feel for a vein
● Heparin tube with or without gel plasma separator
- E.g., green stopper
● EDTA tube
- E.g., lavender stopper ● Clean with alcohol swab in concentric circles
● Oxalate/fluoride, glycolytic inhibitor tubes
- E.g., gray stopper

● Hold skin taut with non-dominant thumb

● When needle enters vein, should see “flash” of blood

NOTE: If not all tubes in order of draw are to be collected, order is started
with first tube needing collection

● Insert evacuated tube into holder

● Apply tourniquet
● Feel for vein
● Clean with alcohol swab in concentric circles
● Release tourniquet
● Remove butterfly needle from arm

● Hold skin taut with non-dominant thumb

● Insert needle at 15-degree angle with bevel up

● Activate safety shield

● Remove hand from drawing the skin taut

● Insert tubes into holder in correct order of draw

 ● Pain Allen test
● Nerve damage ● Used to check for collateral circulation
● Syncope (Fainting) Hazards
● Nausea ● Hematoma
● Diabetic shock ● Arteriospasm
● Convulsions Sites
● Cardiac arrest ● Radial artery on adults
● Continued bleeding ● Infant: catheterization (inserting a catheter) of umbilical arteries
● Hematoma Arterial punctures are not for the beginning phlebotomist.
● Skin allergies Extensive observation and training in the technique should be
completed before an arterial puncture is attempted.

● Anemia (low number of red blood cells)

● Hemolysis (the destruction of red blood cells)
PEDIATRIC PUNCTURE
● Jaundice (yellowing of the skin or whites of the eyes)
➔ Should be limited to superficial veins to minimize pain &
● Lipemia (abnormally large amount of fat in the blood)
trauma.
➔ Veins are usually small & underdeveloped making it
difficult to draw blood.
From left to right: ➔ Risk of anemia (iatrogenic blood loss).
A. Normal serum ➔ The phlebotomist should exhibit a warm & caring
B. Hemolyzed serum approach as dealing with the parents or guardians could
C. Icteric serum be a challenge.
D. Lipemic serum Iatrogenic -induced unintentionally by a physician or surgeon or by medical treatment or diagnostic
procedures.

GERIATRIC VENIPUNCTURE
➔ Elderly patients with special conditions; may have
● Retie tourniquet hearing, visual, or mental impairment.
● Use blood pressure cuff as tourniquet ➔ Thinner skin & smaller muscles may cause the veins to
● Massage the arm. Do not slap the arm. roll easily. As a person ages, his/her veins lose their
● Lower patient’s arm elasticity, making them prone to collapse during
● Warm venipuncture location venipuncture.
● Reseat tube in holder ➔ Carefully select which needle to use. Vein may be
● Use different tube prevented from rolling by anchoring it firmly during the
● Place your finger below venipuncture site and stretch procedure.
vein slightly ➔ Hold the pressure over the site as bleeding in the
● Rotate needle one-quarter to one-half turn elderly may take a longer time to stop.
● Pull back or advance needle slightly

LONG-TERM CARE PATIENTS

Dialysis Patients – use dorsum of the hand to preserve the veins
★ Blood collected above IV line will result in inaccurate of the arms for HD access.
results because of IV fluid contamination. Long-term Care Patients – patients who cannot perform regular
daily activities due to their health condition.
★ To avoid contamination, phlebotomists must draw Home-care Patients – patients who need medical attention &
below IV in hand or do fingerstick. assistance from health professionals from time to time.
Hospice Patients – patients who need end-of-life care, & mostly
have a prognosis of six months or less.