HEMATOLOGY – LABORATORY

PRELIMS TOPIC 2. Proper Blood Collection: Venipuncture and Capillary Puncture

Lecturer/s: Ms. Regine Morados, RMT, Mrs. Lorraine Mission-Maravilla, RMT
FULL TRANSES MASTERLIST: https://bit.ly/masterli_st

VENIPUNCTURE PROCEDURES 6. Apply TOURNIQUET. Ask the patient to make a

fist without vigorous pumping. Select a suitable
1. Prepare request form of the patient vein for puncture
● Test request form should contain:
i. Patient’s complete name SITES TO BE AVOIDED: (Advise to read further for
ii. Age detailed explanation)
iii. Date of birth ● Burns, scars or tattoos
iv. Patient identification number ○ Avoid due to compromised blood
v. Type of test to be collected flow and potential contamination
vi. Date and time the sample is to be from ink or scars.
obtained ● Damaged veins
vii. Department or location of the ○ Avoid pain, complications, and
patient difficulty in obtaining a proper
viii. Clinical impression/ diagnosis blood sample.
ix. Physicians name ● Edema
2. Greet and identify the patient ○ Avoiding swollen tissue can
● Conscious patients (Out-patient) obscure veins and increase the
○ Ask patients to give their FULL NAME and likelihood of unsuccessful
spell their last name. attempts.
○ Compare the information on the request ● Hematoma
form ○ Avoid pain and further tissue
● Conscious patients (In-patient) damage from puncturing near a
○ Ask patients to give their FULL NAME and hematoma.
spell their last name. ● Mastectomy
○ Compare the information on their ○ Avoid on the side of mastectomy
identification bracelet and request form to prevent potential complications
● Sleeping patient and lymphedema.
○ Awaken a sleeping patient before ● IV line, cannula, fistula
attempting venipuncture ○ Avoid drawing from these sites to
○ If the patient is already awake, do the prevent contamination and vessel
same steps as conscious patients damage; opt for a different vein if
● Semi-conscious or Comatose Patients possible.
○ Ask the watcher (or nurse, if no watcher is
around) to identify the patient. 7. Put on gloves. Cleanse the venipuncture site
○ Compare the information on their with 70% isopropyl alcohol. Allow the area to
identification bracelet and request form dry.
● Too young, mentally incompetent or do not 8. Anchor the vein firmly.
speak the language of a phlebotomist 9. Enter the skin with a needle at approx.
○ Ask the watcher (or nurse, if no watcher is 30-degree angle, bevel up.
around) to identify the patient. ● Pull back on the barrel with a SLOW and
○ Compare the information on their EVEN tension up to the desired volume of
identification bracelet and request form blood.
● Unidentified Emergency Patient
○ Upon admission, a temporary identification ORDER OF DRAW
number will be assigned to the patient. 1. Blood culture bottles (sterile procedure) – Yellow Top
Use this ID number on all tests. 2. Coagulation tubes – Light Blue Top
○ When a permanent number or when the 3. Serum tubes w/ or w/o clot activator or gel serum
patient has already been identified, separator – Red/ Gold Top
cross-reference it with the temporary 4. Heparin tubes w/ or w/o gel plasma separator – Green
number. Top
3. Verify diet restriction, latex sensitivity, and other 5. EDTA tubes – Lavender Top
allergies 6. Oxalate/fluoride, glycolytic inhibitor tubes – Black Top
4. Sanitize hands and position the patient
5. Assemble equipment and supplies

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 10. Release the tourniquet. NEVER WITHDRAW THE
NEEDLE WITHOUT REMOVING THE CONTINUOUS BLEEDING
TOURNIQUET.
● Some patients take more than 5 MINUTES for the
11. Place gauze,withdraw needle and apply
site to stop bleeding
pressure
● Continue to wrap an elastic gauze around the arm
12. Properly recap the needle using “fishing out”
with a pad
technique.
● Leave it on for 15 MINUTES or until the bleeding
13. Check the condition of the patient.
stops.
14. Dispose contaminated material (needle and
holder, and syringe) in designated containers
using Universal Precautions. ALLERGY
15. Label tubes at the patient's side. ● Some patient are allergic to latex, tape or iodine
● use hypoallergenic tape and non-latex elastic wrap
Problems encountered in Venipuncture
HEMATOMA
PAIN ● Discontinue venipuncture and apply pressure
● Reposition the needle
● Release the tourniquet
● Discontinue venipuncture
● Avoid deep, probing venipunctures

NERVE DAMAGE
● If the nerve is ONLY TOUCHED, not damaged, it
may be gone in a few hours or days.
● If damaged, numbness could be PERMANENT.
● Discontinue venipuncture

NAUSEA
● Make the patient as comfy as possible UNUSUAL BLOOD SPECIMENS
● Instruct him/her to breathe slowly ICTERIC SAMPLES
● Apply COLD COMPRESS if necessary ● Serum/plasma that contains large amounts of
● Give waste basket or container and have tissues BILIRUBIN
and water ready ● Patient presents with jaundice

LIPEMIC SAMPLES
SYNCOPE/FAINTING
● Serum/plasma contains large amounts of FATS and
● Warning signs: LIPIDS.
○ Perspiration beads on the forehead ● May be due to the patient NOT FASTING.
○ Hyperventilation
○ Loss of color HEMOLYZED SAMPLES
● Vasovagal syncope – fainting due to abrupt pain or ● Serum/plasma contaminated with RBC contents.
trauma
● Lower the head and arms
CAUSES OF HEMOLYSIS
● Discontinue venipuncture
● Drawing from a hematoma
● Rupturing of RBCs by using needle that is too small
DIABETIC SHOCK
● ALCOHOL on the site of venipuncture that entered
● Experience hypoglycemia because they fasted the blood sample
● If conscious, let them drink a glass of ORANGE ● Pulling the plunger too forcibly
JUICE or COLA will temporarily help ● Fast drip/ expelling blood vigorously as it is
● If unconscious, call a PHYSICIAN transferred to the tube
● Redirecting
TREMBLING (Nangirig) ● Mixing tubes vigorously
● Patient become unconscious and exhibit mild to
violent uncontrollable movements POSSIBLE CAUSES FOR FAILED VENIPUNCTURE
● DO NOT RESTRAIN the patient 1. Vacuum in tube is not working
● move object out if the way; PROTECT THE HEAD 2. Bevel against the vein wall
● Patients will usually recover after a few minutes. 3. Bevel inserted too far
4. Needle partially inserted
5. Needle slipped beside the vein
CARDIAC ARREST
6. Collapsed vein
● Patient falls into unconsciousness, no pulse or 7. Undetermined needle position
respiration, dilated eyes and pale skin
● IMMEDIATE CPR

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 ● Improperly timed specimen/ delayed delivery to the
laboratory
● Processing errors:
○ Incomplete centrifugation
○ Improper storage

CAPILLARY PUNCTURE PROCEDURES

Bevel on lower wall of vein (Does not allow blood to flow)
LANCET/INCISION DEVICES
● Finger puncture
● Heel puncture
● Laser lancet
COLLECTION CONTAINERS
● Capillary tubes (w/ different anticoagulants)
● Microtainers (w/ different anticoagulants)
Needle rotated 45° (Allows blood to flow)
COMPOSITION OF CAPILLARY BLOOD

Needle inserted too far

● Arterial Blood
● Venous Blood
● Interstitial Fluid
● Intracellular Fluid

INDICATIONS FOR PERFORMING CAPILLARY

PUNCTURE
ADULTS
● No accessible veins
Needle partially inserted (Causes blood to leak into the ● To save veins for chemotherapy
tissue) ● Clotting tendencies
● POCT procedures such as glucose monitoring
TECHNIQUES TO ENHANCE VEIN AND RECOVER A
FAILED VENIPUNCTURE
CHILDREN AND INFANTS
● Retie the tourniquet
● use a blood pressure cuff in place of a tourniquet ● To prevent anemia
● Massage the arm or warm the location ● To prevent cardiac arrest from removal of large
● Lower the patient’s arm quantities of blood
● Reseat the tube holder ● Venipuncture injury
● Use a different tube ● When capillary blood is preferred
● Place your finger below the venipuncture site and
stretch the vein slightly STEPS IN CAPILLARY PUNCTURE
● Pull back or advance the needle slightly
● Rotate the needle ONE QUARTER to ONE HALF 1. Prepare request form of the patient
TURN. make sure to pull a little backward before 2. Greet and identify the patient
redirecting 3. Verify diet restriction, latex sensitivity, and other
● Venipuncture attempts should be upto 2 tries only. allergies
Ask someone else to do it (endorse to another staff) 4. Sanitize hands and position the patient
5. Select puncture/ incision site
MOST COMMON ERRORS IN SPECIMEN COLLECTION
● Misidentification of patient
● Mislabeling of specimen
● Short draws/wrong Anticoagulant-Blood ratio
● Mixing problems/ clots
● Hemolysis/ lipemia
● Hemoconcentration from prolonged tourniquet time
● Exposure to light/ extreme temperatures

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Adults and older children (Over 1 year old) TEST THAT CANNOT BE PERFORMED BY CAPILLARY
- Use the palmar surface of the distal or end segment PUNCTURE
of the middle or ring finger of the nondominant ● Erythrocyte sedimentation rate
hand. ● Coagulation studies that requires plasma
- Fleshy area, slightly off center, ● Blood cultures
perpendicular to whorls of fingerprint. ● Tests that require large volumes of blood

Infants (Less than 1 year old)

- use the medial or lateral plantar surface of the heel

● For both finger and heel punctures place

lancet firmly against site
● Warn the patient
● Depress lancet trigger
● Discard lancet in sharps container

6. Warm site if applicable

7. Cleanse and air-dry site
8. Prepare equipment
9. Puncture the site and discard the lancet
10. Wipe away the first blood drop
11. Fill and mix tubes/ containers in order of draw
● Gentle intermittent pressure, do not milk,
position site downward to enhance flow
● SLIDE FIRST, then EDTA, other
ADDITIVES, SERUM
● Microhematocrit tube: use capillary action
● MIcrocollection containers: touch blood
drop, do not “scoop” or touch site
● Mix gently.
12. Place gauze and apply pressure
13. Label specimen and observe special handling
instructions
● Label with appropriate information
● Apply label directly to microcollection
container
● Place microhematocrit tubes in a
nonadditive tube then label that tube.
● Ice, body temperature, protection from
light, etc.
14. Check the site and apply bandage
15. Dispose of used and contaminated materials
16. Thank patient, remove gloves and sanitize
hands
17. Transport specimen to the laboratory

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