PHLEBOTOMY
By: Patricia T. Roja
WHAT IS PHLEBOTOMY?
• “Phlebo“ means blood vessels or vein and “tomy” means
to cut into or to make an incision to
• Phlebotomy is the surgical opening or puncture of a vein
in order to withdraw blood or introduce a fluid, or
(historically) as part of the procedure of letting blood.
• The most common method is by venipuncture (opening a
vein to obtain a blood sample without destroying the
integrity of the vein) ; (this is an invasive procedure
which must be performed with skill to prevent harming
3 PURPOSES FOR COLLECTION AND
ANALYSIS OF LABORATORY SAMPLES
1.Diagnostic Testing
2.Therapeutic
Assessment
3.Monitoring Patient
•Venipuncture procedure
it is a detailed procedure
requiring careful attention in
order to prevent error in the
laboratory
Most common site for
venipuncture is the
THE ANTECUBITAL FOSS A
•Patient Identification-
is the most critical step
in phlebotomy.
•Mislabeling- mortal sin
in phlebotomy
EQUIPMENTS, USES AND PROCEDURES
OF VENIPUNCTURE IN PHLEBOTOMY
SYRINGE
• The syringe and needle method is one of the
oldest methods known that does not destroy
the integrity of the vein
• PRINCIPLE: a syringe creates a vacuum when
the plunger is pulled.
• “breathing the syringe“ - makes the plunger
pull more smoothly.
• The larger the syringe, the greater the
amount of vacuum obtained- too large
vacuum has the tendency to pull too hard on
the vein and collapse it
• Needle should be inserted at 15-30 degree
PARTS OF A
SYRINGE
PROCEDURE
Greet the patient
Introduce yourself and explain briefly your purpose
Identify the patient
Verify that any dietary restrictions have been met and check for any sensitivity to latex
Perform hand hygiene
Assemble the materials needed
Reassure the patient
Position the patient
Verify paperwork and tube selection
Apply torniquet
Locate the vein, ask the patient to close his/her hand
Select the appropriate
Remove the torniquet
Clean the puncture site w/ 70% isopropyl alcohol swab
Put on gloves while the alcohol is drying (air dry: do not touch)
Re-apply the torniquet
Inspect the needle and equipment
Anchor the vein before drawing of blood.
Release and remove torniquet as soon as blood is established
Ensure that the patient‘s hand is open.
Place the gauze/cotton ball lightly on the puncture site without pressing down
Remove the needle
Activate the safety shield over the needle
Apply direct pressure
Bandage the punctured site
Remove the needle from the syringe (discard into
sharps container), fill the tubes following the correct
of draw. Mix the tubes with anticoagulant
Dispose of the puncture equipment and other
biohazardous waste
Label the tubes with the correct information, while
doing this compare it with the identification bracelet
and requisition form
Carry out any special handling requirements
Remove gloves and perform hand hygiene
Thank the patient before leaving
Send the properly labelled specimens to the
EVACUATED SYSTEM
• The system is often called
Vacutainer system
• PRINCIPLE: a tube with a
vacuum already in it attached
to the needle and the tube’s
vacuum is replaced by blood.
• Consists of:
Double-pointed needle
Plastic holder/ tube adapter
Vacuum tubes
PARTS OF EVACUATED SYSTEM
PROCEDURE
Greet the patient
Introduce yourself and explain briefly your purpose
Identify the patient
Verify that any dietary restrictions have been met and check for any sensitivity to latex
Perform hand hygiene
Assemble the materials needed
Reassure the patient
Position the patient
Verify paperwork and tube selection
Apply torniquet
Locate the vein, ask the patient to close his/her hand
Select the appropriate
Remove the torniquet
Clean the puncture site w/ 70% isopropyl alcohol swab
Put on gloves while the alcohol is drying (air dry: do not touch)
Re-apply the torniquet
Inspect the needle and equipment
Anchor the vein before drawing of blood, push the tube to puncture the stopper
Fill the tube in the correct order of draw (multiple sample can be obtain)
Mix immediately after drawing blood from anticoagulated tube
Additional samples can be obtain (repeat steps starting from 18)
Release and remove torniquet as soon as the tube is properly filled
Ensure that the patients hand is open
Remove the last tube to draw from the holder
Place the gauze/cotton ball lightly on the puncture site without pressing down
Remove the needle
Activate the safety shield over the needle
Apply direct pressure
Bandage the punctured site
Dispose the puncture equipment and other biohazards
waste
Label the tubes with the correct information, while doing
this compare it with the identification bracelet and
requisition form
Carry out any special handling requirements
Remove gloves and perform hand hygiene
Thank the patient before leaving
BUTTERFLY (WINGED INFUSION SET)
COLLECTION SYSTEM
• The butterfly system is used for small
veins that are difficult to draw with
the other systems
• The butterfly collection set works well
on children who have both small veins
and the tendency to move while blood
is being collected.
• The winged infusion needle is inserted
at approximately 5 degree angle.
PARTS OF BUTTERFLY (WINGED
INFUSION SET) COLLECTION SYSTEM
TORNIQUET
• The torniquet constricts the flow of
blood in the arm and makes the
vein more prominent
• It is applied 3-4 inches above the
puncture site
• It should be on the arm no longer
than 1 minute
• Palpating with the non-dominant
hand is recommended
• Finger of choice to palpate: Index
NON-RETRACTABLE LANCET
(FEATHER TYPE)
• It had a stop point so the
phlebotomist will not stick too
deep. It has a controlled depth
of puncture
• DISADVANTAGES:
The blade was still exposed
The patient could see the
blade coming and become
more apprehensive of the
RETRACTABLE LANCET
• These device hide the
blade in a plastic holder so
the patient cannot see the
blade during punctures
• Devices can be purchased
that puncture no more
than 0.85 mm for
premature infants to 2mm
for full term newborn
MICROHEMATOCRIT CAPILLARY TUBE
• Are narrow-bore pipettes
primarily intended for
determining packed red cell
volume in microsamples
• The tune must be filled
atleast 2/3 full for accurate
results.
MICROCOLLECTION TUBE
• Use to
collect small
amount of
blood.
EVACUATED COLLECTION TUBES
• Contains a vacuum with a
rubber stopper sealing the
tube
• Volume ranges from 2 to 15
ml
• The tubes are glass/plastic
and vary in length from 65
ANTICOAGULANTS
• A tube that has an
anticoagulant removes one of
the steps in the coagulation
cascade, and the blood does
not clot.
• They prevent clotting differently
depending on the anticoagulant
used.
LIGHT GRAY TOP
• CONTAINS: Sodium Flouride
and Potassium Oxalate
• EFFECTS ON SPECIMEN:
Potassium Oxalate
precipitates out the calcium
and Sodium Flouride
Preserves glucose
• USES: for glucose and Lactic
LIGHT BLUE TOP
• CONTAINS: Sodium
Citrate
• EFFECTS ON SPECIMEN:
Forms calcium salts to
remove calcium
• USES: Coagulation tests (
PT, APTT)
SODIUM PLOYANETHOL SULFONATE
(SPS)
• CONTAINS: Sodium
Polyanethol Sulfonate (SPS)
• EFFECTS ON SPECIMEN:
Allows bacteria to grow so
they can be cultured
• USES: for blood culture
• INVERSION: 8-10 times
LAVANDER TOP
• CONTAINS: EDTA
(Ethylynediamine tetraacetate)
• EFFECTS ON SPECIMEN: Forms
calcium salts to remove
calcium
• USES: Hematology (CBC) and
Blood Banking (Crossmatch)
• INVERSION: 8-10 times
GREEN TOP
• CONTAINS: Sodium
Heparin/ Lithium Heparin
• EFFECTS ON SPECIMEN:
Inactivates thrombin and
thromboplastin
• USES: Ammonia, lactate,
HLA typing
• INVERSION: 8-10 times
PLAIN RED TOP
• CONTAINS: none
• EFFECTS ON SPECIMEN:
Blood clots, and the serum is
seperated by centrifugation
• USES: Chemistry tests,
Immunology and Serology
• INVERSION: none
GOLD TOP(SST)
• CONTAINS: Seperating gel
and clot activator
• EFFECTS ON SPECIMEN:
seperates the cells/clot
from the plasma/serum
• USES: Serology, endocrine,
Immunology, HIV tests
• INVERSION: 5 times
YELLOW TOP
• CONTAINS: Acid Citrate
Dextrose (ACD)
• EFFECTS ON SPECIMEN:
Complement activation
• USES: Paternity Testing, DNA
studies
• INVERSION: 6-8 times
BLACK TOP
• CONTAINS: Sodium Citrate
(buffered)
• EFFECTS ON SPECIMEN: Forms
calcium salts to remove calcium
• USES: Erythrocyte
Sedimentation Rate (ESR)
• INVERSION: 6-8 times
ORANGE TOP
• CONTAINS: Thrombin
• EFFECTS ON SPECIMEN:
Quickly clots blood
• USES: STAT serum
Chemistries
• INVERSION: none
ORDER OF DRAW
•C - Citrate
ANTICOAGULANT •H- Heparin
S
•E- EDTA
•F- Flouride
PREPARE FOR A SHORT QUIZ!😉
