Phlebotomy

Kathryn Almquist

• Publisher: QuickStudy Reference Guides
• Year: 2009
• ISBN:
  9781423237198
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Our best-selling comprehensive 6 page laminated guide is the perfect resource to help phlebotomy (venipuncture) students understand those procedures that enable blood draw/testing to be safe and comfortable for patients. Different forms of testing, equipment and other aspects of phlebotomy are explored in detail. Includes easy-to-read tables and diagrams. Each section features "The Phlebotomist Knows" summary of critical points, set off graphically for easy reference. As customers have said this guide has "everything you need to know for phlebotomy.
Topics covered includes:

• Overview – Routine Venipuncture
• How Phlebotomy is Performed
• Circulatory System
• Blood Tests
  • Types of Specimens
  • Common Blood Tests
  • Common Chemistry Tests & Panels
  • Table of Test Types & Purpose
• Phlebotomy Tools, Techniques & Equipment
  • Blood Collection Basics
  • Tourniquets
  • Gloves
  • Needles
  • Evacuated Blood Collection Tubes
  • Tube Additives
  • Order of Blood Draw
• Order of Blood Draw
• Color-Coded Tops for Blood Draw
• Glossary of Phlebotomy Terminology

PHLEBOTOMY TOOLS, TECHNIQUES & EQUIPMENT

Blood Collection Basics

The Phlebotomist Knows The needle should be straight, sharp, beveled and free of nicks; discard any defective needle properly in a sharps container and get a new one!

• The standard phlebotomy cart/tray contains the following blood collection equipment:
  • needles
  • needle disposal containers (mini sharps box)
  • needle holders
  • collection tubes with the various colored tops
  • syringes
  • butterfly needles (winged infusion sets)
  • marking pens
  • tourniquets
  • antiseptic cleaning solutions
  • gauze pads
  • bandages
  • gloves

Tourniquets

Universal precautions should be used on ALL patients in ALL blood collection settings–lab, hospital, doctor’s office, etc. Strict adherence should be given to regulations regarding isolation patients when working in a hospital, rehabilitation center or nursing home

• The most commonly used tourniquet is a flat strip of stretchable latex, 15–18 inches long
• The advantages of latex are that it is inexpensive and disposable; however, the phlebotomist must be aware of the patient that has latex allergies
• Once a tourniquet is used, it is to be disposed of to reduce the risk of passing on any type of pathogen to the next patient
• If there is an incidence where the tourniquet is to be reused, latex is a good choice because it can be easily disinfected and does not support bacterial growth
• Velcro tourniquets are also available, but are much harder to disinfect; they are a good choice for the patient with latex allergies
• Blood pressure cuffs may also be used as tourniquets

Gloves

• Latex gloves have proved effective in preventing transmission of infectious diseases
• However, remember that exposure to latex can result in an allergic reaction in some individuals, and reports of such allergic reactions have increased among both healthcare workers and patients in recent years
• Many facilities have gone over entirely to nitrile gloves, which do not contain powder and come in a variety of colors

Needles

• The phlebotomist must know two critical things for any given blood draw: (1) which kind of needle to use and (2) which kind of tube to use
• In addition, ALL needles used for phlebotomy should be:
  • sterile
  • disposable
  • used ONLY one time
• Inspection of the needle package before use is very important!
• The phlebotomist MUST make sure the seal has NOT been broken
  • if the seal has been broken, the needle should be properly disposed of in a sharps container and a new needle used
• Next, the phlebotomist must inspect the needle itself, to make sure that there are no defects that could cause harm to the patient

Features of Phlebotomy Needles

• Point: a sharp needle will have a smooth entry into the skin, with minimum pain to the patient
• Bevel (a.k.a., angle): eases the needle into the patient’s skin and prevents the needle from coring out a plug of tissue
• Shaft: body of the needle; needle shafts come in a variety of lengths
  • routine venipuncture needles range in length from ¾–1½ inches in length
  • some phlebotomists prefer longer needles because they are easier to manipulate; others prefer shorter needles because they ease the fear of their patient
• Lumen: the hollow tube within the shaft of the needle
• Gauge: the diameter of the lumen; needle packs are color-coded by gauge for easy identification
  • the smaller the gauge number, the larger the lumen; the larger the gauge number, the smaller the lumen
    smaller gauge number = LARGER LUMEN LARGER GAUGE NUMBER = smaller lumen
  • choice of gauge depends on the type of blood collection and the condition of the patient
  • the largest diameter used routinely in phlebotomy is a 16-gauge needle, typically used by blood banks to collect from donors
  • the smallest diameter needle used is a 23-gauge needle, for collection from patients with small, fragile veins
  • 20- to 21-gauge needles are used when collecting routine blood samples from adult patients
• Hub: place where the needle attaches to the collecting tube or syringe

The Phlebotomist Knows Remember to check for patients with conditions that make blood draw uncomfortable or risky (i.e., PVD, Raynaud’s disease, blood-thinner therapy, hemophilia, etc.); physician’s order will specify potentially life-threatening situations

Types of Phlebotomy Needles

• Multi-sample needles: for most blood collections, a multisample needle is used, which is a double-ended needle; one tip of the needle pierces the patient’s skin while the other end is inserted into the evacuation tube
  • multi-sample needles have a retractable rubber sleeve that covers the second tip when it is not inserted in th...