Chapter 6 Phlebotomy Procedure 29 Performing A Venipuncture Procedure 30 Collecting A Blood Specimen Using The Vacuum-Tube System Procedure 31 Collecting A Blood Specimen Using A Needle And Syringe Procedure 32 Collecting A Blood Specimen Using A Butterfly Needle And Syringe Procedure 33 Collecting A Blood Culture Procedure 34 Drawing Blood Using A Lancet For A Microdraw Or Infant Heel Stick Procedure 35 Measuring Bleeding Time
Procedure 29 Performing A Venipuncture PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves 2 x 2 gauze pads Alcohol or povidone-iodine sponges Tourniquet Puncture-resistant needle disposal container Syringe method: 10-mL syringe Sterile needles: 20 21 gauge for adults, or 23-gauge butterfly Vacuum-tube method: Vacuum tube with needle holder Sterile double-needles: 20 21 gauge for adults, 23 25 gauge for children Plastic bag for used supplies Adhesive bandage Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Apply a tourniquet and locate a vein. Select the largest, most stable vein in the area. When palpated, the site will feel firm and rebound slightly. 3. Release the tourniquet.
Procedure Guidelines S/U Initials S/U Initials 4. Cleanse the site with alcohol. Wipe in a circular motion. Begin in the center of the venipuncture site and extend the circle out 2 inches in diameter. 5. Allow the alcohol or other skin prep to dry thoroughly. 6. Reapply the tourniquet, taking care not to bump or touch the prepped skin area. 7. Remove the needle cover, holding the needle bevel facing up in your dominant hand. 8. Stabilize the vein by holding it with your nondominant thumb, approximately 1 inch below the puncture site. Warn the patient that he or she will feel a stick. 9. With the needle at a 15-degree angle, slowly enter the patient s vein. You will feel a change of pressure when it enters the vein. Slowly advance the needle 1 4 inch. 10. Release the tourniquet by pulling the upper end downward, before removing the needle. If you are releasing the tourniquet while filling tubes, hold the collection device securely. Avoid pulling upward, as this may cause the needle to come out of the patient s arm. 11. Continue the procedure by obtaining the blood specimen with the syringe or vacuum method or starting the intravenous infusion. 12. Place a 2 x 2 gauze pad over the insertion site. Avoid using cotton balls. Cotton balls tend to stick to the venipuncture site and, when removed, remove the platelet plug, causing bleeding. 13. Quickly withdraw the needle. Immediately apply pressure on the insertion site. Maintain the pressure for 2 to 3 minutes, or longer, until bleeding stops. 14. Cover the puncture site with an adhesive bandage.
Procedure Guidelines S/U Initials S/U Initials 15. Discard the needle in the punctureresistant container. 16. Perform your procedure completion Instructor Signature Student Signature
Procedure 30 PERFORMANCE REVIEW CHECKLIST Collecting A Blood Specimen Using The Vacuum-Tube System Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves 2 x 2 gauze pads Alcohol or povidone-iodine sponges Tourniquet Blood collection tubes Labels for collection tubes Permanent black pen for labeling tubes Laboratory requisition forms Puncture-resistant needle disposal container Vacuum tubes with needle holder Sterile double-needles: 20 21 gauge for adults, 23 25 gauge for children Plastic bag for used supplies Bandage Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Assemble the needle and tube holder. 3. Check the requisition slip to determine what test to collect. Select the proper tubes. Position the specimen collection tubes in the order in which they will be drawn.
Procedure Guidelines S/U Initials S/U Initials 4. Apply a tourniquet and locate a vein. Select the largest, most stable vein in the area. When palpated, the site should feel firm and rebound slightly. 5. Release the tourniquet. 6. Cleanse the site with alcohol. Wipe in a circular motion. Begin in the center of the venipuncture site and extend the circle out 2 inches in diameter. 7. Allow the alcohol or other skin prep to dry thoroughly. 8. Reapply the tourniquet, taking care not to bump or touch the prepped skin area. 9. Remove the needle cover, holding the needle bevel facing up in your dominant hand. 10. Stabilize the vein by holding it with your nondominant thumb, approximately 1 inch below the puncture site. Warn the patient that he or she will feel a stick. 11. With the needle at a 15-degree angle, slowly enter the patient s vein. You will feel a change of pressure when the needle enters the vein. Slowly advance the needle 1 4 inch. 12. Rest your dominant hand on the patient s arm. Gently insert the first collection tube into the holder, and push forward gently to pierce the rubber stopper. Make sure that the needle does not move. Blood should begin to flow. 13. Release the tourniquet as soon as blood begins to flow. Hold the collection device securely, then pull the upper end of the tourniquet downward. Avoid pulling upward, as this may cause the needle to come out of the patient s arm. 14. When the tube has finished filling, grasp the end of the tube, pushing off the flange with your thumb. 15. Gently invert additive tubes 10 to 12 times, then insert the next tube. Repeat until all tubes are filled with blood.
Procedure Guidelines S/U Initials S/U Initials 16. Remove the last tube drawn from the holder. 17. Place a 2 x 2 gauze pad over the insertion site. Avoid using cotton balls. Cotton balls tend to stick to the venipuncture site and, when removed, remove the platelet plug, causing bleeding. 18. Quickly withdraw the needle. Immediately apply pressure on the insertion site. Maintain the pressure for 2 to 3 minutes, or longer, until bleeding stops. 19. Cover the puncture site with a bandage. 20. Discard the needle in the punctureresistant container. 21. Label the tubes according to facility policy. 22. Perform your procedure completion Instructor Signature Student Signature
Procedure 31 PERFORMANCE REVIEW CHECKLIST Collecting A Blood Specimen Using A Needle And Syringe Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves, 2 pairs Face shield or goggles Surgical mask Fluid-resistant gown or lab coat 2 x 2 gauze pads Alcohol or povidone-iodine sponges Tourniquet 10-mL syringe Sterile needles, 20 22 gauge Kelly clamp Blood collection tubes Labels for collection tubes Permanent black pen for labeling tubes Laboratory requisition forms Puncture-resistant needle disposal container Plastic bag for used supplies Bandage Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Check the requisition slip to determine what specimen to collect. Select the proper tubes.
Procedure Guidelines S/U Initials S/U Initials 3. Assemble the needle and syringe. Move the plunger back and forth to break the seal. 4. Apply a tourniquet and locate a vein. Select the largest, most stable vein in the area. When palpated, the site should feel firm and rebound slightly. 5. Release the tourniquet. 6. Cleanse the site with alcohol. Wipe in a circular motion. Begin in the center of the venipuncture site and extend the circle out 2 inches in diameter. 7. Allow the alcohol or other skin prep to dry thoroughly. 8. Reapply the tourniquet, taking care not to bump or touch the prepped skin area. 9. Remove the needle cover, holding the needle bevel facing up in your dominant hand. 10. Stabilize the vein by holding it with your nondominant thumb, approximately 1 inch below the puncture site. Warn the patient that he or she will feel a stick. 11. With the needle at a 15-degree angle, slowly enter the patient s vein. You will feel a change of pressure when the needle enters the vein. Slowly advance the needle 1 4 inch. 12. Rest your dominant hand on the patient s arm. Make sure that the needle does not move. Blood should begin to flow into the hub of the needle. 13. Release the tourniquet as soon as blood begins to flow. Hold the collection device securely, then pull the upper end of the tourniquet downward. Avoid pulling upward, as this may cause the needle to come out of the patient s arm. 14. Holding the syringe with the dominant hand, slowly pull back on the plunger with the nondominant hand, filling the syringe with blood.
Procedure Guidelines S/U Initials S/U Initials 15. Place a 2 x 2 gauze pad over the insertion site. Avoid using cotton balls. Cotton balls tend to stick to the venipuncture site and, when removed, remove the platelet plug, causing bleeding. 16. Quickly withdraw the needle. Immediately apply pressure on the insertion site. Maintain the pressure for 2 to 3 minutes, or longer until bleeding stops. 17. Cover the puncture site with a bandage. 18. Remove the needle using the Kelly clamp, if this is your facility policy. Discard the needle in the punctureresistant container. (This is not necessary if you will transfer the blood in the patient s room.) 19. Open the 20-gauge needle and attach it to the syringe. 20. Perform your procedure completion 21. After leaving the room, apply full personal protective equipment. 22. Transfer the blood to the vacuum tubes in a rack by inserting the needle through the rubber stopper, allowing the tube to fill. Allow the rack to support the tube when the needle is inserted. Avoid holding it with your hand. 23. Fill the tubes in the order of the draw. 24. Gently invert the tube several times to mix the sample. Avoid shaking. 25. Discard the needle and syringe in the puncture-resistant container. 26. Label the tubes according to facility policy. 27. Transport the blood to the lab, following facility policy. Instructor Signature Student Signature
Procedure 32 PERFORMANCE REVIEW CHECKLIST Collecting A Blood Specimen Using A Butterfly Needle And Syringe Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves, 2 pairs Face shield or goggles Surgical mask Fluid-resistant gown or lab coat 2 x 2 gauze pads Alcohol or povidone-iodine sponges Tourniquet 10-mL syringe Sterile 23-gauge butterfly needle Sterile 20-gauge needle Bandage tape to secure the butterfly in place Blood collection tubes Labels for collection tubes Permanent black pen for labeling tubes Laboratory requisition forms Puncture-resistant needle disposal container Plastic bag for used supplies Bandage Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Check the requisition slip to determine what specimen to collect. Select the proper tubes.
Procedure Guidelines S/U Initials S/U Initials 3. Assemble the needle and syringe. Uncoil the butterfly tubing. Move the plunger back and forth to break the seal. 4. Apply a tourniquet and locate a vein. Select the largest, most stable vein in the area. When palpated, the site should feel firm and rebound slightly. 5. Release the tourniquet. 6. Cleanse the site with alcohol. Wipe in a circular motion. Begin in the center of the venipuncture site and extend the circle out 2 inches in diameter. 7. Allow the alcohol or other skin prep to dry thoroughly. 8. Reapply the tourniquet, taking care not to bump or touch the prepped skin area. 9. Remove the needle cover, holding the needle by the wings, with the bevel facing up, in your dominant hand. 10. Stabilize the vein by holding it with your nondominant thumb, approximately 1 inch below the puncture site. Warn the patient that he or she will feel a stick. 11. With the needle at a 15-degree angle, slowly enter the patient s vein. You will feel a change of pressure when the needle enters the vein. Slowly advance the needle 1 4 inch. 12. Rest your dominant hand on the patient s arm. Make sure that the needle does not move. Blood should begin to flow into the attached tubing. 13. Gently tape the butterfly wings against the skin to hold the needle in place. 14. Release the tourniquet as soon as blood is obtained. Pull the upper end of the tourniquet downward. Avoid pulling upward, as this may cause the needle to come out of the patient s arm. 15. Holding the syringe with the dominant hand, slowly pull back on the plunger, filling the syringe with blood.
Procedure Guidelines S/U Initials S/U Initials 16. Place a 2 x 2 gauze pad over the insertion site. Avoid using cotton balls. Cotton balls tend to stick to the venipuncture site and, when removed, remove the platelet plug, causing bleeding. 17. Quickly withdraw the needle. Immediately apply pressure on the insertion site. Maintain the pressure for 2 to 3 minutes, or longer until bleeding stops. 18. Cover the puncture site with a bandage. 19. Remove the butterfly and tubing from the syringe. Carefully discard them in the puncture-resistant container. 20. Open the package for the 20-gauge needle and attach the needle to the syringe. 21. Perform your procedure completion 22. After leaving the room, apply full personal protective equipment. 23. Transfer the blood to the vacuum tubes in a rack by inserting the needle through the rubber stopper, allowing the tube to fill. Allow the rack to support the tube when the needle is inserted. Avoid holding it with your hand. 24. Fill the tubes in the order of the draw. 25. Gently invert the tubes several times to mix the samples. Avoid shaking. 26. Discard the needle and syringe in the puncture-resistant container. 27. Label the tubes according to facility policy. 28. Transport the blood to the lab, following facility policy. Instructor Signature Student Signature
Procedure 33 Collecting A Blood Culture PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Sterile gloves Disposable exam gloves Face shield or goggles Surgical mask Fluid-resistant gown or lab coat 2 x 2 gauze pads Alcohol sponges or blood culture prep kit Tourniquet 20-mL syringe Sterile needles: 20 22 gauge or 23 25 gauge butterfly Blood culture collection bottles Labels for collection bottles Permanent black pen for labeling bottles Laboratory requisition forms Puncture-resistant needle disposal container Plastic bag for used supplies Bandage Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Check the requisition slip to determine what specimen to collect. Select the proper supplies.
Procedure Guidelines S/U Initials S/U Initials 3. Assemble the needle and syringe. Move the plunger back and forth to break the seal. 4. Apply a tourniquet and locate a vein. Select the largest, most stable vein in the area. When palpated, the site should feel firm and rebound slightly. 5. Release the tourniquet. 6. Cleanse the site with alcohol. Wipe in a circular motion. Begin in the center of the venipuncture site and extend the circle out 3 inches in diameter. Repeat the cleansing procedure twice. Use a clean swab each time you cleanse the skin. 7. Allow the alcohol to dry thoroughly. 8. Reapply the tourniquet, taking care not to bump or touch the prepped skin area. 9. Remove the needle cover, holding the needle bevel facing up in your dominant hand. 10. Stabilize the vein by holding it with your nondominant thumb, approximately 1 inch below the puncture site. Warn the patient that he or she will feel a stick. 11. With the needle at a 15-degree angle, slowly enter the patient s vein. You will feel a change of pressure when the needle enters the vein. Slowly advance the needle 1 4 inch. 12. Rest your dominant hand on the patient s arm. Make sure that the needle does not move. Blood should begin to flow into the hub of the needle. 13. Release the tourniquet as soon as blood is obtained. Hold the collection device securely, then pull the upper end of the tourniquet downward. Avoid pulling upward, as this may cause the needle to come out of the patient s arm. 14. Holding the syringe with the dominant hand, slowly pull back on the plunger with the nondominant hand, withdrawing the required amount of blood.
Procedure Guidelines S/U Initials S/U Initials 15. Place a 2 x 2 gauze pad over the insertion site. Avoid using cotton balls. Cotton balls tend to stick to the venipuncture site and, when removed, remove the platelet plug, causing bleeding. 16. Quickly withdraw the needle. Immediately apply pressure on the insertion site. Maintain the pressure for 2 to 3 minutes, or longer until bleeding stops. 17. Cover the puncture site with a bandage. 18. Using a Kelly or other instrument, carefully remove the needle from the syringe, and discard the needle in the puncture-resistant container. Apply a sterile needle. 19. Apply full protective equipment, including gown, face shield, mask, and gloves. 20. Snap the caps off the culture bottles. 21. Cleanse the rubber stoppers well, using alcohol. Wipe in a circular motion. Use a new sponge for each bottle. Allow to dry thoroughly. 22. Remove the cap from the sterile needle and pierce the rubber stopper of the anaerobic bottle. Slowly depress the plunger, filling the bottle with the appropriate amount of blood. Withdraw the needle and repeat with the aerobic bottle. Inject slowly, and exercise care to avoid injecting air into either bottle. 23. Discard the needle and syringe in the puncture-resistant container. 24. Label the bottles according to facility policy. 25. Perform your procedure completion 26. Transport the samples to the laboratory immediately in a plastic transport bag, or according to facility policy. Instructor Signature Student Signature
Procedure 34 PERFORMANCE REVIEW CHECKLIST Drawing Blood Using A Lancet For A Microdraw Or Infant Heel Stick Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves Alcohol or povidone-iodine sponges Lancets Microvette collection devices 2 3 2 gauze pads Labels for collection devices Permanent black pen for labels Laboratory requisition forms Puncture-resistant needle disposal container Plastic bag for used supplies Bandage or spot adhesive bandage Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure Check the requisition slip to determine what specimen to collect. Select the proper supplies. 2. Identify the specimen collection site. 3. Cleanse the site with alcohol. Wipe in a circular motion. Begin in the center of the puncture site and extend the circle out 2 inches in diameter. 4. Allow the alcohol or other skin prep to dry.
Procedure Guidelines S/U Initials S/U Initials 5. Hold the plastic end of the lancet in your dominant hand. With your nondominant hand, break the plastic cover off the end to expose the needle. 6. Hold the lancet at a 45-degree angle. With the sharp end of the lancet, pierce the skin. For an adult fingerstick, make the stick perpendicular to the lines in the fingerprints. Follow the directions for the type of lancet you are using. If the lancet has a plunger, depress it to pierce the skin while holding pressure on the site. 7. Remove the lancet. Discard it in the puncture-resistant sharps container. 8. Wipe the first drop of blood away with a sterile 2 x 2 sponge. You will need the rest to fill the containers. 9. Hold the collection tube near the puncture site. Position the tube almost horizontally, with the end slightly down. Squeeze the skin slightly, allowing blood to flow into the tube. Do not squeeze hard, as this forces tissue fluid into the sample, diluting it. If blood does not flow freely, create suction by placing your gloved finger over the end of the capillary tube, or by squeezing the small bulb. Fill the tube approximately 2 3 to 3 4 full. Usually, two or three tubes are filled. 10. Apply gentle pressure with the 2 x 2 gauze to the skin to prevent painful bleeding inside the tissues. The patient can hold the gauze sponge in place until the bleeding stops. Avoid using cotton balls. Cotton balls tend to stick to the puncture site and, when removed, remove the platelet plug, causing bleeding. 11. Wipe any remaining blood from the skin, and cover with an adhesive bandage. 12. Label the sample while in the patient s room. 13. Perform your procedure completion
Instructor Signature Student Signature
Procedure 35 Measuring Bleeding Time PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves Alcohol or povidone-iodine sponges Surgicutt, template, spring-loaded blade, or similar device Tourniquet Blood pressure cuff Watch with second hand Filter paper 2 x 2 gauze pads Puncture-resistant sharps container Plastic bag for used supplies Steri-strips, butterfly bandage, or other bandage Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure Double-check the requisition slip. 2. Support the patient s arm on the bed or other surface, palm up. Make sure the patient is comfortable and can maintain this position for the duration of the procedure. 3. Apply the blood pressure cuff to the upper arm. Do not inflate it. 4. Apply gloves.
Procedure Guidelines S/U Initials S/U Initials 5. You will perform the test approximately 4 inches below the antecubital space. Cleanse the site with alcohol or povidone-iodine. Wipe in a circular motion. Begin in the center of the puncture site and extend the circle out 3 inches in diameter. 6. Allow the alcohol or other skin prep to dry. 7. Remove the Surgicutt, template, or other product from the package. Twist off the tab on the side, taking care not to touch the blade or activate the trigger. 8. Inflate the blood pressure cuff until the gauge reads 40mm Hg. You must start the test within 60 seconds of inflating the cuff. 9. Apply the Surgicutt or other device to the prepared skin, approximately 4 inches below the antecubital space. Position the device so the blade is parallel to the bend in the elbow. 10. Depress the trigger while monitoring the second hand on your watch. Remove the blade from the skin within 1 second of depressing the trigger. Record the time. Discard the device containing the blade in the puncture-resistant container. 11. Absorb the blood with the edge of the filter paper. Position the paper near the incision, without touching the wound directly. Placing the paper directly on the incision will interfere with the results of the test. 12. With the filter paper, blot the bleeding every 30 seconds. When the blood no longer stains the paper, stop timing. Discard the filter paper in the plastic bag. Record the time the test ended. 13. Deflate the blood pressure cuff. 14. Wipe remaining blood from the skin. 15. Apply a steri-strip, butterfly bandage, or dressing to the incision. 16. Remove the gloves and discard in the plastic bag.
Procedure Guidelines S/U Initials S/U Initials 17. Remove the blood pressure cuff. 18. Perform your procedure completion Instructor Signature Student Signature