Terence Eday, RMT, IMT(ASCP), MPH| CEU

Phlebotomy Notes

Primary duty of phlebotomist collect blood specimens
for laboratory testing

Methods of Blood Collection:
1. Arterial puncture
2. Capillary puncture
3. Venipuncture

General Blood Collection Equipment & Supplies
1. Blood drawing station
2. Phlebotomy chairs
3. Equipment carriers
4. Glove & glove liners
5. Antiseptics
6. Disinfectants
7. Hand sanitizers
8. Gauze pads/cotton balls
9. Bandages
10. Slides
11. Pen
12. Watch
13. Needle & sharps containers

Blood-drawing station dedicated area of a medical
laboratory or clinic equipped for performing phlebotomy
procedures on patients, primarily outpatients sent by
their physicians for laboratory testing

A typical blood drawing station includes:
a. a table for supplies,
b. special chair where the patient sits during the
blood collection procedure and
c. a bed or a reclining chair for patients with a
history of fainting

Equipment carriers help make blood collection
equipment portable

Hand held carriers are convenient for stat or emergency
situations or when relatively few patients need blood
work

Usage of phlebotomy carts in a hospital setting:
a. early morning phlebotomy rounds when many
patients need lab work
b. scheduled sweep round occur at regular
intervals throughout the day

Phlebotomy carts are bulky and a potential source of
nosocomial infections and are not normally
brought into patient rooms. Instead, they are
parked outside in the hallway. A tray of supplies
to be taken into the room is often carried on the cart.


Antiseptics prevent or inhibit the growth and
development or microorganisms, but do not necessarily
kill them. They are considered safe to use on human
skin and are used to clean the site prior to blood
collection

70% isopropyl alcohol most commonly used for
routine blood collection

For higher degree of antisepsis, the traditional antiseptic
has been Povidone-Iodine in the form of swabsticks or
sponge pads for blood culture collection and prep pads
for blood gas collection

Antiseptics used in blood collection:
1. 70% Ethyl alcohol
2. 70% isopropyl alcohol
3. Benzalkonium choride (e.g. zephiran chloride)
4. Chlorhexidine gluconate
5. Hydrogen peroxide
6. Povidine-Iodine (0.1-1% available iodine)
7. Tincture of iodine

5.25% sodium hypochlorite (household bleach)
may be used as 1:100 dilution recommended
for decontaminating nonporous surfaces after
cleaning up blood or other body fluid spills in
patient-care setting
1:10 dilution of 5.25% sodium hypochlorite
when spills involve large amounts of blood or
other body fluids or occur in the laboratory
At least 10 minutes of contact time is required
for disinfectants to be effective
Fresh bleach solutions are made daily or as
needed
According to CDC, Guideline for Hand Hygiene
in Health care settings recommends use
alcohol-based hand sanitizers for routine
decontamination of hands as a substitute for
hand washing, provided hands are not visibly
dirty

Three (3) forms of alcohol-based cleaners:
1. Rinses
2. Gels
3. Foams

Adhesive bandages are used to cover blood
collection site after the bleeding has stopped.
Paper, cloth, or knitted tape placed over a
folded gauze square can also be used.

Self-adhesive gauze, is also used to form a
pressure bandage following arterial puncture or
venipuncture in patients with bleeding problems



Terence Eday, RMT, IMT(ASCP), MPH| CEU
Six (6) requirements of all Needle & sharps container:
1. Clearly marked biohazard symbol
2. Rigid
3. Puncture resistant
4. Leak proof
5. Disposable
6. Locking lids to seal contents when full

The following equipment is equipment for venipuncture
procedures in addition to the general blood collection
supplies and equipment:
a. Vein locating devices
b. Tourniquet
c. Needles
d. Evacuated tubes system (ETS)
e. Tube holders
f. Evacuated tubes
g. Syringe system
h. Winged infusion set
i. Combination systems

Vein locating devices:
a. Transillumination devices (e.g. Venoscopell,
Neonatal transilluminator and transillumination
vein locator [VL-U])
b. Vein entry indicator

Venoscopell, Neonatal transilluminator and
transillumination vein locator (VL-U) use high
intensity LED lights to shine through the patients
subcutaneous tissue and highlight veins, which absorb
the light rather than reflecting it and stand out as dark
lines

Vein entry indicator (VEID) uses pressure sensing
technology that attaches to catheter needle insertion
unit. When needle penetrates the device senses the
change in pressure and emits a beeping signal that
stops when the needle exits the vein

Tourniquet a device that is applied or tied around
patients arm prior to venipuncture to restrict blood flow.
If properly applied is tight enough to restrict venous flow
out of the area but not so tight as to restrict arterial flow
into the area.

Tourniquet a device that restrict venous blood flow
distends or inflates the veins making them larger and
easier to find, stretches the vein walls so they are
thinner and easier to pierce with needle

Latex or vinyl made tourniquet most common type
that is fairly cheap and disposable

Four (4) types of tourniquets:
1. Velcro closure and buckle closure stay on arm
when released and be tightened again if
necessary; require regular cleaning with
disinfectant or autoclaved, some will not fit
extremely obese patients, not easy to clean
2. Latex strap
3. Nonlatex strap

Common venipuncture needle gauges with needle type
and typical use:
a. Gauges 15-17 needles
Use: collection of donor units, autologous blood
donation and therapeutic phlebotomy
Needle type: Special needle attached to a
collection bag

b. Gauge 18 needle
Type: syringe
Use: primarily as a transfer needle rather than
for blood collection, safety issues have
diminished used

c. Gauge 20 needle
Type: multisample syringe
Use: sometimes when large volume tubes are
collected or large volume syringes are used on
patients with normal sized veins

d. Gauge 21 needle
Type: multisample syringe
Use: considered the standard venipuncture
needle for routine venipuncture on patients with
normal veins or syringe blood culture collection

e. Gauge 22 needle
Type: multisample syringe
Use: Older children and adult patients with
small veins or syringe draws on difficult veins

f. Gauge 23 needle
Type: Butterfly, or syringe
Use: Veins of infants and children and difficult or
hand veins of adults

Length of syringe needles commonly used for
venipuncture: a. 1 inch or b. 1.5 inch

Five (5) causes of premature loss of vacuum in
evacuated tubes:
1. Improper storage
2. Opening the tube
3. Dropping the tube
4. Advancing the tube too far onto the needle
before venipuncture
5. Pulling the needle bevel partially out of the skin
during venipuncture

Short draw premature loss of vacuum,
removing the tube before the vacuum is exhausted,
or stoppage of blood flow during the blood draw can
result in an under filled tube