introduction to blood and Phlebotomy.ppt

Phlebotomy is the process of drawing blood from a vein, typically for laboratory testing, transfusions, or medical diagnosis. A blood vial is a small container used to collect and store the blood sample during this procedure, often color-coded to indicate the type of test it is intended for.

1. PHLEBOTOMY PRACTICE
By
RUBAB IMRAN

2. BLOOD
Blood is a body fluid in humans and other animals that delivers
necessary substances such as nutrients and oxygen to the cells and
transports metabolic waste products away from those same cells

3. HAEMATOLOGY
 haematology, is the branch of medicine concerned with the study of
the cause, prognosis, treatment, and prevention of diseases related to
blood.

4. PHLEBOTOMY

5. THEORY AND PRACTICE OF PHLEBOTOMY

6. WHAT IS PHLEBOTOMY
The term phlebotomy refers to the ancient practice of bloodletting
(from the Greek words phlebo-, meaning "pertaining to a blood
vessel", and -tomia, meaning "cutting of").
Now the term phlebotomy is used for the withdrawal of blood from a
vein, artery, or the capillary bed for lab analysis or blood
transfusion.

7. WHO IS A PHLEBOTOMIST
Collects blood and other specimens

Prepares specimens for testing
Interacts with patients & health care professionals
plays a vital role in any health care system

8. CONFIDENTIALITY
All employees are responsible for maintaining confidentiality of
medical information

9. ATTITUDE
Tone of voice and facial expression will determine how patients
respond to you.
Always be polite, friendly, calm, and considerate.

10. APPEARANCE
Your personal appearance will also affect the impression you make.
Comply with your facility’s dress code and personal appearance
policies.

11. SAFETY

12. PERSONAL PROTECTIVE EQUIPMENT
lab coat
Gloves
Face masks ( certain types of isolation)

13. HAND WASHING
Hand washing is the single most important infection control measure.
Wash hands thoroughly before, after, and between all patient
contacts.
Be sure to turn off faucets using a paper towel to avoid
contamination.

14. HAND WASHING
Remove rings
Stand by the sink but do not touch it
Apply soap and rub hands together
Both sides of the hand, between fingers, around knuckles, under
fingernails
Rinse hands in a downward motion
Dry hands with a clean paper towel
Turn off water with another paper towel

15. NEEDLESTICK

16. NEEDLE STICKS AND PREVENTION ACT
Safety Devices should always be encouraged

17. EQUIPMENT

18. TRAYS
Trays should be sanitized
daily using appropriate
disinfectant
Kept Organized and well-
stocked.

19. BLOOD COLLECTION TUBES
glass or plastic tube with a
rubber stopper.
It has a vacuum so that
blood will flow into the
tube.
anticoagulants and/or
other chemical additives.

20. BLOOD COLLECTION TUBES
Rubber stoppers of blood
collection tubes are color
coded.
Each type of stopper
indicates a different
additive or a different
tube type.

21. LAVENDER
EDTA to prevent clotting
hematology studies.
Should be completely
filled
Must be inverted after
filling

22. LIGHT BLUE
sodium citrate.
coagulation (clotting)
studies.
must be completely filled
must be inverted
immediately after filling

23. GREEN
sodium or lithium heparin
for tests requiring whole
blood or plasma such as
ammonia

24. RED
No additives
Blood bank tests,
toxicology, serology
Must not be inverted after
filing

25. Yellow

26. GRAY
Inhibitor for glycolysis +
anticoagulant
Sodium Fluride +potassium
oxalate.
glucose levels.

27. YELLOW
Acid citrate dextrose
Inactivates complements
DNA studies, paternity
testing

28. ROYAL BLUE
heparin or Na EDTA
anticoagulants
Tube is designed to contain no
contaminating metals
Trace element and toxicology
studies

29. BLOOD CULTURE BOTTLES
Different blood culture
bottles are used for
aerobic, anaerobic, and
pediatric collections.

30. BLOOD COLLECTION TUBES: SAFETY
The rubber stopper is
positioned inside the
plastic shield

31. EXPIRATION DATES

32. HOLDERS
A plastic holder must be
used with the evacuated
tube system.

33. NEEDLES
Different sizes.
size =gauge.
The larger the needle, the smaller the gauge number.
22 or 23 gauge needle is mostly used.

34. NEEDLE COMPONENTS

35. SINGLE DRAW NEEDLE
Single draw needles are
of the type that fit on a
syringe, and can be used
only to fill the syringe to
which they are connected.

36. MULTIPLE DRAW NEEDLE
Used with vacuum
collection tubes.
They have a retractable
sheath over the portion of
the needle that penetrates
the blood tube.

37. BUTTERFLY NEEDLE
Winged infusion set
Difficult venipunctures
including pediatric draws
with a syringe or a holder
and vacuum collection tube
system.
24, or 25 gauge.

38. BUTTERFLIES WITH BUILT-IN SAFETY FEATURES
number-one cause of needlestick injuries, so proper use of their
safety devices is critical.

39. BUTTERFLIES WITH BUILT-IN SAFETY FEATURES

40. LANCETS
Lancets are used for
difficult venipunctures,
including pediatric draws.

41. TOURNIQUETS
Vein easier to SEE, FEEL,
and PUNCTURE

42. STERILIZATION

43. BANDAGING MATERIAL

44. GLOVES
Gloves must be worn for
all procedures requiring
vascular access.
Non-powdered latex
gloves are most commonly
used;

45. SHARP DISPOSAL CONTAINER

46. MARKING PEN

47. COLLECTING BLOOD

48. GREETING
Always greet patient in a professional, friendly manner.
A good initial impression will earn the patients trust, and make it
easier and more pleasant to draw a good specimen.
Knock on the patient’s door before entering.
Identify yourself by name and department.
Explain the reason for your presence.

49. PATIENT IDENTIFICATION
Make sure the name, medical record number, and date of birth on
your order/requisition match those on the patient’s armband.
Verify the patient’s identity by politely asking them to state their full
name.

50. PATIENT IDENTIFICATION
Properly identifying patients and specimens is probably the single
most critical part of your job.
The consequences of misidentifying a specimen can be life
threatening.

51. PATIENT IDENTIFICATION
Never rely on the patient name on the door or above the bed.
Patients are frequently moved from room to room.

52. WASH HANDS

53. APPLY GLOVES

54. POSITION THE PATIENT
Comfortable position
Turn the arm so that the wrist and palm face upward, and the
antecubital area is accessible

55. APPLYING THE TOURNIQUET
Tie the tourniquet just above the elbow.
The tourniquet should be tight enough to stop venous blood flow in the
superficial arm veins.
The tourniquet should be applied a maximum of 1 – 2 minutes.

56. APPLYING THE TOURNIQUET

57. APPLYING THE TOURNIQUET

58. After applying the
tourniquet, you may ask
the patient to make a fist
to further distend the arm
veins.

59. Patients often think they are helping by pumping their fists
This is an acceptable practice when donating blood, but not in sample
collection as this can lead to hemoconcentration
Technical Tip

60. CHOOSE A SITE
The median cubital vein
If not accessible: Cephalic vein, or the Basilic vein.
If not accessible: veins on the back of the hand.
Use a much smaller needle for these hand veins.

62. AVOID PERFORMING A VENIPUNCTURE ON
1.Arm on side of mastectomy. If drawn here, the test results could
be inaccurate because of lymph edema.
2.Scarred or burned areas. Performing a venipuncture at these sites is
more difficult due to the scar tissue.
3.Arm in which blood is being transfusion / IV cannula. The fluid in
the IV could dilute the specimen.
321

63. 4. A hematoma (A hematoma is an abnormal collection of blood
outside of a blood vessel. It occurs because the wall of a blood
vessel wall, artery, vein, or capillary, has been damaged and
blood has leaked into tissues )  If drawn here, could cause incorrect
test results.
5. Edematous (Edema is swelling caused by fluid retention)  should
be avoid because the accumulated fluid could alter test results.

64. CLEANSING THE SITE
Isopropyl alcohol swab
Outward expanding spiral starting with the actual venipuncture site.
Allow the alcohol to dry:-
1-disinfect the site
2-prevent a burning sensation

65. CLEANSING THE SITE

66. Patients are quick to complain about a painful venipuncture. The
stinging sensation caused by undry alcohol is a frequent, yet easily
avoided, cause of complaints.
Technical Tip

67. INSERT NEEDLE
the needle bevel up

68. PUSH TUBE INTO HOLDER
Gently push the tube onto
the needle holder so that
the catheter inside the
needle holder penetrates
the tube.
Blood flow should be
visible at this point.

70. Allow tubes to fill until the vacuum is exhausted to ensure the correct
blood to anticoagulant ratio.
Technical Tip

71. BLOOD WON’T FLOW
If you do not see blood flow, the tip of the needle:
1.May not yet be within the vein.
2.May have already passed through the vein.
3.May have missed the vein entirely.
4.May be pushed up against the inside wall of the vein.

72. TROUBLESHOOTING

73. INCOMPLETE COLLECTION OR NO BLOOD IS OBTAINED:
Change the position of the needle. Move it forward (it may not be in
the lumen)

74. INCOMPLETE COLLECTION OR NO BLOOD IS OBTAINED:
or move it backward (it may have penetrated too far).

75. INCOMPLETE COLLECTION OR NO BLOOD IS OBTAINED:
Adjust the angle (the bevel may be against the vein wall).

76. INCOMPLETE COLLECTION OR NO BLOOD IS OBTAINED:
Loosen the tourniquet. It may be obstructing blood flow.
Try another tube. There may be no vacuum in the one being used.
Re-anchor the vein. Veins sometimes roll away from the point of the
needle and puncture site.

77. OTHER PROBLEMS
A hematoma forms under the skin adjacent to the puncture site -
release the tourniquet immediately and withdraw the needle. Apply
firm pressure.

78. ORDER OF DRAW

80. REMOVING THE NEEDLE
Gently release the tourniquet before the last tube of blood is filled
Remove the last tube from the needle
Withdraw the needle in a single quick movement

81. APPLY PRESSURE
Quickly place clean gauze over the site, and apply pressure.
You may ask the patient to continue applying pressure until bleeding
stops.

82. APPLY ADHESIVE BANDAGE

83. The practice of quickly applying tape over the gauze without
checking the puncture site frequently produces a hematoma
Technical Tip

84. NEEDLE DISPOSAL
Remove the needle from the holder if appropriate, and properly
discard it in an approved sharps disposal container.
Discard all waste and gloves in the appropriate biohazardous waste
container.
Wash hands.

86. SPECIMEN LABELING
Label specimens at the bedside according to your institution’s
standard procedures, or apply preprinted labels.
Proper labeling is the single most critical task you are asked to
perform.

87. PROPER LABELING GENERALLY INCLUDES:
Patient’s first and last name
Hospital identification number
Date & time
Phlebotomist initials
Your institution may provide bar coded computer generated labels
that contain this information.

88. FAINTING
Rarely, patients will faint during venipuncture.  
It is therefore important that patients are properly seated or lying in
such a way during venipuncture so that if they do faint, they won’t
hurt themselves.
self-limited

89. FAINTING; WHAT TO DO?
Gently remove the tourniquet and needle from
the patients arm, apply gauze and pressure to
the skin puncture site. 
Call for help. 
If the patient is seated, place his head between
his knees. 
A cold compress on the back of the neck may help
to revive the patient more quickly.
 

91. UNSATISFACTORY SPECIMENS
They can cause misleading laboratory results
Must be rejected by the laboratory.
The patient must then undergo another
venipuncture to get a better specimen. 
It costs time & money to redraw the specimen.
The credibility of the laboratory is reduced if too
many unsatisfactory specimens are drawn.

92. CAUSES OF UNSATISFACTORY SPECIMENS

93. HEMOLYSIS

94. HEMOLYSIS
Hemolysis means the breakup of fragile red blood cells within the
specimen, and the release of their hemoglobin and other substances,
into the plasma.
A hemolyzed specimen can be recognized after it is centrifuged by
the red color of the plasma.

95. CAUSES OF HEMOLYSIS
Using a too small needle for a relatively bigger vein
Pulling a syringe plunger too rapidly
Expelling blood vigorously into a tube,
Shaking a tube of blood too hard.

96. HEMOLYSIS
Hemolysis can cause falsely increased potassium, magnesium, iron,
and ammonia, AST, LDH levels, and other aberrant lab results.

97. CLOTS

98. CLOTS
Blood clots when the coagulation factors within the plasma are
activated.
Blood starts to clot almost immediately after it is drawn unless it is
exposed to an anticoagulant.
Clots within the blood specimen, even if not visible to the naked eye,
will yield inaccurate results.

99. CAUSES OF CLOTS
Inadequate mixing of blood and anticoagulant
Delay in expelling blood within a syringe into a collection tube

100. INSUFFICIENT VOLUME

101. INSUFFICIENT VOLUME
short draws will result in an incorrect ratio of blood to anticoagulant,
and yield incorrect test results.
Short draws can be caused by:
A vein collapsing during phlebotomy.
The needle coming out of the vein before the collection tube is full.
Loss of collection tube vacuum before the tube is full.

102. LABELING ERRORRS
Labeling errors are the most common cause of incorrect laboratory
results.
If detected, the incorrectly labeled specimen will be rejected.
If undetected, it will produce incorrect results which might adversely
affect your patient’s care.

103. CAUSES
Failure to follow proper patient identification procedure.
Failure to label the specimen completely and immediately after collection.

104. THE END