Phlebotomy all about blood taking in a correct way

all about bloods

1. PHLEBOTOMY

2. •This standard operating procedure (SOP) is applicable to the
collection of blood specimens by venepuncturefor the purpose of
medical diagnostic testing, red cell cross-matching, ongoing
monitoring and / or evaluation of patient responses to treatment.
•This SOP intends to standardisethe venepunctureprocedure for
blood specimens collection executed by all related medical staffs
involved in patient care.

3. ANATOMY….
median cephalic vein
or median basilica
vein is preferable for
taking blood

4. Assemble all equipment and
supplies (Gloves, alcohol swab,
vacutainer(s), needle,
tourniquetgauzeand tape, and
sharp container) and ensure all
vacutainer tubes have not
expired.
Wash hands thoroughly
and put on gloves.
Greet the patient, introduce
yourself and indicate the
procedure to be performed.
Confirm the identity of the
patient.
Check to ensure the patient’s
unique identifiers on the label are
correct and label the correct
specimen vacutainer(s) in front of
the patient
Position the patient so that he/she is
seated or reclined comfortably with
his/her arm extended to form a
straight line from the shoulder to the
wrist. In either situation, the
patient’s arm andelbowshould be
firmly supported with a pillow or
towel and not bent.
Check both arms to identify a
vein, preferable one which runs
along to inner part of the forearm
close to the surface of the skin.
Use of the median cephalic vein
or median basilica vein is
preferable. Select the larger and
fuller vein.

5. Palpate and trace the path of
the vein several times with
your index finger.
Tap the vein at the site of the
draw with your index finger and
second finger; this will cause the
vein to dilate.
Apply tourniquet 8-10 cm above
the desired site of puncture with
enough pressure to compress the
vein but not the artery.
Ask the patient to hold a fist tightly.
They should avoid opening and
closing the fist as studies show that
this can increase blood potassium.
Clean the draw site with an alcohol
swab (70% isopropyl alcohol) in a
circular motion from the center of
the area outwards and allow the
alcohol to dry (30-60 seconds). DO
NOT touch the venepuncture site
again.
Using a sterile 21-23 gauge needle
attached to a holder for vacutainer
or a syringe, gently insert the
needle into the vein at an angle
roughly 15-30 degrees parallel to
the vein making sure that the bevel
of the needle is pointing up.

6. Draw the amount needed
into the syringe
As the blood begins to
flow into the specimen
tubes, have the patient to
open the hand.
once the adequate amount
of blood has been
collected, loosen the
tourniquet.
Remove the needle at the
same angle it was inserted.
Using gauze apply
pressure to the site of the
venepuncturefor 2 minutes
or until bleeding stops.

9. MEDICOLEGAL
•The taking of blood , occurs very regularly in the healthcare setting.
Despite its frequency, or perhaps because of it, Medical Protection often
sees cases arising from injuries suffered by patients during this routine
practice. Any procedure, whether it be straightforward or complex, carries
potential risks. While the risks associated with phlebotomy in general
practice are generally low, there are still some potential risks such as:

10. •Misidentification of blood samples resulting in accidently drawing blood
from the wrong patient or mislabellingblood samples, which can have
serious consequences for patient safety and result in inaccurate test results.
Before performing phlebotomy, should verify the patient’s identity using at
least two patient identifiers, such as the patient’s name, date of birth or
medical record number. Blood samples should be labelled with the
patient’s identifying information, including the patient’s name, date of birth
and medical record number, to ensure accurate test results.

11. •Not obtaining full informed consent from the patient. This involves
explaining the procedure, potential risks, and benefits, and obtaining the
patient’s consent to proceed with the procedure. It would also be helpful to
check their understanding of what bloods they are having taken and how
they can get the results of these tests. If a patient is not made aware of the
potential risks associated with the procedure and an adverse incident
occurs, the patient may be more likely to make a complaint or pursue a
claim.

12. •Bleeding or haematomaformation at the site where the blood was drawn. This can occur
if the needle damages the vein or if there is an underlying bleeding disorder. Patients who
are taking anticoagulant medications, such as warfarin, may be at increased risk of
bleeding. Patients should also be advised to follow appropriate protocol post blood
withdrawal.
•Infection, particularly if proper infection control practices are not followed. Infection can
occur if bacteria or other microorganisms enter the bloodstream through the puncture site,
potentially leading to serious complications. Equipment such as needles, blood tubes, and
other supplies should be prepared and used according to the standard operating
procedures. It is crucial to use sterile equipment and follow the recommended technique
for venepuncture. Dispose of used equipment and materials according to the HSE and
World Health Organisation(WHO) guidelines for medical waste management.

13. •Less than 5 per cent of patients faint (particularly patients who are anxious
or have a fear of needles) during or immediately after the drawing of
blood. Patients can suffer significant dental or facial injuries/lacerations or
even a serious head injury if their faint is not anticipated or appropriately
planned for. Being mindful of and preparing for this scenario will reduce
the risk of the patient suffering an injury, but also the prospect of a claim
for compensation being made.
•Nerve or tissue damage if the needle is not inserted correctly or if the
procedure is performed by an inexperienced or poorly trained
phlebotomist.

14. THANK YOU