Blood Taking Procedures

TIPS ON BLOOD TAKING PROCEDURE:

• Introduce yourself
• Consent
• Explain the reason for the procedure
• Explain the procedure
• Explain the risk of the procedure
• Ask for any allergies to elastoplast
• Obtain patient's consent to undergo the procedure - verbal/ written
• Positioning
• Make the patient comfortable
• Position the patiet according to standard guidelines

Blood Taking Procedures can be viewed in the following videos:
http://www.wonderhowto.com/how-to-draw-blood-with-standard-venepuncture-procedure-235565/


http://library.med.utah.edu/WebPath/TUTORIAL/PHLEB/PHLEB.html#2

• Follow the safety and infection control procedures - PROTECT YOURSELF AND PROTECT YOUR PATIENTS
• Organization of blood collection:
• Test order/ request form from Clinician
• Phlebotomy Supplies and Labels
• Patient Identification: Perform 2 patient ID
• Outpt: Ask Name and DOB
• Inpt: Compare Name and MRN on ID bracelet with EACH label
• Tourniquet Application
• Apply tourniquet 3-5 inches away from the intended puncture site
• Do not leave the tourniquet on for more than 1min --> can lead to Haemolysis
• Ask the pt to tighten their fist and NOT to pump their fist as this can increase K+ and ionized Ca2+ levels
• Let the alcohol dry first before puncturing --> otherwise can lead to Haemolysis
• Vein Selection and Dilatation
• Choose appropriate site - the median cubital and cephalic veins are most frequently used
• Allow 10-15min post transfusion before obtaining a blood sample
• The vein must be held in place for successful needle penetration
• Palpate and trace the path of veins with the index finger
• Arteries pulsate, are most elastic, and have a thick wall
• Thrombosed veins lack resilience, feel cord like, and roll
  easily
• If superficial veins are not readily apparent, you can force
  blood into the vein by massaging the arm from wrist to
  elbow, tap the site with the index and second finger, apply
  warm, damp washcloths to the site for 5 minutes, or lower
  the extremity to allow the veins to fill.
• Do not:
• Draw sample above IV line --> contamination by IV fluids
• Draw sample from arm with cannula. fistula/ vascular graft
• Draw specimen from area of extensive scarring/ burn
• Draw through an existing haematoma
• Draw specimen from an artery
• Site Cleansing

• Needle Selection
• Order of Draw
• Vacutainer Collection
• Syringe Collection
• Tube Inversion - Invert tube gently 5x, DO NOT Shake - vigorous mixing can cause Haemolysis
• Recheck Label
• Specimen Delivery

THE FOLLOWING ARE NEEDED FOR ROUTINE VENIPUNCTURE

• Evacuated collection tubes – the tubes are designed to fill a predetermined volume of blood by vacuum
• The rubber stoppers are color coded according to the additive the tube contains
• Blood should NEVER be poured from one tube to another since the tube can have different additives or coatings
• Needles – The gauge number indicates the bore size: the larger the gauge number, the smaller the needle bore
• Holder – use with the evacuated system
• Tourniquet – wipe off with alcohol and replace frequently
•  Alcohol wipes – 70% isopropyl alcohol
• Adhesive bandages / tape – protects the venipuncture site after collection
• Needle disposal unit – needles should NEVER be broken, bent, or recapped
• Needles should be placed in disposal unit IMMEDIATELY after their use
• Gloves – can be made of latex, rubber, or vinyl, and are worn to protect the patient and the phlebotomist
• Syringes – may be used in place of the evacuated collection tube for special circumstances

PROCEDURE:

• Position the patient so he or she is comfortable and safe in case the patient becomes faint and falls
• Recommended needle size: 20G, 21G or 22G
• Closed vacutainer system is recommended
• Select tube or tubes appropriate for type of samples desired
• Select site for venipuncture
• Put on gloves
• Prepare venipuncture site with alcohol prep. Cleanse in a circular
• fashion, beginning at the site and working outward

• DO NOT PALPATE VENIPUNCTURE AREA AFTER CLEANSING. Allow site to dry
• Apply the tourniquet 3-4 inches above the selected puncture site
• Do not place too tightly or leave on more than 1 minutes
• Remove needle shield. Perform venipuncture WITH PATIENT’S ARM IN A DOWNWARD POSITION AND TUBE STOPPER UPPERMOST
• This reduces the risk of backflow of any anticoagulant into the patient’s circulation
• Push the tube onto the needle, puncturing the stopper
• REMOVE TOURNIQUET AS SOON AS BLOOD APPEARS IN TUBE, within 2 minutes of venipuncture
• DO NOT ALLOW CONTENTS OF TUBE TO CONTACT THE STOPPER DURING THE PROCEDURE
• When first tube has filled to its stated volume, remove it from the holder
• Place succeeding tube in holder puncturing stopper to initiate flow
• While each successive tube is filling invert previous tube GENTLY 5 times
• DO NOT SHAKE. Vigorous mixing can cause hemolysis
• When all tubes of blood have been collected, remove the last tube from the vacutainer holder, place a cotton ball or gauze over the site and withdraw the needle in a smooth and cautious manner so as not to bruise the vein
• After withdrawing the needle fully, apply pressure to the cotton ball over the puncture site and hold pressure
• If patient is able ask them to apply pressure for 3 to 5 minutes until the bleeding stops
• Discard the needle of the vacutainer into the biohazard container WITHOUT RECAPPING the needle
• Immediately invert the last tube GENTLY

CAUSES FOR REJECTION OF SAMPLE

• The quality of laboratory results are directly affected by the quality of the blood sample obtained from the patient
• Samples may need to be rejected as unacceptable for the following reasons:
• Hemolysis - this is usually caused by a procedural error such as using too small of a needle, or pulling back to hard on the plunger of a syringe used for collecting the sample
• Haemolysis is defined as the release of cellular components of erythrocytes and other blood cells into the extracellular space of blood. These cellular components can cause interference in laboratory measurements, potassium being a commonly measured analyte to be affected
• Clotted - failure to mix or inadequate mixing of samples collected into an additive tube
• Insufficient sample (QNS) - certain additive tubes must be filled completely
• When many tests are ordered on the same tube be sure to know the amount of sample needed for each test
• Wrong tube collected for test ordered
• Tubes not processed before shipping to lab
• Tubes held too long in facility before shipping
• Submitting specimens in expired collection tubes. It is the responsibility of the submitter to ensure that specimens are collected in tubes that have not expired

ORDER OF DRAW

Blood collection tubes must be drawn in a specific order to avoid cross-contamination of additives between tubes. The recommended order of draw for plastic vacutainer tubes is:

1. First - blood culture bottle or tube (yellow or yellow-black top)
2. Second - coagulation tube (light blue top). If just a routine coagulation assay is the only test ordered, then a single light blue top tube may be drawn. If there is a concern regarding contamination by tissue fluids or thromboplastins, then one may draw a non-additive tube first, and then the light blue top tube.
3. Third - non-additive tube (red top)
4. Last draw - additive tubes in this order:
   1. SST (red-gray or gold top). Contains a gel separator and clot activator.
   2. Sodium heparin (dark green top)
   3. PST (light green top). Contains lithium heparin anticoagulant and a gel separator.
   4. EDTA (lavender top)
   5. ACDA or ACDB (pale yellow top). Contains acid citrate dextrose.
   6. Oxalate/fluoride (light gray top)

NOTE:Tubes with additives must be thoroughly mixed. Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive.

ADVICE TO PATIENTS

Some people have a fear of needles or of blood and can feel faint. If this is the case for you, it is not a problem but  please make sure you let the person who is taking your blood know in advance so you can be positioned correctly to reduce this situation arising.     If you are taking any blood thinning medicines the procedure should be discussed with your doctor prior to your blood being taken. * A tourniquet will be placed around the upper part of your arm, this will be pulled fairly tight to reduce the blood flow causing the veins in your arm to swell this makes it much easier to locate the vein. * The area is wiped with an antiseptic wipe to reduce the potential germs on your skin surface (everybody has them!) they will wait for this to dry. * The needle will then be inserted through the skin to the vein this is like a pricking sensation it will not hurt excessively. * If you are having fasting bloods taken you may have a “cannula” or “butterfly” placed in the back of your hand and secured. It will be explained to you that as you will be having blood taken over a period of time, this method will reduce the need for repeated insertions of a needle. * The blood will be extracted via either a syringe with a needle, or more often a needle attached to a device where different vacum vials-(small bottles) can be connected so a small amount of blood goes into each vial for a variety of different tests, hence the different coloured vials. * The needle will be removed and a small spot plaster put on the site to minimalise the chance of infection. Please inform the person attending to you if you have allergies to any plasters. If the site does become inflamed, red and sore you will need to visit the doctor. * Pressure will be applied to the wound site for a few minutes to reduce the likelihood of bruising. Do not be too keen to release this pressure too quickly otherwise you may bruise or the site may bleed. * If you have been lying down for the procedure you will need to sit up slowly. * The blood sample will be carefully labelled with all your personal relevant details and stored correctly by the person who took your sample. * The blood samples are then sent to a laboratory where they will be carefully analysed. * The results of your blood test  will be sent back to your own Doctor they will then call you in for a consultation and the results will be explained to you. If you are not sure you will remember what is being said during this appointment, it can be a good idea to take a friend or family member with you. If you are going to receive results of a sensitive nature for instance the HIV test, counsellors are available to help you