LABORATORY COAT AND GLOVES MUST BE WORN DURING PROCEDURE.
- Greet the patient with a friendly, professional manner. Patient cooperation is essential for successful results. The tone of the patient encounter is set within the first 30 seconds of communication.
- Ask patient for her/his full name and verify that spelling of name is correct on laboratory request forms.
- It is essential to put patient at ease by answering questions, being sensitive to patient's fear level, being gentle with technique, and speaking with unhurried, authoritative, but quiet voice. Let the patient know that venipuncture procedure may be a little painful, but of short duration. Never say "This won't hurt a bit."
- Have the patient sit in the phlebotomy chair and raise or lower the chair arm accordingly. Patient arm should not be bent at the elbow. Add support under the arm with a pillow if necessary. DO NOT DRAW BLOOD ON A STANDING PERSON.
- Ask patient if s/he has had any previous problems having blood drawn. If necessary, recline chair If patient is prone to fainting or being ill.
- If patient is not conscious, clinician must identify the patient. Document cIinician's initials on laboratory request forms.
- Review in-house laboratory request forms for completeness:
• FULL NAME, LAST NAME FIRST (if written), LAST NAME LAST (if sticker)
• TELEPHONE NUMBER
• PATIENT ID NUMBER (4 numbers)
• CLINICIAN'S NAME OR INITIALS
• DATE OF REQUEST
• TEST REQUEST(S): check Quest handbook or on-line for specimen requirements
• ARRIVAL TIME AND DATE (stamped by lab personnel)
- For reference laboratory testing, the following are required:
• FULL NAME, LAST NAME FIRST (ifwritten); LAST NAME LAST (if sticker)
• STUDENT ID NUMBER (4 numbers): write in "Chart #" box
• TELEPHONE NUMBER
• CLINlCIAN'S NAME
• TEST REQUEST(S)
• DATE AND TIME OF BLOOD DRAW
- Ask patient if s/he is fasting (usually at least 8 hours) if test requested requires fasting state. lf therapeutic drug monitoring is ordered (l.e. Lithium, Valproic acid), ask patient for time last pill was taken. Blood is usually drawn just prior to scheduled dose.
- Wash hands thoroughly and prepare materials for phlebotomy.
USING SAFETY ENGINEERED VACUTAINER HOLDER WlTH ATTACHED NEEDLE COVER (Smiths Medical supplied by Quest Lab):
a.) Use appropriate size sterile needle (seal must not be broken); gauges 20 and 21 are used for most procedures. Gauge 22 may be used for small veins.
b.) Attach needle to safety Vacutainer holder securely. Needle cover (orange) may need to be adjusted so that needle bevel is up when drawing patient.
c.Select appropriate Vacutainer tube and push halfway onto the needle just to secure it. If pushed all the way to the top, vacuum will be lost and tube is unusable.
d.) If drawing multiple Vacutainer tubes, follow "ORDER OF DRAW FOR PHLEBOTOMY
TUBES" (see following page).
e.) Have two 2 x 2 gauze pads and one alcohol-saturated pad ready.
USING SAFETY ENGINEERED BUTTERFLY NEEDLE (B-D Safety-Lok):
a.) Attach self-sheathing needle to Vacutainer holder.
b.) Select appropriate Vacutainer tube and push halfway onto the needle just to secure it. lf pushed all the way to the top, vacuum will be lost and tube is unusable.
c.) lf drawing multiple Vacutainer tubes, follow "ORDER OF DRAW FOR PHLEBOTOMY
TUBES" (see following page).
d.) Have two 2 x 2 gauze pads and one alcohol-saturated pad ready.
USING SYRINGE FOR HARD DRAWS:
a.) Pull and depress plunger on syringe to allow easier movement of plunger.
b.) Using a 23-gauge butterfly needle, remove the sheath~covered portion below the white plastic end of tubing and attach to appropriate-sized syringe.
c.) After blood draw, remove butterfly needle and attach larger gauge needle to allow easier flow of blood into Vacutainer tubes.
- Application of tourniquet: WEAR LATEX OR VINYL GLOVES.
a.) Wrap tourniquet around the arm approximately 3-4 inches above area of draw.
b.) Have patient make a fist which will make veins more prominent. Vigorous pumping should be avoided.
c.) Palpate selected areas using index finger. If vein is difficult to find, check other arm. Take the time to select the BEST VEIN. Do not leave tourniquet on longer than 1 minute.
d.) Vein location may be done without gloves for more sensitivity if necessary.
- Cleanse chosen site with alcohol~saturated pad. Dry with 2 x 2 gauze pad or allow to air dry.
- Holding safety Vacutainer holder with attached sterile needle (or butterfly with needle holder or syringe) with Vacutainer tube at approximately 15° angle and needle bevel up, puncture chosen vein site with a smooth, swift motion. Skin around puncture site may be held taut with thumb of opposite hand before drawing (downwards motion).
- Push Vacutainer tube into holder as far as it will go. If needle is correctly placed within lumen of vein, blood will flow into tube. Have patient relax hand. If using syringe, pull gently on plunger to fill syringe.
- lf there is no blood flow:
a.) Needle is incorrectly positioned; reposition by withdrawing slightly and trying another area. Index finger may be used to feel for position of needle relative to vein.
b.) Tube has no vacuum; replace with another.
- lf draw is successful, allow tube to fill completely. All tubes with additives must be at least half-full to ensure accurate test results.
- If multiple tubes are being drawn, carefully remove first tube after blood flow stops and
replace with second tube according to Order of Draw. Perform in such a manner so needle remains in correct position. lf tube has an additive, remove and gently mix immediately.
- lf draw is unsuccessful, another vein may be palpated and used. Do not attempt to draw patient more than twice. Arrange for a different staff member to attempt third draw with patient's consent or arrange for a next day draw after oral hydration. Inform the ordering clinician if the phlebotomy was not successful.
- Release tourniquet: may be released as soon as blood flows into tube or may be left on during entire procedure up to one minute.
- Immediately withdraw needle/ holder with straight, even motion. lf using Vacutainer needle holder with attached needle cover (Portex), press down orange cover on hard surface so that it locks into place over needle. Do not use fingers to push cover over needle. Discard entire device into sharps container. lf using butterfly needle, push needle cover upwards and discard entire apparatus into sharps container. If using syringe, remove and replace needle with larger gauge for transfer of blood into Vacutainer tubes.
Place a clean 2 x 2 gauze pad over the site and have patient apply direct pressure for several minutes. Do not have patient bend arm as this will not always stop flow of blood. After bleeding stops, apply strip of paper tape over gauze pad. Ask patient to keep bandage in place for 30 minutes.
Immediately label tube(s) with the following:
PATlENT'S LAST NAME, FIRST NAME
or APPLY PATlENT STICKER
Ask patient his/her birth date or last four numbers of Student lD number as an additional identification measure.
Collection time is written on all reference laboratory requests.
Assess patient's state. Make sure that s/he is all right before allowing patient to stand and leave. THANK THE PATlENT.
Disposition of tubes:
JUNGLE TOP (SST): Allow to clot in upright position for 20-30 minutes but not more than one hour. Centrifuge for 15 minutes.
BLUE, RED, LAVENDER TOPS: Place in reference lab specimen bag. No centrifuging is necessary. Refrigerate.
LAVENDER TOP: For in-house testing, place on aliquot mixer. Remove gloves, wash hands, and put on new set of gloves for the next patient.