Phlebotomy Procedures Overview

Overview

This lecture provides a comprehensive review of key phlebotomy procedures, patient preparation, specimen handling, common complications, and safety/regulatory guidelines in preparation for the national exam.

Patient Preparation and Identification

• Always obtain and verify the requisition form before patient identification or equipment assembly.
• Confirm patient identity using two identifiers (wristband and verbal ID for inpatients, physical ID and verbal for outpatients).
• Assess patient understanding and condition before proceeding with blood draw.
• Educate patients on procedure and complications, especially if they are first-timers.

Site Selection and Venipuncture Technique

• Always examine the antecubital fossa (elbow bend) first for vein selection: median cubital, cephalic, then basilic.
• Avoid drawing from arms with IV, dialysis shunt, on the same side as a mastectomy, swollen, scarred, or hematoma sites.
• For capillary puncture, use the great and ring fingers, and always wipe away the first drop.

Consent and Patient Rights

• Types of consent: express (verbal/written), informed (full understanding), implied (actions or emergencies), minors (guardian consent), refusal (document and respect).
• Never draw from patients who are incoherent, confused, or unable to consent.

Common Complications & Management

• Excessive bleeding: apply pressure, especially for anticoagulated patients.
• Nerve injury: stop immediately if patient reports numbness or loss of sensation.
• Bruising: hold pressure longer if vein is pierced through or patient takes blood thinners.
• Infection: never draw through infected, swollen, or bruised sites.
• Hematoma: prevent with proper pressure, especially in high-risk patients.

Specimen Collection & Processing

• Label tubes in front of the patient before leaving the room.
• Follow the correct order of draw: yellow, blue, red, green, lavender, gray.
• For capillary draws: lavender, green, red.
• Use appropriate additives for tests (e.g., sodium citrate for coagulation, EDTA for hematology).

Special Procedures and Pediatric Collection

• Use heel sticks for infants under 12 months who are not walking.
• Avoid lancets deeper than 2 mm for infants to prevent bone injury.
• For pediatric and capillary draws, use microcontainers and butterfly needles as appropriate.

Non-Blood Samples and Chain of Custody

• Collect urine, stool, semen, and sputum in sterile containers following specific handling protocols.
• Chain of custody required for forensic, drug, alcohol, poisoning, and paternity tests.
• Package and transport specimens according to guidelines with biohazard labeling.

Quality Assurance & Regulatory Standards

• Perform daily quality checks; discard expired or damaged supplies.
• External liquid controls are used with new lots or boxes.
• Know main regulatory bodies: OSHA (worker safety), CDC (public health), NIOSH (sharps), CLSI (standards), HIPAA (privacy), and Joint Commission (accreditation).

Infection Control & Safety

• Follow standard precautions: treat all bodily fluids as potentially infectious.
• Use appropriate PPE based on isolation type (gloves, gowns, masks, face shields, N95 respirators).
• Hand washing is the most effective way to prevent infection.

Emergency Procedures

• Stop procedure immediately if patient faints or has a seizure.
• For shock, raise legs and keep warm.
• Start CPR if patient has no pulse and is not breathing; use AED as soon as possible.

Key Terms & Definitions

• Requisition — physician's order form for lab tests, must be completed before collection.
• Antecubital fossa — inside bend of the elbow, preferred site for venipuncture.
• Implied consent — patient actions indicate agreement, or in emergencies.
• Hematoma — localized collection of blood under the skin due to a puncture.
• Chain of custody — documented tracking of a specimen for legal purposes.
• Apheresis — removal of one blood component during donation.

Action Items / Next Steps

• Read your teal review book for 30–60 minutes nightly.
• Review order of draw and additive purposes.
• Practice patient identification and consent scenarios.
• Prepare for CPR training next Friday.