Overview
This lecture provided a comprehensive review of key phlebotomy principles, procedures, complications, and safety protocols in preparation for the national exam.
Patient Preparation & Identification
- Always obtain and check the requisition form before patient contact or equipment assembly.
- Use two identifiers for patient confirmation; wristband and verbal for inpatients, physical ID and verbal for outpatients.
- Assess the patient’s understanding and condition before drawing blood.
- Educate patients on procedures, complications, and ensure they know when to seek help.
- Evaluate the antecubital fossa (bend of elbow) first, then other sites as needed.
Complications & Site Selection
- Excessive bleeding: apply pressure; more likely in anticoagulated patients.
- Severe pain, numbness, or loss of sensation: stop draw, apply pressure, and refer to physician if persistent.
- Avoid drawing from sclerotic (hard), tortuous (twisted), thrombosed (clotted), or fragile veins.
- Do not draw above IV lines, from arms with dialysis shunts, or the side of a mastectomy.
- Never draw from incoherent or sleeping patients without proper waking and consent.
Consent Types
- Express consent: verbal or written agreement.
- Informed consent: patient receives all necessary information in their language and can ask questions.
- Implied consent: patient’s actions imply consent or in emergencies when unconscious.
- Consent for minors: required from guardian unless emancipated.
- Refusal: educate, inform nurse, and document refusal.
Collection Techniques & Errors
- Use correct order of draw: yellow, blue, red, green, lavender, gray.
- Capillary order of draw: lavender, green, red.
- For fragile veins, use syringe; for slow veins, use butterfly set.
- For infants (<12 months, not walking), do heel stick, never exceeding 2mm depth.
- Label tubes in front of the patient to reduce errors.
Special Sample Handling
- Ammonia, lactic acid, ABG: chill immediately on ice.
- Cold agglutinins and cryoglobulins: keep warm.
- Bilirubin: protect from light.
- For urinalysis, use clean-catch midstream; refrigerate if delayed.
Quality & Safety Protocols
- Check equipment quality daily; never use expired, damaged, or unsealed items.
- CLIA waived tests are simple, low-risk bedside tests (e.g., glucometer).
- Follow strict chain of custody for forensic samples (blood alcohol, drug, paternity, poisoning).
- Use external liquid controls with new lab supplies.
Infection Control & Regulatory Bodies
- Standard precautions for all bodily fluids; treat all as potentially infectious.
- PPE required per exposure type: gloves/gown for contact, mask for droplet/airborne, N95 for TB.
- Key agencies: OSHA (worker safety), CDC (public health), JCAHO (accreditation), CLSI (standards), HIPAA (patient privacy).
CPR & Emergency Protocols
- Begin CPR if patient has no pulse or respiration; use AED as soon as possible.
- Single rescuer: 30:2 compression-to-breath ratio; two rescuers for children: 15:2.
Key Terms & Definitions
- Requisition — form detailing test orders and patient requirements.
- Antecubital fossa — bend of the elbow, primary venipuncture site.
- CLIA waived — simple, low-risk, bedside laboratory tests.
- Implied consent — consent assumed by patient actions or emergencies.
- Chain of custody — documentation for forensic samples.
- Sclerotic vein — hardened, inflexible vein.
Action Items / Next Steps
- Read the review book 30–60 minutes nightly.
- Prepare for CPR training next Friday.
- Email or message instructor with questions before 5:00 PM.
- Review patient identification/consent procedures and order of draw for exam readiness.