Drawing a blood sample from a patient is the main job for a phlebotomy technician. Patients are usually nervous if they’ve never had it done before, or sometimes they have a phobia of needles or doctor’s offices. It is important for the phlebotomist to follow a step-by-step procedure to ensure consistency and to make the patient comfortable. Drawing blood, while routine, is a learned skill. The procedure can be hindered by flinching and tenseness caused by either the patient or phlebotomy technician. If you are a patient reading this that is nervous about having blood work done, read through the following and look at the pictures supplied. They should help calm your nerves and keep you cool when the phlebotomist or nurse enters the room.
The following are steps that should be followed to collect a standard blood sample.
1. Identify the patient : It is important you make sure the patient’s bracelet matches their paperwork, or that they can provide a bit of personal information such as a birth date.
2. Double check the requisition order against the paperwork to ensure the proper tests and samples are required. This helps prevent errors created by administration workers because of mishandled paperwork. Blame shifting is not an option here. Check the paperwork to prevent the mistake from ever occurring.
3. Wash your hands : It is important to do this in view of the patient.
4. Prior to entering the room all supplies should be gathered and organized. They should be clean and still in packaging if applicable. It is necessary for the patient to observe the phlebotomist removing the needles from fresh packaging to ensure they are clean. Bring the tools and supplies next to the patient.
5. Put on gloves : These can either be latex, rubber, or vinyl.
6. Determine which arm you will be drawing your sample from. You can decide or you can let the patient decide. Then tie the tourniquet 2 inches to 3 inches above the puncture site (usual location medical term is antecubital fossa, or “elbow pit”).
7. If no veins are palpable, ask the patient to form a fist and squeeze.
8. Disinfect the area surrounding the puncture site with an alcohol wipe. Start in the middle and wipe in a circular motion gravitating outward.
9. Remove the tourniquet until you are ready to draw the sample. Failure to remove the tourniquet and leaving it on longer than 1 minute can damage both the patient and specimen.
10. Wipe down the area again with a sterile cotton gauze. Do not touch the puncture site again. If you must touch it again to feel the vein, touch your fingertip to a sterile alcohol pad first.
Phlebotomist inserting a needle into the vein
11. Make sure the bevel of the needle is pointing up, anchor the vein with the thumb of your opposite hand about 1 inch below the puncture site, and then insert the needle at no more than 15 degrees.
Tube is inserted into the hub
12. Place a tube from your tray into the hub and check for blood flow. Let the tube fill. Once it is filled remove it from the tube holder.
13. Do not shake the tube. Invert it several time (5 to 10 times) to adequately mix the additives with the sample. Repeat steps 12 and 13 until all tubes are filled.
14. Once the last tube has filled it is time to release the tourniquet. After the tourniquet has been released, remove the tube and then the needle.
15. Have gauze ready in opposite hand and apply it to the puncture site immediately upon removing the needle. Apply firm pressure over the venipuncture site to achieve hemostasis.
16. Ask the patient to continue holding the gauze over the wound. While the patient is holding, immediately engage the needle’s safety function and discard it into an approved disposal container.
17.Label all tubes correctly and in view of the patient.
18. Check the wound to ensure bleeding has stopped. Then apply a bandage, or tape and gauze over the venipuncture site.
Dispose of needle into sharps container
19. Discard all waste and used supplies into appropriate containers, and then put all other equipment away.
As you can see there are numerous steps involved in the collection of a blood sample. The phlebotomy technician must follow these steps to ensure consistency and safety for both the patient and the phlebotomist. It may seem overwhelming at first, but keep in mind that while obtaining your phlebotomy technician certification your training will allow you to follow this procedure many times until you are comfortable.
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