Phlebotomy Basics: What To Know

Phlebotomy technicians are responsible for collecting blood samples for a variety of tests. Since the process is not as straightforward as other jobs, proper training is essential, especially in ensuring that mistakes are avoided or completely eliminated. What is included in phlebotomy 101 then?

What will you learn in phlebotomy?

Basic Anatomy and Physiology

Choosing a puncture site is one of the most delicate steps of the entire procedure. One false move can spell bad news for both the phlebotomist and the patient. This is why comprehensive knowledge about human anatomy is vital, but most especially about major veins, major arteries and other parts closely related to phlebotomy. These include the cephalic vein, basilica vein, vena mediana cubili, lateral antibrachial cutaneous nerve, accessory cephalic vein, and medial and median anti-brachial cutaneous nerve.

Basic Infection Control

Blood carries infections that may be contagious or cause contamination. To ensure the safety of phlebotomists and patients, basic infection control is a priority in the course outline. There are universal precautions that must be followed and CDC has also set preventative measures of transmission of HIV and other bloodborne pathogens (http://www.cdc.gov/mmwr/preview/mmwrhtml/00000039.htm). In the case of a phlebotomy technician, safety techniques include:

Assume that all blood, body fluids and tissues from a patient may be contaminated. They must all be handled with care.

Awareness of risk categorization for every specimen, biosafety manual in microbiological and biomedical, laboratory safety procedures, and vaccinations.

Avoidance and care of accidental needle stick. Phlebotomy basics will teach technicians of safety measures prevent such contact, and what to do in case it really happens, including thoroughly washing the stick site with soap and water while promoting bleeding by squeezing the site, flushing a contaminant from the system, and keeping a record of a patient’s name to keep track of a possible infection.

Follow safety procedures before, during and after venipuncture. Avoid spills of human blood or body fluids. Wear personal protective gear. Understand good microbiological and biosafety practices.

Dispose waste and used equipment properly. Every laboratory or hospital has proper disposals that a phlebotomist must use accordingly and at all times.

Decontaminate all laboratory equipment and protective gear to make them non-infectious. It is also important for work areas and equipment to be kept clean and disinfected right after a procedure has been completed to eliminate contamination.

Adhere to a facility’s safety policies and regulations, as well as universal practices outlines in General Safety Manuals from the CDC and NIH.

Introduction to the Clinical Laboratory

A phlebotomist usually works in a clinical laboratory where several tests are done for a variety of reasons. It can have several departments, two of which are anatomic pathology and clinical pathology. With all the machines and steps involved for a single test, phlebotomy basics always include an introduction to clinical laboratory.

Blood Collection Equipment

A phlebotomist’s tray comes with an array of tools needed for a routine venipuncture. Although some items are added, depending on the type of tests to be carried out, the most common include the following:

Evacuated collection tubes where a pre-determined volume of blood is collected by vacuum. They come in color-coded tops which are indicative of the additive or coating used in them. They are placed in a holder or adapter to keep them organized and according to the order of draw.

Needles used in phlebotomy vary in bore size. If the gauge is large, the needle bore is small. They are used with a syringe, for evacuated tubes, single draw or a butterfly system.

Tourniquets are used to make the veins more prominent and occlude venous blood flow. The use of a latex-free tourniquet is highly recommended to avoid causing allergies to patients that may have a reaction to latex.

Alcohol wipes are used to disinfect the puncture site. 70% isopropyl alcohol must be used.

Needle disposal units, also known as sharp containers, are where used needles are disposed in to prevent accidental needle stick or contamination.

Other equipment includes gauze sponge or cotton balls, adhesive tapes, gloves and syringes.

Routine Venipuncture

The heart of phlebotomy basics is routine venipuncture. This is what phlebotomists train for to ensure that the procedure is carried out according to standards.

Patient identification

Assessment of patient’s condition or disposition prior to blood collection

Request form, patient information and special requirements checks

Suitable venipuncture site selection

Equipment, patient and puncture site preparation

Perform venipuncture

Sample collection in appropriate container

Check for possible complications following a phlebotomy procedure

Collection tubes labelling

Specimen transportation with requisition to the laboratory

Skin Puncture in Adults, older children, infants and neonates

Potential Complications

Drawing blood is not always easy, especially with difficult draws. This is why skin puncture is sometimes performed on certain adults, elderly, children and infants. A phlebotomist is bound to experience possible complications:

Blood sample can’t be obtained, prompting for another puncture site to be used

Blood obtained is incomplete or it stops flowing into the tube

A patient has hematoma, Petechiae, scarred veins

A patient fainted or become dizzy at the sight of blood

Point of Care testing (POCT)

This is a laboratory test “conducted close to the site of patient care”, to provide faster results, for smaller sample volumes and to avoid the pressures of cost-containment. There are benefits to POCT and it is done using specific materials and methods.

Transporting and Disposal of Waste

Needle stick injuries among health care staff, particularly phlebotomists are eliminated when used needles are not left lying around to cause any trouble. A laboratory or any facility must have a needle disposal unit. There are cases, however, when the lack of training in proper disposal is the root cause of the problem. Apart from disposal equipment, personnel must undergo proper training as well. Needles must be disposed according to biomedical waste local regulations.

Phlebotomy basics cover just the surface in this exciting field in health care. Learning all about them is the stepping stone to acquiring a certification. If a technician wishes to venture to other related fields, further training and study are essential. He or she must meet certain qualifications as well, depending on a particular field.