PHLEBOTOMY

CGHMC - Laboratory
Ms. Cristina Labrador

- Not properly identifying the patient is the

single most critical error a phlebotomist
can make.
- Every effort must be done to ensure the
Quality Assurance Program proper patient is receiving the proper test.
-is a continuous program established by the - This is accomplished by asking the patient
healthcare facility, which will provide guidelines, to say his or her name AND using one
protocols and continuing education for their other unique patient identifier.
employees. - The patient's identity must be verified
Three areas in phlebotomy subjected to quality using a second identifier, such as: date of
control: birth and middle name. In an inpatient
setting, the patient's identification band
can be used as the second identifier, but
- Pre-examination Process cannot be used as their primary form of
- What happens before testing identification because ID bands can be
- Phlebotomists are responsible for all wrong.
pre-analytical processes. From reviewing - You cannot use a patient chart, patient
the order to identifying the patient to name on the wall or other piece of patient
collecting the sample to transporting it to the equipment or bed number to identify the
lab, phlebotomists must ensure that all patient.
actions are performed correctly to ensure - The patient's identity must be confirmed
valid, accurate test results. verbally by the patient or another party
- Furthermore, Pre-analytical processes can (nurse or family member).
be broken down into three distinct phases: ➔ Improper Time of Collection
before collection, during collection and after ➔ Wrong tube
collection. Phlebotomists are responsible for ➔ Exercise
all of the actions that occur in the pre- ➔ Patient posture
analytical phase. ➔ Poor coordination with other treatments
- Examples: ➔ Medication interference
❖ Laboratory examination requests/orders During collection
❖ Patient preparation and pre-collection ➔ Extended tourniquet time
assessment ➔ Hemolysis
❖ Collection of specimens ➔ Wrong order of draw
❖ Labeling the specimens ➔ Failure to invert tubes
❖ Transporting the specimens ➔ Faulty technique
❖ Specimen receipt, handling, and storage ➔ Underfilling tubes
❖ Evaluating the condition of the specimens After collection
❖ Communicating when the specimen is ➔ Failure to separate serum from cells
unacceptable ➔ Improper use of serum separator
❖ Processing the specimens ➔ Processing delays
Pre-Analytical Factors ➔ Exposure to light
Before collection ➔ Improper storage conditions
➔ Patient Misidentification ➔ Rimming clots

C.R.D.CORONEL
PHLEBOTOMY
CGHMC - Laboratory
Ms. Cristina Labrador

- Quality control actually starts before the move or roll when the needle is
specimen is collected from the patient inserted. There are also fewer nerve
- To obtain an acceptable specimen, endings surrounding this vein
the patient must be prepared making venipuncture less painful at
properly. In a hospital setting, the this site.
phlebotomist must ensure that the - In some people, the cephalic and/or
nursing department has performed basilic veins maybe more easily
all pre-test preparations (such as located than the median cubital vein
fasting).This means that you must and may be a more appropriate vein
learn what preparations are required to draw blood from. The
for which test. phlebotomist must take care in
- In an outpatient setting, you must anchoring those veins well to
ask the patient about pre-test prevent rolling.
preparations. - Sometimes, venipuncture is
- Venipuncture is when a vein is pierced by performed on hand veins when the
a needle for either intravenous injection or veins in the antecubital fossa are not
the removal of blood. appropriate. Blood is collected from
- Veins are favored over arteries the dorsal or back side of the hand.
because they have thinner walls, Similar to veins in the antecubital
and thus they are easier to pierce. fossa, they are prominent in different
There is also lower blood pressure in positions on different individuals.
veins so that bleeding can be Veins in the hand have a tendency
stopped more quickly and easily to move or roll; thus, the
than with arterial puncture. phlebotomist should ensure that the
- The most common site for skin is pulled and the vein is well
venipuncture is the antecubital fossa anchored down prior to needle
located in the anterior elbow at the insertion.
fold. This area houses three veins: - Procedure:
the cephalic, median cubital, and i. Patient comfort. Is the seating
basilic veins. The veins may be comfortable and has the patient
visible in some individuals but not been seated for at least 5 minutes to
others, or more easily felt in some, avoid being rushed or confused?
depending on the amount of muscle ii. Carry out hand hygiene before and
and fat tissue they have. Vein after each patient procedure, before
patterns may also run differently putting on and after removing gloves
between individuals. iii. Identify the patient using two
- Generally, the cephalic vein runs different identifiers, asking open
along almost the entire length of the ended questions such as, "What is
arm and the median cubital vein your name?" and "What is your date
connects the cephalic vein with the of birth?"
basilic vein. Of these three veins, the iv. Assess the patient's physical
preferred one for venipucture is the disposition (i.e. diet, exercise,
median cubital vein because it is stress).
larger and has a lower tendency to
C.R.D.CORONEL
PHLEBOTOMY
CGHMC - Laboratory
Ms. Cristina Labrador

v. Check the requisition form for or Infant is the heel, only lateral
requested tests, patient information, parts are used, not central part to
and any special requirements. avoid medial calcaneus nerve, injury
vi. Select a suitable site for to this nerve can cause necrotizing
venipuncture. osteochondritis.
vii. Prepare the equipment, the patient - Procedure:
and the puncture site. i. Make sure the baby is lying in a safe
viii. Perform the venipuncture, collecting position.
the sample(s) in the appropriate ii. Prewarming the infant's heel (for 3 to
container(s). 5 minutes) is important to increase
ix. Label the collection tubes at the the flow of blood for collection of
bedside or drawing area. specimens.
x. Recognize complications associated iii. Clean the site to be punctured with
with the phlebotomy procedure. wet cotton.
xi. Assess the need for sample iv. Dry the cleaned area with dry cotton.
recollection and/or rejection. v. Hold the baby's foot firmly to avoid
xii. Promptly send the specimens with sudden movement and to apply
the requisition to the laboratory slight tension to the skin. Note: Care
must be taken not to damage the
heel by holding it too forcibly.
vi. Using a sterile blood lancet,
puncture the heel.
vii. Wipe away the first drop of blood
with a piece of clean, dry cotton.
viii. Since newborns do not often bleed
immediately, use gentle pressure to
produce a rounded drop of blood.
Note: Do not use excessive pressure
because the blood may become
diluted with tissue fluid.
ix. Collect blood sample using a test
tube, capillary tube, or automatic
pipette.
x. When finished, elevate the heel,
place a piece of clean, dry cotton on
the puncture site then with an
injection pad if available. and hold it
in place until the bleeding has
stopped.

- Neonatal Blood Sampling(Heel Prick)

- Site: The recommended location for
blood collection on a newborn baby
C.R.D.CORONEL
PHLEBOTOMY
CGHMC - Laboratory
Ms. Cristina Labrador

❖ Defining and adhering to turnaround

times
❖ Entering critical laboratory data
❖ Correcting erroneous results
❖ Storing specimens appropriately
❖ Obtaining information needed for
follow-up testing
❖ Troubleshooting delays or failures to
communicate critical/alert values

- Examination process
- What happens during testing
- Examples:
❖ Using appropriate testing methods
❖ Using appropriate equipment
❖ Performing quality control
❖ Troubleshooting equipment and reagents
❖ Troubleshooting erroneous results and
quality control errors
❖ Reviewing and verifying results
❖ Interpreting other information that
correlates with the test results
❖ Reconciling discrepancies in laboratory
findings
❖ Maintaining turnaround times for this
phase of testing

- Post-examination Process
- What happens after testing
- Examples:
❖ Reporting the final test result
❖ Notifying appropriate providers of critical
values when appropriate

C.R.D.CORONEL