BLOOD

SAMPLE
COLLECTION
PRESENTED BY:
Sonali
M.Sc. (Nsg.) 1st Year
CON, AIIMS New Delhi
 BLOOD COLLECTION FOR
TESTING
There are
three types of • Venous blood (venous blood is collected
blood samples most frequently, e.g. for erythrocyte
collected for sedimentation rate test)
the • Arterial blood (e.g. examination and
examination
determination of blood gases)
of blood
• Capillary blood (e.g. blood glucose)
parameters
and values:
 TYPES OF BLOOD SPECIMENS
WHOLE BLOOD
To obtain a whole blood specimen, the blood must be collected in a tube that contains an anticoagulant.
The sample then does not clot. Following are examples of laboratory tests that can be performed only on
whole blood.
• Complete blood cell count (CBC)
• Erythrocyte sedimentation rate (ESR)
• Hemoglobin electrophoresis

SERUM
Blood that has been removed from the body will coagulate (clot) in about 20 minutes. The clot consists of
the blood cells trapped in a mesh of fibrin, a product produced during the coagulation process. The
remaining portion of the blood specimen is fluid and is called serum. Following are some examples.
• Serum protein electrophoresis
• Hepatitis B antibody
PLASMA
To obtain plasma in a blood sample, the blood must be prevented from clotting.
This is accomplished by drawing the blood into a tube that contains a substance
called an anticoagulant. Some laboratory tests can be performed only on plasma.
Following are some examples.
• Prothrombin time (PT)
• Activated partial thromboplastin time (aPTT)
• Di-Dimer
COMMON VACUTAINER TYPES
USED FOR BLOOD SAMPLE
COLLECTION
 ADDITIVES USED IN
VACUTAINERS
The following substances are types of
The following substances are other types of
anticoagulants. Their presence in tubes prevents the
additives in tubes that are not anticoagulants.
blood from clotting.
• K2EDTA (potassium ethylenediamine tetra-acetic • Thrombin (helps the blood clot quicker)
acid) • Sodium fluoride (prevents glucose in the blood
• Na2EDTA (sodium ethylenediamine tetra-acetic from decreasing in quantity)
acid) • Gel (during centrifugation, moves up in the tube to
• Sodium citrate form a barrier between red cells and
• Sodium heparin serum/plasma)
• Lithium heparin
• Potassium oxalate
• ACD (acid citrate dextrose)
• SPS (sodium polyanethol sulfonate)
• CTAD (citrate, theophylline, adenosine,
dipyridamole)
ORDER OF
DRAW
VENIPUNCTURE SITE SELECTION
 COLLECTING BLOOD FOR
ROUTINE EXAMINATION
DEFINITION
• Obtaining blood sample by venipuncture for routine laboratory
investigations.

PURPOSES
• To determine variations if any in blood composition
• To determine any abnormality in order to aid in diagnosis
 ARTICLES
Small
mackintosh Sterile Syringes
Tourniquet
with draw 5ml, 10ml
sheet
20 or 23 gauge
Disposable
needles or
Alcohol swabs gloves/clean
vacutainer
gloves
assembly

Specimen Laboratory Dry

container- test requisition cotton/Band-
tube or bottle form aid

Sterile gauze Puncture proof

Adhesive tapes
pads container
PROCEDURE
 Nursing action Rationale
PREPROCEDURAL STEPS
1. Check the physician’s order
2. Identify the patient Ensures performance of procedure on
right patient
3. Reassure the patient and explain that relatively little blood will be Obtains patient’s cooperation and
taken confidence.
INTRAPROCEDURAL STEPS
4. Wash hands and put on gloves Protects health care worker from possible
exposure to blood.
5. Select and examine the vein, visualize the vein, including the Select the vein that is visible, palpable and
antecubital area, wrist, dorsum (back) of the hand and top of foot fixed to the surrounding tissues so that it
(if necessary). Palpate the vein does not roll away

6. Instruct the patient to extend his arm. Hold the arm straight at Proper positioning reduces the risk of
the elbow with fist clenched. injury
7. Apply the tourniquet 5-15cm above the selected site with just A tourniquet when applied increases
sufficient pressure to obstruct venous flow venous pressure and makes the vein more
prominent and easier to enter

8. Cleanse the skin with alcohol swab in a circular motion; center to Cleansing the skin reduces the number of
periphery. Allow to dry microorganisms
9. Fix the chosen vein with thumb and draw the skin taut The vein may roll beneath the skin when
immediately below the site before inserting needle to stabilize the needle approaches its outer surface,
the vein especially in elderly and extremely thin
patients
10. Hold the syringe between the thumb and last three fingers with
the bavel up and directly in line with the course of the vein. Insert
the needle quickly and smoothly under the skin and into the vein.

11. Obtain the blood sample by gently pulling back on the plunger Use minimal suction to prevent hemolysis
of blood and collapse of vein

12. Release the tourniquet as soon as the specimen is obtained and

ask the patient to open the fist.
13. Apply sterile cotton balls to puncture site without applying Slow withdrawl of the needle is less
pressure and withdraw needle slowly along the line of vein painful and reduces trauma

14. Request patient to apply gentle but firm pressure to site for 2-4 Firm pressure over puncture site prevents
minutes leakage of blood into surrounding tissues
with subsequent hematoma development
15. Remove the needle from the syringe as soon as possible after Gentle ejection of blood prevents hemolysis
withdrawing blood, gently eject the blood sample into the
appropriate container without forming bubbles in the test tube or
bottle (some tests require container with anticoagulant)

16. Invert the tube gently several times to mix blood with Gentle handling of specimen prevents risk
anticoagulant where applicable. For some tests blood is allowed to of hemolysis
coagulate in the test tube
17. Apply band-aid/adhesive tape over the puncture site

POSTPROCEDURAL STEPS
18. Label the specimen correctly and send to laboratory immediately Specimen should reach the laboratory with
with completed requisition forms. the minimum of delay for optimum
reliability
19. Dispose the needle and syringe in appropriate containers. Avoids possible spread of blood-borne
diseases
20. Clean all spills with 10% bleach (sodium hypochlorite) solution. Avoids possible spread of blood borne
Remove gloves and wash hands. diseases
21. Record in the patient’s chart the procedure and the tests for which
the sample was sent to the laboratory
22. Replace the tray in the reusable articles in proper place.
 POINTS TO REMEMBER SPECIAL CONSIDERATIONS
• In case of difficult vein, a sterile • Follow standard precautions for ALL
needle must be used for each new patients.
collection attempt. • Never re-use a disposable needle or
• Never re-prick a site using the same instrument.
needle. • Safely dispose all sharps (needles,
lancets, scalpels) after use.
• Do not perform/assist invasive
procedures without gathering all
articles in a tray, it helps in safe
transportation of the needle/syringes
and blood samples.
• Do not re-cap the used needles to
prevent needle stick injury.
• Use personal protective equipment
(PPE) based on risk of the procedure.
 AREAS TO AVOID WHEN
CHOOSING A SITE FOR BLOOD
DRAW
The upper extremity on Hematoma - may cause
Extensive scars from
the side of a previous erroneous test results. If
burns and surgery - it is
mastectomy - test another site is not
difficult to puncture the
results may be affected available, collect the
scar tissue and obtain a
because of specimen distal to the
specimen.
lymphedema. hematoma.

Intravenous therapy Cannula/fistula/heparin

(IV) / blood transfusions lock - blood should not
Edematous extremities -
- fluid may dilute the be drawn from an arm
tissue fluid accumulation
specimen, so collect with a fistula or cannula
alters test results.
from the opposite arm if without consulting the
possible. attending physician.
TECHNIQUES TO PREVENT HEMOLYSIS
(WHICH CAN INTERFERE WITH MANY
TESTS)
Mix all tubes with anticoagulant additives gently (vigorous shaking can cause hemolysis)
Avoid drawing blood from a hematoma; select another draw site.
If using a needle and syringe, avoid drawing the plunger back too forcefully.
Make sure the venipuncture site is dry before proceeding with draw.
Avoid a probing, traumatic venipuncture.
Avoid prolonged tourniquet application (no more than 2 minutes; less than 1 minute is optimal).
Avoid massaging, squeezing, or probing a site.
Avoid excessive fist clenching.
If blood flow into tube slows, adjust needle position to remain in the center of the lumen.
COMPLICATION
S
Haematoma
as a result of Phlebitis – in
unsuccessful
frequently
puncture, or
after repeated
withdrawal of sampling
the needle

Disruption of
Bleeding
limb mobility
from the
– nerve
injection site
disruption
 NURSING RESPONSIBILITIES
Prepare the client
Complete lab requisition forms
Collect right specimen from right patient in right container
Follow the safety measures
Label the specimen correctly
Timely transfer of specimen to the lab
Documentation of the procedure
Examine patient for any complication
 CONCLUSION
Phlebotomy is the process of making a puncture in a vein, usually in
the arm, for the purpose of drawing blood. The procedure itself is
known as a venipuncture.It is essential to follow a standard procedure
for the collection of blood specimens to get accurate laboratory results.

Knowing the procedure or process when drawing blood is the first step
to ensuring that health workers have carried out the procedure
correctly and the phlebotomy (blood draw) process runs smoothly. The
patient’s safety and comfort is, therefore, guaranteed.
THANK YOU