In a healthcare setting, phlebotomy or venepuncture is one of the most common procedures which is performed for blood sample collection. Common but also complex. It requires a certain level of knowledge and skill in order to assure the accuracy and integrity of the samples drawn. Also to eliminate any risk to both patient and the phlebotomist.
What is Phlebotomy and Who is a Phlebotomist?
The majority of you might not know who exactly a phlebotomist is but, it is most likely that you would have used the services of one.
Phlebotomists are trained and skilled healthcare professionals who carry out a phlebotomy, even doctors, nurses and other technicians can also perform phlebotomy.
Phlebotomy is the procedure in which a phlebotomist or a healthcare worker draws out blood from a vein, with the help of a needle, for laboratory testing. It may also be called blood draw or venepuncture.
Now we have a name for the person who draws out blood for laboratory testing and the name of the procedure through which a blood sample collection is carried out or if you need health checkup at home you can also avail that service.
What happens if, during a blood sample collection, the correct procedure is not being followed?
The number of serious adverse events linked with phlebotomy are rare however, may include loss of consciousness with tonic-clonic seizures, and in blood transfusion services, when a poor venepuncture practice is carried out it results in bruising, hematoma and may cause injury to anatomical structures in the vicinity of the needle entry. If a blood sample collection is poorly done, the results may be inaccurate and the patient may have to undergo the inconvenience of repeating the test.
All blood samples are considered as infectious and proper precautions should be observed while collecting blood either from a vein or a skin puncture. Whether you are in a hospital or at home, there are certain guidelines prescribed by the World Health Organization (WHO) which are taken into consideration during a blood sample collection. You can also check our health package offer for the tests combo.
The first and the most important step is to accurately ID the patient using at least two forms of identification, does the name and date of birth on the requisition form match with what the patient is telling, whether the patient followed special orders such as fasting prior to the blood sample collection.
Performing Hand Hygiene
The phlebotomist washes their hands thoroughly with soap and water and lets the hands dry completely before putting on a clean pair of well-fitted and non-sterile gloves.
They can also rigorously sanitize their hands with sanitisers approved by WHO and rubbing the hands dry with hand towels that are sanitized and disposable.
If handwashing with soap and water then the duration of the procedure should be between 40 to 60 seconds, and 20 to 30 seconds when using an alcohol-based solution.
The phlebotomist should perform hand hygiene before coming in contact with the patient.
Accessibility of all Necessary Equipment
Make sure the alcohol prep pads, gauze tape, the correct gauge needles and required evacuated collection tubes are within an easy reach for the phlebotomist but should be at a distance from the patient.
Applying the Tourniquet
While applying the tourniquet (a band or a device which stops blood flow), the arm of the patient should be straightened out. Applying a tourniquet slows down the flow of blood in the veins and it increases venous filling thus making the veins more noticeable, easier to locate and easier to enter.
The tourniquet should not be too tight and should not be applied for more than one minute. Leaving the tourniquet longer than a minute may cause hemoconcentration and may affect the test results and should therefore be removed and reapplied if the procedure will take longer than one minute.
Disinfecting the Entry Site
An alcohol prep pad is used to cleanse the skin around the site in a fluid circular motion and is swabbed from the centre to the periphery of the site. The prep pad should not be dragged back across the cleansed field. The area is then left to air dry. This helps in preventing contamination of either the patient or the specimen.
It is recommended that the entry site should be cleaned with 70% alcohol or 0.5% chlorhexidine.
Making the Patient aware of the Withdrawal
The patient’s arm is grasped firmly, placing the thumb approximately 2 inches below the intended puncture. With the same thumb, the skin taut is pulled over the vein to anchor it in place and then the patient is made aware before making the puncture for the blood sample collection, so the patient does not startle and jump. Making the patient aware of the withdrawal helps in preventing any physical harm to them.
Correct Position of the Needle
The needle bevel side should be up and in line with the vein. The position of the needle should form a 30-degree angle with the surface of the arm with a single, short but firm motion. The needle is swiftly inserted through the skin and into the vein. The evacuated tube onto the needle is pushed when the needle enters the vein as the vein aligns with a needle. When the blood begins to move out of the vein and up into the needle, a constant slight forward pressure is maintained on the end of the tube. The evacuated tubes are colour coded based on their additives.
Removing the Tourniquet
As soon as the blood begins to flow into the collection tube, the patient is instructed to open their hand and then the tourniquet is removed from the arm. Removing the tourniquet allows the blood to return to its normal rate of flow through the vein and helps in reducing the bleeding at the puncture site.
Avoiding Hemolysis
Hemolysis can be avoided during the blood sample collection by withdrawing the blood gradually, and then the needle should be detached from the syringe before dispensing blood into the container. Disassembling of an exposed, used needle should never be done with bare hands.
A gentle mixing by inversion is done at least 8 times, which is required to assure that any additives in the tube are incorporated into the blood sample.
Applying Pressure at the Entry Site
Pressure is applied at the needle entry site immediately after the removal of the needle as it will help in preventing a hematoma formation and allows hemostasis to seal the wound. Failure to apply pressure on the puncture site right after removal of the needle can cause bleeding from the vein into the space around it forming a hematoma, a collection of blood under the surface of the skin that will become bruised in appearance and will be painful to the touch.
Correct Labelling
After the blood sample collection, applying the correct ID label on the filled evacuation tube is of utmost importance and also storing it carefully to transport it to the lab. The label must include at least the patient’s ID number, full name, date of birth and the date of the blood sample collection.
Disposal of Needle and Syringe
Before disposing of the needle, engage the safety device and use the sharps device for proper disposal. The same needle and syringe should not be used for any other patient and should be disposed after each use.
Using standard precautions, disposal of needles in a sharps container, dispense of all other non-sharp materials including gloves and gauze pads in an approved trash receptacle. In addition to that, all contaminated surface areas should be disinfected.
When the blood sample collection is over, the healthcare worker will wash their hands properly and will make sure that the site where the skin was punctured is not bleeding and the customer is feeling alright.
Fortunately, all the blood sample collections are completed in an entirely professional skilled and successful manner. Most but not all. Poor technique, poor judgement, lack of knowledge and skill, loss of concentration and undue haste are factors that can impact the integrity of a sample negatively or worse, which can create undue stress and pain or may physically harm a patient. Serious complications are most likely to arise when targeting the basilica vein with its close proximity to nerves which can be permanently damaged or the brachial artery could be nicked even with a proper angle, the appropriate needle size must be used.
The level of quality and integrity of the blood sample collection that the laboratory receives is dependent upon the level of skill, knowledge and professionalism of the phlebotomist. You can check the other types of blood tests like kft test, lipid profile test, vitamin D test. A big responsibility but one that can make a real difference in the lives the patients.
Now we know all the necessary precautions that a phlebotomist should take during a blood sample collection. So when the next time you go for a blood sample collection, observe whether the phlebotomist or the healthcare worker is using all the precautions that are supposed to be taken by them, and if you notice some precautions being missed then feel free to correct them.
Hope you have a safe and satisfactory experience when you book your next blood sample collection!
FAQ’s
- What are the different types of blood tests and what conditions do they screen for?
There are various types of blood tests that your doctor may recommend, including:
1. Complete Blood Count (CBC): This test examines the overall health of your blood cells, such as red and white blood cells, to detect conditions like anemia and infections.
2. Basic Metabolic Panel (BMP): This test evaluates your general well-being by measuring electrolyte levels, blood sugar, and kidney and liver function.
3. Lipid Panel: This test assesses your cholesterol and triglyceride levels to determine your risk of heart disease.
4. Thyroid Tests: These tests analyze thyroid hormone levels to diagnose thyroid disorders.
Your doctor will suggest the most appropriate tests for your specific needs.”
- Are there any risks or complications associated with venipuncture?
Yes, venipuncture, like any medical procedure, does have potential risks that should be noted. While most of these risks are minor, here are a few to keep in mind:-
Bruising (hematoma): This is the most frequent complication, leading to a sore lump at the spot where the needle was inserted.
Pain: It’s possible to experience some discomfort when the needle is being placed.
Fainting: Some individuals may feel lightheaded or faint when they see blood.
Infection: The chance of infection is minimized by using proper sterilization techniques. Missed puncture: Occasionally, the healthcare provider may need to make more than one attempt to locate a vein.
- What should I do if I experience discomfort or have concerns after venipuncture?
It is normal to experience some mild soreness, bruising, or redness around the spot where blood was drawn. To alleviate these symptoms, apply a cold compress to the area for brief periods and leave the bandage in place for a few hours. If you notice any severe pain, swelling, increasing redness, or continued bleeding, please seek advice from your healthcare provider.
- What are some potential complications of venipuncture?
Getting your blood drawn is a normal part of healthcare, but it’s important to know about potential risks. This can include bruising, swelling, fainting, and discomfort at the needle insertion point. In rare cases, nerve damage or infection can also happen. If you’re worried about getting your blood drawn, discuss it with your doctor.
- How can I prepare for a blood draw to make it less stressful?
Getting a blood draw is a common procedure, but it doesn’t have to make you anxious. Keeping yourself hydrated makes it easier for the technician to locate your veins. If you tend to get nervous, it’s helpful to inform the technician so they can provide relaxation techniques. Taking deep breaths or listening to music can also help you relax during the blood draw.
- What are some signs of infection after a blood draw and what should I do if I experience them?
If you notice some slight bruising or soreness at the spot where you had your blood drawn, don’t worry, that’s normal. However, keep an eye out for any signs of infection such as more redness, swelling, heat, or pus. If you notice these symptoms, along with a fever or chills, it’s important to get in touch with your doctor as soon as possible. Prompt medical attention can help avoid any further issues.
