Before the insertion of the needle, the site should be cleansed with an alcohol wipe. Once the site is chosen the phlebotomist will open the alcohol wipe and apply it to the site to prevent potential contamination. The phlebotomist and the patient must not touch the site after it is cleaned or the phlebotomist will have to repeat the procedure before the needle is inserted.
A tourniquet compresses the veins and restricts the flow of blood back to the heart. This allows the phlebotomist to see the veins more clearly to make a successful venipuncture. After the phlebotomist selects the vein, the tourniquet is tied three to four inches above the intended site. The tourniquet should be removed at the end of the procedure.
Needle selection depends on the procedure and personal choice. Some experienced phlebotomists prefer the butterfly needle for every procedure, while others use the butterfly needle for smaller veins or pediatric procedures. Also known as winged infusion sets, butterfly needles are characterized by a pair of plastic wings that the phlebotomist can grip to more easily guide the needle into the vein. A tube extends from the needle down to a tube holder where the phlebotomist connects the collection tube. Straight needles vary in size and are often connected to a plastic tube holder. After insertion in the vein, the needle will be held still by the phlebotomist while the collection tubes are switched in and out in the tube holder.
BLOOD COLLECTION TUBES
Collection tubes come in a rainbow of colors. Each stopper color denotes a particular function and test. Colored stoppers are essential for the correct order of the draw. A phlebotomist will select the tube depending on the type of test that is ordered for the patient. Additives in the tubes are essential for the type of test for which the blood is collected. For example, lavender tubes contain an additive that helps the blood coagulate and is used for specimen collection specific for hematology procedures. Collection tubes are manufactured so that they are evacuated tubes and then seal. When the phlebotomist inserts a needle in the tube the vacuum pulls the blood from the vein into the tube. At times, a tube will malfunction requiring the phlebotomist to reach for another one to complete the blood collection. For this reason, the phlebotomist should keep extra tubes within reach so that the procedure can continue.
Blood collection tube labels are necessary for the correct transfer of patient samples to the lab for testing and diagnosis. Like other phlebotomy equipment, labels should be secured before the start of the venipuncture. Labels should include the patient’s name, date, and other identifying information. The process for labeling blood collection tubes depends upon the laboratory. Labels may be computer-generated and printed or blank for hand-written labeling. Either way, the phlebotomist will double-check the patient’s identity to make sure the blood sample reaches the lab under the right name.
GAUZE OR BANDAGES
At the end of the venipuncture procedure, the phlebotomist will remove the needle from the blood draw site and check for bleeding. A piece of gauze or a cotton ball will be placed over the injection site and a slight bit of pressure applied to prevent excessive bleeding and to encourage clotting. Afterward, the phlebotomist will affix a bandage or a piece of gauze secured by tape. The bandage should remain in place for the length of time specified by the phlebotomist.