Page 13 - PHLEBOTOMY STUDY GUIDE

Page 13 of 36

PRE-ANALYTICAL ERRORS: An error that is made before the blood is analyzed.
You want to avoid making pre-analytical errors, it prolongs the patient care and is
frustrating to the employer. The chart below gives a description of some common pre-
analytical errors.
Before the collection: During the collection: After the collection:
•Patient misidentification •Drawing blood from the wrong •Improper use of serum separator
•Improper Time of Collection patient •Processing delays
•Wrong Tube •Drawing blood from an IV •Exposure to light
•Inadequate fast •Using the wrong needle gauge •Improper storage conditions
•Exercise •Did not follow the order of draw •Not placing the tube upright
•Improper site preparation
•Medication interference

ROUTINE VENIPUNCTURE

1) Verify the requisition for the tests.
2) Introduce yourself to the patient, explain the procedure, and secure his/her

informed consent. Implied consent is a non-verbal communication, used
when the patient is unconscious or clinically unstable.
3) Identify the patient: for in-patient check the patient’s wristband, if you can not
locate it have the nurse re-band the patient. In a clinic setting have him/her
state his/her name full name and date of birth. 2 Identifier is required,
the most critical mistake a phlebotomist can make during the collection
process is not properly identifying the patient.
4) Wash your hands before touching your patient or the equipment.
5) Tie on the tourniquet; it should be applied 3-4 inches above the site where the
venipuncture will be made. Ask the patient to make a fist or open and close
his/her hand to help engorge the vein. Do not pump this can elevate
potassium levels in the blood and cause hemoconcentration.
6) Palpate the vein while looking for the straightest point. It’s not what you see,
it’s what you feel. Cleanse the area wiping away from the venipuncture site.

Allow the site to air dry.
7) Don your gloves, assemble the needle and tube holder while the alcohol is
drying. Uncap the needle and examine it for defects such as blunted or barbed
points.
8) Hold the patient’s arm, by placing four fingers under the forearm and your
thumb below the antecubital area slightly pulling the skin back (taunt) to
anchor the vein. The purpose of anchoring the vein is to keep it still, veins
can move if you do not anchor it. Hence the term “Rolling veins”
9) With the bevel facing upward, insert the needle at an angle of 15-30 degrees
angle.

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