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Venipuncture using syringe and needle For patients with difficult veins venipuncture using syringe and needle is used. Vacuum tube preparation procedures which are common for both methods are followed for this method. Foaming or rupture of the cells is avoided by gentle expelling of blood into a collection tube after withdrawal.

Venipuncture using the infusion set A syringe and needle or an infusion set (Butterfly) is often used for coagulation studies, for babies and small children with small veins, obese patients with hard to find veins, for scarred veins and for veins other than those in the antecubital fossa. The infusion is used for drawing blood from a patient with small, fragile, rolling veins or in wrist, back of the hand, ankle, foot, or scalp. A 25-gauge needle is recommended for smallest and most fragile veins. A syringe collection system is preferred over evacuated tube system when using 25-gauge infusion set. The infusion set is often used for collecting specimens from pediatric patients. An infusion set is either attached it sterile syringe and manually filling it or by attaching it to an adapter attached to an evacuated tube holder.

Venipuncture from existing intravascular devices or indwelling lines Devices like indwelling lines or intravascular devices are used for vascular access for extended period of time for administration of therapeutic blood products, or for infusion of fluids, medications, or parenteral nutrition solutions. It is possible to collect venous or arterial blood samples from these devices, but this is only done by well trained experienced phlebotomists. Infection and septicemia are serious consequences in an immunosuppressed patient; strict asepsis control protocol is required for collection from intravascular devices. Each healthcare facility has its own policy and procedure for collection from indwelling lines or intravascular devices.

A special training program for phlebotomists is necessary for drawing blood from intravascular devices. An intravascular device consists of a silicon catheter, and a self healing silicon septum encased in a metal/plastic ports. It is surgically implanted in the patient using local or general anesthesia, the catheter is tunneled through subcutaneous tissue to a major blood vessel and the portal is secured to the fascia under the skin. The device is accessed by needle puncture through the skin into a port or through a diaphragm. For venous port catheters are placed in a vein. The decision to use an intravascular device for obtaining a blood specimen is made by attending physicians.

Venipuncture from Heparin lock. A heparin lock system consists of indwelling ringed butterfly needle. It can be used in a vein for 36-48 hours to administer medication intravenously or collecting blood samples. This device can save veins of the patient, and decreases the trauma to the veins by eliminating multiple punctures. Dilute heparin solution is injected into the tubing and a plug at the end of the butterfly line holds the solution in place.

Strict adherence to infection control procedures like using antibiotic ointment and careful monitoring for inflammation is needed because a needle is a foreign body placed directly into patient’s vein. Before using sample for analysis a waste specimen of 2-3 mL is withdrawn and discarded to remove heparin solution. A phlebotomist must be specially trained and educated to withdraw blood from heparin lock.

Blood collection for culture. Blood collected for culture should be free from contamination, so the skin is cleaned three times with povidone iodine solution in a concentric outwardly moving circle. Then povidone iodine is removed with an alcohol pad and aseptic precaution is followed to touch the vein with phlebotomist’s gloved finger. Collection is done in culture bottles using evacuated system. The container tops should be sterilized and dry.

Good working relationship with patients and blood donors (in blood bank) should be maintained by the phlebotomists. A good bedside manner is very important for phlebotomist which is similarly present in doctors and nurses. A phlebotomist should not get distressed when withdrawing blood or other fluids from patients. Fingerstick competency is used when minute blood samples are needed by phlebotomists. An important competency for the phlebotomist is the Heelstick collection from infants. These competencies should be well learned by the phlebotomist which is ensured by the certification.

Written by Phlebotomy Training specialist Dr Shahbaz A. Cheema, Course Director for Maxis Healthcare who run NHS Accredited Phlebotomy Training courses for medical and non medical practitioners. Learn the 3 Steps To Become a Phlebotomist