Venipuncture using syringe and needle It is used to collect blood from patients with difficult veins. The preparation procedures are the same as for the vacuum tube system. After withdrawing blood gently expel the blood into a collection tube, avoiding foaming or rupture of the cells by using gentle pressure.

Venipuncture using the infusion set For veins other than those in the antecubital fossa, for coagulation studies, for babies and small children with small veins, obese patients with hard to find veins, and for collection from scarred veins, a syringe and needle or an infusion set (Butterfly) is used. For a patient with small, fragile, rolling veins or in wrist, back of the hand, ankle, foot, or scalp, the infusion set is used. Winged infusion needles are preferable to standard venipuncture needles when drawing from tiny veins because they are commercially available in small gauges (25 gauge). Pediatric patient collections make use of infusion set. Attachment of the infusion set is done to an evacuated tube holder or it is attached to sterile syringe.

Venipuncture from existing intravascular devices or indwelling lines Vascular access for extended period of time is obtained by devices like indwelling lines or intravascular devices for administration of therapeutic blood products, or for infusion of fluids, medications, or parenteral nutrition solutions etc. Collection of venous or arterial blood from these devices is done by trained and experienced technicians. Stringent aseptic control procedure is required for collection of blood from intravascular devices because one of the serious complications can be infection and septicemia in an immunosuppressed patient.

For collection of blood from intravascular devices, each healthcare facility has its own policy and procedure. Intravascular devices blood collection requires a special training program for phlebotomists. A silicon catheter, and a self healing silicon septum encased in a metal/plastic ports are the main parts of an intravascular device. Under local or general anesthesia, the device is implanted surgically in a patient and the portal is secured to the fascia under the skin and the catheter is tunneled through subcutaneous tissue to a major blood vessel. In the vein the venous port catheters are placed. Attending physicians make the decision to use an intravascular device for obtaining blood specimen.

Venipuncture from Heparin lock Indwelling ringed butterfly needle makes up a heparin lock system. Administration of medication intravenously or collection of blood samples can be done in heparin lock for 36-48 hours. Multiple punctures can be eliminated, veins of patient can be saved and trauma to the veins can be decreased by using this device. The diluted heparin solution is injected into the tubing and held inside by a plug at the end of the butterfly line.

Since a needle is a foreign body placed directly into patient’s vein, stringent infection control procedures like using antibiotic ointment and careful monitoring for inflammation are used to monitor the device. It is important to discard a waste sample of 2-3mL of blood before using the sample for analysis. Collection of blood from heparin lock requires the phlebotomist be specially trained and educated.

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.

Patient and donor (during blood banking) interaction should be cordial for phlebotomists. A good bedside manner is an important trait for a phlebotomist comparable to doctors and nurses. Phlebotomists should not be upset while drawing blood and other fluids from patients. Finger sticks for obtaining minute samples of blood is also a competency for phlebotomists. One of the core competencies is the collection of blood from infants through a heel stick. These competencies are attained by certification which ensures meticulous training for phlebotomists.

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