Methodologies and Regulations in Specimen Collection and Management Module 6: Special Draws

Methodologies and Regulations in

Specimen Collection and ManagementModule 6:

Special Draws

ObjectivesAfter this presentation you will be able to:• Describe the steps in using a winged infusion

needle for the collection of blood• Discuss the use of a syringe for blood

collection• Describe dermal or skin punctures• Describe the correct procedure for capillary

blood collection

Today’s Agenda• Describe the steps in using a winged infusion

needle for the collection of blood

• Discuss the use of a syringe for blood collection

• Describe dermal or skin punctures

• Describe the correct procedure for capillary blood collection

Butterfly or Winged Infusion Set

• Used for small veins on infants and small children

• Adults with difficult veins• Hand or wrist veins• Most commonly used needle is a 23g and

sometimes a 25g• Note:– Specimens can hemolyze– Tubes that are too large can collapse the vein

The Butterfly Winged Infusion Procedure

• Follow the same procedure as for a routine venipuncture

• When removing the butterfly from the package pull on the tubing to keep from coiling

The Butterfly Winged Infusion Procedure

• If using a hand vein, insert the needle at a 10 - 15 degree angle

• Either a syringe or an evacuated tube holder can be added to the end of the tube

Butterfly• A flash of blood will appear in the tubing

• Seat the needle by threading it up the lumen of the vein. This action will prevent the butterfly from twisting

• If the needle needs to be held in place, use the index finger of your left hand with light pressure on the wing (do not tape wings)

NeedleLink Tubing

CollectionVial

Safety Barrel

Butterfly• Keep the tube and holder in

a downward position so that the tube fills from the bottom up

• Follow order of draw

• Safety cover the needle

• Be careful when disposing the needle, sometimes it tends to twist

ANY QUESTIONS?

Today’s Agenda• Describe the steps in using a winged infusion

needle for the collection of blood

• Discuss the use of a syringe for blood collection

• Describe dermal or skin punctures

• Describe the correct procedure for capillary blood collection

Syringe Draw• The syringe is another method of blood

collection

• It is used for fragile veins, elderly patients, and children

• The phlebotomist can control the amount of pressure by pulling on the plunger slowly

Parts of a Syringe

• Plunger– Used to pull the blood out

• Barrel– To hold the syringe in place

• Needle Hub– Needle attaches to

• Needle– Various sizes

PlungerBarrel

Needle Hub

Needle

Syringe Procedure• Follow the same procedure as for a routine

venipuncture

• Place needle on the hub of the syringe securely

• Move the plunger up and down, make sure it moves freely

• Push the plunger all the way to the down to the hub end where the needle is attached

Syringe• When blood enters the syringe, pull the

plunger slowly

• Be careful not to pull the plunger out of the syringe

• Fill syringe to capacity but do not pull out the plunger

• Immediately transfer the contents of the syringe to the appropriate tubes with a safety transfer device

14

Safety Transfer Device

• Follow Order of Draw

• Always use a safety blood transfer device when filling tubes from a syringe draw

Transferring Blood From a Syringe to a Tube

• If a safety transfer device is unavailable, use the following method:– Place the tube in a tube holder

– Keep your free hand behind your back, DO NOT hold the tube or the tube holder

– Slowly pierce the vacuum of the tube with the syringe

– Let the blood flow into the tube

Knowledge Check

• What is the purpose of using a butterfly or syringe for blood collection?

ANY QUESTIONS?

18

Today’s Agenda• Describe the steps in using a winged infusion

needle for the collection of blood

• Discuss the use of a syringe for blood collection

• Describe dermal or skin punctures

• Describe the correct procedure for capillary blood collection

Skin Puncture• Venous

• Arterial

• Tissue

• Capillary

• More closely resembles arterial; especially if area is warmed

• Reference values for skin are different than venipuncture

When to Perform a Skin or Dermal Puncture

• Adults – No accessible veins

• Infants – Difficult to perform venipuncture, may damage

veins, to remove small amounts– Babies over the age of 1 year

• Some laboratory tests are designed to be performed by the skin puncture

Skin or Dermal Puncture Equipment

• Lancet• Microcontainers– red– purple– green

• Microhematocrit Tubes– Hematology or Chemistry Testing

• Warming Devices– Increase the blood flow as much as 7X

Site Selection

• Skin puncture sites should be warm, pink and free of cuts, bruises or rashes.

• Do not choose a site that is cold, cyanotic or swollen

Finger Punctures• Finger punctures can be used for adults

• Should not be performed on infants and children less than one year

• Recommended site: middle finger of the non-dominant hand (second choice: ring finger)

• Remember: Band-aids should not be placed on pediatric patients

Finger Punctures

• The puncture should be done perpendicular to the fingerprint on the fleshy pad

• Never puncture the tip or sides of the finger

• Never use the pinky or thumb

Puncture Site

Correct

Not Correct

Finger Punctures

Finger Stick Procedure• Wash hands and put on gloves

• Greet the client

• Identify the client

• Clean the site

• Make sure site is warm– A clients hand can be warmed by washing with

warm water or applying a paper towel soaked in warm water

Finger Stick Procedure• With the palm

facing upward, grasp the finger firmly between you thumb and index finger

• Puncture across the fingerprint

• Wipe off first drop of blood

Finger Stick Procedure

• Follow order of draw for the skin puncture

• Label all tubes properly

Finger Stick Procedure

ANY QUESTIONS?

Today’s Agenda• Describe the steps in using a winged infusion

needle for the collection of blood

• Discuss the use of a syringe for blood collection

• Describe dermal or skin punctures

• Describe the correct procedure for capillary blood collection

Heel Stick Site• Infant–Recommended heel site

for blood collection is the medial or lateral portion of the heel

Primary Site

Primary Site

Secondary Site

Cleaning Procedures• Clean heel with 70% isopropanol

• Site should dry completely

• Remember: Alcohol + RBC’s = Lysed cells

• Iodine should not be used for skin punctures because it interferes with bilirubin, potassium, phosphorus and uric acid results

Heel Stick Procedure

• Wash your hands and put on gloves

• Properly identify of the client

• Select the site, warm area for at least 3 minutes

• Cleanse the site and let completely dry

Heel Stick Procedure

• Hold the foot with a firm grip, grasp heel with thumb

placed below puncture site and index finger placed over

the arch

• Puncture site at a 90 degree angle parallel to the heel

• Use a quick continuous motion

Heel Stick Procedure• Wipe away the first drop of blood• Ease thumb pressure and apply intermittent

pressure. Avoid milking and scraping• Follow recommended order of draw • When blood collection is complete, clean

area, apply pressure. – Never apply band-aid under the age of two

• Label specimens immediately after the draw; never before

Heel Stick Technique• Infant heels are appropriate for blood collection

until approximately 6 months to one year

• Never exceed 2.0 mm in puncture depth

• Never puncture the posterior curvature of the heel or the arch of the foot

• Never use sites previously punctured, bruised, swollen or red in color

• Never puncture the heel more than twice for any one collection

ANY QUESTIONS?

Knowledge Check• What is the maximum length of a lancet for

performing a heel stick?– Answer: 2.0 mm

• Why is the first drop of blood wiped away during the collection of the finger stick?– Answer: first drop is contaminated with tissue

fluid and will dilute specimen (give false lower results)

• What is the finger of choice for performing a finger stick?– Answer: Middle finger of either hand

Remember: Order of Draw for Skin Puncture

• Peripheral bloods smear

• Hematology tests (EDTA)

• All other additive tubes

• All plain / serum tubes

Successful Blood Collection through Skin Puncture

• Warming the site increases the flow sevenfold

• Avoid milking or scraping the site which can cause hemolysis

• Alternately applying and releasing pressure will promote a good flow

• Betadine or iodine should not be used to cleanse. It interferes with bilirubin, potassium, calcium, phosphorus, uric acid, total protein, and glucose results

• Failure to allow alcohol to dry will cause hemolysis and stinging

Successful Blood Collection through Skin Puncture

Challenging / Difficult Patients

• Injection Drug Users• Babies / Infants• Geriatric patients• Obese patients• Patients with mastectomies• Patients with IVs• Patients with broken bones

SummaryAfter this presentation, you can now:• Describe the steps in using a winged infusion

needle for the collection of blood

• Discuss the use of a syringe for blood collection

• Describe dermal or skin punctures

• Describe the correct procedure for capillary blood collection and Order of Draw

ANY QUESTIONS?THANK YOU!