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Phlebotomy Periprocedural Care

  • Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Vincent Lopez Rowe, MD  more...
 
Updated: Nov 25, 2015
 

Patient Education and Consent

Review the phlebotomy order and the patient’s written consent. Review the procedure with the patient, inform him or her about the tests for which the blood samples are being collected, and allow the patient to ask questions and express any preferences he or she may have for a site or side. Ask the patient if he or she ever experienced complications with phlebotomy in the past or is allergic to latex.

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Equipment

Equipment used for phlebotomy includes the following:

  • Single-use nonsterile gloves
  • Tourniquet
  • Skin disinfectant (eg, chlorhexidine 0.5% in 70% alcohol or 70% alcohol swab or solution)
  • Evacuated tube system with needle and adapter (eg, Vacutainer; BD, Franklin Lakes, NJ; see the first image below) or syringe and needle or winged butterfly needle device
  • 21-gauge (green) or 22-gauge (black) needles are recommended in adults; a 23-gauge (light-blue) winged butterfly device is recommended in young children or in patients with small and fragile veins
  • Blood collection tubes (see the second and third images below)
  • Gauze
  • Hypoallergenic tape (paper is preferred)
Vacutainer(R) needle and adapter. Vacutainer(R) needle and adapter.
Blood collection tubes. Blood collection tubes.
Pediatric blood collection tubes. Pediatric blood collection tubes.

 

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Patient Preparation

To alleviate potential anxiety, approach the patient in a professional, calm, and confident manner. If the patient is very anxious about the pain he or she expects to feel, a topical anesthetic cream may be applied 1 hour before phlebotomy.

Position the patient in a supine or sitting position with the arm resting on a flat surface. Make sure that the arm is positioned on a padded surface to increase comfort.

Verify the patient’s identity against the laboratory requisition, using local patient identification standards. Assemble the required equipment for this blood draw and verify that the correct number and type of blood bottles are available. Wash your hands with soap and water before putting on a pair of nonsterile single-use gloves.

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Contributor Information and Disclosures
Author

Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC

Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Society for Vascular Surgery, Vascular and Endovascular Surgery Society, Society for Clinical Vascular Surgery, Pacific Coast Surgical Association, Western Vascular Society

Disclosure: Nothing to disclose.

Acknowledgements

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

References
  1. Lavery I, Ingram P. Venepuncture: best practice. Nurs Stand. 2005 Aug 17-23. 19(49):55-65; quiz 66. [Medline].

  2. Phlebotomy. WebPath. Available at http://library.med.utah.edu/WebPath/TUTORIAL/PHLEB/PHLEB.html. Accessed: 11/18/2011.

  3. Ernst, Dennis. Flawless phlebotomy: Becoming a great collector. Nursing. Oct/1995. 25(10):54. [Full Text].

  4. Wollowitz A, Bijur PE, Esses D, John Gallagher E. Use of Butterfly Needles to Draw Blood Is Independently Associated With Marked Reduction in Hemolysis Compared to Intravenous Catheter. Acad Emerg Med. 2013 Nov. 20(11):1151-1155. [Medline].

 
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Antecubital veins, left arm.
Antecubital veins, right arm. Note variable anatomy; median cubital vein is not visible.
Metacarpal veins.
Phlebotomy equipment.
Blood collection tubes.
Vacutainer(R) needle and adapter.
Pediatric blood collection tubes.
Phlebotomy. Tourniquet application.
Phlebotomy. Vein palpation.
Phlebotomy. Antiseptic solution application.
Phlebotomy. Assembly of Vacutainer(R) device.
Phlebotomy. Application of traction.
Phlebotomy. Insertion of needle (bevel up).
Phlebotomy. Insertion of winged butterfly device.
Phlebotomy. Insertion of winged butterfly device, flashback of blood.
Phlebotomy. Holding device in place and filling tubes.
Phlebotomy. Blood sample tube inversion.
Phlebotomy. Removal of needle.
Phlebotomy. Application of pressure on straight arm for 5 minutes.
Phlebotomy. Transfer of blood from syringe to vacuum tube.
Phlebotomy. Vacutainer(R).
Phlebotomy. Butterfly needle.
Antecubital veins, right arm.
 
 
 
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