Phlebotomy Techniques & Risks

  • Once all equipment has been prepared and hands are washed and covered with sterile gloves the tourniquet should be fastened round the client’s arm (either just above the elbow for an inner elbow or just above the wrist on the hand).
  • A few seconds should be left for the veins to become distended; the desired area should then be palpated for a bouncy, static vein. (a well felt vein is better than a visible vein)
  • Once desired area has been found, the area should be cleaned thoroughly using a chlorhexidine 2%/ Alcohol 70% wipes and allow 30 seconds to dry before puncturing Do not palpate the skin again after cleaning.
  • Place your needle into the phlebotomy tray along with the vials to collect the blood.
  • Using your non-dominant hand, gently grip the patient’s arm with your thumb to hold the skin taut and immobilise the underlying vein
  • Using your dominant hand, hold the Needle with your thumb securing the plastic base of the needle and confidently puncture the skin at a shallow angle of no more than 30 degrees
  • Gently advance the needle until you pierce the vein and see a flashback of blood in the needle hub
  • If instead you encounter resistance when advancing the needle, then it is likely that the needle is not in the lumen of the vein, in which case you should gently retract the needle and insert a fresh one
  • Once you have fully advanced the needle, carefully remove the tourniquet
  • Collect the tubes from the phlebotomy tray and apply it to front end of the needle to collect the blood. These are usually vacuumed and therefore collect the blood themselves quickly.
  • Once around 5-10ml of blood has been taken the needle should be gently removed and pressure should be applied onto the needle site to minimise bruising.

 

Risks of Phlebotomy

 

  • Bruising/haematoma: relatively common, particularly after failed or vigorous phlebotomy attempts
  • Infection of the needle site: cellulitis may arise around the insertion site, which in some cases may progress to systemic sepsis
  • Arterial puncture: detected by pulsatile blood flow into the needle chamber and from the end of the needle after the needle is removed. Arterial puncture may be intensely painful and lead to distal limb ischaemia. If this occurs you should remove the needle immediately, remove the tourniquet and apply firm pressure to the site
  • Peripheral nerve injury: this is rare. Remove the needle immediately if the patient develops paraesthesia or numbness near the site.

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