HEMA311- LECTURE
v BLOOD COLLECTION
NOTES BY MIRANDA CAPUYON
BLOOD COLLECTION
• Arterial Puncture
• Skin Puncture
• Venipuncture
ARTERIAL PUNCTURE
• Collected from an artery, primary to determine arterial blood gases
• Performed by doctors; NOT MEDICAL TECHNOLOGIST
• Can be obtained through a catheter placed in an artery, or by using
Indications for Skin Puncture
a needle and syringe to puncture an artery
• Tests that requires SMALL AMOUNT OF BLOOD; Hematocrit,
• Pre-heparinized
Blood-typing, Sugar
• ARTERIAL BLOOD - Once exposed to air, it will alter the blood gas
values
Advantages of Skin Puncture
• Easier than Venipuncture
Puncture Sites
• Radial artery – preferred site; wrist
Order of Draw
• Brachial artery – less superficial • EDTA
• Blood Bank
• Femoral artery – less superficial
• Chemistry
Complications
• Non-additive (no anti-coagulant)
• Arteriospasm
o Involuntary contraction of the artery Complications
o Calming the patient • collapse of veins if the tibial artery is lacerated from puncturing the
• Hematoma medial aspect of the heel
o Or excessive bleeding • osteomyelitis of the heel bone (calcaneus)
o Pressure • nerve damage if the fingers of neonates are punctured
• Nerve damage • hematoma and loss of access to the venous branch used
o Prevented by choosing an appropriate site and avoiding • Scarring
redirection of the needle • localized or generalized necrosis
• Fainting • skin breakdown from repeated use of adhesive strips (old age)
o Prevented by ensuring that the patient is supine with feet
elevated before beginning the blood draw VENIPUNCTURE PUNCTURE
o Already supine
• Manner of inserting a needle attached to a syringe to a palpable vein
to collect blood for laboratory testing
• Specimen collected: Venous Blood; large volume blood can be used
in multiple testing
• Most widely used blood sample in all laboratory tests
• Successful venipuncture (1) Phlebotomist (2) Vein of the Patient (3)
Complete set of materials
Puncture Sites
• Antecubital fossa – 3 veins;
o Medial – IDEAL; stable
o Basilic
o Cephalic
Things to remember!
• Proper identification of patient; Let the patient state their
COMPLETE name & bday and ask for their IDs, as for coma
patients, let the relative/nurse state their name
• Tourniquet application; no longer than 1 minute, 3-4 inch away from
the site (to avoid hemoconcentration)
• Disinfection; sidetoside, outward
SKIN PUNCTURE • Angle of needle insertion; 15-45degrees
• A mixture of capillary, venous, and arterial blood with interstitial • Bevel UP;
(tissue) fluid and intracellular fluid • Needle length; 1.5-inch, gauge: 23, 22, 21
• Peripheral blood – mixture of everything • Position of the patient
• More painful due to more nerves • Label
Puncture Sites • Disposal
• Finger; 4th finer non-dominant hand (less kalyo); it needs to be 2- TRANSFER
4mm • By removing the cap of the tube and needle
• Earlobe • By puncturing the cap with the needle (just be careful because when
• <1 yo. Lateral portion of the plantar surface of the heel/toe air gets in, it will hemolyzed your specimen)
Method of Collection
• Single Collection
• Multiple Collection; ETS; 2 way needle
• Winged Collection; Butterfly
Sites to avoid
• Inflamed and pallor areas
• Cold and cyanotic areas
• Congested and edematous areas
• Scarred and heavily calloused areas
MIRANDA BIENNE G. CAPUYON; 3-Y2-IRR3 1
Sites of puncture
• Newborns up to 18 months
o External Jugular Vein
o Temporal Vein
o Antecubital fossa; always the BEST Site
• Older children
o Femoral vein
o Long saphenous vein
o Popliteal vein
o Ankle vein
o Antecubital fossa
• 3 yo to adult life
o Wrist vein
o Dorsal vein of hand
o Dorsal vein of ankle
o Antecubital fossa
Antecubital fossa
• Two patterns of vein
• “H” pattern
o Median capital Vein
o Cephalic vein
o Basilica vein
• “M” pattern
o Median Vein
o Accessory Cephalic vein
o Basilica vein
Sites to avoid
• Sites with hematoma
• Occluded veins
• Edematous area
• Sites with burns, scar, tattoo
• Sites with Fistula; result of surgery/injury
• IV fluid sites; turn off the IV fluid; discard 5-10 ml
Adverse events
ADVERSE CAUSE MANAGEMENT
Hematoma Poor collection Apply pressure and
techniques a firm bandage
Fainting due to a Anxiety Recline chair
hypothalamic Lowered blood Discontinue
response resulting volume and other collection
to bradycardia, associated causes Loosen clothes
vomiting, sweating Give fluid
Syncope Physical stress Fluid administration
Inadequate fluid
intake
Complications
• Hematoma
• Pain
• Syncope and fainting
• Iatrogenic anemia
• Infections
• Edema
• Allergies
• Petechiae
MIRANDA BIENNE G. CAPUYON; 3-Y2-IRR3 2
MIRANDA BIENNE G. CAPUYON; 3-Y2-IRR3 3
MIRANDA BIENNE G. CAPUYON; 3-Y2-IRR3 4
