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Pre-Analytical Consideration in Phlebotomy

This document discusses pre-analytical considerations important for phlebotomy. It covers common test designations and their priorities, physiological variables that can influence test results, problem areas to avoid when selecting vein sites, how to handle patient complications during blood collection, risks of procedural errors, and ways to ensure specimen quality. Key points emphasized are selecting appropriate vein sites, avoiding hematoma formation, inadvertent arterial puncture or nerve injury, and preventing hemolysis, contamination or underfilled tubes that could compromise specimen integrity.

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Jacinta Malamion
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227 views3 pages

Pre-Analytical Consideration in Phlebotomy

This document discusses pre-analytical considerations important for phlebotomy. It covers common test designations and their priorities, physiological variables that can influence test results, problem areas to avoid when selecting vein sites, how to handle patient complications during blood collection, risks of procedural errors, and ways to ensure specimen quality. Key points emphasized are selecting appropriate vein sites, avoiding hematoma formation, inadvertent arterial puncture or nerve injury, and preventing hemolysis, contamination or underfilled tubes that could compromise specimen integrity.

Uploaded by

Jacinta Malamion
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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PRE-ANALYTICAL CONSIDERATIONS IN PHLEBOTOMY

Pre-analytical Testing-everything that precedes test performance e.g., test ordering, patient preparation,
patient ID, specimen collection, specimen transport, specimen processing
Common Test Status Designations

Status Collection Conditions Test examples Priority


STAT, Med Emerg Immediately collect, Glucose, H&H, First
test and report result. Electrolytes, Cardiac
Alert when delivered. Enzymes
ER Stats are priority
Timed Collect close to 2 hour PP, GTT, Second
required time and Cortisol, Cardiac
record actual time enzymes, TDM, Blood
ASAP Follow hospital Electrolytes, Glucose, Second or third
protocol. H&H
Fasting Verify if the patient had Glucose, Cholesterol, Fourth
fasted. If he didn’t, TAG
check if the test could
still proceed.
Routine Collect on time but not CBC, Chem profile None
urgent

Physiological variables that Influence Laboratory Test Results

Age RBC, WBC, Creatinine clearance


Variable Blood Composition Affected
Diet Glucose, lipid, electrolytes
Diurnal Thyroid-Stimulating hormone (TSH), cortisol, iron (Fe)
Variation
Gender RBC, H/H
Position Protein, K
Pregnancy RBC
Stress WBC, Fe, ACTH, catecholmine, cortisol
Smoking Cholesterol, cortisol, glucose, GH, TAG, WBC

Problem Areas to Avoid and Troubleshooting in the Site Selection

1. Burns, Scars and -veins are difficult to examine


Tattoos -blood circulation is impaired
2. Damaged veins- -difficult to perform
Sclerosed/hardened/thrombosed/clotted
-inaccurate results
3. Edema -abnormal swelling caused by accumulation of fluid in the tissues
-tissues become fragile->veins are harder to locate
-medications, pregnancy, infections, etc

Prepared by: Amanda Gayle C. Rivera, RMT pg. 1


4. Hematoma -solid swelling or mass of blood in tissues caused by the leakage of
blood from blood vessels
-painful
-contamination

5. Mastectomy -removal of breast through surgery


-lymph flow Is obstructed, swelling and infection after surgery
6. Obesity -veins are deep and difficult to locate
-use longer tourniquet or locate cephalic or cubital vein

HANDLING PATIENT COMPLICATIONS ASSOCIATED WITH BLOOD COLLECTION

1. Allergies to -adhesive allergy: place gauze and remove after 15 min; apply pressure
equipment and for 5 min
supplies -antiseptic allergy use different antiseptic
-latex allergy: non-latex gloves, tourniquet and bandages
2. Excessive bleeding -aspirin or anticoagulant
-apply pressure
3. Fainting -temporary loss of consciousness caused by insufficient flow of blood to
the brain.
-ask the patient to lie down
4. Nausea and -discontinue procedure until patient feels better
vomiting -an emesis basin or wastebasket should be provided
-use cold damp washcloth
5. Pain -warn the patient before needle insertion
-avoid redirection of needle
-Remove needle and apply ice to the site
6. Petechiae -presence of small red or purple spots that look like rashes
-appear on the arm when tourniquet is applied
7. Seizures or -discontinue immediately
convulsions -pressure held over site
-mouth is free from any obstructuion

AVOIDING AND HANDLING PROCEDURAL ERROR RISKS AND FAILURE TO DRAW


BLOOD

Hematoma Formation Discontinue and apply pressure


Cold compress
✓ Blind probing
✓ Inadvertent arterial puncture
✓ Size of vein is too small
✓ Needle penetrate all through the vein
✓ Needle partially inserted
✓ Tourniquet is still on when needle was removed
✓ Pressure not adequate
Iatrogenic Anemia -Blood loss due to blood draw
-10% of blood volume is removed
Inadvertent Arterial -Blood is filling up the tube rapidly
puncture -hematoma

Prepared by: Amanda Gayle C. Rivera, RMT pg. 2


Infection -Tapes or bandages not opened ahead of time
-Needles are not preloaded into tube holders
-Insertion site of needle is not touched after sterilization
-Cap is removed just before venipuncture
-Keep bandage on the site for at least 15 minutes.
Nerve Injury -Improper site selection
-rapid needle insertion
-Excessive redirection of the needle
-Blind probing
Reflux of anticoagulant -Presence of tube additives
-Patient’s arm: downward
-Tube: below the venipuncture site
Vein Damage -avoid blind probing

Specimen Quality
1. Hemoconcentration- decrease in plasma volume
2. Hemolysis- rupture of red blood cells
3. Partially filled tube or short draw
4. Contamination- alcohol, powder, etc
5. Wrong or expired collection tube

References:
✓ Ebuen, Bernard et.al, 2020. Learning Guide in Principles of Medical Laboratory Science

Prepared by: Amanda Gayle C. Rivera, RMT pg. 3

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