Best Practice and Procedures in Phlebotomy – A Step-by-Step Guide

Phlebotomy is the process of drawing blood for medical testing, transfusions, or donations. It’s crucial to follow best practices and procedures to ensure the safety of both patients and healthcare professionals. So, here’s the brief: the best practices and procedures in phlebotomy involve —

• meticulous planning,
• adherence to infection control measures,
• and patient-focused care, ensuring accurate blood collection, staff safety, and overall healthcare quality.

In this comprehensive guide, we will delve into the meticulous steps outlined by the World Health Organization (WHO) to ensure the best procedures and practices in phlebotomy.

Best Practices in Phlebotomy

The World Health Organization (WHO) suggests the best way in phlebotomy because using large needles to draw blood poses risks for both patients and health workers. These guidelines aim to ensure safety by providing recommended steps for blood collection, minimising the risk of infections, preventing injuries, and maintaining the quality while specimen handling to avoid misdiagnoses and potentially fatal errors.

Let’s get into the details of the best practices in phlebotomy in the following.

Planning Beforehand

Planning ahead is super important before doing any procedure, and it’s usually the first thing you should do in a blood-drawing session.

Using an Appropriate Location

When drawing blood, it’s crucial to work in a quiet, clean, and well-lit area, whether you’ll be working with patients who are staying in the hospital or those who come for a visit.

Quality Control

Making sure things go right in drawing blood is really important. Quality assurance is a big part of this, and it helps prevent things from going wrong.

• Education and Training: Everyone involved needs to be trained on how our bodies work, the risks of being around blood, and why preventing infections is crucial.
• Standard Operating Procedures (SOPs): There are rules for every step in drawing blood. These rules should be written down and easy for healthcare workers to find.
• Correct Identification of the Patient: You must accurately identify the patient and match donors with screening tests.
• Condition of the Sample: Blood samples must be in good condition for accurate test results.
• Safe Transportation: When moving blood, it must be done safely to ensure reliable lab results.
• Incident Reporting System: If something goes wrong, a system is in place to report it, helping you learn and improve for the future.

Quality Care for Patients and Health Workers

Some important factors can enhance quality care for patients, healthcare workers, and lab tests. For safe and good care during blood draws, it’s crucial to have the right supplies and protective gear. This includes things like hand-cleaning stuff, gloves, disposable needles, and syringes. Safety devices can help reduce exposure to blood, but they need to be used correctly.

If something goes wrong, like accidentally getting exposed to blood, keep a record of it and make sure there’s help available. It’s super important to avoid things getting contaminated, especially with items like tourniquets and reusable devices. As we know, phlebotomy poses a risk of exposure to harmful viruses like —

• Hepatitis B,
• Hepatitis C,
• and HIV through blood contact.

That’s why, without careful measures, healthcare workers can be at risk of infection from accidental needle sticks or blood contact. Following safety rules, using protective gear (PPE), and having access to post-exposure prophylaxis (PEP) is crucial to minimise infection risks for both healthcare workers and patients.

Quality of laboratory Sampling

Ensuring quality in laboratory sampling involves —

• skilled blood collection,
• proper needle selection,
• anatomical insertion,
• appropriate tubes,
• accurate patient details,
• and careful transportation for reliable and meaningful medical results.

Procedures in Phlebotomy –  Step-by-Step Guide

A Phlebotomist’s main job is to collect a blood sample from a patient. Patients might be scared, especially if it’s their first time or if they are afraid of needles or hospitals. To keep things consistent and help the patient feel at ease, the phlebotomist needs to follow a specific method.

Here are the steps:

Step 1: Getting Ready

Start by making sure your workspace is set up. Check that you have all the things you need for the task in a clean and germ-free area. Make sure you’ve got all the necessary stuff like tourniquets, vials, tubing, disinfectant, gloves, lab forms, and labels, along with the right tools for phlebotomy before you begin.

Step 2: Meeting the Patient

Say hello to the patient and tell them who you are. Ask for their full name and birthdate to be sure it’s the right person. Check that the name is right on the sample labels you’ve prepared. Ask if they have any allergies or if they’ve had issues with a blood draw before. The clinician’s initials should be on the tube label, too.

Step 3: Help the Patient Get Ready and Feel Comfortable

Have the patient sit in the phlebotomy chair and make sure their arm isn’t bent. Adjust the chair if needed, and use a pillow or clean paper/towel for support. Don’t draw blood from a standing patient.

Check the patient’s physical condition, including their diet, exercise, stress level, and basal state. If fasting is needed for the test, ask if they’ve been fasting for at least 8 hours. For drug concentration monitoring, like lithium or valproic acid, ask when they last took their medication.

If blood is taken before a planned dose, check if the patient has had issues with blood draws, like fainting or feeling unwell. Let the patient know the procedure might be a bit uncomfortable, but only for a short time. Don’t say it won’t hurt at all. Discuss the test, get verbal agreement, and reassure the patient. If they’re nervous, ask what would make them more comfortable and be gentle during the procedure.

Step 4: Keep It Clean

Maintain hand hygiene while washing your hands with soap and water or using alcohol rub, making sure to cover your fingertips, the back of your hands, and all over until dry. Put on non-sterile gloves that fit well after washing your hands. Remember to wash your hands before and after each patient and before wearing or removing gloves.

Step 5: Spot the Right Spot

Look at the patient’s arm to find a suitable vein for the procedure. The vein should be visible, straight, and easy to locate before using the tourniquet. If it’s hard to see, you can ask the patient to make a fist.

If you can’t see superficial veins, try the following:

• Stroke the arm from wrist to elbow.
• Tap the spot with your fingers.
• Apply a warm, moist towel to the location for 5 minutes.
• Let the arm hang down to let the veins fill.

Find a vein that you can see easily and is a good size. The median cubital vein, located between muscles, is the easiest to puncture. Avoid the basilic vein, as it exposes an artery and a nerve, making it more painful and risking injury.

Don’t put the needle where veins split, as this increases the risk of a hematoma. Instead, check the vein again after putting the tourniquet 4–5 finger-widths above the phlebotomy site.

Step 6: Apply the Tourniquet

Put the tourniquet about 3-4 inches above where you’ll perform the needle insertion. Don’t stretch it too much, and don’t keep it on for more than 2 minutes (and no more than a minute to avoid increasing the risk of hemoconcentration. If needed, put the tourniquet on again after waiting for 2 minutes.

Step 7: Disinfect the Phlebotomy Site

For disinfection, wipe the area with a 70% alcohol swab for 30 seconds. Let it dry unless you’re taking blood cultures or preparing for a blood sample. If you don’t give it enough time, there’s a higher risk of contamination.

Avoid touching the cleaned area, and don’t guide the exposed needle shaft with a finger over the vein. If you touch the area, you have to disinfect it again.

Step 8: Collect the Blood

Hold the patient’s arm and place your thumb below the phlebotomy site to steady the vein. Ask the patient to make a fist without pumping it to highlight the veins.

Position the needle at a 15° to 30° angle to the arm’s surface. Insert the needle quickly through the skin and into the vein’s centre at a 30° angle or less. Continue introducing the needle along the vein at the best entrance angle, avoiding excessive probing and trauma.

Step 9: Remove the Tourniquet

Release the tourniquet before taking out the needle if you have collected enough blood. The tourniquet should be removed as soon as blood flow is established and never kept on for more than two minutes.

Step 10: Fix the Wound Area

After gently pulling out the needle, cover the wound with clean gauze or a dry cotton ball. Apply light pressure to the area, and ask the patient to extend and lift their arm while holding the gauze or cotton ball in place. Advise the patient not to bend their arm to avoid forming a hematoma. Press down on the gauze with sufficient pressure to prevent a hematoma, and you can use sterile tape to secure the area.

Step 11: Fill the Laboratory Sample Containers

Fill multiple blood tubes using a needle and tube holder or a syringe and winged needle set. If using a syringe or winged needle set, place the tube in a rack before filling. To prevent needle sticks, use one hand to fill the tube or place a needle shield between the needle and the hand holding the tube. Afterward, ensure that all the required tubes are mixed and labelled.

Step 12: Prepare Samples to Deliver to The Laboratory

Put the blood tubes in a sealed plastic bag that has a section outside for the lab request form. Attach the requisition form on the outside to prevent contamination. Arrange the tubes on a rack or cushioned holder to avoid breakage during transport. Finally, deliver the samples to the lab as quickly as possible.

Step 13: Dispose of the Used Staff

After collecting blood, discard used needles and collection items in a biohazard bin. Properly dispose of contaminated materials in designated containers.

Step 14: Finish the Phlebotomy Procedure

To complete the procedure:

• Check the patient’s well-being.
• Ensure the patient is okay before allowing them to stand.
• Provide food or juice if possible.
• Wash your hands again and ensure the area is clean.

Besides, if you’re interested in having detailed knowledge of how to gain phlebotomy work experience as a beginner, visit our informative blog to learn the process.

Wrapping Up

In closing, following the best practices and procedures in phlebotomy is very important for safety and precision in healthcare. This guide highlights the need for careful planning, sticking to cleanliness rules, and using proper blood collection methods. To learn everything thoroughly, it’s a good idea for people to get trained at a recognised institute that provides Basic and Advanced Phlebotomy Competency Training, covering Cannulation and catheterisation. A certification from a recognised program like the CPD-accredited and NHS-accepted one at the Phlebotomy Training Institute ensures that individuals gain both theoretical knowledge and practical skills. This certified training prepares individuals to be skilled phlebotomists through a mix of hands-on practice and online learning.

FAQs

1) What is the first thing the phlebotomist should do?

The first thing a phlebotomist should do is perform proper patient identification using two or more identifiers (e.g., name, date of birth, medical record number). This ensures they are drawing blood from the correct individual and maintains patient safety.

2) What is the correct order of blood draw?

The correct order of blood draw in phlebotomy is:

1. Blood culture tube, 2. Sodium citrate tube, 3. Serum tubes, 4. Heparin tube, 5. EDTA tube, 6. Sodium fluoride/potassium oxalate tube.

3) How do I start a career in phlebotomy in the UK?

You can begin a career in phlebotomy by following a step-by-step guide that covers the essential information needed to commence a career in this field.

4) What are the basic steps involved in phlebotomy procedures?

The basic steps in phlebotomy procedures include patient identification, selecting the appropriate vein, disinfecting the site, performing venipuncture, and labelling the collected samples.

5) How can I ensure patient safety during phlebotomy procedures?

Patient safety during phlebotomy procedures can be ensured by following best practices, maintaining hygiene standards, verifying patient information, and using proper techniques for blood collection.