Phlebotomy Protocol

SB HOME PHLEBOTOMY PROTOCOL

(See secure server for additional contact information)

Prepared by Tomas Lazo

Prior to clinic, please bring the following supplies, forms, and information:

  1. Butterfly needles
  2. Hubs/Needle Adapters
  3. Plastic Bags for samples
  4. Tubes – red, green, lavender, blue, gold, urine cultures, throat swabs
  5. Urine Cups (midstream, sterile, etc.)
  6. Gauze/Cotton (or use clinic supplies)
  7. Bandaids (or use clinic supplies)
  8. Alcohol preps (or use clinic supplies)
  9. Lab Test forms – are usually with other important clinic forms in black organizer
  10. Medifleet Courier Service Phone Number
  11. Pen, paper, sharpie marker
At clinic, perform the following steps in the order listed to assure best possible flow. We are attempting to have patients receive bloodwork after they have seen the clinical student, but before they are off to social work in the patient exam rooms. This way, the clinical student can finish their patient notes and the phlebotomist can perform the blood draw supervised by the clinical student or another appropriate supervisor.

1.      Place supplies in communal area (back lab room).

2.      Clinical students should come to the phlebotomist asking for blood draw information and you should give them a lab form. Have them fill it out, get the attending physician to sign the form, and return it to the phlebotomist. Also inform the clinic managers that your patient requires bloodwork.

3.      Organize yourself for the blood draw to be done. Gather your supplies needed – correct number of tubes, 2 butterflies, 1 hub/adapter, 2 alcohol preps, bandaids, gauze/cotton, plastic bag for samples, and a blue and white absorbent pad (by the EKG machine).

4.      Bring supplies to the patient exam room and set up with two chairs facing each other. The supplies can be placed on the garbage can over the blue and white pad for easy access, as well as for the patient to lay their arm on. If performing without a surface, be mindful of your equipment and supplies.

5.      First, assess the patient’s veins. With moderate pressure, squeeze their arm that you wish to draw blood for and palpate for candidate veins. Feel for the rebound of a vein and attempt to both visualize and palpate as best as possible for optimal results. This may be more difficult for obese, older, or darker skinned patients.

6.      Upon completion of evaluation, lay your supplies out and wash your hands and put on gloves.

7.      Open all of your supplies and materials, including butterfly needle, gauze, bandaid, and alcohol prep. Fasten butterfly tubing to the adapter hub firmly and place first collection tube within the hub WITHOUT releasing the vacuum.

8.      Palpate patient’s vein one more time to make sure you’re ready. Then apply tourniquet and swab the area with alcohol.

9.      Allow sufficient time for EtOH to dry (15 seconds). Remove the needle cover at this time. Then, anchor patient’s skin below the vein with non-dominant hand and move the needle closer.

10.  Warn the patient that they will feel a pinch and pierce the patient’s skin at a shallow angle. Advance the needle slowly until you see a flash in the yellow part of the tubing. Upon seeing a flash, advance the needle slightly and push the tube into the hub with your non-dominant hand. Keep your dominant hand and butterfly needle steady.

11.  Allow for appropriate filling and switch tubes with your non-dominant hand as needed.

12.  Upon completion of tube filling, slowly remove the needle and cover the wound with gauze, instructing the patient to hold firm pressure.

13.  Promptly COVER THE NEEDLE with the safety. Push the cap up to cover the needle.

14.  Remove the tourniquet and place a bandaid on the patient’s wound. Ask them to sit in the waiting room.

15.  At this point, label your tubes with the patient’s name, date, and time of collection. Please fill out the patient’s Lab form with the date and collection time as well.

16. Label your tubes with the patient’s name, date, and time of collection

17.  Gently invert the tubes back and forth 10 times and then place tubes into plastic baggie.

18.  Copy the patient’s lab form and give one copy to the clinical student to place in the patient chart. Then place your copy into the front pocket of the plastic baggie and place sample bag with your other samples in the supply room (use a bin in there for organizational purposes). Only urine samples should be refrigerated.

19.  Clean up your area, place the needle in the sharps container, and tidy up as necessary.

20. Schedule a pickup - See secure server for contact information.

21. Please fill out the sample pickup form with all the patient names with samples, and the number of total samples.

22.  When the courier arrives, make sure to provide all samples and the form. Make him fill out your form and be sure to keep one copy of the sheet for our records. Double check to see if you have labeled your tubes with the patient's name, date, and time of collection. Please also write the reference/confirmation number given by the dispatcher on this sheet as well.

*****MAKE SURE YOU LABEL THE TUBES******

Special Notes

One patient = one bag; all tubes and samples from one patient belong in one bag

Remember to put patient name, DOB, date collected, and time collected on tubes

Refrigerate urine samples until the courier arrives

·he courier service should be called about 30-45 minutes ahead of scheduled pick up time; OR you could call earlier in the day if you know about what time you’ll have your samples ready and ask them to come pick up AT a certain time

If we are unable to get the courier over to the clinic for whatever reason, we can bring the samples back to the hospital ourselves

Please write down the reference number given to you by the courier service when you call them – it’s for tracking purposes in case samples are lost

Tubes with green (chems) or lavender (CBCs) have an 8 hour window period to get the lab at room temperature; blue tops (citrate – probably won’t use) are 4 hrs

If you’re unsure about a particular test that isn’t written on our lab sheet, call the customer service line (top of the lab form, or another number at specimen receiving) and ask them which tube to use for the test in question

Please make sure to ask patients if they have been fasting – mainly for triglycerides – if labs will be drawn, make a note in the patient chart about when they last ate and how long it has been

o   6-8 hours is usually enough time for fasting

If you are unable to get a successful venipuncture after some trying, do not keep poking and prodding. If no one is available to help, you can always send our patients to SB Hospital Labs or the Lab Satellite Facility on Research Way (3 Technology Drive, Suite 600, East Setauket, NY – 631-444-4033) in order to get their bloodwork done – no appointment is needed. Just send them with a filled out lab form, signed by the attending, and they should be good to go.

o   Hours for the satellite clinic are M: 7-5, T: 8.30-5, W:8.30-7, Th/F: 8.30-5, Sat: 8-11.45am.