Lab Test Procedure : PRE-PHLEBOTOMY PROCEDURES

Preparation for the Phlebotomy:
• Before performing any phlebotomy procedure, carefully review the orders to calculate the volume of blood to draw and select the necessary blood tubes. See specific information below.
• Carefully and fully follow hospital Patient Identification Policy requiring the use of two identifiers, generally name and medical record number on Inpatients and name and date of birth on Outpatients.
• The patient should be lying down, sitting on their bed or sitting in a chair with arms so they don’t injure themselves if they lose consciousness and fall.
• The patient should not be eating, drinking or chewing gum while the phlebotomy procedure is performed.

Volume of Blood: The amount of blood drawn from any patient should be kept to a minimum. The guidelines at Akron Children’s are to determine the amount of serum/plasma required and draw approximately 2.5 times that amount. For example, if 1.0 ml of plasma is needed, then 2.5 ml of blood should be drawn. Extra blood should not be drawn on a routine basis. Particular care should be taken in the Neonate population where the overall blood volume is minimal. See the “Maximum Allowable Blood Draw Volumes for Pediatric Patients” policy for maximum volumes of blood that can safely be drawn from a pediatric patient based on their weight. The Lab Test Directory (located as on icon on many desk tops or available on myKidsnet under “Departments – Lab”) lists many of the available tests along with the volume of blood and type of tube needed to perform each test and how it should be stored for transport to the lab (room temperature, on ice, etc.). It also contains further information including the OC power entry word, availability of the test, turn-around times, normal ranges, special instructions (fasting specimen required, timing for peak and trough drug levels, etc.), and causes for rejection of the specimen.

Choosing the best method for phlebotomy: The following should be kept in mind when deciding whether to perform a venipuncture, arterial stick or capillary puncture:
• The size of the patient – heel sticks are generally done on patients less than six months of age.
• The volume of blood needed – capillary punctures yield smaller volumes of blood.
• The tests ordered – some tests, such as ammonia, cannot be drawn by capillary puncture. An arterial gas must be drawn by an arterial stick.
• The condition of the patient – if a patient is “crashing” and a volume of blood is needed quickly, an arterial stick should be considered. Capillary punctures may be easier on a patient with burns over a large portion of their body.
• The training level of the person performing the phlebotomy – not all staff is trained to perform arterial sticks.


References

Ernst, Dennis J. “Pediatric Pointers.” Center for Phlebotomy Education, Inc. 2004-2008, edited for accuracy 1/08.

Ernst, Dennis J. and Catherine Ernst. “Mastering Pediatric Phlebotomy.” Center for Phlebotomy Education, Inc. Adapted from Phlebotomy for Nurses and Nursing Personnel. HealthStar Press, Inc. 2001, updated 1/08.

Kiechle, Frederick L. So You’re Going to Collect a Blood Specimen: An Introduction to Phlebotomy, 11th Edition. Northfield, IL: College of American Pathologists, 2005.

NCCLS. Procedures and Devices for the Collection of Diagnostic Capillary Blood Specimens; Approved Standard—Sixth Edition. CLSI document H04-A6. Wayne, PA: Clinical and Laboratory Standards Institute; 2008.

NCCLS. Procedures for the Collection of Arterial Blood Specimens; Approved Standard—Fourth Edition. CLSI document H11-A4. Wayne, PA: Clinical and Laboratory Standards Institute; 2004.

NCCLS. Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; Approved Standard—Fifth Edition. CLSI document H3-A5. Wayne, PA: Clinical and Laboratory Standards Institute; 2003.

Akron Children’s Hospital Policy - Maximum Allowable Blood Volumes for Pediatric Patients. Policy # 1122

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