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PRE-PHLEBOTOMY PROCEDURES

Collection Procedure:

Policy Tech: Version 5

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 StandardSixth Edition. CLSI document H04-A6.

Wayne, PA: Clinical and Laboratory Standards Institute; 2008.

NCCLS. Procedures for the Collection of Arterial Blood Specimens; Approved

StandardFourth 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 StandardFifth 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