Which of the following would you include when performing venipuncture using an evacuation system?

Student name:__________MULTIPLE CHOICE - Choose the one alternative thatbest completes the statement or answers the question.1)Withdrawing blood from a vein is called __________.A)hematologyB)phlebotomyC)morphologyD)coagulationE)serology

2)Which of the following is the liquid or fluid portion ofthe blood?

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3)Which of the following is the term for red blood cells,white blood cells, and platelets?

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4)The description of whole blood is __________.

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A)capillary punctureB)hemolysisC)coagulationD)venipunctureE)phlebotomy6)Which of the following is the most common antisepticused to cleanse the skin before drawing blood?A)alcoholB)soap and waterC)HibiclensD)hydrogenperoxideE)10% bleach

7)In tests for which the use of alcohol may result ininaccurate test results, which of the following chemicals maybe used to prepare the skinbefore venipuncture?

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8)Which of the following is part of the preparation for aglucose tolerance test?

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A)femoral and inguinal veinsB)median cubital and cephalic veinsC)great saphenous and superior vena cava veinsD)popliteal andposterior tibial veinsE)radial andulnar veins10)Which of the following items forms the first line ofdefense during a phlebotomy procedure?

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11)Which of the following would you include whenperforming venipuncture using an evacuation system?A)Bunch up the patient's skin above and below theinsertion site.B)Insert the needle at a 45º angle with the bevelside down.C)Penetrate the vein wall to a depth of 1/4 to 1/2inch.D)Leave the tourniquet on until after you withdrawthe needle from the vein.E)Be careful notto invert collection tubesthat have additives inthem.

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NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy. Geneva: World Health Organization; 2010.

3Blood-sampling systems

Users of these guidelines should read Chapter 2 before reading the information given below. This chapter covers background information (Section 3.1), practical guidance (Section 3.2) and illustrations (Section 3.3) relevant to closed and open blood-sampling systems.

Several blood-sampling systems are available for phlebotomy. The system most appropriate for the procedure should be chosen. Annex C provides detailed information on all the systems available for drawing blood, and outlines the advantages and disadvantages of each device.

3.1. Background information on blood-sampling systems

3.1.1. Closed systems

Closed systems for blood sampling are preferable because they have proven to be safer than open systems (23).

Needle and syringe

The use of a hypodermic needle and syringe is the most common means of blood sampling.

Choice of gauge

If the needle is too large for the vein for which it is intended, it will tear the vein and cause bleeding (haematoma); if the needle is too small, it will damage the blood cells during sampling, and laboratory tests that require whole blood cells, or haemoglobin and free plasma, will be invalid.

Blood collection for transfusion requires a larger gauge than is used for blood drawing.

Vacuum extraction systems

The use of vacuum extraction tube systems as closed systems for blood collecting reduces the risk of direct exposure to blood and has made it easier to take multiple samples from a single venepuncture.

Vacuum extraction systems are widely available in most well-resourced countries. These are recommended, but users should check their own country's recommendations. Although vacuum extraction systems are safe, training and skill is required for their use.

Double-ended needles are available in several recommended gauge sizes. The end covered by a rubber cuff is screwed into the barrel (also known as the tube holder, evacuated tube needle holder or bulldog). A thread separates the two ends, and this is where the barrel is screwed into place. The barrel holds the sample collection tube in place and protects the phlebotomist from direct contact with blood. The sample tube is under vacuum. Once the needle is in the vein, the tube is pressed on to the needle and the blood is drawn automatically into the sample tube by vacuum until the required amount is collected. This system comes complete with needle, barrel and the laboratory sample tubes with appropriately coloured tops for different types of samples. Tubes for adult and paediatric specimens are available.

Discard the barrel and syringe as a single entity where possible. If there is a need to reuse the barrel, use a one-hand scoop technique (Annex G) to cover the sharp end of the needle and thus to safely remove the needle from the barrel. Alternately, use a sharps container with a needle removal hold, again employing a one-handed technique.

Some systems have a mechanism that can be activated once the needle has been used; the mechanism retracts the used needle into the barrel and snaps it shut. Others have a quick-release mechanism to dislodge the used needle into the sharps container.

Vacuum systems may also be used with a winged butterfly needle and luer-lock connectors. Winged butterfly needles are also available with safety-engineered devices.

The sharps container must be within arm's reach and clearly visible, to ensure safe disposal of sharps.

3.1.2. Open systems

Open systems include hypodermic needle and syringes, as well as winged steel needles attached to a syringe.

3.2. Practical guidance on blood-sampling systems

3.2.1. Needle and syringe

To use a needle and syringe system:

• open the packaging of the hypodermic needle from the hub end (back of the needle), keeping it capped;

• open the sterile packaging of the syringe from the plunger end (back of the syringe), keeping the nozzle protected in the packaging;

• carefully remove the syringe from the packaging and insert the nozzle of the syringe firmly into the exposed hub of the capped hypodermic needle;

• leave the needle and syringe in place until ready for use.

3.2.2. Choice of gauge

Choose the gauge of hypodermic needle that fits comfortably into the most prominent vein with little discomfort (Table 3.1).

Table 3.1

Recommended needle gauge, length and device for routine injection and phlebotomy procedures for different age groups.

3.3. Illustrations for blood-sampling systems

Figure 3.1Blood-sampling systems

Copyright © 2010, World Health Organization.

All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: tni.ohw@snoissimrep).

Bookshelf ID: NBK138666

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