SOUTHCOUNTYHOSPITAL
Infusion Nursing Manual
Procedures / PAGE 1 OF 5
Original Issue Date: 3/2011
Last Revision Date: 9/11
Review:
Therapeutic Phlebotomy

Policy:The patient must have an order from a provider stating volume to be removed and current hemoglobin/hematocrit.

Who Can Perform:RN with documented training and competency

Equipment:Manual BP CuffNonsterile Gloves

ChloraPrep®Blood Collection Set

2x2 GauzeScale for Weighing

TapeMicrofoam Tape

Squeezable Ball

Steps / Key Points
1. / Obtain and document vital signs on the Therapeutic Phlebotomy Record. / Acceptable values are:
B/P less than 180mmHg systolic and less than 100mmHg diastolic.
Pulse 50 – 100 bpm.
Temperature less than or equal to 37.5C. (99.5F).
2. / Obtain and document questions on Therapeutic Phlebotomy Record. Explain procedure to patient.
3. / Select a prominent vein in an area free of skin lesions by use of a blood pressure cuff inflated to 40mmHg. (Having the patient hold the squeezable ball). Once a site is selected, release pressure and cleanse the area as follows:
  1. Scrub site with ChloraPrep® swab for 30 seconds.
  2. Wipe with sterile gauze.
  3. Using a circular motion, beginningwith the site for venipuncture, scrub site with # 2 ChloraPrep® swab covering approximately a two inch circle. Let this dry for 30 seconds. If the venipuncture is not performed immediately, cover the area with dry sterile gauze. NOTE: If thephlebotomist needs/wants to touch the vein again, his/her finger must be cleansed in the same manner.

4. / Phlebotomy:
  1. Visually inspect the bag for defects.
  2. Make a very loose knot below the needle guard.
  3. Re-apply pressure to the cuff and have the donor (patient) open and close his/her fist until the selected vein is prominent.
  4. Remove the cover from the needle and promptly perform the venipuncture. Perform venipuncture with the bevel of the 16-guage needle up. After the needle has been inserted, engage the DonorCare Needle Guard by sliding the device up the tubing and over one half to two thirds of the needle hub. Secure the needle guard to the donor’s arm by placing tape over the raised arrow then put sterile gauze over the site.

5. / Collection of Blood:
  1. When collection amount ordered is collected, release pressure from the cuff. Lift Gauze to view angle of needle placement. Hold the DonorCare Needle Guard with thumb and forefinger at the raised arrow end. Remainder of fingers should be poised above the gauze over the site. Withdraw the needle from the patient’s arm. Following the same angle as needle placement, pull swiftly until the needle is removed from the donor’s arm and you hear the needle click and lock in the needle guard. Immediately apply pressure to the gauze over the venipuncture site. Remove the tape and needle guard from the donor’s arm. Have the patient raise his/her arm, keeping the elbow straight, and hold the gauze firmly onto the phlebotomy site with his/her other hand for approximately 5 minutes. Apply a pressure bandage before the patient leaves.
  2. Tighten the loose knot in the tubing set. (Pull the tubing tightly until white and free of blood).
  3. Discard the unit and needle (secured in needle guard) in a red biohazard bag.Discard the blood bag in a rigid container for disposal.
  4. Do not leave the patient unattended during the procedure. Ask for help if something is needed outside of the room.
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  1. Release or lessen pressure from the BP cuff to facilitate blood flow.
  1. Instruct the patient to gently squeeze the ball every 10 seconds during phlebotomy.
  1. Monitor the patient and blood flow continuously.

ALTERNATIVE BLOOD DRAW
Blood collection may be done using a butterfly needle and 30ml or 60ml syringes if unable to use the blood collection bag. Draw the ordered volume in the syringes and discard in red medical waste or sharps container.
6. / Have the patient rest at least 15 minutes or longer if necessary.
Sit the patient up and have him/her drink6-8 oz. of juice or water.
  1. Explain the precautions that should be taken to the patient and provide Post Therapeutic Phlebotomy Instruction sheet. If he/she feels dizzy or nauseated then lie down elevating the feet or place head between knees. If the venipuncture site starts to bleed again, apply pressure.

7. / Indicate in the patient’s record how much blood was drawn (ml).
9. / Patient Instructions:
  1. Monitor phlebotomy site for bleeding
  2. Encourage increase in oral intake for 24 hours.
  3. Report symptoms of dizziness and lightheadedness to provider.
  4. No prolonged standing or strenuous activity for 24 hours.
  5. Avoid alcoholic beverages before your next meal.

10. / Adverse Donor Reactions:
Symptoms of an adverse donor reaction may include the following:
WEAKNESS, SWEATING, DIZZINESS, PALOR, LOSS OF CONSCIOUSNESS, CONVULSIONS, INVOLUNTARY PASSAGE OF URINE OR FECES, COLD SKIN, AND FALLING BLOOD PRESSURE.
What to do:
At first sign of symptoms release pressure and withdraw the needle from the arm. If the donor does not respond to the following treatment notify a floor nurse or physician immediately.
  1. Fainting:Place the donor on his/her back and raise feet above the level of the head. Have someone get a cold compress for the donor’s forehead or back of neck.
  1. Nausea and/or Vomiting:Make the donor as comfortable as possible and turn his/her head to the side. Instruct the donor to breathe slowly and deeply. Provide a receptacle if the donor vomits and have cleansing towels ready. Give the donor a cup of water to rinse out his/her mouth.
  1. Hyperventilation: Try to interrupt hyperventilation by engaging the donor in conversation to distract him/her. If necessary, have the donor breathe into a paper bag.
  1. Hematoma:Place 4 sterile gauze pads over the hematoma and apply firm pressure for 10 minutes, holding the arm up high. Should an arterial puncture be suspected, check for a radial pulse, if not palpable, notify a physician immediately.
  1. True Convulsions or Suspected Heart Attack: Notify a floor nurse or physician immediately! If necessary, call a “Rapid Response” or “Code Blue” to the operator.

Documentation:Total volume of blood withdrawn and patient’s response to the procedure shall be documented in the patient’s medical record.