Summarize the following text to main points and sub-points and make detailed explain for them:

 procedure is also known as Venipuncture as shown in figure 
(1-10). 
 
 
 
 
 
 
 
 
Figure (1-10): Phlebotomy 
 
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2. PHLEBOTOMY 
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1.15.1 Training and development  
Phlebotomists are trained on the job, so securing a trainee 
phlebotomist position is recommended as shown in figure (1-11). The 
training includes theory and practical work including 
1. How to take blood from different patient groups, including children 
and the elderly. 
2. Different ways to take blood. 
3. Health and safety. 
4. Anatomy and physiology. 
5. Labelling samples. 
Figure (1-11): Tips to help stay calm during Phlebotomy 
1.15.2 Equipment 
The following are suggested supplies for blood specimen collection as 
shown in figure (1-12): 
1. Non-sterile exam gloves. 
2. Puncture-resistant sharps container. 
3. Alcohol wipes. 
4. Tourniquet. 
 
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2. PHLEBOTOMY 
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5. Appropriate specimen collection lab tubes. 
6. 2 x 2 gauze. 
7. Tape. 
8. Evacuated tube holder. 
9. Multisampling blood collection needle. 
 
Figure (1-12): The equipment necessary to perform a Phlebotomy  
1.15.3 Phlebotomy (Venipuncture) procedure 
1. After you’ve gathered the materials listed above, you’re ready to 
perform venipuncture. These are the steps: 
2. Explain the procedure and verify why you are drawing blood. 
 
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2. PHLEBOTOMY 
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3. Identify the patient using two patient identifiers as approved by 
The Joint Commission. 
4. Confirm the tests required and that you have the necessary vacuum 
tubes for collection. 
5. Ensure the vacuum tubes are labeled with the patient’s information 
6. Wash your hands and put on your sterile gloves 
7. Place the patient’s arm on the arm board (if available) and extend 
the arm fully. 
8. Apply the tourniquet 3 to 4 inches above the access site. 
9. Have the patient form a fist and look for a good vein. 
10. 
Select a vein as shown in figure (1-13), release the tourniquet, and 
ask the patient to relax their fist. 
11. 
Cleanse the site thoroughly with the alcohol swab. 
12. 
Reapply the tourniquet and have the patient again make a fist. 
13. 
Uncap the needle. 
14. 
Grasp the patient’s lower arm to draw the skin taut and anchor the 
vein from rolling. 
15. 
Insert the needle. 
16. 
If correctly inserted, blood should flow into the vacuum tube. If 
this is not happening, the needle either misses or passed through 
the vein. 
17. 
As the blood flows into the tube, have the patient release their fist. 
18. 
After you collect the requisite number of tubes, you can release the 
tourniquet. 
19. 
Place the gauze pad over the needle and remove it. Apply slight 
pressure to the sight and cover it with a bandage. 
20. 
Place the labels on the collected blood. 
21. 
Discard the collection unit, placing the needle in the container. 
22. 
Send the blood specimens to the lab for testing. 
 
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Figure (1-13): Best Sites for Phlebotomy Superficial Veins of the upper limb 
Human anatomy and physiology 
 
Figure (1-14): Skin Layers and Phlebotomy 
1.15.4 Troubleshooting guidelines 
If an incomplete collection or no blood is obtained 
a. Change the position of the needle. Move it forward (it may not 
be in the lumen) Or move it backward (it may have penetrated 
too far) as shown in figure (1-16). 
 
 
1. Median cubital vein 
A superficial vein, most commonly 
used for venipuncture, it lies over the 
cubital fossa and serves as an 
anastomosis between the cephalic 
and basilic veins. 
2. Cephalic vein 
Shown in both forearm and arm, it 
can be followed proximally where it 
empties into the axillary vein. 
3. Basilic vein 
Shown in the forearm and arm, it 
divides to join the brachial vein. 
 
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2. PHLEBOTOMY 
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b. Loosen the tourniquet. It may be obstructing blood flow. 
c. Try another tube. There may be no vacuum in the one being 
used. 
d. Re-anchor the vein. Veins sometimes roll away from the point 
of the needle and puncture site. 
 
 
 
 
 
 
 
 
 
 
Figure (1-16): Change the position of the needle through Phlebotomy 
The process leading to a clinical lab result involves an examination 
and assessment process that is composed of the following steps :
  
1. Preanalytical phase includes patient preparation for sample 
collection and further treatment of the sample up to the beginning 
of analysis. 
2. Specimen analysis. 
3. Analytical assessment: the reliability of the test method according 
to criteria established for each test method such as precision, 
accuracy, analytical sensitivity and specificity. 
 
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1.15.5 Corrective Technique
 
The corrective technique is performed when no there is no blood 
return. After two unsuccessful attempts, the rule for Phlebotomists is 
to call in another Phlebotomist to perform the venipuncture. However, 
you must try to successfully obtain the sample before giving up. The 
proper procedure to do this is called Corrective Technique. 
1.16 Blood sampling 
Blood should always be collected at the same time of day, ideally 
between 7:00 and 8:00 a.m., especially for monitoring purposes. The 
last food and fluid intake should have occurred the proceeding 
evening between 6:00 and 7:00 p.m. The blood sample must be 
collected during the drug-free interval. i.e. prior to the morning dose 
of any medication. During blood collection, the patient should be in a 
supine position. 
Various Blood sample types: 
1. Venous blood: 
a. This is the easiest way to collect the blood sample. 
b. It is free of complications. 
c. Blood is taken from the superficial veins. 
d. The commonest site is the antecubital fossa because of the 
presence of basilic vein, cephalic vein; median cubital veins 
are the commonest veins. 
1. Veins of the wrist or hand may be used. 
2. Another site is the femoral vein. 
 
 
 
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2. Arterial blood: 
a. Arterial blood is used to measure arterial blood gases as shown in 
figure (1-17), like oxygen, CO2, and pH. 
b. Arterial puncture is more difficult than the venous sample. 
c. The Brachial and radial arteries are often used; the femoral artery is 
usually avoided because of bleeding. 
 
 
 
 
 
 
 
Figure (1-17): blood arterial collection 
3. Capillary blood: 
a. It is mostly used in the pediatric patient’s group where there is no 
need for a large amount of blood. 
b. The common sites are the fingertips, heel, and ear lobe as shown in 
figure (1-18). The heel is most commonly used in infants. 
 
 
 
 
 
 
 
Figure (1-18): Capillary blood collection 
 
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1.16.1 Blood collection methods for Infants : 
 
The neonatal heel prick, also known as a dermal puncture, is by 
far the most popular way to collect blood from newborns and infants up 
to about six months of age. Dermal punctures are preferable because, 
when done correctly, they are guaranteed to produce blood, removing the 
uncertainty of needle sticks. The heel prick is used to fill small collection 
tubes called pediatric “bullet” tubes, named after their shape. The steps 
for a proper neonatal heel prick are as follows: 
1. Be sure to place the infant in a safe, comfortable position, face-up, 
either on an infant draw table or a parent’s lap. Leave the baby as 
swaddled as possible for comfort, only exposing one leg for the 
draw. 
 
 
 
Figure (1-19): Capillary blood collection 
2. Choose heel areaas shown in figure (1-19) using an approved heel-
warmer pad, heat the baby’s entire foot for approximately one 
minute until the skin is very warm to the touch. This technique 
dilates capillaries in the area, maximizing blood flow. 
3. Gently flexing the foot upward, encase the baby’s entire foot in one 
hand. Rather than pinching the heel directly, you will be using a 
full-foot massage technique to collect the blood. This ensures both 
the baby’s comfort and a much better blood flow. 
4. Wipe the heel with an alcohol pad and allow it to air dry. Do not 
blow on the foot as it dries. Softly squeeze the baby’s foot so that 
the skin of the heel is bunched up. Press the lancet flat against the 
 
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inner, bottom edge of the heel, along the same side as the big toe, 
and depress the trigger. The lancet will make a quick swipe of the 
heel with a clicking sound. 
5. Wipe the first drop of blood away with a clean cotton pad. Then, 
using a massagi

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