How to Avoid Hemolyzing As a Phlebotomist

Phlebotomist's are responsible for drawing blood from patients for testing at a clinical laboratory. Hemolysis occurs when red blood cells breakdown and release hemoglobin. This can be a result of incorrectly collecting the specimen or improper handling after the specimen has been drawn. When blood specimens hemolyze, the samples cannot be tested to achieve accurate results and the blood must be re-drawn from the patient. Following proper procedure and guidelines can help the phlebotomist minimize the chances of hemolysis.

Instructions

• 1

  Select the proper needle size for your patient. This will vary based on the characteristics of the patient and the number of vials you will need to draw. The sizes used most often are 19 to 23.

• 2

  Look at the patient's arm to plan your blood draw. Draw the specimen from an antecubital site--the area in front or inside of the elbow. Avoid drawing the specimen from a distal site of the antecubital area of the patient's arm. The areas above, below or to the side of the antecubital area would be a distal site.

• 3

  Clean the venipuncture site with alcohol, but allow the alcohol to completely dry before drawing the specimen. Allowing the alcohol to completely dry will reduce hemolysis.

• 4

  Place the tourniquet on the arm. Minimize the time you leave the tourniquet on the patient's arm. The tourniquet should never be left on the patient's arm more than one minute. Leaving the tourniquet on too long can result in hemolysis. Watch the patient to ensure he is not gripping his fist too tightly. Ask him to release his fist and remove the tourniquet once blood is flowing into the vial.

• 5

  Avoid pulling the plunger back too quickly if you are collecting the blood with a needle and syringe. Forcing the blood out too quickly can result in hemolysis.

• 6

  Gently invert (flip upside down and then right-side up) vials of blood containing a clot activator five times and then allow the vials to sit, in a vertical position, for 30 minutes. Vials without clot activators should be left to sit, in a vertical position, for 60 minutes. Vials used for sodium citrate tubes need to be inverted, gently, three to four times. All other vials of anticoagulant tubes need to be gently inverted eight to 10 times.