This article is about the collection of blood and how to deal with the specimen collected from the patient’s body. This gives an in-depth description of procedures on how to collect samples and specimen, how to collect blood from patient to perform necessary tests and works on it. This article talks and describes about the routine venipuncture techniques and methods for those interested to become a professional Phlebotomist and want to get an outlook of their career. In this article we provide you with a better insight towards the various procedures used in Phlebotomy (depending on the age of the patient being dealt with), phlebotomy equipment and certain precautionary measures to be undertaken for the patient’s safety.
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Crucial Points to Remember: 
The role of a Phlebotomist necessitates 3P’s: polite, professed and perceptive in order to maintain a good contact with the patients. The phlebotomist has to understand what the patient feels and act accordingly.
• The foremost important aspect in this is identifying the patient. All sorts of patients need to be handled. Once the identification is done, make sure that a bracelet or arm-band is present and then draw the blood.
• The patient is given rights so that the patient feels comfortable while carrying out this operation. All patients are given certain rights while undergoing such operations. All phlebotomists abide by this bill.

The following are various procedures used in Phlebotomy based on different age groups and requirements:

Heelstick Procedure (0-6 months of age)
For babies, the blood collection is ideally done in the heels. Consider the bottom most tip on the heel as one corner of a triangle. Extend the two sides from the corner. These two sides extend throughout the length of the foot of the infant and cover the whole foot. The area on either side of the triangle’s side is the best position for the blood collection. Anywhere inside the triangle, it is not a good place to draw blood. Before drawing blood, the baby’s foot must be warmed to 42 degrees centigrade which increases the blood flow. Follow all the rules that are to be followed while drawing blood from any individual and the phlebotomist needs to be extra careful. New born babies do not need to produce more blood, so just follow a simple procedure to produce a bubble of blood. Do not exert much pressure. It hurts the child and also it dilutes the blood with tissue fluid.

Fingerstick Procedure (6 months-2 years of age)
Follow all the procedures required to perform blood collection. After everything is set, make sure the patient is in the right position. Draw his non dominant hand and stretch it. Separate the middle i.e. 3rd finger and the ring, i.e. 4th finger. Perform the venipuncture there and wipe off the first drop of blood as it mostly contains tissue fluid. Then collect the later drops of blood. Make sure that the incision is made perpendicular to the ridges so that the blood won’t fall down the fingers and arm. Perform the post-phlebotomy procedures promptly.

Venipuncture Routine (2 years and above)
The act of piercing the veins with the help of a syringe is called Venipuncture. There is a specific style and method of doing this task for every single phlebotomist. However, there are a set of instructions that one should follow for effective collection of the specimen. The first and foremost thing in venipuncture is identifying the right patient. Once the patient is identified as the person, (who exactly wants the phlebotomy to be done) the physical condition of the patient is to be checked. If the patient passes this check, verify the type of tests that the patient needs and what kind of specimens are needed to be collected. Once the types of tests are verified, the site for venipuncture needs to be decided (for e.g., infants need to be venipunctured on the heel). Then, prepare the venipuncture equipment and perform venipuncture. Make sure the punctured blood vessel is a vein. Collect the specimen and store it in a suitable container. Make a point that any complications during or as a consequence of phlebotomy are taken care of. Label the container having the sample correctly to avoid a mix up and send them to the laboratory for testing.

• Selecting a right venipuncture site
Venipuncture site selection is one of the most important jobs of phlebotomy. The median cubital and cephalic veins of the arm are in general used; the veins of the dorsal hand or the basilica vein of the dorsum arm are accepted for venipuncture. Foot is last resort because of high probability of issues. There are a few aspects which should be kept in mind while performing these operations. Avoid taking specimens from scars, injuries etc. Also avoid hematoma as they may cause erroneous results. Blood transfusion might dilute specimen. So use another arm to avoid erroneous results. Improper devices might not be used to draw blood unless the physician decides it is important.

• Accomplishing Venipuncture
The performance of a venipuncture starts with the phlebotomist approaching the patient. The phlebotomist must be in a cool and composed mood. He must identify the patient correctly and fill out the required forms. After verifying the patient’s condition, check if the patient is allergic to the operating equipment. Then position the patient to perform phlebotomy and extend the patients arm so that puncture is made on the vein on the hand. Position the tourniquet correctly at a decent distance above the puncture site. Sterilize the puncture site with alcohol solution and let it dry. Insert the needle at 15-30 degrees angle and place the needle in the lumen of the vein. Remove the tourniquet and store the specimen properly in the right container. Dispose the needle and make sure hematoma is not formed at the site of the puncture by applying enough pressure. Send specimens to the laboratory.

One more procedure used for patients above 2 years of age is the Handstick Procedure. This is also a procedure which can be performed after obtaining the permission from the doctor and it is used in cases where only a small amount of blood is to be drawn.

Phlebotomy Equipments and Tools
There are different tools that are used during venipuncture. Let us go through them. Evacuated Collection tubes: These are vacuum filled tubes to collect blood. There are different additives in each tube. For this reason, blood is not transferred from one tube to another as the additives are different in different tubes.

Needles: The gauge number indicates the bore size.

Needle disposable unit: This must be used to dispose needles. There are equipments like holder, tourniquet, alcohol wipes, gloves etc.

Precautionary Measures
The two basic principles of safety and infection in phlebotomy and any medical field is that the technician must ensure personal safety and also the safety of the patient. The phlebotomist has to wear gloves for every job that he undertakes. He must change gloves for every patient he treats. He must wash hands repeatedly and regularly. He must treat all blood spills with disinfectant. Avoid piercing the infected needle into the body. When it comes to the patient, all types of care must be taken to protect the hygiene of the patients. Like wearing gloves, washing hands, disinfectant wipes etc. can be used. Special care must be taken to protect children or old people from infections through blood or any other fluids. Cleaning up of the work area is important to maintain overall hygiene.