LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH   Policy 354.03 Phlebotomy Venipuncture and Phlebotomist Responsibilities     PROCEDURES

At the beginning of each shift, phlebotomist shall check sharps container remaining capacity. Sharps container shall never be used beyond 80% filled and shall be replaced with new empty ones before performing any venipuncture  Phlebotmist shall obtain printed laboratory orders or requisition form for each client prior to performing blood draw  Phlebotomist shall use two unique identifiers for verbal identification of all clients before procedure begins. Verbal identity verification shall be performed by asking clients to verbalize their Last Name and First Name and Date of Birth. Common acceptable unique identifiers include: Last Name, First Name Date of Birth Other acceptable unique identifiers include: Telephone number IBHIS number Last four (4) digit of Social Security Number  All necessary supplies shall be gathered and organized prior to each venipuncture procedure  Phlebotomists shall sanitize hands prior to venipuncture procedure and after each blood draw by using alcohol-based sanitizer or washing hands with soap and water  Gloves shall be worn for all venipuncture procedures to comply with OSHA regulations  Phlebotomist shall screen clients for allergies prior to donning gloves Phlebotomist shall use latex free gloves if client has an allergy or hypersensitivity to latex proteins Gloves shall be worn intact with no rips or holes  Phlebotomist shall inquire about clients fasting status, if applicable  Phlebotomist shall inquire about client's of history of reactions to phlebotomy procedures (e.g. history of fainting or loss of consciousness) If client loses consciousness during venipuncture procedure: Call psychiatrist on duty Where practical, lay client flat or lower his/her head and arms Instruct client to breathe deeply and slowly Apply cold compresses to the client’s forehead  Clients shall be seated in a phlebotomy chair that prevents clients from falls in the event of lightheadedness or loss of consciousness  A new tourniquet shall be used for each client for each blood draw  All supplies shall be taken out from sterile packages, if applicable, in the presence of client and never pre-assembled All vacutainer holders and needles shall be single-use only Contaminated blood tube holder with needle attached shall be immediately discarded into a sharps container after safety feature has been activated Only sterile needles shall be used and shall never be recapped or pre-assembled  Approved site of venipuncture includes: Antecubital veins Cephalic vein Median cephalic vein Median basilic vein Basilic vein Veins on back of the hands  Phlebotomist shall clean venipuncture site with 70% isopropyl alcohol pads or use appropriate cleanser in a circular motion from the center to the periphery. Allow the site to dry prior to venipuncture procedure  Phlebotomist shall notify client that procedure is about to begin prior to performing venipuncture  No more than three (3) venipunctures shall be attempted by a single phlebotomist per session. If unsuccessful, client shall be referred to another phlebotomist or taken to nearest contracted laboratory draw station  Apply pressure with cotton ball or gauze immediately to venipuncture site after needle is withdrawn. Phlebotomist may also instruct client to apply pressure on his/her own over gauze bandaged venipuncture site and leave bandage on for at least fifteen (15) minutes Notify psychiatrist if hematoma develops or bleeding persists longer than five (5) minutes  Label specimens clearly and properly  Clients' insurance information and billing information shall be documented on specimen slip and provided to external laboratory vendor with specimen drop-off  Phlebotomist shall perform the following at the end of each phlebotomy procedure session: Dispose of all used equipment in appropriate biohazard containers or sharps containers Disinfect all surfaces with antiseptic wipes Dispose of any materials from the blood draw Ensure that any materials that include HIPAA materials are disposed of in an appropriate manner to protect patient's privacy Restock all supplies and equipment  Storage and transportation of specimens shall be done in appropriate transport container under appropriate temperature and condition for specimen processing to minimize pre-analytical error Coordinate and ensure that all specimens are appropriately dropped off or picked up by analytical laboratory vendor in a timely manner  Venipuncture shall be discontinued immediately under the following circumstances: If client feels a shooting, electric-like pain, or tingling or numbness proximal or distal to the venipuncture site. Client shall be referred for medical evaluation. Incident shall also be reported in Safety Intelligence If you suspect arterial puncture during specimen collection. Remove the needle and apply forceful pressure to the puncture site for at least five (5) minutes until active bleeding is ceased. Incident shall be reported in Safety Intelligence  Specimen shall be drawn in accordance with order’s priority: STAT – specimen shall be collected and delivered immediately to contract laboratory sites during business hours and following appropriate protocol Routine – specimen shall be collected when next available  Equipment and Supplies Antiseptics- Approved antiseptics include: 70% isopropyl alcohol PVP iodine prep pads 2% iodine tincture Bandages/Tape Biohazard bags and containers Centrifuge Cold compresses Cotton ball Flat board Gauze bandages Gauze pads Germicidal wipes Gloves Laboratory caddy Phlebotomy chair Puncture-resistant disposable container Sharps container Specimen bags Specimen carrier cooler – temperature regulated Specimen collection tubes Sterile urine containers Tourniquets Vacutainer holders, needles and adapters