Obtain and Label Blood Specimens

Introduction Venipuncture is a technique that permits access to a vein so that a needle or catheter can be inserted, usually to withdraw a blood specimen or initiate an intravenous infusion Venipuncture is a sterile procedure since the integrity of the skin is broken

Terms and Definitions Venipuncture Palpate Antecubital fossa Anticoagulant Hematoma

Veins Used for Drawing Blood Antecubital Area Vessels Cephalic Vein Median Cubital Vein Basilic Vein

Venipuncture Procedure Universal precautions - hand wash & gloves Strict adherence to the sharps policy Verify the request to obtain specimen Check the physician's orders Select the proper specimen tube/s Prepare label(s) Perform a patient care hand wash/don gloves

Stamp Label With Patient’s Addresograph Plate 20 000-00-0000 DP 210-221-4450 A1401TMC GAVIN, JAMES 07DEC55 M USA AD ENL SFC HHC 2/505th PIR TMC-OUTPATIENT RECORDS, FBNC

Gather Equipment Constricting band Vacutainer holder or Syringe Sterile disposable double-ended needle or Butterfly or Hypodermic needle Betadine or alcohol wipe or sponge Protective pad (chux) Sterile 2 x 2-inch gauze sponge(s) Band-Aid

Venipuncture Equipment

Assemble Holder & Needle Put short end of needle into threaded hole in vacutainer holder Screw tightly using clockwise motion

Insert the Tube into the Holder Insert stoppered end of the tube into holder Do not push tube beyond the guideline Inspect the needle for barbs, corrosion

Identify Patient Explain the procedure and purpose Ask patient about allergies (i.e., iodine or alcohol). Position the patient - sitting or lying Never draw blood from a standing patient. Position protective pad

Apply Constricting Band Apply with enough pressure to stop venous return A radial pulse should be felt Place latex tubing around limb about 2 inches above venipuncture site If a commercial band is used, wrap it around limb and secure by overlapping velcro ends

Apply Constricting Band Instruct patient to clench and unclench his fist several times to trap blood and distend veins Avoid veins that are infected, injured, irritated, or have an IV running distally.

Palpate Selected Vein Palpate along length of vein with index finger Vein should have a spongy feel Clean the skin Do not re-palpate the vein after cleansing the skin.

Prepare the Puncture Site Cleanse area with betadine or alcohol using a circular motion Do not touch the area once cleansed

Prepare to Puncture the Vein Remove protective cover from needle Position needle in line with vein and grasp patient's arm below entry point with free hand Place thumb of free hand 1 inch below entry site and pull skin taut toward hand

Puncture the Vein Align needle bevel up Pierce skin at a 15° to 30 ° angle Decrease angle until parallel to skin surface, then pierce vein If needle is withdrawn above skin surface, do not attempt venipuncture again with the same needle 15 ° to 30 °

Puncture Vein If unsuccessful Release the constricting band Place 2 x 2 gauze sponge over site Quickly withdraw the needle and instruct the patient to elevate arm slightly and keeping the arm fully extended apply pressure to the site for 2 to 3 minutes. Notify supervisor before attempting another venipuncture

Single Tube Collections When the tube is nearly full release the tourniquet Remove the tube from the holder DO NOT withdraw the needle before the constricting band is released

Multiple Tube Collections When the Tube Stops Filling Pull It Out of the holder After the last tube stops filling remove from the holder Release the tourniquet DO NOT withdraw the needle before the tourniquet is released

Complete the Procedure Place 2 x 2 sponge over venipuncture site Withdraw the needle smoothly and quickly Immediately apply pressure to the site Have patient elevate arm and apply pressure to site

Complete the Procedure If tube contains an anticoagulant or other additive, gently invert tube several times to mix with blood Apply a Band-Aid to the venipuncture site DO NOT unscrew needle from sleeve with hands DO NOT recap needle Dispose of needle into sharps

Patient Comfort and Safety Remove protective pad Roll down patient's sleeve If patient is in bed reposition and raise side rails Remove all the equipment from area Dispose of used supplies Store reusable equipment and dispose of needle IAW local sharps SOP Remove gloves and wash hands

Dispose of the Needle in a Sharps Container

Administrative Duties Check and complete laboratory form IAW local SOP Apply prepared label(s) Document procedure IAW local SOP

Summary If venipuncture is done smoothly and properly, there should be little pain for the patient and little risk to medical personnel The procedural steps are designed to ensure a properly drawn specimen With practice, obtaining a blood specimen can become a smooth routine