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

Antecubital Area Vessels

Cephalic Vein

Median Cubital Vein

Basilic Vein

Veins Used for Drawing Blood

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

20 000-00-000020 000-00-0000DP 210-221-4450 A1401TMCDP 210-221-4450 A1401TMCGAVIN, JAMESGAVIN, JAMES07DEC55 M USA AD ENL07DEC55 M USA AD ENLSFC HHC 2/505th PIRSFC HHC 2/505th PIRTMC-OUTPATIENT RECORDS, FBNCTMC-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

• 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.

Apply Constricting Band

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 °

• 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

Puncture Vein

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

• 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

Complete the Procedure

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