POLICY:
Technologists.
A work instruction to perform Venipuncture to serve as a guide to Medical
PURPOSE:
To establish a documented work instruction for the Venipuncture procedure.
MATERIALS:
Requisition form, gloves, goggles and mask, laboratory gown, phlebotomy collection
tray, tourniquet, 70% isopropyl alcohol pad, 10 mL syringe and 21-gauge hypodermic needle, 21gauge multidraw needle, vacuum tubes or special collection tubes, vacuum tube adapter or holder,
transfer devices, cotton balls, 2×2 gauze, adhesive bandage or micropore tape, antimicrobial hand gel,
indelible pen, sharps container and biohazard red bag, test tube rack, biohazard transport bag
(optional).
PRINCIPLE:
PROCEDURES:
Venipuncture (Syringe and Evacuated Tube System)
1.
2.
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14.
Assemble the supplies. Organizing supplies before the procedure ensures a more timely
and professional process.
Obtain and examine the requisition form.
Greet and reassure the patient and explain the procedure to be performed. Help the
patient into a comfortable position in a phlebotomy chair or bed.
Identify the patient verbally by asking the patient’s both first name and last name. Verify
it with the tests ordered and the computer label or identification number. If a fasting
specimen is required, the patient should be verified from refraining food or drink
consumption except water for 12 hours.
Wash hands and apply gloves, goggles, and mask.
Needle preparation:
A. Syringe
i.
Open the sterile needle and sterile syringe packages. Check if the syringe and
needle is well-assembled by pulling the plunger halfway out and pushing it all
the way in again.
ii. Choose the right vacuum tubes for later transfer of the specimen.
B. Evacuated Tube System
i.
Break the seal on the shorter needle; thread the shorter needle into the
holder/adapter. Select the first tube and gently place it into the holder/adapter
(do not puncture the tube yet).
All tubes with anticoagulants should be tapped and checked for expiration dates. Place
the tubes in the correct order in a holding rack.
Apply the tourniquet 3 to 4 inches above the antecubital fossa and select a site. Pull it
tight enough to trap venous blood without cutting off the arterial flow.
Position the patient by slightly bending their arm and asking them to make a fist. Patient
must avoid a hand pumping action and hard tapping of the veins is discouraged. The
patient must not hyperextend the arm.
Select a vein by palpation. Note the location and direction of the vein. Palpate the area in
a vertical and horizontal direction to locate a large vein and to determine the depth,
direction, and size. To test the vein's elasticity and rebound, place your index finger over
it and lightly press, then release the pressure.
Cleanse the site with 70% isopropyl alcohol alcohol swab in concentric circles moving
outward and allow it to air dry. Avoid touching the site after cleansing.
Draw the skin taut with the thumb by placing it 1 to 2 inches below the puncture site
With the bevel up, line up the needle with the direction of the vein and perform the
puncture. The point of the needle should enter the skin about 1⁄4 inch below where the
vein was palpated. Do not move the needle from side to side once the vein has been
entered. Do not push down or pull up the needle.
Proceeding venipuncture procedures:
A.
Syringe
i.
15.
16.
17.
18.
Let go of the skin and use the other hand to pull back on the plunger. Pull gently
and only as fast as the syringe fills. If the vein collapses, stop pulling on the
plunger and let the vein refill.
ii. Have the patient open the hand when the syringe is full. Remove the tourniquet.
iii. Lightly place a cotton ball above the puncture site and remove the needle in the
same direction as inserted.
iv. Apply pressure to the site for 2 to 3 minutes. Let the patient assist by holding
the pressure if desired. The patient can elevate the arm but should be
instructed not to bend the elbow.
v. Aliquot blood into the appropriate tubes in the rack in the proper order. During
transfer, hold each tube at the base only.
vi. Puncture the vacuum tube through the rubber stopper with the syringe needle
and allow the blood to enter the tube until the flow stops. Never push on the
plunger or force blood into the tube.
vii. Implement safety mechanism or devices on the needle immediately.
viii. Mix any anticoagulant tubes immediately.
B. Evacuated Tube System
i.
Let go of the skin and use that hand to grasp the flange of the vacuum tube
holder and push the tube forward until the needle has completely entered the
tube. Do not change hands while performing venipuncture. The hand
performing the venipuncture is the hand that is holding the vacuum tube holder.
The other hand is free for tube insertion and removal.
ii. Fill the tube until the vacuum is exhausted and the blood flow stops. Rotate
tubes so the label is down.
iii. When the blood ceases, gently remove the vacuum tube from the needle and
holder.
iv. Immediately mix the blood in the anticoagulant tubes by gently inverting them
several times.
v. Insert the second tube onto the needle by using the same motion as the first
tube. Let it fill then remove it with the same motion as the first tube. Invert it
several times if it contains anticoagulants.
vi. When the last tube has filled, remove it from the needle. Ask the patient to
open the hand and release the tourniquet.
vii. Lightly place a cotton ball above the puncture site and remove the needle in the
same direction as inserted.
viii. Immediately activate the safety device.
ix. Apply pressure to the site for 2 to 3 minutes. Let the patient assist by holding
the pressure if desired. The patient can elevate the arm but should be
instructed not to bend the elbow.
Discard the syringe and needle into a sharps container and the contaminated cotton ball
and other contaminated waste into a red biohazard bag.
Label all tubes before leaving the patient and verify identification with the patient ID
band or verbally with an outpatient. If any special treatment is required for the
specimens, institute the handling protocol. Complete paperwork.
Check the patient. Observe for signs of stress. When sufficient pressure has been applied
to stop the bleeding, apply a small pressure bandage by pulling a cotton ball in half,
applying it to the puncture site, and placing an adhesive bandage or tape over it. Instruct
the patient to remove the bandage in 20 minutes. If the patient is sensitive or allergic to
latex, use nonlatex paper tape. If the bleeding has not stopped after 2 to 3 minutes, have
the patient continue to hold direct pressure on the site for another 5 minutes with the
arm elevated above the heart and by lying down with the other arm on a pillow. Recheck
after 5 minutes.
Disinfect surfaces and supplies/equipment and dispose of all contaminated items
properly. Remove gloves using proper technique.
19. Thank the patient, wash hands, record the procedure, and complete the laboratory
requisition.
QUALITY CONTROL:
Properly identify the patient and tests ordered as well as the preparation of
the patient for blood tests.
REFERENCE VALUES:
N/A
PRECAUTIONS:
a)
b)
c)
d)
e)
f)
Wear gloves and a laboratory gown when handling blood/body fluids.
Change gloves after each patient or when contaminated.
Wash hands frequently.
Dispose of items in the appropriate containers.
Dispose of needles immediately upon removal from the patient’s vein. Do not bend,
break, recap, or re-sheath needles to avoid accidental needle puncture or splashing of
contents.
Clean up any blood spills with a disinfectant such as freshly made 10% bleach.