ACTIVITY 5

Venipuncture
procedures
Judy Ann Nichole A. Dionio, RMT
Laboratory Activity 5
Tourniquet Tying and Vein
5.1 Selection
Evacuated Tube System
5.2 (Single Draw)

Evacuated Tube System

5.3 (Multiple Draw)

5.4 Syringe Procedure

5.5 Butterfly Procedure

5.1 Tourniquet
Tying and Vein
Selection
 Objective

At the end of this activity, the

student should be able to
properly apply to a patient’s
arm and select veins for
venipuncture.
Tourniquet
is a device that is used to
apply pressure to a limb or
extremity in order to limit –
but not stop – the flow of
blood.

It may be used in
emergencies, in surgery, or
in post-operative
rehabilitation.
Tourniquet
Provides a barrier against venous blood
flow to help locate a vein.

It also stretches the blood

vessel walls so they are
thinner and easier to pierce
during venipuncture

A tourniquet can be a
disposable strap, a heavier
Velcro straps or a blood
pressure cuffs.

Latex Free- tourniquets are available for

individuals with a latex allergy.
 History of Tourniquets

4th 1785 2000s

century 1718
BC

The silicon ring

During Alexander French surgeon Sir Gilbert Blane
tourniquet, or elastic
the Great’s Jean Louis Petit advocated that, in
ring tourniquet, was
military developed a battle, each Royal
developed by Noam
campaigns, screw device for Navy sailor
Gavriely, a professor
tourniquets were occluding blood should carry a
of medicine and
used to stanch flow in surgical tourniquet
former emergency
the bleeding of sites. physician.
wounded soldiers.
Different
Kinds of
Tourniquet
Found in the
Disposable elastic Velcro Strap
laboratory straps

Rubber tubbings Blood Pressure Cuffs

 Procedure of Tourniquet Tying
01Position the vinyl or later 02 Grasp both sides of the
tourniquet and, while
03 Hold both ends 04 Tuck a portion of the
strips 3 to 4 inches above between the thumb left side under the
maintaining the tension,
the venipuncture site. and forefinger of one right side to make a
cross the tourniquet hand close to the arm.
Avoid areas with a skin partial loop facing
lesion or apply tourniquet over the patient’s arm . the antecubital area
over the patient’s gown

06 Your Text
Here

05 Atourniquet
properly applied
will have the
06 Pull the end of the loop to
release the tourniquet with ends pointing up away
one hand. The tourniquet from the venipuncture
should only be on for 1 site
min.
Vein Selection

Major ot the veins for venipuncture

are in the antecubital fossa, the
area of the in front of the elbow.

Median Vein Cephalic Vein Basilic Vein

The median cubital The cephalic The basilic vein located
vein or median vein, often the in the inner portion of
vein is the only vein that the arm is the last
preferred site for can be felt in choice for venipuncture
collecting blood in obese patient, is because of the risk of
adults because the located on the puncturing a median
vein is both large edge of the cutaneous nerve branch
and close to the outer arm. of the brachial artery. .
surface of the skin.
 Vein Selection
If ankle/foot must be used for
The vein on the back of the venipuncture, a nurse or physician
hand and wrist may also be should be consulted because these
used for venipuncture. Veins sites cannot be used in some patients
on the underside of the wrist, (circulatory problems in the lower
however, should never be extremity, diabetes in poor control, or
hemoglobinopathies)
used of venipuncture
 Procedure
Palpate veins in the Locate the three major
antecubital area veins

Use the tip of the index

finger to palpate or feel
The median Cubital Vein
veins to determine
suitability of locate veins
which cannot be seen
(help determine size,
depth and direction of
veins.)
The Cephalic Vein

Palpate with a pushing

motion rather than a
stroking motion.

The Basilic Vein

Veins will feel like spongy,
resilient (have a bounce),
tube like structures.
 Procedure
Check antecubital region
on both arms to find
Select Venipuncture Site Mastectomy patients suitable vein

Dominant arm will have Avoid burned, scarred or Draw from the side Check hand or wrist veins.
generally the most tattooed areas opposite of mastectomy
prominent veins whenever possible

Use leg, ankle, or foot

Do not select a vein that veins except as last resort
feels hard and cord-like or and after and after
Edematous areas should Application of tourniquet
lacks resilience. Tendons obtaining permission from
be avoided may cause injury on the
are hard and lack patient’s physician
mastectomy site
resilience

Blood flow to the

Do not draw above an IV. If extremities may not be
Avoid drawing in the are of If patient has double
necessary, have IV turned representative of general
a hematoma. Draw from mastectomy, physician
off for a minimum of 2 circulation producing
below site if there are no should be consulted –
minute. erroneous results.
alternative usually avoid the side of the
most recent mastectomy Lower extremities
venipuncture may cause
blood for formation.
Venipuncture
Venipuncture
Is defined as the process of
collecting or “drawing”
blood from a vein. It is the
most common way to
collect blood specimens for
laboratory testing.
There are two ways by which
blood can by collected by
venipuncture.

There are by the use of the

needle and syringe which is also
refereed to as “open system”,
and by the use of the evacuated
tube system referred to as
“closed system”.
Venipuncture is one of the most routinely
performed invasive
Content procedures
Content and isContent
Content

carried out for any of five reasons:

1. to obtain blood for diagnostic purposes;

2. to monitor levels of blood components;

3. to administer therapeutic treatments including

medications, nutrition, or chemotherapy;

4. to remove blood due to excess levels of iron or

erythrocytes (red blood cells); or

5. to collect blood for later uses, mainly transfusion

either in the donor or in another person.
Venipuncture is the most common
invasive medical procedure performed
by health care providers and a variety

Complications
of adverse complications may be
encountered during blood collection
process.
1. Hematoma Formation
2. Infection
3. Nerve Damage
4. Hemoconcentration
5. Syncope and Fainting
6. Petechiae
7. Excessive Bleeding
8. Edema
9. Fear and Phobia
10. Thrombosis
11. Arterial Puncture
12. Pain
13. Allergies
14. Iatrogenic Anemia Reference:Buowari, O. 2013 Complications of venepuncture.
Retrieved from https://file.scirp.org/pdf/ABB_2013013114170934.pdf
5.2 Evacuated
tube system
(Single Draw)
 Objective

At the end of this activity, the

student should be able to
identify the proper
venipuncture steps by
evacuated tube system
(single draw).
 Materials Needed
1.Alcohol Prep Pads
2.Povidone – iodine swabs for blood
culture
3.Nonalcohol-based antiseptic for blood 0
alcohol collections
4.Gauze pads or cotton balls
5.Adhesive bandages or other bandaging
materials
6.Gloves
7.Tourniquet
8.Blood collection evacuated tubes
9.Multiple sample needle
10.Standard tube holder
11.Sharps container
12.Permanent marker or pen
 Procedures
05
Prepare the 04 Assemble
03 patient for equipment
Identify the patients and put on
Obtain and a. The most important 02 Verify diet testing
a.Bedside gloves
restrictions
accession the test 01 step in specimen
collection (fasting) manner
request
- Requisition are b. Ask patient to state b.Explain
the forms on which name and date of procedure
birth (DOB)
test orders are
c. Check patient’s
c.Obtain
entered and sent to consent
the laboratory identification
a. Manual bracelet
requisitions - Name
b. Computer - Identifying
generated number: medical
requisition record number or
c. Barcode labels visit number
 Procedures
Ask the patient to 10
09 make a fist.
08 Apply a. Vein become
07 Position tourniquet more prominent
b. Do not allow
06 Reassure patients patient to pump
Wash hand Patients fist as this can
and put on cause
gloves hemoconcentrat
ion and lead to
erroneous
results.
 Procedures
15
Clean the site 14 Reapply
a. Clean with antiseptic 13 Verify
tourniquet. Do
12 70%isopropyl alcohol not touch the
b. Clean using circular equipment
Release cleansed area
11 tourniquet
motion
c. Do not contaminate
Select vein the site by drying the
alcohol with unsterile
puncture gauze
site d. Do not introduce
airborne contaminants
by fanning or blowing
on it
e. Do not touch the site
after cleaning
 Procedures
Fill the tube
a. Advance the tube into
Insert needle into
the needle 20
Anchor the vein
the vein
a. Have a patient19 b. As soon as blood flows
a. Place your 18 make a fist
into the tube, release the
tourniquet and have the
Remove the thumb1-2 inches b. Line up needle in
patient release his/her
below the the direction of
Pick up
cover and
17 intended the vein – Bevel
fist. – on elderly
patient and other with
and 16 inspect
needle. venipuncture up
c. Warn the patient
fragile veins that might
position Visually site collapse or in difficult
d. Insert needle
blood b. Pull skin situations, the
inspect the into the skin at
tourniquet is sometimes
collection needle tip towards the 15 – 30 degrees
wrists left on until the last tube
equipment for angle
is filled; however do not
obstructions, c. Use the finger of e. Advance needle
leave the tourniquet for
your anchoring until you a
imperfection decrease in
more than one minute
s, or barbs hand to support c. Mix the tube with
the back of the resistance
additives immediately
f. Securely anchor
arm by gently inversions
the tube holder
 Procedures
Observe special
handling instructions 25
Label the 24 a. Putting on
tubes crushed ice (e.g.
23 a. Patients ammonia, BNP,
Withdraw the needle 22 Dispose name lactic acid, blood
a. Place gauze over the Engage of
site 21 safety b. Identifying gases)
b. Do not press down sharps number b. Keeping it warm
the gauze while device
needle is in the vein c. Date of (e.g. cold
c. Withdraw the needle agglutinin,
in one smooth
Collection
cryoglobulin
motions d. Time of
d. Apply pressure to the c. Protecting from
site with gauze pad
Collection light (e.g.
e. Do not bend arm up –
keep extended or
bilirubin)
raised
 Procedures
Check 30
Remove the 29 specimen
28 Gloves and
collection logs
Dispose 27 Thank the wash hands
Check 26 patient (if applicable)
contaminated
patient’s
materials
arm and
apply
bandage
 Procedures

a. Transport specimen
Transport 31 in a timely manner
specimen into b. Enter specimen into
the laboratory the computer
system or logbook
to verify collection
and receipt into the
laboratory
5.3 Evacuated
tube system
(Multiple Draw)
The evacuated tube
system has its own
advantages and
disadvantages over
the needle and Some of its advantages are the
syringe system. procedure is simple as it will
require fewer steps and the
chance of specimen
contamination is avoided.
Blood is allowed to fill the tube
by vacuum. Blood flow
automatically stops when the
vacuum inside the tube is used
up.
Two or more tubes can be
filled up according to the order
of draw.
 Objective

At the end of this activity, the

student should be able to
identify the proper
venipuncture steps by
evacuated tube system
(Multiple draw).
 Materials Needed
1.Alcohol Prep Pads
2.Povidone – iodine swabs for blood
culture
3.Nonalcohol-based antiseptic for blood 0
alcohol collections
4.Gauze pads or cotton balls
5.Adhesive bandages or other bandaging
materials
6.Gloves
7.Tourniquet
8.Blood collection evacuated tubes
9.Multiple sample needle
10.Standard tube holder
11.Sharps container
12.Permanent marker or pen
 Procedure
Follow same procedure
(steps 1-19) in Evacuated
Tube System (Single
Draw) and continue as
follows:
c. For the evacuated tube
system multiple draw, remove
the first tube, mix, and then
insert next tube. Draw tubes
needed in the correct order to
prevent back flow of additives
as follows:
1. Fill the tube
Blood-culture tubes (yellow)
Coagulation sodium citrate tube
(blue stopper)
Serum tubes with or without clot
activator or gel separator
Heparin tubes with or without
gel (green stopper.
Ethylenediaminetetraacetic acid
tubes (lavender stopper)
Glycolytic inhibitor tubes (gray
stopper)
a. Advance tube
onto the needle
b. As soon as blood flows
into tube, release the
tourniquet and have the
patient release his/her fist.
- On elderly patients and others
with fragile veins that might
collapse or in other difficult
draw situations, the tourniquet
is sometimes left on until the
last tube is filled; however, do
not leave the tourniquet for
more than one minute
 Procedure
d. Mix tubes with additives 2. Withdraw the 3. Engage
by gentle inversion needle safety device
a. Place gauze over site
b. Do not press down on the gauze
while the needle is in the vein
c. Withdraw the needle in one
smooth motion
d. Apply pressure to site with gauze 4. Dispose of sharps.
pad
e. Do not bend arm up – keep
extended or raised

a. Patient’s name 5. Label the tubes

b. Identifying number
c. Date of collection
d. Time of collection
 Procedure
6. Observe special 7. Check the 8. Dispose of
handling instructions contaminated
patient’s arm and
apply bandage materials
a. Putting on crushed ice (e.g.
ammonia, BNP, lactic acid,
blood gases)
b. Keeping it warm (e.g. cold
agglutinin, cryoglobulin)
c. Protecting from light (e.g.
bilirubin)
9. Thank the patient.

10. Remove gloves

and wash hands
 Procedure
11. Check specimen 12. Transport the
collection logs (if specimen into the
applicable) laboratory
a. Transport specimens in a
timely manner
b. Enter specimens into the
computer system or logbook
to verify collection and
receipt into the laboratory.
If you are unable
to obtain a
specimen:
1. Evaluate the problem
2. Try again below the first
site, on the opposite arm, or
hand or wrist vein
3. Do not try a third time
5.4 Syringe
Procedure
A syringe procedure may be performed if
a patient has small, fragile or weak veins
that collapse easily.
The vacuum pressure of the evacuate tube may be
too great for such veins. When a syringe is used,
the pressure can be controlled by pulling slowly
on the syringe plunger
 Objective

At the end of this activity, the

student should be able to
identify the proper
venipuncture steps by
syringe procedure
 Materials Needed
1.Alcohol Prep Pads
2.Povidone – iodine swabs for blood culture
3.Nonalcohol-based antiseptic for blood alcohol 0
collections
4.Gauze pads or cotton balls
5.Adhesive bandages or other bandaging materials
6.Gloves
7.Tourniquet
8.Blood collection evacuated tubes
9.Syringe needle
10.Syringe
11.Transfer Device
12.Sharps container
13.Permanent marker or pen
 Procedure

1. 4. 5.
2. 3.
Obtain and Prepare Assemble
Identify Verify diet
Accession the equipment
the restriction
the test patient for and
patient s (fasting)
request testing supplies

a. Requisitions are the a. The most important a. Bedside manner

forms on which test step in specimen b. Explain the
orders are entered and collection procedure
sent to the laboratory b. Ask patient to state c. Obtain consent
name and date of birth
.
i.Manual requisitions (DOB)
ii. Computer generated c. Check patient’s
requisitions identification bracelet
iii. Barcode labels i. Name
. ii. Identifying number:
medical record number
or visit number
 Procedure

6.
Wash 7. 8. 10.
9.
hands Reassure Position Ask the
Apply
and put patient patients patient to
tourniquet
on gloves make a fist

a. Seated patients: a. Veins become

patient arm should more prominent
be supported firmly; b. Do not allow
arm should not be patient to pump
bent at the elbow (open and close)
b. Supine patients: fist as this causes
arm extended; not hemoconcentration
bent at elbow and lead to
. erroneous results.
.
 Procedure

15.
11. 14. Reapply
Select 12. 13. Verify tourniquet.
venipuncture Release Clean the equipment Do not touch
site tourniquet site and tube the cleansed
selection area
a.Clean with antiseptic –
70% isopropyl alcohol a. Remove syringe
b.Clean using circular from the package
motion b. Advance the
c.Do not contaminate the plunger to the end
site by drying the alcohol of the syringe
with unsterile gauze
d.Do not introduce airborne
c. Securely attach
contaminants by fanning or the needle to the
blowing on it system
e.Do not touch the site after .
cleaning
.
 Procedure
16. 17.
Remove the cover
Pick up and and inspect the 19.
position needle. Visually 18. Insert the 20.
blood inspect the needle Anchor needle into Fill the
collection tip for the vein syringe
obstructions,
the vein
equipment. imperfections, or
barbs.

a. Place your thumb a. Insert needle a. Slowly pull back

1-2 inches below the bevel up on the plunger of
intended b. A flash or small the syringe and
venipuncture site amount of blood allow the barrel of
b. Pull the skin
will appear in the the syringe to fill
towards the wrist
c. Use the fingers of hub of the needle with blood.
your anchoring hand while the needle is
to support the back in the vein
of the arm c. Release
. tourniquet
.
 Procedure

21. 24.
22. 23. Transfer
Withdraw the Engage
needle Dispose blood to
safety of sharps evacuated
device tubes

a. Place gauze over the site

b. Do not press down on the
gauze while the needle is in
the vein
c. Withdraw the needle in
one smooth motions
d. Apply pressure to site
with gauze pad
e. Do not bend arm up –
keep extended or raised
.
 Procedure
c.When the
last tube is
b.Transferring filled,
a.Syringe
without a withdraw
transfer the needle,
device transfer
activate the
device safety
device and
i. Attach the transfer device to the syringe dispose of
ii. Hold the syringe vertically, with the tip down and i. If a transfer device is not available, place sharps.
transfer device at the bottom the required tubes in the proper order of
iii. Following the proper order of draw for syringes, draw in a rack or slot in a phlebotomy tray
push the evacuated tube onto the needle within the ii. Never hold the tubes in your hand
transfer device iii. Penetrate the stopper of the tube with the
iv. Keep the tube vertical so it fills from the bottom syringe needle and allow the vacuum draw
up – let the tube fill using the vacuum draw of the tube to fill the tube
v. If you do not want to fill the tube completely, pull iv. Slant the needle to the side of the tube so
back on the plunger to stop the flow before the blood runs down the side of the tube to
removing the tube. prevent hemolysis
vi. Dispose of the transfer device into a sharps .
container
 Procedure

31.
32.
30. Check
Transport the
Remove specimen
specimen
gloves and collection
into the
wash hands logs (if
laboratory
applicable)

a. Transport
specimens in a timely
manner
b. Enter specimens
into the computer
system or logbook to
verify collection and
receipt into the
laboratory.
.
 Procedure

27.
26. 28.
25. Check the
Observe Dispose of 29.
Label the patient’s
special contaminat Thank the
tubes arm and
handling ed patient
apply
instructions materials
bandage

a. Patient’s name a. Putting on crushed

b. Identifying ice (e.g. ammonia,
number BNP, lactic acid, blood
c. Date of collection gases)
d. Time of b. Keeping it warm
collection (e.g. cold agglutinin,
. cryoglobulin)
c. Protecting from light
(e.g. bilirubin)
.
5.5 Butterfly
Procedure
 A phlebotomist may choose to use a winged infusion set or butterfly when
attempting to draw blood from antecubital veins of infants and small children or
when drawing blood from difficult adult veins, such as small antecubital veins or
writs or hand veins. In this activity, venipuncture by butterfly procedure will be
performed
 Objective

At the end of this activity, the

student should be able to
identify the proper
venipuncture steps by
butterfly procedure
 Materials Needed
1.Alcohol Prep Pads
2.Povidone – iodine swabs for blood
culture
3.Nonalcohol-based antiseptic for blood 0
alcohol collections
4.Gauze pads or cotton balls
5.Adhesive bandages or other bandaging
materials
6.Gloves
7.Tourniquet
8.Blood collection evacuated tubes
9.Butterfly needle
10.Tube Holder
11.Sharps container
12.Permanent marker or pen
 Procedure
Obtain and Verify diet Prepare the
accession the Identify the restrictions patient for
test request. patient (fasting) testing

1 2 3 4

a. Requisitions are a. The most important

the forms on which step in specimen a. Bedside manner
test orders are collection b. Explain the
entered and sent to b. Ask patient to state procedure
the laboratory name and date of birth c. Obtain consent
(DOB) .
i. Manual requisitions c. Check patient’s
ii. Computer generated identification bracelet
requisitions i. Name
iii. Barcode labels ii. Identifying number:
medical record number or
visit number
.
 Procedure
Assemble Position
Wash hands and Reassure
equipment and patients
put on gloves patient
supplies.

5 6 7 8

a. Seated patients:
patient arm should
be supported firmly;
arm should not be
bent at the elbow
b. Supine patients:
arm extended; not
bent at elbow
.
 Procedure
Apply Select Release
tourniquet Ask the patient venipuncture
to make a fist tourniquet
site

9 10 11 12

a. Veins become
more prominent
b. Do not allow
patient to pump
9open and close)
fist as this causes
hemoconcentration
and lead to
erroneous results.
 Procedure
Reapply Pick up and
Clean the Verify equipment tourniquet. Do position blood
site and tube not touch the collection
selection cleansed area equipment.

13 14 15 16

a. Clean with antiseptic –

70% isopropyl alcohol
b. Clean using circular
motion
c. Do not contaminate the
site by drying the alcohol
with unsterile gauze
d. Do not introduce
airborne contaminants by
fanning or blowing on it
e. Do not touch the site
after cleaning
.
 Remove the cover and
inspect the needle.
Procedure
Visually inspect the
needle tip for Insert the needle
obstructions, Anchor the vein into the vein Fill the tube
imperfections, or barbs.

17 18 19 20

a. Place your thumb a. Grasp the needle between the
1-2 inches below the thumb and index finger by holding the
intended back of the needle or by folding the
venipuncture site wings together.
b. Insert needle bevel up
b. Pull the skin
c. Use a shallow angle 10-15 degrees
towards the wrist d. A flash or as small amount of blood
c. Use the fingers of will appear in the hub of the needle
your anchoring hand when the needle is in the vein
to support the back e. “Seat” the needle by threading it
of the arm within the lumen of the vein
. f. hold the needle with the thumb of
the opposite hand
a. Tourniquet is sometimes
left until the last tube is
filled, as long as the draw
takes less than 1 minute
b. Keep the tube holder in
a downward position so the
tube fills from the bottom
c. Mix tube with additives
immediately by gentle
inversion
 Procedure
Dispose of
Withdraw the needle Engage safety sharps Label the tubes
device

21 22 23 24

a. Place gauze over

the site a. Patient’s name
b. Do not press down b. Identifying number
on the gauze while the c. Date of collection
needle is in the vein d. Time of collection
c. Withdraw the
needle in one smooth
motions
d. Apply pressure to
site with gauze pad
e. Do not bend arm up
– keep extended or
raised
 Procedure
Check the
Observe special
patient’s arm Dispose of
handling contaminated Thank the
and apply
instructions materials patient
bandage

25 26 27 28

a. Putting on crushed
ice (e.g. ammonia,
BNP, lactic acid, blood
gases)
b. Keeping it warm
(e.g. cold agglutinin,
cryoglobulin)
c. Protecting from light
(e.g. bilirubin)
.
 Procedure
Remove gloves Check specimen Transport the
and wash hands collection logs specimen into
(if applicable) the laboratory

29 30 31

a. Transport
specimens in a timely
manner
b. Enter specimens
into the computer
system or logbook to
verify collection and
receipt into the
laboratory.
.
THANK YOU