VENIPUNCTURE

3 METHODS OF VENIPUNCTURE
• ETS- Evacuated Tube System
• Syringe Method
• Butterfly/ Winged Method

Foundation in Venipuncture
• Safety
• Patient comfort
• Quality

NOTE: an evacuated tube represents the patient’s clinical situation

- All phlebotomy procedures begin with the receipt of a test requisition form that is
generated by or at the request of a health-provider.
- Required information:
1. Patient’s name and last name
2. Identification number
3. Patient’s date of birth
4. Patient’s location
5. Ordering healthcare provider/ physician
6. Test requested
7. Date and time that is requested (Stat/Immediate & Routine/Scheduled with time)
8. Date and time of extraction
9. Status of sample

REQUISITION
GREETING THE PATIENT
• Phlebotomist should greet the patient,introduce his name and explain the
procedure

PATIENT IDENTIFICATION
• Identify the patient verbally by having him or her state both the first name and last
name and compare the information on the patient’s ID band with the requisition
form.
• The most important procedure in phlebotomy is correct identification of the patient.

PATIENT PREPARATION
• Positioning the Patient
- Patient must be positioned conveniently and safely for the procedure.

• Always ask the patient if he or she is allergic to latex.

EQUIPMENT SELECTION
• phlebotomist should collect all necessary supplies and place them close to the
patient.

WASH HANDS AND APPLY GLOVES

• OSHA regulations mandate that gloves be worn when performing a venepuncture
procedure.
• 1:1 (1 glove= 1 patient)

TOURNIQUET APPLICATION
Function: impeding venous blood flow that causes blood to accumulate in the veins
making them more easily located and provides a larger amount of blood for collection.
* Maximum time for tourniquet application: 1 minute
* Tourniquet be applied twice, first when vein selection is made, second when
puncture is performed.
* According to the CLSI, when a tourniquet is used during preliminary vein selection, it
should be released and reapplied after 2 minutes.

TOURNIQUET APPLICATION
• Apply the tourniquet 3 to 4 inches above the antecubital fossa.
• When the tourniquet is in place, ask the patient to clench or make a fist.
• When a patient makes a fist, the veins in that arm become more prominent, making
them easier to locate and enter with a needle.
• The use of disposable one-time use tourniquets is advised, although not required,
as part of good infection control practice to avoid health-care acquired infections
(HAIs) for patients.

SITE OF COLLECTION
• Preferred site for venipuncture: antecubital fossa (located anterior and below the
bend of the elbow)

Site Selection in Arm:

• Median Cubital Vein
• located near the center; preferred vein for
venipuncture because it is large and stationary
• It is often closer to the surface of the skin, more
isolated from underlying structures, and the least
painful to puncture as there are fewer nerve endings
in this area.

• Cephalic Vein
• lateral aspect; located on the thumb side of the arm;
second choice; hard to palpate but fairly well
anchored & the only vein can be felt in large patients
• has more tendencies to move
• Basilic Vein
• medial side; not well anchored & rolls easily, ↑ risk
of puncturing median cutaneous nerve or the
brachial artery
• should be used as the last choice because the
median nerve and brachial artery are in close
proximity to it, increasing the risk of permanent
injury
Site Selection in
Hand:
• May be used if antecubital fossa veins are unsuitable or
unavailable.
• Extra care must be used to anchor these veins
• Use of winged (“butterfly”) blood collection set may enhance
success and make the procedure less painful

Site Selection in Foot:

• The last resort for blood collection is from the foot veins
after the arm veins have been determined unsuitable.
• As for dorsal veins, institutional policies may determine
which health careworkers are authorised to access veins in
this area.

SITE OF COLLECTION
- Palpation is usually performed using the tip of the index finger of the nondominant
hand to probe the antecubital area with a pushing motion rather than a stroking
motion.
- Pressure applied by palpating locates deep veins; distinguishes veins, which feel
like:

• spongy
• resilient tube-like structures

CLEANSING THE SITE

• 70% Isopropyl Alcohol
• Cleansing is performed with a circular motion – concentric circles (2-3 inches in
diameter)
• Allow to dry for 30-60 seconds
• povidone-iodine and tincture of iodine or chlorohexidine gluconate – most
frequently used solution

ASSEMBLY OF PUNCTURE EQUIPMENT

• Check equipment for defects
• Check needle and syringe if properly screwed
• Extra tubes should be near at hand
• Do not place collection tray on patient’s bed

PERFROMING VENIPUNCTURE
IMPORTANT: RE-APPLY TOURNIQUET FIRST

Examine the needle – needle must be bevel up

Anchoring the vein- Use the thumb of the nondominant hand to anchor the selected
vein while inserting the needle.

- Place the thumb 1 or 2 inches below and slightly to the left of the insertion site and
the four fingers on the back of the arm and pull the skin taut

Inserting the needle - When the vein is securely anchored, align the needle with the
vein and insert it, bevel up, at an angle of 15 to 30 degrees depending on the depth of
the vein.

- This should be done in a smooth movement so the patient feels the stick only
briefly.

*Filling the tubes; syringe

REMOVING OF THE NEEDLE

• Important: RELEASE TOURNIQUET BEFORE NEEDLE
• Failure to remove the tourniquet before removing the needle may produce a bruise
(hematoma).
• Place folded gauze over the venipuncture site and withdraw the needle in a smooth
swift motion and activate the safety device if it is designed to function after the
needle is removed from the vein.
• Apply pressure to the site as soon as the needle is withdrawn. Do not apply
pressure while the needle is still in the vein.

DISPOSAL OF NEEDLE
• dispose of the contaminated needle and holder in an acceptable sharps container
conveniently located near the patient.

LABELLING THE TUBES

Information on the sample label must include the following:

● Patient’s name and identification number

● Date and time of collection

● Phlebotomist’s initials

Additional: Gender, Age, Birthday

* The tubes are labeled after they are drawn and mixed, while the patient is still
present, to reduce the risk of specimen misidentification.

BANDAGING THE PATIENT’S ARM

• Bleeding at the venipuncture site should stop within 5 minutes.
• Before applying the adhesive bandage, the phlebotomist should examine the
patient’s arm to be sure the bleeding has stopped.

LEAVING THE PATIENT

• Return the bed and bed rails to the original position if they have been moved.
• Failure to replace bed rails that results in patient injury can result in legal action.
• In the outpatient setting, patients can be excused when the arm is bandaged and
the tubes are labeled.
• If patients have been fasting and no more procedures are scheduled, they should be
instructed to eat.
• Before calling the next patient, the phlebotomist cleans up the area.
• In both the inpatient and outpatient settings, patients should be thanked for their
cooperation .