MLSP112: PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2
TOPIC: VENIPUNCTURE (NEEDLE AND SYRINGE)
2nd SEMESTER | S.Y 2022-2023
LECTURER: Sir Joshua Luigi Ramel, RMT
TOPIC
SUBTOPIC
SUB SUBTOPIC
VENOPUNCTURE
• The most frequently performed procedure in
phlebotomy
• Phlebotomy is the general term for the blood
collection
- Venipuncture
- Capillary Puncture
- Arterial Puncture
PATIENT IDENTIFICATION AND REQUISITION SLIPS
• All phlebotomy (specimen collection) procedures
begin with the receipt of a test requisition form
- These are handed by the nurses or doctors
(physicians)
• Requisitions must contain certain basic information
to ensure that the sample drawn and the test
results are correlated with the appropriate patient
- Patient’s location states which ward is the
patient and the floor, with the room number
(pediatrics, surgical, etc.)
- In the Philippines, the number of requisition
form can be more than 1 for each patient
(chemistry tests, blood-relates [hematology],
urinalysis, fecalysis, etc.)
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- Some specimens will be requested immediately
or upon receipt of the requisition form, and
some requests will have a specific time
[Example: A patient has malaria, which have
certain periods of activity during the day, so for
the doctor to have an accurate diagnosis, he will
request a CBC or a differential smear in a
certain date or time, more specifically, time.]
- Status of sample: if it is ASAP, immediate
collection, etc.
- Number and type of collection tubes are usually
found in barcode systems wherein this
information is found
- If the test requested by the physician includes
that a patient should be fasted, it could be
indicated in the form [ask the patient when is
his last meal, if over fasted or under fasted, do
not collect]
- Ask the patient if he is allergic to latex [non-
latex tourniquet and gloves should be readied]
• To ensure that the blood is drawn from the right
patient, identification is made by comparing
information obtained verbally and from the
patient’s wrist ID band with the information on the
requisition form. (CLSI)
- When confined, you will be given a wrist ID
band that will be barcoded (for some) or
handwritten. Nevertheless, you, as a
phlebotomist, should confirm the identification
of the patient.
Transcribed by: JAMARA
 PATIENT PREPARATION
• Patient should be given a brief explanation of the
procedure
• They should not be told that the procedure will be
painless
- You are injecting a needle on a patient, so it is
painful. So tell them that it’ll hurt, but it will be
a fast procedure
- That will give you the responsibility to do the
procedure correctly (one hit)
• 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
• It may be necessary to move a hospitalized patient
slightly to make the arm more accessible
- Ask permission [in case the patient’s body is MEDIAN CEPHALIC VEIN
hurting or sore] • Located near the center; preferred vein for
• Place a pillow or towel under the patient’s arm for venipuncture because it is large, stationary, least
better support and to position the arm in a straight painful due to less nociceptor and bruises less easily
line downward - You don’t need to anchor the elbow as much
because this vein is supported by a bone so it
will not move [unless you are not experienced]
GLOVES AND TOURNIQUET APPLICATION - You can choose which site to puncture in this
type of vein: Median cubital vein or Median
• Gloves should be worn when performing a
cephalic vein
venipuncture procedure! (OSHA Mandate)
- Practice palpating the vein while wearing gloves
• INITIAL TOURNIQUET APPLICATION: 1 MINUTE
ONLY!
- While palpating the vein (tourniquet should last
in only 1 minute)
- If exceeded, you are forming something called
hemoconcentration, which you want to avoid
• The tourniquet serves two functions:
- Impedes venous blood flow, causing blood to
accumulate in the veins making them more
easily located
- Provides a larger amount of blood for collection

IV SELECTION
• The preferred site for venipuncture is the
antecubital fossa located anterior and below the
bend of the elbow
• 3 Veins: Median, Cephalic, and Basilic Vein
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 CEPHALIC VEIN
• Lateral aspect; second choice; hard to palpate but
fairly well anchored and the only vein can be felt in
obese
- Quit close to the skin and close to the edge of
the arm, so it is easily felt in obese patients
BASILIC VEIN
• Medial side; not well anchored and rolls easily, high
risk of puncturing median cutaneous nerve or the
brachial artery
- High chance or accidental arterial puncture and
nerve injury.
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• M pattern: have 2 choices of the median vein
• In H pattern: 1 choice of median vein
- Most patients have this kind of pattern; 70%
• To know if the patient have an H pattern or an M
one, palpate the vein
OTHER SITES
• Veins on the underside of the wrists, however,
should never be used for venipuncture
• Leg, ankle, and foot veins are sometimes used but
not without permission of the patient’s physician
- Will have a request [to see if there is a spread
bacterial infection]
• Vein of the longitudinal sinus or sagittal sinus
• Femoral vein, wrist vein (anterior portions)
• Saphenous vein
• Veins on the dorsal portion of the hand (IV
transfusion; sinesweruhan)
CLEANSING THE SITE
• 70% Isopropyl alcohol
• Concentric circles (2-3 inches in diameter)
Transcribed by: JAMARA
 ASSEMBLY OF EQUIPMENT
• Check equipment for defects
- Experimentation dates
• Check needle and syringe if properly screwed
• Extra tubes should be near at hand
• Do not place collection tray on patient’s bed
- Use the bedside table
PERFORMING THE VENIPUNCTURE
• IMPORTANT: RE-APPLY TOURNIQUET FIRST
1. Examine needle – BEVEL UP (butas ng needle;
should be pointed upwards)
2. Anchoring Vein
3. Insertion of Needle (30-40 degrees)
4. Filling Tubes
5. Removal of Needle
• REMOVE TOURNIQUET BEFORE NEEDLE
6. Disposal of Needle
7. Labelling Tubes (full name, age, sex, date and
time of collection, initials of the phlebotomist
[include the time of the last meal of the patient,
if fasting])
8. Bandaging Patient’s Arm
9. Disposing Used Supplies
10. Leaving Patient (check the patient if the patient
is fine [numbing, signs of nausea, pain]
VENIPUNCTURE COMPLICATIONS AND PRE-
EXAMINATION VARIABLES
SLEEPING PATIENTS AND UNCONSCIOUS
PATIENTS
• Sleeping patients should be gently awakened
- If the patient has a companion, the companion
is the one you’ll wake up
• Unconscious patients should be greeted in the same
manner as conscious ones
• Nursing personnel can assist patient
UNAVAILABLE PATIENT
• Seek assistance form attending nurse/nurse station
to locate patient
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YOUNG AND COGNITIVELY IMPAIRED PATIENTS
• Ask the patient’s nurse, relative, or a friend to
identify the patient
BASAL STATE
• The ideal time to collect blood from a patient:
- Refrained from strenuous exercise
- Has not ingested food or beverages except
water for 12 hours
- The patient did not change position for 10-15
mins.
PATIENT COMPLICATIONS
IMMEDIATE LOCAL COMPLICATIONS
FAINTING (SYNCOPE)
• Spontaneous loss of consciousness caused by
insufficient blood flow to the brain
- When a patient is prone to fainting, or because
of nervousness
- Take a look at the patient while doing the
procedure
- Prioritize the patient’s safety, rather than the
specimen
SIGNS
• Paleness of the skin, hyperventilation,
lightheadedness, dizziness, nausea, feeling of
warmth/cold, clammy skin
REMEDY
• Patient’s head is lowered between legs and
instructed to breath deeply; give spirit of ammonia
FAILURE OF BLOOD TO ENTER THE SYRINGE DUE
TO:
• Excessive pull of the plunger
• Going through the vein reaching the musculature
• Very small angle of entry
- The vein will not be available for some time for
blood collection
Transcribed by: JAMARA
 HEMOCONCENTRATION OR VENOUS STASIS
• Increase in the number formed elements in blood
due to decrease plasma volume
• Happens on prolonged tourniquet application!
- Follow the 1 minute during the first tourniquet
application
- The second tourniquet application, you can go
as far as 2 minutes
SEIZURES
• Tourniquet and needle should be removed,
pressure applied to the site, and summon help
- If the needle is first removed because of
seizure, recap then detach the tourniquet
- If seizure is controlled, follow the procedure
[tourniquet is removed first, before the needle]
• Restrain the patient only to the extent that injury is
prevented
• Document the time that the seizure started and
stopped according to institutional policy
• Make sure that the patient do not further harm
himself
PETECHIAE
• Small, nonraised red hemorrhagic spots
- Will appear immediately
• May have prolonged bleeding following
venipuncture
- Expect bruising later on; avoid hematoma
- Patients that have platelet disorders are
common to this
• Additional pressure should be applied to the
puncture site following needle removal
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VOMITTING
• If the patient is nauseated, instruct the patient to
breathe deeply and slowly; apply cold compresses
to the patient’s forehead
• If the patient vomits, stop the blood collection and
provide an emesis basin or wastebasket and tissues
• Notify the patient’s nurse or designated first aid
personnel
NERVE INJURY
• May result in loss of movement to the arm or hand
• Permanent injury in the venipuncture procedure is
damage to the median antebrachial cutaneous
nerve
SIGNS
• Shooting pain, electric-like tingling or numbness,
running up or down the arm or in the fingers of the
arm
DELAYED LOCAL COMPLICATIONS
THROMBOSIS OF VEINS
• Formation of blood clots inside the lumen of the
vein due to trauma
THROMBOPHLEBITIS
• Inflammation of the vein caused by thrombus
HEMATOMAS
• Blue or black skin discoloration commonly due to
repeated trauma or puncture of the veins
• Most common one (pagpapasa)
- If the needle penetrates through the vein
- The vein is fragile
- Fishing through the patient’s vein
AREAS TO AVOID
• Damaged veins
• Hematoma (you can collect blood on the same side
or part of the body, just not the exact vein; avoid
the vein with hematoma)
• Edema
Transcribed by: JAMARA
• Burns (prone to infection), Scars (more painful), and LIPEMIA OR LACTESCENSE
tattoos (interference in the results)
• This is caused by transient rise
• Arm on the same side of a mastectomy
in chylomicrons following a meal
• IV Therapy
containing fat
- Can be used after doing more
procedures in the specimen
COMMON DIFFICULTIES ENCOUNTERED DURING • It causes interference with large
COLLECTION AND PROCESSING OF BLOOD number of chemical analyses because
HEMOLYSIS of turbidity
• It disturbs the following
• We don’t want are specimen to be hemolyzed investigations particularly strongly:
• This must be avoided because of the following - Amylase
reasons: - Bilirubin
- Most constituents, such as SGOT, LDH, Acid - Protein
Phosphatase and Potassium are present in large - SGOT
amount in erythrocytes - SGPT
- Invalidates determination due to color changes
- May directly interfere in a chemical
determination by inhibiting an enzyme such as
lipase
- Hemoglobin may interfere with the
diazotization of bilirubin
• Causes:
- The needle is too small
- The gauge is not right
- The plunger is pulled too fast
- Shaking of the tubes vigorously
- Forcing blood into the evacuated tube
- Alcohol did not dry

- NORMAL

- HEMOLYZED (has
ruptured blood cells)

6|Page Transcribed by: JAMARA