Venipuncture

Procedure
Prepared by:
Patricia Nicole
D. Fernandez, RMT
process of collecting or "drawing"
blood from a vein of the patient for
laboratory testing purposes

knowledge
and skill
1 STEP
ST ▌ manual
PRE-ANALYTICAL PHASE
▌ computerized
PARTS: ▌ bar-coded
 request
 report
 billing
Required requisition information:
Name of the
physician who
ordered the test
Patient's full name
including the middle
initial
The medical record
number for
inpatients
Birthday and age of
the patient
Room number and bed
number if inpatient
Required requisition information:
Type of test ordered

Date when the test is

to be performed

Billing information
with ICD-9 codes for
outpatient

Test status

Special precautions
 1 step one
Review and Accession
the Test Request
Review and Accession the Test Request
thorough review of the
test requisition
REASONS:
o avoid duplication of
request
o ensure proper collection
timing
o identify special
instructions or equipment
required for the test
Check the completeness of
the required information
Verify the tests to be
collected including information
(time and date of collection)
Take note of any
diet restrictions or
special conditions that should
be followed before the actual
collection
Determine the test status or
priority of collection
Review and Accession the Test Request

Status designations, status priorities and procedure for each status designation
Table 5.1 Common Test Status Designations
 2 step two
Approach, identify, &
prepare patient
Approach, identify, & prepare patient
o Check for
Proper "bedside phlebotomy-related signs
manner" and handling and warnings
regarding the condition of the
special situations
patient such as:
 “no bp or venipuncture
o Organize the test request right arm”
according to priority DNR
do not resuscitate
o Prepare all the necessary
equipment and supplies needed DNAR
to complete collection round do not attempt to
resuscitate
PROPER BEDSIDE MANNER
Knock on the door gently
before entering the room.

Make a good impression by

greeting the patient
warmly.

Stay organized and have

all supplies available and
approach the patient in a
professional manner that
goes well with having a
neat appearance.
PROPER BEDSIDE MANNER
Most patients are afraid of
blood collection, so maintain
a calm expression.
Introduce yourself and
explain the procedure. Obtain
the verbal or expressed
consent of the patient before
proceeding with the test.
Remain compassionate and
professional during the
procedure.
Thank the patient for their
cooperation before leaving.
PROPER BEDSIDE MANNER
If there is a
physician or clergy in
the room, interrupt
only if the ordered
test is stat or timed.
Family members or
visitors can stay in
the room, but it would
be better if they
could step out of the
room until you are
finished.
 PROPER Obtaining a specimen from the
wrong person can have
PATIENT serious consequences and can
even be fatal in cases that
IDENTIFICATION involve blood transfusion.

Misidentifying patients can

be a
ground for dismissal or
lawsuit on the grounds of
malpractice.
 PROPER Confirm the NAME and DATE OF BIRTH

PATIENT
of the patient.
If the patient is fast asleep, the
phlebotomist should wake him up
IDENTIFICATION gently for proper identification.
If the patient is young, mentally
incapacitated or there is language
barrier:
a. The phlebotomist should ask a relative,
attendant, or the nurse to identify the patient
and
b. The information provided should match those on
record and the information on the ID bracelet.
 The phlebotomist should

PATIENT *explain the test procedure to the

patient and
*confirm that the patient
PREPARATION understood what was discussed.
It is best to direct inquiries on
the
purpose or result of the test to
the patient's nurse or physician
to avoid any miscommunication.
The phlebotomist must remain
calm and professional even if the
patient is being difficult or have
needle-phobia.
 3 step three
Verify the Patient’s
Diet Restrictions and
Latex Sensitivity
DIET RESTRICTIONS

NPO
The phlebotomist
should verify if
there are
special
instructions
on the diet of the
patient that needs
to be followed such
as
fasting for about 8
to 10 hours.
ALLERGIES
A patient with
allergic reaction to
latex can have life-
threatening reactions
upon exposure, so it
is important to
check that all
equipment used on him
is latex-free, and
there are no latex
items in the room.
 4 step four

Sanitize hands
HAND HYGIENE

Proper hand
hygiene
should be
observed to
avoid spreading
infection.
 5 step five
Position the patient, apply
the tourniquet and ask
patient to make a fist
PATIENT POSITIONING
Be sure that the hand or
arm for venipuncture
procedure is
well supported
The phlebotomist can
then proceed to the
tourniquet application
and fist clenching.
The tourniquet should be
placed 3 to 4 inches
from the intended site
 6 step six
Select Vein,
Release Tourniquet, and
Ask Patient to Open Fist
PALPATING THE VEIN OF CHOICE
The ANTECUBITAL AREA of
the arm is the preferred
venipuncture site.
Using your fingers,
trace the path to
determine a possible
entry point.
If the vein is not
suitable, look for an
alternative site, or
capillary puncture could
be an option.
TOURNIQUET APPLICATION
1) Place the tourniquet
3 to 4 inches from the intended
puncture site.
2) Hold one side of the tourniquet
in each hand. It should be a
few inches from the end.
3) Apply a little tension so that
it will be snug when tied.
4) Bring the two sides together.
Hold both ends between the
thumb and forefinger of the
right hand.
TOURNIQUET APPLICATION
5) Reach over the right hand and grasp the right side of
the tourniquet between the thumb and forefinger of the
left hand and release it from the grip of the right
hand.
6) Near the left index finger, cross the left end over
the right. Hold both sides together between the thumb
and forefinger of the left hand, close to the patient's
arm.
7) While securely holding both sides, use either the
left middle finger or the right index finger to tuck a
portion of the left side under the right side and pull
into a loop.
8) A properly tied tourniquet has its ends pointing
toward the shoulder.
 7 step seven
Clean and
air-dry the site
ANTISEPTIC TECHNIQUE
The venipuncture site should be
cleaned using an antiseptic, such
as 70% isopropyl alcohol, to
prevent infection or
contamination.
The area should cover about
2 to 3 inches diameter using a
circular motion, and moving
outward in concentric circular
motion.
 Allow the area to dry for about a
minute, but don't use unsterile
gauze, fan, or don't blow the
site.
Avoiding touching the site after
cleaning.
 8 step eight
Prepare equipment and
put on gloves
PREPARE MATERIALS
factors considered in
choosing the:
system, needle size and
volume of the tube

age of the patient

volume of blood for
collection
size and location
of the vein
Evacuated Tube System
1) Select the appropriate tube for
ETS and tap to dislodge any
additives in the stopper.
2) Select and inspect the needle
for defects.
3) Twist needle to expose the back
of the needle.
4) Screw this end to the threaded
hub of the tube holder.
5) Place the first tube in the
holder.
6) Position the tube in the
holder.
Evacuated Tube System
Winged Infusion set Butterfly
1)Use a 23-gauge butterfly
gauge with a safety
feature.
2)Inspect the package before
aseptically opening and
removing the butterfly.
3)Attach the butterfly to an
ETS holder or syringe.
4)Select the appropriate
small-volume tube for the
test.
Syringe System
1)Select the appropriate
syringe and needle
2)Test the plunger before
opening the sterile
package.
3)Open the package
aseptically.
4)Securely attach the
needle to the syringe.
Syringe System
Syringe System
 9 step nine
Reapply tourniquet,
uncap and inspect
needle
REAPPLY TOURNIQUET
 Reapply the tourniquet
without touching the
cleaned area.
 Get the collection
equipment using your
dominant hand.
 Remove the needle cover
and inspect the needle.
 The needle should not get
into contact with anything
prior to venipuncture. If
this happens, remove and
replace with a new one.
 10 step ten
Ask patient to remake a
fist, anchor to vein,
and insert needle
BLOOD EXTRACTION
 The patient is asked to
make a first. Anchor the
antecubital vein by
holding the patient's arm
with your free hand.
 The fingers support the
back of the arm just below
the elbow. Place the thumb
at least 1 to 2 inches
below, but slightly on the
side of the site of
venipuncture, and pulling
the skin towards the
wrist.
BLOOD EXTRACTION
 When inserting the
needle, the
phlebotomist should
hold the collection
device or butterfly
needle with his
dominant hand.
Position the needle
above the insertion
site with the bevel
facing up, then insert
using a smooth forward
motion in a

30 degree angle.
 11 step eleven
Establish blood flow,
release tourniquet, and
ask patient to open fist
BLOOD EXTRACTION
 The phlebotomist should
press on the collection
tube into the tube holder.
Make sure that the needle
has completely penetrated
the stopper.
 Push the tube with the
thumb while the middle and
index fingers straddle and
grasp the flanges of the
tube holder while slightly
pulling it back.
BLOOD EXTRACTION
 Let the blood
flow into the
tube.
 Release the
tourniquet and
ask the
patient to
release his
fist.
 12 step twelve
Fill, remove, and mix
tubes in order of draw
or fill syringe
FILL THE VACUTAINERS
 The phlebotomist should
make sure that required
volume has been
collected.
Tubes that contain
additive must be
inverted gently several
times to mix the
content. Release the
tourniquet before
removing the needle.
 Order of Draw Tube stopper color

Blood Culture
Yellow SPS
(sterile collections)

Coagulation tube Light Blue

Glass non-additive tube Red

Plastic clot activator tube Red

Serum separator tube (PSTs) Red and grey rubber, Gold plastic

Herapin tube Green and grey rubber, Light green plastic

EDTA tube Lavender, pink or purple

Plasma-preparation
Pearl top
tube (PPTs)

Oxalate/fluoride tubes Gray

 13 step thirteen

Place gauze, remove needle,

activate safety feature, and
apply pressure
PATIENT CARE
 Fold a gauze square into
fourths and place it
lightly over the site
where the needle is
inserted. Do not apply
pressure.
 Remove the needle and
activate the
safety feature while
simultaneously apply
pressure with your free
hand.
 The arms should be
extended or raised.
SYRINGE METHOD
 Place gauze and withdraw
needle
 Activate safety device,
apply pressure
 Discard needle and attach
a transfer device,
rotating it to ensure
secure attachment
 Hold the syringe
vertically with the tip
down and the transfer
device at the bottom
SYRINGE METHOD
 Place an ETS tube in the
transfer device in the order
of draw, and push it in all
the way
 Fill the tubes using the
vacuum draw of the tube; do
not push on the syringe
plunger
 Mix additive tubes upon
removal from the transfer
device
 Discard the empty syringe and
transfer device unit in a
sharps container
 14 step fourteen

Place gauze, remove needle,

activate safety feature, and
apply pressure
WASTE DISPOSAL

Discard
collection
unit, syringe
needle, or
transfer
device.
WASTE DISPOSAL
 15 step fifteen

Label tubes
LABEL TUBES
NECESSARY INFORMATION IN THE
SPECIMEN TUBE LABELING

a) Patient's complete name

(first & last name)
b) Date of birth
c) ID number (if applicable)
d) Date & time of collection
e) Initials of the
phlebotomist
f) Additional information such
as "fasting"
LABEL TUBES

FERNANDEZ, Patricia Nicole D.

6/12/2020
 16 step sixteen

Observe special
handling instructions
SPECIMEN HANDLING
 17 step seventeen

Check patient's arm

and apply bandage
AFTER CARE
 18 step eighteen

Dispose of contaminated
materials
INFECTIOUS WASTE DISPOSAL
 19 step nineteen
Thank patient, remove
gloves, and sanitize
hands
 20 step twenty

Transport specimen
to the lab
REQUIREMENTS FOR
DRAWING BLOOD FROM
SPECIAL POPULATION
PEDIATRIC PUNCTURE
Pediatric Puncture
Challenges
Veins that are usually
small and underdeveloped
making it difficult to
draw blood.
A considerable risk of
damage could be permanent
if proper procedure is
not followed.
Pediatric Puncture
Challenges
There is also risk of
anemia, since the volume
of blood in the body is
smaller.
Dealing with the parents
or guardians could also
be a challenge.
Pediatric Puncture
During the procedure,
there are several ways
to restrain the movement
of the patient: infants
are wrapped in the
blankets, toddlers are
usually held in the
parent's lap, and for
children, a second
person usually leans
over the child who is in
lying position.
GERIATRIC PUNCTURE
Geriatric Puncture
Challenges
Special conditions such
as arthritis, diabetes,
parkinson's & stroke,
atherosclerosis and
dementia, which makes
blood drawing a
challenge.
Geriatric Puncture

Challenges
Hearing, visual and
mental impairment.
Geriatric Puncture

Challenges
The elderly have thinner
skin and smaller muscles
which causes the veins to
roll easily.
Geriatric Puncture
PROCEDURE
Identify the patient
properly and confirm the
patient information, ask
the attendant or relative
if needed
Carefully select which
needle to use
(short draw or butterfly
needle)
Geriatric Puncture
Apply tourniquet carefully
to make sure that skin will
not be damaged
Make sure that the site is
not previously the site
from previous venipuncture
Avoid rubbing the site
vigorously during cleaning
Geriatric Puncture
Prevent the vein from
rolling by anchoring the
vein firmly during the
venipuncture
Hold the pressure over the
site and take note that
bleeding could take longer
to stop than regular
patients.
LONG-TERM CARE
PATIENTS
Long-term care patients

A patient who undergoes dialysis

may request that the dorsum of
their hands be used for
venipuncture to preserve veins
of the arms for hemodialysis
access. The phlebotomist should
comply and select another site
other than the arm used with
arteriovenous (AV) fistula.
Long-term care patients

private homes or in community-

based rehabilitation facilities
such as an adult day care long-
term care services are provided
to patients who cannot perform
regular daily activities due to
their health condition. These
can be assisted-living with the
help of relatives or friends,
which could be in their center.
Long-term care patients

Home health services are for

patients who need medical
attention and assistance from the
health professionals from time to
time. Home care phlebotomists are
independent, flexible, with
exceptional interpersonal and
organizational skills, and can
carry all necessary equipment
with them during house calls.
Long-term care patients

Hospice care is for patients that

need end-of-life care, wherein
most have a prognosis of six
months or less. The phlebotomist
should work with extra care with
these patients, treating them
kindly and with respect, giving
these dying patients comfort and
dignity.
 Venipuncture
Procedure
END OF PRESENTATION