Locating the Vein and Tourniquet

Application in Venipuncture

PMLS 2 Laboratory
Locating a Vein
▶ Median cubital vein:
▶ near the center of the antecubital area
▶ preferred vein
▶ larger, closer to the surface, better anchored, and more stationary
▶ easiest and least painful to puncture and the least likely to bruise
▶ Cephalic vein:
▶ lateral aspect of the antecubital area
▶ Second choice vein
▶ harder to palpate than the median cubital
▶ can be palpated (felt) in obese patients
▶ Basilic vein:
▶ medial aspect (inner side) of the antecubital area
▶ last-choice vein for venipuncture
▶ not as well anchored and rolls more easily,
▶ near medial cutaneous nerve (a major nerve of the arm) or the brachial artery
▶ more painful
M-Shaped Antecubital Vein
▶ Median vein (intermediate antebrachial vein)
▶ Median cephalic vein (intermediate cephalic vein)
▶ Median basilic vein ( intermediate basilic vein)
▶ Cephalic vein
▶ Basilic vein
Other venipuncture sites

Arm and Hand Veins

▶ back of the hand
▶ wrist
Venipuncture Sites
▶ Leg, Ankle, and Foot Veins
▶ potential for significant medical complications such as phlebitis or
thrombosis
▶ veins of the leg, ankle, and foot must not be used for venipuncture without permission
from the patient’s physician
▶ puncture of the femoral vein is performed only by physicians or
specially trained personnel
Tourniquet application
Tourniquet application
Tourniquet application
Tourniquet application
Tourniquet application
Venipuncture Procedures

PMLS 2 Laboratory
Venipuncture Steps
▶ 1. Review and Accession test Request
▶ 2. Approach and Identify
▶ 3. Verify Diet restrictions and Latex Sensitivity
▶ 4. Sanitize hands
▶ 5. Position Patient, Apply tourniquet, and ask patient to
make a fist

▶ Option: You may put on your gloves before reviewing the requisition.
Tourniquet application
Clean and air-dry the site
▶ Clean the site with a circular motion
▶ start at the point where you expect to insert the needle
▶ move outward in concentric circles until you have cleaned an area
▶ use sufficient pressure to remove surface dirt and debris
▶ do not rub so vigorously that you abrade the skin
▶ If the site is especially dirty, clean it again with another alcohol prep pad
▶ Allow the area to dry naturally for 30 seconds to 1 minute

NOTE:
▶ Do not dry the alcohol with unsterile gauze
▶ Do not fan the site with your hand or blow on it to hasten drying time
▶ Do not touch the site after cleaning it
Prepare the Equipment
▶ Move the plunger back and forth a few times and advance it
to the end of the syringe before opening the sterile package
▶ Open the needle packages in an aseptic manner
▶ Securely attach the needle to the syringe
Reapply the tourniquet, uncap, inspect needle

▶ Reapply the tourniquet

▶ Remove the needle cover
▶ Visually inspect the needle
Ask patient to remake a fist, anchor vein, insert needle

▶ Use non-dominant hand to anchor (secure firmly)

the vein
▶ Hold the collection equipment and insert needle
using the dominant hand

Anchoring
▶ Grasp the patient’s arm with your free hand
▶ Use fingers to support the back of the arm just below
the elbow
▶ Place your thumb a minimum of 1 to 2 in. below
and slightly to the side of the intended
venipuncture site and pull the skin toward the wrist
Needle Insertion
▶Bevel of the needle should be facing up
▶Insert the needle into the skin at an angle of 30 degrees or less
✓ Shallow vein may need an angle closer to 15 degrees
✓ Deeper vein may require an angle closer to 30 degrees

▶Use one smooth, steady forward motion

✓ Too slowly prolongs any discomfort
✓ Rapid jab can result in missing the vein or going all the way
through it
Establish blood flow, release tourniquet, ask patient to open fist

❑Blood in the syringe hub indicates that the vein has

been successfully entered

❑Slowly pull back the plunger with your free hand

❑Ask the patient to release the fist as soon as blood flows

into the syringe

❑Release the tourniquet

Place gauze, remove needle, and apply pressure

▶ Place gauze directly over the site where the

needle enters the skin
▶ Hold the gauze lightly in place but do not press
down on it until the needle is remove
▶ Remove needle
▶ Apply pressure to the site for 3 to 5 minutes or
until the bleeding stops. (Ask the patient)
▶ Do not ask the patient to bend the arm up.
▶ The arm should be kept extended or even
raised.
Fill tubes

▶ Transfer blood into the tubes

**Number of inversion
▶ Follow the order of draw
Recapping the Needle
TRANSFERRING OF BLOOD
1. Recap the needle
2. Unscrew the needle from the
syringe
3. Open the evacuated tube
4. Hold the syringe vertically while
pushing the plunger gently to the
tube
5. Tilt the tube while transferring
the blood.
Discard syringe, needle
 Label tubes
▶ Label tubes immediately after blood collection
▶ Label permanently attached to the tube before leaving an
inpatient’s bedside or dismissing an outpatient
▶ preprinted computer or barcode label
▶ Labels should include the following information as a minimum:
▶ Patient’s first and last names
▶ Patient’s identifica tion number (inpatient)
▶ date of birth (outpatient)
▶ Date and time of collection
▶ Phlebotomist’s initials
• Pertinent additional information, such as “fasting"
Check patient’s arm

▶ Apply an adhesive bandage

▶ Instruct the patient to leave the bandage on for a minimum of 15
minutes
▶ Instruct an outpatient not to heavy object or lift heavy objects with that
arm for a minimum of 1 hour
Thank patient, remove gloves, and sanitize hands