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Patient Preparation for Routine Venipuncture

 

Principle

 

As first-line ambassadors of the laboratory, the manner in which a phlebotomist greets a patient can often set the tone for the remainder of the procedure.Phlebotomists must always conduct themselves in a professional manner, while at the same time treating the patient with courtesy and respect.The watchword is to treat the patient as you would like to be treated.

 

Procedure

 

  1. Greet the patient in a professional manner and inform them why you are there.Identification of the patient should be both verbal, by asking the patient to state his/her name, and visual, by checking the patientís identification armband.Never obtain a specimen from a patient without an armband.
  2. Gloves must be worn during all collection procedures.They can be put on at any point before the actual puncture.
  3. Position the patientís arm so that it is comfortable for the patient and so that you have clear access to the antecubital area.The arm should be supported by a firm surface.
  4. Apply the tourniquet by placing it firmly about the upper arm.The tourniquet should be tight enough to increase blood pressure in the veins but not so tight that it cuts off circulation.The tourniquet should never remain on the patientís arm for more than 1 Ė 2 minutes.
  5. Choose the site by the largest and best-anchored vein that is the median cubital vein, near the center of the antecubital area.Also acceptable are the cephalic and the basilic veins.Veins in the back of the hand are also acceptable if necessary, but in these cases, pediatric size needles and tubes should be used.Positioning the arm at a downward angle, rubbing the forearm toward the antecubital area, and instructing the patient to make a fist may enhance visualization of the vein.Palpate with the forefinger.The site should be free of abrasions, lesions, and scar tissue.If you cannot easily see or feel a vein, check the other arm.
  6. Release the tourniquet; assemble the needle, barrel, tubes, cotton balls, alcohol pads, and bandages.Some phlebotomists prefer to do this step before applying the tourniquet, which is acceptable.The needle should not be uncovered until ready to perform the venipuncture.
  7. Cleanse the site with 70% isopropyl alcohol by making outward concentric circles.Allow the alcohol to air dry or by using clean cotton or gauze.Do not touch the site once it is cleansed.
  8. Reapply the tourniquet.Take care that the ends of the tourniquet do not touch the cleansed venipuncture site.
  9. Position the holder between your thumb and index finger.
  10. Uncap the needle and inspect for manufacturing defects.

  11. Anchor the vein selected and perform the venipuncture by holding the barrel so that the needle bevel is up.Quickly and smoothly insert the needle into the vein and gently push the evacuated tube onto the back of the needle.Stretching the skin surrounding the venipuncture before inserting the needle will help anchor the vein and make insertion less painful.Keep the holder absolutely still.If no blood immediately flows into the tube or if blood starts to enter the tube and then stops, slight manipulation of the needle may be helpful.However, these circumstances are the only appropriate times to move the needle once it has entered the vein.Avoid ďprobingĒ in the patientís arm.Do not attempt a venipuncture more than 2 times on any one patient.
  12. Allow the tube(s) to fill.
  13. Keeping the holder still, pull the evacuated tube off the back of the needle.Additional tubes may be pushed onto the back of the needle and allowed to fill.
  14. Once blood has filled the last tube, release the tourniquet within 1 Ė2 minutes of application.If properly applied, you can release it with a simple pull.
  15. Pull the evacuated tube off the back of the holder allowing it to rest in the holder.
  16. Remove the needle in a single smooth, swift motion.Quickly apply a clean cotton ball over the puncture site.
  17. Instruct the patient to keep their arm straight and apply pressure to the site.If the patient is unable to do this, it is the phlebotomistís responsibility to apply pressure until the bleeding has stopped.A band-aid or other dressing may then be applied.
  18. Remove the evacuated tube from the holder and place the needle into the nearest sharps container.Never recap a needle and do not lay it down.
  19. If the evacuated tube(s) contain an additive, invert gently several times to mix the blood with the additive.
  20. Specimen labeling and transportation should be done immediately.In most cases, you will have an ancillary form with computer labels that you may use for labeling.In these cases, you need only write your initials, the date and time of the blood draw on the label and apply the label to the tube.If the labels are not available, the patientís last name, followed by patientís first name, location, medical record number, phlebotomist initials, date, and time of the blood draw must be hand written on each tube.It is also the phlebotomistís responsibility to be aware of any special transportation requirements.(i.e.:Ammonia and Arterial Blood Gases need to be on ice and brought back to the lab ASAP.)Be familiar with these special requirements before collecting the specimen.
  21. Before moving on to the next patient, remove gloves and wash hands.