Patient Preparation for Routine Venipuncture
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.
- 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.
- Gloves must
be worn during all collection procedures.†
They can be put on at any point before the actual puncture.
- 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.
- 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.
- 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
- 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.
- 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.
- Reapply the
tourniquet.† Take care that the
ends of the tourniquet do not touch the cleansed venipuncture site.
- Position the
holder between your thumb and index finger.
- Uncap the
needle and inspect for manufacturing defects.
- 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.
- Allow the
tube(s) to fill.
- 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.
- 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.
- Pull the
evacuated tube off the back of the holder allowing it to rest in the
- Remove the
needle in a single smooth, swift motion.†
Quickly apply a clean cotton ball over the puncture site.
- 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.
- 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.
- If the
evacuated tube(s) contain an additive, invert gently several times to mix
the blood with the additive.
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.
moving on to the next patient, remove gloves and wash hands.