OVERVIEW

Routine venipuncture is the most common procedure a phlebotomist performs. The most important step in venipuncture is positive identification (ID) of the patient. This is done by matching the information on the requisition with, the information on the patient's ID band and the information provided by the patient. Although most patients are suitable candidates for drawing blood with evacuated tubes , patients with fragile veins may be better candidates for wing-set collection devices.

Venipuncture Steps 

Step 1. Review and Accession Test Request

All blood collection procedures begin with a request for a test from the treating physician. A physician 's request for tests can be presented on the following types:

Types 

    -Manual requisitions 

    -Computer requisitions 

    -Barcode requisitions 

Requisitions have the following information:

• Patient demographics, including full name, date of birth, sex, and race

• If an inpatient, hospital ID number and room and bed number

• Name or code of the physician making the request

• Test status (e.g. , short turnaround time, or stat; timed; or fasting)

Phlebotomist Must 

    -Check to see that required inform is present & complete

    -Verify test to be collected & time & date of collection 

    -Identify diet restrictions other special circumstances 

    -Accession or record the order received 

Step 2. Approach, Identify & Prepare Patient 

    

Approach the patient:

    -Identify yourself 

    -Obtain consent for procedure

    -Put patient at ease, using professional bedside manner

“Hi Mrs. Garcia, My name is _____________ and I'm your phlebotomist today.

Did you eat this morning?

Are you allergic to latex?

Are you currently taking blood thinners?”

Patient identification 

    -Verify name & date of birth 

    -Check ID bracelet

    -Notify nurse of ID discrepancies

    -Search for missing IDs

    -Wake sleeping patients

    -Ask a relative or nurse to identify a patient who is 

    unconscious, young, or mentally incompetent  

Preparing the patient 

    -Explain the procedure 

    -Address patient inquiries

    -Handle patient objections

    -Address objects in patients mouth 

Step 3: Hand Sanitize

Step 4: Position Patient, Apply Tourniquet, and ask patient to make fist

Position Patient

    -Inpatients; Typically are lying down in bed

    -Outpatient; sitting up in blood-drawing chair

    -Patients prone to fainting; reclining chair, sofa, or bed

    -Support hand or arm that is to be site of venipuncture 

Tourniquet application & fist clenching

    -apply tourniquet snugly 3 to 4 in above in above intended site

    -Never apply over open sore

    -Ask patient to make fist 

Step 5: Select Vein, Release Tourniquet, and Ask Patient to open Fist 

-First choices are median cubital & medial veins

-Palpate patients dominant arm with index finger

-Roll finger side to side while pressing against vein to judge size

-Avoid veins that feel hard & cord-like or lack resilience 

-Release tourniquet & have patient open fist 

Step 6: Clean and Air-Dry the site 

-Clean site with an antiseptic to avoid infection or contamination 

-Use 70% isopropyl alcohol

-Use circular motion, moving outward in widening concentric circles

-Clean an area about 2 to 3in in diameter

-Avoid veins that feel hard & cord-like or lack resilience 

-Allows area to dry 30 seconds

-Do not dry alcohol with unsterile gauze or fan or blow on site 

-Do not touch site after cleaning it 

Step 7: Prepare Equipment and Put on Gloves

-EDTS Equipment preparation 

-Positioning equipment for use 

Step 8: Reapply Tourniquet, uncap and Inspect needle 

     

Step 9: Ask patient to remake a fist, anchor vein, and insert needle 

Anchoring 

    -Use non-dominant hand to anchor the vein securely

    -Place thumb at least 1 to 2 inches below and slightly to the side of site 

    -Pull skin towards wrist 

Needle insertion 

    -Hold collection device or butterfly in dominant hand 

    -with the bevel facing up, position needle above insertion site

    -Insert at 30-degree angle or less in smooth, steady forward motion 

            -NOTE: you should only attempt 2 time to establish insertion into view, if failed to do so, allow another phlebotomist to collect the specimen 

Step 10: Establish Blood Flow. release Tourniquet, and ask patient to open fist 

-Advance collection tube into tube holder until stopper is completely penetrated by needle 

-Push tube with thumb while index and middle fingers straddle & grasp flanges of tube holder, pulling back slightly 

-Blood will begin to flow into tube

-Release tourniquet 

-Have patient release fist

Step 11: Fill tubes in order of draw 

Step 12: Remove needle, Activate Safety Feature, and Apply Pressure with Gauze

-Remember: avoid using cotton balls for pressure over sit because cotton will mesh into fibrinogen and will pull the platelet plug away from site upon removal 

Step 13: Discard used equipment and any other trash appropriately

Step 14: Label Tubes

-Patients first & Last Names

-Patients Identification number or date of birth 

-Date & time of collection 

-Phlebotomist initials 

Step 15: Observe Special Handling Instructions

Step 16: check patients arm and apply bandage

Step 17:Thank Patient, Remove Gloves and Sanitize Hands

Step 18: Transport Specimen to the lab

Venipuncture Procedure