Performing a Venipuncture

Basic Venipuncture Procedure– Outpatients

Principle

Most laboratory tests require collection of a blood specimen by means of a basic venipuncture. A patient's veins are the main source of blood for laboratory testing and a point of entry for IV's and blood transfusions. Because only a few veins are easily accessible to phlebotomy and other hospital personnel, it is important that everything be done to preserve the vein's good condition and availability. Standardization of laboratory analyses begins with proper blood specimen collection.

Equipment
  1. Gloves: non-latex or powder free latex only
  2. Tourniquet
  3. 70% alcohol preps or other appropriate cleansing preps
  4. Vacutainer or syringe blood collection system
  5. Evacuated tubes for ordered tests
  6. Clean gauze squares
  7. Appropriate bandages
  8. Needle disposal unit
Procedure
  1. Review test requisitions
    1. Verify time and date of collection
    2. Check for any special draw requirements or patient restrictions
  2. Introduce self and explain your purpose
  3. Identify patient
    1. Ask the patient to state his or her complete name, address, identification number and/or date of birth and compare to the specimen labels or lab requisition.
      1. If patient cannot verbally supply identification, ask a relative or friend to identify the patient by name, address, identification number and/or date of birth.
  4. Verify patient’s diet restrictions, as appropriated, and inquire if patient has a latex sensitivity. Select appropriate gloves and tourniquet.
  5. Assemble equipment and supplies, position bed and/or chair
  6. Put on gloves
  7. Position patient and visually assess patient's arm (arms) for most likely venipuncture site
  8. Secure tourniquet, ensure the patient’s hand is closed, and select venipuncture site
  9. Release the tourniquet and cleanse the site with appropriate cleanser
  10. Allow the site to air dry
  11. Reapply the tourniquet using caution to avoid contamination of the cleansed site
  12. Pick up blood-drawing equipment, remove needle sheath, and visually inspect the needle tip for defects
  13. Anchor the vein selected using appropriate technique
  14. Position the needle and insert in vein
  15. Fill appropriate tube or tubes according to proper Order of Draw
    1. Mix all tubes by gentle inversion as recommended
    2. Release tourniquet after no more than one minute to avoid hemoconcentration of blood specimen
  16. Release tourniquet
  17. Place clean gauze over the puncture site and remove needle using care not apply pressure to the gauze while the needle is still in the vein
  18. Activate safety device on needle
  19. Apply pressure to the puncture site or, if appropriate, ask patient to do this
    1. Pressure should be applied for a minimum of 30 seconds
    2. Patients on anticoagulants require pressure application for longer periods
  20. Place used needle in appropriate needle disposal unit (no two-hand recapping)
  21. Check puncture site for cessation of bleeding and apply appropriate post phlebotomy care
  22. Label all tubes according to labeling protocol
  23. Properly dispose of all biohazard materials
  24. Remove gloves and wash hands
  25. Thank patient, ask if you can provide further assistance, and Transport Specimen
References

McCall, R.E. & Tankersley, C.M., Phlebotomy Essentials, Second Edition, Lippincott-Williams and Wilkins

Clinical and Laboratory Standards Institute, H3-A5, Vol. 23 No. 32, (2003). Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture (5 th ed.). Wayne, PA: NCCLS

Phelan, S., Phlebotomy Techniques: A Laboratory Workbook, 1993, American Society of Clinical Pathologists, Chicago

 

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