LESSON 4 : The most frequently performed procedure in phlebotomy

VENIPUNCTURE
is the venipuncture

Prepared by: Rochelle D. Darlucio, RMT

John Kenneth L. Pagdanganan, RMT
Joshua Luigi D. Ramel, RMT

The Required Information On A Other information:

I. PATIENT IDENTIFICATION AND REQUISITION SLIPS Requisition Includes The Following: ● Number and type of collection tubes
● Special collection information
All phlebotomy procedures begin with the receipt of a test requisition form. ● Patient’s full name Ex: Fasting
● Identification number Latex Sensitivity
Requisitions must contain certain basic information to ensure that the sample ● Patient’s date of birth
● Patient’s location ● Special patient information
drawn and the test results are correlated with the appropriate patient. Ex: Areas to be avoided in
● Ordering health-care provider’s
collection
name
● Test(s) requested
● Requested date and time of sample
collection
● Status of sample

• When identifying a patient, never say, for example, “Are you Mrs. Smith?” A
person who is very ill, hard of hearing, or sedated may say “Yes” to anything.
To ensure that blood is drawn from the right patient, identification is made
by comparing information obtained verbally and from the patient’s wrist ID • Never verify information from an ID band that is not attached to the patient
band with the information on the requisition form. (CLSI) or collect a specimen from an inpatient who is not wearing an ID band.

• Never attempt to collect a blood specimen from a sleeping patient. Such an

attempt may startle the patient and cause injury to the patient or the
phlebotomist.

• An unconscious patient may be able to feel pain and move when you insert
the needle, so it may be necessary to have someone assist you in holding the
arm during the blood draw.
 II. PATIENT PREPARATION II. PATIENT PREPARATION

Patients should be given a brief explanation of the - Always ask the patient if he or she is
procedure allergic to latex.

They should not be told that the procedure will be - It may be necessary to move a hospitalized
painless patient slightly to make the arm more
accessible,
Positioning the Patient
-patient must be positioned conveniently - Place a pillow or towel under the patient’s
and safely for the procedure.
arm for better support and to position the
arm in a straight line downward.

GLOVES AND TOURNIQUET APPLICATION A tourniquet that is too tight may prevent arterial
blood flow into the area and result in failure to
Gloves be worn when performing a venipuncture procedure! obtain blood.
(OSHA Mandate)

INITIAL TOURNIQUET APPLICATION: 1 MINUTE ONLY!!

A tourniquet that is too loose will be useless.

The Tourniquet Serves Two Functions: According to the CLSI, when a tourniquet is used
- Impedes venous blood flow, causing blood to accumulate in the veins during preliminary vein selection, it should be
making, them more easily located released and reapplied after 2 minutes.
- Provides a larger amount of blood for collection.

SITE SELECTION
• When the tourniquet is in place, ask the patient to clench or
make a fist. The preferred site for venipuncture is the antecubital fossa located anterior
and below the bend of the elbow
• When a patient makes a fist, the veins in that arm become 3 Veins:
- Median Vein
more prominent, making them easier to locate and enter - Cephalic Vein
with a needle. - Basilic Vein

• Pumping (repeatedly opening and closing the fist) should be

prohibited, as it causes muscle movement that can make
vein location more difficult; it can also cause changes in
blood components that could affect test results.
 SITE SELECTION SITE SELECTION

The preferred site for venipuncture is the antecubital fossa located anterior The preferred site for venipuncture is the antecubital fossa located anterior
and below the bend of the elbow and below the bend of the elbow
Median Cephalic Vein Cephalic Vein
– located near the center; preferred vein – lateral aspect; second choice; hard to
for venipuncture because it is large, palpate but fairly well anchored & the
stationary, least painful due to less only vein can be felt in obese
nociceptor & bruises less easily

SITE SELECTION

The preferred site for venipuncture is the antecubital fossa located anterior
and below the bend of the elbow
Basilic Vein
– medial side; not well anchored & rolls
easily, ↑ risk of puncturing median
cutaneous nerve or the brachial artery

Other Sites:

- Veins on the underside of the wrist, however,

should never be used for venipuncture.

- Leg, ankle, and foot veins are sometimes used

but not without permission of the patient’s
physician

- Vein of the longitudinal sinus or sagittal sinus

- Femoral vein, Wrist vein
- Saphenous vein
- Veins on the dorsal portion of the hand
 CLEANSING THE SITE ASSEMBLY OF EQUIPMENT

- 70% Isopropyl Alcohol - Check equipment for defects

- Concentric Circles (2-3 inches in - Check needle and syringe if
diameter) properly screwed
- approximately 2 to 3 in. in diameter - Extra tubes should be near at hand
- Do not place collection tray on
patient’s bed

PERFORMING THE VENIPUNCTURE

IMPORTANT: RE-APPLY TOURNIQUET FIRST III. VENIPUNCTURE COMPLICATIONS AND PRE-EXAMINATION

VARIABLES
1. Examine Needle – BEVEL UP
2. Anchoring Vein Sleeping Patients and Unconscious Patients
3. Insertion of Needle
4. Filling tubes
5. Removal of Needle - Sleeping patients should be gently awakened
- REMOVE TOURNIQUET BEFORE NEEDLE - Unconscious Patients should be greeted in the same manner as conscious
ones
6. Disposal of Needle - Nursing personnel can assist patient
7. Labelling Tubes
8. Bandaging Patient’s Arm
9. Disposing Used Supplies
10. Leaving Patient

III. VENIPUNCTURE COMPLICATIONS AND PRE-EXAMINATION III. VENIPUNCTURE COMPLICATIONS AND PRE-EXAMINATION
VARIABLES VARIABLES

Unavailable Patient BASAL STATE

-Seek assistance from attending nurse/ nurse station to locate patient The ideal time to collect blood from a patient:

Young and Cognitively Impaired Patients Refrained from strenuous exercise

Has not ingested food or beverages except water for 12 hours
-Ask the patient’s nurse, relative, or a friend to identify the patient
 IV. PATIENT COMPLICATIONS IV. PATIENT COMPLICATIONS

Immediate Local Complications SIGNS: Immediate Local Complications

1. Fainting (Syncope) Paleness Of The Skin 2. Failure Of Blood To Enter The Syringe Due
Hyperventilation To:
- spontaneous loss of consciousness Lightheadedness
caused by insufficient blood flow to the Dizziness - Excessive pull of the plunger
brain. Nausea - Going through the vein reaching the
Feeling Of musculature
Warmth/Cold - Very small angle of entry
Remedy: Patient’s head is lowered Clammy Skin.
between legs & instructed to breath
deeply; Give spirit of ammonia

IV. PATIENT COMPLICATIONS IV. PATIENT COMPLICATIONS

Immediate Local Complications Immediate Local Complications

4. Seizures
3. Hemoconcentration Or Venous Stasis:
- Tourniquet and needle should be removed,
– Increase in the number formed elements in blood due to decrease plasma pressure applied to the site, and summon
volume help.
- Restrain the patient only to the extent that
- Happens on prolonged tourniquet application! injury is prevented.

- Document the time the seizure started and

stopped according to institutional policy.

IV. PATIENT COMPLICATIONS IV. PATIENT COMPLICATIONS

Immediate Local Complications Immediate Local Complications

5. Petechiae 6. Vomiting

- Small, nonraised red hemorrhagic spots - If the patient is nauseated, instruct the patient to
- May have prolonged bleeding following breathe deeply and slowly;apply cold compresses to
venipuncture. the patient’s forehead.

- Additional pressure should be applied - If the patient vomits, stop the blood collection and
provide an emesis basin or wastebasket and tissues.
to the puncture site following needle
removal.
- Notify the patient’s nurse or designated firstaid
personnel.
 IV. PATIENT COMPLICATIONS IV. PATIENT COMPLICATIONS

Immediate Local Complications SIGNS

Delayed Local Complications:
7. Nerve Injury Shooting pain 1. Thrombosis of veins
Electric-like tingling/numbness
- May result in loss of movement to the running up or down the arm or Formation of blood clots inside the lumen of the vein
•
arm or hand in the fingers of the arm due to trauma

- Permanent injury in the venipuncture 2. Thrombophlebitis

procedure is damage to the median Inflammation of the vein caused by thrombus
•

antebrachial cutaneous nerve.

3. Hematomas
Blue or black skin discoloration commonly due to
•

repeated trauma or puncture of the veins

IV. PATIENT COMPLICATIONS

COMMON DIFFICULTIES ENCOUNTERED DURING
COLLECTION AND PROCESSING OF BLOOD
AREAS TO AVOID
Hemolysis
1. Damaged Veins
2. Hematoma • This must be avoided because of the
3. Edema following reasons:
4. Burns, Scars, and Tattoos –Most constituents, such as SGOT, LDH, Acid
5. Arm on the same side of a Mastectomy Phosphatase and Potassium are present in large
6. IV Therapy amount in erythrocytes
–Invalidates determination due to color changes
–May directly interfere in a chemical determination
by inhibiting an enzyme such as lipase.
–Hemoglobin may interfere with the diazotization
of bilirubin.

COMMON DIFFICULTIES ENCOUNTERED DURING

COLLECTION AND PROCESSING OF BLOOD
LIPEMIA OR LACTESCENSE
• This is caused by transient rise in chylomicrons
following a meal containing fat
• It causes interference with large number of chemical

analyses because of turbidity.

• It disturbs the following investigations particularly
strongly:
–Amylase

–Bilirubin

–Protein

–SGOT

–SGPT