VENIPUNCTURE LEC

• Venipuncture is the most frequently performed procedure in phlebotomy
• Patient Identification and Requisition Slips:

  • All phlebotomy procedures start with a test requisition form containing basic information
  • Required information includes patient’s full name, identification number, date of birth, location, health-care provider’s name, tests requested, date and time of sample collection, and more
  • Identification is done by comparing information from the patient’s wrist ID band with the requisition form
• Patient Preparation:

  • Patients should be given a brief explanation of the procedure
  • Position the patient conveniently and safely for the procedure
  • Always ask about latex allergies
  • Use a pillow or towel under the patient’s arm for support
• Gloves and Tourniquet Application:

  • Gloves must be worn during venipuncture
  • The tourniquet impedes venous blood flow and provides a larger amount of blood for collection
  • Initial tourniquet application should be for 1 minute only
• Site Selection:

  • The preferred site for venipuncture is the antecubital fossa
  • Veins in this area include the median, cephalic, and basilic veins
  • Each vein has specific characteristics for venipuncture
• Cleansing the Site:

  • Use 70% Isopropyl Alcohol in concentric circles for cleansing
  • The site should be approximately 2 to 3 inches in diameter
• Assembly of Equipment:

  • Check equipment for defects
  • Ensure the needle and syringe are properly assembled
  • Have extra tubes nearby
  • Do not place the collection tray on the patient’s bed
• Performing the Venipuncture:

  1. Re-apply tourniquet first

  2. Examine needle with bevel up

  3. Anchor the vein

  4. Insert the needle

  5. Fill tubes

  6. Remove the needle after removing the tourniquet

  7. Label tubes

  8. Bandage the patient’s arm

  9. Dispose of used supplies

  10. Leave the patient
• Venipuncture Complications and Pre-examination Variables:

  • Address complications like fainting, failure of blood to enter the syringe, hemoconcentration, seizures, petechiae, vomiting, and nerve injury
  • Understand how to handle different patient complications during venipuncture
• Immediate Local Complications:

  1. Fainting (Syncope): Caused by insufficient blood flow to the brain

  2. Failure of Blood to Enter the Syringe: Due to various factors like excessive pull of the plunger

  3. Hemoconcentration or Venous Stasis: Increase in formed elements in blood due to decreased plasma volume

  4. Seizures: Remove tourniquet and needle, apply pressure, and seek help

  5. Petechiae: Small red hemorrhagic spots that may require additional pressure

  6. Vomiting: Provide support and notify healthcare personnel

  7. Nerve Injury: May result in loss of movement to the arm or hand
• Delayed Local Complications:

  1. Thrombosis of veins: Formation of blood clots inside the vein

  2. Thrombophlebitis: Inflammation of the vein caused by a thrombus

  3. Hematomas: Blue or black skin discoloration due to trauma
• Areas to Avoid during Venipuncture:

  • Damaged veins, hematoma, edema, burns, scars, tattoos, arm on the same side of a mastectomy, IV therapy
• Common Difficulties Encountered during Collection and Processing of Blood:

  • Hemolysis: Must be avoided due to various reasons like interfering with chemical analyses
  • Lipemia or Lactescence: Caused by a transient rise in chylomicrons after a fatty meal, leading to interference with chemical analyses