Venipuncture

• Evacuated Tube System


  Closed collection system, the most efficient and frequently used method for venipuncture
• The median antecubital vein of the arm is the most frequent site for Venipuncture
• Syringe System


  Used as an alternative method when drawing blood, preferred method when drawing blood from patients with small or fragile veins
• General Blood Collection Equipment and Supplies

  • Phlebotomy area/Phlebotomy chair
  • Equipment carrier/Phlebotomy collection tray/Tackle box
  • Syringe/ETS/Lancets
  • Tourniquet
  • Evacuated Collection tubes
  • Gloves
  • Antiseptics/Disinfectants/Hand sanitizers
  • Gauze pads/Cotton
  • Bandages
  • Sharps container
  • Biohazard bags
  • Marking pen
  • Slides
  • Timer
• Evacuated tubes can be additive or non-additive
• Butterfly System


  Has long tubing with Luer fitting and Luer adapter
• Phlebotomists are responsible for blood sample collection and should be familiar with materials used in blood collection
• Requisition forms are used during the identification process of each patient prior to the venipuncture procedure to ensure proper healthcare is given to the appropriate individual
• Syringe system allows control of suction pressure on the vein and is routinely used in 2mL, 5mL, and 10mL sizes
• Needle Adapter in Evacuated Tube System

  A translucent plastic cylinder with one end accepting the multisample needle and the other end accepting the collection tube
• Phlebotomy or Venipuncture


  The act of obtaining a blood sample from a vein using a needle attached to a collection device or a stoppered evacuated tube
• Blood is collected directly into the evacuated tube in the Evacuated Tube System, enabling multiple tubes to be collected in a single venipuncture
• Phlebotomists should be knowledgeable to help prevent pre-analytical errors that will be encountered in the laboratory, as these errors affect the validity of the results
• Phlebotomy Needles

  • Sterile and single use
  • Needle gauge refers to the diameter of the needle bore
  • Length: 1-1.5 inches
  • Gauge: 16-25
  • 3 Types of Needles: Multi-sample, Hypodermic, Winged infusion set
• Phlebotomy may be done either using the conventional needle and syringe or through the use of Evacuated Tube System (ETS)
• Syringe System

  Composed of syringe needle, syringe, barrel, and plunger
• Butterfly System

  Used for IV fluid infusion and venipuncture for very small and fragile veins, with a short needle and plastic part resembling butterfly wings
• Components of Evacuated Tube System

  • Multi-sample needle, Tube holders, Evacuated tubes
• Microcollection tubes

  • Common type of collection containers used for dermal puncture samples
  • Also available with a plastic capillary tube that is fitted inside the container to aid in the collection of the sample
• Antiseptics

  • 70% Ethyl alcohol
  • 70% Isopropyl alcohol
  • Benzalkonium chloride
  • Chlorhexidine gluconate
  • Hydrogen peroxide
  • Povidone-iodine
  • Tincture iodine
• Butterfly System

  • Used for IV fluid infusion and venipuncture for very small and fragile veins (pediatrics and geriatrics)
  • Has short needle with a plastic part resembling butterfly wings
  • Needle size: ½ to ¾ inches
  • With long tubing with Luer fitting – syringe and Luer adapter – ETS
• Vein-Locating Materials

  1. Tourniquet is used as a vein compressor

  2. Vein Locating Devices are transillumination portable devices that use infrared light to help health professionals locate and assess veins for safe venous access
• Evacuated Collection Tubes


  • May be plastic or glass with a colored, rubber top
  • The color of each top will vary in accordance with its additive to indicate the specific diagnostic test to be performed
• Adapters

  • Come in different sizes to fit tubes of different diameters
  • It is important to choose an adapter that fits the tube you are using
• • Blood Collection Tube Additives may contain none to more than one additives depending on the test ordered
  • Forms of additives include Liquid, Spray-dried, or Powdered
  • Additive Categories include Anti-coagulants (Blood thinners) and Anti-glycolytic agents
• Skin Puncture Devices

  1. Manual Lancets

  2. Automatic puncture devices deliver a swift puncture to a predetermined depth, which can be a significant advantage at sites where the bone is close to the skin

  3. The dimensions of the puncture are controlled by the width and depth of the point

  4. Some automatic puncture devices have a platform that is positioned over the puncture site and color coded for different depths
• General Blood Collection Equipment and Supplies

  • Phlebotomy area/Phlebotomy chair
  • Equipment carrier/Phlebotomy collection tray/Tackle box
  • Syringe/ETS/Lancets
  • Tourniquet
  • Evacuated Collection tubes
  • Gloves
  • Antiseptics/Disinfectants/Hand sanitizers
  • Gauze pads/Cotton
  • Bandages
  • Sharps container
  • Biohazard bags
  • Marking pen
  • Slides
  • Timer
• Disinfectants

  • 10% Sodium hypochlorite
• Additives in blood collection tubes

  • Anti-coagulants
  • Anti-glycolytic agents
  • Clot activators
  • Thixotropic gel separator
  • Trace element-free tube
• Order of draw in blood specimen collection

  Special sequence of tube collection that reduces the risk of specimen contamination by microorganisms and additive carry over
• Computer-generated labels are used
• Venipuncture additional materials

  1. Gloves - OSHA mandates that gloves must be worn when collecting blood and must be changed after each patient

  2. Sharps Container - Necessary for the proper and safe disposal of used needles, syringes, lancets, and any tool that can cause an incision

  3. Biohazard bags - Should be available for transport of specimens based on institutional protocol

  4. Pen/Marker - Necessary information in the specimen tube labeling: Patient’s complete name (First and last names), Date of Birth, ID number if applicable, Date of collection, Initials of phlebotomist, Additional information such as “fasting”
• Reasons for using self-adhesive gauze


  When bleeding has stopped or when more pressure is required following arterial puncture or blood collection in patients with excessive bleeding
• Order of draw for blood specimen collection

  1. Blood Cultures (Sterile Collections) - Yellow SPS/Sterile Media Bottles minimize chance of microbial contamination

  2. Coagulation tubes - Light Blue, the first additive tube in the order because all other additives affect coagulation tests

  3. Glass nonadditive tubes - Red, prevents contamination by additives in other tubes

  4. Plastic clot activator tubes - Red, filled after coagulation tests because silica particles activate and affect coagulation tests

  5. Serum Separator Tubes - Red and Gray Rubber/Gold Plastics, filled after coagulation tests because Heparin affects coagulation tests and interferes in collection of serum specimens

  6. Heparin EDTA tubes - Lavender, pink, or purple, pearl top, responsible for more carryover problems than any other additive, elevates Na and K levels, chelates and decreases calcium and iron levels, elevates PT and PTT results

  7. Plasma preparation tubes - Oxalate/fluoride tubes, Gray, filled after hematology tubes because oxalate damages cell membranes and causes abnormal RBC morphology, interferes in enzyme reactions
• Venipuncture Steps

  1. Step 1: Review and accession the test request

  2. Step 2: Approach, identify, and prepare patient

  3. Step 3: Verify the patient’s diet restrictions and latex sensitivity

  4. Step 4: Sanitize hands and put on gloves

  5. Step 5: Position patient, apply tourniquet and fist clenching
• Step 5: Position patient, apply tourniquet and fist clenching

  1. Positioning the patient

  2. Tourniquet application and fist clenching

  3. 3-4 inches above the site

  4. Closed to the site: collapsed vein

  5. Far from the site: ineffective

  6. Avoid Fist pump- affects potassium and Ionized calcium

  7. Bariatric tour
• Step 2: Approach, identify, and prepare patient


  1. Approaching the patient

  2. Look for signs

  3. Entering Patient’s room

  4. Physicians and Clergy

  5. Family and Visitors

  6. Unavailable patient

  7. Identifying yourself

  8. Obtaining consent

  9. Bedside manner
• Phlebotomist


  • The person who performs phlebotomy
• Step 3: Verify the patient’s diet restrictions and latex sensitivity

  1. Diet Restriction

  2. Latex Sensitivity
• Step 1: Review and accession the test request

  1. Test Requisition

  2. Receipt of the Test Request

  3. Reviewing the Requisition

  4. Accessioning the Test Request