RD (Transes) Venipuncture Syringe

• Collecting or drawing is the most frequent procedure in venipuncture
• Three techniques in venipuncture

  • ETS
  • Butterfly
  • Syringe
• Venipuncture sites


  • Antecubital Fossa
  • Wrist
  • Hand
  • Legs
  • Feet
• Avoided/Problem sites in venipuncture

  • Burns, scars, and tattoos
  • Damaged veins
  • Edema
  • Hematoma
  • Mastectomy
  • Fistula arm
• Pediatric venipuncture guidelines


  • Tests that require venous blood
  • Limited to superficial veins
  • Collect only the minimum requirement
  • Large amounts lead to anemia
  • More than 10% can lead to shock and cardiac arrest
• Pain interventions in pediatric venipuncture

  • EMLA
  • 12% to 24% oral sucrose
• Pediatric venipuncture sites


  • Antecubital fossa
  • Forearm
  • Others: medial wrist, dorsum of the foot, scalp, medial ankle
• Pediatric restraint methods


  • Blanket wrap
  • Physical restraint
• Geriatric venipuncture considerations


  • Fragile veins that collapse easily
  • Hearing impairment
  • Visual impairment
  • Mental impairment
  • Coagulation problems
  • Diabetes
  • Parkinson’s Disease
• Review and Accession Test Request details

  • First step in the pre-examination phase
  • By a physician or other qualified healthcare professional
  • Requisition form details: Physician’s name, Patient’s complete name, Patient’s medical record number, Date of birth, age, and sex, Room number and bed, Tests to be performed, Date, Test status, Special precautions
• Venipuncture steps for inpatients

  • Arrange according to priority
  • Stat requests take priority
  • Look for signs posted on the door
  • Inform the nurses’ station if patient is unavailable
  • Identify yourself and obtain consent
  • Identify the patient
• Venipuncture steps


  1. Wash hands and put on gloves

  2. Assemble equipment and material

  3. Place venipuncture equipment and clean gauze within easy reach

  4. Identify patient
• Conditions for phlebotomy

  • Cannot be done on an arm with a shunt
  • Avoid if patient has allergies to latex (do not use latex gloves and latex tourniquet), iodine (do not use iodine to disinfect, use isopropyl alcohol)
• Identifying yourself and asking consent

  1. Greet the patient good morning, state your name, ask if it's okay to collect a blood sample

  2. If a student intern, inform the patient
• Consent process

  If patient gives permission (verbal-yes, non-verbal-hand out their arm), if they say no, do not extract blood
• Patient identification


  1. Two-way ID and three-way ID (inpatient or outpatient)

  2. 3-way ID: Full name and DOB, Check ID bracelets/computer label/requisition information, Visual comparison of the labeled specimen with the patient’s ID band
• Identification in different scenarios

  1. Sleeping patient - wake gently

  2. Unconscious patient - talk to them as you would in a conscious patient, ask nurse, physician, or relative for identification

  3. Emergency room ID: Assign temporary number, Fill out labels, Cross-reference, Attach an ID band
• Identification of specific patient groups

  1. Young, mentally incompetent, or non-English-speaking patients

  2. Neonates and other infants
• Outpatient ID


  1. Verify diet restrictions and latex sensitivity

  2. Patient fasting 8 to 12 hours (8 hours for FBS, 10 to 12 hours for lipid profile)

  3. Use latex-free equipment

  4. Verify patient's identification before venipuncture
• Explaining venipuncture procedure and positioning patient

  1. Position the patient (lying down, sitting up)

  2. Arm extended downward in a straight line

  3. Explain the procedure, address patient inquiries, handle objections
• Attaching sterile capped needle to the sterile syringe

  If packed separately
• Patient positioning


  1. Lying down

  2. Sitting up
• Preparing the patient


  1. Explain the procedure

  2. Address patient inquiries

  3. Handling patient objections
• Attaching sterile capped needle to the sterile syringe

  Maintain sterility
• Sliding the plunger up and down in the barrel


  So that no air remains in the syringe
• Pushing the plunger to the bottom of the barrel


  So that no air remains in the syringe
• Placing the tourniquet around the patient's arm

  Tourniquet application - 3 to 4 inches
• Palpating the vein


  1. Feels bouncy

  2. Distended or bulging

  3. Tube-like feel
• What to do when veins still cannot be found

  1. Flick the area

  2. Massage the arm

  3. Wrap a warm towel
• Cleaning and air-drying the site

  1. Use 70% isopropyl alcohol - an antiseptic

  2. In concentric circles, from inside to outside
• Reapplying tourniquet


  1. Be careful not to touch the cleansed area

  2. Lactic acid - not collected with a tourniquet
• Holding the needle at 15° or 30° angle to the arm

  1. Dominant hand - for inserting the needle

  2. Nondominant hand - for anchoring the vein

  3. Bevel up when inserting the needle

  4. L-hold technique

  5. C-hold technique
• Placing a dry, sterile gauze

  1. Do not press down the cotton ball while the needle is still inside the vein of the patient because that will cause hematoma and you may end up slitting the vein of the patient

  2. When taking off the needle and there is a drop of blood at the tip, do not wipe it off using the cotton ball
• Instructing the patient to press the sterile gauze

  1. Do not press the sterile gauze over the wound for 3-5 minutes with arm extended

  2. Do not tell your patients to fold their arm because it can cause hematoma (especially if the site is the cephalic or the basilic vein) and it may cause bleeding again if the platelet plug is disturbed
• Filling the blood collection tube


  Order of filling: In one end, the barrel of the syringe
• Do not tell your patients to fold their arm because it can cause hematoma (especially if the site is the cephalic or the basilic vein) and it may cause bleeding again if the platelet plug is disturbed
• Fill the blood collection tube

  1. Order of filling:

  2. Blood is transferred from the syringe to the evacuated tube

  3. Do not push down the plunger (that will cause hemolysis)

  4. Blood will flow freely because there is vacuum in the evacuated tube and blood will stop flowing by itself once the vacuum in the tube has been exhausted

  5. It should be done in that way because you are less prone to contact with blood and needlestick injuries

  6. It should be done vertically because you are filling the evacuated tube bottom up

  7. Most laboratories do not have syringe transfer device because it is expensive

  8. Tubes have to be prepared on a test tube rack before assembling the equipment so that once extraction is done, you can puncture the evacuated tube right away

  9. Mix tube with additives immediately by gentle inversions

  10. In syringe method, there is a specific Order of Filling Tubes
• Order of Filling Tubes

  • Sterile tube/Blood Culture Tubes (yellow-topped tube)
  • Coagulation sodium citrate tube (light blue-topped tube and black-topped tube)
  • EDTA - Ethylenediaminetetraacetic acid tubes (lavender-topped tube)
  • Heparin tubes with or without gel (green-topped tube)
  • Glycolytic inhibitor tubes (gray-topped tube)
  • Serum tubes with or without clot activator or gel separator (red-topped tube plastic/glass)
• Inability to collect specimen

  • Not more than two times
  • Ask another phlebotomist
  • Inform the nurse or physician
• Using a syringe transfer device

  1. Remove the needle from the syringe

  2. Attach the syringe hub to the transfer device hub

  3. Hold the syringe vertically with the tip down and the device at the bottom

  4. Place an ETS tube in the barrel of the device

  5. Follow the order of filling

  6. Keep the tubes and transfer device vertical

  7. Let tubes fill using the vacuum draw of the tube

  8. Mix additives

  9. Discard the unit in a sharps container