Syringe method

• Venipuncture


  Collecting or “drawing” blood from a vein, the most common way to collect blood specimens for laboratory testing
• Venipuncture techniques


  • ETS, butterfly, syringe procedures
• Routine syringe venipuncture procedure

  To obtain a blood specimen for patient diagnostic or monitoring purposes from an antecubital vein using a needle and a syringe
• Equipment for routine syringe venipuncture

  • Tourniquet, gloves, antiseptic prep pad, syringe needle, syringe, ETS tubes, gauze pads, sharps container, permanent ink pen, bandage
• Either the needle or syringe must have a safety feature to prevent needlesticks
• Review and accession of test request

  Recording test orders on a form, can be manual or computerized, may contain a barcode to decrease clerical errors
• Test accession


  Recording in the order received, assigned a unique number to identify the specimen and all associated processes and paperwork
• Approaching, identifying, and preparing patient

  Arranging requisitions according to priority, looking for signs, identifying oneself, obtaining consent, checking ID band or bracelet
• Identifying the patient


  The most important step in specimen collection, asking for full name and date of birth, using 3-way ID for patient identification
• How to identify patients with...

  • ID discrepancies, missing ID, sleeping patients, unconscious patients, young, mentally incompetent, non-English-speaking patients, neonates or infants, outpatients
• Never collect a specimen without a way to positively connect it to the patient
• Verify diet restrictions and latex sensitivity


  Checking if the patient needs to fast, verifying latex allergies, ensuring all equipment is latex-free
• Sanitize hands


  Decontaminating hands by washing or using alcohol-based hand sanitizers, washing with soap and water if visibly dirty or contaminated with blood or other body fluids
• Hand Sanitization


  1. Hands can be decontaminated by washing or use of alcohol-based hand sanitizers

  2. If hands are visibly dirty or contaminated with blood or other body fluids, they must be washed with soap and water
• Positioning Patient, Applying Tourniquet, and Asking Patient to Make a Fist


  1. The patient’s arm should extend downward in a straight line from shoulder to wrist and not be bent at the elbow

  2. For patients who are lying down, a pillow or rolled towel can be used to support and position the arm so that at least the hand is lower than the elbow

  3. A tourniquet is applied 3 to 4 inches above the intended venipuncture site to restrict venous blood flow and make the veins more prominent

  4. When a patient makes a fist, the veins in that arm become more prominent, making them easier to locate and enter with a needle

  5. Pumping (repeatedly opening and closing the fist) should be prohibited
• Tying a Tourniquet


  1. Place the tourniquet around the arm 3–4 in. above the intended venipuncture site

  2. Grasp one side of the tourniquet in each hand a few inches from the end

  3. Apply a small amount of tension and maintain it throughout the process

  4. Bring the two sides together and grasp them both between the thumb and forefinger of the right hand

  5. Reach over the right hand and grasp the right side of the tourniquet between the thumb and forefinger of the left hand and release it from the grip of the right hand

  6. Cross the left end over the right end near the left index finger, grasping both sides together between the thumb and forefinger of the left hand, close to the patient’s arm

  7. While securely grasping both sides, use either the left middle finger or the right index finger to tuck a portion of the left side under the right side and pull it into a loop

  8. A properly tied tourniquet with the ends pointing toward the shoulder
• Selecting Vein, Releasing Tourniquet, and Asking Patient to Open Fist

  1. The preferred venipuncture site is the antecubital area of the arm, where a number of veins lie close to the surface

  2. Dominant arms should be examined first because they have the most prominent veins

  3. To locate a vein, palpate (examine by touch or feel) the area by pushing down on the skin with the tip of the index finger

  4. An artery has a pulse and must be avoided

  5. If no suitable antecubital vein can be found in either arm, check for veins on the back of the hand or wrist

  6. After selecting a suitable vein, mentally visualize its location if it is not obvious
• Venipuncture Procedure


  1. Feel the area by pushing down on the skin with the tip of the index finger

  2. Avoid arteries with a pulse

  3. If no suitable antecubital vein is found, check for veins on the back of the hand or wrist

  4. Mentally visualize the selected vein's location

  5. Release the tourniquet and ask the patient to open the fist after vein selection

  6. According to CLSI, release and reapply the tourniquet after 2 minutes when used during vein selection
• Cleaning and Air-Drying the Site

  Use 70% isopropyl alcohol to clean the site in concentric circles
• Preparation of Syringe Equipment and Putting on Gloves

  1. Select a syringe and needle size compatible with the patient's veins and blood amount

  2. Move the plunger back and forth, advance it to the end of the syringe before opening the sterile package
• Vein Choices


  • First Choice: Median Cubital and Median Veins
  • Second Choice: Cephalic and Median Cephalic Veins
  • Third Choice: Basilic and Median Basilic Veins
• Reapplying Tourniquet, Uncapping, and Inspecting Needle


  1. Reapply the tourniquet without touching the cleaned area

  2. Visually inspect the needle for obstructions or imperfections

  3. Do not let the needle touch anything prior to venipuncture after removing the cap
• Inserting Needle


  1. Use the "L-hold" technique

  2. Insert the needle at an angle of 30 degrees or less, depending on vein depth
• Establishing Blood Flow, Releasing Tourniquet, and Filling Syringe

  1. A "Flash" of blood in the syringe hub indicates successful entry

  2. Achieve blood flow by slowly pulling back on the plunger
• Placing Gauze, Removing Needle, Activating Safety Feature, and Applying Pressure


  1. Do not press down on the gauze while the needle is in the vein

  2. Apply pressure to the site for 3-5 minutes or until bleeding stops
• Discarding Needle, Filling Tubes, Discarding Syringe and Transfer Device

  1. OSHA regulations prohibit cutting, bending, breaking, or recapping needles

  2. Use a transfer device to reduce accidental needlesticks and confine aerosol or spraying
• Labelling Tubes


  1. Never pre-label tubes

  2. Include patient's first and last names, identification number or date of birth, date and time of collection, phlebotomist's initials, and additional information like "fasting"
• Minimum information for labels

  • Patient’s first and last names
  • Patient’s identification number (inpatient) or date of birth (outpatient)
  • Date and time of collection
  • Phlebotomist’s initials
  • Pertinent additional information, such as “fasting”
• Special handling instructions


  1. Place specimens that must be cooled (e.g., ammonia) in crushed ice slurry

  2. Put specimens that must be kept at body temperature (e.g., cold agglutinin) in a 37°C heat block or other suitable warming device

  3. Wrap specimens that require protection from light (e.g., bilirubin) in aluminum foil
• Check patient’s arm and apply bandage

  If bleeding has not stopped, the phlebotomist must apply pressure until it does
• Dispose of contaminated materials

  Dispose of contaminated materials in the proper biohazard containers or according to facility protocol; place other materials such as needle caps and wrappers in the trash receptacle
• Venipuncture Syringe Method


  To safely transfer blood from a syringe into ETS tubes
• Procedure for inability to collect specimen

  If unable to obtain a specimen on the first try, evaluate the problem and try again below the first site, on the opposite arm, hand, or wrist vein, or use a butterfly or syringe on the second attempt if veins are small or fragile. Arterial puncture should not be used as an alternative to venipuncture on difficult veins
• Reasons for inability to obtain a specimen

  • The phlebotomist attempted but was unable to draw blood
  • Patient refused to have blood drawn
  • Patient was unavailable
• Removing more than 10% of an infant’s blood volume at one time can lead to shock and cardiac arrest
• Dealing with pediatric patients and guardians

  Selecting a method of restraint: A newborn or young infant can be wrapped in a blanket, but physical restraint is often required for older infants, toddlers, and younger children. Older children may be able to sit by themselves in the blood-drawing chair, but a parent or another phlebotomist should help steady the child’s arm
• Regardless of the collection method, every attempt should be made to collect the minimum amount of blood required for testing because of the small blood volume of the patient
• Dealing with geriatric patients

  1. Skin changes

  2. Hearing and visual impairment

  3. Mental impairment<|Effects of Diseases: Arthritis, Coagulation Problems, Diabetes, Parkinson’s disease and stroke, Pulmonary function problems. Geriatric patients may need wider open areas to accommodate wheelchairs and walkers. It is generally safest and easiest to draw blood with the patient in the wheelchair, supporting the arm on a pillow or on a special padded board placed across the arms of the chair
• Dealing with dialysis patients

  Procedure in which patients whose kidneys do not function adequately have their blood artificially filtered to remove waste products. In hemodialysis, the patient’s blood is filtered through a special machine often referred to as an artificial kidney. A special needle and tubing set is inserted into the fistula to provide blood flow to the dialysis machine. A phlebotomist must be able to recognize a fistula to avoid damaging the area, as it is the dialysis patient’s lifeline
• Dealing with long-term care patients

  Certain patients with functional disabilities cannot care for themselves but do not require hospitalization. Primary recipients are the elderly