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• Pre-venipuncture considerations


  1. Requisitions

  2. Greeting patient

  3. Room Signs

  4. Entering a Patient’s Room

  5. Patient identification

  6. Patient preparation

  7. Positioning the patient

  8. EQUIPMENT SELECTION

  9. Tourniquet application

  10. Site selection
• Requisitions


  • All phlebotomy procedures begin with the receipt of a test requisition form that is generated by or at the request of a health-care provider
  • The required information on a requisition includes: Patient’s first and last names, Identification number, Patient’s date of birth, Patient’s location, Ordering health-care provider’s name, Tests requested, Requested date and time of sample collection, Status of sample, Other information such as special collection information and special patient information
• Greeting patient


  • When approaching a patient, phlebotomist should introduce themselves, say that they are from the laboratory, and explain that they will be collecting a blood sample in a non-technical term and in a manner the patient can understand
• Room Signs


  • Observe any signs on the patient’s door or in the patient’s room relaying special instructions
• Entering a Patient’s Room

  • When entering a patient’s room, it is polite to knock lightly on the open or closed door to make your presence known
• Patient identification


  • 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 with the name in the requisition form
• Patient preparation


  • Phlebotomists should demonstrate concern for the patient’s comfort and confidence in their own ability to perform the procedure
• Positioning the patient


  • Always ask the patient if he or she is allergic to latex. Blood should never be drawn from a patient who is in a standing position. Outpatients should be seated or reclined at a drawing station. The patient’s arm should be firmly supported and extended downward in a straight line
• EQUIPMENT SELECTION


  • Before approaching the patient for actual venipuncture, the phlebotomist should collect all necessary supplies and place them close to the patient
• Tourniquet application


  • The tourniquet causes blood to accumulate in the veins making them more easily located and provides a larger amount of blood for collection. The maximum amount of time the tourniquet should remain in place is 1 minute
• Site selection


  • The preferred site for venipuncture is the antecubital fossa located anterior and below the bend of the elbow. The three major veins: the median cubital, the cephalic and the basilic vein
• Venipuncture Procedure


  1. Applying a tourniquet and asking the patient to clench his or her fist to locate a suitable vein

  2. Cleansing the site using a 70% isopropyl alcohol pad/cotton

  3. Assembly of puncture equipment

  4. Examining the needle before entering the vein

  5. Anchoring the vein by placing the thumb and fingers in a specific position

  6. Inserting the needle at an angle of 15 to 30 degrees

  7. Filling the tubes with blood

  8. Removing the needle and disposing of it in a sharps container

  9. Labeling the tubes after collection

  10. Bandaging the patient's arm after the procedure

  11. Leaving the patient's room after cleaning up
• Preferred site for venipuncture

  • Antecubital fossa located anterior and below the bend of the elbow with major veins: median cubital, cephalic, and basilic veins
• Arrangement of veins in the antecubital fossa

  • "H-shaped" pattern includes cephalic, median cubital, and basilic veins
  • "M-shaped" pattern includes cephalic, median cephalic, median basilic, and basilic veins
• Locating veins


  By sight and touch (palpation) using the tip of the index finger with a pushing motion to locate deep veins, distinguish spongy veins, and differentiate veins from arteries
• Needle examination


  Removing the plastic cap and visually examining the needle for defects before entering the vein
• Vein anchoring


  Thumb 1 or 2 inches below and slightly to the left of the insertion site, fingers on the back of the arm to pull the skin taut
• Needle insertion


  Aligning the needle with the vein, inserting it bevel up at an angle of 15 to 30 degrees, and bracing fingers against the patient's arm for stability
• Tubes filling


  Pushing the evacuated tube into the holder, releasing the tourniquet, and allowing blood to flow into the tube
• Needle removal


  Removing the tourniquet before withdrawing the needle to prevent hematoma, applying pressure after needle withdrawal
• Needle disposal


  Immediately disposing of the contaminated needle and holder in a sharps container
• Labeling tubes


  After sample collection, writing on the attached label or applying a computer-generated label with a designated barcode
• Bandaging the arm


  Placing hypoallergenic tape on top of the gauze pad or cotton to stop bleeding within 5 minutes
• Leaving the patient's room


  Disposing of used supplies, washing hands, and returning the bed and bed rails to the original position