ROUTINE VENI

• The most frequently performed procedure in phlebotomy is the venipuncture
• Performing venipuncture


  • In an organized, patient-considerate manner is the key to success as a phlebotomist
  • Each phlebotomist develops their own style for dealing with patients and performing the actual venipuncture
• Administrative protocols vary among institutions and every patient is different, however many basic rules are the same in all situations
• These basic rules must be followed to ensure the safety of the patient and the phlebotomist, produce samples that are representative of the patient's condition, and create an efficient phlebotomy service for the institution
• Routine venipuncture technique


  1. Presented for the beginning phlebotomist in a step-by-step procedure

  2. Outlined again in Chapter 10 with a presentation of the complications that may occur at each step
• 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 requisition becomes part of the patient's medical record and is essential to provide the phlebotomist with the information needed to correctly identify the patient, organize the necessary equipment, collect the appropriate samples, and provide legal protection
• Phlebotomists should not collect a sample without a requisition form, and this form must accompany the sample to the laboratory
• Requisition


  A form that provides the phlebotomist with the information needed to correctly identify the patient, organize the necessary equipment, collect the appropriate samples, and provide legal protection
• Required information on a requisition

  • 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 (stat, timed, routine)
  • Number and type of collection tubes
  • Special collection information
  • Special patient information
  • Billing information and ICD-9 codes
• Phlebotomists should carefully examine all requisitions for which they are responsible before leaving the laboratory
• The requisition should be reviewed to verify the tests to be collected and the time and date of collection, and to determine whether any special conditions such as fasting or patient preparation requirements must be met before the venipuncture
• Phlebotomists must be sure they have all the necessary equipment
• The actual format of a requisition form may vary
• Requisitions must contain certain basic information to ensure that the sample drawn and the test results are correlated with the appropriate patient and that these can be correctly interpreted with regard to any special conditions, such as the time of collection
• Phlebotomists should never collect samples before receiving or generating the requisition form
• Greeting the patient


  A phlebotomist's professional demeanor instills confidence and trust in the patient, which can effectively ease patient apprehension about the procedure
• Entering a patient's room

  1. Knock lightly on the open or closed door to make your presence known

  2. If the curtain is closed around the bed, speak to the patient first through the curtain
• The most important procedure in phlebotomy is correct identification of the patient
• Serious diagnostic or treatment errors and even death can occur when blood is drawn from the wrong patient
• Patient identification


  • The Clinical and Laboratory Standards Institute (CLSI) recommends two identifiers for patient identification
  • The College of American Pathologists (CAP) and the Joint Commission (JC) patient safety goals require a minimum of two patient identifiers when collecting blood
• Inpatient identification


  1. Verbal identification by asking the patient to state their full name

  2. Examining the information on the patient's wrist ID band
• It is essential that identification of hospitalized patients be made from an ID band attached to the patient
• Outpatient identification


  1. Ask the patient to state their full name, address, birth date, and/or unique identification number after calling them back to the drawing area

  2. Compare the verbal information with the requisition form to verify the patient's identification
• Bar code technology and radio frequency identification (RFID) can be used for positive patient identification
• Patient preparation


  • Reassurance of the patient actually begins with the greeting and continues throughout the procedure
  • Phlebotomists should demonstrate both concern for the patient's comfort and confidence in their own ability to perform the procedure
• Patients should be given a brief explanation of the procedure, including any nonroutine techniques that will be used
• The phlebotomist's conversation with the patient should include verifying that the appropriate pretest preparation such as fasting or abstaining from medications has occurred
• When these procedures have not been followed, this problem should be reported to the nurse before drawing the blood
• Ask the patient if they have a latex sensitivity and use nonlatex supplies where appropriate
• When patients are having repeated bedside tests performed such as glucose testing, the patient may ask for the result
• If the sample is still required, the irregular condition, such as "not fasting," should be written on the requisition form and the sample
• Other preexamination variables will be discussed in Chapter 10
• Technical Tip 9-3


  A hospitalized patient must always be correctly identified by an ID band that is attached to the patient
• Technical Tip 9-4


  When necessary, writing down information or using sign language or an interpreter will help the patient to understand the procedure and to give permission for the blood collection
• Technical Tip 9-5


  Good verbal, listening, and nonverbal skills are very important for patient reassurance
• Safety Tip 9-1


  Personnel already familiar with a patient must never become lax with regard to patient identification
• Preexamination Consideration 9-4


  Failure to properly identify the patient may result in patient medication and treatment mismanagement
• Blood should never be drawn from a patient who is in a standing position
• Technical Tip 9-6


  When supporting the patient's arm, do not hyperextend the elbow. This may make vein palpation difficult. Sometimes bending the elbow very slightly may aid in vein palpation