VENIPUNCTURE PROCEDURES

• Venipuncture


  Process of collecting or "drawing" blood from VEIN
• Venipuncture


  • MOST common way to collect blood specimens for laboratory testing
• Methods of venipuncture


  • Syringe method
  • Evacuated tube System
  • Butterfly
• Steps in blood collection

  1. Review and Accession test Request

  2. Approach, Identify, and prepare Patient

  3. Verify Diet restrictions and Latex Sensitivity

  4. Sanitize hands

  5. Position Patient, Apply torniquet, and ask patient to make a fist

  6. Select Vein, Release torniquet, and ask patient to open fist

  7. Clean and air-dry the site

  8. Prepare equipment and put on gloves

  9. Reapply tourniquet, uncap and inspect needle

  10. Ask patient to remake a fist, anchor vein, and insert needle

  11. Establish blood flow, release the tourniquet, and ask patient to open fist

  12. Fill, remove, and mix tubes in order of draw or fill syringe

  13. Place gauze, remove needle, activate safety feature, and apply pressure

  14. Discard collection unit, syringe needle, or transfer device

  15. Label tubes

  16. Observe special handling instructions

  17. Check patient's arm and apply bandage

  18. Dispose of contaminated materials

  19. Thank patient, remove gloves, and sanitize hands

  20. Transport specimen to the lab
• Patient Identification is the most important step
• Skills used in phlebotomy

  • Social Skills (Interpersonal)
  • Administrative/Clerical Skills
  • Technical Skill
• Social Skills (Interpersonal)


  • Should be polite and friendly even if the patient is rude
  • Professionalism
• Administrative/Clerical Skills


  • Clerical errors – most common error in the laboratory
  • Ex. Patient misidentification, mislabeling
• Technical Skill


  • Obtain blood successfully with minimum pain
  • Steps are memorized
• Test Request Form/Requisition Form

  • Lists the information needed for the phlebotomist to collect blood sample
  • Form on which test orders are entered
• Information included in Test Request Form

  • Ordering physician's name
  • Patient's first and last names and middle initial
  • Patient's medical record number (if inpatient)
  • Patient's date of birth or age
  • Room number and bed (if inpatient)
  • Type of test to be performed
  • Date test is to be performed
  • Billing information and ICD-9 codes (if outpatient)
  • Test status (e.g., timed, fasting, priority)
  • Special precautions (e.g., latex sensitivity)
  • Accessioning number
  • Department or location where to do the test
• Part of patient's medical record requires specific information to ensure right patient is tested, physician's orders are met, correct tests are performed at the proper time
• Verbal test requests are accepted in case of emergency, but still needs to be documented after
• Accession Order


  • A number to identify all paperwork and supplies associated with each patient
  • Used for tracking the sample
  • Entering the result
  • Checking and reporting the result
  • Can be computerized or manual
• Computerized Accession Order


  • contain the actual labels that are placed on the specimen tubes immediately after collection
  • each patient has a designated barcode
  • barcode is scanned to know which tests will be performed
• Manual Accession Order


  • Multipart carbon form
  • Imprinting plate
  • Full name, ID #, Rm #, Physician's name, Request tests (handwritten only)
  • Can be given to the phlebotomist or the patients
  • A three-part manual test request
  • First part is for the request
  • Second part is for the report
  • Third part is for the billing form
  • Usually used as a back-up
• Receipt of Test Request

  • Inpatients
  • Outpatients
• Inpatient Test Request Receipt

  • Computer requisitions for inpatients
  • print out at a special computer terminal at the phlebotomist station in the laboratory
  • according to priority – emergency first
• Outpatient Test Request Receipt

  • laboratory requisitions or prescription slips with test orders written on them by their physicians
  • responsible for taking them to a blood collection site
  • first come first serve
• Reviewing the Test Request

  1. Check to see that all required information is present and complete

  2. Verify the tests to be collected and time and date of collection

  3. Identify diet restrictions or other special circumstances that must be met prior to collection

  4. Determine test status or collection priority
• • To avoid duplication of orders
  • To ensure that the specimen is collected at the right time and under proper conditions
  • To identify other equipment needed
• Accessioning of Test Request


  • Process of recording in the order received
  • This means to take steps to unmistakably connect the specimen and the accompanying paperwork with a specific individual
  • It ensures prompt and accurate processing from receipt of the order to reporting of test results
  • Accession number
• Approaching the Patients


  1. Organized and effective and efficient

  2. Arrange the requisitions according to priority

  3. Review the requisitions in order to see what equipment is in cart or tray before going to the patient

  4. Outpatients, summoned from waiting area according to arrival

  5. Looking for signs-"code"

  6. Entering a patient's room

  7. Physicians and Clergy

  8. Family and Visitors

  9. Unavailable Patient

  10. Obtaining Consent

  11. Bedside manner

  12. Introduce yourself
• Greeting the Patient


  • Gaining the patient's trust
  • Introduce yourself to the patient
  • Give your name, your title and why you are there
  • Immediate role in his/her care
  • How long the procedure will take
  • What you are going to do
  • Never give false assurance to the patient
• Patient Identification


  1. Ask the patient to state his/her full name and DOB

  2. Check ID Bracelets

  3. 3 Way ID

  4. if there are errors/does not match, do not draw blood
• Patient Identification Procedures


  • Conscious Inpatients/Hospitalized patients
  • Sleeping patients
  • Unconscious
  • Infants and Children and Mentally Incompetent
  • Outpatient/Ambulatory patients
  • Emergency Room Patients
• ID Discrepancies


  • Notify the nurse
  • Do not obtain until discrepancy is addressed and the ID has been verified
  • Missing ID
• Preparing the Patient


  1. Explaining the procedure

  2. Addressing Patient Inquiries

  3. Handling Patient Objections

  4. Addressing Needle Phobia

  5. Addressing Objects in the Patient's Mouth
• Diet Restrictions


  • Most common is fasting (8-12 hrs)
  • Depends on the test required
• Latex Sensitivity


  • Can be life threatening
  • If with allergy, use equipment/materials with no latex or latex free
• Sanitize Hands


  1. Proper hand hygiene

  2. Preferably done in the presence of the patient

  3. Sanitize or decontaminate hands

  4. Observe infection control and isolation policies

  5. Prevent spread of disease and to protect the patient

  6. Gloves are usually put on at this point
• Position the Patient


  1. Arm in a downward and comfortable manner not bent on the elbow

  2. Outpatients

  3. Inpatients

  4. NOT STANDING nor SITTING in a TALL STOOL

  5. Chair with adequate arm support
• Select Appropriate Site


  1. Apply the tourniquet

  2. Locating a vein

  3. Vein selection

  4. Sites for Newborns

  5. Sites to be avoided
• Tourniquet


  • Purpose: Obstruct the venous blood flow, Make the veins prominent
  • Applied 3-4 inches above the site
  • Applied not longer than 1 minute
  • Blood pressure cuff: 60 mmHg (between systolic and diastolic pressure)
  • Ask patient to clench or make a fist
• Locating a vein


  • Felt the vein using the tip of the index or middle fingers
  • Soft and bouncy to touch
  • Determine roundness, direction and depth of vein
  • Veins has different angles or cross the arm going side to side
  • If there is pulse when you pulsate, that is an artery
  • Avoid puncturing tendons and nerves
• Vein selection


  • Select the most prominent vein
  • Order of checking for the best available site: (1) Upper arm, (2) hand, (3) wrist, (4) foot or ankle
  • Always choose the best vein
  • Enhance vein prominence
• Sites for Newborns


  • Scalp
  • Popliteal
  • Jugular
  • Dorsal of the hand
• Sites to be avoided

  • IV lines in both arms
  • Areas with Hematoma
  • Burned or scarred areas
  • Thrombosed veins
  • Edematous arms
  • Partial/Radial mastectomy
  • With AV shunt or fistula
  • Cast(s) on arm(s)
• What if a suitable vein cannot be found?

  1. Massage the arm, from wrist to elbow

  2. Wrap a warm, wet towel around the arm or hand for a few minutes
• • If already found, you can mark the vein's location
  • Do not use pen
  • Use alcohol pads