LABORATORY

• Median Cubital Vein


  • Near the center of the antecubital area
  • Preferred vein
  • Larger, closer to the surface, better anchored, and more stationary
  • Easiest and least painful to puncture and the least likely to bruise

  
• Cephalic Vein


  • Lateral aspect of the antecubital area
  • Second choice vein
  • Harder to palpate than the median cubital
  • Can be palpated (felt) in obese patients
• Basilic Vein


  • Medial aspect (inner side) of the antecubital area
  • Last-choice vein for venipuncture
  • Not as well anchored and rolls more easily
  • Near medial cutaneous nerve (a major nerve of the arm) or the brachial artery
  • More painful

  
• 1. Shaped Antecubital Vein


  • Median vein (intermediate antebrachial vein)
  • Median cephalic vein (intermediate cephalic vein)
  • Median basilic vein (intermediate basilic vein)
  • Cephalic vein
  • Basilic vein
• Other Venipuncture Sites


  • Arm and Hand Veins
  • Back of the hand
  • Wrist
  • Leg, Ankle, and Foot Veins

  
• Leg, Ankle, and Foot Veins

  • Potential for significant medical complications such as phlebitis or thrombosis
  • Veins of the leg, ankle, and foot must not be used for venipuncture without permission from the patient's physician
  • Puncture of the femoral vein is performed only by physicians or specially trained personnel

  
• Tourniquet Application


  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
• A properly tied tourniquet with the ends pointing toward the shoulder
• Venipuncture Procedures


  1. Review and Accession test Request

  2. Approach and Identify

  3. Verify Diet restrictions and Latex Sensitivity

  4. Sanitize hands

  5. Position Patient, apply tourniquet, and ask patient to make a fist

  
• Clean and Air-Dry the Site

  1. Clean the site with a circular motion

  2. Start at the point where you expect to insert the needle

  3. Move outward in concentric circles until you have cleaned an area

  4. Use sufficient pressure to remove surface dirt and debris

  5. Do not rub so vigorously that you abrade the skin

  6. If the site is especially dirty, clean it again with another alcohol prep pad

  7. Allow the area to dry naturally for 30 seconds to 1 minute

  8. Vertical motion is also accepted
• • Do not dry the alcohol with unsterile gauze
  • Do not fan the site with your hand or blow on it to hasten drying time
  • Do not touch the site after cleaning it
  • Puncturing when the site is still wet can cause hemolysis
• Prepare the Equipment


  1. Move the plunger back and forth a few times and advance it to the end of the syringe before opening the sterile package

  2. Open the needle packages in an aseptic manner

  3. Securely attach the needle to the syringe
• Reapply the Tourniquet, Uncap, Inspect Needle


  1. Reapply the tourniquet

  2. Remove the needle cover

  3. Visually inspect the needle
• Ask Patient to Remake a Fist, Anchor Vein, Insert Needle


  1. Use non-dominant hand to anchor (secure firmly) the vein

  2. Hold the collection equipment and insert needle using the dominant hand

  3. Grasp the patient's arm with your free hand

  4. Use fingers to support the back of the arm just below the elbow

  5. Place your thumb a minimum of 1 to 2 in. below and slightly to the side of the intended venipuncture site and pull the skin toward the wrist

  6. Bevel of the needle should be facing up

  7. Insert the needle into the skin at an angle of 30 degrees or less

  8. Use one smooth, steady forward motion
• Establish Blood Flow, Release Tourniquet, Ask Patient to Open Fist


  1. Blood in the syringe hub indicates that the vein has been successfully entered

  2. Slowly pull back the plunger with your free hand

  3. Ask the patient to release the fist as soon as blood flows into the syringe

  4. Release the tourniquet

  
• Place Gauze, Remove Needle, and Apply Pressure


  1. Place gauze directly over the site where the needle enters the skin

  2. Hold the gauze lightly in place but do not press down on it until the needle is remove

  3. Remove needle

  4. Apply pressure to the site for 3 to 5 minutes or until the bleeding stops. (Ask the patient)

  5. Do not ask the patient to bend the arm up. The arm should be kept extended or even raised.

  
• Fill Tubes


  1. Transfer blood into the tubes

  2. Syringe or tube should be slanted

  3. Number of inversions

  4. Follow the order of draw

  
• Recapping the Needle


  Fishing out
• Transferring of Blood


  1. Recap the needle

  2. Unscrew the needle from the syringe

  3. Open the evacuated tube

  4. Hold the syringe vertically while pushing the plunger gently to the tube

  5. Tilt the tube while transferring the blood
• Label Tubes


  1. Label tubes immediately after blood collection

  2. Label permanently attached to the tube before leaving an inpatient's bedside or dismissing an outpatient

  3. Preprinted computer or barcode label

  4. Labels should include the following information as a minimum: Patient's first and last names, Patient's identification number (inpatient), Date of birth (outpatient), Date and time of collection, Phlebotomist's initials, Pertinent additional information, such as "fasting"

  5. Invert first before labelling
• Check Patient's Arm


  1. Apply an adhesive bandage

  2. Instruct the patient to leave the bandage on for a minimum of 15 minutes

  3. Instruct an outpatient not to heavy object or lift heavy objects with that arm for a minimum of 1 hour

  
• Thank Patient, Remove Gloves. Sanitize Hands

  Use glove-in-glove technique for removing gloves