Venipuncture Procedures

• Conscious Patients (out-patient)

  • Ask patient to give their full name and spell their

  last name

  • Compare the information on the request form
• Conscious Patients (in-patient)

  • Ask patient to give their full name and spell their last name
  • Compare the information on their identification bracelet and request form
• Sleeping Patient

  • Awaken a sleeping patient before attempting venipuncture
  • If the patient is already awake, do the same steps as conscious patients
• Semi-conscious or Comatose Patient

  • Ask the watcher (or nurse, if no watcher is around) to identity the patient
  • Compare the information on the identification bracelet and request form
• Too young, mentally incompetent or do not speak the language of a phlebotomist

  • Ask the watcher (or nurse, if no watcher is around) to identify the patient
  • Compare the information on the identification bracelet and request form
• Unidentified Emergency Patient

  • Upon admission, a temporary identification number will be assigned to the patient. Use this ID number on all tests
  • When a permanent number or when the patient has already been identified, cross-reference it with the temporary number
• Burns, scars or tattoos: impaired circulation, hard to palpate and draw from
• Damaged veins: Sclerosed (hardened), thrombosed (clotted)
• Edema (swelling/high tissue fluid): veins are not prominent and hard to locate; tourniquet will be ineffective due to swelling
• Hematoma (leakage of blood in surrounding tissues): painful and erroneous test results
• Mastectomy (lymph node removal): susceptible to swelling and infection
• IV line, cannula, fistula: draw on the opposite arm.
• Cannula: a thin tube inserted into a vein or body cavity to administer medicine, drain off fluid, or insert a surgical instrument
• IV line: If both arms have IV lines and no other vein is available, ask the nurse to turn off the IV fluid for 5 minutes, discard the first 5ml of blood then collect the desired sample. Ask the nurse to turn the IV fluid back on.
• Properly recap the needle using "fishing-out" technique.
• Label tubes at patient's side.

  1. patient's first and last name
  2. identification number
  3. date and time of collection
  4. Initials of phlebotomist
• PAIN

  ▪ Reposition the needle

  ▪ Release the tourniquet

  ▪ Discontinue venipuncture

  ▪ Avoid deep, probing venipunctures
• NERVE DAMAGE

  ▪ If nerve is only touched, not damaged, it may be

  gone in a few hours or days.

  ▪ If damaged, numbness could be permanent

  ▪ Discontinue venipuncture
• NAUSEA

  ▪ Make the px as comfy as possible

  ▪ Instruct him/her to breathe slowly

  ▪ Apply cold compress if necessary

  ▪ Give waste basket or container and have tissues

  and water ready
• SYNCOPE

  ▪ Warning signs: perspiration beads on the forehead, hyperventilation, loss of color

  ▪ Discontinue venipuncture

  ▪ Lower the head and arms
• Vasovagal syncope - fainting due to abrupt pain or trauma
• DIABETIC SHOCK

  ▪ experience hypoglycemia because they fasted

  ▪ if conscious, let them drink a glass of orange

  juice or cola will temporarily help

  ▪ If unconscious, call a physician
• CONVULSIONS

  ▪ Px become unconscious and exhibit mild to

  violent uncontrollable movements

  ▪ Do not restrain the px

  ▪ Move objects out of the way; protect the head

  ▪ Px will usually recover after a few minutes
• CARDIAC ARREST

  ▪ Px falls into unconsciousness, no pulse or respiration, dilated eyes and pale skin

  ▪ Immediate CPR
• CONTINOUS BLEEDING

  ▪ Some patients take more than 5 minutes for the

  site to stop bleeding

  ▪ Continue to wrap an elastic gauze around the

  arm with a pad

  ▪ Leave it on for 15 min or until the bleeding stops
• SKIN ALLERGIES

  ▪ Some px are allergic to latex, tape or iodine

  ▪ Use hypoallergenic tape and non-latex elastic

  wrap
• НЕМАТОМА

  ▪ Leakage of blood under the skin at the site of

  venipuncture

  ▪ Discontinue venipuncture and apply heavy

  pressure
• ICTERIC

  • Serum/plasma that contains large amounts of

  bilirubin

  • Px presents with jaundice
• LIPEMIC

  • Serum/plasma contains large amounts of fats and

  lipids

  • May be due to px not fasting
• HEMOLYZED

  • serum/plasma contaminated with RBC contents
• SPECIMEN CONSIDERATIONS

  • Fasting

  • Random

  • Post-prandial

  • Basal state
• EXERCISE

  Moderate exercise can increase:

  • Blood glucose, lactic acid, serum proteins, muscle enzymes
• Did not undergo fasting: Elevated blood glucose, potassium, and lipids
• Prolonged fasting: Elevated serum bilirubin, TAG, glycerol, free FA, and decreased plasma glucose
• high protein diet- increased urea, ammonia, urates
• long time vegetarian- decreased LDL, VLDL, total lipid, phospholipid, cholesterol, TAG
• hyperchylomicronemia- increases turbidity or latescence (TAG level exceeds 4.6 mmol/L (4.0g/L)
• POSITION OR POSTURE

  • Preferably supine or upright sitting position
• TOURNIQUET

  • One-minute application
  • Prolonged application = venous stasis or hemoconcentration
• SMOKING

  • Affects hematological tests such as hemoglobin, hematocrit and blood counts