veni

• Venipuncture


  Considered the most frequently performed procedure in phlebotomy
• Standardized venipuncture procedure


  Can reduce or eliminate errors that can affect sample quality and patient test results
• Requisitions


  1. All phlebotomy procedures begin with the receipt of a test requisition

  2. Phlebotomist must NOT collect a sample without requisition slip
• Required information on requisitions

  • Patient's first and last name
  • Identification number
  • Patient's date of birth
  • Patient's location
  • Ordering physician
  • Tests requested
  • Requested sample collection date and time/status
  • Special collection/patient information
  • Status of collection (stat, timed, routine)
  • Billing information
• Status Designation


  • STAT
  • Med Emerg
  • Timed
  • ASAP
  • Fasting
  • NPO
  • Preop
  • Postop
  • Routine
• STAT


  Immediately collect, test and report results. ER stats are priority
• Med Emerg


  Immediately collect, test and report results. ER stats are priority
• Timed


  Collect close to required time
• ASAP


  Results needed to respond to serious but not yet critical situation
• Fasting


  No food or drink intake for 8-12 hours
• NPO


  Nothing by mouth prior to surgery
• Preop


  Collect before surgery
• Postop


  Collect after surgery
• Routine


  Collect on time but not urgent
• Greeting the Patient


  1. Entering the patient's room

  2. Introduction

  3. Explain purpose of visit

  4. Use nontechnical terms

  5. Obtain consent

  6. Observe patient reaction

  7. Provide feedback

  8. Good communication skills
• Room Signs


  • Allergic to latex
  • NPO (non-per-orem) (nothing by mouth)
  • DNR (do not resuscitate)
  • Do not draw blood here
  • Infection control precautions
  • Patient expired
• Entering a Patient's Room

  1. Knock lightly (whether closed or open) to make your presence known

  2. If curtain is closed; respect privacy
• Patient Identification


  The most important procedure in phlebotomy
• Recommended patient identifiers


  • CLSI, Joint Commission, and CAP recommend two identifiers
• Inpatient Identification


  1. Patient must state their name

  2. Never ask for the patient by name

  3. Wrist band with correct and complete information must be present on the patient
• Wristband Information


  • Patient's Name
  • Hospital ID #
  • Date of Birth
  • Name of Physician
• Wristbands are sometimes removed when IV is administered; should be reattached to patient's ankle
• Ankle bands are common for pediatric and newborns
• Wristband lying on bedside; tied on the bed; or label on the doors are unreliable forms of identification
• Outpatient Identification


  1. Patient states full name

  2. Other identifier

  3. Date of birth

  4. Address

  5. Identification number

  6. Compare verbal interpretation with requisition form

  7. In behalf of an impaired patient, the relative can provide info; document the name of verifier
• Bar Code Technology


  • Wireless handheld bar code scanner
  • Interfaced with the laboratory information system (LIS)
  • Capable of creating sample labels
  • Radio frequency identification (RFID)
  • w/ sample tracking device
  • can update patient data anytime
• Patient Preparation


  1. Brief explanation of the procedure

  2. Do not tell patients that procedure will be painless

  3. Do not give details of specific tests; refer the patient to their health-care provider

  4. Verification of pretest instructions

  5. Fasting

  6. Medication

  7. Inquire about possible latex allergies
• Positioning the Patient


  1. Position for convenience and safety

  2. Never draw blood from a standing patient

  3. Outpatient: Drawing station (phlebo chair), Arm fully supported and angled downward (allow tubes to fill from bottom up)

  4. Use recliner/reclining chair for patients with a history of syncope

  5. Ask patient to make a fist (the other hand can be used for support- placed behind elbow to make the veins easier to locate)

  6. Be alert with patient's condition during the process

  7. For hospitalized patients; one can place pillow or towel under patient's arm

  8. If bed rails are lowered return them to the raised position after phlebo

  9. Patient's should remove anything in the mouth (food, drinks, gums, or thermometer) before veni; they may cause choking
• Equipment Selection


  1. Necessary equipment is selected and placed close to the patient

  2. No blood collection tray placed on the bed

  3. Accessible on the same side as your free hand

  4. Eliminates "reaching across"

  5. Reexamine the requisition

  6. Select appropriate supplies based on patient age and condition

  7. Correct type and number of evacuated tubes

  8. Appropriate venipuncture needle and holder

  9. Antiseptic; Bandaging; Tourniquet

  10. Inspect supplies (i.e., expiration date)

  11. Place tubes in "order of draw"

  12. Keep extra tubes handy
• Wash Hands and Apply Gloves

  1. Perform in front of patient

  2. Gloves are changed between each patient
• Tourniquet Application


  1. Impedes venous flow

  2. Allowing accumulation of blood to veins

  3. Easier to locate veins

  4. Allows arterial flow

  5. Maximum allowable duration of tourniquet application is 1 minute

  6. Complications can arise with prolonged application

  7. When used during vein selection; tourniquet must be released and REAPPLIED ONLY AFTER 2 MINUTES

  8. Tourniquet is placed 3 to 4 inches above the puncture site

  9. A tourniquet applied near the venipuncture site may cause vein to collapse

  10. The loop formed should face downward

  11. Free end should be away from the venipuncture area to allow easy removal

  12. Tourniquets should not be applied too tight: Uncomfortable, Obstruct blood flow to the area

  13. Signs of too tight tourniquet application: Appearance of small red patches called petechiae, Blanching of the skin around the tourniquet, Inability to feel radial pulse
• Site Selection


  • Major veins: antecubital fossa
  • Median cubital vein
  • Cephalic vein
  • Basilic vein
  • "H" and "M" pattern
  • CLSI discourages the use of veins in the underside of the wrist because of the chance to accidentally puncture arteries, nerves or tendons
• Median Cubital Vein


  • Vein of choice for venipuncture
  • Located near the center of the antecubital fossa
  • Large, close to the surface of the skin, stationary and sufficiently anchored to the tissue for a successful venipuncture, least painful to puncture (less nerve endings), least likely to bruise

  
• Cephalic Vein


  • Located in the thumb side; Second-choice vein
  • More difficult to locate, Fairly well anchored (tendency to move), Often the only vein that can be felt in obese patients, Easily bruises, Possibility of blood spurt (close to the surface), Remedy: lower the angle; use 15 degree angle

  
• Basilic Vein


  • Located on the medial side (inner edge) of the antecubital fossa; last-choice vein
  • Large and easy to feel, Least firmly anchored; rolls easily, Increase risk of puncturing median nerve and brachial artery, CLSI does not recommend the use of this vein (last resort), Easily bruises (may form hematoma)
• Locating Suitable Veins


  1. Place tourniquet

  2. Ask patient to close fist

  3. Avoid clenching or pumping of fist

  4. Can increase blood potassium levels "PSEUDOHYPERKALEMIA"
• Procedure for Vein Palpation

  1. Veins are located by sight and touch (palpation)

  2. Palpate and trace the path of veins (both vertical and horizontal motion) with the index finger of the non-dominant hand

  3. Veins feel spongy; resilient; tube/cord-like

  4. Arteries pulsate

  5. Do not use thumb to palpate veins (it has pulse)

  6. Patients have more prominent veins in the dominant arm

  7. If superficial veins are not readily apparent you can: tap the site with index and middle finger, apply a warm, damp washcloth to the site for 5 minutes, or lower the extremity over the bedside to allow the veins to fill
• Cleansing the Site


  1. Antiseptic of choice: 70% isopropyl alcohol (routine)

  2. Manner of Disinfection
• ICLSI does not recommend the use of this vein (last resort)
• Vein easily bruises (may form hematoma)