Lesson 5: VENIPUNCTURE PROCEDURE

• This term refers to the process of collecting or "drawing" blood from a vein of the patient for laboratory testing purposes.

  Venipuncture
• Phlebotomist should posses the necessary knowledge and skills to perform venipuncture since they will perform this procedure frequently as part of their duties and responsibilities in the healthcare institution.
• The first step of the pre-examination phase is the test request that comes from a physican
• Includes information on the type of test ordered and any special instructions or conditions that should be considered during the pre-examination and examination phases.

  Request form
• This form will be a part of the patient's medical record and can be referred to, should issues regarding the test arise.

  Request form
• This could be manual, computerized, or bar-coded.

  Test requisition
• This form usually have parts for request, report, and billing.

  Manual requisition form
• With the advances in technology, the use of the manual method has declined. However, these forms still serve as back-up when the computerized system fails.
• This form includes patient information, test status, and other details that are useful for the test.

  Computerized requisition form
• A computer-generated label for the collection tube is made available, with which the phlebotomist must note the time of collection and confirm the information by affixing his/her initials.
• The required pieces of information in the reqiusition form are as follows:

  • Name of the physician who ordered the test
  • Patient's full name including the middle initial
  • The medical record number for inpatients
  • DOB and age of the patient
  • Type of test ordered
  • Date when the test is to be performed
  • Billing information (if required)
  • Test status
  • Special precaution
• The manual or computerized request may contain a barcode, which is scanned into a computer using a special device with a laser. The information is then interpreted and processed.
• The use of these codes greatly help in minimizing clerical errors.
• Review and accession the test request

  Step 1
• The venipuncture procedure begins with a thorough review of the test requisition to avoid duplication of request, to ensure proper collection timing, and to identify special instructions or equipment required for the test.
• In reviewing the request, the phlebotomist must:

  1. Check the completeness of the required information
  2. Verify the tests to be collected including information such as the time and date of collection.
  3. Take note of any dietary restrictions or special conditions that should be followed before the actual collection, and
  4. Determine the test status or priority of collection.
• The test request is then accession, which means that the specimen to be collected is assigned a special number that will serve as the reference number for all associated processes and paperwork.
• Accessioning the test request helps improve the documentation, handling, and reporting of test results.
• STAT

  Meaning: Immediately

  When used: Results are needed for critical patient

  Collection conditions: Immediately collect, test, and report results. Alert when delivered, ER stats are priority.

  Test examples: Glucose, H&H, electrolytes, cardiac enzymes

  Priority: FIRST
• MED EMERG

  Meaning: Medical Emergency

  When used: Results are needed for critical patient

  Collection conditions: Immediately collect, test, and report results. Alert when delivered, ER stats are priority.

  Test examples: Glucose, H&H, electrolytes, cardiac enzymes

  Priority: FIRST
• TIMED

  Meaning: Collect at a specific time

  When used: Timing of collection is important

  Collection conditions: Collect close to required time and record actual time.

  Test examples: 2-hour PP, GTT Cortisol, Cardiac Enzymes, TDM, blood

  Priority: SECOND
• ASAP

  Meaning: As soon as possible

  When used: Results needed to respond to serious but not yet critical situation

  Collection conditions: Follow hospital protocol

  Test examples: Electrolytes, glucose, H&H

  Priority: SECOND or THIRD
• FASTING

  Meaning: Prior to collection, there should be no food or drink intake for 8-12 hours

  When used: Eliminate effects of the diet

  Collection conditions: Verify if the patient had fasted. If he did not, check if the test could still proceed.

  Test examples: Glucose, cholesterol, Triglycerides

  Priority: FOURTH
• NPO

  Meaning: Nothing by mouth

  When used: Prior to surgery or other anesthesia procedures

  Collection conditions: Do not give food or water

  Test examples: N/A

  Priority: N/A
• PREOP

  Meaning: Before an operation

  When used: Determine eligibility for surgery

  Collection conditions: Collect before surgery

  Test examples: CBC, PTT Platelet function studies

  Priority: SECOND or THIRD
• POSTOP

  Meaning: After an operation

  When used: Assess condition after surgery

  Collection conditions: Collect after surgery

  Test examples: H&H

  Priority: SECOND or THIRD
• ROUTINE

  Meaning: Relating to established procedure

  When used: Establish diagnosis or monitor progress

  Collection conditions: Collect on time but not urgent

  Test examples: CBC, Chem profile

  Priority: NONE
• Approach, Identify, and Prepare the Patient

  Step 2
• Phlebotomist should organize the test request according to priority, and prepare all the necessary equipment and supplies needed to complete their collection round.
• Phlebotomist should check for phlebotomy-related signs and warnings regarding the condition of the patient such as "No taking of blood pressure (BP) or venipuncture on the right arm." These signs are usually posted on the door or wall next to the patient's room.
• Bedside manner refers to the behavior of a healthcare worker as perceived by the patient which is applicable to both in and out-patient settings.
• Proper approach, conduct, and demeanor which help the phlebotomists gain the trust and confidence of the patient are part of the professtional bedside manner.
• The following practices of phlebotomists show proper bedside manner (1):

  • Knock on the door gently before entering the room
  • Make a good impression by greeting the patient warmly
  • Stay organized and have all the supplies available and approach the patient in a profession manner that goes well with having a neat appearance
  • Maintain a calm expression as most patients are afraid of blood collection
• The following practices of phlebotomists show proper bedside manner (2):

  • Introduce yourself and explain the procedure. Obtain the verbal or expressed consent of the paitent before proceeding with the test.
  • Remain compassionate and professional during the procedure
  • Thank the patient for his/her cooperation before leaving.
• If there is a physician or clergy in the room, the phlebotomists may interrupt only if the ordered test is stat or timed. They have to excuse and ask permissoin to proceed with the test.
• Family members or visitors can stay in the room, but it would be better if they could step out of the room until the process is finished.
• If the patient to be tested is not available and the phlebotomists are unable to obtain the specimen, it should be indicated in the form that no collection has been made. The form should be submitted to the nurses' station.
• Positively confirming the identitiy of the patient is an important part of specimen collection.
• Obtaining a specimen from the wrong person can have serious consequences and can even be fatal in cases that involve blood transfusion.
• Misidentifying patients can be a reason or cause for a phlebotomist's dismissal or lawsuit against him/her on the grounds of malpractice.