MODULE 5: VENIPUNCTURE

PROCEDURE A.GOMEZ
PMTP2/SCHOOL OF MEDICAL TECHNOLOGY/CENTRO ESCOLAR UNIVERSITY

3. Take note of any dietary restrictions

or special
VENIPUNCTURE
conditions
4. Determine the test status
● Most frequently performed procedure COMMON TEST STATUS
in phlebotomy DESIGNATION:
● Process of collecting or drawing blood FIRST PRIORITY
from a vein of the - STAT - Immediately
patient for laboratory testing purposes - MED EMERG – Medical Emergency
● Phlebotomist – the person who SECOND PRIORITY
perform phlebotomy - TIMED – timing of collection is
● REQUISITION: important
Communication between the SECOND/THIRD PRIORITY
requesting physician and the – ASAP – as soon as possible
laboratory. - PREOP – before an operation
- POSTOP – after an operation
Includes:
FOURTH PRIORITY
● Patient’s correct and complete name
– FASTING – restriction of food intake
● Medical record number
8-12 hours prior to specimen collection
● Patient’s age and date of birth
N/A
● Patient’s location (OPD or room
- NPO – non per orem (nothing by
number of IP)
mouth)
● Type of test ordered
Routine
● Name of requesting physician
● STEP 2: IDENTIFY THE PATIENT
● Date and time of sample collection
● The most important step in specimen
● Status of Sample (Stat, Routine,
collection
Timed)
● Ask patient to state name and DOB
● Billing information
● Check patient’s identification bracelet
● Special Precaution
● Name
VENIPUNCTURE STEPS ● Identifying number
● STEP 1: REVIEW AND ACCESSION THE ● Medical record number
TEST REQUEST ● Visit number

REVIEWING: ● STEP 3: VERIFY THE PATIENT’S

1. Check the completeness of the DIET RESTRICTIONS AND LATEX
required
SENSITIVITY
information
-Patient Diet Restriction
2. Verify the tests to be collected

1 ( A.N.C.G)
MODULE 5: VENIPUNCTURE
PROCEDURE A.GOMEZ
PMTP2/SCHOOL OF MEDICAL TECHNOLOGY/CENTRO ESCOLAR UNIVERSITY

● Fasting (8-12 hours) – for tests that are ● Follow proper hand hygiene
affected by diet ● 2 Methods of hand hygiene
● Glucose (FBS, OGTT, Post- Prandial
Glucose)
● Lipid Profile
Latex Sensitivity
● - Do not use latex items for patients
with latex allergy
STEP 4: PROPER BEDSIDE PROPER HAND WASHING PROCEDURE
MANNER AND HANDLING 1. Stand a few inches from the sink
SPECIAL SITUATION ASSOC. WITH 2. Turn on the faucet and place hands
PATIENT CONTACT under the running water
● -Prepare the patient for testing 3. Use soap and work up lather to
● -Bedside Manner – behavior of ensure that hand surfaces are reached
healthcare worker as perceived by the Scrub for at least 15 seconds. Make sure
patient (OPD or IPD) to scrub all surfaces
● -Includes proper patient identification 5. Apply a little friction and rub hands
and preparation of patient for testing together for at
● Room signs: least 15 seconds
● NPO 6. Rinse the hands
● DNR 7. Dry hands using a clean paper towel
● Do not draw blood from 8. Use the paper towel to close the
faucet.
● Latex allergy
● Infection control precaution STEP 7-10
● Patient expired STEP 7: REASSURE PATIENT
STEP 8 POSITION PATIENT:
STEP 5; ASSEMBLE EQUIPMENT
● In-patient – usually in supine
AND SUPPLIES
position
Before approaching the patient for the
● Out-patient – seated on a
actual venipuncture, the blood
phlebotomy chair
collector should collect all necessary
STEP 9: APPLY TOURNIQUET
supplies (including collection
● Constricting device that
equipment, antiseptic pads, gauze
inflates veins by restricting
pads, bandages, and needle disposal
blood flow
system) and place them close to the
● Apply tourniquet 3 to 4
patient
inches above the puncture site
STEP 6: WASH HAND AND PUT
● Do not apply for more than
ON GLOVES
one minute –

2 ( A.N.C.G)
MODULE 5: VENIPUNCTURE
PROCEDURE
PMTP2/SCHOOL OF MEDICAL TECHNOLOGY/CENTRO ESCOLAR UNIVERSITY
hemoconcentration
STEP 10: ASK PATIENT TO ME A FIST
● Clenching fist increases
palpability of vein
SELECT VEIN, RELEASE
TOURNIQUET, AND ASK PATIENT
TO OPEN
STEP 11: Site Selection:
● Palpation – locating veins by
sight and touch (rolling of
fingers on the sight)
● Antecubital area/fossa – cloth/cotton/gauze to wipe wet areas
preferred venipuncture site
● Other arm and hand veins
● Leg, ankle, and foot veins
STEP 12: Release Tourniquet
● to relax vein after palpation
avoiding hemoconcentration
Unclench fist
● Relaxing the vein
A.GOMEZ
STEP 13: CLEAN AND AIR-DRY
STEP 13: Cleaning of site
● Antiseptic – solution used for cleaning
venipuncture site
● Cleaning should cover 2-3 inches
diameter of the site (concentric circular
motion moving outward)
Airdrying
● Allow airdrying of cleansed site – 1
minute
● Do not use unsterilized
● Do not fan out or blow
STEP 14: VERIFY EQUIPMENT AND TUBE
SELECTION
Evacuated tube system
1. Select the appropriate tube for ETS
2. Select and inspect needles for defects
3. Twist the cap of rubber-sleeved needle to
expose it
4. Screw this end to the tube holder
5. Place the first tube in the holder
6. Position the tube in the holder
3 ( A.N.C.G)
MODULE 5: VENIPUNCTURE
PROCEDURE
PMTP2/SCHOOL OF MEDICAL TECHNOLOGY/CENTRO ESCOLAR UNIVERSITY
Winged Infusion Set
1. Use a 23-g butterfly needle
2. Inspect package before aseptically
opening and removing the butterfly
3. Attach the butterfly to an ETS holder
or syringe barrel
4. Select the appropriate small-volume
tube for the test
Syringe System
1. Select the appropriate syringe and
needle
2. Test the plunger before opening the
sterile package
3. Aseptically open the package
4. Securely attach the needle to the
syringe
STEP 15-17
STEP 15: Reapply tourniquet
● Avoid touching the cleaned area
STEP 16: Pick up and position blood
collection equipment
STEP 17: Uncap and Inspect the
Needle
● Only use unused, sterile needle
Inspect bevel (should be pointed)
● Needle should not come in contact with
anything prior to
venipuncture
● Dispose and replace new needle if this
happens
STEP 18: ASK THE PATIENT TO
REMAKE A FIST, ANCHOR THE
VEIN, AND INSERT NEEDLE
● Re-clenching of fist
● To promote easier palpation of vein
STEP 18: Anchoring the vein
A.GOMEZ
● Anchoring vein – prevents veins from
slipping sideways when the needle
enters
● Use thumb of the free hand
● Place thumb 1-2 inches below the
puncture site and the four fingers
below the arm
● Use the thumb to pull the skin
STEP 19: Needle insertion
● Needle should be aligned with the vein
● Needle bevel should be facing up
● Inserted in a smooth forward
movement (15-30 ̊ angle)
STEP 20: FILL THE
SYRINGE/TUBE
● Slowly pull back on the plunger of the
syringe
and allow the barrel of the syringe to fill
with
blood.
● Observe for blood flow in the needle
hub (ensures that the needle is inside
the vein)
● Push collection tube into the tube
holder
(needle should completely penetrate
the stopper)
● Let blood flow into the tube
● Release tourniquet and ask patient to
4 ( A.N.C.G)
MODULE 5: VENIPUNCTURE
PROCEDURE
PMTP2/SCHOOL OF MEDICAL TECHNOLOGY/CENTRO ESCOLAR UNIVERSITY
unclench fist
STEP 21: WITHDRAW THE NEEDLE
● Make sure that required blood volume
is collected
● Syringe Method - Transfer blood
sample from syringe to blood
collection tubes (order of draw)
● Place gauze over the site
● Do not press down on the gauze while
the needle is in the vein
● Withdraw the needle in one smooth
motion
● Apply pressure to site with gauze pad
● Do not bend arm up-keep tended or
raised
● Invert tubes gently after transfer blood
(inversion depends on the additive
present)
● Tourniquet should be removed before
removing the needle
STEP 22: ENGAGE IN SAFETY
DEVICE
STEP 23: DISPOSE OF SHARPS
● Follow proper disposal protocol:
● Sharps container – used needle
● Yellow bag – used gloves, tourniquet,
holder, barrel, ETS holder, used
antiseptic pads/cotton
STEP 24: TRANSFER BLOOD TO
EVACUATED TUBES
Syringe transfer device
● Attach the transfer device to the
syringe
● Hold the syringe vertically, with the tip
down and transfer device at the bottom
A.GOMEZ
Following the proper order of draw for
syringes, push the evacuated tube onto
the needle within the transfer device
● Keep the tube vertical so it fills from
the bottom up-let the tube fill using the
vacuum draw
● If you do not want to fill the tube
completely, pull back on the plunger to
stop the
flow before removing the tube
● Dispose of the transfer device into a
sharps container
Transferring without a transfer
device
● If a transfer device is not available,
place the required tubes in the proper
order of draw in a rack or slot in the
phlebotomy tray
● Never hold the tubes in your hand
● Penetrate the stopper of the tube with
the syringe needle and allow the
vacuum draw of the tube
to fill the tube
● Slant the needle to the side of the tube
so the blood runs down the side of the
tube to prevent hemolysis.
● *When the last tube is filled, withdraw
the needle, activate the safety device
and dispose of the sharps
STEP 25:PROPERLY LABEL THE
TUBES
Proper labeling is essential!
● Labeling method:
● Use of Indelible ink
● Computer generated label sticker with
barcode
● Label information:
5 ( A.N.C.G)
MODULE 5: VENIPUNCTURE
PROCEDURE A.GOMEZ
PMTP2/SCHOOL OF MEDICAL TECHNOLOGY/CENTRO ESCOLAR UNIVERSITY

● Patient’s complete name Geriatric venipuncture

● Date of birth ● Elder have thinner skin and
● ID number (Accession number) smaller muscles which
● Date and time of Collection cause veins to roll easily
● Initials of phlebotomist ● Veins lose elasticity –
● Additional information (fasting time, prone to collapse
etc)
STEP 26-32 Long-term Care Patients
26. Observe Special handling ● Dialysis Patients
Instructions ● Use dorsum of hands of patients to
27. Check patient’s arm and apply preserve arm veins for hemodialysis
bandage access.
28. Dispose of Contaminated Materials ● Phlebotomist should select another
29. Thank the patient site other than the arm with AV fistula
30. Remove gloves, and wash/sanitize ● Home-care Patients
hands ● Patients who need medical attention
31. Check specimen collection logs (if and assistance from health
applicable) professionals from time to time.
20. Transport the specimens to the ● Phlebotomist should carry all
laboratory. necessary equipment with them during
house calls.
Requirements for Drawing Blood ● Hospice Patients
from Special Populations ● Patients who need end-of-life care
(mostly with prognosis of six months or
Pediatric puncture less)
● Veins are usually small and ● Extra care should be given
underdeveloped
● Risk of iatrogenic anemia (due to
smaller blood volume)
● EMLA may be used prior to
venipuncture
● Restraining methods:
● Infant - wrapped in blanket
● Toddler - seated on parent’s lap
● Children – second person leans over
the child who is in supine position

6 ( A.N.C.G)