Venipuncture Procedures - verify the bracelet name

 Venipuncture - hospital number/requisition information

- accessing venous blood flow; collecting - for outpatients: identification card
or drawing blood - multiple identifiers (birthday, middle
- most frequent procedure performed by a initial)
phlebotomist - ask for the preferred side
o Single draw/ Syringe
o Multiple draw/ Evacuated tube Precautions:
 Mastectomy- removal of lymph nodes
 2 minutes: palpation-label
causes a decrease in lymph fluid; no
 Patient identification is the most
equilibrium
important step.
 Edema- decrease in hydrostatic pressure,
 Venous blood- commonly used blood
fluid exits from the blood vessels to the
 Phlebotomists need to undergo training tissues; clear fluid/edematous fluid will
in order to perform arterial puncture. be collected which will cause
 Arterial puncture- determination of contamination
blood gasses; performed by respiratory
therapists 2. If fasting sample is required, ask the
patient when he/she last ate
Single Draw  Blood sugar: 6-8 hours (for basal state
 Advantages: of sugar level)
o Controlled pressure  Lipid profile: 10-12 hours
 Disadvantages: o Under fasting: meal last
o Limited blood sample consumed will have an effect to
o Prone to coagulation the results
o Prone to needle prick o Over fasting: sugar is already
consumed; lower than normal
Materials  Fasting hours is based on the last meal
 Syringe o Example: NPO at 8pm: last
 Disposable needle (21 or 22) meal should be at 8pm
 Evacuated tubes or special collection  Special considerations: samples needed
containers undergo diurnal variations
 Tourniquet  Diurnal Variations:
 70% isopropyl alcohol o Cortisol: higher at morning;
 Sterilize gauze or cotton balls lower at evening
 Adhesive bandage/medical tape o Growth hormones: higher at
 Biohazard sharps container noon and evening
 Disposable gloves
 Safety glasses and mask 3. Explain the procedure to the patient
 Transfer device (requisition form)

4. Prevent the plunger from sticking by

Procedures pulling it halfway out and pushing it all
1. Identify the patient the way in one time.
 Clerical errors- number one/most
common mistake in laboratories  Make sure there is no air
 Inpatient- confined; check for  Thromboembolism- air bubbles that
precautions cause platelets to clot due to the
 Outpatient- walk-ins negative change of air; blockage of
- ask the name of the patient circulation
 18. Aliquot blood into appropriate tubes.
5. Select the proper tubes to transfer the - By puncturing the evacuated tubes
blood after collection. Place in the - By manual transfer of blood into the
proper order for filling. tubes
 Serum/clotting factors: last 19. Remove the needle from the syringe and
- First blood collected will be at the last discard the needle into the sharp’s
part of the barrel: micro clot container.
20. Dispose the syringe and transfer device
6. Apply tourniquet 3-4 inches above the into sharps container. Do not disconnect
puncture site. the syringe from the transfer device or
7. Ask the patient to close his/her hand. needle before disposal.
The patient must not be allowed to 21. Recheck the identification bracelet with
pump the hand. the labels or requisition
8. Place the patient’s arm in downward 22. Label all tubes
position if possible. 23. Check the puncture site. Apply adhesive
9. Select the vein, noting the location and bandage
direction of vein.  Infant: use of bandage should be
10. Clean the venipuncture with 70% eliminated
isopropyl alcohol swab. Cleanse the area 24. Remove gloves and wash hands
in a circular motion, beginning at the 25. Thank the patient and transport
site and working outward. sample(s) to the laboratory.
 Inside to out
11. Put on gloves while the alcohol is
drying. Do not touch the venipuncture
site.
 If site needs to be re-evaluated by
palpation, cleanse site again.
12. Draw the patient’s skin taut with your
thumb. The thumb should be 1-2 inches
below the puncture site.
13. With the bevel up, align the needle with
the vein and perform venipuncture.
While securely grasping the syringe
with one hand, use the other hand slowly
pull the plunger back until the desired
amount of blood has been obtained.
Avoid excess probing.
 5-30-degree angle from the arm surface
 Median cubital, cephalic, basilic; dorsal
hand veins are also acceptable; foot
veins are the last resort because of the
higher probability of complications
14. Lightly place gauze square or cotton ball
above venipuncture site.
15. Gently remove the needle
16. Activate the safety shield over the
needle (if applicable)
17. Apply pressure to the site (3-5 mins).
The patient may assist if able. This is to
avoid formation of a hematoma.
PREANALYTICAL  Altitude
CONSIDERATIONS IN o RBC count: elevated in higher
altitude (elevation)
PHLEBOTOMY o Hemoglobin: elevated in higher
 Specimen Variables altitude
Phases of lab testing: o Hematocrit: elevated in higher
 Pre-analytical altitude
- Pre-testing phase o C-Reactive proteins: elevated in
- Requirements: requisition/ lab higher altitude
form/receipt of laboratory request;  Test for inflammatory
prepared by clinician or secretary infection
o Patient preparation: fasting o Uric acid: elevated in higher
o Label specimen: do not pre- altitude
label; label in front of patient  For elderly; gout,
o #1 error: technical errors; arthritis
misidentification of patient and o Creatinine: decreases in higher
mislabeling of specimens altitude
o Prepare materials: warding  Kidney test (BUMM
bag; hema kit/ tool box Creatinine)
o Forward blood in the lab:
consider motility; avoid  Dehydration
containing too long - Decrease in total body fluids
o Specimens that are difficult to o RBC count: elevated
contain should not be discarded o Iron: elevated
immediately: csf, synovial fluid o Calcium: elevated
(..)
 Diet
 Analytical o High protein: elevated NPN
- Testing phase
compounds (nonprotein non
-nitrogen
 Post-analytical o Caffeine: elevated cortisol and
- Post-testing/reporting phase
ACTH and NEFA (non-
esterified fat acid)
Physiological variable
o Carbohydrate: elevated glucose
 Age
and insulin
o RBC count: higher in younger
o Excessive water and other fluid:
patients
decreased hemoglobin
o WBC: higher in younger
o Fatty fluid: elevated lipid profile
patients
 LDL bad cholesterol
 Newborn: higher
lymphocyte than
 Diurnal/Circadian Variation
neutrophil
 Viral infection:  Diurnal- affective during the
o Renal Function test: decrease day/happening daily
with age  Circadian- having. A 24 hours cycle
 Declines because of less
creatine clearance; urine  Drug therapy
sample (24 hours),
volume o Chemotherapy drugs: decreased
in blood cells (wbc, platelets)
 - Chemo- normal cells are destroyed Request Form
 Requisition from physician transcribed
by nurses and ordered in the lab,
Inappropriate venipuncture sides performed by a MedTech/phlebotomist;
 Arm on side of mastectomy paper trail
 Edematous areas
 Hematomas Materials
 Arms in which blood is being transfused  Requisition form
 Scarred area  PPE
 Arms with fistulas or vascular grafts  Phlebotomy chair
 Sites above an IV cannula
o Frist 10 ml: discard; second  Laboratory service is a service
specimen for cross matching organization
o IV: blood is diluted  Pre-analytical- most critical process;
patient identification, labelling)
Vascular access devices arm sites
 Arterial line Test Requisition
- Catheter that is placed in an artery  First step in the process of blood
- Used to provide accurate and continuous collection
measurements of patients’ blood  Test request from- all information
pressure needed for proper handling and
 Arteriovenous shunt, fistula, or graft sampling (special request)
- Permanent surgical connection of an  Can be manual, computer generated, bar
artery and vein by direct fusion code
- For dialysis o Encoded through hospital info
 Blood sampling device system
- Needleless closed blood sampling o Contain the actual lb4ls that are
device placed in specimen tubes
- Reduces the chance of infection, prevent  Bar code
needlesticks, and minimize waste - Series of black stripes and white spaces
associated with line draws varying width
 Heparin or Saline lock
- Catheter or canula connected to a Essential information for the test requisition
stopcock or a cap with diaphragm form:
- Access for administering medication or  Patient Identification
drawing of blood o Complete name (f, m, l)
o Patient identification number
(inpatient)
o Date of birth
o Room number and bed
(inpatient)
 Test requested; if hand written: readable
 Time and date of the sample collection
 Source of the sample (microbiology or
histopathology sample)
 Clinical data (when indicated)
 Test status
 Special precautions (e.g. mastectomy)
  Information of the physician r healthcare o Reverse isolation: super
provider requesting the test immunocompromised
 Billing information (outpatient)  Typically posted to the patient’s room or
patient’s bed
Reviewing the test request  Can be words, colors, pictures
 All required info is present and complete understood t health care
 Verify the to be collected and time and o Arm, precaution, infection-
date of collection control precaution
 Identify diet restriction or other special  Physician and Clergy
circumstances that must be met prior to - Time is private and limited
collection - If not stat, check back after; if stat, ask
 Determine test status or collection permission to proceed
priority  Family and Visitors
o Emergency room- priority - Best to ask them to step outside until
 Accession- process of recording in the finished
order received; log the requisition - Letting a family member help steady the
received; log book arm or hold pressure over site while
o Connecting the specimen, the labelling tubes (child)
accompanying paperwork with a  Unavailable patient
specific individual - Missing
 Unique number- generated; used to - Ongoing procedures like ECG
identify the specimen, all associated - Unable to collect specimen/s
processes and paperwork and connect  Inform the nurse and filling out a form
them to the patient stating the reason form
o 03061901 (March 6, 2019, #1)
3. Identify yourself to the patient
Approaching, Identifying and Preparing the - Dialogue: name, title, ehy you are there,
Patient procedure obtain consent
1. Be organized. Arrange the - Patient has the right to refuse to have
requisition according to priority and blood drawn
if the need equipment is on the - If patient refused: inform the nurse or
blood collecting tray physician to help explain further the
o STAT- priority; Statin; Greek- reason for blood collection
immediate; emergency
4. Patient Identification
situations
- Most important step in specimen
o Check for status designation
collection
o ICU, CCU, ER, OR
- Patient identifiers: must match the
 Bedside Manner behavior of a patient’s or relative’s verbal ID
healthcare provider toward a patient statement, requisition form, ID band and
 Aim: specimen label
o Gain the patient’s trust and - Patient must be actively involved
confidence  Identification band
o Putting the patient at ease  In cases of discrepancies
- Request form has mismatches
2. Look for signs when entering a  Missing ID
patent’s room  Sleeping Patients
 Containing information concerning the  Unconscious Patients
patient
 No identification of patient
- Common in ER
 Mentally Incompetent or Non-English-
Speaking patient
 Neonants
 Patients who answered you indirectly
regarding their identification

5. Prepare the patient

- Explain the procedure
- All inquiries must be addressed to the
nurse
 Addressing Needle Phobia
- Look for symptoms: pallor, profuse
sweating, hyperventilate