How to Subscribe. Need multiple seats for your university or lab? Get a quote. Venous Blood. Venous blood is deoxygenated blood that flows from tiny capillary blood vessels within the tissues into progressively larger veins to the right side of the heart. Deoxygenated blood is pumped from the right side of the heart to the lungs where it takes up oxygen. Capillary blood is obtained from capillary beds that consist of the smallest veins venules and arteries arterioles of the circulatory system.
Add to cart. Avoid trauma and excessive probing. The phlebotomist should be alert to excessive bleeding. If bleeding persists longer than 5 minutes, immediately notify supervisor or provider. Label all tubes immediately at blood drawing station in the presence of the patient using two patient identifier protocol.
Place tech code, time, and date on tubes. Place on requisition form, if applicable. Clean work area. Discard tourniquet, paper, extra cotton balls, and other items in the regular trash.
Remove gloves and wash hands with foam antiseptic hand-rub or antiseptic soap. Venipuncture Policy. Greet the patient and identify yourself and indicate the procedure that will take place.
Effective communication — both verbal and nonverbal — is essential. Wash hands using foam antiseptic hand-rub or antiseptic soap and water. Gather all appropriate materials needed for the venipuncture Vacutainer tubes, needles, gauze, etc. Apply clean non-latex gloves and select appropriate gauge needle needed for this venipuncture Select arm for venipuncture and apply clean tourniquet.
A tourniquet is used to increase venous filling and makes the veins more prominent and easier to enter. Never leave the tourniquet on for longer than one 1 minute. To do so may result in either hemoconcentration or a variation in blood test values. These conditions can be avoided by releasing the tourniquet after a preliminary study of the veins has been made. Ask the patient to make a fist. A closed hand causes the veins to become more prominent and easier to enter.
Hower Medical Library. Nursing Overview. Research Institute. Search our site:. Toggle navigation. Laboratory Services. Click image to enlarge. Collection Procedure:. Alternative sites are the basilic vein on the dorsum of the arm or dorsal hand veins.
Due to its close proximity to the brachial artery and median nerve, the basilic vein, which is located on the pinkie side of the arm, should be used only if there is not another more prominent arm vein.
Certain other sites should also be avoided. See picture. If there is not an alternate vein to draw, the venipuncture should be performed distal to below the hematoma. The tourniquet should be applied between the IV site and the venipuncture site. If drawing above the IV site is the only option, then the IV infusion must be turned off for at least 2 minutes before performing the venipuncture.
As there is still a risk that the sample could be contaminated, you must document that the specimen was drawn above proximal to an IV site and how many minutes the IV was turned off before the draw occurred.
The lab may reject the specimen as contaminated based on the test results. Arteries pulsate, are more elastic and have a thicker wall than a vein. Thrombosed veins lack resilience, feel cord-like and roll easily. If you are using a tourniquet for preliminary vein selection, it should be released after one minute, left off for two minutes and then reapplied before performing the venipuncture.
Apply the tourniquet inches above the selected puncture site. Do not place tightly or leave on for more than 1 minute. Instruct the patient to make a fist and hold it; do not have them pump their hand. Select the venipuncture site by palpating with the gloved index finger.
Do not dry the site with gauze and do not blow on the area to dry as this will contaminate the site. After cleansing the area, if it is accidentally touched before performing the venipuncture, it should be cleansed again. Swiftly insert the needle through the skin, bevel side up, at a 15 — 30 degree angle with the skin, into the lumen of the vein.
It is possible that a nerve has been punctured and possibly damaged. The venipuncture should be repeated in a different site. A Supervisor or Manager should be notified and the incident should be documented. Forceful, direct pressure should be applied to the site for a minimum of five minutes or until the bleeding has stopped.
The nursing staff should be notified, and they in turn must notify the physician. A laboratory Supervisor or Manager should also be notified and the incident should be documented. If the blood is flowing slowly, gently adjust the angle to see if the needle is sitting up against the wall of the vein.
Loosen the tourniquet, as it may be obstructing blood flow. If you are vacutaining, try another tube — there may be no vacuum in the tube. In the case of a difficult venipuncture, an individual may make a maximum of two attempts before having someone else try. A third stick is allowable if a partial sample has been obtained and you as the drawer feel reasonably confident that you can obtain the specimen on the next try. While the needle is still in the vein, activate the safety button with the tip of the index finger; the needle will automatically retract from the vein and the safety device will cover the needle.
If you used a needle and syringe, ask your patient or a parent to apply pressure to the site so that you can fill your tubes. Return to your patient and assess the site of the puncture. Apply a band-aid or CoFlex to the site. Make sure the needle fully penetrates the upper-most wall of the vein; partial penetration may allow blood to leak into the tissue surrounding the vein.
Adequate pressure should be applied to stop the bleeding once the phlebotomy is complete. A hematoma can cause a post-phlebotomy compression injury to a nerve. If using a needle and syringe, avoid drawing the plunger back too forcefully. Make sure the venipuncture site is dry. If using a blood transfer device to fill vacutainer tubes, allow the vacuum to pull the blood into the tubes; do not use the plunger on the syringe to force the blood into the tubes more quickly.
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