Blakes Venipuncture Flashcards
Epuipment for Phlebotomy
-Iospropyl alcohol
-Sterile gauze pads
-Tourniquet
-Vacutainer
-Vacutainer tubes
-Vacutainer holder sleeves
-Sterile, disposable needles
-Band-aids
-Biohazard container suitable for -sharpes disposal
The most common techique for blood specimens is
Venipuncture
1st step of venipuncture
- Lay out your supplies before you ever put the tourniquet on the patient’s arm. Choose the required
Vacutainers first & lay them next to the patient’s arm. Screw the needle into the Vacutainer sleeve &
place the first Vacutainer to be used inside the sleeve. Do NOT uncap the needle yet, or push the
Vacutainer onto the needle yet! Open the alcohol prep pad & lay it on top of its packet. Get out 2 gauze
pads & place them next to the alcohol pad.
2nd step of Venipuncture
- Apply the tourniquet securely above the elbow. Try very hard to keep it flat & prevent it from rolling into
a band. Have the patient make a fist to aid in venous filling, & to make the vein more palpable.
3rd step of venipuncture
- Select the venipuncture site. With protective gloves on, palpate the site with the tip of the index finger in
order to locate the best vein. (Most venipunctures are done using the cephalic, median cephalic,
median basilic, or median cubital veins.)
4th step of venipuncture
- Thoroughly cleanse the intended site with a 70% isopropyl alcohol pad. Be sure to let dry completely
before inserting the needle! Place the gauze pads on the patient’s forearm where they are immediately
available to staunch blood flow when needed.
5th step of venipuncture
- Anchor the vein by pulling the skin taut with the thumb or two fingers.
6th step of venipuncture
- Align the needle (bevel up) with the vein and smoothly insert it into the vein at a 15-degree angle. Try
to visualize threading a piece of rubber tubing.
7th step of venipuncture
- Grasp the Vacutainer sleeve tightly with the opposite hand and anchor the fingers against the arm so
that the sleeve & the needle are immovable.
8th step of venipuncture
- Using your thumb, smoothly push the Vacutainer tube onto the needle. If you are in the vein, the tube
will fill with blood by itself.
9th step of venipuncture
- When the tube is full, blood will stop moving into it. Change Vacutainers once flow has ceased. As soon
as tubes with anticoagulant are collected, use your other hand to mix them by inversion 5-6 times while
the next tube is filling.
10th step of venipuncture
- Once all tubes are filled, release the tourniquet and have the patient relax his/her fist.
11th step of venipuncture
- Gently remove the Vacutainer tube from the needle. Only after the Vacutainer is removed from the
needle should the needle be removed from the arm! As the needle is removed, place a gauze pad
over the venipuncture site. Once the needle is away from the arm, apply gentle pressure to the
puncture site.
12th step of venipuncture
- If possible, ask the patient to apply pressure to the site with the gauze pad. Immediately do the
following:
a. Gently invert anticoagulated tubes again in order to mix.
b. Dispose of the needle appropriately in a Biohazard container specifically made for this
purpose.
c. Label the specimen legibly with the 6 essential items: Patient name, patient ID number,
patient location, complete date, time drawn, & your initials. (Some institutions may also
require the doctor’s name.)
the order of draw by color
BLOOD CULTURES, royal blue, red, light blue, SST (Gold), green, tan, yellow, pink, pearl, lavender.
Order of draw by test
When a Vacutainer system is used to collect several tubes of blood, collect the non-anticoagulated tube
first. Coagulation specimens should be collected next, followed by heparin, EDTA and fluoride. If a
coagulation tube needs to be drawn first, collect a “discard” tube with several mLs of blood before it
(and then throw it away in Biohazard trash). This prevents contamination of the specimen with tissue
fluid from the initial skin piercing.
Do not draw above what
- Do not draw above (proximal to) an IV! The IV fluid may dilute the specimen. (Think about the
consequences of drawing above a K/dextrose IV.) It is acceptable to draw a blood sample from below
(distal to) an IV site if the line is stopped for a minimum of 2-3 minutes before the venipuncture.
It is important to apply what
- It is important to apply sufficient pressure to the venipuncture site after the draw. Failure to do so
causes hematomas (bleeding into the tissues).
- If the area around the venipuncture site begins to swell while blood is being drawn
- If the area around the venipuncture site begins to swell while blood is being drawn, this usually
indicates that the needle has gone through the vein, and blood is leaking into the tissues. The
tourniquet must be released and the needle withdrawn immediately, with gentle pressure
applied to the site for several minutes thereafter. The arm may also be elevated to help prevent
pooling of the blood into one area (this causes a more painful hematoma.)
Dot not leave what on
- Do not leave the tourniquet on for prolonged periods of time. This stops blood flow into the area
(venous stasis), which causes an influx of tissue fluid into the circulation & dramatically alters
normal physiologic levels of most analytes, yielding
If a patient faints while in a sitting position, do the following exactly in this order:
a. Keep their body propped upright (insofar as possible) with your body.
b. Release the tourniquet.
c. Remove the needle & place it safely away from both of you.
d. Cover the venipuncture site & apply pressure.
e. Call for help (if possible, without leaving the patient.)
6 things that must be on labels
Patient name, patient ID number,
patient location, complete date, time drawn, & your initials. (Some institutions may also
require the doctor’s name.)
