Blakes Venipuncture

Question 1

Epuipment for Phlebotomy

Answer 1

-Iospropyl alcohol
-Sterile gauze pads
-Tourniquet
-Vacutainer
-Vacutainer tubes
-Vacutainer holder sleeves
-Sterile, disposable needles
-Band-aids
-Biohazard container suitable for -sharpes disposal

Question 2

The most common techique for blood specimens is

Answer 2

Venipuncture

Question 3

1st step of venipuncture

Answer 3

1. 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.

Question 4

2nd step of Venipuncture

Answer 4

2. 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.

Question 5

3rd step of venipuncture

Answer 5

3. 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.)

Question 6

4th step of venipuncture

Answer 6

4. 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.

Question 7

5th step of venipuncture

Answer 7

5. Anchor the vein by pulling the skin taut with the thumb or two fingers.

Question 8

6th step of venipuncture

Answer 8

6. 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.

Question 9

7th step of venipuncture

Answer 9

7. Grasp the Vacutainer sleeve tightly with the opposite hand and anchor the fingers against the arm so
   that the sleeve & the needle are immovable.

Question 10

8th step of venipuncture

Answer 10

8. 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.

Question 11

9th step of venipuncture

Answer 11

9. 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.

Question 12

10th step of venipuncture

Answer 12

10. Once all tubes are filled, release the tourniquet and have the patient relax his/her fist.

Question 13

11th step of venipuncture

Answer 13

11. 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.

Question 14

12th step of venipuncture

Answer 14

12. 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.)

Question 15

the order of draw by color

Answer 15

BLOOD CULTURES, royal blue, red, light blue, SST (Gold), green, tan, yellow, pink, pearl, lavender.

Question 16

Order of draw by test

Answer 16

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.

Question 17

Do not draw above what

Answer 17

2. 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.

Question 18

It is important to apply what

Answer 18

3. It is important to apply sufficient pressure to the venipuncture site after the draw. Failure to do so
   causes hematomas (bleeding into the tissues).

Question 19

4. If the area around the venipuncture site begins to swell while blood is being drawn

Answer 19

4. 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.)

Question 20

Dot not leave what on

Answer 20

5. 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

Question 21

If a patient faints while in a sitting position, do the following exactly in this order:

Answer 21

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.)

Question 22

6 things that must be on labels

Answer 22

Patient name, patient ID number,
patient location, complete date, time drawn, & your initials. (Some institutions may also
require the doctor’s name.)