2 IntroductionVenipuncture is a technique that permits access to a vein so that a needle or catheter can be inserted, usually to withdraw a blood specimen or initiate an intravenous infusionVenipuncture is a sterile procedure since the integrity of the skin is broken
3 Terms and Definitions Venipuncture Palpate Antecubital fossa AnticoagulantHematoma
4 Veins Used for Drawing Blood Antecubital Area VesselsCephalic VeinMedian Cubital VeinBasilic Vein
5 Venipuncture Procedure Universal precautions - hand wash & glovesStrict adherence to the sharps policyVerify the request to obtain specimenCheck the physician's ordersSelect the proper specimen tube/sPrepare label(s)Perform a patient care hand wash/don gloves
6 Stamp Label With Patient’s Addresograph Plate DP A1401TMCGAVIN, JAMES07DEC55 M USA AD ENLSFC HHC 2/505th PIRTMC-OUTPATIENT RECORDS, FBNC
7 Gather Equipment Constricting band Vacutainer holder or Syringe Sterile disposable double-ended needle or Butterfly or Hypodermic needleBetadine or alcohol wipe or spongeProtective pad (chux)Sterile 2 x 2-inch gauze sponge(s)Band-Aid
9 Assemble Holder & Needle Put short end of needle into threaded hole in vacutainer holderScrew tightly using clockwise motion
10 Insert the Tube into the Holder Insert stoppered end of the tube into holderDo not push tube beyond the guidelineInspect the needle for barbs, corrosion
11 Identify Patient Explain the procedure and purpose Ask patient about allergies (i.e., iodine or alcohol).Position the patient - sitting or lyingNever draw blood from a standing patient.Position protective pad
12 Apply Constricting Band Apply with enough pressure to stop venous returnA radial pulse should be feltPlace latex tubing around limb about 2 inches above venipuncture siteIf a commercial band is used, wrap it around limb and secure by overlapping velcro ends
13 Apply Constricting Band Instruct patient to clench and unclench his fist several times to trap blood and distend veinsAvoid veins that are infected, injured, irritated, or have an IV running distally.
14 Palpate Selected Vein Palpate along length of vein with index finger Vein should have a spongy feelClean the skinDo not re-palpate the vein after cleansing the skin.
15 Prepare the Puncture Site Cleanse area with betadine or alcohol using a circular motionDo not touch the area once cleansed
16 Prepare to Puncture the Vein Remove protective cover from needlePosition needle in line with vein and grasp patient's arm below entry point with free handPlace thumb of free hand 1 inch below entry site and pull skin taut toward hand
17 Puncture the Vein Align needle bevel up Pierce skin at a 15° to 30 ° angleDecrease angle until parallel to skin surface, then pierce veinIf needle is withdrawn above skin surface, do not attempt venipuncture again with the same needle15 ° to 30 °
18 Puncture Vein If unsuccessful Release the constricting band Place 2 x 2 gauze sponge over siteQuickly withdraw the needle and instruct the patient to elevate arm slightly and keeping the arm fully extended apply pressure to the site for 2 to 3 minutes.Notify supervisor before attempting another venipuncture
19 Single Tube Collections When the tube is nearly full release the tourniquetRemove the tube from the holderDO NOT withdraw the needle before the constricting band is released
20 Multiple Tube Collections When the Tube Stops Filling Pull It Out of the holderAfter the last tube stops filling remove from the holderRelease the tourniquetDO NOT withdraw the needle before the tourniquet is released
21 Complete the Procedure Place 2 x 2 sponge over venipuncture siteWithdraw the needle smoothly and quicklyImmediately apply pressure to the siteHave patient elevate arm and apply pressure to site
22 Complete the Procedure If tube contains an anticoagulant or other additive, gently invert tube several times to mix with bloodApply a Band-Aid to the venipuncture siteDO NOT unscrew needle from sleeve with handsDO NOT recap needleDispose of needle into sharps
23 Patient Comfort and Safety Remove protective padRoll down patient's sleeveIf patient is in bed reposition and raise side railsRemove all the equipment from areaDispose of used suppliesStore reusable equipment and dispose of needle IAW local sharps SOPRemove gloves and wash hands
25 Administrative Duties Check and complete laboratory form IAW local SOPApply prepared label(s)Document procedure IAW local SOP
26 SummaryIf venipuncture is done smoothly and properly, there should be little pain for the patient and little risk to medical personnelThe procedural steps are designed to ensure a properly drawn specimenWith practice, obtaining a blood specimen can become a smooth routine
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