Needle and syringe draw

Introduction to Venipuncture

• Venipuncture is the process of obtaining intravenous access for intravenous therapy or venous blood sampling.

• The procedure discussed is collecting a blood specimen from an antecubital vein using a needle and syringe.

• Preliminary procedures include patient identification and obtaining consent.

• Essential procedures such as hand hygiene and wearing gloves are critical for infection control.

Hand Hygiene and Personal Protective Equipment

• Always sanitize hands before venipuncture to protect against contamination.

• Gloves are required by OSHA to protect phlebotomists from bloodborne pathogen exposure.

Patient Positioning

• Proper arm positioning enhances comfort and increases the chance of successful venipuncture.

• Position the patient's arm straight from shoulder to wrist for optimal vein exposure.

Tourniquet Application

• Apply a tourniquet 3-4 inches above the antecubital area to enlarge the veins, making them easier to see and access.

• Instruct the patient to make a fist, which helps in vein visibility and stability.

Selecting a Vein

• Palpate the site to identify a vein suitable for venipuncture.

• Choose a large, resilient vein; the median cubital vein is preferred, followed by the cephalic and median cephalic veins.

• Avoid using the basilic vein unless no other options are available due to the risk of complications.

Pre-Venipuncture Steps

• After selecting a vein, release the tourniquet and ask the patient to relax their fist to restore normal blood flow.

• Clean the venipuncture site using an antiseptic (e.g., 70% isopropyl alcohol) and allow to air dry for maximum efficacy.

Syringe and Needle Preparation

• Use sterile syringes and needles designed for blood collection; ensure the plunger moves freely before use.

• Select an appropriate needle size and syringe volume based on the required blood tests.

Venipuncture Procedure

• Reapply the tourniquet before needle insertion.

• Hold the syringe as an ETS holder, inspecting the needle for defects before use.

• Instruct the patient to make a fist again prior to puncture.

• Anchor the vein by pulling the skin taut below the puncture site with your thumb.

Needle Insertion

• Warn the patient prior to puncture.

• Insert the needle at an angle of 30 degrees or less, bevel up, using a smooth motion.

• Stop advancing the needle when feeling a decrease in resistance and seeing blood in the syringe hub.

Blood Collection

• Press fingers against the arm to hold the syringe steady as blood flow is established.

• Release the tourniquet and instruct the patient to open their fist after the flow starts, minimizing hemoconcentration.

• Slowly pull back on the plunger to fill the syringe.

Post-Venipuncture Handling

• Withdraw the needle smoothly, activating the safety feature immediately afterward.

• Apply gauze to the site and maintain pressure to help with clotting.

• If the patient is able, they may hold the pressure while the phlebotomist disposes of the needle.

• Dispose of the used needle in a sharps container immediately after use.

Tube Transfer and Filling

• Attach a syringe transfer device to the syringe hub.

• Transfer blood into the appropriate ETS tubes ensuring that they fill from bottom to top to avoid contamination.

• Mix additive tubes immediately after drawing to prevent clotting and follow the order of draw to avoid carryover.

Labeling and Patient Dismissal

• Label tubes before dismissing the patient to prevent mislabeling.

• Show the labeled tube to the patient for verification of identification information.

• Examine the venipuncture site for bleeding; apply a bandage if bleeding has stopped.

• Discard used materials properly and follow protocol to remove gloves safely.

Conclusion

• Thank the patient and ensure proper hand sanitation after the procedure is completed.

Introduction to Venipuncture

Venipuncture is a crucial medical procedure used for obtaining intravenous access, which is essential for administering intravenous therapy or collecting venous blood samples for diagnostic testing. This process is predominantly performed on patients in outpatient or inpatient settings. The following notes detail the steps involved in venipuncture, focusing on collecting a blood specimen from an antecubital vein using a needle and syringe.

Preliminary Procedures

Prior to beginning venipuncture, it is imperative to ensure proper patient identification to avoid any mix-ups or errors. Verification of the patient's identity should be done against their wristband and health records. Consent must be obtained from the patient, ensuring that they understand the procedure's purpose, benefits, and potential risks.

Essential procedures, such as maintaining proper hand hygiene and wearing gloves, are critical for minimizing infection risk. It is a standard practice guided by OSHA regulations to protect healthcare workers from exposure to bloodborne pathogens.

Hand Hygiene and Personal Protective Equipment

• Hand Hygiene: Always perform hand sanitization before and after performing venipuncture. This may involve washing hands with soap and water or using an alcohol-based hand sanitizer that contains at least 60% alcohol.

• Personal Protective Equipment (PPE): Wear disposable latex or nitrile gloves at all times during the procedure to create a barrier and protect against potential contamination and exposure to blood and other bodily fluids.

Patient Positioning

Proper positioning of the patient plays a vital role in the success of venipuncture:

• Ensure that the patient's arm is straight and comfortably supported. Instruct the patient to sit or lie down in a position that promotes relaxation, reducing anxiety which may otherwise cause vein collapse.

• Maintain an unobstructed view of the antecubital fossa for optimal visibility of the vein.

Tourniquet Application

• Apply a tourniquet approximately 3-4 inches above the selected antecubital area. This temporary occlusion of venous blood flow helps to engorge the veins, making them more prominent.

• Encourage the patient to make a fist to further enhance vein visibility while instructing them to refrain from excessive muscle tension.

Selecting a Vein

• Palpation: Utilize your fingers to locate firm, resilient veins. The median cubital vein is the first choice for venipuncture due to its size and location. The cephalic and median cephalic veins may be chosen if the median cubital vein is not accessible.

• Avoiding Complications: The basilic vein should be used only when alternatives are not available as it is close to arteries and nerves, increasing the risk of complications.

Pre-Venipuncture Steps

Once a suitable vein is selected:

• Release the tourniquet to restore normal blood flow before cleaning the site, as a full vein improves the efficacy of the antiseptic.

• Cleansing: Clean the venipuncture site thoroughly using an antiseptic such as 70% isopropyl alcohol. Allow the site to air dry completely to enhance the antiseptic’s effectiveness and minimize discomfort at the puncture site.

Syringe and Needle Preparation

• Equipment: Utilize sterile syringes and specifically designed needles for blood collection. Inspect each needle before use to ensure there are no defects.

• Selection of Supplies: Choose an appropriate needle gauge (often between 21-23 for adults) and syringe volume based on the volume of blood needed for the tests.

Venipuncture Procedure

• Reapply the tourniquet before needle insertion to engorge the vein further. Hold the syringe as an ETS (Evacuated Tube System) holder.

• Instruct the patient to make a fist again to promote better vein visibility and stability while you prepare for the insertion.

• Before puncturing, anchor the vein by pulling the skin tightly below the puncture site with your thumb to stabilize it during the process.

Needle Insertion

• Communicate with the patient by warning them just before insertion.

• Gently insert the needle at an angle of no more than 30 degrees with the bevel facing upward. Use a smooth, confident motion to minimize discomfort. Stop advancing the needle when a decrease in resistance is felt, and blood can be seen in the syringe hub.

Blood Collection

• Steady the syringe by pressing fingers against the arm to maintain a stable blood flow.

• Release the tourniquet once blood flow is established to minimize hemoconcentration, which can affect test results.

• Slowly pull back on the plunger to collect the requisite amount of blood without causing excessive suction that could collapse the vein.

Post-Venipuncture Handling

• Withdraw the needle smoothly from the puncture site, immediately activating the safety feature to prevent needlestick injuries.

• Apply gauze to the puncture site and encourage the patient to maintain pressure to promote clotting. Instruct the patient to hold the gauze if they are able, while you dispose of the used needle.

• Disposal: Dispose of the needle in a designated sharps container immediately after use to prevent accidents.

Tube Transfer and Filling

• Use a syringe transfer device to attach to the syringe hub for safely transferring blood into appropriate ETS tubes.

• Ensure tubes fill from bottom to top to avoid contamination, and mix additive tubes immediately after drawing to ensure anticoagulants can act efficiently to prevent clotting. Adhere strictly to the order of draw to limit carryover contaminants.

Labeling and Patient Dismissal

• Label all tubes before dismissing the patient to prevent mix-ups. Show the labeled tubes to the patient for verification of their identification information.

• Check the venipuncture site for any bleeding and apply a bandage if bleeding has stopped. Properly discard all used materials and follow protocol for safe glove removal.

Conclusion

Express gratitude to the patient for their cooperation during the procedure and ensure proper hand sanitation is performed afterward to maintain safety and hygiene practices.