CHAPTER 8: VENIPUNCTURE PROCEDURES :CHAPTER 8: VENIPUNCTURE PROCEDURES By: Group II


OBJECTIVES :OBJECTIVES Describe the patient identification process List supplies used in a typical venipuncture procedure Describe hand hygiene & gloving procedures Identify sites for venipuncture Describe how to apply a tourniquet to a patient’s arm Describe steps of a basic venipuncture Identify potential causes of phlebotomy complications during a venipuncture procedure


PREPARE FOR PATIENT :PREPARE FOR PATIENT Hand hygiene: precautions Review lab test orders Active listening: observations Prepare equipment: supplies


HAND HYGIENE & GLOVING PROCEDURES :HAND HYGIENE & GLOVING PROCEDURES Hand hygiene and use of gloves should be considered routine procedure Washing hands and using alcohol wipes This is done as soon as you come into visual contact with the patient and before you begin the procedure Glove removal and hand hygiene should be performed after each patient encounter


APPROACHING THE PATIENT :APPROACHING THE PATIENT Introduce self Describe what procedure is to be done Recheck & document if… Patient is missing Patient is comatose or heavily medicated


IDENTIFICATION :IDENTIFICATION Cross check multiple identifiers: ID band, verbal, test requisition Recheck & document if… ID does not match other identifiers


IDENTIFICATION :IDENTIFICATION Greet patient and ask to state and spell their full name, ID number or birth date Compare the information state with the information on the laboratory test requisitions Compare the ID with another reliable source Hospital ID band Drivers License


PATIENT ASSESMENT :PATIENT ASSESMENT Be observant and alert Look for the likelihood of fainting Ask if the patient has fasted or not Check sensitivity to latex Recheck & document if… Patient is a potential bleeder Patient has a history of fainting


SUPPLIES :SUPPLIES Laboratory labels Marking pens Gloves Non-latex tourniquets Alcohol pads- skin disinfectants Two iodine-tincture swabs for blood culture Safety needles for single use Safety syringes and transfer devices Blood collection tubes Plastic capillary tubes Non-latex bandages & sterile gauze pads Glass microscope slides Puncture- proof sharp container SUPPLIES


POSITION PATIENT/ LOCATE VEIN :POSITION PATIENT/ LOCATE VEIN Find comfortable, safe position Apply clean tourniquet Vein palpitation Select correct site Recheck & document if… Patient has IV Patient has poor vein selection Patient is obese


COMMON SITES/ CHOICES FOR VENIPUNCTURE :COMMON SITES/ CHOICES FOR VENIPUNCTURE Common site: Antecubital area- just below the bend of the arm Common choices Median cubital: Median vein; most commonly used, easiest to obtain blood from Cephalic vein: On the outer edge of the arm, or thumb side Basilic vein: On the inside edge or pinky side. It is close to the median nerve and brachial artery so the other two nerves are more preferable to be used


CLINICAL ALERTS WITH VENIPUNCTURE :CLINICAL ALERTS WITH VENIPUNCTURE Serious damage can occur if a nerve is accidentally nicked, probed or punctured. Puncture of an artery may result in excessive bleeding and an hematoma formation Do no use the veins in an arm if… IV lines in both arms Burned or scarred areas Cast(s) on arm(s) Thrombosed veins Mastectomy on both sides


USE OF A TOURNIQUET (Application) :USE OF A TOURNIQUET (Application) Wash/ sanitize hands, put on gloves Use a clean latex- free tourniquet Stretch the end of the tourniquet around the patients arm about 3 inches about the puncture area. Tuck a section next to the skin, making a partial loop Tourniquet should be tight but not painful. Do not leave on for more than 1 minutes


USE OF A TOURNIQUET (Release) :USE OF A TOURNIQUET (Release) When it is time to release the tourniquet, the partial loop should release easily. Release it after the needle puncture, when blood has begun to flow into the collection tube Once released, the tourniquet can remain loosely on the arm or surface of work area


PREPARE/DECONTAMINATE PUNCTURE SITE :PREPARE/DECONTAMINATE PUNCTURE SITE 60-second alcohol scrub Area is either then air dried or wiped with a sterile gauze 30- 60- second iodine tincture scrub with removal by sterile gauze or alcohol pad *chlorohexidine is an alternative to patients allergic to both iodine and alcohol wipes


COLLECT BLOOD SPECIMEN(S) :COLLECT BLOOD SPECIMEN(S) Needle puncture Use correct tube in correct order Release tourniquet Discontinue if… Complication with supplies and equipment Patient feels faint or dizzy or other complications


PREFORMING A VENIPUNCTURE :PREFORMING A VENIPUNCTURE Assemble equipment in the presence of the patient. Offer to answer any questions Prepare equipment according to the manufacturer’s instructions Position patient’s arm slightly bent, in a downward manner. Apply the tourniquet and check for potential puncture sites. Choose a vein that feels the fullest Select the site and decontaminate the patient’s skin. Ask patient to “please close his/her fist” to make veins more prominent. Patient should not pump their hand Mention to patient that they might feel a stick or slight prick. Patient may feel faint or lose consciosness after this point


PREFORMING A VENIPUNCTURE :PREFORMING A VENIPUNCTURE Remove the needle cap carefully. Needle cannot touch anything that may contaminate it. Hold the needle assembly in one hand while the thumb of the other hand anchors he vein 1 to 2 inches below the puncture site. Position the needle so that it is parallel or running in the same direction as the vein. Insert the needle quickly with the bevel side up and to a 15- 30 degree angle with the skin. A slight “pop” should be heard Press the evacuated tube gently onto the sheathed needle. Blood should begin to flow. Palpate gently if it does not As the blood flow, ask patient to release fist and release the tourniquet. Push evacuated tube into the holder so that blood can enter. Orient tube in a downward position.


PREFORMING A VENIPUNCTURE :PREFORMING A VENIPUNCTURE Allow flow into the tube until it stops so that the proper dilution of blood additive can occur. Watch to see how the blood flow ceases. If multiple tubes are being collected, remove each tube from the holder with a gentle twist and pull motion and replace it with the next tube When all tubes have been filled and removed from the holder, withdraw the needle and hold a gauze pad over the site Instruct patient to apply pressure on gauze over site, while you resheath or cover the needle Apply pressure until bleeding stops. Label specimens appropriately Dispose of contaminated supplies, wash hands and sanitize Deliver sample immediately to the laboratory


PREPARE SPECIMEN FOR TRANSPORT :PREPARE SPECIMEN FOR TRANSPORT Label specimens Patient’s full name Patient’s number Date of collection Time of collection Health care worker’s initial Patient’s room #, bed assignment Place in secure container *If biohazard container is full… Report it Discard waste in another container *Maintain hygiene Safely discard waste Perform hand hygiene


CHECK PATIENT STATUS :CHECK PATIENT STATUS Assure bleeding has stopped Check cleanliness of area Thank the patient


TRANSPORT SPECIMENS :TRANSPORT SPECIMENS Use secure containers Prioritize specimens if needed Assess for possible rejection Consider special transportation needs Light-sensitivity Thermal requirements


POTENTIAL COMPLICATIONS :POTENTIAL COMPLICATIONS Sepsis (infection) Hematoma Cellulites Thrombosis Phlebitis Air embolism


Summary :Summary Check all patients for proper identification and compare with other forms of ID Make sure all supplies are in hand and ready to be used Always us proper hand hygiene such a washing and using sanitizers as well as always using gloves and changing them when necessary Best site for venipuncture it at the antecubital area of arm and puncture in the median cubital vein


Summary :Summary Steps for venipuncture are sanitize area, apply tourniquet, find vein and stick. Draw blood, remove needle and dispose appropriately. Sanitize area with gauze, apply pressure until bleeding stops. Complication that may occur are… Air embolism Sepsis (infection) Hematoma Cellulites Thrombosis Phlebitis


QUESTIONS :QUESTIONS When should you first put on gloves? What can happened if you puncture an artery? What is the first thing you do when asking for identification True or False. A tourniquet should be wrapped tightly to the point of discomfort


ANSWERS :ANSWERS Upon visual contact Excessive bleeding Ask patient to state and spell full name False


REFERENCES :REFERENCES Physics & Radiobiology of Nuclear Medicine. Saha B. Gopal PhD 2nd Edition. Springer, New York