STEPS TO FOLLOW IN PERFORMING A VENIPUNCTURE
15. If blood does not flow immediately, several steps can be taken to obtain the specimen.
a. Change the position of the needle. The needle may have penetrated the vein too far. In that case, pull back gently. If the needle has not penetrated far enough, gently push it in. Use the free index finger to feel above the puncture to locate the vein. Do not probe through tissue. This is painful and damaging. It may be just necessary to change the needle angle slightly. The bevel of the needle may be up against the vein wall and may be obstructing the blood flow.
b. Sometimes the Vacutainer tubes will lose vacuum and will not fill. In this case, try another tube.
c. Sometimes the tourniquet is so tight that it is obstructing blood flow. Loosen the tourniquet to see if this helps.
16. If blood still does not flow trying another site may be necessary, preferably in the other arm. Never stick a patient more than twice. After two unsuccessful tries, call someone else more experienced. By this time, the phlebotomist and the patient have lost confidence.
NOTE: You should never attempt an arterial stick or a stick to a foot vein without an order from the physician. An arterial stick is very traumatic to the patient and can result in serious, permanent damage to the circulation in that limb and to the nerves in that area. (Refer to the arterial puncture procedure for more details concerning the risks involved in arterial punctures.) Sticking a foot vein also involves risk, especially to a diabetic patient or any patient with poor circulation, due to risk of infection. If you cannot obtain blood from the arm by way of venipuncture (maximum of two attempts), ask another phlebotomist to try. Only after we have exhausted all other means, should an arterial puncture or a foot-puncture be attempted, and then only with a physician’s order.
17. As soon as the blood starts to flow, loosen the tourniquet. Remember, if the tourniquet is left on too long, the blood in this area will have an increased concentration of cells (hemoconcentration) and test results may be affected. If the veins are very small, leave the tourniquet on until the collection is complete. Always remove the tourniquet before removing the needle. The patient may open his fist as soon as the blood flow starts.
18. Apply clean, dry gauze to the site and gently withdraw the needle. Immediately lock the safety shield in place over the needle.
19. Apply gentle pressure to the point of the puncture until the bleeding has stopped. The patient should keep arm straight and/or elevate it above the heart. After the bleeding stops, apply a pressure bandage to the site, unless the patient refuses. Instruct the patient to leave the bandage on for at least 15 minutes. (NOTE: The patient may apply pressure if able.)
20. Dispose of needle and needle holder by way of Bio-Hazard sharp container.
21. PROPERLY LABEL TUBES FROM THE ARMBAND. Computer labels may be used after comparing with the armband. All tubes must be labeled with the patient’s name, account number, date collected, time collected, and collector’s initials. Additionally, any tube collected for any Blood Bank test, must have the hospital number handwritten from the armband, unless the patient identification system label is used.
22. Clean the area. Never leave anything in a patient’s room unless isolation techniques are warranted. Remove gloves after each patient contact. Wash hands before leaving the patient’s room. Do not wear gloves while going from room to room.
PATIENTS WITH IVs
a. Blood may be drawn in an arm with an I.V. only if drawn below the I.V.
b. If the patient has an I.V., one alternative to an impossible venipuncture is to request the nurse in charge to disconnect the I.V., wait at least 2 minutes, and draw blood from the needle already in the vein. Just remember that at least 3 ml should be discarded before the samples are collected. This avoids dilution and contamination of the sample with the I.V. fluid. Alternately, venipuncture can be performed in this arm after the 2 minute wait.
c. Always have the nurse disconnect the I.V. Phlebotomists should never turn off or on the patient’s I.V.
d. Do not put a tourniquet on above an I.V. without checking with the nurse.
e. The phlebotomist should always check with the nurse or the lab supervisor/charge tech if there are any questions.
Note: Refer to the procedure, “Adverse Reactions to Phlebotomy” for additional information. If the patient develops a hematoma, excel bleeding, tingling in the arm, or any other adverse reaction, this should be reported to the patient’s nurse and documented. Inform your supervisor so that a Risk Management report may be initiated.