MODULE 5: VENIPUNCTURE

PROCEDURE A.GOMEZ
PMTP2/SCHOOL OF MEDICAL TECHNOLOGY/CENTRO ESCOLAR UNIVERSITY

3. Take note of any dietary restrictions

or special
VENIPUNCTURE
conditions
4. Determine the test status
● Most frequently performed procedure COMMON TEST STATUS
in phlebotomy DESIGNATION:
● Process of collecting or drawing blood FIRST PRIORITY
from a vein of the - STAT - Immediately
patient for laboratory testing purposes - MED EMERG – Medical Emergency
● Phlebotomist – the person who SECOND PRIORITY
perform phlebotomy - TIMED – timing of collection is
● REQUISITION: important
Communication between the SECOND/THIRD PRIORITY
requesting physician and the – ASAP – as soon as possible
laboratory. - PREOP – before an operation
- POSTOP – after an operation
Includes:
FOURTH PRIORITY
● Patient’s correct and complete name
– FASTING – restriction of food intake
● Medical record number
8-12 hours prior to specimen collection
● Patient’s age and date of birth
N/A
● Patient’s location (OPD or room
- NPO – non per orem (nothing by
number of IP)
mouth)
● Type of test ordered
Routine
● Name of requesting physician
● STEP 2: IDENTIFY THE PATIENT
● Date and time of sample collection
● The most important step in specimen
● Status of Sample (Stat, Routine,
collection
Timed)
● Ask patient to state name and DOB
● Billing information
● Check patient’s identification bracelet
● Special Precaution
● Name
VENIPUNCTURE STEPS ● Identifying number
● STEP 1: REVIEW AND ACCESSION THE ● Medical record number
TEST REQUEST ● Visit number

REVIEWING: ● STEP 3: VERIFY THE PATIENT’S

1. Check the completeness of the DIET RESTRICTIONS AND LATEX
required
SENSITIVITY
information
-Patient Diet Restriction
2. Verify the tests to be collected

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MODULE 5: VENIPUNCTURE
PROCEDURE A.GOMEZ
PMTP2/SCHOOL OF MEDICAL TECHNOLOGY/CENTRO ESCOLAR UNIVERSITY

● Fasting (8-12 hours) – for tests that are ● Follow proper hand hygiene
affected by diet ● 2 Methods of hand hygiene
● Glucose (FBS, OGTT, Post- Prandial
Glucose)
● Lipid Profile
Latex Sensitivity
● - Do not use latex items for patients
with latex allergy
STEP 4: PROPER BEDSIDE PROPER HAND WASHING PROCEDURE
MANNER AND HANDLING 1. Stand a few inches from the sink
SPECIAL SITUATION ASSOC. WITH 2. Turn on the faucet and place hands
PATIENT CONTACT under the running water
● -Prepare the patient for testing 3. Use soap and work up lather to
● -Bedside Manner – behavior of ensure that hand surfaces are reached
healthcare worker as perceived by the Scrub for at least 15 seconds. Make sure
patient (OPD or IPD) to scrub all surfaces
● -Includes proper patient identification 5. Apply a little friction and rub hands
and preparation of patient for testing together for at
● Room signs: least 15 seconds
● NPO 6. Rinse the hands
● DNR 7. Dry hands using a clean paper towel
● Do not draw blood from 8. Use the paper towel to close the
faucet.
● Latex allergy
● Infection control precaution STEP 7-10
● Patient expired STEP 7: REASSURE PATIENT
STEP 8 POSITION PATIENT:
STEP 5; ASSEMBLE EQUIPMENT
● In-patient – usually in supine
AND SUPPLIES
position
Before approaching the patient for the
● Out-patient – seated on a
actual venipuncture, the blood
phlebotomy chair
collector should collect all necessary
STEP 9: APPLY TOURNIQUET
supplies (including collection
● Constricting device that
equipment, antiseptic pads, gauze
inflates veins by restricting
pads, bandages, and needle disposal
blood flow
system) and place them close to the
● Apply tourniquet 3 to 4
patient
inches above the puncture site
STEP 6: WASH HAND AND PUT
● Do not apply for more than
ON GLOVES
one minute –

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MODULE 5: VENIPUNCTURE
PROCEDURE A.GOMEZ
PMTP2/SCHOOL OF MEDICAL TECHNOLOGY/CENTRO ESCOLAR UNIVERSITY

hemoconcentration
STEP 10: ASK PATIENT TO ME A FIST
● Clenching fist increases
palpability of vein

STEP 13: CLEAN AND AIR-DRY

STEP 13: Cleaning of site
● Antiseptic – solution used for cleaning
venipuncture site
SELECT VEIN, RELEASE ● Cleaning should cover 2-3 inches
TOURNIQUET, AND ASK PATIENT diameter of the site (concentric circular
TO OPEN motion moving outward)
STEP 11: Site Selection: Airdrying
● Palpation – locating veins by ● Allow airdrying of cleansed site – 1
sight and touch (rolling of minute
fingers on the sight) ● Do not use unsterilized
● Antecubital area/fossa – cloth/cotton/gauze to wipe wet areas
preferred venipuncture site ● Do not fan out or blow
● Other arm and hand veins
● Leg, ankle, and foot veins STEP 14: VERIFY EQUIPMENT AND TUBE
STEP 12: Release Tourniquet SELECTION
● to relax vein after palpation
Evacuated tube system
avoiding hemoconcentration
1. Select the appropriate tube for ETS
Unclench fist 2. Select and inspect needles for defects
● Relaxing the vein 3. Twist the cap of rubber-sleeved needle to
expose it
4. Screw this end to the tube holder
5. Place the first tube in the holder
6. Position the tube in the holder

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MODULE 5: VENIPUNCTURE
PROCEDURE A.GOMEZ
PMTP2/SCHOOL OF MEDICAL TECHNOLOGY/CENTRO ESCOLAR UNIVERSITY

Winged Infusion Set ● Anchoring vein – prevents veins from

1. Use a 23-g butterfly needle slipping sideways when the needle
2. Inspect package before aseptically enters
opening and removing the butterfly ● Use thumb of the free hand
3. Attach the butterfly to an ETS holder ● Place thumb 1-2 inches below the
or syringe barrel puncture site and the four fingers
4. Select the appropriate small-volume below the arm
tube for the test ● Use the thumb to pull the skin
Syringe System STEP 19: Needle insertion
1. Select the appropriate syringe and ● Needle should be aligned with the vein
needle ● Needle bevel should be facing up
2. Test the plunger before opening the ● Inserted in a smooth forward
sterile package movement (15-30 ̊ angle)
3. Aseptically open the package
4. Securely attach the needle to the
syringe
STEP 15-17
STEP 15: Reapply tourniquet
● Avoid touching the cleaned area
STEP 16: Pick up and position blood
collection equipment
STEP 17: Uncap and Inspect the
Needle STEP 20: FILL THE
● Only use unused, sterile needle SYRINGE/TUBE
Inspect bevel (should be pointed) ● Slowly pull back on the plunger of the
● Needle should not come in contact with syringe
anything prior to and allow the barrel of the syringe to fill
venipuncture with
● Dispose and replace new needle if this blood.
happens ● Observe for blood flow in the needle
STEP 18: ASK THE PATIENT TO hub (ensures that the needle is inside
REMAKE A FIST, ANCHOR THE the vein)
VEIN, AND INSERT NEEDLE ● Push collection tube into the tube
● Re-clenching of fist holder
● To promote easier palpation of vein (needle should completely penetrate
STEP 18: Anchoring the vein the stopper)
● Let blood flow into the tube
● Release tourniquet and ask patient to

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MODULE 5: VENIPUNCTURE
PROCEDURE A.GOMEZ
PMTP2/SCHOOL OF MEDICAL TECHNOLOGY/CENTRO ESCOLAR UNIVERSITY

unclench fist Following the proper order of draw for

syringes, push the evacuated tube onto
STEP 21: WITHDRAW THE NEEDLE the needle within the transfer device
● Make sure that required blood volume ● Keep the tube vertical so it fills from
is collected the bottom up-let the tube fill using the
● Syringe Method - Transfer blood vacuum draw
sample from syringe to blood ● If you do not want to fill the tube
collection tubes (order of draw) completely, pull back on the plunger to
● Place gauze over the site stop the
● Do not press down on the gauze while flow before removing the tube
the needle is in the vein ● Dispose of the transfer device into a
● Withdraw the needle in one smooth sharps container
motion
● Apply pressure to site with gauze pad Transferring without a transfer
● Do not bend arm up-keep tended or device
raised ● If a transfer device is not available,
● Invert tubes gently after transfer blood place the required tubes in the proper
(inversion depends on the additive order of draw in a rack or slot in the
present) phlebotomy tray
● Tourniquet should be removed before ● Never hold the tubes in your hand
removing the needle ● Penetrate the stopper of the tube with
STEP 22: ENGAGE IN SAFETY the syringe needle and allow the
DEVICE vacuum draw of the tube
STEP 23: DISPOSE OF SHARPS to fill the tube
● Slant the needle to the side of the tube
● Follow proper disposal protocol:
so the blood runs down the side of the
● Sharps container – used needle
tube to prevent hemolysis.
● Yellow bag – used gloves, tourniquet,
● *When the last tube is filled, withdraw
holder, barrel, ETS holder, used
the needle, activate the safety device
antiseptic pads/cotton
and dispose of the sharps
STEP 24: TRANSFER BLOOD TO
STEP 25:PROPERLY LABEL THE
EVACUATED TUBES
TUBES
Syringe transfer device
Proper labeling is essential!
● Attach the transfer device to the
● Labeling method:
syringe
● Use of Indelible ink
● Hold the syringe vertically, with the tip
● Computer generated label sticker with
down and transfer device at the bottom
barcode
● Label information:

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MODULE 5: VENIPUNCTURE
PROCEDURE A.GOMEZ
PMTP2/SCHOOL OF MEDICAL TECHNOLOGY/CENTRO ESCOLAR UNIVERSITY

● Patient’s complete name Geriatric venipuncture

● Date of birth ● Elder have thinner skin and
● ID number (Accession number) smaller muscles which
● Date and time of Collection cause veins to roll easily
● Initials of phlebotomist ● Veins lose elasticity –
● Additional information (fasting time, prone to collapse
etc)
STEP 26-32 Long-term Care Patients
26. Observe Special handling ● Dialysis Patients
Instructions ● Use dorsum of hands of patients to
27. Check patient’s arm and apply preserve arm veins for hemodialysis
bandage access.
28. Dispose of Contaminated Materials ● Phlebotomist should select another
29. Thank the patient site other than the arm with AV fistula
30. Remove gloves, and wash/sanitize ● Home-care Patients
hands ● Patients who need medical attention
31. Check specimen collection logs (if and assistance from health
applicable) professionals from time to time.
20. Transport the specimens to the ● Phlebotomist should carry all
laboratory. necessary equipment with them during
house calls.
Requirements for Drawing Blood ● Hospice Patients
from Special Populations ● Patients who need end-of-life care
(mostly with prognosis of six months or
Pediatric puncture less)
● Veins are usually small and ● Extra care should be given
underdeveloped
● Risk of iatrogenic anemia (due to
smaller blood volume)
● EMLA may be used prior to
venipuncture
● Restraining methods:
● Infant - wrapped in blanket
● Toddler - seated on parent’s lap
● Children – second person leans over
the child who is in supine position

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