Using Venipuncture to Collect a Venous Blood Sample for Routine Testing

Goal: An uncontaminated specimen is obtained without causing anxiety, injury, or infection to the patient

1. Gather the necessary supplies. Check product expiration dates. Identify ordered tests and select the appropriate blood-collection tubes.

2. Bring necessary equipment to the bedside stand or overbed table.

3. Perform hand hygiene and put on PPE, if indicated.

4. Identify the patient. Explain the procedure. Allow the patient time to ask questions and verbalize concerns about the venipuncture procedure.

5. Close curtains around bed and close the door to the room, if possible.

6. Check the specimen label with the patient’s identification bracelet. Label should include the patient’s name and identification number, time specimen was collected, route of collection, identification of the person obtaining the sample, and any other information required by agency policy.

7. Provide for good light. Artificial light is recommended. Place a trash receptacle within easy reach.

8. Assist the patient to a comfortable position, either sitting or lying. If the patient is lying in bed, raise the bed to a comfortable working height, usually elbow height of the caregiver (VISN 8 Patient Safety Center, 2009).

9. Determine the patient’s preferred site for the procedure based on his or her previous experience. Expose the arm, supporting it in an extended position on a firm surface, such as a tabletop. Position self on the same side of the patient as the site selected. Apply a tourniquet to the upper arm on the chosen side approximately 3 to 4 inches above the potential puncture site. Apply sufficient pressure to impede venous circulation but not arterial blood flow.

10. Put on gloves. Assess the veins using inspection and palpation to determine the best puncture site. Refer to the Assessment information above.

11. Release the tourniquet. Check that the vein has decompressed (Lavery & Ingram, 2005).

12. Attach the needle to the Vacutainer device. Place first blood-collection tube into the Vacutainer, but not engaged in the puncture device in the Vacutainer.

13. Clean the patient’s skin at the selected puncture site with the antimicrobial swab. If using chlorhexidine, use a back-andforth motion, applying friction for 30 seconds to the site, or use the procedure recommended by the manufacturer. If using alcohol, wipe in a circular motion spiraling outward. Allow the skin to dry before performing the venipuncture. Alternately, the skin can be dried with a sterile gauze (Fischbach & Dunning, 2009). Check facility policy.

14. Reapply the tourniquet approximately 3 to 4 inches above the identified puncture site. Apply sufficient pressure to impede venous circulation but not arterial blood flow.

15. Hold the patient’s arm in a downward position with your nondominant hand. Align the needle and Vacutainer device with the chosen vein, holding the Vacutainer and needle in your dominant hand. Use the thumb or first finger of your nondominant hand to apply pressure and traction to the skin just below the identified puncture site.

16. Inform the patient that he or she is going to feel a pinch. With the bevel of the needle up, insert the needle into the vein at a 15-degree angle to the skin (Fischbach & Dunning, 2009).

17. Grasp the Vacutainer securely to stabilize it in the vein with your nondominant hand, and push the first collection tube into the puncture device in the Vacutainer, until the rubber stopper on the collection tube is punctured. You will feel the tube push into place on the puncture device. Blood will flow into the tube automatically.

18. Remove the tourniquet as soon as blood flows adequately into the tube.

19. Continue to hold Vacutainer in place in the vein and continue to fill the required tubes, removing one and inserting another. Gently rotate each tube as you remove it.

20. After you have drawn all required blood samples, remove the last collection tube from the Vacutainer. Place a gauze pad over the puncture site and slowly and gently remove the needle from the vein. Engage needle guard. Do not apply pressure to site until the needle has been fully removed.

21. Apply gentle pressure to the puncture site for 2 to 3 minutes or until bleeding stops.

22. After bleeding stops, apply an adhesive bandage.

23. Remove equipment and return the patient to a position of comfort. Raise side rail and lower bed.

24. Discard Vacutainer and needle in sharps container.

25. Remove gloves and perform hand hygiene.

26. Place label on the container per facility policy. Place container in plastic, sealable biohazard bag.

27. Check the venipuncture site to see if a hematoma has developed.

28. Remove other PPE, if used. Perform hand hygiene.

29. Transport the specimen to the laboratory immediately. If immediate transport is not possible, check with laboratory personnel or policy manual whether refrigeration is contraindicated.