Venipuncture

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Venipuncture
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Objectives

• List basic concepts and guidelines for
  venipuncture.
• List the supplies needed to perform venipuncture.
• Define common complications of venipuncture.
• List documentation requirements for
  venipuncture.
• Perform venipuncture to collect a laboratory
  specimen.

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Purpose of venipuncture

• To obtain blood for a specimen
• To infuse fluids and blood
• To administer medication
• Diagnostic tests

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Characteristics of a suitable vein

• Large enough to receive the shaft of the needle
• Visible and palpable
• Intact

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• Use veins in uninjured arm
• Do NOT use veins if IV fluids are being
  administered
• Do NOT use veins that are thrombosed, tortuous,
  or rolling

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Antecubital space contains the most common
venipuncture sites
Use Universal Precautions!!!
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Promote vein distension

• Patient clench and unclench fist
• Tap area lightly
• Have patient lower arm
• Apply warm compress

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List the supplies needed to perform venipuncture.
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Specimen label

• Patients full name
• FMP and Social Security Number
• Rate or dependency status, branch of service, and
  active duty or retired.

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Vacutainer holder and needle

• Clean holder with soap and water
• Vacutainer needle used for single or multi-draw
  type

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Vacutainer tube

• Vacuum blood collection tube
• Rubber stopper are color coded
• Various sizes
• 3 sources to determine appropriate tube to be used

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TUBES, Tubes, TUBES

• Order of Draw
• to avoid cross-contamination of additives between
  tubes
• Yellow-Black top Blood culture, this is always
  FIRST.
• Red-top non-additive. Use this before using
  tubes containing additives
• EXCEPTION When using SYRINGE, this tubes is
  last.
• Light-Blue top Coagulation, contains sodium
  citrate
• Last draw -additive tubes in this order
• Dark-Green top Used for Heparin
• Lavender top CBC
• Gray-top Glucose

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Vocabulary

• Glossary of terms
• PPE-Personal Protective equipment
• Wing-tipped needle set-Butterfly needle, used on
  elderly female patients

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Define common complications of venipuncture.
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Hematoma

• Needle has gone through the vein
• Bevel is only partially in the vein
• Insufficient pressure on a puncture site after
  needle is removed

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Phlebitis

• May result from repeated puncture of vein and/or
  improper technique

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Septicemia

• Results from improper technique
• Results from using contaminated equipment

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Trauma

• Usually caused by probing with the needle
• List documentation requirements for venipuncture

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Patient Profile

• Date lab was ordered
• Date sample was sent to lab

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Nursing Notes

• Date/time specimen drawn
• Specific test
• Disposition
• Patients tolerance
• Location specimen was drawn from

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The Stick

• Apply tourniquet 2-4 inches above proposed
  venipuncture site
• Cleanse area with antiseptic wipe circular
  motion from center out
• Anchor vein with thumb about 2 inches below site

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The Stick...continued

• Enter skin with the needle bevel up at a 15
  degree angle in line with the vein
• Insert the needle smoothly and confidently, deep
  enough to enter the vein
• If using a syringe Pull back on barrel with
  slow, even tension as blood fills syringe

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Still Sticking

• If using a vacutainer as soon as needle enters
  vein, ease the tube forward into holder.
• Release tourniquet before withdrawing needle.
• Remove needle from vein, and place a sterile 2X2
  over site with direct pressure.
• Invert tube gently to mix additive.

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Reminders

• Specimen handling zip-lock bag with blood
  specimen enclosed
• Wear gloves
• Sharps management No recapping, bending of
  needles. Place all sharps in proper sharps
  container.

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CLASSROOM DEMONSTRATIOIN

• Perform venipuncture to collect a laboratory
  specimen.

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Summary
and
Evaluation