SPECIMEN PROCESSING
Procedure 8-2: Venipuncture Using a Syringe—cont’d
16. Have the patient make a fist.
17. Remove the cap to expose the end of the needle to
be inserted into the arm. Do not allow this needle to touch anything before piercing the skin.
18. Stabilize the chosen vein by anchoring it with the
thumb of the nondominant hand about 2 in. below the draw site, and/or off to the side. Make sure that the skin is pulled taut over the vein.
19. As you prepare to pierce the skin with the needle,
it is good practice to warn the patient by saying something like, “Here we go; you will feel a stick.”
20. Insert the needle at an angle of approximately
15 degrees, with the bevel up. The actual insertion site is approximately 1/
4 to 1/2 inch below the
identified draw site so that the needle is actually inserted into the vein at the chosen site.
21. The needle needs to be inserted quickly, with one
smooth gentle motion. As the insertion is accom- plished, follow the direction of the vein that was previously identified; if the vein is running at an angle across the arm or hand, this is how the needle should be directed into the vein. Approx- imately a third of the needle is usually below the surface of the skin when the insertion is complete.
Forming a fist may help with the visualization of the veins once the tourniquet is reapplied.
Touching this needle to any surface before it pierces the skin will cause contamination and possible intro- duction of bacteria into the vein.
It is important to stabilize the vein, but if the thumb is placed too close to the draw site, it will be in the way of the needle insertion and could cause interference with the angle used for the process and result in an unsuccessful blood draw.
If the patient is not expecting the skin to be pierced, he or she may be startled and move the arm or hand, causing an unsuccessful venipuncture.
If the angle is significantly less or more than 15 degrees, it may slide just above the vein or puncture through both sides of the vein rather than just entering the vein. The bevel facing upward allows the blood to enter the needle with minimal trauma.
Smooth insertion minimizes the trauma to the patient. It is important to follow the direction of the vein as the needle is inserted; this allows a better opportu- nity for the blood to enter the needle without obstruction. The needle needs to be inserted far enough to enter the vein, but not so far that it punc- tures both sides of the vein.
Chapter 8 Collection and Processing of Blood Samples 165
Procedure Rationale
22. When using the syringe technique, there may be a
“flash” of blood visible in the hub of the needle as soon as it is inserted in the vein. Gently pull back on the plunger of the syringe to create a vacuum and pull the blood into the syringe.
23. Continue to pull back slowly on the plunger and
monitor the volume of blood entering the syringe. Keep gentle pressure on the arm of the patient with the back of the fingers holding the syringe.
24. When the required amount of blood has almost
been obtained, release the tourniquet and have the patient open his or her fist.
25. As the needle is removed from the skin, place
gauze over the site, without applying initial pres- sure. The needle is to be removed quickly, and at the same angle as the insertion. Do not apply pres- sure to the site with the gauze until the needle has been removed completely from the skin, as this will cause pain for the patient.
26. Ask the patient to apply pressure to the site for 3
to 5 minutes. Do not allow the patient to bend his or her arm.
It is important to pull back relatively slowly because if the plunger is pulled back too fast, it can cause hemolysis. It is also possible that if the vein is small, it will collapse with the pressure applied by pulling the plunger back too quickly.
The medical assistant must continue to pull back on the plunger so that the blood will continue to enter the syringe. To keep the needle from moving during the process, pressure should be applied with the back of the fingers holding the syringe.
The tourniquet must not stay on longer than 1 minute. It is always necessary to release the tourniquet and have the patient open the fist before the needle is removed from the arm to avoid bleeding from the venipuncture site.
The gauze placed over the site will minimize bleeding as the needle is removed.
The pressure should be adequate to stop any bleeding before the patient leaves the drawing area. Bending the arm increases the risk for bleeding and bruise formation.
Procedure Rationale
27. Once the needle has been removed from the arm,
immediately activate the needle safety device. Grasp the needle at its base, and remove it from the syringe. Discard the needle in the biohaz- ardous sharps container. Never recap contaminated
needles.
28. Screw the transfer device onto the end of the
syringe filled with blood.
29. While holding the syringe upright, insert each
evacuated tube into the open end of the transfer device. Follow the recommended order of draw.
30. Dispose of the transfer device and syringe in a
biohazardous sharps container.
31. Gently invert the blood specimens containing
anticoagulant 5 to 10 times.
32. Label the tubes, including the full name of the
patient, birth date (or other unique identifier assigned by the health-care provider), the date and time of collection, and the initials of the collector.
The needle must be removed from the syringe so that the transfer device can be applied. Recapping con- taminated needles increases the risk of needlestick accidents and potential exposure to bloodborne pathogens.
Make sure this is a secure seal so that the blood will flow adequately.
Holding the syringe upright will minimize the oppor- tunity for anticoagulant crossover as the transfer device is used.
Chapter 8 Collection and Processing of Blood Samples 167
There is a needle within the transfer device, so this must go into a sharps container.
Insufficient mixing of the anticoagulant with the spec- imen will result in clotted blood and a sample that must be discarded.
All samples must be labeled using at least two unique identifiers. The date and time provide additional information that may be necessary for interpretation of the results. Identification of the phlebotomist may be helpful if there are questions about the procedure or the specimens collected.
Procedure Rationale
33. Use the requisition form or the labels to verify that
all the necessary tubes were drawn for the speci- mens ordered.
34. Observe any special handling instructions for the
specimens.
35. Monitor the patient for any signs of distress from
the procedure.
36. Once the tubes have been labeled, check the draw
site for bleeding. If it has not stopped bleeding, apply pressure for another few minutes, and if the bleeding is still present, contact a physician.
37. If the bleeding has subsided, apply an adhesive
bandage, but leave the gauze in place to allow for additional pressure.
38. Advise the patient to avoid heavy lifting or exces-
sive exercise of the arm used for venipuncture for at least 1 hour.
39. Assist the patient to stand (if necessary) and thank
them for their cooperation.
40. Discard all trash, and place the tubes in an appro-
priate vessel for processing. Never touch full tubes of blood without wearing gloves.
41. Remove gloves and sanitize hands.
Verifying the details of the blood draw once more in the presence of the patient allows for a redraw to be performed immediately if something is missing. Some types of specimens must remain at room temper-
ature, whereas others may need to be put on ice immediately. This should be information that is ascertained before the procedure starts.
These may include pallor, perspiration (especially on the upper lip or forehead), increased anxiety, or light-headedness. If the patient is exhibiting any of these symptoms, it is best to have him or her lie down if possible. This may be easily accomplished if the patient is in a chair that can recline. If not, a cold compress on the forehead and/or the back of the neck may help. Continue to converse with the patient and move the blood out of sight. Ask for assistance if you feel that your patient is feeling faint. If the patient loses consciousness, it may be necessary to lower him or her to the floor from the phlebotomy chair.
It is important to look under the gauze for 2 or 3 seconds before applying the adhesive bandage to be certain that the site has actually stopped bleeding.
Self-adhesive bandages (such as Coban) may be wrapped around the site rather than applying an adhesive to the skin directly. Self-adhesive bandages may be especially effective for those patients who are on anticoagulant therapy.
Heavy lifting or exercise could cause the site to resume bleeding.
Patients may be a bit light-headed and assistance may be needed when he or she first stands up.
Touching the tubes of blood without wearing gloves offers potential opportunities for exposure to blood- borne pathogens.
Hands must always be sanitized after removing gloves.
Procedure Rationale
42. Document the procedure in the patient’s chart as
well as on the requisition form. Include the date and time of collection, what was collected, and if there were any circumstances that were out of the ordinary. Also document where the vein was accessed (such as right arm, left hand, etc.). The documentation should include the type (color) of tubes drawn, as well as the identity of the person who collected the sample.
All patient interactions must be carefully documented. The site used for vein access should always be writ- ten in the chart or on the requisition form so that if there are any negative outcomes associated with the procedure, the site has been noted.
Chapter 8 Collection and Processing of Blood Samples 169
Date
1/18/2020: Phlebotomy performed in left antecubital area for H&H. Lavender top tube drawn .
1100 a.m. Connie Lieseke, CMA (AAMA)
Procedure Rationale