Venipunture Procedure - Ministry Health Care
Contents
1. Minimum Volumes For Specific Tests coc tavende 250met daffy Lavender im wm Genosnb psms 0 MPO gWOGmesexh SnL o PST Lom mo Gen snb psms 0 ER aea mem Green 0 5 mL PST 0 5 mL cm Genosnb GSROSRb 0 mR 0 0 Pnbskbed CBC MPB MPC TSH T4 CRP ESR Page 12 of 14 Rev 1 02 2013 TF Saint Michael s Hospital MINISTRY HEALTH CARE Laboratory Services Minimum Volumes For Pediatric Patients Minimum Volume microtainer a Lavender 250 mcL half full mm TWO Greens each 0 5 mL D m Green 0 5 mL PST 0 5 mL Lavender 250 mcl half full TWO Serum Amber each 0 5mL ommo Green 0 5 mL Lavender 250 mcl half full n a CBC MPB MPC TSH T4 CRP ESR 5 c Page 13 of 14 Rev 1 02 2015 a S N S I AY VACUTAINER TUBES USED BY SAINT MICHAEL S HOSPITAL Effective 1 1 09 yss G araa A LavHemogurd EDTA 7 2mg 13X75 4 0 ml Lis 367861 Blue Plastic 3 2 Na Citrate 13X75 2 7 ml 1000 cs xm Loo m xs anni ons sm o ome nins E Lo owe oxw E 13 X 75 P Greiner Less E Lwens E each 3n Lon cach 364816 each K2EDTA 7 2mg 3 2 Na Citrate Plain plastic Plain plastic Plain plastic TY c B PY c c ae va Serum SST Yellow Hemoguard Lithium Heparin PST Gm Hemoguard Lithium Heparin Drugs en c S c c Le2. Rev 1 02 2013 REFERENCES Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture Second Edition NCCLS Vol 18 No 7 PHLEBOTOMY HANDBOOK Blood collection essentials Fifth Edition Diana Garza amp Kathleen Becan McBride 1999 ORIGINATING DEPARTMENT SECTION Phlebotomy Services Saint Michael s Hospital AUTHOR AND DATE Peggy A Carlson Phlebotomy Coordinator REVISED BY AND DATE Chad Moertl Phlebotomy Coordinator 3 30 09 Michelle O Connell MT ASCP Quality Improvement Coordinator October 11 2012 Mary West MT ASCP 1 15 2013 Joseph Teddy MT ASCP 06 26 14 APPROVAL Dawn Finch MT ASCP Director of Laboratory Services Jason Heese MD Medical Director of Laboratory Services H Lab LabManuals Phlebotomy CurrentPhlebotomy Policies PH 001 04 Venipuncture 2 21 2013 doc Page 10 of 14 PH 001 05 Venipuncture Rev 1 02 2013 SUPERFICIAL VEINS OF THE UPPER LIMB Median Accessory cubilal cephalic vein vein Basilic vein Antebrachiat f vein Cephalic vein Radial vein Reprinted with permission from PHLEBOTOMY ESSENTIALS McCall R E amp Tankersley C M J B Lippincott Co Phlladelphla PA 1993 HAND FOOT AND ANKLE VEINS Cephalic vein Dorsal metacarpal veins Great saphenous Deep lemoral Basilic vein 2 Femoral Popliteal Anterior libiai Posterior tibia Page 11 of 14 PH 001 05 Venipuncture Rev 1 02 2013 Laboratory Services
3. better 20 1 9 In patients Notify nursing personnel 20 2 Nausea Vomiting 20 2 1 Make the patient as comfortable as possible 20 2 2 Instruct the patient to take slow deep breaths 20 2 3 Give the patient an emesis basin or bag and have tissues available 20 2 4 Apply cold compresses to the patient s forehead if they desire 20 2 5 Offer the patient water to rinse out his her mouth 20 3 Convulsions 20 3 1 Prevent the patient from injuring him herself DO NOT restrain the movements of the patient s extremities completely but try to prevent injury 20 3 2 Dial 911 and state First Responder Alert then give the location 20 4 Patient Refusal 20 4 1 Do not argue with the patient 20 4 2 Try to reassure the patient 20 4 3 Talk in a calm direct manner 20 4 4 Emphasize that the doctor ordered the tests 20 4 5 Notify the patient s nurse of all refusals Page 6 of 14 PH 001 05 Venipuncture Rev 1 02 2013 20 5 20 6 20 7 20 8 Locating a Vein 20 5 1 20 5 2 20 5 3 20 5 4 Massage the arm 1f not readily apparent Tap vein site Apply heat pack Lower the extremity Unable to obtain a specimen 20 6 1 20 6 2 20 6 3 20 6 4 20 6 5 Carefully re position the needle Do Not probe Try another tube Loosen the tourniquet DO NOT attempt a venipuncture more than twice Hematoma prevention 20 7 1 20 7 2 20 7 3 20 7 4 20 7 5 Puncture only the upper most wall of the vein Remove the tourniq
4. ca a cJ P w Cn cem S c gt gt Sd C2 cA A c E p c c c ua 56 usp of lithium heparin Green glass 13 X 75 en c i ER c c c as C2 ca 68 usp units lithium heparin me c B res 5 ga NaFI K oxylate 10 mg Grey Hemoguard NaFL K oxylate 10 mg 8mg 13X75 h aw 3X Navy Blue Hem NECEM 13 X100 EDTA Heavy Metals Royal Blue 10 5 mg EDTA Na2 13 X100 Sodium Heparin ee ae 13 X75 Lam vd soins x Lacs vaw seis xt EDTA Na MetabiSO4 i mede 13 X100 Plain Tr Elements e zi Ep EE IE Ex is HA c E ge A ga LT c E c E C3 gt c B Ci gt gt B gt B BRE z co Page 14 of 14
5. e 2 of 14 Rev 1 02 2015 7 9 Alcohol wipes or non alcohol wipe if medical alcohol ordered 7 4 Gauze 7 5 The appropriate type and size of needle and system to be used is based on the patient s physical characteristics and the amount of blood to be drawn 7 6 Bandage tape 8 0 Apply tourniquet and select Venipuncture site 8 1 Apply at least 3 inches from puncture site 8 2 Apply no longer than 1 minute longer may result in erroneous results 8 3 Release and reapply after two minutes if additional time is needed 8 4 Apply over clothing to prevent pinching or irritating skin 8 5 Disconnect or remove auto blood pressure cuff if placed on arm being used for venipuncture 9 0 Suitable site selection 9 1 Veins of the antecubital fossa suitable for venipuncture 9 1 1 Median cubital vein MCV 9 1 2 Cephalic vein CV 9 1 3 Basilic vein BV see subsequent pictures 9 2 The larger and fuller median cubital cephalic and basilica veins are used most frequently wrist and hand veins are also acceptable for venipuncture 9 3 Sites to avoid 9 3 1 Burned or scarred areas 9 3 2 Mastectomy patients avoid side of body of mastectomy surgery 9 3 3 Double mastectomy avoid arm with lymphedema 9 3 4 IV sites 9 3 4 Use opposite arm when possible 9 3 4 2 If necessary draw below IV line site Ask nursing staff to turn off IV two minutes before drawing 90 3 5 Arteries 9 3 5 1 Arteries pulsate are more elastic and have a thick
6. ient s nurse or provider 3 0 If a citrate tube is the only tube to be drawn a discard tube is no longer required When using a butterfly collection kit a discard tube is necessary due to the dead space within the tubing which will result in inadequate sample volume 4 0 In the event that it is absolutely necessary to draw blood from a site above or below an IV line the nurse should turn off the IV for at least 2 minutes After the 2 minute wait the tourniquet may be applied Draw the sample Inform the nursing staff when you have completed the draw to restart the IV 5 0 Ensure that there 1s the correct ratio of anticoagulant to blood Citrate tubes must be full EDTA tubes must be filled to at least one third of the fill volume but do not overfill 6 0 TPN Draws 6 1 If at all possible to save the patient a needle stick blood should be drawn off the indwelling line that the TPN is being infused The following is the process as outlined in The Nursing Service Manual NS 550 Any labs except blood cultures Page 8 of 14 Rev 1 02 2013 a Stop IV infusions When drawing from a central line with TPN running through a lumen turn off the TPN for 15 minutes prior to the lab draw b Attach 10 mL syringe to lumen and discard waste according to chart below To assist with blood return may flush with 10 mL saline prior to waste c Draw amount of blood needed for test as indicated by laboratory personnel d Flush w
7. ipment Tourniquet PH 001 05 Venipuncture Rev 1 02 2013 STANDARDS Saint Michael s Hospital hand washing and safety policies are monitored for use CALIBRATION NA QUALITY CONTROL NA PROCEDURE 1 0 Greet patient and explain procedure to be performed 1 1 Initiate the Five Fundamentals of Service 1 2 Reassure the patient The phlebotomist must gain the patient s confidence and assure the patient that although the venipuncture will be slightly painful it will be of short duration 1 3 Never tell a patient This won t hurt 2 0 Check identification band and the patient labels Refer to the patient identification policy 2 Identification of the patient 1s crucial to insuring that the blood specimen is being drawn from the individual designated on the registration form 3 0 Verify patient fasting or non fasting status and therapeutic drug dosage time if applicable 3 1 Document information on tube label 4 0 Review paperwork and select appropriate tubes 4 If paperwork or labels are not available at the time of the collection label all tubes following guidelines of identification policy 5 0 Position the patient comfortably 5 1 Seated 2 2 Lying down 5 3 Never standing 5 4 Arm supported and extended straight from shoulder to wrist 6 0 Wash and glove hands 6 1 Use non latex gloves 6 2 Clean pair of gloves for each patient 7 0 Assemble supplies 7 1 Evacuated Tubes 7 2 Tourniquet Pag
8. ith prefilled saline syringe as needed to clear tubing of all blood using a pulsing method to create a turbulence that results in an effective clearance of blood from the line e Resume IV infusions Flush and Waste Chart for central lines TPN amp lipids Coag Studies Flush in mL NER P RR P RN WaseinmL 5 o 10 0 b TPN amp lipids Coag Studies Flush in mL If it 15 not possible to get the blood specimen off the TPN line do a venipuncture from the opposite side from which the infusion is occurring In these cases it should not be necessary to stop the TPN infusion and a waste tube would not be necessary If the venipuncture needs to be drawn off the same side as the TPN infusion staff needs to follow the same process as if drawing were done where there was an IV SAFETY PRECAUTIONS Safety devices are always used Needles are not recapped or clipped Contaminated waste 1s disposed into biohazard containers Follow procedures and precautions described in the Saint Michael s Hospital Infection Control and Hazard Communication manuals as well as the Saint Michael s Hospital Chemical Hygiene Plan Refer to the MSDS for reagent specific handling guidelines ATTACHMENTS I SUPERFICIAL VEINS OF UPPER ARM 2 HAND FOOT AND ANKLE VIEWS 3 Vacutainers Used By Saint Michael s Hospital Laboratory 4 Minimum Volumes for Pediatric Patients 5 Minimum Volumes for Specific Tests Page 9 of 14 PH 001 05 Venipuncture
9. ith the bevel up line up needle with the vein at about a 15 degree angle to the skin 16 1 2 Use a clean smooth motion 16 1 3 Grasp the flange of the needle holder and push the tube forward until the needle punctures the stopper 16 1 4 Using correct order of draw refer to Procedure Notes fill tubes until vacuum is exhausted and blood flow stops 16 1 5 Remove tube 16 1 6 Mix immediately after drawing any tube containing an additive and any plastic tube by gently inverting 5 10 times 16 1 7 Insert next tube and repeat procedure Page 4 of 14 Rev 1 02 2015 16 1 8 Remove last tube 16 1 9 Release the tourniquet 16 1 10 Cover the needle with gauze 16 1 11 Remove the needle 16 1 12 Apply pressure to the site 16 1 13 Engage needle safety device 16 1 14 Dispose in biohazardous waste container 16 2 Syringe and Needle System 16 2 1 With the bevel up line up needle with the vein at about a 15 degree angle to the skin 16 2 2 Use a clean smooth motion 16 2 3 Withdraw the desired amount of blood by pulling back on the plunger while maintaining equal pressure with the hand holding the syringe barrel 16 2 4 Change syringes if additional volume is needed 16 2 5 Release the tourniquet 16 2 6 Remove the needle 16 2 7 Apply pressure 16 2 8 Engage needle safety device 16 2 8 1 Use transfer device to fill evacuated tubes 16 2 8 2 Dispose in biohazardous waste container 17 0 Label the Specimen 17 1 Refe
10. r to patient labeling policy 18 0 Bandage patient s arm 18 1 Check to insure blood flow has stopped Be alert to excess bleeding lasting longer than 5 minutes Notify nursing staff and continue pressure 18 1 1 Use appropriate bandage 18 1 2 Advise patient to keep bandage on for 15 minutes 18 1 3 Pediatric patients advise caregiver regarding choking hazards 19 0 Deliver specimens to Laboratory for Processing 19 1 Place labeled tubes in a biohazard bag with the labels and send to the Laboratory via the pneumatic tube system or take directly to the laboratory 19 2 All temperature specific samples must be taken directly to the lab Page 5 of 14 PH 001 05 Venipuncture Rev 1 02 2013 20 0 Adverse reactions to phlebotomy procedure 20 1 Syncope fainting Release the tourniquet and withdraw the needle Dispose of the needle properly Keep gauze on the puncture site or bandage right away 20 1 1 If the patient is sitting lower their head and arms 20 1 2 Loosen tight clothing 20 1 3 Instruct the patient to take slow deep breaths 20 1 4 If possible escort the patient to a reclining chair and place a pillow under legs to help return blood flow to the head 20 1 5 20 1 6 Offer sips of cold water or juice 20 1 7 Have an emesis basin or bag available If patient has lost consciousness dial 911 and state First Responder Alert Then give the location 20 1 8 Do not allow a patient to leave the area before they feel
11. sje ur MINISTRY HEALTH CARE Ministry Saint Michael s Hospital Laboratory LABORATORY POLICY AND PROCEDURE PH001 05 Phlebotomy Specimen Procurement 6 6 2007 June 26 2014 All Saint Michaels Hospital Laboratories PRINCIPLE PURPOSE To obtain proper blood specimens for Laboratory analysis in the area of Hematology Chemistry Coagulation and Bacteriology for the purpose of aiding in the diagnosis and treatment of illnesses and disorders monitoring progress and following results of treatment PATIENT PREPARATION Some tests may require that the patient fast 8 to 10 hours Other tests may need to be drawn at a specific time such as post dose drug levels or timed glucose testing See corresponding in house procedure or reference manual specimen requirements for specific sample requirements SPECIMEN HANDLING As determined by tests ordered Serum plasma or whole blood may be required Refer to SMH blood collection requirements evacuated tube collection information and specific department test collection procedures and recommended order of draw MATERIALS No expired supplies are used Latex free supplies are used whenever possible Protective safety devices are not removed from equipment Evacuated tubes and bottles Alcohol wipes Sterile needles holders Non alcohol wipes if Syringes medical alcohol is ordered Transfer devices Bandages Tape Winged infusion sets Disposable gloves Gauze Personal Protective equ
12. uet before needle Apply pressure when bandaging If a hematoma occurs suggest that the patient apply 1ce to reduce swelling Increased pain and redness should be followed up by a physician Hemolysis Prevention 20 8 1 20 8 2 20 8 3 20 8 4 20 8 5 20 8 6 20 8 7 20 8 8 DERIVATION OF RESULTS Mix specimens gently but thoroughly invert 5 10 times Avoid drawing from a hematoma Avoid extreme pressure on the syringe plunger Avoid using small gauge needles Avoid frothing Thoroughly allow alcohol to dry before proceeding Slow start and stop draws may cause hemolysis Repeat collection with smaller needle if needed Refer to specific Laboratory Procedure REPORTING Refer to specific Laboratory Procedure NORMAL VALUES Page 7 of 14 PH 001 05 Venipuncture Rev 1 02 2013 Refer to specific Laboratory Procedure CRITERIA FOR IMMEDIATE NOTIFICATION Refer to specific Laboratory Procedure INTERPRETATION Refer to specific Laboratory Procedure CRITERIA FOR UNACCEPTABLE RESULTS AND CORRECTIVE ACTION 1 0 Unlabeled or incorrectly labeled tubes require repeat collection 2 0 Hemolyzed specimens if test is affected by hemolysis require repeat collection 3 0 Improperly processed or clotted specimens from anticoagulated tubes require repeat collection LIMITATIONS PROCEDURE NOTES Brera ep e a e e ps ame aalal 2 0 Samples will be drawn from lower extremities after checking with the pat
13. wall 9 3 6 Thrombosed veins 9 3 6 1 Thrombosed veins lack resilience feel cord like and roll easily 10 0 Palpate 10 1 Trace vein path several times 10 2 Vein will feel elastic resilient 11 0 Prepare Equipment 11 1 Evacuated system E22 Securely thread needle butterfly into adaptor Page 3 of 14 Rev 1 02 2015 11 2 Needle syringe 11 2 1 Sterile needle butterfly 11 2 2 Select appropriate size needle syringe combination 11 2 5 Move plunger to ensure freedom of movement and syringe needle patency 12 0 Order of Draw 12 1 Blood Cultures mix 3 5 times 12 3 Citrate Tube invert 3 4 times 12 4 SST gel separator tube plain red top invert 5 times 12 5 Heparin Tube PST gel separator tube invert 8 to 10 times 12 6 EDTA Tube invert 8 to 10 times 12 7 Oxalate Fluoride Tube invert 8 10 times 12 8 Any other additive tubes see manufacturer instructions 13 0 Cleanse venipuncture site 13 1 Cleanse with alcohol 13 1 1 Cleanse with a non alcohol wipe if a medical alcohol level is ordered 13 2 Allow site to thoroughly dry to prevent hemolysis 13 3 Re cleanse if site 1s re palpated 14 0 Uncap needle 14 1 Inspect the tip of the needle for burrs obstructions 15 0 Anchor Vein 15 1 Grasp the arm firmly using your thumb to draw the skin taut 15 2 Make sure the venipuncture site is in a downward position to prevent reflux 16 0 Perform the Venipuncture 16 1 Evacuated System 16 1 1 W
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