Tourniquet Information and Courses from MediaLab, Inc.

Tourniquets wrap around the arm to increase venous pressure, and fill the veins, so that they are easier to see, feel, and puncture. They can be made of latex, Velcro, or other material.

Removing the needle:Gently release the tourniquet before the last tube of blood is filled.Remove the last tube from the needle.Withdraw the needle in a single quick movement.

Tie the tourniquet just above the elbow.The tourniquet should be tight enough to stop venous blood flow in the superficial arm veins.

Firmly grasp the infants foot. Do not use a tourniquet. The heel may be warmed with a cloth to help increase blood flow. Wipe the collection site with an alcohol prep pad, and allow the alcohol to dry. Wipe the site with sterile cotton or gauze, to be sure all the alcohol has been removed.

Posted signs should alert you to patient allergies. Some patients may be allergic to latex gloves or tourniquets, or to iodine.Avoid using latex in case of allergy. Latex allergies are fairly common, and can be severe. May health-care institutions have reduced the use of latex because of allergies, but complete elimination of latex in the hospital environment is difficult, since it is a component of many medical products.

Hidden errors are those that cannot be detected or corrected by the laboratory analyst prior to testing. Most often these errors can be prevented by the phlebotomist following correct venipuncture procedure for every procedure, every time.Hidden errors include hemoconcentration, incorrect order of draw, and (the most serious of all errors) misidentification of patient or specimens. Because these errors often are unknown, the analyst may inadvertently report erroneous patient results which could be harmful to the safety and well-being of the patient. Condition What is it? How does it happen? What is the Result? Hemoconcentration Blood pools at site of venipuncture Tourniquet is applied for a prolonged period of time Test results may be inaccurate because blood components move between blood and tissues Pouring Blood between tubes Mixing contents of two or more tubes Removing top of tube to combine contents of one tube with another Inaccurate test results due to over or under dilution or incorrect anticoagulant Clots form due to lack of mixing Patient may have to be redrawn Incorrect patient identification and incorrect specimen labeling Using the wrong name to label a specimen Failure to positively identify EVERY patient using 2 unique identifiers BEFORE beginning venipuncture Failure to label EVERY specimen in the presence of the patient Failure to concentrate fully on the task Results reported to caregiver for wrong patient Compromises patient care; may be life-threatening

A tourniquet is used by the phlebotomist to assess and determine the location of a suitable vein for venipuncture. Single-use, latex-free tourniquets are preferred but reusable tourniquets are acceptable. However, if the reusable tourniquet becomes contaminated with blood or body fluid, it must be discarded immediately to avoid the spread of harmful contaminants to other patients. Follow the guidelines established by your facility for cleaning reusable tourniquets.Proper application of a tourniquet will partially impede venous blood flow back toward the heart and cause the blood to temporarily pool in the vein so the vein is more prominent and the blood is more easily obtained. The tourniquet is applied three to four inches above the needle insertion point and should remain in place no longer than one minute to prevent hemoconcentration. If the tourniquet is used during preliminary vein selection, it is best to release the tourniquet after assessing the vein and while you are assembling your supplies. Reapply the tourniquet just before starting the venipuncture; it should then be released soon after the needle has been inserted into the vein and the blood flows into the first tube. If collecting multiple tubes, the tourniquet may remain in place until blood enters the last tube.

Hand position: It is best practice to position the patient's hand slightly downward with the top of the hand facing the phlebotomist. The fingers of the patient's hand should be rolled underneath and wrapped around the fingers of the phlebotomist's "anchoring" hand forming a loose fist. The phlebotomist should use his or her thumb to pull back gently on the surface of the skin, making the skin taut. The vein should be anchored adequately to proceed with venipuncture. The phlebotomist may have the patient roll his/her fingers over a pillow or a rolled up washcloth to make the hand vein more prominent.Tourniquet Position: The tourniquet should always be applied 3 - 4 inches above the needle insertion point. Therefore, when assessing for a usable vein in a hand, apply the tourniquet 1 - 2 inches above the wrist. If the tourniquet is on longer than one minute, release and reapply prior to venipuncture to avoid hemoconcentration.Cautions: Choose a straight section of the hand vein-- avoid the "intersection" or "V" where a vein branches into another vein. This juncture may contain a valve and could be damaged if punctured. Only use the top of a hand or thumb-side of the wrist for puncture. Avoid the fingers or the underside of the wrist. This will prevent the inadvertent puncture of hidden arteries, tendons or nerves in the area.

Required Step Description Step #1 Wash your hands. Clean your hands with soap and water or gel cleanser. Step #2 Positively identify patient using unique identifiers. Ask the patient to state his/her first and last name; if the patient is unable to give you this information, ask the patient's caregiver to confirm the patient's name. A second unique identifier must also be used. Step #3 Special test requirements Determine if the test to be obtained has any special requirements. For example, should the patient be fasting? Is this a timed test? If any requirements are not met, consult with the caregiver to determine a course of action. Step #4 Prepare the patient Explain the procedure to the patient and obtain cooperation. Usually the patient will extend an arm. (This is a form of implied consent.) Position the arm for venipuncture; support the arm on a firm surface; the arm should be in a downward position. Step #5 Site determination The patient can make a fist, but should not pump the hand open and closed. Apply tourniquet Palpate the vein. Release the tourniquet and assemble appropriate equipment. Step #6 Aseptic technique Wear gloves that have not been altered in any way. Cleanse site with approved disinfectant. Allow the disinfectant to air-dry to avoid hemolysis of the specimen and discomfort to the patient. Step #7 Specimen collection Re-apply tourniquet about 3-4 inches above puncture site, insert needle, bevel-side up, at about a 30° angle, and collect specimens. Remove needle and immediately activate the safety device. Mix specimens by gentle inversion 5-10 times. Step #8 Patient care Apply direct pressure to stop bleeding at puncture site; do not have patient bend arm as this may cause a hematoma to form. After about 2 minutes, check the puncture site to verify that bleeding has stopped. Apply bandage if appropriate. Thank the patient for his/her cooperation. Step #9 Specimen labeling Label specimen(s) in the presence of the patient including all the information that is required by your facility. Check the labeled tubes a second time against the patient's wristband to verify labeling accuracy. A professional phlebotomist follows the procedure in the same way for every venipuncture. This ensures that none of the vital steps are omitted. The phlebotomist who is consistent in performance and who concentrates fully to obtain a quality specimen is an indispensable part of the healthcare team.