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Venipuncture Information and Courses from MediaLab, Inc.

These are the MediaLab courses that cover Venipuncture and links to relevant pages within the course.

Learn more about laboratory continuing education for medical technologists to earn CE credit for AMT, ASCP, NCA, and state license renewal and recertification. Or get information about laboratory safety and compliance courses that deliver cost-effective OSHA safety training and continuing education to your laboratory's employees.

Laboratories Individuals

CLIA General Laboratory Review
When drawing blood for coagulation studies, one should always:View Page
Which of the following is not appropriate for a routine blood specimen:View Page

Medical Error Prevention
RCA Value

A technologist performs a venipuncture for glucose testing on the wrong patient. This medical error leads to the patient receiving an incorrect dose of insulin and the patient goes into a coma--this medical error led to an adverse event. Analysis without RCA: Determines the technologist should have checked the patient's wristband (the immediate reaction).Questions why the technologist did not also verbally identify the patient (the subsequent reaction).Restates these reactions (in the internal follow-up review).Misses causes discoverable by a detailed and open investigation. Analysis with RCA: Includes descriptions of events leading up to a "wrong person procedure" in its reports.Describes 17 separate errors identified in the follow-up investigation.Recommends actions that should avoid reoccurrence of the error.

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Avoiding Systems Failure

Standardized systems should be used in virtually every circumstance to reduce errors. For example, medical errors can be avoided by using the standardizing procedure for preparing a venipunture site before drawing a blood alcohol specimen. A standardized system for this procedure is developed, published, trained, and posted. Everyone learns one protocol. Encouraging them to review and use the procedure for drawing blood alcohol tests avoids the error of using alcohol wipes to prepare the venipuncture site.

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Bleeding After a Venipuncture Can Be an Adverse Event

Excessive bleeding after a venipuncture can occur as a preventable or an unpreventable adverse event. Laboratory professionals might or might not have control over this situation because of the factors involved. For example: Bleeding due to failure to apply immediately pressure on the venipuncture site is a preventable adverse event. Bleeding due to later injury to the venipuncture site is an unpreventable event. Circumstances that cause the bleeding determine whether it is a preventable or unpreventable adverse event.

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Phlebotomy
Case

Julie Smith was a newly certified phlebotomist and had been working at Northwood Hospital for several months. As she approached room 825, she looked on her collection list to verify this was the correct room for her first collection. Indeed it was, even though there was no patient name on the door. Her collection list told her the patient in room 825 was a 55 year old male named John Ready. After knocking several times, Julie entered the room to find a middle aged man who appeared to be sleeping. Julie approached the patient and said, “Good day Mr. Ready. My name is Julie and I am from the lab. I need to draw blood for some tests ordered by your doctor.” The man awoke and seemed irritated as Julie repeated herself. The patient responded and told Julie to do whatever she needed to do so he could go back to sleep Julie then proceeded to do the venipuncture.

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Discussion

A phlebotomist should never use an arm with restricted usage for the venipuncture. Even if no sign is posted, the patient may tell you not to use a particular arm for various reasons, i.e. previous mastectomy, history of phlebitis, active AV fistula, etc. Do not draw blood above an IV line. If blood is taken from a vein above an IV line it might be diluted by the IV fluid, which could cause incorrect test results. In this case, Bobby should choose a vein on the dorsum of Mrs. Grayson’s hand, below the IV. A butterfly needle would facilitate drawing blood from these small hand veins.Relevant topics:Alternate sites, Sites to avoid, Signs, Arms to avoid

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Case

Bobby Jones, a phlebotomist at Georgetown Hospital, entered the room of Mrs. Mary Grayson with a physician's order to draw some blood work. After properly greeting Mrs. Grayson, identifying himself and checking her armband, Bobby prepared for the venipuncture. He suddenly notice a sign posted above the bed that read: “Restricted left arm usage. Previous mastectomy - Do no use left arm for venipuncture.” Bobby set up his equipment to use her right arm and noticed an IV line in Mrs. Grayson’s right arm positioned in a vein slightly above her wrist on the dorsum (top) of her forearm.

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Which site should Bobby choose for the venipuncture?View Page
Case

Julie Smith, a newly certified phlebotomist at Northlake Hospital, entered a patient’s room on the third floor for a routine blood draw. The patient was an elderly woman who had very small fragile veins. Julie therefore decided to use a safety butterfly needle attached to a Vacutainer tube in order to draw the blood. When Julie was finished with the venipuncture, she detached the butterfly needle from the Vacutainer, and approached the Biohazard needle disposal box. She noticed that the disposal box was full , but decided to try to fit the butterfly into the box anyway. Holding the butterfly by the tubing, she tried to push the butterfly into the box. The needle suddenly recoiled and stuck Julie’s finger. Julie left the patient’s room in a panic and headed back to the lab to report the needle stick injury.

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Case

A phlebotomist at Monroe Medical Center entered patient room and prepared for a venipuncture. The tests ordered were: BCP, CBC, and PTT. The phlebotomist pulled a tiger top tube, a lavender tube and a blue top tube from her tray.

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Discussion

The phlebotomist should always carefully observe the patient for clues about his mental and physical condition. In this case, the patient verbally expressed her fear of needles. In other cases, such fear may be expressed on the patient’s face or through other clues. It may help to engage apprehensive patients in conversation during the venipuncture to keep their mind off the procedure.As soon as the patient stated that she felt faint, the procedure should have been terminated. If a sitting patient faints, placing her head between her knees will help to revive her. Make sure the patient does not injure herself. Ammonium (smelling) salts, if in use at your institution, should be used cautiously, since they can be irritating. Get help from the nursing staff or a physician. Stay with the patient at least 15 minutes. The patient should not leave the area for at least 30 minutes. Make sure other appropriate institutional procedures are followed after fainting.Relevant topics:Fainting, Fainting continued

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Case

A phlebotomist at an outpatient drawing station prepares to collect blood from a patient who is scheduled for surgery the next day. The patient tells the phlebotomist that she is afraid of needles. The phlebotomist assures the patient that everything will be fine. He seats the patient in a phlebotomy chair. He talks the patient through the beginning of the venipuncture and she seemed to be doing fine. As the second of four tubes is being drawn, the patient suddenly blurts out that she fells very dizzy and is going to faint.

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What should the phlebotomist do now?View Page
What did the phlebotomist do wrong?View Page
Butterfly needles with built-in safety features continued

Two examples of butterfly needles with built-in safety devices are shown.The Punctur-Guard™ (Bioplexus), shown above, uses an internal blunt needle which is activated after blood is drawn. The activated device showing the blunt internal needle is shown in the inset on the upper right. The Angel Wing ™ (Monoject), is activated by sliding a safety shield over the needle after venipuncture.

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Needle holders with built-in protection devices

You will be required to use appropriate safety devices with your needle holder. Various options are available. The Needle-Pro™ Needle protection device (Sims Portex) shown here is an example of a needle holder with a built-in safety device. It is activated after venipuncture by pressing the orange protection device against any flat surface so as to engage the sheath firmly on the needle.

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Multiple draw needles

Multiple draw needles are used with vacuum collection tubes.They allow the collection of blood into multiple vacuum collection tubes during a single venipuncture. They have a retractable sheath over the portion of the needle that penetrates the blood tube.

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Routine Venipuncture equipment continued

Basic equipment includes: Alcohol swab, Bandage, Tube(s), Needle, Needle holderDo not remove the needle cover until you are ready to perform the venipuncture.

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Cleaning the site

Use an isopropyl alcohol swab to clean the site.Move the swab in an outward expanding spiral starting with the actual venipuncture site.

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Wash hands and apply gloves

Before Venipuncture: Wash hands and apply new gloves

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Routine venipuncture equipment

Basic equipment must be in close proximity to the venipuncture site for easy access.

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Cleaning the site continued

Allow the alcohol to dry prior to performing the venipunctureDrying gives the alcohol time to disinfect the site.It also tends to prevent a burning sensation from occurring during venipuncture.

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Hold vein in place

You may now hold the patients arm below the venipuncture site.Pull the skin below the vein to anchor it and keep it from rolling.

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Venipuncture Standard precautions

Treat all blood & body fluids as if they were infectious.Always wear gloves during vascular access procedures.

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Finger stick - Site preparation

If possible, use the fourth (ring) finger or the middle finger.Many patients prefer that you use fingers on their nondominant hand. Choose a puncture site near the right or left edge of the finger tip.Clean the site as you would for routine venipuncture.

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Select the site

Assemble the proper equipment, and place it in a convenient location.Apply the tourniquet, then choose a venipuncture site.

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Remove iodine

Clean the venipuncture site with alcohol to remove all the iodine from the patients arm, then apply a bandage.

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Clean the bottle tops

Clean blood culture bottles while the iodine on the venipuncture site is drying. Wipe the tops of the blood culture bottles, first with a new iodine swab, then with a clean alcohol pad.

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Fainting

Rarely, patients will faint during venipuncture.  It is therefore important that patients are properly seated or lying in such a way during venipuncture so that if they do faint, they won’t hurt themselves.A typical fainting spell is self-limited, and the patient usually “comes-to” in a few minutes or less.

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Blood should not be drawn from arms with IVs

Blood drawn from veins with intravenous lines (IVs) may be diluted by the IV fluids. Arms containing IVs should therefore not be used to draw blood specimens.  If an arm with an IV line in place must be used for venipuncture, be sure to choose a site below the location of the IV, so that the specimen will not be diluted with IV fluids.

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What if no blood flows when the needle is in place?

The needle may not be in a vein. Try slightly manipulating the needle. If no blood flows, withdraw the needle and repeat the venipuncture. Never probe the patient’s arm with the needle. The bevel of the needle may be compressed against the inside of the vein wall. Slightly manipulating the needle should result in blood flow.  The needle may have passed entirely through the vein. Pull it back slightly, and blood should flow.

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Unsatisfactory specimens

Poor and unsatisfactory specimens pose significant problems : They can cause misleading laboratory results.Unsatisfactory specimens must be rejected by the laboratory. The patient must then undergo another venipuncture to get a better specimen. It costs time & money to redraw the specimen.The credibility of the laboratory is reduced if too many unsatisfactory specimens are drawn.

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What is phlebotomy?

Phlebotomy, also known as venipuncture, means collecting blood from veins.Phlebotomists, by definition, collect venous blood, but perform a variety of other important medical tasks as well.

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Professionalism: appearance continued

Long hair should be arranged so that it does not touch the patient or venipuncture site during collection. Long necklaces should be avoided for the same reason. Excessively large rings should not be worn since they may damage gloves.

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Blood

Collect the blood specimen next, if required.Be sure to use the iodine swab provided in the collection kit to disinfect the venipuncture site.Do not use an alcohol swab, as this might lead to suspicion of a falsely elevated blood alcohol result.

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