Venipuncture Procedure Notes

1. Test Requisition Form

  • Must accompany every sample; part of patient's medical record

  • Required info:

    1. Patient's first & last name

    1. Identification number

    1. Date of birth

    1. Patient's location

    1. Ordering healthcare provider's name

    1. Test requested

    1. Requested date & time of collection

    1. Status (Stat, Timed, Routine)

    1. Number/type of collection tube, special collection & patient info

    1. Billing information

2. Greeting the Patient

  • Introduce yourself, state you're from the laboratory

  • Explain that you'll be collecting a blood sample

  • Use nontechnical terms the patient can understand

  • Obtain patient's permission before proceeding

3. Entering a Patient's Room

  • Observe signs on door/room for special instructions:

    1. Allergic to latex

    1. Nothing by mouth (NPO)

    1. Do not resuscitate (DNR)

    1. Do not draw blood from a particular arm

    1. Infection control precautions

    1. Patient expired

4. Patient Identification

  • Most important procedure in phlebotomy

  • CAP & JC require minimum 2 patient identifiers

    • Patient's wrist band

    • Verbal communication

Inpatient ID

  • Let the patient state their full name

  • Check wrist ID band: name, hospital ID number, DOB, physician

Outpatient ID

  • Ask patient to state full name, address, birth date, and/or unique ID number

  • May use photo identification

Bar Code Technology

  • Wireless hand-held computer scans patient's hospital ID band barcode

  • Matches against blood collection order to verify correct patient

5. Patient Preparation & Positioning

  • CLSI guidelines emphasize: accurate ID, proper fasting, timing

  • Verify fasting status, document collection time, educate patient on restrictions

6. Equipment Selection

Collect the following:

  1. Collection equipment

  1. Antiseptic pads

  1. Gauze or bandages

  1. Needle disposal system (sharps container)

  1. Blood collection system

  • Assemble tubes in correct order; check expiration dates

  • Place supplies on the same side as your free hand

7. Tourniquet Application

  • Apply 3–4 inches above the selected site

  • Tight enough to restrict venous flow but NOT arterial pulse

  • Secure with a quick-release knot facing upward

  • Do NOT leave on for more than 1 minute (prevents hemoconcentration)

  • CLSI: release for 2 minutes before reapplying

Steps:

  1. Position strip 3–4 in. above site (avoid skin lesions; can apply over gown)

  1. Grasp both sides, cross over patient's arm while maintaining tension

  1. Hold both ends between thumb & forefinger close to arm

  1. Tuck left side under right to make a partial loop facing antecubital area

  1. Ends should point upward, away from the venipuncture site

  1. Pull end of loop to release with one hand

8. Site Selection — Antecubital Fossa Veins

Vein

Priority

Notes

Median Cubital

1st choice

Large, doesn't move, least painful, fewer nerve endings

Cephalic

2nd choice

Thumb side of arm, hard to locate, tends to roll

Basilic

Last choice

Near brachial artery & median nerve, tends to roll, least anchored

  • H-pattern (~70% of population): cephalic, median cubital, basilic

  • M-pattern: cephalic, median cephalic, median basilic, basilic

  • Hand/wrist veins: secondary site when antecubital veins aren't accessible (elderly, scarring, edema, hematoma)

9. Palpation

  • Use tip of index finger of nondominant hand

  • Probe antecubital area with pushing motion

  • Feel vein in both vertical and horizontal direction

10. Cleansing the Site

  • Use 70% isopropyl alcohol

  • Traditional: center outward in a spiral motion (~2–3 inches)

  • Current CLSI: back-and-forth friction scrub for 30 seconds

  • Air dry 30–60 seconds

  • Do NOT re-palpate after cleansing

11. Performing the Venipuncture

  1. Examine the needle — remove cap, inspect tip for defects, bevel facing up

  1. Anchor the vein — thumb of nondominant hand, 1–2 in. below & slightly left of site; four fingers on back of arm, pull skin tight

  1. Insert the needle — bevel up, 15–30° angle depending on vein depth

  1. Fill the tube — release anchor hand, push tube into holder; release tourniquet within 1 min; keep needle steady; gently insert/remove tubes

12. Removal of the Needle

  • Release tourniquet first, ask patient to relax

  • Withdraw needle smoothly, activate safety device

  • Apply firm pressure with gauze for 2–3 minutes, arm extended (prevents hematoma)

13. Disposal of the Needle

  • Immediately dispose needle + holder in sharps container

  • Never bend, cut, recap, or leave needle unattended

14. Labeling the Tubes

  • Label immediately after collection, before leaving the patient

  • Verify patient ID; ensure accurate labeling

  • Label info: patient's complete name, age, sex, DOB, date & time of collection, phlebotomist's initials

15. Bandaging the Patient's Arm

  • Ensure bleeding stops (~5 min) before bandaging

  • Apply gauze with tape or Coban

  • Instruct patient to remove bandage after 1 hour and avoid heavy arm use

16. Disposing of Used Material

  • Discard contaminated items in biohazard containers

  • Sharps containers: do not fill past ¾ full or the "full" line

  • Remove gloves, perform hand hygiene

17. Leaving the Patient

  • Confirm site has stopped bleeding

  • Apply secure bandage

  • Label all tubes before leaving bedside

  • Verify patient feels well; watch for complications (e.g., fainting)

18. Transporting Samples

  • Use standard precautions

  • Seal in leak-proof biohazard bags

  • Maintain specific temperatures for sample integrity

  • Use cushioned, rigid, labeled containers

  • Follow triple packaging protocols to prevent contamination & leakage