Edited for Class Phlebotomy

© 2004 Elsevier, Inc. All rights reserved. Slide 1

CHAPTER - 17CHAPTER - 17 PHLEBOTOMYPHLEBOTOMY CHAPTER - 17CHAPTER - 17 PHLEBOTOMYPHLEBOTOMY


Introduction to Phlebotomy Introduction to Phlebotomy Introduction to Phlebotomy Introduction to Phlebotomy

Purpose of phlebotomy: collect blood for laboratory Purpose of phlebotomy: collect blood for laboratory analysisanalysisTypes of blood collections:Types of blood collections:

• Arterial puncture (performed in a hospital setting; Arterial puncture (performed in a hospital setting; not by medical assistants)not by medical assistants)

• Venipuncture Venipuncture • Skin puncture Skin puncture

Purpose of phlebotomy: collect blood for laboratory Purpose of phlebotomy: collect blood for laboratory analysisanalysisTypes of blood collections:Types of blood collections:

• Arterial puncture (performed in a hospital setting; Arterial puncture (performed in a hospital setting; not by medical assistants)not by medical assistants)

• Venipuncture Venipuncture • Skin puncture Skin puncture


Venipuncture Venipuncture Venipuncture Venipuncture

Puncturing of a vein for the removal of a venous Puncturing of a vein for the removal of a venous blood sampleblood samplePerformed when a large blood specimen is neededPerformed when a large blood specimen is neededMethodsMethods

• Vacuum tube:Vacuum tube: use of evacuated tube (glass or plastic use of evacuated tube (glass or plastic tube containing a vacuum)tube containing a vacuum) FastestFastest Most convenientMost convenient Most often usedMost often used

• Butterfly and syringe:Butterfly and syringe: for difficult draws (e.g., small for difficult draws (e.g., small veins)veins)

Puncturing of a vein for the removal of a venous Puncturing of a vein for the removal of a venous blood sampleblood samplePerformed when a large blood specimen is neededPerformed when a large blood specimen is neededMethodsMethods

• Vacuum tube:Vacuum tube: use of evacuated tube (glass or plastic use of evacuated tube (glass or plastic tube containing a vacuum)tube containing a vacuum) FastestFastest Most convenientMost convenient Most often usedMost often used

• Butterfly and syringe:Butterfly and syringe: for difficult draws (e.g., small for difficult draws (e.g., small veins)veins)


General Guidelines for Venipuncture General Guidelines for Venipuncture General Guidelines for Venipuncture General Guidelines for Venipuncture

Patient preparation for venipuncturePatient preparation for venipunctureProvide patient with advance prep, if requiredProvide patient with advance prep, if required

• Patient prep listed in reference sources (e.g., lab Patient prep listed in reference sources (e.g., lab directory)directory)

• Ask patient if he/she prep properly before performing Ask patient if he/she prep properly before performing (i.e. if need to be fasting, verify before drawing blood) (i.e. if need to be fasting, verify before drawing blood)

• Just before inserting needle, tell patient he/she will Just before inserting needle, tell patient he/she will ““feel a small stick”feel a small stick”

• Avoids startling patient, which could cause patient to Avoids startling patient, which could cause patient to movemove

Patient preparation for venipuncturePatient preparation for venipunctureProvide patient with advance prep, if requiredProvide patient with advance prep, if required

• Patient prep listed in reference sources (e.g., lab Patient prep listed in reference sources (e.g., lab directory)directory)

• Ask patient if he/she prep properly before performing Ask patient if he/she prep properly before performing (i.e. if need to be fasting, verify before drawing blood) (i.e. if need to be fasting, verify before drawing blood)

• Just before inserting needle, tell patient he/she will Just before inserting needle, tell patient he/she will ““feel a small stick”feel a small stick”

• Avoids startling patient, which could cause patient to Avoids startling patient, which could cause patient to movemove


Patient Position of Venipuncture Patient Position of Venipuncture Patient Position of Venipuncture Patient Position of Venipuncture

Depends on vein being usedDepends on vein being usedMost common VP site: antecubital spaceMost common VP site: antecubital space

• Patient should be seated in chairPatient should be seated in chair• Arm extended in downward position to form straight Arm extended in downward position to form straight

line from shoulder to wrist with palm facing upline from shoulder to wrist with palm facing up• Arm should be well supported on armrest by rolled Arm should be well supported on armrest by rolled

towel or by patient placing fist of the other hand towel or by patient placing fist of the other hand under elbowunder elbow

• If patient state that he/she faints during VP, draw with pt. lying If patient state that he/she faints during VP, draw with pt. lying and arm extended off of tableand arm extended off of table

Depends on vein being usedDepends on vein being usedMost common VP site: antecubital spaceMost common VP site: antecubital space

• Patient should be seated in chairPatient should be seated in chair• Arm extended in downward position to form straight Arm extended in downward position to form straight

line from shoulder to wrist with palm facing upline from shoulder to wrist with palm facing up• Arm should be well supported on armrest by rolled Arm should be well supported on armrest by rolled

towel or by patient placing fist of the other hand towel or by patient placing fist of the other hand under elbowunder elbow

• If patient state that he/she faints during VP, draw with pt. lying If patient state that he/she faints during VP, draw with pt. lying and arm extended off of tableand arm extended off of table


Patient Position of Venipuncture Patient Position of Venipuncture Patient Position of Venipuncture Patient Position of Venipuncture

Never have patient on stool or standingNever have patient on stool or standing• Fainting could occur; patient may be injuredFainting could occur; patient may be injured

Venous reflux:Venous reflux: blood flows from evacuated blood flows from evacuated tube back into patient’s vein tube back into patient’s vein

• Can cause patient to have adverse reaction to a tube Can cause patient to have adverse reaction to a tube additive (particularly EDTA-Lavender tube)additive (particularly EDTA-Lavender tube)

• To prevent:, keep keeping patient’s arm in a downward To prevent:, keep keeping patient’s arm in a downward positionposition

Never have patient on stool or standingNever have patient on stool or standing• Fainting could occur; patient may be injuredFainting could occur; patient may be injured

Venous reflux:Venous reflux: blood flows from evacuated blood flows from evacuated tube back into patient’s vein tube back into patient’s vein

• Can cause patient to have adverse reaction to a tube Can cause patient to have adverse reaction to a tube additive (particularly EDTA-Lavender tube)additive (particularly EDTA-Lavender tube)

• To prevent:, keep keeping patient’s arm in a downward To prevent:, keep keeping patient’s arm in a downward positionposition


Application of the Tourniquet Application of the Tourniquet Application of the Tourniquet Application of the Tourniquet

PurposePurpose: makes patient’s veins stand out so they : makes patient’s veins stand out so they are easier to palpateare easier to palpateCauses venous blood to slow down and pool in Causes venous blood to slow down and pool in veins in front of tourniquetveins in front of tourniquetWhen applying:, important to obtain correct tensionWhen applying:, important to obtain correct tension

• Should slow (not stop!!) venous flow without affecting Should slow (not stop!!) venous flow without affecting arterial flowarterial flow

• Too tight:Too tight: obstructs arterial and venous flow and may obstructs arterial and venous flow and may give inaccurate test resultsgive inaccurate test results

• Too loose:Too loose: veins won’t stand out enough to be veins won’t stand out enough to be palpatedpalpated

• Should fit snugly and not pinch skinShould fit snugly and not pinch skin

PurposePurpose: makes patient’s veins stand out so they : makes patient’s veins stand out so they are easier to palpateare easier to palpateCauses venous blood to slow down and pool in Causes venous blood to slow down and pool in veins in front of tourniquetveins in front of tourniquetWhen applying:, important to obtain correct tensionWhen applying:, important to obtain correct tension

• Should slow (not stop!!) venous flow without affecting Should slow (not stop!!) venous flow without affecting arterial flowarterial flow

• Too tight:Too tight: obstructs arterial and venous flow and may obstructs arterial and venous flow and may give inaccurate test resultsgive inaccurate test results

• Too loose:Too loose: veins won’t stand out enough to be veins won’t stand out enough to be palpatedpalpated

• Should fit snugly and not pinch skinShould fit snugly and not pinch skin


Guidelines for Applying the Tourniquet Guidelines for Applying the Tourniquet Guidelines for Applying the Tourniquet Guidelines for Applying the Tourniquet

• Do not apply over sores or burned skinDo not apply over sores or burned skin• Place 3 to 4 inches above bend in elbowPlace 3 to 4 inches above bend in elbow• Ask patient to clinch fist: pushes blood from lower Ask patient to clinch fist: pushes blood from lower

arm into veins for easier palpationarm into veins for easier palpation• Never leave on for more than 1 minNever leave on for more than 1 min

Uncomfortable for patientUncomfortable for patient Causes venous blood to stagnate and can alter Causes venous blood to stagnate and can alter

resultsresults

• Do not apply over sores or burned skinDo not apply over sores or burned skin• Place 3 to 4 inches above bend in elbowPlace 3 to 4 inches above bend in elbow• Ask patient to clinch fist: pushes blood from lower Ask patient to clinch fist: pushes blood from lower

arm into veins for easier palpationarm into veins for easier palpation• Never leave on for more than 1 minNever leave on for more than 1 min

Uncomfortable for patientUncomfortable for patient Causes venous blood to stagnate and can alter Causes venous blood to stagnate and can alter

resultsresults


Guidelines for Applying the Tourniquet Guidelines for Applying the Tourniquet Guidelines for Applying the Tourniquet Guidelines for Applying the Tourniquet

• Remove tourniquet when good blood flow is Remove tourniquet when good blood flow is established (Note: it is best to remove established (Note: it is best to remove tourniquet just before removing needle)tourniquet just before removing needle)

• Always remove the tourniquet before Always remove the tourniquet before removing the needleremoving the needle If needle removed first: blood is forced out If needle removed first: blood is forced out

of puncture site into surrounding skin of puncture site into surrounding skin causing a hematomacausing a hematoma

• Remove tourniquet when good blood flow is Remove tourniquet when good blood flow is established (Note: it is best to remove established (Note: it is best to remove tourniquet just before removing needle)tourniquet just before removing needle)

• Always remove the tourniquet before Always remove the tourniquet before removing the needleremoving the needle If needle removed first: blood is forced out If needle removed first: blood is forced out

of puncture site into surrounding skin of puncture site into surrounding skin causing a hematomacausing a hematoma


Types of Tourniquets Types of Tourniquets Types of Tourniquets Types of Tourniquets

• Rubber tourniquet:Rubber tourniquet: flat, soft band of rubber flat, soft band of rubber Advantage: easily removed with one hand Advantage: easily removed with one hand

Velcro-closure tourniquetVelcro-closure tourniquet Band of rubber with Velcro attached at endsBand of rubber with Velcro attached at ends Easier to apply; more comfortable for patientEasier to apply; more comfortable for patient Disadvantage: more difficult to remove; may not fit Disadvantage: more difficult to remove; may not fit

around arm of obese patientsaround arm of obese patients

• Rubber tourniquet:Rubber tourniquet: flat, soft band of rubber flat, soft band of rubber Advantage: easily removed with one hand Advantage: easily removed with one hand

Velcro-closure tourniquetVelcro-closure tourniquet Band of rubber with Velcro attached at endsBand of rubber with Velcro attached at ends Easier to apply; more comfortable for patientEasier to apply; more comfortable for patient Disadvantage: more difficult to remove; may not fit Disadvantage: more difficult to remove; may not fit

around arm of obese patientsaround arm of obese patients


Site Selection for Venipuncture Site Selection for Venipuncture Site Selection for Venipuncture Site Selection for Venipuncture

Best site usually located in antecubital space Best site usually located in antecubital space Antecubital space:Antecubital space: surface of arm in front of elbow surface of arm in front of elbow

• Veins have wide lumen, easily accessible, close to Veins have wide lumen, easily accessible, close to surface of skinsurface of skin

• Skin is less sensitive; less pain for patientSkin is less sensitive; less pain for patient

Do not use small spidery veins on surface of skinDo not use small spidery veins on surface of skin

Best site usually located in antecubital space Best site usually located in antecubital space Antecubital space:Antecubital space: surface of arm in front of elbow surface of arm in front of elbow

• Veins have wide lumen, easily accessible, close to Veins have wide lumen, easily accessible, close to surface of skinsurface of skin

• Skin is less sensitive; less pain for patientSkin is less sensitive; less pain for patient

Do not use small spidery veins on surface of skinDo not use small spidery veins on surface of skin


Site Selection for Venipuncture Site Selection for Venipuncture Site Selection for Venipuncture Site Selection for Venipuncture

Veins to use:Veins to use:• Median cubital:Median cubital: best vein; located in middle of best vein; located in middle of

antecubital spaceantecubital space

• Basilic and cephalic:Basilic and cephalic: located on either side, located on either side, when median cubital cannot be usedwhen median cubital cannot be used Disadvantage: may roll; firm pressure should be Disadvantage: may roll; firm pressure should be

applied below vein to stabilize itapplied below vein to stabilize it

Veins to use:Veins to use:• Median cubital:Median cubital: best vein; located in middle of best vein; located in middle of

antecubital spaceantecubital space

• Basilic and cephalic:Basilic and cephalic: located on either side, located on either side, when median cubital cannot be usedwhen median cubital cannot be used Disadvantage: may roll; firm pressure should be Disadvantage: may roll; firm pressure should be

applied below vein to stabilize itapplied below vein to stabilize it


Site Selection for VenipunctureSite Selection for VenipunctureSite Selection for VenipunctureSite Selection for Venipuncture

Brachial artery is located in antecubital spaceBrachial artery is located in antecubital space• Artery Artery pulsatespulsates, is more elastic, and has a , is more elastic, and has a thickerthicker

wallwall• If punctured patient feels more pain and blood is If punctured patient feels more pain and blood is

bright redbright red and and comes out pulsingcomes out pulsing If occurs: remove tourniquet and needle, apply If occurs: remove tourniquet and needle, apply

pressure with gauze pad for 4 to 5 minpressure with gauze pad for 4 to 5 min

Brachial artery is located in antecubital spaceBrachial artery is located in antecubital space• Artery Artery pulsatespulsates, is more elastic, and has a , is more elastic, and has a thickerthicker

wallwall• If punctured patient feels more pain and blood is If punctured patient feels more pain and blood is

bright redbright red and and comes out pulsingcomes out pulsing If occurs: remove tourniquet and needle, apply If occurs: remove tourniquet and needle, apply

pressure with gauze pad for 4 to 5 minpressure with gauze pad for 4 to 5 min


Antecubital veins Antecubital veins Antecubital veins Antecubital veins


Guidelines for Site Selection Guidelines for Site Selection Guidelines for Site Selection Guidelines for Site Selection

• Examine antecubital veins in both armsExamine antecubital veins in both arms Ask patient which vein which arm is usually used Ask patient which vein which arm is usually used

for VP.for VP.

• Ensure that veins “stand out” as much as possibleEnsure that veins “stand out” as much as possible Apply tourniquet Apply tourniquet Ask patient to clench fistAsk patient to clench fist

• Palpate for median cubital vein first; celphalic is Palpate for median cubital vein first; celphalic is second choice (does not roll as much as basilic)second choice (does not roll as much as basilic)

((

• Examine antecubital veins in both armsExamine antecubital veins in both arms Ask patient which vein which arm is usually used Ask patient which vein which arm is usually used

for VP.for VP.

• Ensure that veins “stand out” as much as possibleEnsure that veins “stand out” as much as possible Apply tourniquet Apply tourniquet Ask patient to clench fistAsk patient to clench fist

• Palpate for median cubital vein first; celphalic is Palpate for median cubital vein first; celphalic is second choice (does not roll as much as basilic)second choice (does not roll as much as basilic)

((


Guidelines for Site SelectionGuidelines for Site SelectionGuidelines for Site SelectionGuidelines for Site Selection

• Use inspection and palpation to palpate veinUse inspection and palpation to palpate vein Vein does not have to be seen in order to be a good Vein does not have to be seen in order to be a good

selectionselection Vein feels like an elastic tube (gives under pressure)Vein feels like an elastic tube (gives under pressure)

• Thoroughly assess veinThoroughly assess vein Place one or two fingertips over veinPlace one or two fingertips over vein Press lightly, then release pressurePress lightly, then release pressure Do not use thumb to palpate (not as sensitive)Do not use thumb to palpate (not as sensitive) Good vein feels round, firm, elastic, and engorgedGood vein feels round, firm, elastic, and engorged

• Use inspection and palpation to palpate veinUse inspection and palpation to palpate vein Vein does not have to be seen in order to be a good Vein does not have to be seen in order to be a good

selectionselection Vein feels like an elastic tube (gives under pressure)Vein feels like an elastic tube (gives under pressure)

• Thoroughly assess veinThoroughly assess vein Place one or two fingertips over veinPlace one or two fingertips over vein Press lightly, then release pressurePress lightly, then release pressure Do not use thumb to palpate (not as sensitive)Do not use thumb to palpate (not as sensitive) Good vein feels round, firm, elastic, and engorgedGood vein feels round, firm, elastic, and engorged


Guidelines for Site SelectionGuidelines for Site SelectionGuidelines for Site SelectionGuidelines for Site Selection

• Do not leave tourniquet on for more than 1 minDo not leave tourniquet on for more than 1 min Causes patient discomfort and hemoconcentration Causes patient discomfort and hemoconcentration

• Hints to make veins more prominent:Hints to make veins more prominent: Remove tourniquet and have patient dangle arm Remove tourniquet and have patient dangle arm

over side of chair 1to 2 minover side of chair 1to 2 min Tap vein site sharply a few times with index and Tap vein site sharply a few times with index and

second fingers ( Do not do the arm slap thing!!!)second fingers ( Do not do the arm slap thing!!!) Gently massage the arm from wrist to elbowGently massage the arm from wrist to elbow Apply warm, moist washcloth for 5 minApply warm, moist washcloth for 5 min

• Do not leave tourniquet on for more than 1 minDo not leave tourniquet on for more than 1 min Causes patient discomfort and hemoconcentration Causes patient discomfort and hemoconcentration

• Hints to make veins more prominent:Hints to make veins more prominent: Remove tourniquet and have patient dangle arm Remove tourniquet and have patient dangle arm

over side of chair 1to 2 minover side of chair 1to 2 min Tap vein site sharply a few times with index and Tap vein site sharply a few times with index and

second fingers ( Do not do the arm slap thing!!!)second fingers ( Do not do the arm slap thing!!!) Gently massage the arm from wrist to elbowGently massage the arm from wrist to elbow Apply warm, moist washcloth for 5 minApply warm, moist washcloth for 5 min


Alternative Venipuncture Sites Alternative Venipuncture Sites Alternative Venipuncture Sites Alternative Venipuncture Sites

Alternative sites:Alternative sites:• Inner forearmInner forearm• Wrist area above thumbWrist area above thumb

• Back of handBack of hand Are smaller and have thinner wallsAre smaller and have thinner wallsUse veins in hands as a last resortUse veins in hands as a last resort

• Have a tendency to rollHave a tendency to roll• Are more difficult to stickAre more difficult to stick• Abundant supply of nerves in hand; uncomfortable for patientAbundant supply of nerves in hand; uncomfortable for patient• Thin walls make them susceptible to collapsing, bruisingThin walls make them susceptible to collapsing, bruising

Alternative sites:Alternative sites:• Inner forearmInner forearm• Wrist area above thumbWrist area above thumb

• Back of handBack of hand Are smaller and have thinner wallsAre smaller and have thinner wallsUse veins in hands as a last resortUse veins in hands as a last resort

• Have a tendency to rollHave a tendency to roll• Are more difficult to stickAre more difficult to stick• Abundant supply of nerves in hand; uncomfortable for patientAbundant supply of nerves in hand; uncomfortable for patient• Thin walls make them susceptible to collapsing, bruisingThin walls make them susceptible to collapsing, bruising


Alternative Venipuncture SitesAlternative Venipuncture SitesAlternative Venipuncture SitesAlternative Venipuncture Sites


Types of Blood Specimens Types of Blood Specimens Types of Blood Specimens Types of Blood Specimens

Clotted blood:Clotted blood: obtained from tube with no obtained from tube with no anticoagulantanticoagulantSerum:Serum: obtained from clotted blood: allow specimen obtained from clotted blood: allow specimen to stand and then centrifuge itto stand and then centrifuge it

• Separates into serum and cells Separates into serum and cells

Whole blood:Whole blood: use tube containing an anticoagulant use tube containing an anticoagulant to prevent clottingto prevent clotting

• Tube must be gently inverted 8 to 10 timesTube must be gently inverted 8 to 10 times

Clotted blood:Clotted blood: obtained from tube with no obtained from tube with no anticoagulantanticoagulantSerum:Serum: obtained from clotted blood: allow specimen obtained from clotted blood: allow specimen to stand and then centrifuge itto stand and then centrifuge it

• Separates into serum and cells Separates into serum and cells

Whole blood:Whole blood: use tube containing an anticoagulant use tube containing an anticoagulant to prevent clottingto prevent clotting

• Tube must be gently inverted 8 to 10 timesTube must be gently inverted 8 to 10 times


Types of Blood SpecimensTypes of Blood SpecimensTypes of Blood SpecimensTypes of Blood Specimens

Plasma:Plasma: obtained from whole blood that has been obtained from whole blood that has been centrifugedcentrifuged

• Separates into:Separates into: Top layer: plasmaTop layer: plasma Middle layer: buffy coat (WBCs and platelets)Middle layer: buffy coat (WBCs and platelets) Bottom layer: RBCsBottom layer: RBCs

Plasma:Plasma: obtained from whole blood that has been obtained from whole blood that has been centrifugedcentrifuged

• Separates into:Separates into: Top layer: plasmaTop layer: plasma Middle layer: buffy coat (WBCs and platelets)Middle layer: buffy coat (WBCs and platelets) Bottom layer: RBCsBottom layer: RBCs


Types of Blood Specimens Types of Blood Specimens Types of Blood Specimens Types of Blood Specimens


OSHA Safety Precautions (Just in case OSHA Safety Precautions (Just in case you forgot!!!)you forgot!!!)OSHA Safety Precautions (Just in case OSHA Safety Precautions (Just in case you forgot!!!)you forgot!!!)

• Wear gloves Wear gloves • Wear face shields (or masks and eye protection) whenever Wear face shields (or masks and eye protection) whenever

splashes, spray, splatter, or droplets of blood may be splashes, spray, splatter, or droplets of blood may be generatedgenerated

• Perform all procedures involving blood in a manner so as to Perform all procedures involving blood in a manner so as to minimize splashing, spraying, splattering, and generating minimize splashing, spraying, splattering, and generating droplets of blooddroplets of blood

• Bandage cuts before gloving Bandage cuts before gloving • Wash hands after removing glovesWash hands after removing gloves• If hands or other skin surface come in contact with blood: If hands or other skin surface come in contact with blood:

wash with soap and water ASAPwash with soap and water ASAP

• Wear gloves Wear gloves • Wear face shields (or masks and eye protection) whenever Wear face shields (or masks and eye protection) whenever

splashes, spray, splatter, or droplets of blood may be splashes, spray, splatter, or droplets of blood may be generatedgenerated

• Perform all procedures involving blood in a manner so as to Perform all procedures involving blood in a manner so as to minimize splashing, spraying, splattering, and generating minimize splashing, spraying, splattering, and generating droplets of blooddroplets of blood

• Bandage cuts before gloving Bandage cuts before gloving • Wash hands after removing glovesWash hands after removing gloves• If hands or other skin surface come in contact with blood: If hands or other skin surface come in contact with blood:

wash with soap and water ASAPwash with soap and water ASAP


OSHA Safety Precautions OSHA Safety Precautions OSHA Safety Precautions OSHA Safety Precautions

• If mucous membranes come in contact with blood: flush with If mucous membranes come in contact with blood: flush with water ASAPwater ASAP

• Do not break, bend, or shear contaminated venipuncture Do not break, bend, or shear contaminated venipuncture needlesneedles

• Do not recap contaminated venipuncture needleDo not recap contaminated venipuncture needle• Immediately after use place needle (and holder) in Immediately after use place needle (and holder) in

biohazard sharps containerbiohazard sharps container• Place blood specimens in containers that prevent leakage during Place blood specimens in containers that prevent leakage during

collection, handling, processing, storage, transport, or shippingcollection, handling, processing, storage, transport, or shipping• If exposed to blood:, report incident immediately to your If exposed to blood:, report incident immediately to your

physician/employerphysician/employer

• If mucous membranes come in contact with blood: flush with If mucous membranes come in contact with blood: flush with water ASAPwater ASAP

• Do not break, bend, or shear contaminated venipuncture Do not break, bend, or shear contaminated venipuncture needlesneedles

• Do not recap contaminated venipuncture needleDo not recap contaminated venipuncture needle• Immediately after use place needle (and holder) in Immediately after use place needle (and holder) in

biohazard sharps containerbiohazard sharps container• Place blood specimens in containers that prevent leakage during Place blood specimens in containers that prevent leakage during

collection, handling, processing, storage, transport, or shippingcollection, handling, processing, storage, transport, or shipping• If exposed to blood:, report incident immediately to your If exposed to blood:, report incident immediately to your

physician/employerphysician/employer


Vacuum Tube Method of Venipuncture Vacuum Tube Method of Venipuncture Vacuum Tube Method of Venipuncture Vacuum Tube Method of Venipuncture

Frequently used to collect venous blood specimensFrequently used to collect venous blood specimensConsists of:Consists of:

• Collection needleCollection needle• Plastic needle holderPlastic needle holder• Evacuated tubeEvacuated tube

Commercially available system: VacutainerCommercially available system: Vacutainer

Frequently used to collect venous blood specimensFrequently used to collect venous blood specimensConsists of:Consists of:

• Collection needleCollection needle• Plastic needle holderPlastic needle holder• Evacuated tubeEvacuated tube

Commercially available system: VacutainerCommercially available system: Vacutainer


Vacuum Tube Method of VenipunctureVacuum Tube Method of VenipunctureVacuum Tube Method of VenipunctureVacuum Tube Method of Venipuncture

(…Cont’d)(…Cont’d)(…Cont’d)(…Cont’d)


NeedleNeedleNeedleNeedle

Available in 20 to 22 gaugeAvailable in 20 to 22 gauge• 21 gauge most commonly used21 gauge most commonly used

Two lengths: 1 inch or 1½ inchesTwo lengths: 1 inch or 1½ inches

Available in 20 to 22 gaugeAvailable in 20 to 22 gauge• 21 gauge most commonly used21 gauge most commonly used

Two lengths: 1 inch or 1½ inchesTwo lengths: 1 inch or 1½ inches


NeedleNeedleNeedleNeedle


Plastic Holder Plastic Holder Plastic Holder Plastic Holder

Consists of plastic cylinder with two openingsConsists of plastic cylinder with two openings• Small opening: used to secure needleSmall opening: used to secure needle• Large opening: holds evacuated tubeLarge opening: holds evacuated tube

Flange:Flange: extension on large opening extension on large opening• Assists in insertion and removal of tubesAssists in insertion and removal of tubes• Prevents holder from rolling when placed on a flat Prevents holder from rolling when placed on a flat

surfacesurface

Consists of plastic cylinder with two openingsConsists of plastic cylinder with two openings• Small opening: used to secure needleSmall opening: used to secure needle• Large opening: holds evacuated tubeLarge opening: holds evacuated tube

Flange:Flange: extension on large opening extension on large opening• Assists in insertion and removal of tubesAssists in insertion and removal of tubes• Prevents holder from rolling when placed on a flat Prevents holder from rolling when placed on a flat

surfacesurface


Safety-Engineered Venipuncture Devices Safety-Engineered Venipuncture Devices Safety-Engineered Venipuncture Devices Safety-Engineered Venipuncture Devices

OSHA stipulates requirements to reduce needlestick OSHA stipulates requirements to reduce needlestick and other sharps injuries Employers must evaluate and other sharps injuries Employers must evaluate

and implement safer and implement safer medical devicesmedical devices

• Includes safety-engineered VP devices Includes safety-engineered VP devices Have a built-in safety feature to reduce risk of Have a built-in safety feature to reduce risk of

needlestick injuryneedlestick injury

((

OSHA stipulates requirements to reduce needlestick OSHA stipulates requirements to reduce needlestick and other sharps injuries Employers must evaluate and other sharps injuries Employers must evaluate

and implement safer and implement safer medical devicesmedical devices

• Includes safety-engineered VP devices Includes safety-engineered VP devices Have a built-in safety feature to reduce risk of Have a built-in safety feature to reduce risk of

needlestick injuryneedlestick injury

((


Safety-Engineered Venipuncture DevicesSafety-Engineered Venipuncture DevicesSafety-Engineered Venipuncture DevicesSafety-Engineered Venipuncture Devices


Evacuated Tubes Evacuated Tubes Evacuated Tubes Evacuated Tubes

Glass tube with rubber stopperGlass tube with rubber stopperContains vacuum that creates suctionContains vacuum that creates suction

• Pulls blood specimen into tubePulls blood specimen into tube

Glass tube with rubber stopperGlass tube with rubber stopperContains vacuum that creates suctionContains vacuum that creates suction

• Pulls blood specimen into tubePulls blood specimen into tube



Color-coded for easy identification of additive Color-coded for easy identification of additive • Red:Red: does not contain an anticoagulant does not contain an anticoagulant

Used to obtain clotted blood or serumUsed to obtain clotted blood or serum

• Lavender:Lavender: EDTA (anticoagulant) EDTA (anticoagulant) Used to obtain whole blood or plasma (e.g., Used to obtain whole blood or plasma (e.g.,

CBC)CBC)

• Light blue:Light blue: sodium citrate (anticoagulant) sodium citrate (anticoagulant) Used to obtain whole blood or plasma Used to obtain whole blood or plasma

Color-coded for easy identification of additive Color-coded for easy identification of additive • Red:Red: does not contain an anticoagulant does not contain an anticoagulant

Used to obtain clotted blood or serumUsed to obtain clotted blood or serum

• Lavender:Lavender: EDTA (anticoagulant) EDTA (anticoagulant) Used to obtain whole blood or plasma (e.g., Used to obtain whole blood or plasma (e.g.,

CBC)CBC)

• Light blue:Light blue: sodium citrate (anticoagulant) sodium citrate (anticoagulant) Used to obtain whole blood or plasma Used to obtain whole blood or plasma



• Green:Green: heparin (anticoagulant) heparin (anticoagulant) For blood gas determinations and pH assaysFor blood gas determinations and pH assays

• Gray:Gray: potassium oxalate (anticoagulant) potassium oxalate (anticoagulant) Used to obtain whole blood or plasma (e.g., GTT)Used to obtain whole blood or plasma (e.g., GTT)

• Dark blue:Dark blue: heparin or no additive heparin or no additive Made of refined glass and special stopperMade of refined glass and special stopper Used to detect trace elements (e.g., lead, arsenic)Used to detect trace elements (e.g., lead, arsenic)

• Green:Green: heparin (anticoagulant) heparin (anticoagulant) For blood gas determinations and pH assaysFor blood gas determinations and pH assays

• Gray:Gray: potassium oxalate (anticoagulant) potassium oxalate (anticoagulant) Used to obtain whole blood or plasma (e.g., GTT)Used to obtain whole blood or plasma (e.g., GTT)

• Dark blue:Dark blue: heparin or no additive heparin or no additive Made of refined glass and special stopperMade of refined glass and special stopper Used to detect trace elements (e.g., lead, arsenic)Used to detect trace elements (e.g., lead, arsenic)


Evacuated TubesEvacuated TubesEvacuated TubesEvacuated Tubes

((((



Additive used depends on type of test performedAdditive used depends on type of test performed• Do not substitute one additive for anotherDo not substitute one additive for another

Leads to inaccurate resultsLeads to inaccurate results

Label of tube indicates: Label of tube indicates: • Additive contentAdditive content• Expiration dateExpiration date• Tube capacityTube capacity

Additive used depends on type of test performedAdditive used depends on type of test performed• Do not substitute one additive for anotherDo not substitute one additive for another

Leads to inaccurate resultsLeads to inaccurate results

Label of tube indicates: Label of tube indicates: • Additive contentAdditive content• Expiration dateExpiration date• Tube capacityTube capacity



(…Cont’d)(…Cont’d)

(Cont’d…)(Cont’d…)

(…Cont’d)(…Cont’d)

(Cont’d…)(Cont’d…)


Order of Draw for Multiple Tubes Order of Draw for Multiple Tubes Order of Draw for Multiple Tubes Order of Draw for Multiple Tubes

Blood culture tubesBlood culture tubes• Drawn first to prevent contamination by other Drawn first to prevent contamination by other

tubestubes

Red-stoppered tubes-known as red plain topsRed-stoppered tubes-known as red plain tops • To prevent contamination of nonadditive tubes by To prevent contamination of nonadditive tubes by

additive tubesadditive tubes

Blood culture tubesBlood culture tubes• Drawn first to prevent contamination by other Drawn first to prevent contamination by other

tubestubes

Red-stoppered tubes-known as red plain topsRed-stoppered tubes-known as red plain tops • To prevent contamination of nonadditive tubes by To prevent contamination of nonadditive tubes by

additive tubesadditive tubes


Order of Draw for Multiple TubesOrder of Draw for Multiple TubesOrder of Draw for Multiple TubesOrder of Draw for Multiple Tubes

Coagulation tubes (light blue)Coagulation tubes (light blue)• To prevent erroneous test resultsTo prevent erroneous test results• When needle penetrates skin: thromboplastin can When needle penetrates skin: thromboplastin can

enter blood specimen affecting resultsenter blood specimen affecting results• If no other tube is needed: red-stoppered should be If no other tube is needed: red-stoppered should be

drawn first to prevent contamination by thromboplastin drawn first to prevent contamination by thromboplastin or draw two blue tops and discard the firstor draw two blue tops and discard the first

Serum separator tubes Serum separator tubes Additive tubes:Additive tubes: in this order: green, lavender, gray in this order: green, lavender, gray

Coagulation tubes (light blue)Coagulation tubes (light blue)• To prevent erroneous test resultsTo prevent erroneous test results• When needle penetrates skin: thromboplastin can When needle penetrates skin: thromboplastin can

enter blood specimen affecting resultsenter blood specimen affecting results• If no other tube is needed: red-stoppered should be If no other tube is needed: red-stoppered should be

drawn first to prevent contamination by thromboplastin drawn first to prevent contamination by thromboplastin or draw two blue tops and discard the firstor draw two blue tops and discard the first

Serum separator tubes Serum separator tubes Additive tubes:Additive tubes: in this order: green, lavender, gray in this order: green, lavender, gray


Evacuated Tube Guidelines Evacuated Tube Guidelines Evacuated Tube Guidelines Evacuated Tube Guidelines

Select proper tubes Select proper tubes • According to tests being performed According to tests being performed

• Amount of specimen neededAmount of specimen needed

Check tubes for cracks; will not hold vacuumCheck tubes for cracks; will not hold vacuum

Check expiration dateCheck expiration date: outdated tube may not have : outdated tube may not have

a vacuum and lab will not process results.a vacuum and lab will not process results.

Label tube with patient’s name, date, MA initialsLabel tube with patient’s name, date, MA initials

Select proper tubes Select proper tubes • According to tests being performed According to tests being performed

• Amount of specimen neededAmount of specimen needed

Check tubes for cracks; will not hold vacuumCheck tubes for cracks; will not hold vacuum

Check expiration dateCheck expiration date: outdated tube may not have : outdated tube may not have

a vacuum and lab will not process results.a vacuum and lab will not process results.

Label tube with patient’s name, date, MA initialsLabel tube with patient’s name, date, MA initials


Evacuated Tube GuidelinesEvacuated Tube GuidelinesEvacuated Tube GuidelinesEvacuated Tube Guidelines

Fill tubes until vacuum is exhaustedFill tubes until vacuum is exhausted• Tube will be almost, but not quite fullTube will be almost, but not quite full• Prevents rush of air from entering tube and Prevents rush of air from entering tube and

damaging cellsdamaging cells• Tube with additive: ensures proper ratio of additive Tube with additive: ensures proper ratio of additive

to bloodto blood

Fill tubes until vacuum is exhaustedFill tubes until vacuum is exhausted• Tube will be almost, but not quite fullTube will be almost, but not quite full• Prevents rush of air from entering tube and Prevents rush of air from entering tube and

damaging cellsdamaging cells• Tube with additive: ensures proper ratio of additive Tube with additive: ensures proper ratio of additive

to bloodto blood


Evacuated Tube Guidelines Evacuated Tube Guidelines Evacuated Tube Guidelines Evacuated Tube Guidelines

Remove last tube from plastic holder before removing Remove last tube from plastic holder before removing needleneedle• Prevents blood from dripping out of needlePrevents blood from dripping out of needle

Mix tubes containing anticoagulant immediatelyMix tubes containing anticoagulant immediately• Invert tube gently 8 to 10 timesInvert tube gently 8 to 10 times• Shaking tube causes hemolysisShaking tube causes hemolysis• Inadequate mixing may cause inaccurate test resultsInadequate mixing may cause inaccurate test results

After VP:, top of stopper may contain residual bloodAfter VP:, top of stopper may contain residual blood• Follow OSHA BBPs Standard to avoid exposureFollow OSHA BBPs Standard to avoid exposure

Remove last tube from plastic holder before removing Remove last tube from plastic holder before removing needleneedle• Prevents blood from dripping out of needlePrevents blood from dripping out of needle

Mix tubes containing anticoagulant immediatelyMix tubes containing anticoagulant immediately• Invert tube gently 8 to 10 timesInvert tube gently 8 to 10 times• Shaking tube causes hemolysisShaking tube causes hemolysis• Inadequate mixing may cause inaccurate test resultsInadequate mixing may cause inaccurate test results

After VP:, top of stopper may contain residual bloodAfter VP:, top of stopper may contain residual blood• Follow OSHA BBPs Standard to avoid exposureFollow OSHA BBPs Standard to avoid exposure


Butterfly Method of Venipuncture Butterfly Method of Venipuncture Butterfly Method of Venipuncture Butterfly Method of Venipuncture

Also called winged infusion methodAlso called winged infusion methodTerm “butterfly” derived from plastic wings located Term “butterfly” derived from plastic wings located between needle and tubing between needle and tubing Use:Use:

• Adult patients with small antecubital veinsAdult patients with small antecubital veins• Children, who typically have small antecubital veinsChildren, who typically have small antecubital veins• When antecubital veins not available and an When antecubital veins not available and an

alternative site is used (e.g., hand)alternative site is used (e.g., hand)

Also called winged infusion methodAlso called winged infusion methodTerm “butterfly” derived from plastic wings located Term “butterfly” derived from plastic wings located between needle and tubing between needle and tubing Use:Use:

• Adult patients with small antecubital veinsAdult patients with small antecubital veins• Children, who typically have small antecubital veinsChildren, who typically have small antecubital veins• When antecubital veins not available and an When antecubital veins not available and an

alternative site is used (e.g., hand)alternative site is used (e.g., hand)


Butterfly Method of Venipuncture Butterfly Method of Venipuncture Butterfly Method of Venipuncture Butterfly Method of Venipuncture

Gauge of needle: 21 to 23Gauge of needle: 21 to 23Length of needle: ½ to ¾ inchLength of needle: ½ to ¾ inchNeedle attached to tubing Needle attached to tubing Luer adapter attached to posterior needleLuer adapter attached to posterior needle

Plastic holder screwed into Luer adapter Plastic holder screwed into Luer adapter

Also available with a hub adapter; used to attach Also available with a hub adapter; used to attach syringe syringe Safety needles availableSafety needles available

Gauge of needle: 21 to 23Gauge of needle: 21 to 23Length of needle: ½ to ¾ inchLength of needle: ½ to ¾ inchNeedle attached to tubing Needle attached to tubing Luer adapter attached to posterior needleLuer adapter attached to posterior needle

Plastic holder screwed into Luer adapter Plastic holder screwed into Luer adapter

Also available with a hub adapter; used to attach Also available with a hub adapter; used to attach syringe syringe Safety needles availableSafety needles available


Butterfly Method of VenipunctureButterfly Method of VenipunctureButterfly Method of VenipunctureButterfly Method of Venipuncture


Guidelines for the Butterfly Method Guidelines for the Butterfly Method Guidelines for the Butterfly Method Guidelines for the Butterfly Method

Patient positionPatient position• Antecubital, wrist, and forearm veinsAntecubital, wrist, and forearm veins

Arm in straight line from shoulder to wristArm in straight line from shoulder to wrist

• Hand veinsHand veins Hand on armrest with loose fist or grasp a rolled Hand on armrest with loose fist or grasp a rolled

toweltowel Locate vein between knuckles and wrist bonesLocate vein between knuckles and wrist bones

TourniquetTourniquet• Forearm or wrist: 3 inches above siteForearm or wrist: 3 inches above site• Hand: just above wrist boneHand: just above wrist bone

Patient positionPatient position• Antecubital, wrist, and forearm veinsAntecubital, wrist, and forearm veins

Arm in straight line from shoulder to wristArm in straight line from shoulder to wrist

• Hand veinsHand veins Hand on armrest with loose fist or grasp a rolled Hand on armrest with loose fist or grasp a rolled

toweltowel Locate vein between knuckles and wrist bonesLocate vein between knuckles and wrist bones

TourniquetTourniquet• Forearm or wrist: 3 inches above siteForearm or wrist: 3 inches above site• Hand: just above wrist boneHand: just above wrist bone


Guidelines for the Butterfly Method Guidelines for the Butterfly Method Guidelines for the Butterfly Method Guidelines for the Butterfly Method

Compress plastic wings togetherCompress plastic wings together• Insert with bevel up at 15-degree angle to skinInsert with bevel up at 15-degree angle to skin• Once entered:, decrease angle to 5 degreesOnce entered:, decrease angle to 5 degrees

After needle insertion:After needle insertion: slowly thread needle inside slowly thread needle inside vein an additional ¼ inch.vein an additional ¼ inch.

• Anchors needle in center of veinAnchors needle in center of vein

To prevent venous reflux: To prevent venous reflux: keep tube and holder in keep tube and holder in a downward position a downward position Follow proper order of drawFollow proper order of draw (same as for vacuum (same as for vacuum tube method)tube method)

Compress plastic wings togetherCompress plastic wings together• Insert with bevel up at 15-degree angle to skinInsert with bevel up at 15-degree angle to skin• Once entered:, decrease angle to 5 degreesOnce entered:, decrease angle to 5 degrees

After needle insertion:After needle insertion: slowly thread needle inside slowly thread needle inside vein an additional ¼ inch.vein an additional ¼ inch.

• Anchors needle in center of veinAnchors needle in center of vein

To prevent venous reflux: To prevent venous reflux: keep tube and holder in keep tube and holder in a downward position a downward position Follow proper order of drawFollow proper order of draw (same as for vacuum (same as for vacuum tube method)tube method)


Syringe Method of VenipunctureSyringe Method of VenipunctureSyringe Method of VenipunctureSyringe Method of Venipuncture

Least used methodLeast used method• Blood specimen must be transferred from syringe to Blood specimen must be transferred from syringe to

evacuated tubeevacuated tube Risk of accidental needlestickRisk of accidental needlestick

Used to obtain blood from small veins that are likely Used to obtain blood from small veins that are likely to collapseto collapseOffers more control than other methodsOffers more control than other methodsOnce vein is entered, specimen obtained by pulling Once vein is entered, specimen obtained by pulling back on plunger of syringeback on plunger of syringe

Least used methodLeast used method• Blood specimen must be transferred from syringe to Blood specimen must be transferred from syringe to

evacuated tubeevacuated tube Risk of accidental needlestickRisk of accidental needlestick

Used to obtain blood from small veins that are likely Used to obtain blood from small veins that are likely to collapseto collapseOffers more control than other methodsOffers more control than other methodsOnce vein is entered, specimen obtained by pulling Once vein is entered, specimen obtained by pulling back on plunger of syringeback on plunger of syringe


Problems Encountered with Problems Encountered with Venipuncture Venipuncture Problems Encountered with Problems Encountered with Venipuncture Venipuncture

Failure to obtain bloodFailure to obtain bloodMay occur with:May occur with:

• Obese patients: often have small veins, superficial Obese patients: often have small veins, superficial veins, and veins buried deeper in adipose tissueveins, and veins buried deeper in adipose tissue

• Elderly patients with arteriosclerosis may have Elderly patients with arteriosclerosis may have veins that are thick and hardveins that are thick and hard Are difficult to punctureAre difficult to puncture

• Veins that are small or thin-walled are likely to Veins that are small or thin-walled are likely to collapsecollapse

After two unsuccessful attempts, notify physicianAfter two unsuccessful attempts, notify physician

Failure to obtain bloodFailure to obtain bloodMay occur with:May occur with:

• Obese patients: often have small veins, superficial Obese patients: often have small veins, superficial veins, and veins buried deeper in adipose tissueveins, and veins buried deeper in adipose tissue

• Elderly patients with arteriosclerosis may have Elderly patients with arteriosclerosis may have veins that are thick and hardveins that are thick and hard Are difficult to punctureAre difficult to puncture

• Veins that are small or thin-walled are likely to Veins that are small or thin-walled are likely to collapsecollapse

After two unsuccessful attempts, notify physicianAfter two unsuccessful attempts, notify physician


Failure to Obtain Blood Failure to Obtain Blood Failure to Obtain Blood Failure to Obtain Blood

Factors that result in failure to obtain blood once Factors that result in failure to obtain blood once needle has been inserted: needle has been inserted:

• Not inserting needle far enough prevents needle from Not inserting needle far enough prevents needle from entering the vein entering the vein

• Inserting too far causes needle to go through veinInserting too far causes needle to go through vein

Factors that result in failure to obtain blood once Factors that result in failure to obtain blood once needle has been inserted: needle has been inserted:

• Not inserting needle far enough prevents needle from Not inserting needle far enough prevents needle from entering the vein entering the vein

• Inserting too far causes needle to go through veinInserting too far causes needle to go through vein


Failure to Obtain Blood Failure to Obtain Blood Failure to Obtain Blood Failure to Obtain Blood

• Bevel opening becoming lodged against veinBevel opening becoming lodged against vein

• Bevel opening becoming lodged against veinBevel opening becoming lodged against vein


Failure to Obtain BloodFailure to Obtain BloodFailure to Obtain BloodFailure to Obtain Blood

Remove needle if blood not obtained: do not probe Remove needle if blood not obtained: do not probe • Uncomfortable for patientUncomfortable for patient• May affect integrity of blood specimenMay affect integrity of blood specimen

Occasionally, evacuated tube may not have a Occasionally, evacuated tube may not have a vacuum; replace with a new tubevacuum; replace with a new tube

Remove needle if blood not obtained: do not probe Remove needle if blood not obtained: do not probe • Uncomfortable for patientUncomfortable for patient• May affect integrity of blood specimenMay affect integrity of blood specimen

Occasionally, evacuated tube may not have a Occasionally, evacuated tube may not have a vacuum; replace with a new tubevacuum; replace with a new tube


Inappropriate Puncture Sites Inappropriate Puncture Sites Inappropriate Puncture Sites Inappropriate Puncture Sites

If patient complains of pain or soreness, avoid siteIf patient complains of pain or soreness, avoid siteDo not use areas that are:Do not use areas that are:

• ScarredScarred• BruisedBruised• BurnedBurned

• Adjacent to areas of infectionAdjacent to areas of infection Avoid an arm in a cast or affected by mastectomyAvoid an arm in a cast or affected by mastectomy

If patient complains of pain or soreness, avoid siteIf patient complains of pain or soreness, avoid siteDo not use areas that are:Do not use areas that are:

• ScarredScarred• BruisedBruised• BurnedBurned

• Adjacent to areas of infectionAdjacent to areas of infection Avoid an arm in a cast or affected by mastectomyAvoid an arm in a cast or affected by mastectomy


Scarred and Sclerosed Veins Scarred and Sclerosed Veins Scarred and Sclerosed Veins Scarred and Sclerosed Veins

Caused by:Caused by:• Many venipunctures over years (scarred veins)Many venipunctures over years (scarred veins)• Elderly patients with arteriosclerosis (sclerosed Elderly patients with arteriosclerosis (sclerosed

veins)veins)

Veins feel stiff and hard; difficult to stickVeins feel stiff and hard; difficult to stickRecommended: use another veinRecommended: use another vein

• If not possible:, insert needle with careful pressure If not possible:, insert needle with careful pressure to avoid going through veinto avoid going through vein

Caused by:Caused by:• Many venipunctures over years (scarred veins)Many venipunctures over years (scarred veins)• Elderly patients with arteriosclerosis (sclerosed Elderly patients with arteriosclerosis (sclerosed

veins)veins)

Veins feel stiff and hard; difficult to stickVeins feel stiff and hard; difficult to stickRecommended: use another veinRecommended: use another vein

• If not possible:, insert needle with careful pressure If not possible:, insert needle with careful pressure to avoid going through veinto avoid going through vein


Collapsing Veins Collapsing Veins Collapsing Veins Collapsing Veins

Most likely to collapse: small veins with thin wallsMost likely to collapse: small veins with thin wallsMore likely to occur with vacuum tube methodMore likely to occur with vacuum tube method

Sucking action of vacuum causes vein to collapseSucking action of vacuum causes vein to collapse

Use butterfly or syringe method on patients with small Use butterfly or syringe method on patients with small veinsveins

Most likely to collapse: small veins with thin wallsMost likely to collapse: small veins with thin wallsMore likely to occur with vacuum tube methodMore likely to occur with vacuum tube method

Sucking action of vacuum causes vein to collapseSucking action of vacuum causes vein to collapse

Use butterfly or syringe method on patients with small Use butterfly or syringe method on patients with small veinsveins


Premature Needle Withdrawal Premature Needle Withdrawal Premature Needle Withdrawal Premature Needle Withdrawal

Needle comes out of vein prematurelyNeedle comes out of vein prematurelyCaused byCaused by

• Patient movementPatient movement• Improper VP techniqueImproper VP technique

Blood is forced out of puncture site from pressure of Blood is forced out of puncture site from pressure of tourniquettourniquetImmediate action is required to prevent hematoma:Immediate action is required to prevent hematoma:

• Remove tourniquet Remove tourniquet • Apply pressure with gauze until bleeding stopsApply pressure with gauze until bleeding stops

Needle comes out of vein prematurelyNeedle comes out of vein prematurelyCaused byCaused by

• Patient movementPatient movement• Improper VP techniqueImproper VP technique

Blood is forced out of puncture site from pressure of Blood is forced out of puncture site from pressure of tourniquettourniquetImmediate action is required to prevent hematoma:Immediate action is required to prevent hematoma:

• Remove tourniquet Remove tourniquet • Apply pressure with gauze until bleeding stopsApply pressure with gauze until bleeding stops


Hematoma Hematoma Hematoma Hematoma

Blood leaks from vein, resulting in a bruiseBlood leaks from vein, resulting in a bruiseCause:Cause:

• Needle inserted too far and goes through vein Needle inserted too far and goes through vein • Bevel opening is partially within and partially out of Bevel opening is partially within and partially out of

vein vein • Applying insufficient pressure after removal of needleApplying insufficient pressure after removal of needle

First sign: sudden swelling in area around puncture First sign: sudden swelling in area around puncture sitesite

• Remove tourniquet and needle STATRemove tourniquet and needle STAT• Apply pressure until bleeding stopsApply pressure until bleeding stops

Blood leaks from vein, resulting in a bruiseBlood leaks from vein, resulting in a bruiseCause:Cause:

• Needle inserted too far and goes through vein Needle inserted too far and goes through vein • Bevel opening is partially within and partially out of Bevel opening is partially within and partially out of

vein vein • Applying insufficient pressure after removal of needleApplying insufficient pressure after removal of needle

First sign: sudden swelling in area around puncture First sign: sudden swelling in area around puncture sitesite

• Remove tourniquet and needle STATRemove tourniquet and needle STAT• Apply pressure until bleeding stopsApply pressure until bleeding stops


HematomaHematomaHematomaHematoma

(…Cont’d)(…Cont’d)(…Cont’d)(…Cont’d)

Documents

Edited for Class Phlebotomy