Skill 07[1]..Venipuncture.pdf

SKILL 7

Venipuncture

EQUIPMENT

Syringe and needle (scalp vein or straight) or Vacutainer and

needle

Appropriate blood collection tubes

Labels

Completed laboratory requisition forms

Tourniquet or rubber band

Adhesive bandage

Antiseptic pads (alcohol or povidone-iodine)

Gloves, nonsterile

Dry gauze pads (2

Fowler’s position. Protects against injury if child should

become faint.

5. Put on nonsterile gloves. Protects from contact with

blood-borne organisms.

6. Apply tourniquet 3–4 inches above venipuncture site.

Provides improved visibility of veins as they dilate in

response to decreased venous return from extremity to

heart.

2 sponges, sterile)

NOTE: Tourniquet should be able to be removed by

pulling the end with a single motion.

GENERAL GUIDELINES FOR SPECIMEN

COLLECTION

1. Check physician’s order. Ensures appropriate specimen

obtained from the correct child.

2. Check child for allergies to any materials used, e.g.,

povidone-iodine.

3. Prepare child and family. Enhances cooperation/partici-

pation; reduces anxiety/fear.

7. Check for distal pulse. If none, tourniquet is too tight

and should be reapplied. If too tight, arterial blood flow

impeded.

8. Have child open and close fist several times, leaving fist

clenched prior to venipuncture. Muscle contraction

increases blood flow to the arm, increases venous disten-

tion, and enhances vein visibility.

NOTE: Vigorous motion may result in hemoconcentra-

tion of the specimen.

NOTE: Have an assistant hold/comfort the child as nec-

essary and in accordance with agency policy.

9. Maintain tourniquet only 1–2 minutes. Prolonged time

may increase child’s discomfort and alter some labora-

tory results, e.g., falsely high serum potassium.

10. Identify best venipuncture site by palpation. Ideal site is

straight, prominent vein that feels firm and slightly

rebounds when palpated. Straight, intact veins are eas-

ier to puncture. A thrombosed vein is rigid or rolls easily

and is difficult to stick.

11. Select site. If tourniquet has been on too long release it,

wait 1–2 minutes and reapply. Increases client comfort;

ensures accuracy of results.

12. Cleanse site with solution prescribed by the agency

using circular motion at the site and extending 2 inches

beyond the site. Allow to dry. Cleans skin surface of bac-

teria that may cause site infection; allowing antiseptic to

dry reduces stinging sensation.

13. Remove needle cover and warn child will feel needle

stick. Child better able to control reactions when knows

what to expect.

14. Place thumb or forefinger of nondominant hand 1 inch

below site and pull skin taut. Helps stabilize the vein

during insertion.

15. Hold needle at 15°–30° angle from skin, bevel up.

Reduces chance of penetrating through vein on inser-

tion. Causes less trauma to skin and vein.

4. Gather equipment. Promotes organization and effi-

ciency.

5. Wash hands. Don gloves. Reduces transmission of

microorganisms.

PROCEDURE

1. Steps 1–5 of General Guidelines.

2. Prepare equipment so you are ready to obtain sample.

Promotes organization and efficiency.

a. Syringe method: Have syringe with appropriate nee-

dle attached. A very small bore needle can damage

red blood cells, leading to inaccurate results.

b. Vacutainer method: Attach double-ended needle to

Vacutainer and have proper blood specimen tube

resting inside the Vacutainer. Do not puncture the

rubber stopper yet. Vacuum is lost when stopper is

punctured.

NOTE: Long end of needle punctures vein, short end

punctures stopper.

3. Raise or lower bed to a comfortable working height.

Maintains good body mechanics.

4. Extend arm to form a straight line from shoulder to

wrist; place a pillow or towel under upper arm to

enhance extension; child should be in supine or semi-

continued

SKILL 7

Venipuncture

continued

16. Slowly insert needle. Prevents puncture through other

side of vein.

17. After entering vein, slowly lower needle toward skin.

Thread needle along path of vein. Decreases risk of pen-

etrating other side of vein.

18. Check for blood flow.

a. Syringe method: Gently pull back on plunger and

look for blood return. Obtain desired amount of

blood.

b. Vacutainer method.

1. Hold Vacutainer securely and advance specimen

tube into needle of holder, being careful not to

advance the needle further into the vein. Blood

should flow into the collection tube. Pushing the

needle through the stopper breaks the vacuum

and causes blood to flow into the collection tube.

Failure of blood to appear in collection tube indi-

cates vacuum in tube has been lost or needle is not

in vein.

2. After collection tube full, grasp Vacutainer firmly

and remove tube; insert additional collection

tubes as needed.

19. After specimen collection complete, remove tourniquet.

Reduces bleeding from pressure when needle is removed.

20. Apply 2

d. If any specimen tubes contain additives, gently rotate

back and forth 8–10 times. Ensures additive is prop-

erly mixed throughout the specimen.

23. Inspect the puncture site for bleeding. Reapply a clean

tape and gauze if necessary. Keeps site clean and dry.

24. Assist child to a comfortable position.

25. Check tubes for external blood. If any, wipe away with

alcohol. Prevents contamination of equipment and other

personnel.

26. Check tubes for proper labeling. Place tubes in appro-

priate bag or container along with laboratory requisition

slips. Ensures specimen properly identified and appro-

priate test performed.

27. Dispose of equipment in appropriate manner.

Consistent with handling of body fluids.

28. Remove gloves. Wash hands. Reduces transmission of

microorganisms.

29. Send specimens to laboratory.

2 gauze over puncture site without applying

pressure and quickly remove the needle from the vein.

Positions gauze for removal and helps to gently prevent

skin from pulling with needle removal.

21. Immediately apply pressure over venipuncture site with

gauze for 2–3 minutes or until the bleeding has stopped.

Hold arm straight. Stops bleeding and minimizes forma-

tion of a hematoma. Bending the elbow can facilitate

hematoma formation.

22. If syringe method used to obtain sample, transfer blood

to appropriate specimen tube.

a. Carefully transfer blood to the appropriate specimen

container. If specimen not handled carefully, RBCs

can be destroyed and false readings may be obtained.

b. Using one hand, insert the needle into the appropri-

ate collection tube and allow vacuum to fill the tube.

Allowing tube to fill slowly helps prevent hemolysis.

Using one hand helps reduce chance of needle stick

injury.

c. Alternative method is to remove stopper from collec-

tion tube and needle from syringe. Fill the tube with

the amount of blood needed and replace the stopper.

This method allows you to control speed and amount

of fill in collection tubes .

DOCUMENTATION

1. Time, source/site, specimen sent to lab (specify for what

test).

2. Record results of any test performed on the unit.

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