Procedure 40-3

Venipuncture by Vacuum tube system

STANDARD PRECAUTIONS                                     

PURPOSE:

Ø  To obtain Verious blood acceptable for laboratory testing as requested by a provider.

EQUIPMENT/SUPPLIES:

·         Gloves

·         Googles and mask

·         Vacuum tube

·         Adapter/holder

·         Lab requisition (optional)

·         70% isopropyl

·         Alcohol swab

·         Cotton balls21-gauge multidraw

·         Needle

·         Vacuum tube or (s) special

·         Collection tube (s)

·         Torniquet

·         Adhesive bandage or tape

·         Sharps container and

·         biohazard red bag

·         Biohazard transport bag (optional)

PROCEDURE STEPS

1.      Place specimen and requesition into biohazard transfer bag.

2.      Position and identify the patient. Ask the patient’s name and verify it with the test ordered and the computer label or identification number. If a fasting specimen is required, verify that the patient has not had anything to cat or drink except water for 12 hours. RATIONALE: Proper identification of the patient and the test ordered and ensuring that the patient is properly prepared for the blood test or all quality-control and quality assurancen measures.

3.      Wash hands and apply gloves and googles/mask. RATIONALE: Clean hands further protect the patient. Gloves protectyon. Googles mask should be worn if there is a possibility of blood splatter.

4.      Break the seal on teh shorter needle, thread the shorter needle into the holder/adapter (do not puncture the tube yet). RATIONALE: Preparing the equipment ahead of time ensures a smoother process.

5.      Tap all tubes containing coagulants check the expiration dates. RATIONALE: Tapping the tube ensures that all the additive dislodged from the stopper and wall of the tubes. Checking expiration dates is a quality assurance measure.

6.      Select a site and apply  the torniquet (see procedure 40-1). RATIONALE: Applying the torniquet causes the vein to enlarge for easier venipuncture.

7.      Ask the patient to close the hand. The patient must not pump the hand. Place the hand in a downward position. RATOINALE: Closing the hand and placing the arm in a down ward position further enlarges the vein, allowing for easier venipuncture, pumping  the hand can damage the quality of the specimen collected.

8.      Select a vein, nothing the location and direction of the vein. RATIONALE: This allows you to prepare mentally for the venipuncture (Figure 40-33A).

9.      Cleanse the size with an alcohol swap with one firm swip. RATIONALE: Alcohol removes body oils and contaminations (Figure 40-33B).

10.  Avoid touching the site after cleansing. RATIONALE: The site should stay as clean as possible.

11.  Draw the skin taut with your thumb by placing it 1 to 2 inches below the puncture site. RATIONALE: This will anchor the vein.

12.  With the bevel up, line up the needle with the direction of the vein and perfome the puncture. The point of the needle should enter the skin about ¼ inch below where the vein waas palpated. With experience, a sensation of entering the vein can be felt. Once the vein has been entered, do not move the needle. RATIONALE: Lining up the needle with the vein is a mental exercise to help enter the vein in the proper direction. Entering the skin a fraction of an inch below the palpated site will aid in entering the vein at the palpated site (Figure 40-33C).

13.  Let go of the skin and use that hand to graps the flange of the vacuum tube holder and push the tube forward until the needle has completely entered the tube (Figure 33-40D). Do not change hands while performing venipuncture. The hand performing venipunctureb is the hand that is holding the vacuum tube holder. The other hand is free for tube insertion and removal. RATIONALE: Using the flange of the adapter helps you hold the needle steady while changing hands while performing venipuncture could cause the needle to move.

14.  Fill the tube until the vacuum is exhausted and the blood flow stop. Rotate tubes so the label is down. RATIONALE: Letting the tubes completely fill will ensure the right ratio of blood the additive. Positioning the label down enable you to see the tube filling.

15.  When the blood ceases, gently remove the vacuum tube from the needle and holder. Do this by grasping the tube with the fingers and palmof your spare hand and using your thumb to push off from flange of the holder (Figure 33-40E). RATIONALE: Using the flange will help steady the needle.

16.  Immediately mix the blood in the anticoagulant tubes by gently inverting tyhem several times. RATIONALE: Mixing the anticoagulant tubes right away minimizes the chance of miaiclots forming.

17.  Insert the second tube onto the needle by using the same motion as the first tube. Invert it several times if it contains anticoagulant. RATIONALE: Mixing the additive prevents the blood from coagulating.

18.  When the last tube has filled, remove it from the needle. Ask the patient to open his or her

Figure 40-33. Performing a venipuncture with: a vacuum tube assembly. (A) After tying the tourniquet, palpate the vein. (B) Cleanse the site with alcohol. Allow area the dry or wipe with a clean 2 x 2 gauze. (C) While holding the skin taut, hold needle with bevel up and penetrate the vein with a smooth ravid movement. (D) Grasp the flange of the vacuum tube holder to push the vacuum tube on to the needle. (E) When the tube has stopped filling, remove in gently from the needle and holder using the flange to push from. Invert it several times to mix the additive. (F) Place another tube on to the needle and let it fill. (G) When the last tube has filled, gently remove it from the holder. Released the tourniquet (not shwon) and smoothly remove the needle from the vein, immediately applying pressure with the cotton ball. Mix well by inverting several times. (H) Dispose of the needle and holder into nearby sharps container. (I) Properly label the tubes.

19.  Alliquot blood into the appropriate tubes in the rack in the proper order (see table 40-4). During transfer, hold each tube at the base only. RATIONALE: Having the tubes in the rack and holding the tubes and the base protects your hands from accidental needlestick during the transfer process.

20.  Puncture the vacuum tube through the rubber stopper with syringe needle and allow the blood to enter the tube the until the flow stops. Never push on the plunger or force blood into the tubes. RATIONALE: Puushing on the plunger and forcing blood into the vacuum tube can cause the rubber stopper to pop off, splashing blood.

21.  Implement safety mechanism or devices on the needle immediately. RATIONALE: Immediate implementation of safety mechanism will protect from accidental needlestick.

22.  Mix any anticoagulant tubes immediately. RATIONALE: Mixing the anticoagulant right away minimizes the chance of miniclots of forming.

23.  Discard the syringe and needle into a sharps container and the contaminated waste into a red biohazard bag. RATIONALE: Proper disposal a sharps and biohazard waste protects all personnel.

24.  Label all tubes before leaving the room. If any special treatment is required for the specimens, institute  the handling protocol right away. RATIONALE: Labeling the tubes right away lessens the chances of a mix-up error. Proper handling of specimens ensures an accurate test result.

25.  Check the patient, Observe him or her for signs or stress. RATIONALE: Venipuncture can be stressfull from some patient.

26.  When suffecient pressure has been applied to stop the  bleeding, apply a small pressure bandage by pulling a cotton ball in half, applying it to the puncture site and placing an addesive bandage or tape over it (Figure 40-321). Instruct the patient to remove the bandage in 20 minutes. If the patient is sensitive or allergic to latex, be sure to use nolatex to paper tape. If the bleeding has not stopped after 2 to 3 minutes, have the patient continue to hold direct pressure on the site for another 5 minutes with his or her arm elevated aboved the heart. He or she can do this by lying down with his or her arm on a pillow. Recheck after 5 minutes. RATIONALE: The patient should not leave your care until the bleeding has stopped.

27.  Disinfect tray and supplies and dispose of all contaminated items properly, remove gloves using proper technique. RATIONALE: Proper disposal  and disinfection of all contaminated supplies and equipment protects from exposure to biohazardous subtances.

28.  Wash hands, recore the procedure, and complete the laboratory requisition. RATIONALE: Washing hands after removing gloves further protects from biohahardous subtances and lessens the chance of cross contamination to the patient’s chart and the laboratory requisition. Completing the documentation and requisition as soon as possible after the procedure improve accuracy.
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