bayou pines west lake charles l · needle and inserting into the hub, twisting tightly. 2) remove...

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Informative · Policy830 BAYOU PINES WEST · LAKE CHARLES, LA. 70601

VENIPUNCTURE COLLECTION

ISO 5.4.4INFO-28

Adopted Date: October 19, 2015

Purpose:To explain the pre-analytic process for collecting venipuncture samples and to define the maximum allowable total blood draw volumes.

Policy: Gloves are to be worn during the collection process, and changed between patient collections. Gloves are to be discarded in the appropriate container immediately after the procedure. All other items used in the collection process must be disposed of according to proper biohazardous waste disposal. Needles and hubs are single use and are disposed of in an appropriate nearby sharps container as one unit. Needles are NEVER recapped, removed, broken, or bent after a phlebotomy procedure. Contaminated surfaces must be cleaned with a solution containing 10% bleach. All surfaces are cleaned daily. In the case of an accidental needle stick, immediately wash the area with antibacterial soap, express blood from the wound, and contact your supervisor. To avoid drawing too much blood on a patient, refer to Chart 1: Maximum Allowable Total Blood Draw Volumes and Chart 2: Blood Volume mL/kg on page 6 of the policy.

Needed Materials:Safety NeedlesButterfly needlesSyringesNeedle HoldersBlood Collection TubesTourniquetAlcohol Prep2x2 GauzeSharps DisposalBand-AidLancets

Approved and current. Effective starting 8/29/2018. INFO 28 (version 2.0) Venipuncture Collection

Controlled copy ID 153351. Printed on 9/21/2018 12:57 PM (EDT). Page 1 of 9

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Procedure:BEFORE Venipuncture Collection1. Pull the patient’s label from the printer.2. Go to the lobby and call the patient by their first and last name. Avoid hollering from the draw

room or hallway.3. Verify the patient’s ID by asking the patient to state their DOB and repeating his/her name again.

This information must match the requisition and printed labels.4. Verify the patient’s orders to the patient’s requisition.5. Get supplies ready for collection.

Always check expiration dates before use. DO NOT use expired supplies. Order of Draw: Blood cultures > Light Blue top > Red top > SST > Pearl (PPT) > Green

top > Purple top > Grey top. All drug levels should be drawn in a RED tube with NO additive.

Venipuncture Collection1. Put gloves on. Position the patient’s arm, extended to form a straight line from shoulder to wrist.2. Select the appropriate vein for venipuncture. Remember to ask the patient if he/she has a

preference of draw site. The larger median cubital, basilica, and cephalic veins are most frequently used, but

other veins may be necessary and/or become more prominent if the patient closes his fist tightly. Always use the same finger to feel for a vein.

At NO time may a phlebotomist perform venipuncture on an artery. At NO time will blood be drawn from the feet unless instructed to do so by the ordering

physician. Factors to consider in site selection:

a) Extensive scarring or healed burn areas should be avoided.b) Specimens should not be obtained from the arm on the same side as a

mastectomy.c) Avoid areas of hematoma.d) Do not obtain specimens from an arm having a cannula, fistula, or vascular graft.

3. Apply the tourniquet 3-4 inches above the collection site. Never leave the tourniquet on for over 1 minute.

4. Clean the puncture site by making a smooth circular pass over the site with a 70% alcohol pad, moving in an outward spiral from the zone of penetration. Allow the skin to dry before proceeding. DO NOT touch the puncture site after cleaning. If you must re-palpate, disinfect glove finger.

5. Perform the venipuncture. See Vacutainer and Syringe collection procedures below.

A. Venipuncture using a VACUTAINER:1) Attach the appropriate needle to the hub by removing the plastic cap of the small end of the

needle and inserting into the hub, twisting tightly.2) Remove the plastic cap over the needle. Hold the bevel up.3) Pull the skin tight with your thumb or index finger just below the puncture site.4) Holding the needle in line with the vein, use a quick, small thrust to penetrate the skin and

enter the vein in one smooth motion.5) Holding the hub securely, insert the first vacutainer tube following proper order of draw into the

large end of the hub penetrating the stopper. Blood should flow into the evacuated tube.6) After blood starts to flow, release the tourniquet and ask the patient to open his or her hand.7) When blood flow stops, remove the tube by holding the hub securely and pulling the tube off

the needle. If multiple tubes are needed, repeat step 5.8) Invert tubes as needed. DO NOT SHAKE OR MIX VIGOROUSLY.

Light blue top (Coagulation tube) should be gently inverted 4 times after being removed



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from the hub. Red and gold tops should be inverted 5 times. All other tubes containing additives should be gently inverted 8-10 times.

9) Place a gauze pad over the puncture site and remove the needle. Immediately apply slight pressure. Ask the patient to apply pressure for at least 2 minutes. When bleeding stops, apply a fresh bandage, gauze, or tape.

10) Properly dispose of the hub with needle attached into a sharps container. 11) In the presence of the patient, label all tubes with the patient’s labels, containing your written

initials and collection time.

B. Venipuncture using a SYRINGE:1) Place a sheathed needle or butterfly on the syringe.2) Remove the cap and turn the bevel up.3) Pull the skin tight with your thumb or index finger just below the puncture site.4) Holding the needle in line with the vein, use a quick, small thrust to penetrate the skin and vein

in one motion.5) Draw the desired mount of blood by pulling back slowly on the syringe stopper.6) Release the tourniquet.7) Place a gauze pad over the puncture site and quickly remove the needle. Activate the safety

feature of the needle. 8) Immediately apply pressure. Ask the patient to apply pressure to the gauze for at least 2

minutes. When bleeding stops, apply a fresh bandage, gauze, or tape.9) Remove and discard the assembly and apply a safety transfer device to the syringe.

10) Transfer blood drawn into the appropriate tubes as soon as possible. A delay could cause improper coagulation. Gently invert tubes containing an additive 5-8 times.

11) If the transfer device is not available, you may transfer the blood by inserting the unsheathed needle into free standing tube. Never hold tubes while puncturing the tubes.

12) Dispose of the syringe and needle as a unit into an appropriate nearby sharps container.

Infant/Child Phlebotomy:

Age Blood Collection Procedure0-6 months Heel Stick6 months-2 years Finger Stick, Venipuncture2 years & older Venipuncture

1. Confirm the patient’s identification.2. Request the adult to sit with the patient in the chair and help stabilize them if child is unable to sit

upright on their own3. Assemble the required supplies4. Select the collection site and proceed as routine phlebotomy

A. Heel Stick Method:1) Confirm the patient’s identification.2) Assemble the required supplies.3) Put on gloves.4) Warm area for at least 3 minutes.5) Disinfect area with a 70% alcohol prep pad.6) Make sure the area is completely dry before collection. Any alcohol left on the skin will cause

the specimen to hemolyze.7) Hold the foot with a firm grip. Grasp the foot so that the heel is exposed between your thumb

and index finger.



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8) Apply pressure to heel and activate the lancet. Make sure the blade retracts.9) Puncture the Lateral Medial part of the heel at a 90° angle, parallel to the bone. Stick across

the heel prints. a) NEVER puncture posterior curvature of heel.b) NEVER puncture the arch.

10) Never puncture deeper than 1.2 - 2.2mm, as this can cause osteomyelitis or sepsis, or could injure the bone, blood vessels, tendons, nerves, or cartilage.

11) Wipe off the first drop of blood, due to tissue fluid. Ease thumb pressure to the site and then apply intermittent pressure to obtain a good blood flow.

12) Do NOT milk, squeeze, or massage the area. It could cause the specimen to hemolyze and have excessive tissue fluid.

13) Collect the specimens in the proper tubes and correct order of draw.

B. Finger Stick Method:1) Confirm the patient’s identification.2) Use only the middle and ring finger for finger sticks.3) Clean finger with 70% alcohol prep pad.

Scrub the area to remove dead cells. Rubbing the finger increases the blood flow. 4) Let finger completely air-dry.5) Apply pressure to the finger by wrapping your finger around the patient’s finger.

NEVER go above the first crease of the finger. Hold hand downward for better blood flow by the pull of gravity.

6) Puncture the side of the fleshy pad area where there is less fluid and more capillaries to cut.7) Puncture finger across (perpendicular) the fingerprint, so blood will bead up. If you puncture

finger in line (parallel) with fingerprint, the blood will flow down the fingerprint.8) Wipe off the first drop of blood, as it is contaminated with tissue fluid and will dilute the

specimen.9) A second drop will form and should be collected when touched by the tip of the micro collection

device.10) Let the capillary blood flow freely down into the tube on contact. If blood becomes jammed in

the collection top, gently tap on a hard surface to dislodge it so the blood can flow freely again to the bottom of the tube.

11) Gently apply pressure to finger and hold the puncture site in a downward position so the blood will flow freely into the tube.

12) Do NOT milk, massage the finger, or scoop the blood into the tube, as this can contaminate the specimen with tissue fluid.

*Puncture only the black areas



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Limitations: Hemolysis may affect certain tests. Watch for slow draw. Blue tops should be filled to the maximum line. If a blood sample is not attainable:

Reposition the needle. Ensure that the collection tube is completely pushed onto the back of the needle in the

hub. Use another tube if you suspect vacuum has been lost. Loosen the tourniquet. In most cases, another puncture in a site below the first site is advised. Probing is NOT

recommended. A phlebotomist should NEVER stick a patient more than twice unsuccessfully. The supervisor or a co-worker should be called to assess the patient.

Expected Results:A phlebotomist should attain 97% accuracy on the first attempt at a blood draw.



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Chart 1: Maximum Allowable Total Blood Draw Volumes

CMRC IRB MAXIMUM ALLOWABLE TOTAL BLOOD DRAW VOLUMES (CLINICAL + RESEARCH)

Body Wt (kg)

Body Wt (lbs)

Total blood volume (mL)

Maximum allowable volume (mL) in one

blood draw( = 2.5% of total blood

volume)

Total volume (clinical + research) maximum volume (mL) drawn in a

30-day period

Minimum Hgb

required at time of

blood draw

Minimum Hgb required at time of

blood draw if subject has

respiratory/CV compromise

1 2.2 100 2.5 5 7.0 9.0 -10.02 4.4 200 5 10 7.0 9.0-10.03 6.3 240 6 12 7.0 9.0-10.04 8.8 320 8 16 7.0 9.0-10.05 11 400 10 20 7.0 9.0-10.06 13.2 480 12 24 7.0 9.0-10.07 15.4 560 14 28 7.0 9.0-10.08 17.6 640 16 32 7.0 9.0-10.09 19.8 720 18 36 7.0 9.0-10.010 22 800 20 40 7.0 9.0-10.0

11-15 24-33 880-1200 22-30 44-60 7.0 9.0-10.016-20 35-44 1280-1600 32-40 64-80 7.0 9.0-10.021-25 46-55 1680-2000 42-50 64-100 7.0 9.0-10.026-30 57-66 2080-2400 52-60 104-120 7.0 9.0-10.031-35 68-77 2480-2800 62-70 124-140 7.0 9.0-10.036-40 79-88 2880-3200 72-80 144-160 7.0 9.0-10.041-45 90-99 3280-3600 82-90 164-180 7.0 9.0-10.046-50 101-110 3680-4000 92-100 184-200 7.0 9.0-10.051-55 112-121 4080-4400 102-110 204-220 7.0 9.0-10.056-60 123-132 4480-4800 112-120 224-240 7.0 9.0-10.061-65 134-143 4880-5200 122-130 244-260 7.0 9.0-10.068-70 145-154 5280-5600 132-140 264-280 7.0 9.0-10.071-75 156-185 5680-6000 142-150 284-300 7.0 9.0-10.076-80 167-176 6080-6400 152-160 304-360 7.0 9.0-10.081-85 178-187 6480-6800 162-170 324-340 7.0 9.0-10.086-90 189-198 6880-7200 172-180 344-360 7.0 9.0-10.091-95 200-209 7280-7600 182-190 364-380 7.0 9.0-10.096-100 211-220 7680-8000 192-200 384-400 7.0 9.0-10.0

Chart 2: Blood Volume (mL/kg)

Based on blood volume of:kg mL/kg1-2 100 Pre-term infant> 2 80 Term infant - adult

This information is similar to that used by the Committee on Clinical Investigations, Children’s Hospital in Los Angeles, CA; Baylor College of Medicine, Dallas, TX; and Cincinnati Children’s Hospital Institutional Review Board, OH. These charts were adapted by: Rhona Jack, Ph.D. Children’s Hospital and Regional Medical Center Laboratory, Seattle, WA in August 2001.

References:The Pathology Laboratory, ISO 15189 Standards The charts were adapted by: Rhona Jack, Ph.D. Children’s Hospital and Regional Medical Center Laboratory, Seattle, WA in August 2001.



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