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If unable to collect a specimen after two attempts, seek another qualified health care team member to attempt venipuncture.undefined#ref2">2
At the completion of the procedure, ensure that all choking hazards (e.g., syringe caps, port caps, adhesive bandages, bits of tape, twist-off caps from saline bullets) are removed from the patient’s linens and placed in the appropriate receptacle.
Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions.
The primary methods of obtaining a blood specimen are through venipuncture, capillary draw, central venous access, arterial puncture, and arterial line.
Venipuncture involves inserting a needle into the lumen of a vein. The nurse may use a winged infusion set (Figure 1) attached to a small-volume syringe to collect the specimen. Before collecting blood specimens, the nurse should select the appropriate laboratory tubes and check the practitioner’s orders when obtaining several specimens of various types for the tests (e.g., chemistry, hematology, coagulation studies).
The nurse should also identify the best place to perform a venipuncture on the patient. For example, the antecubital fossa and the saphenous vein (Figure 2) (Figure 3) are common sites for venous access in children. The scalp veins can be used in infants. Veins of the foot can be used in infants who are not yet walking. The nurse must have a good understanding of the anatomy, physiology, and physics related to venipuncture.
Venipuncture can be a painful and stressful experience for a child. In most cases, venipuncture is viewed as a routine procedure, but just the appearance of a needle can be frightening to a child. A calm approach and skilled technique of the nurse can help to limit a child’s anxiety, pain, and stress during venipuncture.
Using interventions such as distraction, sucrose, topical analgesia, positioning, music, and family involvement significantly decreases a child’s anxiety, pain, and stress related to a venipuncture.1,10 Several topical agents may be used to provide analgesia for venipuncture (Table 1).
In infants younger than 6 months old, oral sucrose has been shown to work well to manage needle-related pain.8
A child may fear that the loss of blood is a threat to his or her life; therefore, developmentally appropriate language should be used to explain that blood is continually being made. An adhesive bandage may give the child assurance that the blood will not leak out through the puncture site. Make sure the bandage is removed if the child may chew or suck on the extremity as this may result in a choking hazard.
Rationale: Drawing minimum volumes decreases the incidence of iatrogenic anemia.
Use small-volume syringes to avoid vein collapse from the negative pressure created by a larger syringe.
Rationale: Onset of action of these agents requires application before the procedure begins.
Rationale: Obtaining a sample from a cool extremity may be difficult because of vasoconstriction.
Rationale: Holding the patient ensures that the position is maintained and the site is not contaminated.
Do not offer a bottle to an infant during the procedure because choking may occur.
If possible, avoid using a tourniquet to reduce the risk of injury to the vascular endothelium. If a tourniquet is required, limit the time of use to less than 1 minute to reduce the risk of hemolysis and inaccurate laboratory results.4
Do not keep the tourniquet on the patient longer than needed.
Rationale: Heat causes local dilation and makes the vein more visible.
Use chlorhexidine cautiously because it may cause skin irritation and chemical burns in infants less than 2 months old or infants with compromised skin integrity (premature infants).2
Rationale: This technique allows controlled entry into the vein after the skin has been pierced. Entering the skin distal to the vein prevents unanticipated vein puncture, which may result in inadequate blood specimen retrieval and development of a hematoma.
Rationale: Applying traction serves to stabilize and straighten the vein, allowing easier penetration without going through the vein. The patient may move slightly, even when well immobilized, in response to the initial puncture. Entering the skin distal to the vein prevents unanticipated vein puncture, which may result in inadequate blood specimen retrieval and a large hematoma.
Rationale: Entering the vein using a quick, small motion allows a controlled entry into the vein to avoid through-and-through penetration of the vein and extravasation of blood into the surrounding tissues.
Rationale: Venous distention is no longer required; removing the tourniquet decreases hematoma formation.
Rationale: Pressure over the needle can cause discomfort. Carefully removing the needle minimizes discomfort and vein trauma.
Follow the order of the draw specified by the laboratory to ensure that the specimens are processed correctly and yield accurate results.
Rationale: Bleeding may occur after the vein is punctured if inadequate pressure is applied, particularly in an active patient.
Reportable condition: Persistent active bleeding
Rationale: Inadvertent arterial puncture may affect perfusion distal to the puncture site.
Reportable condition: Decreased or absent perfusion distal to the puncture site
Rationale: The patient may require more blood tests in the future. Anxiety or concerns should be expressed and addressed.
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