Strictly adhere to guidelines for hand hygiene, standard precautions, and site preparation to minimize the risk of a health care–associated infection.undefined#ref11">11
Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions.
Infection control standards must be followed when obtaining a blood specimen. Appropriate safety devices should always be used and blood-borne pathogen standards should be followed to minimize the risk of exposure to blood-borne pathogens.12 The use of safer needleless devices, such as those with a reliable integrated safety feature, is recommended.12 Venipuncture requires an aseptic, no-touch technique.5 Veins used for venipuncture should be repeatedly assessed for infiltration, extravasation, infection, and phlebitis using standardized scales.7,8,9 Pain, burning, stinging, erythema, warmth, and subcutaneous swelling should be reported to the practitioner.
The correct amount of blood required by the laboratory must be drawn into each blood collection tube (Table 1) to ensure accurate laboratory test results and decrease the patient’s risk of anemia.6 Some blood collection tubes contain additives that require an exact amount of blood in the collection tube. Blood collection tubes without additives allow variable amounts of blood. Some laboratory tests require less blood than others; the minimum amount needed for a required laboratory test should be confirmed with the organization’s laboratory and the manufacturer’s instructions for use.6 Some additives are more likely to contaminate other blood specimens when blood collection tubes are sequentially engaged in the rubber-sheathed needle. Knowing the correct laboratory order of the blood specimens to be obtained into the collection tubes is essential.13 The sequence of collecting blood specimens is different when using a syringe and transfer device than when using a vacuum-extraction blood collection system. Blood specimens should be transported to the laboratory immediately after collection per the organization’s practice. Some blood specimens may require special storage or handling, such as being placed on ice, refrigerated, or frozen.13
The patient’s anatomy should be assessed for sites contraindicated for venipuncture, such as:2
Venipuncture can be painful, and the patient may experience anxiety or fear before the procedure. In some cases, just the appearance of a needle is frightening. A calm approach and skilled technique may help limit a patient’s aversion to venipuncture. To reduce pain during venipuncture, an appropriate pain management strategy for the patient should be determined based on the patient’s condition, developmental level, and engagement of the patient and family.3 Anxiety may be assuaged by communicating with the patient about how to help relieve the patient’s concerns.
Appropriate laboratory tubes should be obtained before the home visit. If needed, the laboratory should be called so that the proper tubes and the volume required to process the specimens can be confirmed.
See Supplies tab at the top of the page.
Rationale: Drawing blood specimens from contraindicated sites can result in false test results or may injure the patient.
Rationale: Exercise and changes from supine to upright positions can alter plasma volume because of the force of gravity on venous hydrostatic changes and distribution of bodily fluids, which can change the values of hemoglobin, hematocrit, and other blood cell counts.6
Avoid contraindicated sites.2
Rationale: Obtaining a blood specimen from an arm with an existing peripheral access device may interfere with laboratory analysis of the specimen.13
Consult with the practitioner about stopping the IV infusion for a minimum of 2 minutes13 before obtaining the blood specimen, as applicable.
Rationale: Stopping an IV infusion allows the medication to clear before obtaining the blood specimen, as the medication may interfere with laboratory analysis of the specimen.13
Rationale: Warming enhances blood flow, making veins more prominent.
Rationale: To reduce the risk of a hematoma, avoid venipuncture in a location where a vein branches.6
Rationale: Prolonged tourniquet application causes stasis, hemolysis, and hemoconcentration because of changes in the vascular epithelium from increased venous pressure and hypoxia.6
Do not touch the site after preparation unless sterile gloves are worn.1
Do not fasten the tourniquet for longer than 1 minute.13
Rationale: Prolonged tourniquet application can cause stasis, localized acidemia, and hemoconcentration.13
If contamination occurs, discard the needle and the syringe in a sharps container and prepare a new venipuncture needle.
Rationale: Gently pulling and stretching the patient’s skin help stabilize the vein and prevent it from rolling during needle insertion.
Rationale: The smallest and sharpest point of the needle should puncture the skin first to reduce the chance of penetrating the sides of the vein during insertion. Keeping the bevel up causes less trauma to the vein. Entering the skin distal to the vein prevents unanticipated vein puncture, which may result in inadequate blood specimen retrieval and hematoma.
Signs of nerve injury include severe, unusual, or shooting pain, tingling or numbness, or a tremor in the arm. If the patient complains of any of these symptoms during venipuncture, withdraw the needle immediately and notify the practitioner.5
Rationale: If blood does not appear, the needle is not in the vein.
Rationale: Gently pulling on the plunger creates just enough vacuum needed to draw blood into the syringe. If the plunger is pulled back too quickly, pressure may collapse the vein.
Rationale: Laboratory results are more accurate when the required amount of blood is obtained.
Rationale: Releasing the tourniquet before obtaining the required amount of blood for the laboratory tests reduces bleeding at the site when the needle is withdrawn.
Rationale: Direct pressure minimizes bleeding and prevents hematoma formation. A hematoma may cause compression and nerve injury.
For a patient who has a bleeding disorder or is undergoing anticoagulant therapy, hold pressure for several minutes, as needed, until the bleeding stops.
Do not recap needles or attempt to remove the needle from the collection barrel.12
Rationale: Blood collection tubes contain different additives as indicated by the colored closure top and labeling and are based on international standards. Do not remove the colored closure top from the tube.6
Rationale: Using a safety-transfer device with the blood collection tubes allows the vacuum to draw the blood into the tube, reducing the risk of needlestick injury.
Rationale: The blood collection tubes should be filled to the correct level because additives in certain tubes are measured in proportion to the filled tube.
Rationale: Inverting the tube gently ensures that the additives are properly mixed and prevents erroneous test results.
Do not shake the blood collection tube.6,13
Rationale: Shaking the blood collection tube may cause lysis of the blood cells, resulting in inaccurate test results.
Rationale: Transfer devices and sheathed needles are considered sharps that are associated with needlestick injuries, and they must be disposed of in a sharps container. The sheathed needle’s flexible cover prevents blood from flowing when the needle is not engaged in a vacuum tube; however, the sheath does not prevent a needlestick injury if a finger inadvertently enters the collection barrel.12
Rationale: Decontamination prevents cross-contamination and reduces the risk of exposure to pathogens in the blood specimen.
O’Grady, N.P. and others. (2011, updated 2017). Guidelines for the prevention of intravascular catheter-related infections, 2011. Centers for Disease Control and Prevention. Retrieved October 24, 2022, from https://www.cdc.gov/infectioncontrol/pdf/guidelines/bsi-guidelines-H.pdf
World Health Organization (WHO). (2010). WHO guidelines on drawing blood: Best practices in phlebotomy. Retrieved October 24, 2022, from http://whqlibdoc.who.int/publications/2010/9789241599221_eng.pdf (classic reference)* (Level VII)
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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