26
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 2 sponges, sterile)
GENERAL GUIDELINES FOR SPECIMEN
COLLECTION
1. Check physicians 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.
NOTE: Have an assistant hold/comfort the child as nec-
essary and in accordance with agency policy.
4. Gather equipment. Promotes organization and effi-
ciency.
5. Wash hands. Don gloves. Reduces transmission of
microorganisms.
PROCEDURE
1. Steps 15 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-
Copyright 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.
Fowlers position. Protects against injury if child should
become faint.
5. Put on nonsterile gloves. Protects from contact with
blood-borne organisms.
6. Apply tourniquet 34 inches above venipuncture site.
Provides improved visibility of veins as they dilate in
response to decreased venous return from extremity to
heart.
NOTE: Tourniquet should be able to be removed by
pulling the end with a single motion.
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.
9. Maintain tourniquet only 12 minutes. Prolonged time
may increase childs 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 12 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 1530 angle from skin, bevel up.
Reduces chance of penetrating through vein on inser-
tion. Causes less trauma to skin and vein.
continued
 27

SKILL 7 Venipuncture continued

16. Slowly insert needle. Prevents puncture through other d. If any specimen tubes contain additives, gently rotate
side of vein. back and forth 810 times. Ensures additive is prop-
17. After entering vein, slowly lower needle toward skin. erly mixed throughout the specimen.
Thread needle along path of vein. Decreases risk of pen- 23. Inspect the puncture site for bleeding. Reapply a clean
etrating other side of vein. tape and gauze if necessary. Keeps site clean and dry.
18. Check for blood flow. 24. Assist child to a comfortable position.
a. Syringe method: Gently pull back on plunger and 25. Check tubes for external blood. If any, wipe away with
look for blood return. Obtain desired amount of alcohol. Prevents contamination of equipment and other
blood. personnel.
b. Vacutainer method.
26. Check tubes for proper labeling. Place tubes in appro-
1. Hold Vacutainer securely and advance specimen
priate bag or container along with laboratory requisition
tube into needle of holder, being careful not to
slips. Ensures specimen properly identified and appro-
advance the needle further into the vein. Blood
priate test performed.
should flow into the collection tube. Pushing the
needle through the stopper breaks the vacuum 27. Dispose of equipment in appropriate manner.
and causes blood to flow into the collection tube. Consistent with handling of body fluids.
Failure of blood to appear in collection tube indi- 28. Remove gloves. Wash hands. Reduces transmission of
cates vacuum in tube has been lost or needle is not microorganisms.
in vein. 29. Send specimens to laboratory.
2. After collection tube full, grasp Vacutainer firmly
and remove tube; insert additional collection
DOCUMENTATION
tubes as needed.
1. Time, source/site, specimen sent to lab (specify for what
19. After specimen collection complete, remove tourniquet.
test).
Reduces bleeding from pressure when needle is removed.
2. Record results of any test performed on the unit.
20. Apply 2 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 23 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.

Copyright 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.