Chapter V Part 1:

LOCATING PROPER SITE AND Sites to Avoid the Practice of Venipuncture:

ANCHORING VEINS  Extensive Scarring from burns or surgery
Principle: To locate the site that will give the best blood return.  Edematous Arms
Resources:  Upper extremity where a masectomy was performed
1) 70% Isopropyl Alcohol  Hematoma - venipuncture should not be performed on
2) Tourniquet a hematoma regardless of how small. If unavoidable,
3) Cotton (wet & dry) venipuncture should be distal and below the hematoma.
4) Gloves  Intravenous therapy/Blood Transfusions - if not possible
Venipuncture on the opposite arm, blood should be drawn below and
 is the process of obtaining intravenous access for the distal to the IV.
purpose of intravenous therapy or for blood sampling of  Avoid sites with cannulas or fistulas.
venous blood.  Avoid arms in casts
 In healthcare, this procedure is performed by:  Avoid sites with birthmarks, moles, and tattoo
a) Medical Laboratory Scientists
b) Medical Practitioner Note: The tourniquet should be applied between the IV site
c) Phlebotomist and the venipuncture site.
d) Nursing Staff If drawing above the IV site is the only option, then the IV
infusion must be turned off for at least 2 minute before
Note: It is essential to follow a standard procedure for the performing venipuncture.
collection of blood specimen to get the accurate laboratory
results. Any kind of error in collection of blood or filing the test Procedure:
tubes may lead erroneous results. 1. Wear appropriate PPE
2. Prepare the equipment
Primary vein used in venipuncture is Median Cubital Vein - the 3. Select the best puncture site
prominent vein in the middle arm 4. Position the patient’s arm slightly bent in a downward
position
Other site to venipuncture in upper arm: 5. Apply and place tourniquet 3 to 4 inches above the
Basilic, Cephalic, or Median Veins selected puncture site.
Note: Application of tourniquet near the puncture site
may cause the vein to collapse
6. Free end of tourniquet should be away from the
puncture area. Make sure there are no folds.
Note: Tourniquet should only be applied not more
than 1 minute; prolonged application can cause
hemoconcentration and hemolysis to the specimen.
7. Ask the patient to make a fist. This makes the vein
more palpable.
Note: Never ask the patient to “pump” the fist because
it will cause hemoconcentration.
8. Palpate the vein using the index finger or middle
fingers in a vertical and horizontal direction to
determine depth, direction, and size of the vein.
9. Release the tourniquet and have the patient open fist.
(This is not necessary if you can locate, palpate, and
extract within a minute)
10. Sanitize the area with 70% alcohol in a circular motion
from the center to outside.
11. Allow the area to dry.
To Keep in Mind: Note(bold mo yung note mahalaga yun): Do not blow
 Median Cubital and Cephalic veins are most commonly or fan the venipuncture site.
used for venipuncture.
 Alternative sites are the basilic vein on the dorsum of
the arm or dorsal hand veins.
 Due to it close proximity to the brachial artery and
median nerve, the basilic vein, should used only if
there is no other prominent arm vein.
 Veins in the foot and ankle should only be utilized as a
last resort.
 Veins o the underside of the wrist should be avoided.