Venipuncture

Equipment:

• Sterile packages of 70% isopropanol (antiseptic) and povidone-iodine (topical anti-infectant)
• Sterile needle and syringe or vacutainer system (20- or 21-gauge needle for cubital vein puncture on an adult)
• Sterile 2 x 2 cotton gauze and povidone-iodine
• Tourniquet
• Nonsterile gloves
• Bandage or sterile adhesive bandage
• Collecting tube

Nursing Procedures:

1. Check patient identification band
2. Wash hands
3. Inform and explain the procedure to patient
4. Position patient in a sitting or supine position and lower side rail
5. Prepare supplies: open sterile packages and label specimen tubes with the patient's data
6. Place arm straight or in dependent position if possible
7. Tourniquet is applied 6-10 cm above the elbow and should only obstruct venous blood flow, not arterial flow
8. Select a dilated vein. SEE PICTURE.
9. If a vein is not visible, encourage patient to pen and close his / her fist, or stroke extremity from proximal to distal, tap lightly over a vein, apply warmth
10. Palpate vein for size and pliancy and make sure it is well seated
11. Release the tourniquet



12. Cleanse puncture site with isopropanol, let it dries and cleanse it with povidone-iodine, let dry or wipe with sterile gauze. Do not touch site after cleansing.
13. Store equipment in easy reach and position yourself to access the puncture site
14. Apply the tourniquet again (should not exceed 3 minutes)
15. Don glove
16. Perform venipuncture
17. Remove cap from 20- or 21-gauge needle.
18. With nondominant hand, stabilize the vein by holding the skin taut over the puncture site (apply downward tension on the forearm with your thumb).
19. With dominant hand, hold the needle bevel facing upward at an approximate 30° angle to the arm
    
20. Puncture the skin into the straightest part of vein with a steady, moderately fast movement. (When the vein is entered you will feel a slight give and can see blood at the needle’s hub.)
21. Apply moderate negative pressure by puncturing the vacuum tube or by gently retracting the syringe plunger. (When first performing a venipuncture, use a syringe. It takes greater dexterity to puncture the vacuum tube with a two-sided needle; if you apply too much pressure you will go through the vein.)
22. The tourniquet is removed when blood is flowing into the tube or syringes then collect specimens
23. Remove the needle and apply pressure to site immediately for 2-3 minutes or 5-10 minutes if patient is in under anticoagulant treatment. Keep the arm straight
24. Let patient maintain pressure on the puncture site
25. Apply a sterile bandage or adhesive bandage to the puncture site
26. If using a needle and syringes, transfer the blood into test tube under moderate pressure
27. Dispose the needle or syringes into a sharp box container
28. Remove glove and wash your hands