MLS TERM

CLINICAL CHEMISTRY II
02
32
01
LABORATORY

[TRANS] MODULE 1: VENIPUNCTURE (EVACUATED TUBE SYSTEM)

2. Grasp both sides of the tourniquet and, while
Venipuncture maintaining the tension, cross the tourniquet
- Is defined as the process of collecting or over the patient’s arm.
“drawing” blood from a vein. It is the most
common way to collect blood specimens for
laboratory testing. 3. Hold both ends between the thumb and
- Reasons: forefinger of one hand close to the arm.
 To obtain blood for diagnostic 4. Tuck a portion of the left side under the right
purposes; side to make a partial loop facing the
 To monitor levels of blood antecubital area.
components; 5. Properly applied tourniquet will have the ends
 To administer therapeutic treatments pointing up away from the venipuncture site.
including medications, nutrition, or
chemotherapy;
 To remove blood due to excess levels
of iron or erythrocytes (red blood
cells); or
 To collect blood for later uses, mainly
transfusion either in the donor or in
another person.

Factors affecting test results:

- Posture
- Diurnal Rhythm
- Stress
- Exercise
- Diet 6. Pull the end of the loop to release the
- Smoking tourniquet with one hand. The tourniquet
should only be on for 1 minute.
Complications:
- Hematoma Formation
- Infection Vein Selection
- Nerve Damage - Major of the veins for venipuncture are in the
- Hemoconcentration antecubital fossa, the area of the in front of
- Syncope and Fainting the elbow.
- Petechiae - The vein on the back of the hand and wrist
- Excessive Bleeding may also be used for venipuncture.
- Edema - Veins on the underside of the wrist, however,
- Fear and Phobia should never be used of venipuncture.
- Thrombosis - If ankle/foot must be used for venipuncture, a
- Arterial Puncture nurse or physician should be consulted
- Pain because these sites cannot be used in some
- Allergies
- Iatrogenic Anemia

Evacuated Tube System

- A.K.A “closed system”
- Advantage is the procedure is simple as it will
require fewer steps and the chance of
specimen contamination is avoided.

Procedure (Tourniquet Tying)

1. Position the vinyl or later strips 3 to 4 inches
above the venipuncture site. Avoid areas with
a skin lesion or apply tourniquet over the
patient’s gown. patients (circulatory problems in the lower
extremity, diabetes in poor control, or
hemoglobinopathies).

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 Procedure: (For both Single Draw and Multiple
Draw)
1. Greet the patient and obtain the request form
**ADDITIONAL NOTES: from the patient.
- The median cubital vein or median vein is the 2. Identify the patient and verify diet restriction
preferred site for collecting blood in adults (fasting requirement).
because the vein is both large and close to the 3. Prepare the patient for the venipuncture.
surface of the skin. Assemble the equipment.
- The cephalic vein, often the only vein that can 4. Position the patient. Apply the tourniquet. Ask
be felt in obese patient, is located on the edge the patient to make a fist.
of the outer arm. 5. Select the vein for venipuncture then release
- The basilic vein located in the inner portion of the tourniquet.
the arm is the last choice for venipuncture 6. Remove the needle cap and inspect for
because of the risk of puncturing a median possible defects.
cutaneous nerve branch of the brachial artery. 7. Anchor the vein and insert the needle. Insert
needle into the skin at 15 – 30 degrees angle.
Tips and Tricks for Venipuncture 8. Advance the tube into the needle holder/
- Dominant arm will have generally the most adapter.
prominent veins. 9. Fill the required tube/tubes. (follow the correct
- Do not select a vein that feels hard and cord- for multiple draw). Invert the tubes.
like or lacks resilience. Tendons are hard and 10. Withdraw the needle.
lack resilience. 11. Engage safety device or cap and dispose of
- Do not draw above an IV. If necessary, have Iv sharps.
turned off for a minimum of 2 minutes. 12. Label the tubes and observe proper handling
- Avoid burned, scarred or tattooed areas. instructions.
- Edematous areas should be avoided. 13. Check patient’s arm and apply bandage.
- Avoid drawing in the area of hematoma. Draw 14. Thank the patient.
from below site if there are no alternative. 15. Dispose contaminated materials

Mastectomy Patients: **ADDITIONAL NOTES:

 Mastectomy due to lymph edema Steps from 6 - 9
 Draw from the side opposite of Anchoring:
mastectomy whenever possible. • Place your thumb 1-2 inches below the
 Application of tourniquet may cause intended venipuncture site
injury on the mastectomy site. • Pull skin towards the wrists
 If patient has double mastectomy, • Use the finger of your anchoring hand to
physician should be consulted – support the back of the arm
usually avoid the side of the most • As soon as blood flows into the tube, release
recent mastectomy. the tourniquet and have the patient release
 Check antecubital region on both arms his/her fist. – on elderly patient and other
to find suitable vein. with fragile veins that might collapse or in
 Check hand or wrist veins. difficult situations, the tourniquet is sometimes
 Use leg, ankle, or foot veins except as left on until the last tube is filled; however, do
last resort and after obtaining not leave the tourniquet for more than one
permission from patient’s physician. minute
 Blood flow to the extremities may not • Mix the tube with additives immediately by
be representative of general gently inversions
circulation producing erroneous
results. Steps from 10 - 15
 Lower extremities venipuncture may Withdraw:
cause blood for formation. • Place gauze over the site
• Do not press down the gauze while needle is
Materials needed: in the vein
- Alcohol Prep Pads • Withdraw the needle in one smooth motions
- Povidone – iodine swabs for blood culture • Apply pressure to the site with gauze pad
- Gauze pads or cotton balls • Do not bend arm up – keep extended or raised
- Adhesive bandages or other bandaging Proper Handling:
materials • Putting on crushed ice (e.g. ammonia, BNP,
- Gloves lactic acid, blood gases)
- Tourniquet • Keeping it warm (e.g. cold agglutinin,
- Blood collection evacuated tubes cryoglobulin
- Multiple sample needle • Protecting from light (e.g. bilirubin
- Standard tube holder
- Sharps container
- Permanent marker or pen

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ORDER OF DRAW:

1 – BLOOD CULTURE
2 – SODIUM CITRATE (BLUE)
3 – CLOT ACTIVATOR (RED)
4 – SST / SERUM-SEPARATING TUBE (GOLD)
5 – LITHIUM HEPARIN (LIGHT GREEN)
6 – SODIUM HEPARIN (DARK GREEN)
7 – EDTA / ETHYLENEDIAMINE TETRAACETIC
ACID (LAVENDER)
8 – SODIUM FLOURIDE (GRAY)
9 – ACD SOLUTION / ACID-CITRIC DOSE
SOLUTION (YELLOW)

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