At times you might need to look to the hands to find the best venipuncture location, even though there are plenty of bigger veins to work with, and these are used more than any other. Veins in the feet aren’t good candidates for venipuncture, because things are just too complicated with the veins in that area, so feet should be avoided except as a last resort.[pe_estro_slider id="2"]
Venipuncture becomes difficult when the phlebotomist runs into scarring as the result of operations or being burned. Arms near a place of previous mastectomy might skew blood sample results because of lymph edema. Another place of venipuncture that could cause the wrong results with testing is any area of the body that has a hemotoma. If there are no other appropriate spots to get a good venipuncture, and if the hematoma is the only place left to gather a sample, then make it as far from the center point of the hematoma as you can.
Should the patient be on an IV, or is undergoing a blood transfusion at the time you are taking a sample of their blood, the fluid being used in the IV or transfusion might taint the sample, or with the tranfusion might skew the outcome of the sample’s testing, so it is best to gather any blood samples from the arm not being used for the transfusion or the intravenous therapy, if you can. If you can’t do this, then one thing you can consider is to turn off the IV for not longer than a couple of minutes before you perform your venipuncture. Place your tourniquet right below the site of the IV’s entrance point and pick a vein that is not in use for the IV needle.
After finding a successful site using the above instructions, take out 5 mil of blood and immediately throw it away, then proceed to gather the samples that will be used for testing. You might think it easier to just take your sample from the IV line so that you won’t have to go through all the trouble, but this will bring about even more complications. You will have to gather blood back into the IV line using another syringe that is inserted into the line, and will need to take it out slowly and gradually to keep from giving the patient hemolysis.
Using the cannula or fistula heparin lock, found in almost all hospitals, require strictly following a set of guidelines. Firstly, blood shouldn’t be taken from a patient’s leg that is in a fistula heparin lock or a cannula unless the doctor is consulted first, or if you are trained to do so. And you will not have been trained to do so unless you’ve received training to work in the ER or CCU or ICU, where these are mainly used.
If you are trained to work around heparin locks, or the doctor has granted permission to take your blood sample from around it, then first take out the blood into a syringe to get out the heparin, then take out some blood to be placed into your tubes for testing. Afteward, take the syringe containing the heparin and put it back into the lock.
If you find an area where serous fluid is collecting in the body tissue, this could pose a problem with the lab tests. To find the right site for venipuncture, take your index finger and trace the line of veins you are targeting and cause them to palpate. Each of the arteries are thick-lined and elastic, and pulsate. Veins on the other hand, feel like cords, easily roll under your finger, and don’t feel resilient. If you can’t find superficial veins easy enough, rub the patient’s arms starting at the wrist and moving up to the elbow, then tap the area around the vein with both your index and middle finger. Take a clean, damp towel and leave it on the area of your venipuncture site candidate for around five minutes. Another option is to have the patient lower their arm so that their veins can fill up with blood.
To draw a patient’s blood successfully, be calm and friendly as you begin the process. If they look uncomfortable, tend to their needs as best as you can, so that they can work towards becoming relaxed and cooperative.
Ask them their name, and look to see if it is the same name on the ID band on their wrist, as well as on your lab aperwork. Match their hospital ID number at the same time. Then you will fill out the correct for asking for the blood sample to be taken. This will list all of the testing that has been requested by the doctor for the lab.
Identify the general health of your patient. Note anything on the lab request form, from whether the patient has been fasting, to any medicines they take or are allergic to, what treatment they are under with their doctor, and any food allergies or limitations they may have.
Find out if the patient is allergic to adhesives, latex or antispetics by glancing at their arm and wristbands, or simply by asking the patient.
In preparing for the blood extraction, have the patient sit in a chair or lie down on the bed. They should then stretch out their arm so that you can place the tourniquet around three to four inches above where you are going to do the venipuncture. Don’t make this too tight and don’t let it stay in place for more than a couple of minutes. If you remove the tourniquet, what a couple more minutes before putting it back on. Ask the patient to make a fist without moving their hand.
Use alcohol to prepare your chosen venipuncture site. Apply it using a circular movement around the area, starting at the midpoint of where you will insert the needle and moving out from there. Let it dry in the air. Take a tight hold on their arm (not too tight), and manipulate the vein in place using your thumb to stretch their skin. Place the needle at anywhere from a 30 degree angle down to as low as 15 degrees, compared to the top of the patient’s arm. Swiftly insert the needle into the vein, making sure that you don’t prod multiple times trying to catch the needle in the vein.