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Venipuncture Steps Procedure
- Make Appointment
- Confirm appointment
- Check order or requisition for tests and specimen requirements
- If fasting tell patient appropriate hours to not eat the night before until after appointment time
- Map Quest your patients address
- Greet the patient
- Confirm identity of the patient/compare information with work-order, same with social security card and identification card.
- Have patient sign HIV consent form.
- Cleanse your hands.
- Have patient sit or lie down.
- Put on gloves.
- Ask patient "Which arm was their last blood draw in?"
- Place tourniquet on patients arm.
- Locate the vein to be punctured.
Paramedical Examiner/Insurance Examiner
- Release the tourniquet.
- Cleanse the venipuncture site with 70% isopropyl alcohol or other appropriate antiseptic. Clean venipuncture site area in circular motion from inside to out, with soiled alcohol-100% cotton ball.
- Try to avoid or prevent from reaching over the patients arm, for supplies or changing hands during venipuncture to hold the hub. This way you never risk the needle being move while in the vein. You should never get too sure.
- Place all venipuncture supplies to one side of patient's arm, especially the sharps container.
- Assemble the venipuncture equipment (pre-open bandages, gauze, etc.)
- Assure the antiseptic has dried on the arm.
- Retie the tourniquet 2"- 4" above bend of elbow and use half bow with tourniquet.
- For difficult veins use a warm towel compress placed on the arm.
- Place arm on the arm wedge or have patient to place their fist under their other arm to form a bridge.
- Locate the venipuncture site and perform the venipuncture. Tell the patient "this won't take long, please relax."
- Ask patient to make a fist so the vein will be more prominent, NO fist pumping or clenching. Then patient can release fist once the blood is flowing into the tube.
- Always use proper "order of draw" use red top tube first then the lavender. (Most Paramedical Exam Companies only use 2 tubes.
- Pull skin below vein taut using your non-dominant hand.
- Quickly but gently insert needle at 15 degree angle bevel up, if using syringe breathe syringe before entering vein, insert each tube for the procedure according to order of draw. ♥ There is a draw capacity line on each blood tube. ♥
- While needle is in the arm, the first and second fingers should be lightly resting on the patients arm as your 15-degree angle.
- Release tourniquet as soon as possible after last tube starts to fill with blood.
- Quarter-fold gauze onto venipuncture site, then apply bandage and pressure* Ask patient to "keep their elbow straight, don’t bend."
- Place sharps devices into bio-hazard container.
- Invert tubes approximately 6- 8 times up and down, don't shake.
- Place specimens in lab kit, dispose of all disposables.
- Watch patient for signs of shock or syncope, ask patient if they are alright.
- Urine collection, ask patient to bring urine cup back to you, to read temperature.
- For males do chest measurements, for females ask about current menses; if this information is on insurance form ask for it.
- Fill-out Medical exam questions, have patient sign all forms and initial lab slip for urine label, and males initial chest measurement section. Some insurance forms ask for patient initials for vitals section.
- Check pulse-rate on thumb side of wrist.
- Before doing the blood-pressure reading, wipe the stethoscope diaphragm with and alcohol-wipe.
- Tell patient "Thanks for their time and have a nice day."
- Put on a pair of gloves while handling blood tubes or centrifuged blood tube.
- Centrifuge tubes, always set centrifuge at 15 RPM, pour serum into serum tube. Do this with a window partly open and with no one else in that room. Follow lab instructions on lab handling label, and placing blood tubes into lab pack kit. Transport specimens to required lab.
- Call Fed-Ex for Specimen Pick-Up.
- If Amplified/blood/urine = without paramedical examiner forms. Use HIV consent form also with lab form.
- Always use HIV consent forms for all Paramedical Exam appointments.
Interacting With The Patient
The practice of collecting a blood sample does not rely on only the ability to draw blood from a patient, social skills are important. Always be polite and friendly with patients even if they are rude or inconsiderate. Patients are often angry about their condition, or fearful, or their doctor recently gave them bad news.
Whatever a patient says that is rude, it is inappropriate for the medical profession to reply with unprofessional remarks. The easiest way to defuse an upset patient is to be as polite as possible and explain that the doctor's orders need to be obtained.
This one patient I visited had a couple excuses for not getting his blood drawn the day of his appointment. But after I calmed him down with conversation, letting him know to relax and it wouldn't take long. Also telling him the reason why we needed to obtain the blood specimen for his doctor, he finally gave-in.
My other article on "The Order of Draw for Blood Tubes"
- Order of Draw Blood Tubes for Health Care Professionals; Mobile Phlebotomist - Paramedical Examiner
Memorizing the "Order of Draw for Blood Tubes" can be easy. Did you know that there is no additive in the red top tube? Also, knowing which tests are required for each color top blood tube is important.
Mobile Phlebotomist Poll
Venipuncture, Close the Needle Cap on a Edge of Table, Then Dispose of the Needle and the Tube Holder!
My other article - How to Make an Invoice Form for Mobile Phlebotomist
© 2011 Brinafr3sh