02.02 Drawing Blood

Overview

1. Purpose
   1. To obtain a blood sample for lab testing
   2. May be done by venipuncture or by drawing blood from an existing venous access device.
      1. This lesson discusses venipuncture

Nursing Points

General

1. Supplies needed
   1. Butterfly needle (23g or 25g)
   2. Vacutainer
      1. Plastic safety device to hold lab tubes
   3. Syringe(s) (if no vacutainer is available)
      1. Will have to collect enough blood to fill lab tubes/bottles
   4. Tourniquet
   5. Alcohol pads
   6. Antiseptic scrub for blood cultures
   7. Gauze
   8. Tape
   9. Lab tubes and/or blood culture bottles
      1. Read the label on the lab tube to determine how much blood you will need, especially if you have to use the syringe method
      2. 5 mL each for Blood Culture bottles is sufficient
   10. Patient labels to label lab tubes

Nursing Concepts

1. 1. Steps and Nursing Considerations
      1. Gather supplies
      2. Verify orders
      3. Explain procedure to patient
      4. Perform hand hygiene
      5. Raise bed to comfortable working height
      6. Don clean gloves
      7. Identify an appropriate access site
         1. Apply tourniquet 4-6 inches above planned insertion site
         2. Visualize, then palpate the vein
            1. Should be soft and bouncy
         3. Avoid:
            1. Varicose veins
            2. Sclerosed or hard veins
            3. Extremity with central line, AV graft, lymphedema, or paralysis
         4. Once identified – release the tourniquet to finish preparing supplies
         5. In the case of blood cultures, TWO sites should be selected
      8. Prepare supplies within arm’s reach
         1. Remove butterfly needle from package
         2. Attach vacutainer
         3. If using syringe, carefully remove the vacutainer needle and screw on the syringe
         4. Have lab tubes laid out in appropriate order
      9. Re-apply tourniquet and confirm insertion site by palpation
      10. Cleanse insertion site
          1. Alcohol pad: move in a circular motion from the site outward, allow to dry
          2. Antiseptic scrub: scrub the site in multiple directions for a full minute – MUST allow to dry
             1. DO NOT TOUCH the site after cleaning (especially if doing blood cultures)
      11. Remove the cover from the needle and warn the client of a quick stick
      12. Use thumb of nondominant hand to stabilize vein below the site and pull skin taut
      13. Slowly insert the needle, bevel up, at approximately a 15° angle
          1. With experience, you will feel a ‘pop’ when the needle enters the vein
      14. Using a butterfly you MAY see a flash of blood
      15. Stabilize the needle with one hand
      16. Vacutainer – with the other hand, insert the first lab tube into the acutainer
          1. Repeat with each lab tube as they are full
          2. Invert each tube 4-5 times before setting on the table
      17. Syringe – with the other hand, gently draw back on the syringe until the desired amount of blood is obtained
          1. If you need to switch syringes, you may need to kink the butterfly tubing to make the switch
          2. Have a friend to assist!
      18. When you have the blood you need, release the tourniquet
      19. Gently place a 2×2 gauze over the site
      20. Retract the needle, activate the safety device
      21. Quickly put pressure on the site until bleeding stops
      22. Tape the gauze in place
          1. Check again in 5 minutes
      23. Dispose of all sharps in  sharps container
      24. Dispose of all used supplies in the appropriate waste container
      25. Remove gloves and perform hand hygiene
      26. Return bed to low/locked position
      27. Ensure patient is comfortable
      28. Document procedure and patient response/tolerance
   2. For blood obtained by syringe:
      1. Use a needle to carefully fill each lab tube in the correct order
         1. Let the vacuum in the tube draw blood in, do not push the plunger
      2. Carefully and safely dispose of the syringe/needle in sharps container
   3. For all lab tubes:
      1. Label per facility policy
         1. Patient’s name, DOB, MR #
         2. Date and time of specimen
         3. Your initials
      2. Send to the lab in appropriate manner
   4. If drawing blood from venous access device
      1. WASTE the first aspiration because it is contaminated with saline
         1. Rule of thumb is 2-3 times the ‘dead space’
         2. For a PIV – wasting 3 mL is sufficient
         3. For a CVC or PICC – need to waste 7-10 mL
      2. Will likely use a syringe and needle to fill lab tubes
         1. If your facility has a safety device – USE it!

Patient Education

1. Purpose for lab draws