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02.02 Drawing Blood

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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. 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

Reference Links

Study Tools

Video Transcript

In this video we’re going to look at how to draw blood from a patient using venipuncture with a butterfly needle. We try to draw blood from a working line if a patient has one, but if not, we need to use venipuncture to do it!

You’re going to start by identifying a good vein, just like you would if you were starting an IV. The difference is, in this case, you can go in the AC if you want because we aren’t leaving the catheter in. So place your tourniquet and palpate until you feel a good vein. Remember to aim for what you can FEEL, not just what you can see!
Then release the tourniquet while you get your supplies ready. In this video, we’re going to use the vacutainer method. So you’ll need a butterfly needle and you’ll need to attach the vacutainer to the end of the butterfly tubing.
You will also need alcohol prep pads or antiseptic scrub if you’re drawing blood cultures, a tourniquet, gauze and tape. And of course, whatever blood tubes you’re drawing!
When you’re ready, replace your tourniquet about 6 inches above where you’ll be sticking. Palpate again to make sure the vein is still there.
Then clean your site. If it’s a regular blood draw, use alcohol pads in a circular fashion from the inside out. However, if you are drawing blood cultures, you must use antiseptic scrub and you MUST scrub for a full minute back and forth, up and down, around and around to get rid of as many bacteria as possible. Either way, don’t touch it once you clean it and make sure you let it dry!
Now take the cap off your butterfly needle. Then, you’re going to stabilize the vein below the insertion site and hold your needle bevel up at about a 15 degree angle so you don’t go right through the vein or go above it.
Insert the needle until you feel a bit of a pop – you’ll learn that feeling more with experience. You may or may not see a flash of blood.
Once you think you’re in, keep one hand on the needle and use your other hand to insert the first tube into the vacutainer and the vacuum action will pull the blood for you. Gently pull it out and turn the tube 4 or 5 times to mix. Repeat that with as many tubes as you need.
Once you have what you need, release your tourniquet.
Then put a piece of gauze over the site and quickly pull out the needle while applying pressure to the site. Make sure you activate the safety device on your needle as well.
Hold pressure until the bleeding stops, then tape a piece of gauze over the site.
Put your sharps in the sharps container and throw your trash away. Label the lab tubes appropriately and send them off to the lab!

That’s it! Easy as that! Just like starting an IV, drawing blood this way takes practice and you’ll get better and better at it.

We love you guys! You can do this! Now, go out and be your best selves today! And, as always, happy nursing!

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