Procedure for Collection of Blood Specimens by Venipuncture

PROCEDURE:

1. Wash hands

2. Patient identification is the very most important step in securing a quality blood sample. Follow existing procedures as detailed in "Identification of Patient and Samples."

See special identification requirements below for Blood Bank Specimens which must use the Typenex Barcode Plus system.

3. Verify the patient's diet restrictions. Medication dosing and/or fasting status may be important.

4. Verify orders for tests and correct tubes.

NOTE: Non-additive tubes are drawn before additive tubes to avoid contamination. The following

is order of draw:

◦ Y – (Yellow) blood culture tubes

◦ B – (Blue) citrate

◦ R – (Red/Gold) SST clotted samples

◦ G – (Green) heparin

◦ P – (Purple) EDTA

5. Assemble the following supplies:

◦ Gloves

◦ Collection tubes

◦ Needles

◦ Hubs

◦ Tourniquet

◦ Alcohol Preps

◦ Povidone –iodine (blood cultures)

◦ Chloraprep (blood cultures)

◦ Elastic bandage

◦ Gauze

6. Reassure the patient.

7. Position the patient to best accommodate the blood draw as well as providing patient comfort.

8. Apply tourniquet; explain the tourniquet will be temporarily tight.

9. Select the vein site. (Look at both arms. The preferred veins are the larger fuller median cubital and

cephalic veins.)

10. Apply gloves.

11. Clean

the area with 70% isopropyl alcohol, cleanse with a circular motion and allow to dry.

NOTE: If blood culture is to be drawn, follow proper protocol with aseptic technique.

12. Grasp the patient's arm firmly, using your thumb to pull the skin tight in order to anchor the vein. Your

thumb should be 1-2 inches below the venipuncture site.

13. With the bevel up on the needle, apply puncture at 30 degrees angle or less.

14. While holding the evacuated tube holder in place, push the tube onto the needle. Fill the tube until the

vacuum is exhausted and blood flow ceases. Mix immediately after drawing. Tubes with additives must be

thoroughly mixed. Erroneous test results may be obtained when the blood is not mixed with the additive.

15. Release the tourniquet after the first tube is filling.

16. Lightly apply gauze over the venipuncture site and remove the needle while keeping the bevel in an

upward position. Activate safety device over the needle. Apply an adhesive bandage over the

venipuncture site. Inform patient to leave on at least 15 minutes.

17. Dispose of needles and hub.

18. The identifying label must be attached to the blood tube at the time of collection and before leaving the

patient's side – NOT DEFERRED UNTIL LATER.

19. Follow existing procedures as detailed in "Identification of Patient and Samples."

20. Compare the labeled tube to the patient's identification bracelet or have the patient verify that the

information on the labeled tube is correct.

21. Promptly send completed blood draw to laboratory.

SPECIAL NOTES:

• The patient's veins become more prominent when they form a fist.

• Palpate the vein with the finger, unlike veins, arteries pulsate. Tapping sharply at the vein site with second

finger a few times will cause the vein to dilate.

• Warming devices: These can be used to dilate the blood vessels and increase blood flow. Warming

devices should not exceed 42°C. Manufacturer's recommendations should always be followed.

• Apply the tourniquet to increase venous filling, which makes the veins more prominent and easier to

enter. Wrap the tourniquet 3-4 inches above the venipuncture site. Never leave the tourniquet on longer

than one minute.

• Inspect the tip of the needle to determine that it is free of hooks at the end point.

• If the blood does not come into the tube change the position of the needle, try another tube, loosen the

tourniquet.

• Intravenous fluids: Do not draw from a vein above the IV. Draw from the opposite arm. If needed to

draw from IV site:

◦ Turn off IV for 2 minutes

◦ Apply tourniquet below IV site

◦ Select a vein other than the one with the IV

◦ Perform venipuncture. Draw 10 mL of blood and discard before drawing the test specimen

◦ Label tubes or identify samples as 'IV arm, 10cc discard"

Special Requirements for Blood Bank Specimens

The purpose of the Typenex Barcode Plus System is to add additional safety to the transfusion process. The Typenex blood recipient identification system positively links the blood sample, the patient and all blood products back to the patient's specimen.

PROCEDURE:

A. Phlebotomy Process:

1. All specimens with Blood Bank orders need to have the Typenex Band System used except prenatals and cords.

2. Once the phlebotomist has verified the patient's identity:

a. Write the patient's first and last name and DOB on the patient information part of the arm band prior to placing the blood band on the patient. If the patient is unable to identify themselves, information can be obtained from the hospital arm band that is already in place.

b. One barcoded label from the Typenex band is placed horizontally on the tube. Specimen is labeled per Blood Bank specimen guidelines.

c. Attach the Typenex band on one of the patient's extremities (wrist is first choice).If the patient is pre-op or scheduled for outpatient transfusion, the patient needs to be given the written patient instructions concerning the green Blood Bank band

3. How to change Typenex band in Meditech if a new band is used or the number was entered incorrectly.

1. Specimen Desktop

2. Edit tab

3. BBK Wristband

a. Enter Specimen Number

b. Enter new number

c. At the prompt – Change All Pt Specimens with Old WB#?, Enter "N".

NOTES:

1. When the patient is already banded with a Blood Band, the phlebotomist does not need to cut off the old Blood Band, just draw a new specimen.

2. All patients for possible transfusion and surgery are banded at the same time (or band given to them – OP) the specimen is drawn, no exceptions.

3. All outpatients including pre-ops need be told that they need to bring their band with them when they come back for their transfusion, procedure or surgery.

4. "Jane Doe" or "John Doe", unidentified patients, can have crossmatch specimens based on the Typenex band identification only.

Typenex R3 bands are available for reattachment or to readjust size.