EXERCISE NO.

1 VENIPUNCTURE

OBJECTIVES
After performance of this exercise, the students must be able to: Explain the venipuncture procedure Give the advantages of venipuncture Give the remedies to failure of blood to come out into the syringe/ vacuum tubes Prepare the equipment/ materials needed to perform the venipuncture Apply the tourniquet Select the proper venipuncture site Perform venipuncture Care for a puncture site after venipuncture List the preparations to be observed when performing the venipuncture Enumerate the different types of anticoagulants and their uses Define terms related to venipuncture

INTRODUCTION
The most common method of obtaining blood for laboratory examination is by venipuncture. In venipuncture, sometimes called phlebotomy, the blood is taken directly from superficial vein. The vein is punctured with a needle and blood is collected in a syringe or tube. The venipuncture is the fastest way of obtaining a sample of blood form which many different determinations/ tests can be performed. The venipuncture is a safe procedure when performed correctly by a skilled medical technologist. The procedure should be performed with care. Every effort should be made to preserve the conditions of the vein. Much observation and practice are required to become skilled and self-confident in the art of venipuncture.

FIGURE 1

Materials for venipuncture

1. Hypodermic needle 2. Syringe 3. Syringe and needle assembled

The steps in venipuncture are summarized as follows: 1. 2. 3. 4. 5. 6. Preparing the equipment materials Preparing the subject (patient) for venipuncture Applying the tourniquet Preparing the puncture site Obtaining the blood Care of the puncture site

Note: When performing a venipuncture, the students must be supervised by a qualified instructor.

PRINCIPLE
Blood specimen is obtained by puncturing the vein for examination which require more than a few drops of blood. The venipuncture may be made by either the syringe method or the vacutainer method.

MATERIALS/ EQUIPMENTS
1. 2. 3. 4. Anticoagulated tube or bottle. Plain test tube Disposable sterile dry syringe Disposable sterile needles (gauge 21 or 23) Tourniquet (rubber tubing, rubber bandage, flat rubber with commercial trade names such as Veniket, Velket, etc.,) 5. Cotton balls 6. Vacutainer kit (In place of syringe and needle, if vacutainer method is to be used)

SYRINGE METHOD Procedure

1. Assemble the equipment/ materials. Gather all the required tubes and supplies for the procedure. 2. Identify and position the patient. Verify your patients identity and then ask him to sit alongside the table used for taking blood. Lay his arm on the table, palm upwards and support it by placing a small cushion under the elbow.

3. Apply the tourniquet tourniquet must be placed above the elbow about 5 to 15cm away from the site of puncture. Place the tourniquet firmly but not too tight to loose. 4. Select the vein with the tourniquet in place, use the pad of the index finger to palpate the cubital fossa. Work across the fossa pressing up and down. The vein will feel like an elastic tube under the skin. Select the best vein that is more fixed and anchored better (median cubital fossa)

5. Apply the antiseptics clean and sterilize the area using cotton balls with 70% alcohol. Let it dry.

6. Insert the needle while holding the syringe with thumb top and the four finger under and bringing the needle to an angle of about 15 to 30 degrees. Puncture the vein you have selected. 7. Withdraw the blood pull the plunger with the either free hand not too fast and not too slow until the desired volume is achieved.

8. Release the tourniquet remove the tourniquet as soon as the blood flows into the syringe or before the desired volume is achieved. 9. Withdraw the needle place dry cotton ball in entrance of needle, ensuring no pressure is applied. Then with one withdrawing motion, withdraw the needle, keep the cotton ball in place and apply a little pressure to stop bleeding. Note: ask the patient to elevate his arm for a while 10. Transfer the blood sample to anticoagulated and non-coagulated bottles or tubes remove the needle with its cap, and let the blood flow along the side to avoid hemolysis.

FIGURE 2

Tying a tourniquet

FIGURE 3 releasing the tourniquet

FIGURE 4 Veins most commonly used for venipuncture