A Step-by-Step Guide to Venipuncture
What is venipuncture? Learn about the procedures, steps, risks, and requirements for performing venipuncture.
Drawing a blood sample or starting an IV isn’t usually the highlight of a medical worker’s day. It’s certainly not one for the patient either, especially if multiple needlesticks or other complications are involved. However, phlebotomy and venipuncture are critically important to patient care. Mastering these skills will lead to a much better experience for all healthcare practitioners as well as their patients.
This article focuses on the art and science of venipuncture, one of the most important healthcare procedures for nurses and other medical staff.
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Venipuncture is an essential practice for various medical diagnoses, procedures, and tests. This important skill can be exciting for new healthcare professionals. It’s especially vital that nurses learn the proper method for drawing blood as well as the various venipuncture techniques in a healthcare environment.
What is Venipuncture?
If you’re new to the medical field, you might be wondering, what does venipuncture consist of? In medicine, venipuncture is the process of drawing blood from a vein. It is an important skill that aspiring nurses should consider learning for their career. It’s also an essential medical practice for several diagnoses, tests, blood transfusions, donations, and other routine procedures.
Think about it: Without the proper blood samples to accurately diagnose our health, we could all suffer from a host of dangers, including treatment errors or the lack of proper medical attention to undiagnosed illnesses or conditions.
Phlebotomy vs. Venipuncture
Many people use the terms “phlebotomy” and “venipuncture” interchangeably. However, there is a slight difference between these two concepts.
Venipuncture is the act of puncturing the vein for various medical purposes. A healthcare professional might perform venipuncture to start an IV (intravenous therapy) or they might pierce their patient’s skin to draw samples of blood.
Phlebotomy specifically refers to the single-use needlestick for drawing blood specimens. Whereas venipuncture refers to the broader concept of entering the vein for either drawing blood or administering an IV for an extended period, phlebotomy is limited to blood-sample collection. Furthermore, phlebotomists must use a new needle for each sample that’s drawn, and they may not necessarily be authorized to apply this skill to administering an IV treatment.
What is the Purpose of Venipuncture?
Venipuncture is a routine procedure that’s typically performed for one of the following reasons:
- To acquire blood samples for diagnostic purposes.
- To monitor levels of various blood components.
- To administer therapeutic treatments intravenously, including medications, nutrition, or chemotherapy.
- For removing blood to combat high levels of iron or red blood cells.
- To collect blood for later uses, such as blood transfusions.
How Long Does it Take to Perform Venipuncture?
In one study, it took 10 seconds or less to collect blood for one tube. The average time to acquire blood for three tubes was between 26 and 44 seconds.
When you factor in some of the initial steps of venipuncture—collecting supplies, verifying information, preparing the patient, etc.—the entire process may take anywhere from five to ten minutes.
Who Performs Venipuncture?
Venipuncture can be performed by various healthcare professionals, including medical laboratory scientists, medical practitioners, phlebotomists, dialysis technicians, and other nursing staff.
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Some EMTs and paramedics may also perform venipuncture, and in veterinary medicine, the procedure is usually performed by veterinarians or veterinary technicians.
Depending on the location (i.e. state of employment), employer, and experience level, Medical Assistants can also draw blood with the proper training.
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Training Requirements for Venipuncture
Venipuncture requirements can greatly vary and will depend on your location as well as your profession. For instance, in all but four states, phlebotomists aren’t required to obtain a phlebotomy certificate or license to draw blood (don’t worry – most employers will only hire phlebotomists with valid certifications or diplomas). There are, however, some people who have years of phlebotomy experience but have never passed a phlebotomy program.
When it comes to venipuncture training, many programs in your chosen profession will likely include some component of venipuncture or phlebotomy. At Unitek College, for example, students in the Medical Assisting program must demonstrate the application of adult and pediatric phlebotomy, venipuncture, and capillary blood collection.
A Step-by-Step Guide to Venipuncture
With these steps, you can start to learn more about the process of venipuncture. Like any other skill, venipuncture requires a lot of time and practice to get it right. Try not to feel disheartened if you don’t get it right the first time. And don’t hesitate to ask for help. Veteran nurses or other healthcare professionals can assist you in honing your craft and mastering this new skill.
Have your supplies ready! Once you know the site of the blood draw, you’ll want to gather the necessary supplies. Some healthcare facilities have pre-made kits, but others involve individual retrieval. It’s a good idea for nurses to take an extra set of supplies into the exam room. Why? You might need to perform more than one venipuncture.
Here are some of the general guidelines you should follow when performing venipuncture on adults or children:
- Explain the procedure and reason for the blood draw to the patient.
- Identify the patient using two patient identifiers as mandated by the Joint Commission (JCAHO).
- Confirm the ordered blood tests and fill out the appropriate forms and labels.
- Check for any allergies or sensitivities with the patient regarding antiseptics, adhesives, or latex.
- Position the patient and hyperextend the patient’s arm.
- Perform good hand hygiene and wear appropriate PPE (personal protective equipment).
- Apply a tourniquet approximately three to four inches above the selected site. Closely monitor the arm to ensure that it is not applied too tight or for more than two minutes. Reasons for concern would include numbness, tingling, change of color to blue or white, and extreme pain.
- Ask the patient to make a fist and not pump the hand.
- Prep the venipuncture site by cleansing the area with an alcohol prep pad for 30 seconds and allow to air dry for 30 seconds.
- Grab the patient’s lower arm (below site of puncture) firmly to draw the skin taut and anchor the vein from rolling. Insert the needle at a 15 to 30-degree angle into the vessel.
- If properly inserted, blood should flash into the catheter. If this does not happen then the needle has either not punctured the vein or the needle went through the vessel.
- Attach the needed tubes or syringes to remove the proper volume of blood. Only remove the tourniquet as the last amount of blood is drawn.
- Remove the needle from the patient’s arm and press down on the vessel with gauze.
- Dispose of contaminated materials and needles in the designated hospital-approved containers.
- Label appropriate tubes at the bedside and place into transport bags.
- Deliver blood specimens to the laboratory promptly.
Healthcare professionals will stem the blood by holding a cotton swab to the puncture site. They’ll also apply a bandage or tape the cotton swab. After the procedure, the patient should try to drink water and eat something. If they feel dizzy or experience any other unusual symptoms, they must tell someone right away.
Necessary Equipment for Venipuncture
The suggested supplies for venipuncture include the following items.
- Evacuated collection tubes
- Personal Protective Equipment
- Needles and syringes
- Hand Sanitizer
- Alcohol swabs
- Laboratory specimen labels
- Blood transfer device
- Tape or adhesive bandages
- Laboratory forms
- Bio-hazard leak-proof transportation bags
- Puncture resistant sharps container
Potential Risks or Complications of Venipuncture
Serious venipuncture risks or complications can include some of the following conditions:
- Cellulitis – A common but potentially serious bacterial infection of the skin. The affected areas typically appear swollen and red.
- Phlebitis – Inflammation of the vein. It can occur due to blood clot(s) in a vein that cause inflammation.
- Diaphoresis – Perspiring from sweat glands, which is often a response to heat, exercise, or stress.
- Hypotension – Low blood pressure. It can result in fainting or dizziness, as the brain isn’t receiving enough blood.
- Syncope or near syncope – Fainting, or a sudden temporary loss of consciousness.
- Seizure activity – A sudden, uncontrolled electrical disturbance in the brain. It can alter your behavior, movements, or feelings.
However, minor bruising is the most common reaction to venipuncture, and serious complications are fairly rare.
You can typically avoid these issues by knowing your veins and following the appropriate steps. For more tips, just keep reading!
Pro Tips for Mastering the Art of Venipuncture
Some of the most basic venipuncture tips involve planning ahead, using an appropriate location, and ensuring there’s quality control. Here are other pro tips that may assist you in the future.
- Know Your Veins – A common choice for adult patients is the median cubital vein in the antecubital fossa (think crevice of the elbow). This vein is a good choice for beginners, as it’s close to the surface and tends not to roll when punctured. Some other commonly used veins are the basilic vein and the cephalic vein.
- Take a Deep Breath – By asking the patient to take a deep breath just before the stick, you can help keep them calm and distracted. A person will often feel more in control of the situation if you give them something to do. This may work as the needle is being removed, too.
- Anchors Away – Stretching the skin by “anchoring” the vein doesn’t just help you stick the vein on the first try, it also helps make the stick less painful. Remember, your thumb goes below the venipuncture site, and give yourself plenty of room so you don’t accidentally jab your own fingers.
- Feelings, Nothing More Than Feelings – Part of selecting the vein comes down to feeling. Not a gut feeling but literally feeling for the vein—no slapping, despite what you see in movies—will always be the most reliable approach. Palpate for that “spongy firmness,” and feel above and below your target area for a better idea of direction.
- The Invisible Vein – Still can’t find a place to stick? Dr. Jabr of Florence, Oregon suggests “to obviate the need for multiple inconvenient and painful attempts at securing the needle, apply a warm pad to the target vein for a few minutes. This helps dilate the vein and makes it more visible and accessible.” Another trick is to bend the arm upward if the veins are hiding. This sometimes makes them easier to spot.
- Less Than Thirty – You’ve probably heard this a hundred times in your nurses training, but it never hurts to hear again. The World Health Organization guidelines suggest keeping the angle of insertion at 30 degrees or less (15 is ideal) to avoid passing through the vein.
- Label Immediately – There’s nothing worse than getting a great stick, drawing a great sample, then forgetting to label it right away. Actually, there is something worse… and that’s mixing up samples because they weren’t labeled at the bedside. For your sake and the patient’s sake, label all sample immediately, even if things are going a mile a minute.
- Know When to Quit – Just can’t get that blood sample? Veins just aren’t cooperating? Considering a third or fourth attempt? Here’s something else to consider—getting help. Don’t think of it as failure or defeat, think of it as making the best decision for your patient. Getting a fresh set of eyes on the situation might be all that’s needed to finally draw a good sample, and knowing when to seek help is the mark of a pro.
- There’s a Body Attached to That Arm – At the end of the day, though, everything really comes down to how safe and peaceful you make your patient feel. So, treat each and every one as if they were a friend or relative, and remember that just because you see needles and blood samples many times a day, this is a fairly rare experience for them. They will often be nervous. Some may faint. Some may be nervous because they’re afraid they’ll faint. It’s up to you to coach them through it and make the experience as positive as possible. The better it goes, the better the chances of that person seeking medical attention in the future, and that’s always a great takeaway.
Why Should Nurses Learn Venipuncture?
Even though many hospitals employ phlebotomy teams, it’s still vital for nurses to learn these skills so that they may provide the best care possible. Some intensive-care units may even require that their nursing staff maintain proficiency in venipuncture. This is because phlebotomy teams typically make rounds at specific times in most hospital settings. If a doctor orders an immediate lab test, the responsibility could fall to the nurses on duty.
Venipuncture isn’t something that should be learned from study alone. Watching videos or reading guides like these are great, but remember to practice in a controlled environment with trained professionals. If you’re already in the healthcare field, try speaking with your supervisor to learn the steps for certification.
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