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Sites For Venipuncture
1. Median cubital vein
A superficial vein, most commonly used for venipuncture, it lies over the cubital fossa and serves as an anastomosis between the cephalic and basilic veins.
2. Cephalic vein
Shown in both forearm and arm, it can be followed proximally where it empties into the axillary vein.
3. Basilic vein
Shown in the forearm and arm, it divides to join the brachial vein.
a) Safety needles 22 gauge.
e) Antiseptic (70% isopropanol).
f) Cotton swab.
g) Sharps disposal container.
h) Collection bottles.
Venipuncture is one of the most routinely performed invasive procedures and is carried out for any of these five reasons:
a) To obtain blood for diagnostic purposes.
b) To monitor levels of blood components.
c) To minister therapeutic treatments.
d) To remove blood due to excess levels of iron or erythrocytes.
e) To collect blood for other uses e.g. transfusion
a) Make sure the patient is calm or has settled down for at least five minutes before taking the sample.
b) Select a sterile dry syringe of the required capacity. E.g. 2.5ml, 5ml, and attach a needle to it.
c) Select a vein on the upper arm. Apply a tourniquet around 10cm above it. (not tightly and for long). Request the patient to make a fist.
d) Using the index finger feel the vein.
e) Clean the site with 70% alcohol.
f) Puncture the site at approximately 30º from the vein with the bevel of the needle directed upwards in the line of the vein.
i. With needle and syringe:
Steadily withdraw the plunger of the syringe at the speed it is taking the vein to fill. Avoid moving the needle in the vein.
ii. With vacutainer:
Gently attach the vacutainer to the hub; multiple vacutainers can be used on a single procedure.
a) When sufficient blood has been collected, release the tourniquet and instruct the patient to open his fist. Remove the needle and immediately press on the puncture site.
b) Remove the needle from the syringe and carefully fill the container with the required amount of blood. Discard the needle safely. Do not attempt to re-sheath it because it can lead to needle stick injury (NSI).
c) Mix immediately the blood in the EDTA or citrate anticoagulant container. Label the container immediately.
d) Check that bleeding from the venipuncture site has stopped. Cover the area with a small dressing.
a) Gloves are to be worn during all phlebotomies.
b) Palpation of phlebotomy site may be performed without gloves provided the skin is not broken
c) A lab coat must be worn during blood collection
d) Needles are single use and are disposed off in an appropriate sharps container.
e) Needles are never recapped, removed, broken or bent after phlebotomy procedure.
f) Gloves are to be discarded in appropriate container immediately after phlebotomy procedure.
g) Contaminated surfaces must be cleaned with freshly prepared 10% bleach solution.
h) Wash hands in warm running water with chlorohexydine gluconate hand washing product.
i) Avoid brachial sites in obese patients because of the difficulty in attaining homeostasis.
j) The femoral artery is linked to higher rates of hematoma and infection and should be used only as a last resort.
Phlebotomy plays a vital role in the field of medicine. Skills learnt help maintain and preserve human and animal health.