Blood sampling from a vein with a Vacutainer vacuum set

Authors: Rednenko V.V., Rednenko L.I., Poplavets E.V.

Editor: Rednenko V.V.

Equipment for the practical skill:

• Workplace for injections and intravenous infusions (see PS1 - Preparing of the workplace for injections and intravenous infusions) including
  • venous tourniquet
  • venipuncture pad
• Vacutainer vacuum set
  • a double-sided needle
  • needle holder
  • vacuum test tubes with stoppers of different colors
• Items for storing and transporting blood
• test tube rack
• container for transporting samples of biological material
• marker or stick labels
• Medical records 
• Blank of a referral for blood test

Clinical situation:

• You are a nurse at a hospital's therapeutic department. The doctor ordered to the patient a venous blood sampling. Follow doctor's orders withe a Vacutainer vacuum set

Order of the skill performance:

Preparatory stage:

• inform the patient about a procedure, get verbal consent to giving it, ask him to take the required position
• check the integrity of the package of sterile medical items and dressings, their expiry dates
• check in the patient in the referral blank
• prepare the workplace for injections and intravenous infusions (see PS1 - Preparing of the workplace for injections and intravenous infusions)
• prepare test tubes
• put a test tube rack on the manipulative table
• take a test tube and mark it with marker or stick a label on it

Maine stage:

• ask a patient to sit next to the intravenous injection table and place his hand on it
• place a pad under a patient's shoulder
• put a tourniquet on patient's shoulder over clothing 10-12 cm above the venipuncture site
• make 2-3 massaging movements with the edge of the palm in the direction from the periphery to the center (with poorly contoured veins)
• ask the patient to clench fingers in a fist

• select, examine and palpate a injection site (vein) with your dominant hand
• take two swabs with your dominant hand, wet it with skin antiseptic;
• treat the skin at the injection site 2-3 times in one direction:
  
  • with one swab a “large field” (10x10 cm in size);
  • wtithe second one the "small field" (size 5x5 cm) ;
• place the used swabs in the container “Disinfection of dressings, PPE”;
• wait until the disinfectant has completely evaporated from the surface of the skin;
• take one swab and wet it with skin antiseptic;
• keep this swab with fourth and fifth finger of non dominant hand
• take the needle of Vacutainer (the needle has two plastic caps of different colors) from the table with your non dominant hand

• remove the needle cap from the side of the rubber valve with your dominant hand and put it in the "Plastic" container
• take the holder with your dominant hand and insert the needle into the holder from the side of the rubber valve
• screw the needle all the way
• take the swab with your non dominant hand, moisten it with an antiseptic, put it in the palm of your non dominant hand, holding it with the fourth and fifth fingers
• remove the other cap from the needle with your non dominant hand‚ put the cap in the container "Plastic"
• fix the vein by pulling the skin below the venipuncture site with the first finger of the left hand
• holding the needle with the cut up, pierce the skin at a slight angle (no more than 15°), place the needle parallel to the vein, without changing the position of the holder in the hand
• continuing to fix the vein, slightly change the direction of the needle, pierce the front wall of the vein (there is a “hit in the void”) and carefully push the needle along the vein until blood appears in the needle cannula (no more than half the length of the needle)
• take the test tube with your non dominant hand from the rack and insert it into the holder until it stops, piercing the rubber stopper of the test tube with the needle
• untie the tourniquet with your left hand, invite the patient to unclench his fist
• fill the test tube with blood (under vacuum)
• disconnect the test tube with blood from the needle holder
• flip the test tube three times
• put the test tube in the tube rack
• put a swab moistened with an antiseptic to the venipuncture site, remove the needle with a quick movement, press the swab for 3-5 minutes. For puncture of the ulnar vein, suggest that the patient bend the arm at the elbow joint.

Final stage:

• insert the needle through the hole with a serrated edge into the container "Disinfection of sharp medical devices", disconnect it by unscrewing from the holder
• place the holder in the container "Disinfection of syringes and other medical items"
• take off the gloves, place it in the container “Disinfection of dressings, PPE” (see Removal contaminated gloves); 
• place the test tube rack in the container for transportation of biological material samples 
• wash your hands (see Hygienic hand washing)