Blood sampling from a vein with a syringe

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
  • 10 or 20 ml syringe with needle of size 0.8x 40 mm (green needle hilt, G21) 
• Items for storing and transporting blood
  • 2-10 ml test tubes with plugs
  • 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

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 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
• remove a plug from the test tube
• place the plug on the manipulative table
• put the test tube in the test tube rack
• prepare a syringe with needle
  • open a syringe package
  • take the syringe and connect it with a needle
  • remove the syringe with needle from the package
  • place the package on a manipulative table
  • check needle patency by withdrawing air into the syringe and removing it
  • put the syringe with needl in the package

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 syringe with a medication from the opened package with your dominant hand, place the second finger on the needle hilt, grasp the syringe barrel with others fingers;
• place the package in the "Package" container;
• remove a cap from the needle with your non dominant hand, holding the needle hilt with the index finger of your dominant hand, place the cap in the "Plastic" container
• put the syringe in your dominant hand: place the index finger on the needle hilt, grasp with other fingers the syringe barrel
• check the parallel position of the needle bevel and the syringe barrel scale
• 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 syringe 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)
• untie the tourniquet with your left hand, invite the patient to unclench his fist
• pull the syringe plunger “towards you” until blood appears in the syringe barrel
• withdraw required amount of blood
• put a ball moistened with an antiseptic to the venipuncture site, remove the needle with a quick movement, press the ball for 3-5 minutes. For puncture of the ulnar vein, suggest that the patient bend the arm at the elbow joint.

• put the needle into test tube by bevel to test tube wall
• displace slowly the blood from the syringe to the test tube (the blood must flow on the test tube wall)
• close the test tube with the plug

Final stage:

• disinfect syringe and injection needle (see PS3 - Disinfection of disposable syringes and injection needles);
• 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)