The right equipment
Nurses are accustomed to working with sharp objects, performing hand hygiene, and using protective equipment for invasive procedures. Phlebotomy is no different! You should maintain sharps safety, protect yourself from blood-borne pathogens and remember the chain of infection at all times. As you gather your supplies, there's a variety of blood drawing tools available so how do you know what size needle or device would be best?
A quick patient assessment can give you the information to make appropriate equipment choices. Take a minute to inspect and palpate their veins - are they readily visible or closer? Are small or large? Condition dictates your decisions when choosing what type of I.V., also consider that patients may have hardened veins due to cancer treatment with chemotherapy drugs so avoid them as well! There are reasons to consider avoiding certain veins that may be difficult to puncture, due to the patient's history of chemotherapy or drug use.
For patients with difficulty in vein search or immature venipuncture technology, nurses can also be equipped with vein finder to improve work efficiency and improve patient satisfaction.
If you are not familiar with a vein finder, please click here to see a comparison of the best vein detector on the market to help you find the most suitable vein detector.
Evacuated tube system vs. syringe
The evacuated tube system (ETS) is the standard equipment used for routine venipuncture. It consists of a needle device, a tube holder, and an air-evacuated tube that you attach to both at once before inserting into your vein. The plastic adapter helps align everything easily and keeps hold while drawing blood out in one fluid motion! Once penetrated by the needle, a tube will automatically fill with blood according to how much vacuum pressure is within it.
When manufactured, negative air pressure is created in this space and removed before use so that when you insert something into it like a syringe or blood sample for example--it fills right up! Once the tube is punctured by engaging it with a needle, the negative pressure causes suction to draw blood into the tube. This is easy until you realize that not all tubes are created equal when it comes to being able to handle this process without breaking!
If the vein is small, thin, and fragile a syringe draw may be your best bet. This method will allow you to control pressure and speed by varying how quickly it pulls back on the plunger. You can choose a syringe draw to use with veins that collapse easily.
But keep in mind you must also consider how many total milliliters of blood are needed for each tube and which size syringe is appropriate. When drawing using the syringe technique, completes this process by transferring the blood into tubes with a Luer-lock transfer device!
Butterfly needle vs. straight multisample needle
If you're performing a blood draw on someone with small, difficult veins that are close to the surface such as those on their hands and wrists, butterfly needles would be your best choice. Butterfly needles have smaller diameters (23-25 gauge) which make them easier to control than traditional cannulas meaning they reduce pain for patients during procedures. The clear tubing between the needle that accesses the vein and the one that attaches to a tube holder lets you know when your blood flashback has begun. The length of this tubing makes it easier for you to recognize if you've accessed a vein or not.
With a straight multisample needle being 1-1.5 inches in length and the gauge ranging from 20 to 22, these are considered to be your standard choice for routine venipuncture with no issues within healthy veins. If a patient has veins that are particularly fragile, you can also use a butterfly needle device with every patient. This practice is costly because butterfly needles are expensive compared to multisample needles.
Tourniquet
Tourniquets vary in elasticity, width, and length. Most facilities are now using latex-free tourniquets, but you should ask your patient about latex sensitivity if it is not one of those types. These come in two options: longer for obese patients or smaller for pediatric ones along with petite adults too! The Clinical and Laboratory Standards Institute recommends single use to avoid hospital-acquired infection transmission from them when used more than once before disposal.
Site antiseptic
For routine blood draws, 70% isopropyl alcohol or 70% ethyl alcohol should be used. For standard antisepsis, you can use a standard prep pad with either of these types of liquid on it. If drawing up multiple vials for culture tests, the facility policy will say what to do instead so follow that guideline! The skin antiseptics are typically chlorhexidine gluconate or benzalkonium chloride but if using something else make sure they're listed in your procedure manual and get confirmation from whoever wrote them before doing anything different!
Tubes
In order to ensure accurate test results, it is important that nurses understand the different types of tubes as well as how much blood should be placed in each one.
Knowledge of tube additives and types is helpful but not necessary for understanding the main concept. The most important thing to keep in mind is whether you need a plasma or serum sample. There are two basic principles: 1) Does this need to be a plasma sample? 2) Does this need to be a serum sample?
If a test requires whole blood or plasma, such as CBC count and stat chemistries, then the tubes need to be refrigerated. If its serum for tests like electrolytes and BUN/creatinine, the tubes must clot before centrifugation and collection of sera.
Centrifugation is when a centrifugal force causes the denser blood cells to move into a specific area of their tubes. It can be used in order to separate plasma and serum, which are less dense than red blood cells, platelets or white cell components respectively.
Separator gel is a special type of liquid within certain blood collection tubes. As part of the blood centrifugation process, it forms an impenetrable barrier between whole cells and serum or plasma samples so that these contaminants don't contaminate them during analysis.
