How Can Nurses Draw Blood Efficiently?

The process of drawing blood from a vein is known as Phlebotomy. The blood is drawn for various tests, procedures, and diagnoses. Phlebotomy is a critical skill that every nurse must learn to offer effective patient care. In fact, most of the Intensive Care Unit prefers to hire those nurses who possess the ability to draw blood splatter.

Due to legal issues, nursing schools don’t impart knowledge about how to draw blood cultures. However, you can take additional courses to master this skill. Aspirants can learn the skill by studying the art of venipuncture in textbooks and watching LPNs or RNs performing this task in clinical settings. But, reading books or watching videos will not suffice; you will have to practice this skill under the supervision of a trained professional, under a controlled environment.

Best Guidelines to Draw Blood Sample

The WHO (World Health Organization) has put forward some best guidelines to draw blood cultures.

  • Make an appropriate plan ahead
  • Choose the right location that is well-lit and clean
  • Quality Control

Skills Required to Become Proficient in Phlebotomy

  • Knowledge of the anatomy of the main arteries and veins in the body
  • Attention to detail
  • Strong interpersonal skills and empathy
  • Understanding of relevant procedures, policies, and equipment

How Long do Fast Before the Blood Draw?

Ensure that the patient doesn’t drink anything (other than water) or eat for 8-12 hours before the blood test.

  • Fast for 8 hours for a glucose test
  • Fast for 10-12 hours for lipid/cholesterol testing

Note: Do not fast for more than 12 hours as it will affect the test results

Drawing Blood Procedure

Below are the steps to draw blood easily:

Step 1 – Identify the Correct Vein

Identification of the right vein to puncture will make the entire process of drawing blood sample easy and will yield excellent blood results.

You can choose any of the following 3 veins for venipuncture:

  • Median cubital vein
  • Basilic vein
  • Cephalic vein

The median cubital vein (found between the crevice of the elbow between the median cephalic and the median basilica vein) is mostly chosen to draw blood in adult patients. Some good reasons to choose this vein by new phlebotomists are:

  • It is close to the surface of the skin.
  • It does not roll when punctured.
  • In comparison to other veins, this vein has a low risk of harming surrounding tendons, arteries, and nerves.

Points to Remember:

  1. You must avoid puncturing the arm:
    • on the side of a surgical procedure
    • in which blood is being transfused
    • on the side of a mastectomy
    • with a current or pre-existing blood clot
    • with PICC line
  2. You must also not draw blood from an area of open wound or infection, sites above an IV cannula in the same vessel, hematomas, grafts and fistulas, burned or scarred areas, and areas filled with severe fluid.
  3. Use a tourniquet if the veins are not deep and not visible. Ask the patient to lower their arm. It will increase pressure on the vein and make it visible.
  4. If the vein is already visible, do not use a tourniquet as it will put excessive pressure on the vein, causing the vein to collapse.

Step 2 – Gather the Requisite Supplies

Once you identify the vein to puncture, gather the necessary supplies. Some healthcare institutes provide the required supplies to nurses, while others need nurses to assemble and bring their kit.

You will need the following supplies for venipuncture:

  • Puncture resistant sharp container
  • Leak-proof and bio-friendly transportation bags
  • Tape/Adhesive bandage
  • Gauze
  • Laboratory specimen labels
  • Alcohol swabs
  • Hand Sanitizer
  • Tourniquet
  • Needles for drawing blood
  • Gloves/Personal Protective Equipment
  • Evacuated collection tubes

Point to Remember:

If you require performing a second venipuncture on the patient, take extra supplies.

Step 3 – Perform Venipuncture

For pediatric and adult patients, follow the below-given steps to draw the blood:

1. Explain the Procedure

The cooperation and involvement of the patient in drawing the blood is quite essential. Therefore, explain the reason for venipuncture to the patient and describe the step-wise procedure of drawing blood to him/her.

2. Identify the Patient

A mistake in patient identification may lead to errors in diagnostic lab results, incompatible blood transfusions, errors in administering medications, etc. In order to prevent treatment errors, the  Joint Commission mandates  two identifiers, such as full name of the patient, medical identification (ID) number, and/or date of birth. After confirming the patient’s identity and ordered tests, fill out the appropriate labels and forms.

3. Identify the Allergy

Check for any sensitivities or allergies with the patient regarding latex, adhesives, or antiseptics. Use an allergy ID band to identify the allergies.

4. Position the Patient

  • Position the patient appropriately and ask him/her to hyperextend the arm.
  • Ensure proper hygiene of your hand and wear appropriate PPE.
  • Approximately 3-4 inches above the selected venipuncture area, apply a tourniquet, ensuring that it is not applied too tight.
  • Instruct the patient not to pump the hand and make a fist.

5. Prepare the Venipuncture Site

Make the venipuncture site infection-free by cleansing it for 30 seconds with an alcohol prep pad. Let it dry in the air for 30 seconds. Avoid drying it with a blow or fan as it will increase the risk of infection.

6. Draw the Blood

  • Grab the lower arm (below site of puncture) of the patient to draw the skin taut and prevent the vein from rolling.
  • Insert the needle into the vein at a 15 to 30-degree angle.
  • The blood will flash into the catheter if the needle is punctured correctly into the vein.
  • Attach the required syringes or tubes to obtain the requisite amount of blood. While drawing the last amount of blood, remove the tourniquet.
  • Remove the needle and use gauze to gently press down on the vein.
  • Dispose of contaminated needles and materials in the designated containers.

Troubleshooting the Issues Related to Venipuncture

  • If you pop on the tubes and no blood is coming out – It indicates that you have placed the needle against a valve. Slowly and gently move the needle back and check if blood comes out. If you use a tourniquet, ensure it doesn’t come off.
  • Suddenly the blood stops coming out – It occurs if the needle goes through the vein, the needle is clotted off, or the vein collapses.

Step 4 – Deliver the Blood Sample to the Lab

Label the tubes and put them into transport bags. Deliver the blood specimen to the lab without delay. Any delay will result in hemolysis and distort the lab results.

Step 5 – Clean up Body Fluids or Blood

  • Wear apron or gown and gloves
  • Use paper towels to mop the spilled blood and fluids
  • Depending on the surface, use sodium hypochlorite or bleach solution to make the area infection-free

The skill of drawing the blood can’t be acquired overnight. It takes time and a lot of practice to gain expertise in phlebotomy. So, keep practicing!

quick RN guide links