Phlebotomy Practice Guidelines for Nurses

Phlebotomy, the act of drawing blood from the body with a needle, is a specialized skill. It is necessary for blood to be drawn in a variety of medical settings. Many nurses need to be proficient in phlebotomy in order to best serve their patients. Typically nurses will use veins rather than arteries for phlebotomy, performing venipuncture on the patients.

Veins to Use

• The cephalic, median cubital and basilic veins are the three most common veins to use when drawing blood. These are found in the antecubital fossa area of the arm. The median cubital, which is preferred, is found close to the center of the arm. The basillic vein is found on the medial, or inner, part of the antecubital area and the cephalic vein is found on the outer, or lateral, section.

Identification

• The most essential step in phlebotomy happens before a needle is picked up. Proper identification of the patient is crucial. If the wrong patient is drawn, the results can be harmful. A patient may be treated for a condition that he or she does not have, leading to serious harm. If the patient is in an outpatient setting, he or she should be able to give name, address, social security number and other identifying information. In a hospital, the identification wristband of the patient should be checked against the physician orders for blood work.

Supplies

• Gloves, a tourniquet, lancet or needle, correct tubes, alcohol, gauze, tape and the physician orders should all be assembled prior to prepping the patient. Determine which tests are needed and be certain to follow the order of draw for your institution. It is very important that certain tubes be drawn before others, so check with the laboratory if you have any questions. Be sure a sharps container is near for quick disposal of your needle. Have extra supplies within reach in case an item is dropped or broken.

Phlebotomy

• Wash your hands prior to the procedure. After explaining to your patient that you will be drawing blood, make sure the patient is comfortable. Put on your gloves and place the tourniquet on the patients arm. Identify the vein you wish to use, clean the area with the appropriate disinfectant, and be sure all tubes are within reach. Advise the patient that he or she may feel a slight pinch and quickly draw the necessary tubes. Loosen the tourniquet and fill the last tube, prior to withdrawing the needle. Place gentle pressure on the site for a moment or two and then bandage once you are sure bleeding has stopped.

Vein Anchoring

• Veins have a tendency to roll or move under the skin. This can make phlebotomy difficult as well as painful for the patient. The best thing to do is to anchor the vein, by holding it with the hand you are not holding the needle in. Place your hand above the venipuncture site and anchor the vessel by placing gentle pressure on it. This will help keep it still and prevent it from rolling away from the needle.

Important Facts

• Do not continue to draw a patient who states that he or she is in pain. There is a possibility that you struck a nerve with the needle and the procedure should be stopped immediately.

  Do not tell a patient to bend at the elbow after phlebotomy. This encourages bruising to occur, by allowing the blood to pool in the area.