Blood Sampling: Venipuncture

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1 Approved by: Blood Sampling: Venipuncture Gail Cameron Senor Director, Operations, Maternal, Neonatal & Child Health Programs Dr. Paul Byrne Medical Director, Neonatology Neonatal Nursery Policy & Procedures Manual : Date Effective Next Review May 2018 Dr. Sharif Shaik Medical Director, Neonatology Purpose To provide safe blood sampling access for patients while minimizing trauma. This will maximize the number of sites available for possible future intravenous therapy, and at the same time provide adequate experience for nurses to develop this skill. Nurses eligible to carry out this procedure will have successfully completed orientation and a skills competency. Policy Statement Equipment Veins are selected for bloodletting according to the following: Amount of blood required. Anticipation of future IV therapy. Suitability of vein for other uses. A maximum of 2 venipuncture attempts for ANY person at each sampling. If blood sampling is unsuccessful after two attempts, notify the charge nurse and then a designated nurse will attempt blood collection. If more than 1.5mL of blood is required, the charge nurse is notified and the specimen is drawn by a designated nurse. Blood sampling via venipuncture is to be done with a minimum of two people to maximize success and maintain infant comfort. Developmentally supportive care including positioning, swaddling, and environmental controls that enhance infant comfort will be used before blood sampling is attempted. Use of sucrose and topical anesthetics will be used when appropriate. 25 gauge long or short butterfly needle, according to preference 3 ml syringe(s), depending on volume of blood sample required Heparinized syringe for blood gas Antiseptic pledget Cotton ball or gauze Appropriate specimen tube(s) and requisitions Non-sterile gloves Sucrose if patient allowed this intervention

2 Page 2 of 5 Procedure ACTION RATIONALE 1. Gather equipment, perform hand hygiene, and don gloves. Standard precautions. 2. Identify patient using two identifiers Ensures correct patient. 3. Notify Respiratory Therapist if samples are to be analyzed on blood gas machine. To ensure availability of unit machine for sample analysis. 4.. Select venipuncture site considering: Condition of the vein. Size of the vein in relation to the volume of sample required. Presence of an infusing IV access device. Need for IV therapy. Do not use jugular veins, femoral veins or saphenous veins for blood sampling. 5.. Attach butterfly needle to syringe or cut tubing if planning to drip specimen. Check the tip of needle to ensure there are no barbs. 6.. Obtain assistance from a second nurse. Endeavour to soothe the infant with comfort measures such as swaddling, soother use, and/or sucrose administration. Keep the patient warm and maintain appropriate oxygenation. 7. Clean area with antiseptic pledget using a back-and-forth motion with light friction, in 2 different directions. 15 sec each direction. Allow to air dry. 8. Have the assisting nurse restrain the infant and provide a tourniquet above the venipuncture site using a forefinger and thumb. Good venous return and no bruising is desired. Dorsal venous arch of hand or foot, lower great saphenous and scalp veins yield less blood. An intravenous in the same limb will contaminate the blood results. Consider not using veins that are best for IV therapy. Physicians only use femoral veins for procedures or central lines. Jugular and saphenous veins are reserved for PICC lines. Swaddling and sucrose are methods used to restrain and comfort the infant to minimize stress. The second nurse provides a tourniquet and assists in obtaining the specimen. A third individual may be required to assist with displacing blood into specimen containers. Localized infection and/or sepsis may be prevented by use of strict aseptic technique. Back-and-forth promotes binding of antiseptic to layers of skin and improves efficacy. Flipping the swab allows for maximum dispensing of antiseptic solution The tourniquet helps to distend the vein. It should not be so tight that arterial blood flow is impeded.

3 Page 3 of 5 9. Hold the skin taut over the venipuncture site with the needle bevel up at an angle of o to the skin. Helps to prevent the vein from rolling. The shallow angle helps to prevent puncturing the posterior vein wall. 10. Puncture the skin at a point slightly distal from the entry site into the vein so that the needle is stabilized. 11. Advance the needle into the vein until blood return is obtained and hold butterfly needle stable. The assistant pulls back on the barrel of the syringe slightly to create suction at the same time gently compressing and releasing finger tourniquet. Low suction assists with blood flow. Too much suction may collapse the vein. Pumping allows for blood refill into the vein. 12. If blood flow slows or ceases, try repositioning the needle in the vein by changing the angle of the needle or withdrawing it slightly. 13. Once the sample of blood is obtained, release tourniquet pressure, withdraw needle, and apply pressure to the site with a cotton ball or gauze until oozing stops. 14. Place blood specimens in containers. Label containers and fill out requisitions. Co-sign labels and requisitions Pressure at the site reduces the risk of bruising or hematoma formation at the site. Controlled bleeding indicates hemostsis is achieved To ensure correct identification of specimen and patient Related Documents Definitions RELATED POLICIES AND PROCEDURES Sucrose Policy & Procedure Covenant Health corporate policy VII-B-25, Identification of Patient, Resident or Client Using Two Identifiers DESIGNATED NURSE Refers to nurses in charge, Clinical Educators, Supervisor, or nurses that a charge nurse has identified. RESTRICTED SITES Long saphenous veins and antecubital veins are not to be used for IV or venipuncture attempts, to protect them for establishment of long lines, etc. References Adapted with permission from Stollery Children s Policy and Procedure Manual: Blood Sampling - Venipuncture March 2012

4 Page 4 of 5 Perry, A. G., & Potter, P. A. (2014). Chap. 43 Specimen Collection. Clinical Nursing Skills & Techniques (8 th ed). (pp ). St. Louis, Missouri: MOSBY Elsevier. Walton, D.M. & Short, B.L. (2007). Venipuncture. In: M.G. MacDonald and J. Ramasethu (Eds). Atlas of Procedures in Neonatology (4th ed.). Toronto: Lippincott, Williams & Wilkins. Revisions Intravenous Access/Blood Letting, July 2005 Venipuncture Policy, November 2004 Venipuncture Procedure, November 2004 Blood sampling Venipuncture

5 Page 5 of 5 Signing GAIL CAMERON SENIOR DIRECTOR, OPERATIONS MATERNAL, NEONATAL & CHILD HEALTH PROGRAMS GREY NUNS & MISERCORDIA HOSPITALS DR. Paul Byrne MEDICAL DIRECTOR NEONATAL PROGRAM GREY NUNS HOSPITAL DR. Sharif Shaik MEDICAL DIRECTOR NEONATAL PROGRAM MISERCORDIA HOSPITAL September 2015 September 2015 September, 2015

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