Today, we're going to perform a venipuncture on our patient.
We're going to use it with what's called the straight draw method with just a regular multi-sample
needle.
And, we'll be accessing in the antecubital fossa of the patient's body.
What you'll want to do is first you'll want to sanitize your hands.
Or, if you do not have hand sanitizer available, you'll need to wash your hands in the sink,
humming "Happy Birthday" twice to yourself to make sure you wash your hands long enough.
With the hand sanitizer, you put a small amount in your hand and you rub your hands until
they're dry.
Then, after that, you'll introduce yourself to the patient.
Hi, I'm Trevor from the lab.
The doctor's ordered some tests today.
Do you mind if I collect these samples?
So, the patient shook their hand no, they don't mind.
So, with this, I've informed my patient.
So, I've achieved informed consent.
And, since the patient didn't verbalize anything back to me and they have their arm sticking
out, I also have implied consent.
With implied consent, this is where a patient makes a gesture, such as sticking out their
arm or shaking their head as they do not mind.
So, I have my consent.
We'll go ahead and begin the procedure.
The supplies I'll need is a new tourniquet.
We'll need a couple of alcohol swabs.
And, you'll need a couple of pieces of two by two gauze, non-sterile is okay.
You'll need your multi-sample needle.
You want to make sure that it is in date and the paper label is intact.
This is very important to check this every time.
If the paper label is not intact and matching up, we do not use the needle.
You'll need your holder or your hub.
And, you'll need whatever evacuated tubes that you'll use.
In this instance, I'm going to use a serum tube and I'm also going to use a coag tube.
I check the dates on these tubes to make sure they're both in date.
They're good.
Make sure that they're new, no puncture marks, everything's good with my tubes.
I also have some paper tape.
If you're patient was allergic to paper tape, you would consider using Coban.
And, also I have my lab sample bag.
Note the biohazard label.
Any time we send blood specimens, urinary specimens, any body fluid specimens, we need
to have a bag with the biohazard symbol on it.
So, I have all my equipment together.
And, let's go ahead and begin with the procedure.
Apply the tourniquet.
Make sure that it's flush in the back and try not to let it roll.
You want bunny ears up, not frog legs down.
You're going to palpate.
Go across and then come back.
And, with this patient, I want to choose this vein here to do the phlebotomy.
One of the ways if you're having a hard time determining which vein you should choose is,
in your book you will see that every patient has either an "H" pattern or "M" pattern.
This patient right here, he has an "H" pattern.
Here is the outside of the "H" and here's the connecting line across.
So, I have a vein here I can choose, a vein here, and also a vein here.
If this patient had an "M" pattern, a vein would lie here, lie here, here, and here,
okay.
So, I've chosen my vein.
I'm going to go for this one right here.
I'm going to make sure that I have a landmark or something that I can determine which side
I've chosen.
It can be a freckle.
It can be a little mole, a pimple, anything to determine where you want to stick.
If not, you can slightly take your fingernail and just make a little indention of where
you want to stick.
That lasts about thirty to sixty seconds.
So, I'm going to release my tourniquet, as I gather my supplies, assemble all my equipment.
Unscrew the label of your multi-sample needle and insert it into the holder.
Tighten it carefully.
Gather your tubes.
Go ahead and pull out a piece of tape.
It's okay to tear off a piece of tape ahead of time.
And, you can place just a small corner at the end of the table.
Have your alcohol pads ready.
You're going to go ahead and cleanse your patient before you put your tourniquet back
on.
But first, at this time, if you do not already, you'll want to put your gloves on.
Alright, now what I want to do is I'm going to imagine where I'm going to insert my needle.
That's where I'm going to place the alcohol, which is seventy percent isopropyl alcohol.
Start in the center of the patient.
And, I want to do an inside out concentric method, trying to push the dirt away from
the skin.
And, you'll always want to check and make sure that the alcohol swab comes out clean.
If it had a little bit on it, it doesn't mean your patient was unsanitary.
Just take another alcohol swab and swab again.
I'm going to throw this alcohol pad into the regular trash.
Remember, the only thing that goes in the biohazard trash is sharps such as needles
or used tubes or any gauze or material that's been saturated with fifty percent more of
blood, okay.
Everything else can go in the regular trash.
So, I've cleansed my patient.
I have my needle assembled.
I'm letting the alcohol dry.
And, that will take about thirty seconds.
I'll go ahead and reapply my tourniquet.
And, this is something that you'll need to do as you become more experienced as a phlebotomist,
you can leave your tourniquet on.
Remember, you can only leave a tourniquet on for a maximum of sixty seconds.
So, I have my tourniquet.
And, now that I have my tourniquet on, I'm going to ask my patient to make a fist.
I cannot touch the site no more since I've cleansed it.
We're going to release, pull back my safety cap of my needle.
You're going to want to release the cap in a downward motion.
Check your needle.
Make sure that you have bevel up, there's no barbs, shards, or any bent material on
the needle.
Everything's good with this.
Okay, with my non-dominant hand, I'm going to anchor with my thumb.
My other forefingers are going to wrap around the patient's arm.
What you'll do is you'll push down and pull back a little bit and that anchors your patient's
vein a little bit.
With my dominant hand, that's the one I will stick with.
Alright, there I go.
Alright, so I have my needle in.
And, with correct order of draw, the light blue tube will go first.
We'll let it fill.
And, this is one of the hard parts is holding steady with the tube as you're drawing.
You still want to have a good hold on the needle, okay.
Now, remember, always with light blue you need to let it fill completely.
It's pre-vacuumized to stop at a certain amount.
Alright, so that's full.
We'll go ahead and disengage this tube.
Insert the next.
And, sometimes a little blood will come out around the edges.
That's okay too.
And, one of the things that you can look for to help you tell when the blood is done, is
it shimmers as it's moving, as it moves in.
Once it stops shimmering, more than likely, your tube's full.
And, this tube is full.
It's my last tube.
So, I'll release my tourniquet.
Pull the tube out, get my gauze, fold it over once, twice, pull my needle out, cover, and
immediately safety cap.
Ask your patient to hold the gauze.
Sir, will you please hold that?
Immediately take your needle to the biohazard container.
You do not sit it down on the table.
We must protect ourself first.
Next, we'll grab the tape that you've already torn, and place over.
You wan to instruct your patient not to bend their arm as this can cause a hematoma.
Tell your patient to keep the tape and the bandage on for about an hour.
And, also at this time, you'll need to invert your tubes four to six times slowly.
If you invert your tubes fast, such as this, hemolysis is likely to occur.
So, we want to go slow, mixing the chemicals into the blood.
Alright, and then at this time, you would place your labels on the tube, put the date,
the time, and your initials with the patient's name.
Place your tubes into a lab bag and carry to the lab.
You may also use a pneumatic tube system, if your facility has one.
You want to be sure to pad the tube appropriately, though.
And, this is how you do a straight draw.