1.4 Checklist: Perform Venipuncture Blood Draw

*Disclaimer: Always follow agency policy and manufacturer recommendations

Checklist: Perform Venipuncture Blood Draw^[1],[2]

• Verify the provider’s order.
• Review the patient’s medical record for conditions that increase the risk of bleeding or hematoma formation and allergies to antiseptics, adhesive, and latex. Use an alternative product if necessary. Also, check the patient’s medical record for factors that may affect peripheral vasculature.
• Gather the necessary supplies:
  • Clean gloves
  • Antiseptic solution/agent (such as an alcohol wipe, chlorhexidine, or povidone-iodine)
  • Needleless blood sampling access device (vacutainer) or syringes
  • Venipuncture needle or winged collection device
  • Single patient-use tourniquet
  • Blood specimen tubes and labels
  • Needleless connector
  • Labels
  • 2” x 2” gauze pads
  • Tape or adhesive bandage
  • Biohazard specimen transport bag or container
• Perform hand hygiene.
• Confirm the patient’s identity using two patient identifiers per agency policy and ask if they have any allergies.
• Provide privacy.
• Explain the procedure.
• Ask whether the patient has ever felt faint, sweaty, or nauseated when having blood drawn. If so, place the patient in a supine position.
• Raise the bed to a working level.
• Perform hand hygiene.
• Put on gloves and, as needed, other personal protective equipment.
• Position the patient’s arm horizontally or slanting slightly downward.
• Inspect the patient’s veins.
• Check if the patient has a history of easy bruising, increased risk of bleeding, compromised circulation, or fragile veins or skin.
• Apply a tourniquet about 2” (5 cm) above the site. Make sure that you can palpate an arterial pulse distal to the tourniquet. Be aware the tourniquet should only be applied for 2 minutes or less.
• Prepare the venipuncture site using an antiseptic agent. Apply the agent using a single-use sterile applicator. Allow the agent to dry completely.
• Immobilize the vein with the nondominant thumb or forefinger and thumb.
• Position the needle holder or syringe with the needle bevel up and the shaft parallel to the path of the vein at a 30-degree angle to the arm.
• Tell the patient you are about to perform the venipuncture.
• Insert the needle into the vein. Push the collection tube into the holder when the vein is cannulated.
• Release the tourniquet when blood begins to flow.
• Remove the first tube from the holder when the first tube fills. Continue to fill the tubes using the correct order of draw to avoid cross-contamination of the sample by additives found in different collection tubes (Review information about Order of Blood Draw Tubes.)^[3] Remove each tube from the holder, gently invert it, and return it to its upright position.
• After drawing all samples, place a gauze pad over the puncture site, disengage an evacuated tube, and remove the needle from the vein. Do not remove the needle with the collection tube still in the vacutainer.
• Activate the needle protector safety device, if applicable.
• Apply pressure to the puncture site until bleeding stops.
• Apply an adhesive bandage or tape a gauze bandage to the needle insertion site.
• If a syringe was used to collect the sample instead of a vacutainer, transfer the blood sample immediately to a collection tube.
• Carefully invert each collection tube according to the additive.
• Label all samples in the presence of the patient.
• Place the labeled specimen in a biohazard bag and transport it to the laboratory immediately per agency policy.
• Discard used supplies and place sharps into a sharps container.
• Remove the gloves and perform hand hygiene.
• In an inpatient setting, help the patient into a comfortable position and place personal items, the tray table, and the call light within easy reach. Make sure the patient knows how to use the call light to summon assistance. To ensure the patient’s safety, raise the appropriate number of side rails and lower the bed to the lowest position. Ensure the bed is locked.
• Perform hand hygiene.
• Document the procedure and assessments.

 Documentation Cues:

• Site and location of vein used, the appearance of the site, and the condition and type of dressing used over the blood draw site
• Date, time, and blood samples drawn
• Patient teaching
• Any unexpected outcomes, related nursing interventions, health care provider notification, and the patient’s response to treatment
• Communication of laboratory results to the provider (if applicable)