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ASO Venipuncture
Venipuncture Skills (Prep., Selected site, Pre, During, & Post Procedure)
| Steps | Detail |
|---|---|
| Step 1 | Review patient’s chart for providers orders |
| Step 2 | Perform hand hygiene. |
| Step 3 | Introduce self to patient. |
| Step 4 | Identify patient with confirmation of full first and last name and D.O.B. |
| Step 5 | Organize supplies (alcohol pads, band-aids, cotton ball or 2x2s, needles - 21g direct draw needle or 23g butterfly, specimen tubes, tape, tourniquet, vacutainer holder, and labels) on your nondominant side |
| Step 6 | Ensure patient is comfortable with the procedure and ask which arm they’d prefer to use |
| Step 7 | Assist patient into a comfortable/sitting position |
| Step 8 | Check for contraindicated sites and risks associated with history of patient (bruising, past procedures, etc) |
| Step 9 | Apply the tourniquet halfway between the elbow and shoulder to locate a venipuncture site, being sure it is easily removed by pulling one flap with one hand |
| Step 10 | Palpate the distal (radial) pulse and verbally confirm it is palpable to show that the tourniquet is not too tight |
| Step 11 | Ask the patient to make and hold a fist to assist in finding a good vein, do not pump fist |
| Step 12 | Select an appropriate draw site; check both arms and hands if needed |
| Step 13 | *** Tourniquets must be removed within 1 minute if not ready to draw. Wait 30 seconds before re-tying a tourniquet if removed before the draw. |
| Step 14 | Reapply tourniquet 2-4 inches above selected site |
| Step 15 | Confirm the distal pulse is palpable. If not, loosen tourniquet so pulse is palpable |
| Step 16 | ***Attach double-ended needle to vacutainer holder. |
| Step 17 | *** Verbally note “there is no contamination” |
| Step 18 | Rest first specimen tube inside the vacutainer without puncturing the stopper |
| Step 19 | *** Prep draw site with alcohol pad using circular motions starting at center of site and moving outward up to 2 inches |
| Step 20 | ***Allow alcohol to air dry |
| Step 21 | ***Ensure that there is no site contamination once it has been cleaned or you’ll need to clean it again |
| Step 22 | ***Don properly sized gloves before sticking the patient |
| Step 23 | Remove the needle cover |
| Step 24 | ***Verbally note that there is no needle contamination |
| Step 25 | Place thumb or forefinger of nondominant (LEFT) hand 1 inch below and to the side of the intended draw site. Stretch the skin distal to the site until skin is taut |
| Step 26 | ***Hold vacutainer needle at 15-30 degree angle with bevel up |
| Step 27 | Inform the patient the stick is coming. Slowly insert the needle into the vein |
| Step 28 | ***Hold the vacutainer securely to ensure you do not advance the needle further into the vein, advance the 1st specimen tube onto the needle |
| Step 29 | If no flash is seen upon insertion, troubleshoot |
| Step 30 | Keep the tubes properly angled below the venipuncture site to avoid backflow |
| Step 31 | ***Fill the remaining ordered tubes according to the Order of the Draw (for ASO, it’s discard tube [if butterfly is used], blue tube, then lavender tube) |
| Step 32 | ***Release tourniquet once last tube is half full |
| Step 33 | ***Remove the final tube from the vacutainer |
| Step 34 | Lightly cover the site with a cotton ball or 2x2 being careful not to apply pressure with the needle still in the arm |
| Step 35 | ***Remove the needle properly |
| Step 36 | ***Apply pressure to the venipuncture site for 2-3 minutes, or until bleeding stops |
| Step 37 | Invert tubes as required by the proper amount of times |
| Step 38 | Check the tubes for external contamination of blood. Clean with 70% alcohol if needed |
| Step 39 | Ask patient if they prefer the draw site to be covered with Band-Aid or cotton ball and tape |
| Step 40 | ***Label the specimen tubes while the patient is present |
| Step 41 | Discard all supplies appropriately (sharps only in the sharps container) |
| Step 42 | Perform hand hygiene |
| Step 43 | Report any undesirable effects to the doctor (dizziness, fainting, etc) |
| Step 44 | Document procedure |
Created by:
MrsLaceUp
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