Definition
Collecting blood for routine examination commonly called venipuncture is a foundational nursing and phlebotomy skill used to assess a patient’s health through laboratory analysis.
Purpose for Collecting blood
- To determine variations if any in blood composition.
- To determine any abnormality in order to aid in diagnosis.
Articles for Collecting blood
- Tourniquet.
- Small mackintosh.
- Syringes 5 mL, 10 mL.
- No, 20-gauge needles or vacutainer assembly
- Alcohol swabs.
- Disposable gloves.
- Specimen container-test tube or bottle.
- Laboratory requisition form.
- Dry cotton balls/Band-Aid.
- Adhesive tapes.
Procedure for Collecting blood
| NURSING ACTIONS | RATIONALE | |
| 1. | Before procedure Check the physician’s order. | |
| 2. | Identify the patient. | Ensures performance of procedure on right patient. |
| 3. | Reassure the patient and explain that relatively little blood will be taken. | Obtains patient’s cooperation and confidence. |
| 4. | During procedure Wash hands and put on gloves. | Protects healthcare worker from possible exposure to blood. |
| 5. | Select and examine the vein, visualize the vein, including the antecubital area, wrist, dorsum (back) of the hand and top of foot (if necessary). Palpate the vein. | Select a vein that is visible, palpable, and fixed to the surrounding tissues so that it does not roll away. |
| 6. | Instruct the patient to extend his arm. Hold the arm straight at the elbow with fist clenched. | Proper positioning reduces the risk of injury. |
| 7. | Apply the tourniquet 5-15 cm above the selected site with just sufficient pressure to obstruct venous flow. | A tourniquet when applied increases venous pressure and make the vein more prominent and easier to enter. |
| 8. | Cleanse the skin with alcohol swab in a circular motion; center to periphery. Allow it to dry. | Cleansing the skin reduces the number of microorganisms. |
| 9. | Fix chosen vein with thumb and draw the skin taut immediately below the site before inserting needle to stabilize the vein. | The vein may roll beneath the skin when the needle approaches its outer surface, especially in elderly and extremely thin patients. |
| 10. | Hold the syringe between the thumb and last three fingers with the bevel up and directly in line with the course of the vein. Insert the needle quickly and smoothly under the skin and into the vein. | |
| 11. | Obtain blood sample by gently pulling back on the plunger. | Use minimal suction to prevent hemolysis of blood and collapse of vein. |
| 12. | Release the tourniquet as soon as the specimen is obtained and ask the patient to open the fist. | |
| 13. | Apply sterile cotton balls to puncture the site without applying pressure and withdraw needle slowly along the line of vein. | Slow withdrawal of the needle is less painful and reduces trauma. |
| 14. | Request the patient to apply gentle but firm pressure to the site for 2-4 minutes. | Firm pressure over puncture site prevents leakage of blood into surrounding tissues with subsequent hematoma development. |
| 15. | Remove the needle from the syringe as soon as possible after withdrawing blood and gently eject the blood sample into the appropriate container without forming bubbles in the test tube or bottle (some tests require container with anticoagulant). | Gentle ejection of blood prevents hemolysis. |
| 16. | Invert the tube gently several times to mix the blood with the anticoagulant where applicable. For some tests, blood is allowed to coagulate in the test tube. | Gentle handling of specimen prevents the risk of hemolysis. |
| 17. | Apply band aid/adhesive tape over the puncture site. | |
| 18. | Label the specimen correctly and send it to the laboratory immediately with completed requisition forms. | Specimen should reach the laboratory with the minimum of delay for optimum reliability. |
| 19. | Dispose the needle and syringe in appropriate containers. | Avoids possible spread of blood-borne diseases. |
| 20. | Clean all spills with 10% bleach (sodium hypochlorite) solution. Remove gloves and wash hands. | Avoids possible spread of blood-borne diseases. |
| 21. | Record in the patient’s chart the procedure and the tests for which the sample was sent to the laboratory. | |
| 22. | Replace the tray with the reusable articles in proper place. |
Special Considerations
- Do not recap used needle to prevent needle stick injury.
- Considers all patients as potentially infectious source of HIV, HBV, HCV.
- Make appropriate use of personal protective equipment (PPE) based on risk.
- Never reuse disposable needle/instrument.
- Ensure safe disposal of articles.
- Begin invasive procedure only after assembling all required articles
PROTOCOL FOR COLLECTING BLOOD
| Test | Sample type | Volume required | container | Related instruction | Normal values |
| Blood glucose | Serum | 3.0 mL clotted | Plain red top | FBS (fasting) RBS (random) | 70-110 mg% (random) <200 mg/dL |
| BUN (blood urea nitrogen) | Serum | 3.0 mL clotted | Plain red top | 10-30 mg/dL | |
| Creatinine | Serum | 3.0 mL clotted | Plain red top | 0.5-1.5 mg/dL | |
| Total protein | Serum | 3.0 mL clotted | Plain red top | 6-8 g/dl | |
| AST (Aspartate serum aminotransferase) | Serum | 3.0 mL clotted | Plain red top | 7-40 U/L | |
| ALT (alanine aminotransferase) | Serum | 3.0 mL clotted | Plain red top | 5-36 U/L | |
| Bilirubin | Serum | 3.0 mL clotted | Plain red top | Total– 1.0 mg/100ml Direct – 0.4mg/100ml Indirect – 0.6/100ml | |
| Cholesterol | Serum | 3.0 mL clotted | Plain red top | 140-200mg/dl | |
| Triglycerides | Serum | 3.0 mL clotted | Plain red top | 40-150 mg/dl | |
| Lipid profile total lipids HDL, LDL, VLDL | Serum (fasting) | 3.0 mL clotted | Red top | Normal HDL cholesterol– >45 mg/dL; LDL cholesterol- up to 130mg/dL, VLDL cholesterol-7-33 mg/dL | |
| LDH (lactic dehydrogenase) | Serum | 3.0 mL clotted | Red top | 50-150 U/L | |
| Blood gases: arterial O2 saturation, PO2 PCO2, pH | arterial Heparinized blood | 1 ml clotted | Syringe | PCO2 above 500 mmHg while on 100%O2 | 02 saturation 96-100%; PO2– 75-100 mmHg; PCO2– 35-45 mm Hg; pH– 7.35-7.45 |
| Electrolytes Na, K, Mg, CI | Serum | 3 mL clotted | Red top | Sodium– 135-145 mEq/L Potassium– 3.5-5 mEq/L Magnesium– 1.5-2.5 mEq/L Chloride— 95-105 mEq/L | |
| Uric acid | Serum | 3 mL clotted | Red top | Uric acid- 2-6 mg/dL | |
| PT (prothrombin time) | Citrated | Blue top | To avoid hemolysis, mix well and send to laboratory in 30 minutes. | 10-14 seconds | |
| PTT (partial thromboplastin time) | Citrated | Blue top | 25-37 seconds | ||
| Bleeding time | Finger prick | Capillary tube and blotting paper | 3-9 minutes | ||
| WBC | EDTA | 3.0 mL clotted | Purple top | Total— 4.0-11.0×103/μL Differential neutrophils– 60-70% Lymphocytes– 25-35% Monocytes– 5-10% Eosinophils– 1-4% Basophils– up to 1% | |
| RBC | EDTA | 3.0 mL clotted | Purple top | • Male- 4.5-6.5 x106/mL • Female- 3.8-4.8× 106/mL | |
| Hemoglobin | EDTA | 3.0 mL clotted | Purple top | • Male- 13-18g/dL • Female- 12-16 g/dL | |
| Platelets | EDTA | 3.0 mL clotted | Purple top | 150-400 x 103/mL | |
| Hematocrit | EDTA | 2.0 mL | Purple top | • Male- 45-52% • Female- 37-48% | |
| ESR (erythrocyte sedimentation rate) | EDTA with anticoagulant | 2.0 mL | Red top | • Male- <15 mm/h • Female- <20 mm/h | |
| Calcium | Serum clotted | 4-6 mL | Red top | No tourniquet | 9-11 mg/dL |
| CPK (creatinine phosphokinase) | Serum | 3.0 ml | Red top | • Male- 15-105 U/L • Female- 10-80 U/L | |
| Thyroid hormone | Serum | 5.0 ml | Red top | TSH– 0.3-5.4 mU/mL T3– 110-230 ng/dL T4– 35-12 mg/dL | |
| MCHC | EDTA with anticoagulant | 2 mL | blue top | 32-36% |
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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