p. Puncture Vein. Puncture the vein in the following manner.
(1) Place the needle bevel up in line with the vein and pierce the skin at
approximately a 15 to 45 degree angle. (Entering with the bevel up causes the sharp tip
to pierce the skin first, paving the way for the rest of the needle. Entering the vein with
the bevel down will cause painful tearing of the skin.)
(2) Decrease the angle of the needle until it is almost parallel to the skin
surface. Direct the needle toward the vein and pierce the vein wall.
(a) A faint "give" will be felt when the vein is entered and the tube will
begin filling with blood.
(b) If venipuncture is unsuccessful (vein wall is not punctured), pull the
needle back slightly (not above the skin surface) and attempt to direct the point of the
needle into the vein again.
(c) If the venipuncture is still unsuccessful, release the constricting
band, place a 2-inch by 2-inch sponge lightly over the venipuncture site, quickly
withdraw the needle, and immediately apply firm pressure over the site.
(3) Once the needle is withdrawn from under the skin surface, do not reuse
the needle. If a second attempt at venipuncture is required, notify the supervisor, obtain
a new needle, and repeat the procedure.
q. Collect Specimen. When you have successfully punctured the vein,
complete the following steps to collect the blood sample.
(1) Hold the Vacutainer unit and needle steady with your dominant hand. If
the unit and needle are not held steady while pushing in the tube, the needle may either
slip out of the vein or puncture the opposing vein wall.
(2) Place the tips of the index and middle fingers behind the flange of the
Vacutainer. Push the tube all the way into the Vacutainer with your thumb until the
needle completely punctures the rubber stopper.
If the needle is in the vein, the vacuum will draw the blood into the tube.
(4) Instruct the patient to relax and unclench his fist after the needle has
entered the vein. Release the constricting band when the tube is full.
(5) Carefully pull the tube downward, off the tube end of the needle and out
of the Vacutainer. Make sure to stabilize the Vacutainer and needle with your other
hand during the process. If more than one specimen is needed, push another tube onto
the needle. Continue exchanging the tubes until the required number have been filled.