Drawing Blood
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Included In This Lesson
Study Tools For Drawing Blood
Blood drawing (Image)
Vein Sites (Cheatsheet)
Order of Lab Value Draws (Cheatsheet)
Lab Values for Clinical (Cheatsheet)
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Outline
Overview
- Purpose
- To obtain a blood sample for lab testing
- May be done by venipuncture or by drawing blood from an existing venous access device.
- This lesson discusses venipuncture
Nursing Points
General
- Supplies needed
- Butterfly needle (23g or 25g)
- Vacutainer
- Plastic safety device to hold lab tubes
- Syringe(s) (if no vacutainer is available)
- Will have to collect enough blood to fill lab tubes/bottles
- Tourniquet
- Alcohol pads
- Antiseptic scrub for blood cultures
- Gauze
- Tape
- Lab tubes and/or blood culture bottles
- Read the label on the lab tube to determine how much blood you will need, especially if you have to use the syringe method
- 5 mL each for Blood Culture bottles is sufficient
- Patient labels to label lab tubes
Nursing Concepts
-
- Steps and Nursing Considerations
- Gather supplies
- Verify orders
- Explain procedure to patient
- Perform hand hygiene
- Raise bed to comfortable working height
- Don clean gloves
- Identify an appropriate access site
- Apply tourniquet 4-6 inches above planned insertion site
- Visualize, then palpate the vein
- Should be soft and bouncy
- Avoid:
- Varicose veins
- Sclerosed or hard veins
- Extremity with central line, AV graft, lymphedema, or paralysis
- Once identified – release the tourniquet to finish preparing supplies
- In the case of blood cultures, TWO sites should be selected
- Prepare supplies within arm’s reach
- Remove butterfly needle from package
- Attach vacutainer
- If using syringe, carefully remove the vacutainer needle and screw on the syringe
- Have lab tubes laid out in appropriate order
- Re-apply tourniquet and confirm insertion site by palpation
- Cleanse insertion site
- Alcohol pad: move in a circular motion from the site outward, allow to dry
- Antiseptic scrub: scrub the site in multiple directions for a full minute – MUST allow to dry
- DO NOT TOUCH the site after cleaning (especially if doing blood cultures)
- Remove the cover from the needle and warn the client of a quick stick
- Use thumb of nondominant hand to stabilize vein below the site and pull skin taut
- Slowly insert the needle, bevel up, at approximately a 15° angle
- With experience, you will feel a ‘pop’ when the needle enters the vein
- Using a butterfly you MAY see a flash of blood
- Stabilize the needle with one hand
- Vacutainer – with the other hand, insert the first lab tube into the acutainer
- Repeat with each lab tube as they are full
- Invert each tube 4-5 times before setting on the table
- Syringe – with the other hand, gently draw back on the syringe until the desired amount of blood is obtained
- If you need to switch syringes, you may need to kink the butterfly tubing to make the switch
- Have a friend to assist!
- When you have the blood you need, release the tourniquet
- Gently place a 2×2 gauze over the site
- Retract the needle, activate the safety device
- Quickly put pressure on the site until bleeding stops
- Tape the gauze in place
- Check again in 5 minutes
- Dispose of all sharps in sharps container
- Dispose of all used supplies in the appropriate waste container
- Remove gloves and perform hand hygiene
- Return bed to low/locked position
- Ensure patient is comfortable
- Document procedure and patient response/tolerance
- For blood obtained by syringe:
- Use a needle to carefully fill each lab tube in the correct order
- Let the vacuum in the tube draw blood in, do not push the plunger
- Carefully and safely dispose of the syringe/needle in sharps container
- Use a needle to carefully fill each lab tube in the correct order
- For all lab tubes:
- Label per facility policy
- Patient’s name, DOB, MR #
- Date and time of specimen
- Your initials
- Send to the lab in appropriate manner
- Label per facility policy
- If drawing blood from venous access device
- WASTE the first aspiration because it is contaminated with saline
- Rule of thumb is 2-3 times the ‘dead space’
- For a PIV – wasting 3 mL is sufficient
- For a CVC or PICC – need to waste 7-10 mL
- Will likely use a syringe and needle to fill lab tubes
- If your facility has a safety device – USE it!
- WASTE the first aspiration because it is contaminated with saline
- Steps and Nursing Considerations
Patient Education
- Purpose for lab draws
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Transcript
In this video we’re going to look at how to draw blood from a patient using venipuncture with a butterfly needle. We try to draw blood from a working line if a patient has one, but if not, we need to use venipuncture to do it!
You’re going to start by identifying a good vein, just like you would if you were starting an IV. The difference is, in this case, you can go in the AC if you want because we aren’t leaving the catheter in. So place your tourniquet and palpate until you feel a good vein. Remember to aim for what you can FEEL, not just what you can see!
Then release the tourniquet while you get your supplies ready. In this video, we’re going to use the vacutainer method. So you’ll need a butterfly needle and you’ll need to attach the vacutainer to the end of the butterfly tubing.
You will also need alcohol prep pads or antiseptic scrub if you’re drawing blood cultures, a tourniquet, gauze and tape. And of course, whatever blood tubes you’re drawing!
When you’re ready, replace your tourniquet about 6 inches above where you’ll be sticking. Palpate again to make sure the vein is still there.
Then clean your site. If it’s a regular blood draw, use alcohol pads in a circular fashion from the inside out. However, if you are drawing blood cultures, you must use antiseptic scrub and you MUST scrub for a full minute back and forth, up and down, around and around to get rid of as many bacteria as possible. Either way, don’t touch it once you clean it and make sure you let it dry!
Now take the cap off your butterfly needle. Then, you’re going to stabilize the vein below the insertion site and hold your needle bevel up at about a 15 degree angle so you don’t go right through the vein or go above it.
Insert the needle until you feel a bit of a pop – you’ll learn that feeling more with experience. You may or may not see a flash of blood.
Once you think you’re in, keep one hand on the needle and use your other hand to insert the first tube into the vacutainer and the vacuum action will pull the blood for you. Gently pull it out and turn the tube 4 or 5 times to mix. Repeat that with as many tubes as you need.
Once you have what you need, release your tourniquet.
Then put a piece of gauze over the site and quickly pull out the needle while applying pressure to the site. Make sure you activate the safety device on your needle as well.
Hold pressure until the bleeding stops, then tape a piece of gauze over the site.
Put your sharps in the sharps container and throw your trash away. Label the lab tubes appropriately and send them off to the lab!
That’s it! Easy as that! Just like starting an IV, drawing blood this way takes practice and you’ll get better and better at it.
We love you guys! You can do this! Now, go out and be your best selves today! And, as always, happy nursing!
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Study Plan Lessons
05.03 Jaundice for CCRN Review
Abortion in Nursing: Spontaneous, Induced, and Missed
Abruptio Placenta for Certified Emergency Nursing (CEN)
Abruptio Placentae (Placental abruption)
Acyclovir (Zovirax) Nursing Considerations
Addicted Newborn
Adult Vital Signs (VS)
Alpha-fetoprotein (AFP) Lab Values
Ampicillin (Omnipen) Nursing Considerations
Anemia in Pregnancy
Antepartum Testing
Antepartum Testing Case Study (45 min)
Anti-Infective – Aminoglycosides
Anti-Infective – Lincosamide
Aspiration for Certified Emergency Nursing (CEN)
Babies by Term
Behind The Red Line – Live Tutoring Archive
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Betamethasone and Dexamethasone in Pregnancy
Bicarbonate (HCO3) Lab Values
Blood Cultures
Blood Glucose Monitoring
Blood Transfusions (Administration)
Body System Assessments
Breastfeeding
Butorphanol (Stadol) Nursing Considerations
Cardiac (Heart) Disease in Pregnancy
Causes of Chorioamnionitis Nursing Mnemonic (Pregnancies Are Very Interesting)
Causes of Labor Dystocia Nursing Mnemonic (Having Extremely Frustrating Labor)
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Certified Nurse Midwife
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Congestive Heart Failure (CHF) Labs
Day in the Life of a Labor Nurse
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Dexamethasone (Decadron) Nursing Considerations
Direct Bilirubin (Conjugated) Lab Values
Discomforts of Pregnancy
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Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Dystocia
Ectopic Pregnancy
Ectopic Pregnancy Case Study (30 min)
Ectopic Pregnancy for Certified Emergency Nursing (CEN)
Emergent Delivery (OB) (30 min)
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Fundal Height Assessment for Nurses
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HELLP Syndrome
HELLP Syndrome – Signs and Symptoms Nursing Mnemonic (HELLP)
Hematomas in OB Nursing: Causes, Symptoms, and Nursing Care
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Hemorrhage (Postpartum Bleeding) for Certified Emergency Nursing (CEN)
Hepatitis B Vaccine for Newborns
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Hypovolemic Shock Case Study (OB sim) (60 min)
Incompetent Cervix
Infections in Pregnancy
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Inserting a Foley (Urinary Catheter) – Female
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Isotonic Solutions (IV solutions)
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Magnesium Sulfate in Pregnancy
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Possible Infections During Pregnancy Nursing Mnemonic (TORCH)
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Postpartum Discomforts
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Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
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Preterm Labor
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Prolapsed Umbilical Cord
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Protein (PROT) Lab Values
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Rh Immune Globulin (Rhogam)
Rh Immune Globulin in Pregnancy
Signs of Pregnancy – Live Tutoring Archive
Signs of Pregnancy (Presumptive, Probable, Positive)
Spironolactone (Aldactone) Nursing Considerations
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Subinvolution
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Tips & Advice for Newborns (Neonatal IV Insertion)
Tocolytics
Tocolytics
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Transient Tachypnea of Newborn
Umbilical Cord Vasculature Nursing Mnemonic (2A1V)
Uterine Stimulants (Oxytocin, Pitocin)
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What the Heck is Antepartum Testing? – Live Tutoring Archive
54 Common Medication Prefixes and Suffixes
Alpha-fetoprotein (AFP) Lab Values
Carboxyhemoglobin Lab Values
Cardiac Terminology
Diagnostic Testing Course Introduction
Diagnostics Terminology
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Gamma Glutamyl Transferase (GGT) Lab Values
Growth Hormone (GH) Lab Values
Hematology Oncology & Immunology Terminology
Integumentary (Skin) Terminology
Mean Corpuscular Volume (MCV) Lab Values
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MedTerm Basic Word Structure
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Myoglobin (MB) Lab Values
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Prealbumin (PAB) Lab Values
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Psychiatry Terminology
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Sensory Terminology
Urinary Terminology
02.03 Swan-Ganz Catheters for CCRN Review
02.04 Pulmonary Artery Wedge Pressure (PAWP) for CCRN Review
02.05 Calculating PAWP on PEEP for CCRN Review
02.07 Reading “A, C, V Waves” & PAWP Waveforms for CCRN Review
02.09 12 Lead EKG- Leads 1, 2, 3, aVL, and aVF for CCRN Review
02.10 12 Lead EKG- Lead V1-V6 for CCRN Review
02.11 12 Lead EKG- Injuries for CCRN Review
07.02 Neuro Anatomy for CCRN Review
10.01 Arterial Blood Gas (ABG) Interpretation for CCRN Review
10.02 Breath Sounds for CCRN Review
ABG Course (Arterial Blood Gas) Introduction
Adrenal Gland
Alkalosis and Acidosis Nursing Mnemonic (Kick Up, Drop Down)
Anatomy & Physiology Course Introduction
Anticholinergics – Side Effects Nursing Mnemonic (4 Can’ts)
Arterial Blood Gases Nursing Mnemonic (ROME)
Arterial Pressure Monitoring
Atropine (Atropen) Nursing Considerations
Autonomic Nervous System (ANS)
Autonomic Nervous System (ANS)
Beta 1 and Beta 2 Nursing Mnemonic (1 Heart, 2 Lungs)
Blood Grouping
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Bowel Elimination
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Calcium and Magnesium Imbalance for Certified Emergency Nursing (CEN)
Calculating Heart Rate
Cardiac (Heart) Physiology
Cardiac A&P Module Intro
Cardiac Cycle
Causes of Poor Gas Exchange Nursing Mnemonic (All People Can Value Lungs)
Cholinergic Crisis – Signs and Symptoms Nursing Mnemonic (SLUDGE)
Connective Tissues
Cranial Nerves
Development of Bones
Digestion & Absorption
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Drawing Blood
Drawing Blood from the IV
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EKG (ECG) Waveforms
EKG Basics – Live Tutoring Archive
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Electrical Activity in the Heart
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Electrolytes Involved in Cardiac (Heart) Conduction
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Female Reproductive Anatomy (Anatomy and Physiology)
Fluid & Electrolytes Course Introduction
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Hyperkalemia – Causes Nursing Mnemonic (MACHINE)
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Inserting a Foley (Urinary Catheter) – Male
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Introduction to Health Assessment
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Order of Lab Draws
Oxygen Delivery Module Intro
Pancreas
Parasympathomimetics (Cholinergics) Nursing Considerations
Pituitary Gland
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Renal (Kidney) Structure & Function
Renin Angiotensin Aldosterone System
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Selecting THE vein
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Sodium and Potassium Imbalance for Certified Emergency Nursing (CEN)
Spinal Cord
Stomach Video
Tattoos IV Insertion
The EKG (ECG) Graph
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12 Points to Answering Pharmacology Questions
6 Rights of Medication Administration
ACLS (Advanced cardiac life support) Drugs
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Basics of Calculations
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Dark Skin: IV Insertion
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Drawing Blood from the IV
Drawing Up Meds
Drug Interactions Nursing Mnemonic (These Drugs Can Interact)
Epoetin Alfa
Eye Prophylaxis for Newborn
Fentanyl (Duragesic) Nursing Considerations
Geriatric: IV Insertion
Giving Medication Through An IV Set Port
Glipizide (Glucotrol) Nursing Considerations
Guaifenesin (Mucinex) Nursing Considerations
Hanging an IV Piggyback
How to Remove (discontinue) an IV
How to Secure an IV (chevron, transparent dressing)
Hydralazine
Hydrocodone-Acetaminophen (Vicodin, Lortab) Nursing Considerations
Hydromorphone (Dilaudid) Nursing Considerations
IM Injections
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Insulin – Mixtures (70/30)
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IV Complications (infiltration, phlebitis, hematoma, extravasation, air embolism)
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IV Drip Therapy – Medications Used for Drips
IV Infusions (Solutions)
IV Insertion Angle
IV Insertion Course Introduction
IV Placement Start To Finish (How to Start an IV)
IV Pump Management
IV Push Medications
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Labeling (Medications, Solutions, Containers) for Certified Perioperative Nurse (CNOR)
Lidocaine (Xylocaine) Nursing Considerations
Magnesium Sulfate
Magnesium Sulfate in Pregnancy
Maintenance of the IV
Mannitol (Osmitrol) Nursing Considerations
MAOIs
Medication Errors
Medication Reconciliation Review for Certified Perioperative Nurse (CNOR)
Medications in Ampules
Meds for Postpartum Hemorrhage (PPH)
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OB Pharm and What Drugs You HAVE to Know – Live Tutoring Archive
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Pharmacokinetics Nursing Mnemonic (ADME)
Pharmacology Course Introduction
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Phytonadione (Vitamin K) for Newborn
Pill Crushing & Cutting
Positioning
Procainamide (Pronestyl) Nursing Considerations
Propofol (Diprivan) Nursing Considerations
Quetiapine (Seroquel) Nursing Considerations
Ranitidine (Zantac) Nursing Considerations
Rh Immune Globulin in Pregnancy
Sedatives-Hypnotics
Sedatives-Hypnotics
Selecting THE vein
Spiking & Priming IV Bags
Starting an IV
Streptokinase (Streptase) Nursing Considerations
Struggling with Dimensional Analysis? – Live Tutoring Archive
SubQ Injections
Supplies Needed
Tattoos IV Insertion
TCAs
The SOCK Method – C
The SOCK Method – K
The SOCK Method – O
The SOCK Method – Overview
The SOCK Method – S
The SOCK Method of Pharmacology 1 – Live Tutoring Archive
The SOCK Method of Pharmacology 2 – Live Tutoring Archive
The SOCK Method of Pharmacology 3 – Live Tutoring Archive
Tips & Tricks
Tips & Advice for Newborns (Neonatal IV Insertion)
Tips & Advice for Pediatric IV
Understanding All The IV Set Ports
Using Aseptic Technique
Verapamil (Calan) Nursing Considerations