ORDER FORM / REQUISITION
A requisition form must accompany each sample submitted to the laboratory. This requisition form must contain the proper information in order to process the specimen. The essential elements of the requisition form are:

• Patient's surname, first name, and middle initial.
• Patient's ID number.
• Patient's date of birth and sex.
• Requesting physician's complete name.

THE FOLLOWING ARE NEEDED FOR ROUTINE VENIPUNCTURE:

• Needles - The gauge number indicates the bore size: the larger the gauge number, the smaller the needle bore. Needles are available for evacuated systems and for use with a syringe, single draw or butterfly system.
• Tourniquet - Wipe off with alcohol and replace frequently.
• Alcohol Wipes - 70% isopropyl alcohol.
• Povidone-iodine wipes/swabs - Used if blood culture is to be drawn.
• Gauze sponges - for application on the site from which the needle is withdrawn.
• Adhesive bandages / tape - protects the venipuncture site.
• Needle disposal unit - needles should NEVER be broken, bent, or recapped. Needles should be placed in a proper disposal unit IMMEDIATELY after their use.
• Syringes - may be used in place of the evacuated collection tube for special circumstances.

Although the larger and fuller median cubital and cephalic veins of the arm are used most frequently, the basilic vein on the dorsum of the arm or dorsal hand veins are also acceptable for venipuncture. Foot veins are a last resort because of the higher probability of complications.

PROCEDURE FOR VEIN SELECTION:
Palpate and trace the path of veins with the index finger. Arteries pulsate, are most elastic, and have a thick wall. Thrombosed veins lack resilience, feel cord-like, and roll easily.
If superficial veins are not readily apparent, you can force blood into the vein by massaging the arm from wrist to elbow, tap the site with index and second finger, apply a warm, damp washcloth to the site for 5 minutes, or lower the extremity over the bedside to allow the veins to fill.

PERFORMANCE OF A VENIPUNCTURE:

• Approach the patient in a friendly, calm manner. Provide for their comfort as much as possible, and gain the patient's cooperation.
• Identify the patient correctly.
• Properly fill out appropriate requisition forms, indicating the test(s) ordered.
• Verify the patient's condition. Fasting, dietary restrictions, medications, timing, and medical treatment are all of concern and should be noted on the lab requisition.
• Check for any allergies to antiseptics, adhesives, or latex by observing for armbands and/or by asking the patient.
• Position the patient. The patient should either sit in a chair, lie down or sit up in bed.
• Hyperextend the patient's arm.
• Apply the tourniquet 3-4 inches above the selected puncture site. Do not place too tightly or leave on more than 2 minutes.
• The patient should make a fist without pumping the hand.
• Select the venipuncture site.
• Prepare the patient's arm using an alcohol prep. Cleanse in a circular fashion, beginning at the site and working outward. Allow to air dry.
• Grasp the patient's arm firmly using your thumb to draw the skin taut and anchor the vein. The needle should form a 15 to 30 degree angle with the surface of the arm. Swiftly insert the needle through the skin and into the lumen of the vein. Avoid trauma and excessive probing.
• Remove the needle from the patient's arm using a swift backward motion.
• Press down on the gauze once the needle is out of the arm, applying adequate pressure to avoid formation of a hematoma.
• Dispose of contaminated materials/supplies in designated containers.

ADDITIONAL CONSIDERATIONS:

To prevent a hematoma:

• Puncture only the uppermost wall of the vein
• Remove the tourniquet before removing the needle
• Use the major superficial veins
• Make sure the needle fully penetrates the upper most wall of the vein. (Partial penetration may allow blood to leak into the soft tissue surrounding the vein by way of the needle bevel)
• Apply pressure to the venipuncture site
  

SAFETY AND INFECTION CONTROL

Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures.

PROTECT YOURSELF

Practice universal precautions:

• Wear gloves and a lab coat or gown when handling blood/body fluids.
• Change gloves after each patient or when contaminated.
• Wash hands frequently.Dispose of items in appropriate containers.Dispose of needles immediately upon removal from the patient's vein.
• Do not bend, break, recap, or resheath needles to avoid accidental needle puncture or splashing of contents.
• Clean up any blood spills with a disinfectant such as freshly made 10% bleach.
• If you stick yourself with a contaminated needle:Remove your gloves and dispose of them properly.Squeeze puncture site to promote bleeding.Wash the area well with soap and water.Record the patient's name and ID number.Follow institution's guidelines regarding treatment and follow-up.
• NOTE: The use of prophylactic zidovudine following blood exposure to HIV has shown effectiveness (about 79%) in preventing seroconversion
• PROTECT THE PATIENT - Place blood collection equipment away from patients, especially children and psychiatric patients. Practice hygiene for the patient's protection. When wearing gloves, change them between each patient and wash your hands frequently. Always wear a clean lab coat or gown.