Program Operations Guidelines for STD Prevention
Medical and Laboratory Services
Appendix ML-F
VENIPUNCTURE
This appendix contains additional information on venipuncture
that might be useful to a Program Manager in conducting venipuncture training.
One element is a model training program which could be adapted to local areas.
A second element is a list of equipment and supplies needed for training in
venipuncture, which can also serve as a checklist for equipping a venipuncture
kit for field activity. The third element is a Performance Evaluation Checklist
with a step by step procedure guide to evaluate the performance of a trainee
in venipuncture.
Suggested Components of a Venipuncture
Training Program
Lecture
- Overview of Standard Precautions
- Basic anatomy and physiology of the blood supply
- Equipment and supplies
- Venipuncture technique
- Potential patient reactions to venipuncture and complications
- Interventions in caring for patient reactions and complications
- Preparation for practicum
- Evaluation
Practicum
- Venipuncture technique demonstration using training arm or
student partner.
- Venipuncture technique experiences in clinic and field setting
with preceptor.
Documentation
- Skills checklist (venipuncture performance evaluation)
Venipuncture Equipment List for Field Activity
Disease Intervention Specialists (DIS) should be able to draw
blood in field settings as part of disease investigation or outreach activities.
Appropriate equipment and supplies on hand to make up a fully-equipped venipuncture
kit should include the following:
- disposable examination gloves
- eye protection
- container of alcohol sponges or cotton balls
- container of dry cotton balls
- bandages or Band-Aids
- vacutainer holder, vacutainer tubes, sterile needle, 20-22
gauge
- tourniquet (one-inch width preferred)
- laboratory specimen slips; container for blood specimens
- puncture-resistant container for used needles
- re-sealable plastic bag for other waste materials
- spirits of ammonia (inhalant)
- arm board (optional)
- small rubber bands
- small bottle of disinfectant or towelettes with disinfectant
- venipuncture identification card, if needed or available (need
varies from state to state)
Technique for Procedure of Venipuncture
The complete technique of venipuncture is contained in manuals
or guides published by state departments of health in a number of states, e.g.,
Texas, Washington, and California. An outline of the technique of venipuncture
procedure is contained in the following Venipuncture Evaluation Checklist.
Venipuncture Performance Evaluation
Name ___________________________ Date ______________________
Instructions:
1. Practice performing a venipuncture.
2. Demonstrate the procedure for performing a venipuncture satisfactorily
for the instructor. All steps must be completed as listed on the instructor's
Performance Check Sheet.
S=Satisfactory; U=Unsatisfactory
| PROCEDURE |
S |
U |
COMMENT |
| 1. Wash
hands with hand disinfectant or soap and water, if available. |
|
|
|
| 2. Assemble
equipment and materials. Place within easy reach. |
|
|
|
| 3. Identify
patient properly. |
|
|
|
| 4. Explain
venipuncture procedure to patient and position patient properly. |
|
|
|
| 5. Attach
a sterile capped needle to vacutainer holder. Remove cap and position
needle so that bevel faces upward. Inspect needle to see that point is
smooth and sharp. |
|
|
|
| 6. Partially
push vacutainer tube into needle in holder. |
|
|
|
| 7. Place
the tourniquet around the patient's arm above the elbow. CAUTION: Do
not allow the tourniquet to remain in place for more than one minute.
Instruct the patient to open and close the hand three times, making a
fist when closing the hand the third time. |
|
|
|
| 8. Inspect
the bend of the elbow to locate a suitable vein. Palpate the vein with
the finger tip(s) to determine the direction of the vein, to estimate
its size and depth, and any tendency to roll. |
|
|
|
| 9. Cleanse
the skin of the puncture site using a alcohol prep or cotton ball soaked
with alcohol. Allow alcohol to dry. |
|
|
|
| 10. Hold
the needle at a 30 degree angle to the arm and insert the needle into
the vein. Push the collecting tube onto the needle in the vacutainer
holder to fill the tube with blood. Watch for blood flow into the vacutainer
tube. |
|
|
|
| 11. Instruct
the patient to open the fist as soon as the vein has been entered. |
|
|
|
| 12. Release
the tourniquet when the desired amount of blood is obtained. |
|
|
|
| 13. Place
a dry cotton ball over the puncture site and withdraw the needle from
the vein (do not press down on the needle). Instruct the patient to press
the cotton ball over the wound for three to five minutes with arm extended
upward. |
|
|
|
| 14. Adhere
to Standard Precautions when disposing of all contaminated items including
gloves, needles, vacutainer holder, cotton balls and other contaminated
equipment. Note: Universal Precautions should be adhered to throughout
procedure. |
|
|
|
| 15. Check
patient to be sure that bleeding has stopped; apply band-aid if necessary. |
|
|
|
| 16. Clean
work area with surface disinfectant. |
|
|
|
| 17. Wash
hands with hand disinfectant or soap and water if available. |
|
|
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