Skill Checklists for Taylor's Clinical Nursing Skills: A Nursing Process Approach

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Copyright © 2011 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Skill Checklists for Taylor's Clinical Nursing Skills:

SKILL 18-9

Using Venipuncture to Collect a Venous

Blood Sample for Routine Testing (Continued)

Comments

12. Attach the needle to the Vacutainer device. Place first
    blood-collection tube into the Vacutainer, but not engaged
    in the puncture device in the Vacutainer.


13. Clean the patient’s skin at the selected puncture site with the
    antimicrobial swab. If using chlorhexidine, use a back-and-
    forth motion, applying friction for 30 seconds to the site,
    or use the procedure recommended by the manufacturer. If
    using alcohol, wipe in a circular motion spiraling outward.
    Allow the skin to dry before performing the venipuncture.
    Alternately, the skin can be dried with a sterile gauze
    (Fischbach & Dunning, 2009). Check facility policy.


14. Reapply the tourniquet approximately 3 to 4 inches above
    the identified puncture site. Apply sufficient pressure to
    impede venous circulation but not arterial blood flow.


15. Hold the patient’s arm in a downward position with your
    nondominant hand. Align the needle and Vacutainer device
    with the chosen vein, holding the Vacutainer and needle in
    your dominant hand. Use the thumb or first finger of your
    nondominant hand to apply pressure and traction to the
    skin just below the identified puncture site.
    16.Inform the patient that he or she is going to feel a pinch.
    With the bevel of the needle up, insert the needle into the
    vein at a 15-degree angle to the skin (Fischbach &
    Dunning, 2009).


16. Grasp the Vacutainer securely to stabilize it in the vein
    with your nondominant hand, and push the first collection
    tube into the puncture device in the Vacutainer, until the
    rubber stopper on the collection tube is punctured. You
    will feel the tube push into place on the puncture device.
    Blood will flow into the tube automatically.
    18.Remove the tourniquet as soon as blood flows adequately
    into the tube.


17. Continue to hold Vacutainer in place in the vein and con-
    tinue to fill the required tubes, removing one and inserting
    another. Gently rotate each tube as you remove it.


18. After you have drawn all required blood samples, remove
    the last collection tube from the Vacutainer. Place a gauze
    pad over the puncture site and slowly and gently remove
    the needle from the vein. Engage needle guard. Do not
    apply pressure to site until the needle has been fully
    removed.


19. Apply gentle pressure to the puncture site for 2 to
    3 minutes or until bleeding stops.

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