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Practice Performed
Procedure Steps Yes No Master
Procedure
. Withdraws the needle smoothly.
. Activates the safety engineering control device.
Postprocedure
. Applies pressure to the venipuncture site.
. Disposes of the needle and tube adapter in the correct
container.
. Labels the tubes correctly (including date, time, and
phlebotomist identification).
. Places specimen in transport bag observing any special
handling instructions.
. Checks the venipuncture site.
. Applies a bandage.
. Thanks the patient.
. Disposes of used supplies appropriately.
. Removes gloves and washes the hands.
. Transports specimens to the laboratory.
. Documents specimen collection.
COMMENTS: ______________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
SIGNED
EVALUATOR: ___________________________________________________________________________
STUDENT: _____________________________________________________________________________
Chapter Venipuncture
Copyright © 2019 by McGraw-Hill Education
NAME: _____________________________________ DATE: _____________________________________
COMPETENCY CHECKLIST: TRANSFERRING SPECIMENS TO TUBES
Practice Performed
Procedure Steps Yes No Master
Preprocedure
. Prepares for specimen transfer after the venipuncture
preprocedure but prior to the venipuncture procedure.
. Selects the correct equipment and supplies (blood
transfer device).
. Conveniently places the equipment.
. Performs the specimen transfer procedure immediately
after removing the needle from the vein.
Procedure
. Inserts the syringe into the transfer device hub.
. Transfers the specimen into tubes.
. Uses safe technique to fill the tubes.
. Fills the tubes in correct order.
. Allows the tubes to fill naturally.
. Mixes anticoagulated tubes by inversion.
Postprocedure
. Disposes of the transfer device and syringe in the
correct container.
. Continues with the venipuncture postprocedure.
COMMENTS: ______________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
SIGNED
EVALUATOR: ___________________________________________________________________________
STUDENT: _____________________________________________________________________________
Copyright © 2019 by McGraw-Hill Education
Chapter Venipuncture
NAME: _____________________________________ DATE: _____________________________________
COMPETENCY CHECKLIST: ROUTINE VENIPUNCTURE SYRINGE
Practice Performed
Procedure Steps Yes No Master
Preprocedure
. Examines the requisition.
. Greets the patient; introduces self.
. Identifies the patient verbally using two identifiers,
including comparing the identification band with the
requisition for inpatients.
. Explains the procedure to the patient.
. Verifies dietary restrictions or instructions.
. Washes hands and puts on gloves.
. Selects the correct equipment and supplies.
. Assembles the equipment and supplies properly.
. Checks the plunger movement of the syringe.
. Conveniently places the equipment.
. Reassures the patient.
. Positions the patient’s arm comfortably.
. Applies the tourniquet.
. Identifies a vein by palpation.
. Selects the venipuncture site.
. Releases the tourniquet.
. Cleanses the venipuncture site.
. Allows the site to air dry.
Procedure
. Reapplies the tourniquet.
. Confirms the venipuncture site visually.
. Anchors the vein below the puncture site.
. Smoothly inserts the needle at the correct angle.
. Inserts the needle with the bevel up.
. Collects the appropriate amount of the sample.
. Releases the tourniquet.
. Places gauze over the puncture site.
. Withdraws the needle smoothly.
. Activates the safety engineering control device.
Postprocedure
. Applies pressure to the venipuncture site.
. Uses a safe technique to fill the tubes.
Chapter Venipuncture
Copyright © 2019 by McGraw-Hill Education
Practice Performed
Procedure Steps Yes No Master
Postprocedure
. Fills the tubes in correct order.
. Mixes anticoagulated tubes by inversion.
. Disposes of the needle and syringe in the correct
container.
. Labels the tubes correctly (including date, time, and phle-
botomist identification).
. Places specimen in transport bag observing any special
handling instructions.
. Checks the venipuncture site.
. Applies a bandage.
. Thanks the patient.
. Disposes of used supplies appropriately.
. Removes gloves and washes the hands.
. Transports the specimens to the laboratory.
. Documents specimen collection.
COMMENTS: ______________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
SIGNED
EVALUATOR: ___________________________________________________________________________
STUDENT: _____________________________________________________________________________
Copyright © 2019 by McGraw-Hill Education
Chapter Venipuncture
NAME: _____________________________________ DATE: _____________________________________
COMPETENCY CHECKLIST: VENIPUNCTURE USING A BUTTERFLY AND SYRINGE
Practice Performed
Procedure Steps Yes No Master
Preprocedure
. Examines the requisition.
. Greets the patient; introduces self.
. Identifies the patient verbally using two identifiers,
including comparing the identification band with the
requisition for inpatients.
. Explains the procedure to the patient.
. Verifies dietary restrictions or instructions.
. Washes hands and puts on gloves.
. Selects the correct equipment and supplies.
. Assembles the equipment and supplies properly.
. Checks the plunger movement of the syringe.
. Conveniently places the equipment.
. Reassures the patient.
. Positions the patient’s arm comfortably.
. Applies the tourniquet.
. Identifies a vein by palpation.
. Selects the venipuncture site.
. Releases the tourniquet.
. Cleanses the venipuncture site.
. Allows the site to air dry.
Procedure
. Reapplies the tourniquet.
. Confirms the venipuncture site visually.
. Anchors the vein below the puncture site.
. Holds the butterfly needle with the wings upward
and bevel up.
. Inserts the needle smoothly at the correct angle.
. Collects the appropriate amount of the sample.
. Releases the tourniquet.
. Places gauze over the puncture site.
. Withdraws the needle smoothly.
. Activates the safety engineering control device.
Chapter Venipuncture
Copyright © 2019 by McGraw-Hill Education
Practice Performed
Procedure Steps Yes No Master
Postprocedure
. Applies pressure to the venipuncture site.
. Uses safe technique to fill tubes.
. Fills the tubes in correct order.
. Mixes anticoagulated tubes by inversion.
. Disposes of the needle and syringe in the correct
container.
. Labels the tubes correctly (including date, time, and
phlebotomist identification).
. Places specimen in transport bag observing any special
handling instructions.
. Checks the venipuncture site.
. Applies a bandage.
. Thanks the patient.
. Disposes of used supplies appropriately.
. Removes the gloves and washes hands.
. Transports the specimens to the laboratory.
. Documents the specimen collection.
COMMENTS: ______________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
SIGNED
EVALUATOR: ___________________________________________________________________________
STUDENT: _____________________________________________________________________________
Copyright © 2019 by McGraw-Hill Education
Chapter Venipuncture
NAME: _____________________________________ DATE: _____________________________________
COMPETENCY CHECKLIST: VENIPUNCTURE USING A BUTTERFLY AND EVACUATED TUBE ADAPTOR
Practice Performed
Procedure Steps Yes No Master
Preprocedure
. Examines the requisition.
. Greets the patient; introduces self.
. Identifies the patient verbally using two identifiers,
including comparing the identification band with the
requisition for inpatients.
. Explains the procedure to the patient.
. Verifies diet restrictions or instructions.
. Washes hands and puts on gloves.
. Selects the correct equipment and supplies.
. Assembles the equipment and supplies properly.
. Conveniently places the equipment.
. Reassures the patient.
. Positions the patient’s arm comfortably.
. Applies a tourniquet.
. Identifies a vein by palpation.
. Selects a venipuncture site.
. Releases the tourniquet.
. Cleanses the venipuncture site.
. Allows the site to air dry.
Procedure
. Reapplies the tourniquet.
. Confirms the venipuncture site visually.
. Anchors the vein below the puncture site.
. Holds the butterfly needle with wings upward and
bevelup.
. Inserts the needle smoothly at the correct angle.
. Collects tubes in the correct order of draw.
. Mixes the tubes by inversion (as recommended by the
manufacturer).
Chapter Venipuncture
Copyright © 2019 by McGraw-Hill Education
Practice Performed
Procedure Steps Yes No Master
Preprocedure
. Releases the tourniquet.
. Places gauze over the puncture site.
. Withdraws the needle smoothly.
. Activates the safety engineering control device.
Postprocedure
. Applies pressure to the venipuncture site.
. Disposes of the needle and holder in the correct
container.
. Labels the tubes correctly (including date, time, and
phlebotomist identification).
. Places specimen in transport bag observing any special
handling instructions.
. Checks the venipuncture site.
. Applies a bandage.
. Thanks the patient.
. Disposes of used supplies appropriately.
. Removes gloves and washes hands.
. Transports specimens to the laboratory.
. Documents the specimen collection.
COMMENTS: ______________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
SIGNED
EVALUATOR: ______________________________________________________________________________
STUDENT: ________________________________________________________________________________
Design Elements: Law & Ethics icon (marble columns) ©Nice_Media/Shutterstock.com RF; Life Span Considerations icon (baby holding hand) ©Lerche&Johnson/
Shutterstock.com RF; Communicate & Connect icon (patient and doctor) ©Rocketclips, Inc./Shutterstock.com RF; Safety & Infection Control icon (samples in hand)
©motorolka/Shutterstock.com RF.
Copyright © 2019 by McGraw-Hill Education
Chapter Venipuncture
10
calcaneus
interstitial fluid
osteomyelitis
palmar
plantar
essential terms
Dermal (Capillary) Puncture
Learning Outcomes
. Explain why dermal (capillary) puncture is
used instead of routine venipuncture for
some patients.
. Select an appropriate site for dermal
(capillary) puncture and identify the
equipment needed.
. Carry out the procedure for performing a
dermal (capillary) puncture.
. Apply the procedure for collecting a dermal
(capillary) specimen.
©Ana Abejon/Getty Images RF
Related NAACLS Competencies
. Demonstrate knowledge of collection
equipment, various types of additives used,
special precautions necessary, and substances
that can interfere in clinical analysis of blood
constituents.
. List and select the types of equipment needed
to collect blood by venipuncture and capillary
(dermal) puncture.
. Identify special precautions necessary during
blood collections by venipuncture and capillary
(dermal) puncture.
. Follow standard operating procedures to
collect specimens.
. Identify potential sites for venipuncture and
capillary (dermal) puncture.
. Differentiate between sterile and antiseptic
techniques.
. Describe and demonstrate the steps in the
preparation of a puncture site.
. List the effects of tourniquet, hand squeezing,
and heating pads on specimens collected by
venipuncture and capillary (dermal) puncture.
. Describe and perform correct procedure for
capillary (dermal) collection methods.
. Describe the limitations and precautions of
alternate collection sites for venipuncture and
capillary (dermal) puncture.
. List the steps necessary to perform a
venipuncture and a capillary (dermal) puncture in
order.
. Demonstrate a successful capillary
(dermal) puncture following standard operating
procedures.
Introduction
Dermal puncture, also known as capillary puncture, is frequently used when
collecting blood from infants and children as well as when an alternative to
venipuncture is necessary for difficult draws on adults. This chapter outlines
reasons why dermal (capillary) puncture is used, the equipment needed, and
the techniques for performing it.
.
The Dermal (Capillary) Puncture
Venipuncture is more difficult in infants and children than in adults. Because
of a child’s smaller size, it is difficult to locate a vein that is large enough to
withstand the vacuum present in evacuated collection tubes without collapsing. Furthermore, children do not enjoy venipuncture and usually do not
remain still for the length of time this procedure requires. Dermal (capillary)
puncture is therefore the preferred blood collection technique for infants and
very small children.
Dermal (capillary) puncture may also be used as an alternate method of
blood collection for adult patients with whom venipuncture procedures are
too difficult. In some cases, patients who are obese, elderly, or severely burned
have veins that are difficult to locate. These patients are often candidates for
dermal (capillary) puncture. Be certain to check the policy at your facility as
well as the laboratory tests ordered. Blood for some laboratory tests, such as
coagulation tests, may not be collected using dermal (capillary) puncture. See
Table 10-1 for a comparison of blood collection methods.
A dermal (capillary) puncture specimen is obtained from the capillaries.
Recall the capillaries join the smallest veins (venules) and the smallest arteries (arterioles). The specimen obtained during dermal (capillary) puncture is
a mixture of venous blood, arterial blood, and interstitial fluid (fluid between
cells and tissues). When capillary blood is drawn it must be noted for the testing
personnel. Capillary blood is higher in glucose and lower in potassium, total
protein, and calcium making the normal values (reference ranges) different.
Even with these differences, developing technology in laboratory instrumentation allows tests to be performed on capillary blood. The most notable exceptions are blood cultures and erythrocyte sedimentation rate (ESR)
because both of these tests require a relatively large amount of blood. An ESR
is the measurement of the erythrocyte settling rate.
One drawback of a dermal (capillary) puncture for the laboratory is the small
amount of blood collected. This small quantity usually leaves an insufficient
sample if the test requires a large amount of blood or needs to be repeated.
Copyright © 2019 by McGraw-Hill Education
Chapter Dermal (Capillary) Puncture