Conditions: Necessary materials and equipment: blood specimen tubes, constricting band, vacutainer adapter, vacutainer needles, disinfectant pads, sterile 2 x 2 gauze sponges, betadine or alcohol, adhesive bandage strips, protective pad, labels, and gloves.

Standards: Obtained a blood specimen without causing injury to the patient or violating aseptic technique.

Performance Steps

1. Verify the request to obtain a blood specimen. Select the proper blood specimen tube for the test to be performed.

2. Label the blood specimen tube with the information necessary to identify the patient.

3. Perform a patient care handwash.

WARNING: Gloves should be worn for self-protection against transmission of contaminants whenever handling body fluids.

4. Assemble the vacutainer adapter, the needle, and the blood specimen tube.

    a. Inspect the needle for nicks or barbs. Replace the needle if it is flawed or dull.

    b. Insert the rubber stoppered end of the specimen tube into the vacutainer holder and advance the tube until it is even with the guideline.

NOTE: The needle is now partially imbedded into the stopper. If the tube is pushed beyond the guideline, the vacuum of the tube may be broken.

5. Identify the patient.

    a. Ask the patient his or her name and compare the name to the bed card and identification band or tags.

    b. If the specimen is being obtained from an outpatient, identify the patient by asking his or her name and comparing the name with the medical records or the laboratory request.

NOTE: Ask the patient about allergies to such things as iodine or alcohol.

6. Explain the procedure and purpose for collecting the blood specimen to the patient.

7. Position the patient.

    a. Assist the patient into a comfortable sitting or lying position.

WARNING: Never attempt to draw blood from a standing patient.

    b. The patient should be positioned so the arm is well supported and stabilized by using a pillow, table, or other flat surface.

    c. Place a protective pad under the elbow and forearm.

8. Expose the area for venipuncture.

9. Select and palpate one of the prominent veins in the bend of the arm (antecubital space).

    a. The first choice is the median cubital vein. It is well supported and least apt to roll.

    b. The second choice is the cephalic vein. 

    c. The third choice is the basilic vein. Although it is often the most prominent, it tends to roll easily and makes venipuncture difficult.

WARNINGS: 1. Avoid veins that are infected, irritated, injured, or have an IV running distal to the proposed venipuncture site. 2. Do not use the vacutainer to draw blood from small or fragile veins, because this can cause the vein walls to collapse. Use a needle and syringe instead.

10. Prepare the sponges for use.

    a. Open the betadine or alcohol and 2 X 2 gauze sponge packages.

    b. Place them within easy reach (still in the packages).

11. Apply the constricting band with enough pressure to stop venous return without stopping the arterial flow (a radial pulse will be present).

    a. Wrap latex tubing around the limb approximately 2 inches above the proposed venipuncture site.

    b. Stretch the tubing slightly and pull one end so that it is longer than the other.

    c. Form a loop with the longer end and draw the loop under the shorter end so that the tails of the tubing are turned away from the proposed site.

NOTE: If a commercial band is used, wrap it around the limb as in step 11a and then secure the band by overlapping the Velcro ends. 

    d. Instruct the patient to form a fist, clench and unclench several times, and then hold the fist in a clenched position.

12. Palpate the selected vein lightly with the index finger, moving an inch or two in either direction so that the size and direction of the vein can be determined. The vein should feel like a spongy tube.

13. With a disinfectant soaked pad, cleanse the area around the puncture site using an outward circular motion.

CAUTION: After cleansing the skin, do not repalpate the area.

WARNING: Do not leave the constricting band on for more than 2 minutes.

14. Prepare to puncture the vein.

    a. Grasp the vacutainer unit and remove the protective needle cover.

    b. Position the needle directly in line with the vein. Using the free hand, grasp the patient's arm below the expected point of entry.

    c. Place the thumb of the free hand approximately 1 inch below the expected point of entry and pull the skin taut toward the hand.

15. Puncture the vein.

    a. Place the needle, bevel up, in line with the vein and pierce the skin at a 15 to 30 degree angle.

    b. Decrease the angle until the needle is almost parallel to the skin surface. Direct it toward the vein and pierce the vein wall.

NOTE: A faint "give" will be felt when the vein is entered and blood will appear in the hub of the needle.

        (1) If the venipuncture is unsuccessful, pull the needle back slightly (not above the skin surface) and attempt to pierce the vein again.

CAUTION: If the needle is withdrawn above the skin surface, quickly release the constricting band and stop the procedure. Begin again with a new needle.

        (2) If the venipuncture is still unsuccessful, release the constricting band, place a gauze sponge lightly over the site, quickly withdraw the needle, and immediately apply pressure to the site.

        (3) Notify the supervisor before attempting to enter another vein.

    c. Instruct the patient to unclench the fist.

16. Collect the specimen.

    a. Single specimen sample.

         (1) With the dominant hand, hold the vacutainer unit and the needle steady.

         (2) Place the index and middle fingers of the free hand behind the flange of the vacutainer and ease the tube as far forward as possible. Blood will enter the tube.

WARNING: If the unit and needle are not held steady while pushing in the tube, the needlemay either slip out of the vein or puncture the opposing vein wall.

        (3) After the tube is approximately two-thirds full of blood or the flow of blood stops, prepare to withdraw the needle.

    b. Multiple specimen samples (multiple tubes).

         (1) Follow steps 16a(1) and 16a(2) for collecting a single specimen.

         (2) Remove the first tube and insert another tube into the vacutainer.

         (3) Repeat this procedure until the desired number of tubes are filled or blood stops flowing.

         (4) Release the constricting band using the nondominant hand.

         (5) After the last tube is approximately two-thirds full of blood or the flow stops, prepare to withdraw the needle.

NOTE: If the blood flow starts to slow down between samples, remove the constricting band. 

17. Withdraw the needle.

    a. Release the constricting band by pulling on the long, looped end of the tubing or pulling the Velcro fasteners open.

WARNING: Never withdraw the needle prior to removing the constricting band because this will cause blood to be forced out of the venipuncture site with resulting blood loss and/or hematoma formation.

    b. Place a gauze sponge lightly over the venipuncture site.

    c. Keeping the patient's arm fully extended, withdraw the needle smoothly and quickly.  Immediately apply firm manual pressure over the venipuncture site with the sponge. 

    d. Instruct the patient to elevate the arm slightly and keep the arm fully extended.  Continue to apply firm manual pressure to the site for 2 to 3 minutes.

18. Remove the specimen tube from the vacutainer.

    a. Replace the protective cover over the needle.

NOTE: Dispose of the uncapped needle IAW local SOP.

WARNING: If accidentally punctured by a used needle, force the puncture site to bleed, wash it thoroughly, and report the incident to your supervisor immediately.

    b. Pull the tube from the vacutainer.

    c. If the tube contains an anticoagulant, gently invert the tube several times to mix it with the blood.

19. Apply an adhesive bandage strip to the venipuncture site after the bleeding has stopped.  Adhesive bandage strips do not take the place of pressure and therefore, are not applied until the bleeding has stopped.

20. Provide for the patient's safety and comfort.

    a. Remove the protective pad.

    b. Assist the patient to assume a comfortable position.

21. Dispose of and/or store the equipment.

    a. Collect all the equipment and remove it from the area.

    b. Place the used gauze sponge, alcohol or betadine sponge, and the protective pad in the trash receptacle. 

    c. Store the constricting band and vacutainer adapter IAW local SOP and dispose of the needle and syringe IAW local SOP.

22. Remove the gloves.

23. Perform a patient care handwash.

24. Complete the laboratory request.

    a. Patient identification.

    b. Requesting physician's name.

    c. Ward number, clinic, or dispensary.

    d. Date and time of specimen collection.

    e. Test(s) requested.

    f. Specimen source--blood.

    g. Remarks. Write in the admission diagnosis or the type of surgery in this section.

    h. Complete the "urgency" box. (Routine, today, preop, STAT, or ASAP.)

NOTE: There are many lab request slips which are used for requesting specific blood tests. All slips must be checked for the minimum information, as given.

25. Forward the specimen to the laboratory.

    a. Attach the lab request to the specimen tube(s) with a rubber band or paper clip.

NOTE: Ensure that the lab requests and blood tubes are appropriately labeled with infectious warning labels IAW local SOP.

    b. Arrange for the specimen to be sent to the lab or transport the specimen to the lab IAW local SOP.

26. Perform a patient care handwash.

27. Record the procedure on the appropriate form.

Evaluation Guidance: Score each soldier according to the performance measures in the evaluation guide. Unless otherwise stated in the task summary, the soldier must pass all performance measures to be scored GO. If the soldier fails any step, show what was done wrong and how to do it correctly.