Venipuncture Quick Guide: How to draw blood
Of all the skills a budding nurse must learn, few are as dreaded as venipuncture. Yet this procedure is at the core of modern health care. If you’re going into nursing, you must master this skill. The following guide is a to-the-point rundown of the entire procedure.
Confidence is Half the Battle
Your patient will notice your nervousness. When you’re nervous, they’re nervous. When they get nervous, you’ll have a hell of a lot harder time finding veins. If you don’t feel comfortable performing venipuncture let your preceptor know. Better to skip it that one time than to botch it.
Here we mean literal nerves, not nervousness. You must memorize the locations of the major nerves in the arms as quickly as possible. The radial and median nerves are the two major nerves to watch out for. The radial nerve is located on the thumb side of the arm and reaches into the shoulder, along the wrist. It’s pretty close to the cephalic vein, so be careful! The median vein runs into the antecubital fossa and enters into the palm of the hand. This is why blood draw from the antecubital fossa is tricky business.
Gather Your Supplies
Here is what you’ll want to have on-hand at minimum:
- Needles of various gauges
- Vacutainers and other collection tubes
- 2x2 gauze
- Needle holders
- Alcohol prep pads
- Cotton balls
- Stretch gauze
- The all-important tourniquet
Wash Your Hands
Hand washing isn’t just good hygiene, it’s an essential step in preventing the spread of disease. Your hospital will require you to do this, and it’s probably state law where you live. Every year, thousands of people die from infections they got while in the hospital. Remember, patients already have compromised/taxed immune systems. Moreover, the hands are the main pathways for germ transmission.
The first step in cleaning your hands in the clinical setting is to rub them with an alcohol solution. This might take the form of an alcohol wipe or hand sanitizer. Next, wash your hands thoroughly with soap and water. You should always include this step, but especially when the hands are visibly soiled and after every trip to the bathroom.
Select a Site
You will typically draw blood from the arm. The best sites for venipuncture are the:
- Median Cubital Vein. A superficial vein that runs down the middle of the forearm, located beneath the cubital fossa.
- Cephalic Vein. Runs down the arm from the shoulder, into the forearm.
- Basilic Vein. A large vein in the pinky side of the arm. It joins the brachial vein in the forearm.
However, every patient is different. The site you use will depend on vein visibility. Apply the tourniquet snugly and ask the patient to make a fist. This makes the veins more visible. Use your fingertips to find the veins listed above. They will be firm to the touch.
Use a Vein Illumination Light
If you’re having trouble finding a vein, use a vein illumination light like the Illumivein. The Illumivein uses high-grade red LEDs to illuminate a patient’s subcutaneous tissue. The Illumivein’s carefully calibrated light wavelength is absorbed by deoxygenated blood, making big veins pop out like never before.
Ready, Set, Go!
Put your gloves on and cleanse the skin above the vein with an alcohol wipe. Always anchor the vein by holding it directly above the intended insertion site. This will help prevent the vein from rolling away from the needle.
Hold the needle so the bevel is facing up and then confidently insert the needle into the skin at a 15-degree angle. Don’t stop when you penetrate the skin! Instead, push carefully and confidently until you feel resistance from piercing the vein.
When you penetrate the vein, you’ll see blood in the hub of the needle. If you don’t see this blood, you may need to adjust your angle. This can also indicate that you've penetrated the vein on both sides.
Remove the tourniquet and insert the vacutainer. Hold the needle steady to keep pain to a minimum. When you’re ready to remove the needle, do so quickly and then apply gauze or a cotton ball. Tape the gauze down and instruct the patient to leave it on for at least 15 minutes. Discard the used needle and wash your hands.
Never keep a tourniquet on for more than a minute. If you have to take it off, but need more blood, wait for at least three minutes.
Finally, like anything else, the way to improve is through lots of practice.
Having trouble finding veins? Why not look at our revolutionary vein illuminator, the Illumivein?