Venipuncture and arterial puncture must be performed in a manner that prevents infection to the patient.  Caution and adherence to infection control and safety measures must be maintained by personnel performing venipuncture and arterial puncture, in order to prevent needlestick injury.  Refer to Infection Control Manual (ICM), Policy No. 6.03, Venipuncture and Arterial Puncture.

Responsibilities

• Personnel performing venipuncture and/or arterial puncture must follow the guidelines set forth in this policy.
• Clinical Resource Improvement Services, Pathology, and clinical departments should collaboratively investigate problems related to performance and/or outcomes of venipuncture and arterial puncture.
• Products and medical devices used for venipuncture and arterial puncture must meet infection control and safety standards and be approved by a corporate products committee, and the Infection Control Committee.

Personnel Practices

• Personnel involved in performing venipuncture and/or arterial puncture must adhere to employee health standards as outlined in Infection Control Manual, Section 3.
• Personnel must follow standard precautions.  Refer to Infection Control Manual, Policy No. 4.00, Standard Precautions.  Personnel must follow the isolation policies outlined in Section 5 of the Infection Control Manual.
• Appropriate personal protective equipment must be provided.  Personnel are expected to follow directives outlined in this policy and those that are set forth in Infection Control Manual, Policy No. 4.02, Personal Protective Equipment and Policy No. 4.03, Protective Equipment Task Chart.
• Personnel attire must be worn in compliance with departmental policies and in conformance with Henry Ford Health System dress code.
• Gloves must be worn when performing venipuncture or arterial puncture.  Gloves must be discarded and handwashing performed after every patient.
• Facial protection and/or cover gown, lab coat, or fluid resistant gown should be worn if there is anticipated risk of spraying of blood and/or body fluids.  Refer to Infection Control Manual, Policy No. 4.02, Personal Protective Equipment and Policy No. 4.03, Protective Equipment Task Chart.

Site for Venipuncture or Arterial Puncture

• The site for phlebotomy should be chosen prior to skin preparation.  Palpation of the vein or artery may be performed with or without gloves.
• Burned, denuded, or scarred skin must never be used for venipuncture or arterial puncture.  Use of previous phlebotomy sites is discouraged.
• The arm on the side of which a radical mastectomy was performed must not be chosen, in order to prevent lymphomatosis.  Consult physician if patient has bilateral mastectomies.
• The limb containing a cannula, fistula, or vascular graft should not be selected.
• Routine venipuncture should never include use of an artery, a thrombosed vein, or a neonatal femoral vein.
• The lateral or medial portion of the heel's plantar surface is recommended for infant capillary blood collection.

Preparation of the Patient

• The phlebotomy site should be stabilized, in order to prevent accidental needlestick injury to the patient and/or employee.
• Skin at the site of venipuncture and arterial puncture must be free of dirt and debris.  Cleanse the skin with soap and friction when grossly soiled.

Note: A skin cleansing should be performed for blood cultures.  This may include the use of a blood culture preparation kit or the use of an Infection Control approved one-step product.  Follow manufacturer guidelines.

• When a femoral vein is used for phlebotomy, refer to Infection Control Manual, Policy No. 7.01, Preparation of the Patient for Invasive Procedures, for patient preparation.
• An approved antiseptic is applied to the skin prior to phlebotomy.  Refer to Infection Control Manual, Policy No. 7.01, Preparation of the Patient for Invasive Procedures.

Note: A circular pattern from the phlebotomy site to periphery is recommended for the application of most antiseptics.  Follow the product manufacturer's guidelines.

• Allow the antiseptic to air dry before performing phlebotomy.  Never blot with gauze or tissue.  Never fan or blow on the area.

Phlebotomy

• A clean tourniquet should be used for venipuncture.
  • Tourniquets should be wiped with a disinfectant after each patient, if possible.  Grossly soiled tourniquets must be discarded.
  • Tourniquets soiled with blood or other potentially infectious material must be discarded.
  • Patient specific tourniquets may be required for patients placed in isolation.  Refer to Infection Control Manual, Section 5, for specific isolation policies.
  • A non-latex tourniquet must be used for the latex sensitive patient.  Refer to the Clinical Practice Manual.
• Aseptic technique must be used for venipuncture and arterial puncture.  The prepared site or the needle should never be touched during phlebotomy.
• Sterile syringes and Vacutainer® tubes must be used to avoid contamination by the reflux phenomenon (backflow of blood from the tubes to the patient).
• Blood culture must be collected prior to other tube collections.
• Multiple blood cultures (maximum of three sets daily) should be obtained from different venipunctures preferable prior to the start of antibiotics.  When blood cultures are drawn on newly admitted patients at least two sets of blood cultures should be obtained.  If three sets of blood cultures are ordered, they should be spaced out over time; e.g., one hour apart
  • Blood cultures should not be routinely obtained through arterial or venous catheters.  The guideline below may be used whenever this method is utilized.
  • If a patient has a long term vascular catheter, such as a Hickman or Groshong, blood cultures should be obtained from both peripheral blood and blood obtained through the catheter.
• Collection of blood from intravascular lines is discouraged.  When collection from intravascular lines cannot be avoided, it should be obtained by use of a closed system method.
• Self-sheathing needles are recommended.  A "no touch" method in the handling of an unprotected needle after use must be utilized to prevent needlestick injury.  The needle must never be recapped.
• Safety lancets are required for heel or fingersticks.
• Avoid the use of long lancets in low-weight patients and neonates to avoid trauma of the os calcaneum or distal phalanges.
• Automatic lancet devices must be used according to manufacturer's guidelines, whenever used for phlebotomy.
  • The lancet and the platform/endcap must be replaced after each patient use.
  • A single unit disposable lancet device is recommended, in order to prevent needlestick injury
  • When a reusable lancet holder is used, it must be wiped with an approved disinfectant between patient and whenever contaminated with blood or body fluids.
• Microtainers®, Unopettes®, or plastic capillary pipettes should be used when obtaining capillary blood.  Use capillary action for filling.
• Needles, lancets, syringes, and other devices contaminated with blood and/or body fluids must be immediately disposed of into an approved sharps disposal container.  Refer to Infection Control Manual, Policy No. 4.05, Handling/Disposal of Needles and Sharps.
• Disposable Vacutainer® sheaths must be discarded after each use.  Reusable Vacutainer® sheaths must be discarded if grossly soiled, damaged, and/or contaminated with blood and/or body fluids.

Care of the Phlebotomy Site

• Pressure should be applied to the arterial puncture site with gauze for five minutes.
• A clean bandage or gauze should be secured with hypoallergenic tape to cover the phlebotomy site.  Use of non-latex product is required for latex sensitive patients.

            Note: Avoid the use of bandages on the fingers of small children due to the risk of aspiration.

            Note: Avoid the use of cotton balls, except in patients with dermatitis.

NOTE: Refer to Order of Draw tab above.