Skill 83
Venipuncture
Collecting Blood Specimens and Cultures by Syringe and Vacutainer Method
You are often responsible for collecting blood specimens; however, many agencies have specially trained phlebotomists who are responsible for drawing venous blood. Be familiar with your agency policies and procedures and your state Nurse Practice Act regarding guidelines for drawing blood samples.
The three methods of obtaining blood specimens are (1) skin puncture, (2) venipuncture, and (3) arterial puncture. Venipuncture is the most common method of obtaining blood specimens. This involves inserting a hollow-bore needle into the lumen of a large vein to obtain a specimen using either a needle and syringe or a Vacutainer device that allows the drawing of multiple samples. Because veins are major sources of blood for laboratory testing and routes for intravenous (IV) fluid or blood replacement, maintaining their integrity is essential. You need to be skilled in venipuncture to avoid unnecessary injury to veins.
Blood cultures aid in detection of bacteria in the blood. It is important that at least two culture specimens be drawn from two different sites. Because bacteremia may be accompanied by fever and chills, blood cultures should be drawn when the patient is experiencing these clinical signs (Pagana and Pagana, 2011). Bacteremia exists when both cultures grow the infectious agent. If only one culture grows bacteria, the bacteria are considered contaminated.
Draw cultures before antibiotic therapy begins since the antibiotic may interrupt the organism’s growth in the laboratory. If the patient is receiving antibiotics, notify the laboratory of the specific antibiotics the patient is receiving (Pagana and Pagana, 2011).
Delegation Considerations
The skill of collecting blood specimens by venipuncture can be delegated to specially trained nursing assistive personnel (NAP). In some agencies, phlebotomists obtain the venipuncture samples. Agency and governmental regulations and policies differ regarding personnel who may draw blood specimens. The nurse informs the NAP to:
