Skill Demonstration: Blood draw with Vacutainer - for student midwives

Deborah demonstrates how to draw blood with a vacutainer.

Skill: Venipuncture with vacutainer
Objective: Demonstrate the ability to draw blood from a vein with a vacutainer.
Procedure:
1. If you have advance notice of the need for a blood draw, have the woman drink at least a quart of water in the hour or two before the draw.  This will make the veins more full and easier to draw from.
2. Wash and Dry your hands.
3. Explain the procedure to the woman
4. With permission, offer homeopathic arnica and ledum, and rescue remedy if needed.
5. Position the woman so she is comfortable, then position yourself so you will be in a comfortable position while drawing the blood.
6. Assemble equipment on the tray:
 a. Tourniqet or blood pressure cuff
 b. Vacutainer needle and hub
 c. Alcohol swab
 d. Gauze pad, paper towel or tissue
 e. Cotton ball
 f. Bandaid
 g. Correct vacutainer tube(s) for the test or panel you are drawing, labeled with the appropriate information
 h. Lab requisition form, filled out
7. Instruct the woman to hang her arm down, and then:
 a. Apply a tourniquet (or BP cuff)
 b. Locate a suitable vein
 c. Cleanse the puncture site, allowing the alcohol to dry
 d. Put on gloves
 e. Break the seal on the needle and screw it into the plastic hub
 f. When ready to puncture, remove the cap that covers the needle
8. Perform venipuncture in the following manner:
 a. Position the woman’s arm
 b. Maintain traction on the vein
 c. Keep the bevel-side of the needle up
 d. Approach the skin at a 15 to 30 degree angle and puncture the skin and the vein wall, but do not go through the other side of the vein
 e. Maintaining traction and keeping the hub stable, advance the blood collection tube forward into hub.  If you need multiple tubes, fill the red-top tube first since it can substitute for other tubes if necessary.  Blood should flow into the tube.  If not, gently move the needle until blood flows.
 f. Vacutainer tubes are pre-set to remove the amount of blood appropriate for the tube.  Therefore, remove the tube when it is almost full and the blood stops flowing.
 g. Repeat #5 for multiple samples, if necessary, holding the hub as stable as possible.
 h. When the final tube is half full, release the tourniquet, and continue
 i. Hold a tissue, paper towel or gauze over the puncture site as you gently withdraw the needle, applying firm pressure to the puncture site for a minute or so after the needle is withdrawn.
 j. Keep the needle/hub/tube upright until you remove the tube from the hub.
 k. Apply a bandaid or bandaid/cotton ball combination over puncture site.
 l.. Remove the tube from the hub
 m. Dispose of needle in the sharps container and all other trash in the trash can.  
9. Care for the specimen(s) as follows, wearing gloves when appropriate
 a. Keep the serum separator tube(s) upright
 b. Gently mix the blood in the tube(s), if appropriate
 c. Spin in centrifuge 18 min for tiger-top, if appropriate
 d. Dispose of the needle in a sharps container
10. Place the processed tubes in the biohazard bag, the order form (properly folded) in the front pouch of the bag, and the carbon copy in the client chart.
11. Place the biohazard bag in the transport container, keeping the samples at the required temperature until they are at the lab.
12. Transport to the lab at the appropriate time (usually within 24 hours).
13. Document the results.